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Sample records for external defibrillators aeds

  1. Automated External Defibrillator

    Science.gov (United States)

    ... leads to a 10 percent reduction in survival. Training To Use an Automated External Defibrillator Learning how to use an AED and taking a CPR (cardiopulmonary resuscitation) course are helpful. However, if trained ...

  2. [ILCOR recommendation on signage of automated external defibrillators (AEDs)].

    Science.gov (United States)

    Truhlár, A

    2010-05-01

    Early defibrillation is a determinant of survival in both out-of-hospital and in-hospital cardiac arrests from ventricular fibrillation and pulseless ventricular tachycardia. The review summarizes importance of early defibrillation with automated external defibrillators (AED) and presents the International Liaison Committee on Resuscitation (ILCOR) recommendation for universal AED sign. The aim of the recommendation is to unify the AED signs worldwide and to spread the knowledge of this. The public in general, but healthcare professionals particularly, should be able to recognize AED location and use the device immediately in case of cardiac arrest.

  3. Optimizing a Drone Network to Deliver Automated External Defibrillators.

    Science.gov (United States)

    Boutilier, Justin J; Brooks, Steven C; Janmohamed, Alyf; Byers, Adam; Buick, Jason E; Zhan, Cathy; Schoellig, Angela P; Cheskes, Sheldon; Morrison, Laurie J; Chan, Timothy C Y

    2017-06-20

    Public access defibrillation programs can improve survival after out-of-hospital cardiac arrest, but automated external defibrillators (AEDs) are rarely available for bystander use at the scene. Drones are an emerging technology that can deliver an AED to the scene of an out-of-hospital cardiac arrest for bystander use. We hypothesize that a drone network designed with the aid of a mathematical model combining both optimization and queuing can reduce the time to AED arrival. We applied our model to 53 702 out-of-hospital cardiac arrests that occurred in the 8 regions of the Toronto Regional RescuNET between January 1, 2006, and December 31, 2014. Our primary analysis quantified the drone network size required to deliver an AED 1, 2, or 3 minutes faster than historical median 911 response times for each region independently. A secondary analysis quantified the reduction in drone resources required if RescuNET was treated as a large coordinated region. The region-specific analysis determined that 81 bases and 100 drones would be required to deliver an AED ahead of median 911 response times by 3 minutes. In the most urban region, the 90th percentile of the AED arrival time was reduced by 6 minutes and 43 seconds relative to historical 911 response times in the region. In the most rural region, the 90th percentile was reduced by 10 minutes and 34 seconds. A single coordinated drone network across all regions required 39.5% fewer bases and 30.0% fewer drones to achieve similar AED delivery times. An optimized drone network designed with the aid of a novel mathematical model can substantially reduce the AED delivery time to an out-of-hospital cardiac arrest event. © 2017 American Heart Association, Inc.

  4. Use of automated external defibrillators in a Brazilian airline. A 1-year experience

    Directory of Open Access Journals (Sweden)

    Alves Paulo Magalhães

    2001-01-01

    Full Text Available After the incorporation of automated external defibrilators by other airlines and the support of the Brazilian Society of cardiology, Varig Airlines Began the onboard defibrilation program with the initial purpose of equiping wide-body aircrafts frequently used in international flights and that airplanes use in the Rio - São Paulo route. With all fight attendants trained, the automated. External defibrilation devides were incorporated to 34 airplanes of a total pleet of 80 aircrats. The devices were intalled in the bagage compartments secured with velero straps and 2 pairs of electrods, one or which pre-conected to the device to minimize application time. Later, a portable monitor was addres to the ressocitation kit in the long flights. The expansion of the knowledge of the basic life support fundamentors and the correted implantation of the survival chain and of the automated external defibrilators will increase the extense of recovery of cardiorespiratory arrest victins in aircrafts.

  5. Psychological Effects of Automated External Defibrillator Training A randomized trial

    Science.gov (United States)

    Meischke, Hendrika; Diehr, Paula; Phelps, Randi; Damon, Susan; Rea, Tom

    2011-01-01

    Objectives The objective of this study was to test if an Automated External Defibrillator (AED) training program would positively affect the mental health of family members of high risk patients. Methods 305 ischemic heart disease patients and their family members were randomized to one of four AED training programs: two video-based training programs and two face-to-face training programs that emphasized self-efficacy and perceived control. Patients and family members were surveyed at baseline, 3 and 9 months post ischemic event on demographic characteristics, measures of quality of life (SF=36) , self-efficacy and perceived control. For this study, family members were the focus rather than the patients. Results Regression analyses showed that family members in the face-to-face training programs did not score better on any of the mental health status variables than family members who participated in the other training programs but for an increase in self-efficacy beliefs at 3 months post training. Conclusion The findings suggest that a specifically designed AED training program emphasizing self-efficacy and perceived control beliefs is not likely to enhance family member mental health. PMID:21411144

  6. Use of Automated External Defibrillators

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    Gregory K Christensen

    2009-02-01

    In an effort to improve survival from cardiac arrest, the American Heart Association (AHA) has promoted the Chain of Survival concept, describing a sequence of prehospital steps that result in improved survival after sudden cardiac arrest. These interventions include immediate deployment of emergency medical services, prompt cardiopulmonary resuscitation, early defibrillation when indicated, and early initiation of advanced medical care. Early defibrillation has emerged as the most important intervention with survival decreasing by 10% with each minute of delay in defibrillation. Ventricular Fibrillation (VF) is a condition in which there is uncoordinated contraction of the heart cardiac muscle of the ventricles in the heart, making them tremble rather than contract properly. VF is a medical emergency and if the arrhythmia continues for more than a few seconds, blood circulation will cease, and death can occur in a matter of minutes. During VF, contractions of the heart are not synchronized, blood flow ceases, organs begin to fail from oxygen deprivation and within 10 minutes, death will occur. When VF occurs, the victim must be defibrillated in order to establish the heart’s normal rhythm. On average, the wait for an ambulance in populated areas of the United States is about 11 minutes. In view of these facts, the EFCOG Electrical Safety Task Group initiated this review to evaluate the potential value of deployment and use of automated external defibrillators (AEDs) for treatment of SCA victims. This evaluation indicates the long term survival benefit to victims of SCA is high if treated with CPR plus defibrillation within the first 3-5 minutes after collapse. According to the American Heart Association (AHA), survival rates as high as 74% are possible if treatment and defibrillation is performed in the first 3 minutes. In contrast survival rates are only 5% where no AED programs have been established to provide prompt CPR and defibrillation. ["CPR statistics

  7. Data management in automated external defibrillators: a call for a standardised solution

    DEFF Research Database (Denmark)

    Nielsen, Anne Møller; Rasmussen, L S

    2011-01-01

    The ECG data stored in automated external defibrillators (AEDs) may be valuable for establishing a final diagnosis and deciding further diagnostics and treatment. Different data management systems are used and this may create significant problems for data storage and access for physicians treating...

  8. A qualitative study to identify barriers to deployment and student training in the use of automated external defibrillators in schools

    DEFF Research Database (Denmark)

    Zinckernagel, Line; Hansen, Carolina Malta; Rod, Morten Hulvej

    2017-01-01

    such as delayed access have been reported. The purpose of this study was to identify barriers to the implementation of defibrillator training of students and deployment of defibrillators in schools. Methods: A qualitative study based on semi-structured individual interviews and focus groups with a total of 25......Background: Student training in use of automated external defibrillators and deployment of such defibrillators in schools is recommended to increase survival after out-of-hospital cardiac arrest. Low implementation rates have been observed, and even at schools with a defibrillator, challenges...... to their perception of student training but not for their considerations on the relevance of their placement at schools. Conclusions: It is crucial for implementation of automated external defibrillators in schools to inform staff about how they work and are operated and that students are an appropriate target group...

  9. A qualitative study to identify barriers to deployment and student training in the use of automated external defibrillators in schools

    DEFF Research Database (Denmark)

    Zinckernagel, Line; Hansen, Carolina Malta; Rod, Morten Hulvej

    2017-01-01

    to their perception of student training but not for their considerations on the relevance of their placement at schools. Conclusions: It is crucial for implementation of automated external defibrillators in schools to inform staff about how they work and are operated and that students are an appropriate target group...... for defibrillator training. Furthermore, it is important to provide schools with a basis for decision making about when to install defibrillators, and to ensure that school staff and students are informed about their placement.......Background: Student training in use of automated external defibrillators and deployment of such defibrillators in schools is recommended to increase survival after out-of-hospital cardiac arrest. Low implementation rates have been observed, and even at schools with a defibrillator, challenges...

  10. A Magnetic Resonance Imaging-Conditional External Cardiac Defibrillator for Resuscitation Within the Magnetic Resonance Imaging Scanner Bore.

    Science.gov (United States)

    Schmidt, Ehud J; Watkins, Ronald D; Zviman, Menekhem M; Guttman, Michael A; Wang, Wei; Halperin, Henry A

    2016-10-01

    Subjects undergoing cardiac arrest within a magnetic resonance imaging (MRI) scanner are currently removed from the bore and then from the MRI suite, before the delivery of cardiopulmonary resuscitation and defibrillation, potentially increasing the risk of mortality. This precludes many higher-risk (acute ischemic and acute stroke) patients from undergoing MRI and MRI-guided intervention. An MRI-conditional cardiac defibrillator should enable scanning with defibrillation pads attached and the generator ON, enabling application of defibrillation within the seconds of MRI after a cardiac event. An MRI-conditional external defibrillator may improve patient acceptance for MRI procedures. A commercial external defibrillator was rendered 1.5 Tesla MRI-conditional by the addition of novel radiofrequency filters between the generator and commercial disposable surface pads. The radiofrequency filters reduced emission into the MRI scanner and prevented cable/surface pad heating during imaging, while preserving all the defibrillator monitoring and delivery functions. Human volunteers were imaged using high specific absorption rate sequences to validate MRI image quality and lack of heating. Swine were electrically fibrillated (n=4) and thereafter defibrillated both outside and inside the MRI bore. MRI image quality was reduced by 0.8 or 1.6 dB, with the generator in monitoring mode and operating on battery or AC power, respectively. Commercial surface pads did not create artifacts deeper than 6 mm below the skin surface. Radiofrequency heating was within US Food and Drug Administration guidelines. Defibrillation was completely successful inside and outside the MRI bore. A prototype MRI-conditional defibrillation system successfully defibrillated in the MRI without degrading the image quality or increasing the time needed for defibrillation. It can increase patient acceptance for MRI procedures. © 2016 American Heart Association, Inc.

  11. Automated external defibrillators in the hospital: A case of medical reversal.

    Science.gov (United States)

    Stewart, John A

    2018-05-01

    Automated external defibrillators (AEDs) emerged in the 1980s as an important innovation in pre-hospital emergency cardiac care (ECC). In the years since, the American Heart Association (AHA) and the International Liaison Committee for Resuscitation (ILCOR) have promoted AED technology for use in hospitals as well, resulting in the widespread purchase and use of AED-capable defibrillators. In-hospital use of AEDs now appears to have decreased survival from cardiac arrests. This article will look at the use of AEDs in hospitals as a case of "medical reversal." Medical reversal occurs when an accepted, widely used treatment is found to be ineffective or even harmful. This article will discuss the issue of AEDs in the hospital using a conceptual framework provided by recent work on medical reversal. It will go on to consider the implications of the reversal for in-hospital resuscitation programs and emergency medicine more generally. Copyright © 2017 The Author. Published by Elsevier Inc. All rights reserved.

  12. Externalized conductors and insulation failure in Biotronik defibrillator leads: History repeating or a false alarm?

    Science.gov (United States)

    De Maria, Elia; Borghi, Ambra; Bonetti, Lorenzo; Fontana, Pier Luigi; Cappelli, Stefano

    2017-02-16

    Conductor externalization and insulation failure are frequent complications with the recalled St. Jude Medical Riata implantable cardioverter-defibrillator (ICD) leads. Conductor externalization is a "unique" failure mechanism: Cables externalize through the insulation ("inside-out" abrasion) and appear outside the lead body. Recently, single reports described a similar failure also for Biotronik leads. Moreover, some studies reported a high rate of electrical dysfunction (not only insulation failure) with Biotronik Linox leads and a reduced survival rate in comparison with the competitors. In this paper we describe the case of a patient with a Biotronik Kentrox ICD lead presenting with signs of insulation failure and conductor externalization at fluoroscopy. Due to the high risk of extraction we decided to implant a new lead, abandoning the damaged one; lead reimplant was uneventful. Subsequently, we review currently available literature about Biotronik Kentrox and Linox ICD lead failure and in particular externalized conductors. Some single-center studies and a non-prospective registry reported a survival rate between 88% and 91% at 5 years for Linox leads, significantly worse than that of other manufacturers. However, the preliminary results of two ongoing multicenter, prospective registries (GALAXY and CELESTIAL) showed 96% survival rate at 5 years after implant, well within industry standards. Ongoing data collection is needed to confirm longer-term performance of this family of ICD leads.

  13. [Public access defibrillation: successful cardiopulmonary resuscitation due to automatic external defibrillator at traffic accident].

    Science.gov (United States)

    Wanke, S; Reuter, H; Pfister, R; Michels, G

    2014-03-01

    A 65-year-old man collapsed after he stepped out of his car after a traffic accident. Fortunately, two police officers on a routine patrol in the area were quickly on the scene and started cardiopulmonary resuscitation. A passerby noticed that the patient was in distress and that an automatic defibrillator was nearby. He attached the electrodes of the defibrillator to the chest of the patient in accordance with instructions on the defibrillator and terminated the ventricular fibrillation (200 joule, biphasic). Emergency cardiac catheterization revealed a subtotal stenosis proximally in the right coronary artery, which was successfully treated with a stent. Based on the ideal basic life support, the immediate care by emergency mobile system and coronary angioplasty with successful revascularisation the patient could be released without any neurological deficit. This case illustrates that laypersons can use automatic external defibrillator in case of cardiac resuscitation sufficiently and quickly. © Georg Thieme Verlag KG Stuttgart · New York.

  14. [Training program on cardiopulmonary resuscitation with the use of automated external defibrillator in a university].

    Science.gov (United States)

    Boaventura, Ana Paula; Miyadahira, Ana Maria Kazue

    2012-03-01

    Early defibrillation in cardiopulmonary resuscitation (CPR) receives increasing emphasis on its priority and rapidity. This is an experience report about the implementation of a training program in CPR using a defibrillator in a private university. The training program in basic CPR maneuvers was based on global guidelines, including a theorical course with practical demonstration of CPR maneuvers with the defibrillator, individual practical training and theoretical and practical assessments. About the performance of students in the practical assessment the mean scores obtained by students in the first stage of the course was 26.4 points, while in the second stage the mean was 252.8 points, in the theoretical assessment the mean in the first stage was 3.06 points and in the second 9.0 points. The implementation of programs like this contribute to the effective acquisition of knowledge (theory) and skill (pratice) for the care of CPR victims.

  15. Location of cardiac arrest in a city center: strategic placement of automated external defibrillators in public locations

    DEFF Research Database (Denmark)

    Folke, Fredrik; Lippert, Freddy Knudsen; Nielsen, Søren Loumann

    2009-01-01

    BACKGROUND: Public-access defibrillation with automated external defibrillators (AEDs) is being implemented in many countries worldwide with considerable financial implications. The potential benefit and economic consequences of focused or unfocused AED deployment are unknown. METHODS AND RESULTS......: All cardiac arrests in public in Copenhagen, Denmark, from 1994 through 2005 were geographically located, as were 104 public AEDs placed by local initiatives. In accordance with European Resuscitation Council and American Heart Association (AHA) guidelines, areas with a high incidence of cardiac...... arrests were defined as those with 1 cardiac arrest every 2 or 5 years, respectively. There were 1274 cardiac arrests in public locations. According to the European Resuscitation Council or AHA guidelines, AEDs needed to be deployed in 1.2% and 10.6% of the city area, providing coverage for 19.5% (n=249...

  16. Performance of an automated external defibrillator in a moving ambulance vehicle.

    Science.gov (United States)

    Yun, Jong Geun; Jeung, Kyung Woon; Lee, Byung Kook; Ryu, Hyun Ho; Lee, Hyoung Youn; Kim, Mu Jin; Heo, Tag; Min, Yong Il; You, Yeonho

    2010-04-01

    The available data suggest that automated external defibrillators (AED) can be safely used in vibration-like moving conditions such as rigid inflatable boats and aircraft environments. However, little literature exists examining their performance in a moving ambulance. The present study was undertaken to determine whether an AED is able to analyse the heart rhythm correctly during ambulance transport. An ambulance was driven on paved (20-100 km/h) and unpaved (10 km/h) roads. The performance of two AED devices (CU ER 2, CU Medical Systems Inc., Korea, and Heartstart MRx, Phillips, USA) was determined in a moving ambulance using manikins. Vibration intensity was measured simultaneously with a digital vibrometer. AED performance was then evaluated again on manikins and on a swine model under simulated vibration intensities (0.5-5m/s(2)) measured by the vibrometer in the previous phase of the investigation. The vibration intensity increased with increasing speeds on paved roads (1.98+/-0.44 m/s(2) at 100 km/h). While driving on unpaved roads, it increased to 6.40+/-1.06 m/s(2). Both AED algorithms analysed the heart rhythm correctly under resting state. When tested on pigs, both algorithms showed substantially degraded performances, even at low vibration intensities of 0.5-1m/s(2), which corresponded to vibration intensities while driving on paved roads at 20-60 km/h. This study also showed that electrocardiograms generated on manikins were more resistant to motion artifacts than were the pig electrocardiograms. Ambulance personnel should consider the possibility of misinterpretation by an AED when this device is used while transporting a patient. Copyright (c) 2010 Elsevier Ireland Ltd. All rights reserved.

  17. The use of AEDs by police officers in the City of London. Automated external defibrillators.

    Science.gov (United States)

    Ross, P; Nolan, J; Hill, E; Dawson, J; Whimster, F; Skinner, D

    2001-08-01

    The Guidelines 2000 for cardiopulmonary resuscitation recommend shock delivery to victims in ventricular fibrillation within 5 min of call receipt by the Emergency Medical Services. In an effort to achieve this goal, in some parts of the United States, police officers have been trained to use automated external defibrillators (AEDs). We undertook a 3-year pilot evaluation of the use of AEDs by City of London police (CPOL) officers. Over a period of 3 years, 147 CPOL officers were trained in the use of an AED. Four AEDs were placed on rapid response vehicles covering the City of London. An overall call-response interval target was set at 8 min. The CPOL attended 1103 (90%) of the total of 1232 calls to which they were summoned. The mean interval between the first call received and arrival of the CPOL on scene was 8.9+/-4.0 min. The CPOL applied AEDs to 25 victims, 13 of whom were initially in ventricular fibrillation; at least one shock was delivered to all 13. The interval between call reception and delivery of the first shock was 5.5+/-2.5 min. The mean interval between switching on the AED and delivery of the first shock was 24+/-12 s. Two (15%) of these victims survived to hospital discharge. This study has confirmed the feasibility of training police officers in the UK to use AEDs as first responders. The call received to arrival on scene interval should be reduced by improvements in communication between LAS and CPOL.

  18. AEDs at your fingertips: automated external defibrillators on college campuses and a novel approach for increasing accessibility.

    Science.gov (United States)

    Berger, Ryan J; O'Shea, Jesse G

    2014-01-01

    The use of automated external defibrillators (AEDs) increases survival in cardiac arrest events. Due to the success of previous efforts and free, readily available mobile mapping software, the discussion is to emphasize the importance of the use of AEDs to prevent sudden cardiac arrest-related deaths on college campuses and abroad, while suggesting a novel approach to aiding in access and awareness issues. A user-friendly mobile application (a low-cost iOS map) was developed at Florida State University to decrease AED retrieval distance and time. The development of mobile AED maps is feasible for a variety of universities and other entities, with the potential to save lives. Just having AEDs installed is not enough--they need to be easily locatable. Society increasingly relies on phones to provide information, and there are opportunities to use mobile technology to locate and share information about relevant emergency devices; these should be incorporated into the chain of survival.

  19. 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.

  20. Estimation of current density distribution under electrodes for external defibrillation

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    Papazov Sava P

    2002-12-01

    Full Text Available Abstract Background Transthoracic defibrillation is the most common life-saving technique for the restoration of the heart rhythm of cardiac arrest victims. The procedure requires adequate application of large electrodes on the patient chest, to ensure low-resistance electrical contact. The current density distribution under the electrodes is non-uniform, leading to muscle contraction and pain, or risks of burning. The recent introduction of automatic external defibrillators and even wearable defibrillators, presents new demanding requirements for the structure of electrodes. Method and Results Using the pseudo-elliptic differential equation of Laplace type with appropriate boundary conditions and applying finite element method modeling, electrodes of various shapes and structure were studied. The non-uniformity of the current density distribution was shown to be moderately improved by adding a low resistivity layer between the metal and tissue and by a ring around the electrode perimeter. The inclusion of openings in long-term wearable electrodes additionally disturbs the current density profile. However, a number of small-size perforations may result in acceptable current density distribution. Conclusion The current density distribution non-uniformity of circular electrodes is about 30% less than that of square-shaped electrodes. The use of an interface layer of intermediate resistivity, comparable to that of the underlying tissues, and a high-resistivity perimeter ring, can further improve the distribution. The inclusion of skin aeration openings disturbs the current paths, but an appropriate selection of number and size provides a reasonable compromise.

  1. An MRI-Conditional External Cardiac Defibrillator for Resuscitation Within the MRI Scanner Bore

    Science.gov (United States)

    Schmidt, Ehud J.; Watkins, Ronald D.; Zviman, Menekhem M.; Guttman, Michael A.; Wang, Wei; Halperin, Henry A.

    2016-01-01

    Background Subjects undergoing cardiac arrest within an MRI scanner are currently removed from the bore and then from the MRI suite, prior to delivery of CPR and defibrillation, potentially increasing risk of mortality. This precludes many higher-risk (acute-ischemic, acute-stroke) patients from undergoing MRI imaging and MRI-guided intervention. An MRI-conditional cardiac defibrillator should enable scanning with defibrillation pads attached and the generator ON, enabling application of defibrillation within the MRI seconds after a cardiac event. An MRI-conditional external defibrillator may improve patient acceptance for MRI procedures. Methods and Results A commercial external defibrillator was rendered 1.5 Tesla MRI-conditional by addition of novel Radio-Frequency (RF) filters between the generator and commercial disposable surface-pads. The RF filters reduced emission into the MRI scanner, and prevented cable/surface-pad heating during imaging, while preserving all the defibrillator’s monitoring and delivery functions. Human volunteers were imaged using high Specific-Absorption-Rate sequences to validate MRI image quality (IQ) and lack of heating. Swine were electrically fibrillated (N=4) and thereafter defibrillated both outside and inside the MRI bore. MRI IQ was reduced by 0.8 or 1.6 dB, with the generator in monitoring mode and operating on battery or AC power, respectively. Commercial surface-pads did not create artifacts deeper than 6mm below the skin surface. RF heating was within FDA guidelines. Defibrillation was completely successful inside and outside the MRI bore. Conclusions A prototype MRI-conditional defibrillation system successfully defibrillated in the MRI without degrading image quality, or increasing the time needed for defibrillation. It can increase patient acceptance for MRI procedures. PMID:27729363

  2. Automated external defibrillators in National Collegiate Athletic Association Division I Athletics.

    Science.gov (United States)

    Coris, Eric E; Sahebzamani, Frances; Walz, Steve; Ramirez, Arnold M

    2004-01-01

    Sudden cardiac death is the leading cause of death in athletes. Evidence on current sudden cardiac death prevention through preparticipation history, physicals, and noninvasive cardiovascular diagnostics has demonstrated a low sensitivity for detection of athletes at high risk of sudden cardiac death. Data are lacking on automated external defibrillator programs specifically initiated to respond to rare dysrhythmia in younger, relatively low-risk populations. Surveys were mailed to the head athletic trainers of all National Collegiate Athletic Association Division I athletics programs listed in the National Athletic Trainers' Association directory. In all, 303 surveys were mailed; 186 departments (61%) responded. Seventy-two percent (133) of responding National Collegiate Athletic Association Division I athletics programs have access to automated external defibrillator units; 54% (101) own their units. Proven medical benefit (55%), concern for liability (51%), and affordability (29%) ranked highest in frequency of reasons for automated external defibrillator purchase. Unit cost (odds ratio = 1.01; 95% confidence interval, 1.01-1.0), donated units (odds ratio = 1.92; confidence interval, 3.66-1.01), institution size (odds ratio =.0001; confidence interval, 1.3 E-4 to 2.2E-05), and proven medical benefit of automated external defibrillators (odds ratio = 24; confidence interval, 72-8.1) were the most significant predictors of departmental defibrillator ownership. Emergency medical service response time and sudden cardiac death event history were not significantly predictive of departmental defibrillator ownership. The majority of automated external defibrillator interventions occurred on nonathletes. Many athletics medicine programs are obtaining automated external defibrillators without apparent criteria for determination of need. Usage and maintenance policies vary widely among departments with unit ownership or access. Programs need to approach the issue of unit

  3. Out-of-hospital cardiac arrest: Probability of bystander defibrillation relative to distance to nearest automated external defibrillator.

    Science.gov (United States)

    Sondergaard, Kathrine B; Hansen, Steen Moller; Pallisgaard, Jannik L; Gerds, Thomas Alexander; Wissenberg, Mads; Karlsson, Lena; Lippert, Freddy K; Gislason, Gunnar H; Torp-Pedersen, Christian; Folke, Fredrik

    2018-03-01

    Despite wide dissemination of automated external defibrillators (AEDs), bystander defibrillation rates remain low. We aimed to investigate how route distance to the nearest accessible AED was associated with probability of bystander defibrillation in public and residential locations. We used data from the nationwide Danish Cardiac Arrest Registry and the Danish AED Network to identify out-of-hospital cardiac arrests and route distances to nearest accessible registered AED during 2008-2013. The association between route distance and bystander defibrillation was described using restricted cubic spline logistic regression. We included 6971 out-of-hospital cardiac arrest cases. The proportion of arrests according to distance in meters (≤100, 101-200, >200) to the nearest accessible AED was: 4.6% (n=320), 5.3% (n=370), and 90.1% (n=6281), respectively. For cardiac arrests in public locations, the probability of bystander defibrillation at 0, 100 and 200m from the nearest AED was 35.7% (95% confidence interval 28.0%-43.5%), 21.3% (95% confidence interval 17.4%-25.2%), and 13.7% (95% confidence interval 10.1%-16.8%), respectively. The corresponding numbers for cardiac arrests in residential locations were 7.0% (95% confidence interval -2.1%-16.1%), 1.5% (95% confidence interval 0.002%-2.8%), and 0.9% (95% confidence interval 0.0005%-1.7%), respectively. In public locations, the probability of bystander defibrillation decreased rapidly within the first 100m route distance from cardiac arrest to nearest accessible AED whereas the probability of bystander defibrillation was low for all distances in residential areas. Copyright © 2017 Elsevier B.V. All rights reserved.

  4. Cardiopulmonary resuscitation and automatic external defibrillator training in schools: "is anyone learning how to save a life?".

    Science.gov (United States)

    Hart, Devin; Flores-Medrano, Oscar; Brooks, Steve; Buick, Jason E; Morrison, Laurie J

    2013-09-01

    Bystander resuscitation efforts, such as cardiopulmonary resuscitation (CPR) and use of an automatic external defibrillator (AED), save lives in cardiac arrest cases. School training in CPR and AED use may increase the currently low community rates of bystander resuscitation. The study objective was to determine the rates of CPR and AED training in Toronto secondary schools and to identify barriers to training and training techniques. This prospective study consisted of telephone interviews conducted with key school staff knowledgeable about CPR and AED teaching. An encrypted Web-based tool with prespecified variables and built-in logic was employed to standardize data collection. Of 268 schools contacted, 93% were available for interview and 83% consented to participate. Students and staff were trained in CPR in 51% and 80% of schools, respectively. Private schools had the lowest training rate (39%). Six percent of schools provided AED training to students and 47% provided AED training to staff. Forty-eight percent of schools had at least one AED installed, but 25% were unaware if their AED was registered with emergency services dispatch. Cost (17%), perceived need (11%), and school population size (10%) were common barriers to student training. Frequently employed training techniques were interactive (32%), didactic instruction (30%) and printed material (16%). CPR training rates for staff and students were moderate overall and lowest in private schools, whereas training rates in AED use were poor in all schools. Identified barriers to training include cost and student population size (perceived to be too small to be cost-effective or too large to be implemented). Future studies should assess the application of convenient and cost-effective teaching alternatives not presently in use.

  5. Efficacy and retention of Basic Life Support education including Automated External Defibrillator usage during a physical education period.

    Science.gov (United States)

    Watanabe, Kae; Lopez-Colon, Dalia; Shuster, Jonathan J; Philip, Joseph

    2017-03-01

    The American Heart Association (AHA) advocates for CPR education as a requirement of secondary school curriculum. Unfortunately, many states have not adopted CPR education. Our aim was to investigate a low-cost, time effective method to educate students on Basic Life Support (BLS), including reeducation. This is a prospective, randomized study. Retention was assessed at 4 months post-initial education. Education was performed by AHA-certified providers during a 45-minute physical education class in a middle school in Florida. This age provides opportunities for reinforcement through high school, with ability for efficient learning. The study included 41 Eighth grade students. Students were randomized into two groups; one group received repeat education 2 months after the first education, the second group did not. All students received BLS education limited to chest compressions and usage of an Automated External Defibrillator. Students had skills and knowledge tests administered pre- and post-education after initial education, and repeated 2 and 4 months later to assess retention. There was a significant increase in CPR skills and knowledge when comparing pre- and post-education results for all time-points ( p  < 0.001). When assessing reeducation, a significant improvement was noted in total knowledge scores but not during the actual steps of CPR. Our study indicates significant increase in CPR knowledge and skills following a one-time 45-minute session. Reeducation may be useful, but the interval needs further investigation. If schools across the United States invested one 45-60-minute period every school year, this would ensure widespread CPR knowledge with minimal cost and loss of school time.

  6. Efficacy and retention of Basic Life Support education including Automated External Defibrillator usage during a physical education period

    Directory of Open Access Journals (Sweden)

    Kae Watanabe

    2017-03-01

    Full Text Available The American Heart Association (AHA advocates for CPR education as a requirement of secondary school curriculum. Unfortunately, many states have not adopted CPR education. Our aim was to investigate a low-cost, time effective method to educate students on Basic Life Support (BLS, including reeducation. This is a prospective, randomized study. Retention was assessed at 4 months post-initial education. Education was performed by AHA-certified providers during a 45-minute physical education class in a middle school in Florida. This age provides opportunities for reinforcement through high school, with ability for efficient learning. The study included 41 Eighth grade students. Students were randomized into two groups; one group received repeat education 2 months after the first education, the second group did not. All students received BLS education limited to chest compressions and usage of an Automated External Defibrillator. Students had skills and knowledge tests administered pre- and post-education after initial education, and repeated 2 and 4 months later to assess retention. There was a significant increase in CPR skills and knowledge when comparing pre- and post-education results for all time-points (p < 0.001. When assessing reeducation, a significant improvement was noted in total knowledge scores but not during the actual steps of CPR. Our study indicates significant increase in CPR knowledge and skills following a one-time 45-minute session. Reeducation may be useful, but the interval needs further investigation. If schools across the United States invested one 45–60-minute period every school year, this would ensure widespread CPR knowledge with minimal cost and loss of school time.

  7. Automated external defibrillators in the Australian fitness industry.

    Science.gov (United States)

    Norton, Kevin I; Norton, Lynda H

    2008-04-01

    Sudden cardiac arrest (SCA) occurs in many thousands of Australians each year. Scientific evidence shows an increased survival rate for individuals who receive electrical defibrillation in the first few minutes after SCA. In the last decade automated (rhythm-detecting) external defibrillators (AEDs) have become available that are portable and affordable. Although still relatively rare, there is still the potential that SCA may occur when a person undertakes physical activity. Consequently, health/fitness centres are increasingly recognised as higher risk sites that may benefit from placement of AEDs. There are no laws in Australia requiring health/fitness centres to install AEDs. However, several international and professional organisations have "strongly encouraged" larger centres to install AEDs. Guidelines and algorithms are presented to help estimate the risk of SCA in fitness centres. Fitness centre placement is particularly important if the clientele is older or has a 'high-risk' profile, for example, clients with cardiovascular, respiratory or metabolic disease. International negligence case law and duty of care principles suggests the standard of care required in health/fitness centres may be increasing. Therefore, it may be prudent to install AEDs in larger centres and those in which higher risk groups are physically active.

  8. Interprofessional education and social interaction: The use of automated external defibrillators in team-based basic life support.

    Science.gov (United States)

    Onan, Arif; Simsek, Nurettin

    2017-04-01

    Automated external defibrillators are pervasive computing devices designed for the treatment and management of acute sudden cardiac arrest. This study aims to explain users' actual use behavior in teams formed by different professions taken after a short time span of interaction with automated external defibrillator. Before the intervention, all the participants were certified with the American Heart Association Basic Life Support for healthcare providers. A statistically significant difference was revealed in mean individual automated external defibrillator technical skills between uniprofessional and interprofessional groups. The technical automated external defibrillator team scores were greater for groups with interprofessional than for those with uniprofessional education. The nontechnical automated external defibrillator skills of interprofessional and uniprofessional teams revealed differences in advantage of interprofessional teams. Students positively accept automated external defibrillators if well-defined and validated training opportunities to use them expertly are available. Uniprofessional teams were successfully supported by their members and, thereby, used automated external defibrillator effectively. Furthermore, the interprofessional approach resulted in as much effective teamwork as the uniprofessional approach.

  9. Attitudes toward automated external defibrillator use in Japan.

    Science.gov (United States)

    Taniguchi, Takumi; Omi, Wataru; Inaba, Hideo

    2008-11-01

    The American Heart Association 2005 Guidelines recommend immediate defibrillation for ventricular fibrillation (VF) of short duration, such as witnessed sudden cardiac arrest. However, it is unclear if public-access automated external defibrillators (AEDs) would actually be used in Japan, because there have been few studies about public attitudes regarding AED use. Therefore, we examined Japanese attitudes toward AED use. Between February and March 2006, 3328 individuals, including high school students, teachers, emergency medical technicians (EMTs), medical nurses, and medical students, were asked about AED knowledge and their willingness to operate an AED. All EMTs, 86% of nurses, and 90% of medical students knew how to use AEDs, while only 15% of high school students and 44% of teachers had such knowledge. All EMTs, 78% of nurses, and 94% of medical students reported they would 'definitely' use the AED, but only 12% of high school students and 35% of teachers gave this reply. The reasons for unwillingness to operate AEDs among both laypeople and health care providers were poor of awareness of what AED is and/or how to use an AED. However, 83% of students and 81% of teachers with AED knowledge reported they would 'definitely' use the AED. Many non-medical people in Japan would be unwilling to operate an AED, because they do not know what AED is and/or how to use an AED. However, many would be willing to operate AEDs if they had better understanding of AEDs. Thus, it is necessary to improve public knowledge of AEDs and AED use.

  10. Locating Automated External Defibrillators in a Complicated Urban Environment Considering a Pedestrian-Accessible Network that Focuses on Out-of-Hospital Cardiac Arrests

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    Pil Kwon

    2017-02-01

    Full Text Available Automated external defibrillators (AEDs are portable devices that defibrillate and diagnose sudden-cardiac-arrest patients. Therefore, AEDs are widely installed in public places such as airports, schools, sport complexes, etc., and the installation of AEDs is required by law in these places. However, despite their usefulness, AEDs are mostly installed indoors with limited coverage outdoors. Hence, this study conducts research in the placement of AEDs in outdoor locations. This study considers a complicated urban environment using a pedestrian network dataset and network barriers. We draw on the Teitz and Bart’s (1968 heuristic method that was built in the location-allocation solver in ArcMap. The results of this study found that a total of 455 AEDs, including 227 pre-installed AEDs, could be placed in the study area, thus providing an additional 228 devices. Compared with 10 different installation methods that were set as experimental groups, our test results found that additional installations were able to cover 10% to 30% more actual out-of-hospital cardiac-arrest cases. The main contribution of this study is the proposal of a new method in locating AEDs in optimal areas while considering complicated urban environments. We predict that the cardiac-arrest-related mortality rate would be reduced through implementing the findings of this study.

  11. Temporal trends in coverage of historical cardiac arrests using a volunteer-based network of automated external defibrillators accessible to laypersons and emergency dispatch centers.

    Science.gov (United States)

    Hansen, Carolina Malta; Lippert, Freddy Knudsen; Wissenberg, Mads; Weeke, Peter; Zinckernagel, Line; Ruwald, Martin H; Karlsson, Lena; Gislason, Gunnar Hilmar; Nielsen, Søren Loumann; Køber, Lars; Torp-Pedersen, Christian; Folke, Fredrik

    2014-11-18

    Although increased dissemination of automated external defibrillators (AEDs) has been associated with more frequent AED use, the trade-off between the number of deployed AEDs and coverage of cardiac arrests remains unclear. We investigated how volunteer-based AED dissemination affected public cardiac arrest coverage in high- and low-risk areas. All public cardiac arrests (1994-2011) and all registered AEDs (2007-2011) in Copenhagen, Denmark, were identified and geocoded. AED coverage of cardiac arrests was defined as historical arrests ≤100 m from an AED. High-risk areas were defined as those with ≥1 arrest every 2 years and accounted for 1.0% of the total city area. Of 1864 cardiac arrests, 18.0% (n=335) occurred in high-risk areas throughout the study period. From 2007 to 2011, the number of AEDs and the corresponding coverage of cardiac arrests increased from 36 to 552 and from 2.7% to 32.6%, respectively. The corresponding increase for high-risk areas was from 1 to 30 AEDs and coverage from 5.7% to 51.3%, respectively. Since the establishment of the AED network (2007-2011), few arrests (n=55) have occurred ≤100 m from an AED with only 14.5% (n=8) being defibrillated before the arrival of emergency medical services. Despite the lack of a coordinated public access defibrillation program, the number of AEDs increased 15-fold with a corresponding increase in cardiac arrest coverage from 2.7% to 32.6% over a 5-year period. The highest increase in coverage was observed in high-risk areas (from 5.7% to 51.3%). AED networks can be used as useful tools to optimize AED placement in community settings. © 2014 American Heart Association, Inc.

  12. Availability of Automated External Defibrillators in Public High Schools.

    Science.gov (United States)

    White, Michelle J; Loccoh, Emefah C; Goble, Monica M; Yu, Sunkyung; Duquette, Deb; Davis, Matthew M; Odetola, Folafoluwa O; Russell, Mark W

    2016-05-01

    To assess automated external defibrillator (AED) distribution and cardiac emergency preparedness in Michigan secondary schools and investigate for association with school sociodemographic characteristics. Surveys were sent via electronic mail to representatives from all public high schools in 30 randomly selected Michigan counties, stratified by population. Association of AED-related factors with school sociodemographic characteristics were evaluated using Wilcoxon rank sum test and χ(2) test, as appropriate. Of 188 schools, 133 (71%) responded to the survey and all had AEDs. Larger student population was associated with fewer AEDs per 100 students (P schools. Schools with >20% students from racial minority groups had significantly fewer AEDs available per 100 students than schools with less racial diversity (P = .03). Schools with more students eligible for free and reduced lunch were less likely to have a cardiac emergency response plan (P = .02) and demonstrated less frequent AED maintenance (P = .03). Although AEDs are available at public high schools across Michigan, the number of AEDs per student varies inversely with minority student population and school size. Unequal distribution of AEDs and lack of cardiac emergency preparedness may contribute to outcomes of sudden cardiac arrest among youth. Copyright © 2016 Elsevier Inc. All rights reserved.

  13. Basic life support and automated external defibrillator skills among ambulance personnel: a manikin study performed in a rural low-volume ambulance setting

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    Nielsen Anne

    2012-05-01

    Full Text Available Abstract Background Ambulance personnel play an essential role in the ‘Chain of Survival’. The prognosis after out-of-hospital cardiac arrest was dismal on a rural Danish island and in this study we assessed the cardiopulmonary resuscitation performance of ambulance personnel on that island. Methods The Basic Life Support (BLS and Automated External Defibrillator (AED skills of the ambulance personnel were tested in a simulated cardiac arrest. Points were given according to a scoring sheet. One sample t test was used to analyze the deviation from optimal care according to the 2005 guidelines. After each assessment, individual feedback was given. Results On 3 consecutive days, we assessed the individual EMS teams responding to OHCA on the island. Overall, 70% of the maximal points were achieved. The hands-off ratio was 40%. Correct compression/ventilation ratio (30:2 was used by 80%. A mean compression depth of 40–50 mm was achieved by 55% and the mean compression depth was 42 mm (SD 7 mm. The mean compression rate was 123 per min (SD 15/min. The mean tidal volume was 746 ml (SD 221 ml. Only the mean tidal volume deviated significantly from the recommended (p = 0.01. During the rhythm analysis, 65% did not perform any visual or verbal safety check. Conclusion The EMS providers achieved 70% of the maximal points. Tidal volumes were larger than recommended when mask ventilation was applied. Chest compression depth was optimally performed by 55% of the staff. Defibrillation safety checks were not performed in 65% of EMS providers.

  14. [Worldwide experience with automated external defibrillators: What have we achieved? What else can we expect?].

    Science.gov (United States)

    Trappe, Hans-Joachim

    2016-03-01

    In Germany approximately 70,000-100,000 SCD patients die from sudden cardiac death (SCD). SCD is not caused by a single factor but is a multifactorial problem. In 50 % of SCD victims, sudden cardiac death is the first manifestation of heart disease. SCD is caused by ventricular tachyarrhythmias in approximately 90 % of patients, whereas SCD is caused by bradyarrhythmias in 5-10 % of the patients. Risk stratification is not possible in the majority of them prior to the fatal event. Early defibrillation is the method of choice to terminate ventricular fibrillation. Therefore, it is mandatory to install automatic external defibrillators (AED) in places with many people. There is general agreement that early defibrillation with automated external defibrillators (AED) is an effective tool to treat patients with ventricular fibrillation and will improve survival. It seems necessary to teach cardiocompression and AED use, also to children and adolescents. AED therapy "at home" did not improve survival in patients with cardiac arrest and can not be recommended.

  15. The utilization of automated external defibrillators in Taiwan.

    Science.gov (United States)

    Wang, Tsung-Hsi; Wu, Hsi-Wen; Hou, Peter C; Tseng, Hao-Jui

    2018-03-24

    Increasing attention to care of patient succumbed to out-of-hospital cardiac arrest (OHCA) and evidence for improved survival have resulted in many countries to encourage the use automated external defibrillators (AEDs) by legislation. In Taiwan, the amendment of the Emergency Medical Services Act mandated the installation of AEDs in designated areas in 2013. Since then, 6151 AEDs have been installed and registered in mandated and non-mandated locations. The purpose of this study was to investigate the utilization of AEDs at mandated and non-mandated locations. This paper analyzed 217 cases in whom AEDs was used between July 11, 2013 and July 31, 2015. Descriptive statistics were used to analyze the data. The highest frequency of AEDs used was in long-term care facilities, accounting for 34 (15.7%) cases. The second and third highest was in schools and commuting stations. The highest utilization rate of registered AED was in long-term care facilities (73.9%), the second was in residential areas, and the third was in hot spring areas. Employees at the designated locations or medical personnel operated the AED in 143 cases (84.6%), and bystanders, relatives, friends or others operated the AEDs in 26 cases (15.4%). On-site Return of Spontaneous Circulation (ROSC) after applying AEDs occurred in 76 cases (45.8%). Long-term care facilities had the highest utilization of AEDs and government should pay more attention to enforce the installing of AEDs in these places. The government also needs to promote the education public on how to search the AEDs locations. Copyright © 2018. Published by Elsevier B.V.

  16. Survival After Ventricular Fibrillation Cardiac Arrest in the Sao Paulo Metropolitan Subway System: First Successful Targeted Automated External Defibrillator (AED) Program in Latin America.

    Science.gov (United States)

    Gianotto-Oliveira, Renan; Gonzalez, Maria Margarita; Vianna, Caio Brito; Monteiro Alves, Maurício; Timerman, Sergio; Kalil Filho, Roberto; Kern, Karl B

    2015-10-09

    Targeted automated external defibrillator (AED) programs have improved survival rates among patients who have an out-of-hospital cardiac arrest (OHCA) in US airports, as well as European and Japanese railways. The Sao Paulo (Brazil) Metro subway carries 4.5 million people per day. A targeted AED program was begun in the Sao Paulo Metro with the objective to improve survival from cardiac arrest. A prospective, longitudinal, observational study of all cardiac arrests in the Sao Paulo Metro was performed from September 2006 through November 2012. This study focused on cardiac arrest by ventricular arrhythmias, and the primary endpoint was survival to hospital discharge with minimal neurological impairment. A total of 62 patients had an initial cardiac rhythm of ventricular fibrillation. Because no data on cardiac arrest treatment or outcomes existed before beginning this project, the first 16 months of the implementation was used as the initial experience and compared with the subsequent 5 years of full operation. Return of spontaneous circulation was not different between the initial 16 months and the subsequent 5 years (6 of 8 [75%] vs. 39 of 54 [72%]; P=0.88). However, survival to discharge was significantly different once the full program was instituted (0 of 8 vs. 23 of 54 [43%]; P=0.001). Implementation of a targeted AED program in the Sao Paulo Metro subway system saved lives. A short interval between arrest and defibrillation was key for good long-term, neurologically intact survival. These results support strategic expansion of targeted AED programs in other large Latin American cities. © 2015 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

  17. Utilization of automated external defibrillators installed in commonly used areas of Japanese hospitals

    OpenAIRE

    OHTA, SHOICHI; NAKAO, HIROYUKI; KUSHIMOTO, SHIGEKI; HIRAIDE, ATSUSHI; SAKAMOTO, TETSUYA; NAGAO, KEN; HORI, SHINGO

    2013-01-01

    Objective. Since July 2004, it has become legal in Japan for laypersons to use automated external defibrillators (AEDs). We investigated the effect of AED installation in commonly used areas of Japanese Association for Acute Medicine accredited training (JAAM) hospitals. Methods. In 2008, we sent questionnaires to 419 JAAM hospitals enquiring about the systems, operations, outcome and characteristics of AED usage. Results. Valid responses were received from 271 hospitals (64.7%). A total of 2...

  18. Optimal Installation Locations for Automated External Defibrillators in Taipei 7-Eleven Stores: Using GIS and a Genetic Algorithm with a New Stirring Operator

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    Chung-Yuan Huang

    2014-01-01

    Full Text Available Immediate treatment with an automated external defibrillator (AED increases out-of-hospital cardiac arrest (OHCA patient survival potential. While considerable attention has been given to determining optimal public AED locations, spatial and temporal factors such as time of day and distance from emergency medical services (EMSs are understudied. Here we describe a geocomputational genetic algorithm with a new stirring operator (GANSO that considers spatial and temporal cardiac arrest occurrence factors when assessing the feasibility of using Taipei 7-Eleven stores as installation locations for AEDs. Our model is based on two AED conveyance modes, walking/running and driving, involving service distances of 100 and 300 meters, respectively. Our results suggest different AED allocation strategies involving convenience stores in urban settings. In commercial areas, such installations can compensate for temporal gaps in EMS locations when responding to nighttime OHCA incidents. In residential areas, store installations can compensate for long distances from fire stations, where AEDs are currently held in Taipei.

  19. Impact of Bystander Automated External Defibrillator Use on Survival and Functional Outcomes in Shockable Observed Public Cardiac Arrests.

    Science.gov (United States)

    Pollack, Ross A; Brown, Siobhan P; Rea, Thomas; Aufderheide, Tom; Barbic, David; Buick, Jason E; Christenson, James; Idris, Ahamed H; Jasti, Jamie; Kampp, Michael; Kudenchuk, Peter; May, Susanne; Muhr, Marc; Nichol, Graham; Ornato, Joseph P; Sopko, George; Vaillancourt, Christian; Morrison, Laurie; Weisfeldt, Myron

    2018-02-26

    Background - Survival following out-of-hospital cardiac arrest (OHCA) with shockable rhythms can be improved with early defibrillation. Although shockable OHCA accounts for only ≈25% of overall arrests, ≈60% of public OHCAs are shockable, offering the possibility of restoring thousands of individuals to full recovery with early defibrillation by bystanders. We sought to determine the association of bystander automated external defibrillator use with survival and functional outcomes in shockable observed public OHCA. Methods - From 2011 to 2015, the Resuscitation Outcomes Consortium prospectively collected detailed information on all cardiac arrests at 9 regional centers. The exposures were shock administration by a bystander-applied automated external defibrillator in comparison with initial defibrillation by emergency medical services. The primary outcome measure was discharge with normal or near-normal (favorable) functional status defined as a modified Rankin Score ≤2. Survival to hospital discharge was the secondary outcome measure. Results -Among 49 555 OHCAs, 4115 (8.3%) observed public OHCAs were analyzed, of which 2500 (60.8%) were shockable. A bystander shock was applied in 18.8% of the shockable arrests. Patients shocked by a bystander were significantly more likely to survive to discharge (66.5% versus 43.0%) and be discharged with favorable functional outcome (57.1% versus 32.7%) than patients initially shocked by emergency medical services. After adjusting for known predictors of outcome, the odds ratio associated with a bystander shock was 2.62 (95% confidence interval, 2.07-3.31) for survival to hospital discharge and 2.73 (95% confidence interval, 2.17-3.44) for discharge with favorable functional outcome. The benefit of bystander shock increased progressively as emergency medical services response time became longer. Conclusions - Bystander automated external defibrillator use before emergency medical services arrival in shockable observed

  20. Effects of introducing a voluntary virtual patient module to a basic life support with an automated external defibrillator course: a randomised trial

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    Kononowicz Andrzej A

    2012-06-01

    Full Text Available Abstract Background The concept of virtual patients (VPs encompasses a great variety of predominantly case-based e-learning modules with different complexity and fidelity levels. Methods for effective placement of VPs in the process of medical education are sought. The aim of this study was to determine whether the introduction of a voluntary virtual patients module into a basic life support with an automated external defibrillator (BLS-AED course improved the knowledge and skills of students taking the course. Methods Half of the students were randomly assigned to an experimental group and given voluntary access to a virtual patient module consisting of six cases presenting BLS-AED knowledge and skills. Pre- and post-course knowledge tests and skills assessments were performed, as well as a survey of students' satisfaction with the VP usage. In addition, time spent using the virtual patient system, percentage of screen cards viewed and scores in the formative questions in the VP system throughout the course were traced and recorded. Results The study was conducted over a six week period and involved 226 first year medical students. The voluntary module was used by 61 (54% of the 114 entitled study participants. The group that used VPs demonstrated better results in knowledge acquisition and in some key BLS-AED action skills than the group without access, or those students from the experimental group deliberately not using virtual patients. Most of the students rated the combination of VPs and corresponding teaching events positively. Conclusions The overall positive reaction of students and encouraging results in knowledge and skills acquisition suggest that the usage of virtual patients in a BLS-AED course on a voluntary basis is feasible and should be further investigated.

  1. Effects of introducing a voluntary virtual patient module to a basic life support with an automated external defibrillator course: a randomised trial.

    Science.gov (United States)

    Kononowicz, Andrzej A; Krawczyk, Paweł; Cebula, Grzegorz; Dembkowska, Marta; Drab, Edyta; Frączek, Bartosz; Stachoń, Aleksandra J; Andres, Janusz

    2012-06-18

    The concept of virtual patients (VPs) encompasses a great variety of predominantly case-based e-learning modules with different complexity and fidelity levels. Methods for effective placement of VPs in the process of medical education are sought. The aim of this study was to determine whether the introduction of a voluntary virtual patients module into a basic life support with an automated external defibrillator (BLS-AED) course improved the knowledge and skills of students taking the course. Half of the students were randomly assigned to an experimental group and given voluntary access to a virtual patient module consisting of six cases presenting BLS-AED knowledge and skills. Pre- and post-course knowledge tests and skills assessments were performed, as well as a survey of students' satisfaction with the VP usage. In addition, time spent using the virtual patient system, percentage of screen cards viewed and scores in the formative questions in the VP system throughout the course were traced and recorded. The study was conducted over a six week period and involved 226 first year medical students. The voluntary module was used by 61 (54%) of the 114 entitled study participants. The group that used VPs demonstrated better results in knowledge acquisition and in some key BLS-AED action skills than the group without access, or those students from the experimental group deliberately not using virtual patients. Most of the students rated the combination of VPs and corresponding teaching events positively. The overall positive reaction of students and encouraging results in knowledge and skills acquisition suggest that the usage of virtual patients in a BLS-AED course on a voluntary basis is feasible and should be further investigated.

  2. A Smartphone Application to Reduce the Time to Automated External Defibrillator Delivery After a Witnessed Out-of-Hospital Cardiac Arrest: A Randomized Simulation-Based Study.

    Science.gov (United States)

    Hatakeyama, Toshihiro; Nishiyama, Chika; Shimamoto, Tomonari; Kiyohara, Kosuke; Kiguchi, Takeyuki; Chida, Izumi; Izawa, Junichi; Matsuyama, Tasuku; Kitamura, Tetsuhisa; Kawamura, Takashi; Iwami, Taku

    2018-04-13

    We developed a new smartphone application to deliver an automated external defibrillator (AED) to out-of-hospital cardiac arrest scene. The aim of this study was to evaluate whether an AED could be delivered earlier with or without an application in a simulated randomized controlled trial. Participants, who were asked to work as bystanders, were randomly assigned to either an application group or control group and were asked to bring an AED in both groups. The bystanders in the application group sent a signal notification using the application to two responders, who were stationed within 200 meters of the arrest scene, to carry an AED. The primary outcome was the AED delivery time by either the bystander or his/her responder. In total, 61 bystanders were eligible and randomized to either the application group (32) or the control group (29). The 52 with time data were available and analyzed. The AED delivery time by either the bystander or his/her responder was significantly shorter in the application group than in the control group [133.6 (44.4) seconds vs. 202.2 (122.2) seconds, P = 0.01]. In this simulation-based trial, AED delivery time was shortened by our newly developed smartphone application for the bystander to ask nearby responders to find and bring an AED to the cardiac arrest scene (UMIN-Clinical Trials Registry 000016506).This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

  3. Effectiveness of teaching automated external defibrillators use using a traditional classroom instruction versus self-instruction video in non-critical care nurses

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    Ismail M. Saiboon

    2016-04-01

    Full Text Available Objectives: To evaluate the effectiveness and retention of learning automated external defibrillator (AED usage taught through a traditional classroom instruction (TCI method versus a novel self instructed video (SIV technique in non-critical care nurses (NCCN. Methods: A prospective single-blind randomized study was conducted over 7 months (April-October 2014 at the Universiti Kebangsaan Malaysia Medical Center, Kuala Lampur, Malaysia. Eighty nurses were randomized into either TCI or SIV instructional techniques. We assessed knowledge, skill and confidence level at baseline, immediate and 6-months post-intervention. Knowledge and confidence were assessed via questionnaire; skill was assessed by a calibrated and blinded independent assessor using an objective structured clinical examination (OSCE method. Results: Pre-test mean scores for knowledge in the TCI group was 10.87 ± 2.34, and for the SIV group was 10.37 ± 1.85 (maximum achievable score 20.00; 4.05 ± 2.87 in the TCI and 3.71 ± 2.66 in the SIV (maximum score 11.00 in the OSCE evaluation and 9.54 ± 3.65 in the TCI and 8.56 ± 3.47 in the SIV (maximum score 25.00 in the individual’s personal confidence level. Both methods increased the mean scores significantly during immediate post-intervention (0-month. At 6-months, the TCI group scored lower than the SIV group in all aspects 11.13 ± 2.70 versus 12.95 ± 2.26 (p=0.03 in knowledge, 7.27 ± 1.62 versus 7.68 ± 1.73 (p=0.47 in the OSCE, and 16.40 ± 2.72 versus 18.82 ± 3.40 (p=0.03 in confidence level. Conclusion: In NCCN’s, SIV is as good as TCI in providing the knowledge, competency, and confidence in performing AED defibrillation.

  4. A multiple linear regression analysis of factors affecting the simulated Basic Life Support (BLS) performance with Automated External Defibrillator (AED) in Flemish lifeguards.

    Science.gov (United States)

    Iserbyt, Peter; Schouppe, Gilles; Charlier, Nathalie

    2015-04-01

    Research investigating lifeguards' performance of Basic Life Support (BLS) with Automated External Defibrillator (AED) is limited. Assessing simulated BLS/AED performance in Flemish lifeguards and identifying factors affecting this performance. Six hundred and sixteen (217 female and 399 male) certified Flemish lifeguards (aged 16-71 years) performed BLS with an AED on a Laerdal ResusciAnne manikin simulating an adult victim of drowning. Stepwise multiple linear regression analysis was conducted with BLS/AED performance as outcome variable and demographic data as explanatory variables. Mean BLS/AED performance for all lifeguards was 66.5%. Compression rate and depth adhered closely to ERC 2010 guidelines. Ventilation volume and flow rate exceeded the guidelines. A significant regression model, F(6, 415)=25.61, p<.001, ES=.38, explained 27% of the variance in BLS performance (R2=.27). Significant predictors were age (beta=-.31, p<.001), years of certification (beta=-.41, p<.001), time on duty per year (beta=-.25, p<.001), practising BLS skills (beta=.11, p=.011), and being a professional lifeguard (beta=-.13, p=.029). 71% of lifeguards reported not practising BLS/AED. Being young, recently certified, few days of employment per year, practising BLS skills and not being a professional lifeguard are factors associated with higher BLS/AED performance. Measures should be taken to prevent BLS/AED performances from decaying with age and longer certification. Refresher courses could include a formal skills test and lifeguards should be encouraged to practise their BLS/AED skills. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  5. Automated external defibrillation as part BLS: implications for education and practice.

    Science.gov (United States)

    Moule, Pam; Albarran, John W

    2002-09-01

    The latest Adult Basic Life Support (BLS) guidelines support the inclusion of the use of the automated external defibrillator (AED), as part of basic life support (BLS). Emphasis on the provision of early defibrillation as part of BLS acknowledges the importance of this manoeuvre in the successful termination of ventricular fibrillation. The ramifications of such changes for both first responders and organisations implementing the guidelines should not be underestimated. Issues relating to resourcing, content and duration of training and retraining, auditing and evaluation require further exploration. To consider these issues now seems particularly pertinent, given the recent launch of the UK Government's paper on public health, 'Saving Lives-Our Healthier Nation' which seeks to deploy AEDs in busy public places for use by trained members of the lay public. Additionally, defibrillation has been identified as one of the key competencies that all trained nurses and other health care providers should be able to undertake. This paper will consider the background to the current guideline changes, analyse the wider implications of translating the recommendations into practice, and offer possible solutions to address the issues raised. Whilst the analysis is particularly pertinent to the United Kingdom, many of the issues raised have international importance.

  6. Survival and health care costs until hospital discharge of patients treated with onsite, dispatched or without automated external defibrillator

    NARCIS (Netherlands)

    Berdowski, Jocelyn; Kuiper, Mathijs J.; Dijkgraaf, Marcel G. W.; Tijssen, Jan G. P.; Koster, Rudolph W.

    2010-01-01

    Background: This study aimed to determine whether automated external defibrillator (AED) use during resuscitation is associated with lower in-hospital health care costs. Methods: For this observational prospective study, we included all treated out-of-hospital cardiac arrests of suspected cardiac

  7. TED-Time and life saving External Defibrillator for home-use.

    Science.gov (United States)

    Weiss, Teddy A; Rosenheck, Shimon; Gorni, Shraga; Katz, Ioni; Mendelbaum, Mendel; Gilon, Dan

    2014-06-01

    Sudden Cardiac Death--SCD --is a major unmet health problem that needs urgent and prompt solution. AICDs are very expensive, risky and indicated for a small group of patients, at the highest risk. AEDs--Automatic External Defibrillators--are designed for public places and although safe, cannot enter the home-market due to their cost and need for constant, high-cost maintenance. We developed TED, a low-cost AED that derives its energy off the mains, designed for home-use, to save SCD victims' lives. Copyright © 2014 Elsevier Inc. All rights reserved.

  8. A second defibrillator chest patch electrode will increase implantation rates for nonthoracotomy defibrillators.

    Science.gov (United States)

    Solomon, A J; Swartz, J F; Rodak, D J; Moore, H J; Hannan, R L; Tracy, C M; Fletcher, R D

    1996-09-01

    Nonthoracotomy defibrillator systems can be implanted with a lower morbidity and mortality, compared to epicardial systems. However, implantation may be unsuccessful in up to 15% of patients, using a monophasic waveform. It was the purpose of this study to prospectively examine the efficacy of a second chest patch electrode in a nonthoracotomy defibrillator system. Fourteen patients (mean age 62 +/- 11 years, ejection fraction = 0.29 +/- 0.12) with elevated defibrillation thresholds, defined as > or = 24 J, were studied. The initial lead system consisted of a right ventricular electrode (cathode), a left innominate vein, and subscapular chest patch electrode (anodes). If the initial defibrillation threshold was > or = 24 J, a second chest patch electrode was added. This was placed subcutaneously in the anterior chest (8 cases), or submuscularly in the subscapular space (6 cases). This resulted in a decrease in the system impedance at the defibrillation threshold, from 72.3 +/- 13.3 omega to 52.2 +/- 8.6 omega. Additionally, the defibrillation threshold decreased from > or = 24 J, with a single patch, to 16.6 +/- 2.8 J with two patches. These changes were associated with successful implantation of a nonthoracotomy defibrillator system in all cases. In conclusion, the addition of a second chest patch electrode (using a subscapular approach) will result in lower defibrillation thresholds in patients with high defibrillation thresholds, and will subsequently increase implantation rates for nonthoracotomy defibrillators.

  9. Providers with Limited Experience Perform Better in Advanced Life Support with Assistance Using an Interactive Device with an Automated External Defibrillator Linked to a Ventilator.

    Science.gov (United States)

    Busch, Christian Werner; Qalanawi, Mohammed; Kersten, Jan Felix; Kalwa, Tobias Johannes; Scotti, Norman Alexander; Reip, Wikhart; Doehn, Christoph; Maisch, Stefan; Nitzschke, Rainer

    2015-10-01

    Medical teams with limited experience in performing advanced life support (ALS) or with a low frequency of cardiopulmonary resuscitation (CPR) while on duty, often have difficulty complying with CPR guidelines. This study evaluated whether the quality of CPR of trained medical students, who served as an example of teams with limited experience in ALS, could be improved with device assistance. The primary outcome was the hands-off time (i.e., the percentage of the entire CPR time without chest compressions). The secondary outcome was seven time intervals, which should be as short as possible, and the quality of ventilations and chest compressions on the mannequin. We compared standard CPR equipment to an interactive device with visual and acoustic instructions for ALS workflow measures to guide briefly trained medical students through the ALS algorithm in a full-scale mannequin simulation study with a randomized crossover study design. The study equipment consisted of an automatic external defibrillator and ventilator that were electronically linked and communicating as a single system. Included were regular medical students in the third to sixth years of medical school of one class who provided written informed consent for voluntary participation and for the analysis of their CPR performance data. No exclusion criteria were applied. For statistical measures of evaluation we used an analysis of variance for crossover trials accounting for treatment effect, sequence effect, and carry-over effect, with adjustment for prior practical experience of the participants. Forty-two medical students participated in 21 CPR sessions, each using the standard and study equipment. Regarding the primary end point, the study equipment reduced the hands-off time from 40.1% (95% confidence interval [CI] 36.9-43.4%) to 35.6% (95% CI 32.4-38.9%, p = 0.031) compared with the standard equipment. Within the prespecified secondary end points, study equipment reduced the time interval until

  10. Bystander Automated External Defibrillator Use and Clinical Outcomes after Out-of-Hospital Cardiac Arrest

    DEFF Research Database (Denmark)

    Holmberg, Mathias J; Vognsen, Mikael; Andersen, Mikkel S

    2017-01-01

    Aim: To systematically review studies comparing bystander automated external defibrillator (AED) use to no AED use in regard to clinical outcomes in out-of-hospital cardiac arrest (OHCA), and to provide a descriptive summary of studies on the cost-effectiveness of bystander AED use. Methods: We...... randomized trials, and 13 cost-effectiveness studies were included. Meta-analysis of 6 observational studies without critical risk of bias showed that bystander AED use was associated with survival to hospital discharge (all rhythms OR: 1.73 [95% CI: 1.36, 2.18], shockable rhythms OR: 1.66 [95% CI: 1.54, 1.......79]) and favorable neurological outcome (all rhythms OR: 2.12 [95% CI: 1.36, 3.29], shockable rhythms OR: 2.37 [95% CI: 1.58, 3.57]). There was no association between bystander AED use and neurological outcome for non-shockable rhythms (OR: 0.76 [95% CI: 0.10, 5.87]). The Public-Access Defibrillation trial found...

  11. Mobile Versus Fixed Deployment of Automated External Defibrillators in Rural EMS.

    Science.gov (United States)

    Nelson, R Darrell; Bozeman, William; Collins, Greg; Booe, Brian; Baker, Todd; Alson, Roy

    2015-04-01

    There is no consensus on where automated external defibrillators (AEDs) should be placed in rural communities to maximize impact on survival from cardiac arrest. In the community of Stokes County, North Carolina (USA) the Emergency Medical Services (EMS) system promotes cardiopulmonary resuscitation (CPR) public education and AED use with public access defibrillators (PADs) placed mainly in public schools, churches, and government buildings. This study tested the utilization of AEDs assigned to first responders (FRs) in their private-owned-vehicle (POV) compared to AEDs in fixed locations. The authors performed a prospective, observational study measuring utilization of AEDs carried by FRs in their POV compared to utilization of AEDs in fixed locations. Automated external defibrillator utilization is activation with pads placed on the patient and analysis of heart rhythm to determine if shock/no-shock is indicated. The Institutional Review Board of Wake Forest University Baptist Health System approved the study and written informed consent was waived. The study began on December 01, 2012 at midnight and ended on December 01, 2013 at midnight. During the 12-month study period, 81 community AEDs were in place, 66 in fixed locations and 15 assigned to FRs in their POVs. No utilizations of the 66 fixed location AEDs were reported (0.0 utilizations/AED/year) while 19 utilizations occurred in the FR POV AED study group (1.27 utilizations/AED/year; P<.0001). Odds ratio of using a FR POV located AED was 172 times more likely than using a community fixed-location AED in this rural community. Discussion Placing AEDs in a rural community poses many challenges for optimal utilization in terms of cardiac arrest occurrences. Few studies exist to direct rural community efforts in placing AEDs where they can be most effective, and it has been postulated that placing them directly with FRs may be advantageous. In this rural community, the authors found that placing AED devices with

  12. Lay bystanders' perspectives on what facilitates cardiopulmonary resuscitation and use of automated external defibrillators in real cardiac arrests

    DEFF Research Database (Denmark)

    Malta Hansen, Carolina; Rosenkranz, Simone Mørk; Folke, Fredrik

    2017-01-01

    is crucial in improving survival, cannot cause substantial harm, and that the AED will provide guidance through CPR; prior hands-on training in AED use; during CPR performance, teamwork (ie, support), using the AED voice prompt and a ventilation mask, as well as demonstrating leadership and feeling a moral......BACKGROUND: Many patients who suffer an out-of-hospital cardiac arrest will fail to receive bystander intervention (cardiopulmonary resuscitation [CPR] or defibrillation) despite widespread CPR training and the dissemination of automated external defibrillators (AEDs). We sought to investigate what......, until data saturation. We used cross-sectional indexing (using software), and inductive in-depth thematic analyses, to identify those factors that facilitated CPR and AED use. In addition to prior hands-on CPR training, the following were described as facilitators: prior knowledge that intervention...

  13. Lay Bystanders' Perspectives on What Facilitates Cardiopulmonary Resuscitation and Use of Automated External Defibrillators in Real Cardiac Arrests

    DEFF Research Database (Denmark)

    Malta Hansen, Carolina; Rosenkranz, Simone Mørk; Folke, Fredrik

    2017-01-01

    BACKGROUND: Many patients who suffer an out-of-hospital cardiac arrest will fail to receive bystander intervention (cardiopulmonary resuscitation [CPR] or defibrillation) despite widespread CPR training and the dissemination of automated external defibrillators (AEDs). We sought to investigate what...... factors encourage lay bystanders to initiate CPR and AED use in a cohort of bystanders previously trained in CPR techniques who were present at an out-of-hospital cardiac arrest. METHODS AND RESULTS: One-hundred and twenty-eight semistructured qualitative interviews with CPR-trained lay bystanders...... to consecutive out-of-hospital cardiac arrest, where an AED was present were conducted (from January 2012 to April 2015, in Denmark). Purposive maximum variation sampling was used to establish the breadth of the bystander perspective. Twenty-six of the 128 interviews were chosen for further in-depth analyses...

  14. Early cardiopulmonary resuscitation and use of Automated External Defibrillators by laypersons in out-of-hospital cardiac arrest using an SMS alert service

    NARCIS (Netherlands)

    Scholten, Annemieke C.; van Manen, Jeanette Gabrielle; van der Worp, Wim E.; IJzerman, Maarten Joost; Doggen, Catharina Jacoba Maria

    2011-01-01

    Aim: To evaluate an SMS service (SMS = short message service = text message) with which laypersons are alerted to go to patients with suspected out-of-hospital cardiac arrest and perform early cardiopulmonary resuscitation (CPR) and use an Automated External Defibrillator (AED). This study is the

  15. Motivating people to learn cardiopulmonary resuscitation and use of automated external defibrillators.

    Science.gov (United States)

    McDonald, Deborah Dillon; Martin, Deborah; Foley, Diane; Baker, Lee; Hintz, Deborah; Faure, Lauren; Erman, Nancy; Palozie, Jessica; Lundquist, Kathleen; O'Brien, Kara; Prior, Laura; Songco, Narra; Muscillo, Gwyn; Graziani, Denise; Tomczyk, Michael; Price, Sheryl

    2010-01-01

    The purpose of this study was to test the effect of a motivational message on the intention of laypersons to learn cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) use. A pretest-posttest, double-blind, randomized design was used with 220 community-dwelling adults. Participants were randomly assigned to the treatment group reading the CPR and AED pamphlet emphasizing learning CPR and AED use to save someone they love and the 3-minute window for response time; or to the comparison group reading the identical pamphlet without the 2 motivational statements. Intention to learn CPR and AED use and to look for AEDs in public areas was measured before and after reading the respective pamphlet. No significant difference emerged between the groups for the number of participants planning to learn CPR and AED use. A significant number of participants in both groups increased intention to learn CPR and AED use. Significantly more treatment participants than comparison participants planned to routinely look for AEDs in public areas after reading the pamphlet, however. Teaching critical facts such as the low survival rate for out-of-hospital cardiac arrest might encourage laypersons to learn CPR and AED use. Routinely teaching family members of people at risk for a cardiac arrest about the short window of time in which CPR and AED use must begin and encouraging them to learn about CPR and AEDs to save someone they love may encourage family members to identify the location of AEDs in public places.

  16. Quality of basic life support education and automated external defibrillator setting in schools in Ishikawa, Japan.

    Science.gov (United States)

    Takamura, Akiteru; Ito, Sayori; Maruyama, Kaori; Ryo, Yusuke; Saito, Manami; Fujimura, Shuhei; Ishiura, Yuna; Hori, Ariyuki

    2017-03-01

    Automated external defibrillators (AED) have been installed in schools in Japan since 2004, and the government strongly recommends teaching basic life support (BLS). We therefore examined the quality of BLS education and AED installation in schools. We conducted a prefecture-wide questionnaire survey of all primary and junior high schools in 2016, to assess BLS education and AED installation against the recommendations of the Japan Circulation Society. The results were analyzed using descriptive statistics and chi-squared test. In total, 195 schools out of 315 (62%) responded, of which 38% have introduced BLS education for children. BLS training was held in a smaller proportion of primary schools (18%) than junior high schools (86%). More than 90% of primary school staff had undergone BLS training in the previous 2 years. The most common locations of AED were the gymnasium (32%) followed by entrance hall (28%), staffroom (25%), and infirmary (12%). The reasons given for location were that it was obvious (34%), convenient for staff (32%), could be used out of hours (17%), and the most likely location for a heart attack (15%). Approximately 18% of schools reported that it takes >5 min to reach the AED from the furthest point. BLS training, AED location, and understanding of both are not sufficient to save children's lives efficiently. Authorities should make recommendations about the correct number of AED, and their location, and provide more information to improve the quality of BLS training in schools. © 2016 Japan Pediatric Society.

  17. Preventing Sudden Cardiac Death: Automated External Defibrillators in Ohio High Schools.

    Science.gov (United States)

    Lear, Aaron; Hoang, Minh-Ha; Zyzanski, Stephen J

    2015-10-01

    Ohio passed legislation in 2004 for optional public funding of automated external defibrillators (AEDs) in all Ohio high schools. To report occurrences of sudden cardiac arrest in which AEDs were used in Ohio high schools and to evaluate the adherence of Ohio high schools with AEDs to state law and published guidelines on AEDs and emergency action plans (EAPs) in schools. Cross-sectional survey. Web-based survey. A total of 264 of 827 schools that were members of the Ohio High School Athletic Association. We surveyed schools on AED use, AED maintenance, and EAPs. Twenty-five episodes of AED deployment at 22 schools over an 11-year period were reported; 8 (32%) involved students and 17 (68%) involved adults. The reported survival rate was 60% (n = 15). Most events (n = 20, 80%) in both students and adults occurred at or near athletic facilities. The annual use rate of AEDs was 0.7%. Fifty-three percent (n = 140) of schools reported having an EAP in place for episodes of cardiac arrest. Of the schools with EAPs, 57% (n = 80) reported having rehearsed them. Our data supported the placement of AEDs in high schools given the frequency of use for sudden cardiac arrest and the survival rate reported. They also suggested the need for increased awareness of recommendations for EAPs and the need to formulate and practice EAPs. School EAPs should emphasize planning for events in the vicinity of athletic facilities.

  18. [Learning to use semiautomatic external defibrillators through audiovisual materials for schoolchildren].

    Science.gov (United States)

    Jorge-Soto, Cristina; Abelairas-Gómez, Cristian; Barcala-Furelos, Roberto; Gregorio-García, Carolina; Prieto-Saborit, José Antonio; Rodríguez-Núñez, Antonio

    2016-01-01

    To assess the ability of schoolchildren to use a automated external defibrillator (AED) to provide an effective shock and their retention of the skill 1 month after a training exercise supported by audiovisual materials. Quasi-experimental controlled study in 205 initially untrained schoolchildren aged 6 to 16 years old. SAEDs were used to apply shocks to manikins. The students took a baseline test (T0) of skill, and were then randomized to an experimental or control group in the first phase (T1). The experimental group watched a training video, and both groups were then retested. The children were tested in simulations again 1 month later (T2). A total of 196 students completed all 3 phases. Ninety-six (95.0%) of the secondary school students and 54 (56.8%) of the primary schoolchildren were able to explain what a SAED is. Twenty of the secondary school students (19.8%) and 8 of the primary schoolchildren (8.4%) said they knew how to use one. At T0, 78 participants (39.8%) were able to simulate an effective shock. At T1, 36 controls (34.9%) and 56 experimental-group children (60.2%) achieved an effective shock (Paudiovisual instruction improves students' skill in managing a SAED and helps them retain what they learned for later use.

  19. Training lay-people to use automatic external defibrillators: are all of their needs being met?

    Science.gov (United States)

    Harrison-Paul, Russell; Timmons, Stephen; van Schalkwyk, Wilna Dirkse

    2006-10-01

    We explored the experiences of lay people who have been trained to use automatic external defibrillators. The research questions were: (1) How can training courses help prepare people for dealing with real life situations? (2) Who is ultimately responsible for providing critical incident debriefing and how should this be organised? (3) What is the best process for providing feedback to those who have used an AED? Fifty-three semi-structured, qualitative interviews were conducted, some with those who had been trained and others with trainers. Locations included airports, railway stations, private companies and first responder schemes. Geographically, we covered Nottinghamshire, Lincolnshire, Yorkshire, Staffordshire, Essex and the West Midlands in the UK. Our analysis of the data indicates that most people believe scenarios based within their place of work were most useful in preparing for 'real life'. Many people had not received critical incident debriefing after using an AED. There were a variety of systems in place to provide support after an incident, many of which were informal. Training scenarios should be conducted outside the classroom. There should be more focus on critical incident debriefing during training and a clear identification of who should provide support after an incident. Other issues which were of interest included: (1) people's views on do not attempt resuscitation (DNAR); (2) perceived boundaries of responsibility when using an AED; (3) when is someone no longer 'qualified' to use an AED?

  20. Use of a geographic information system to identify differences in automated external defibrillator installation in urban areas with similar incidence of public out-of-hospital cardiac arrest: a retrospective registry-based study.

    Science.gov (United States)

    Fredman, David; Haas, Jan; Ban, Yifang; Jonsson, Martin; Svensson, Leif; Djarv, Therese; Hollenberg, Jacob; Nordberg, Per; Ringh, Mattias; Claesson, Andreas

    2017-06-02

    Early defibrillation in out-of-hospital cardiac arrest (OHCA) is of importance to improve survival. In many countries the number of automated external defibrillators (AEDs) is increasing, but the use is low. Guidelines suggest that AEDs should be installed in densely populated areas and in locations with many visitors. Attempts have been made to identify optimal AED locations based on the incidence of OHCA using geographical information systems (GIS), but often on small datasets and the studies are seldom reproduced. The aim of this paper is to investigate if the distribution of public AEDs follows the incident locations of public OHCAs in urban areas of Stockholm County, Sweden. OHCA data were obtained from the Swedish Register for Cardiopulmonary Resuscitation and AED data were obtained from the Swedish AED Register. Urban areas in Stockholm County were objectively classified according to the pan-European digital mapping tool, Urban Atlas (UA). Furthermore, we reclassified and divided the UA land cover data into three classes (residential, non-residential and other areas). GIS software was used to spatially join and relate public AED and OHCA data and perform computations on relations and distance. Between 1 January 2012 and 31 December 2014 a total of 804 OHCAs occurred in public locations in Stockholm County and by December 2013 there were 1828 AEDs available. The incidence of public OHCAs was similar in residential (47.3%) and non-residential areas (43.4%). Fewer AEDs were present in residential areas than in non-residential areas (29.4% vs 68.8%). In residential areas the median distance between OHCAs and AEDs was significantly greater than in non-residential areas (288 m vs 188 m, p<0.001). The majority of public OHCAs occurred in areas classified in UA as 'residential areas' with limited AED accessibility. These areas need to be targeted for AED installation and international guidelines need to take geographical location into account when suggesting

  1. Barriers and facilitators to public access defibrillation in out-of-hospital cardiac arrest: a systematic review.

    Science.gov (United States)

    Smith, Christopher M; Lim Choi Keung, Sarah N; Khan, Mohammed O; Arvanitis, Theodoros N; Fothergill, Rachael; Hartley-Sharpe, Christopher; Wilson, Mark H; Perkins, Gavin D

    2017-10-01

    Public access defibrillation initiatives make automated external defibrillators available to the public. This facilitates earlier defibrillation of out-of-hospital cardiac arrest victims and could save many lives. It is currently only used for a minority of cases. The aim of this systematic review was to identify barriers and facilitators to public access defibrillation. A comprehensive literature review was undertaken defining formal search terms for a systematic review of the literature in March 2017. Studies were included if they considered reasons affecting the likelihood of public access defibrillation and presented original data. An electronic search strategy was devised searching MEDLINE and EMBASE, supplemented by bibliography and related-article searches. Given the low-quality and observational nature of the majority of articles, a narrative review was performed. Sixty-four articles were identified in the initial literature search. An additional four unique articles were identified from the electronic search strategies. The following themes were identified related to public access defibrillation: knowledge and awareness; willingness to use; acquisition and maintenance; availability and accessibility; training issues; registration and regulation; medicolegal issues; emergency medical services dispatch-assisted use of automated external defibrillators; automated external defibrillator-locator systems; demographic factors; other behavioural factors. In conclusion, several barriers and facilitators to public access defibrillation deployment were identified. However, the evidence is of very low quality and there is not enough information to inform changes in practice. This is an area in urgent need of further high-quality research if public access defibrillation is to be increased and more lives saved. PROSPERO registration number CRD42016035543. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2017. For permissions

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

    Science.gov (United States)

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

    2017-04-04

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

  3. "It Doesn't Make Sense for Us Not to Have One"-Understanding Reasons Why Community Sports Organizations Chose to Participate in a Funded Automated External Defibrillator Program.

    Science.gov (United States)

    Fortington, Lauren V; Bekker, Sheree; Morgan, Damian; Finch, Caroline F

    2017-10-10

    Implementation of automated external defibrillators (AEDs) in community sports settings is an important component of emergency medical planning. This study aimed to understand motivations for why sports organizations participated in a government-funded program that provided AEDs and associated first-aid training. Face-to-face interviews. Community sports organizations in Victoria, Australia. Representatives from 14 organizations who participated in a government-funded AED program. Motivations to participate in the AED program were explored using a qualitative descriptive approach. Two overarching themes emerged: awareness of the program and decision to apply. Awareness was gained indirectly through grant advertising in newsletters/emails/web sites and directly through their sporting associations. For most organizations, there was no decision process per se, rather, the opportunity to apply was the key determinant for participating in the program. A duty of care also emerged as a key driving factor, with recognition of AEDs as a valuable asset to communities broadly, not just the participants' immediate sports setting. Reflecting on participation in the program, these participants identified that it was important to increase awareness about AED ownership and use. The program benefits were clearly summed up as being best prepared for a worst-case scenario. This study provides new understanding of why community sports organizations apply for an AED and training. The strongest reason was simply the opportunity to acquire this at no cost. Therefore, for wider implementation of AEDs, additional funding opportunities, targeted awareness of these opportunities, and continued promotion of AED importance are recommended.

  4. Presence of automated external defibrillators in North Carolina public middle schools.

    Science.gov (United States)

    Fields, Karl B; Bright, Jacob

    2011-01-01

    Automated external defibrillators (AEDs) have been used in the school setting to successfully resuscitate students, staff, and visitors. All public high schools in North Carolina have an AED. However, the number of North Carolina public middle schools with an AED is unknown. The purpose of this study was to determine the presence of AEDs at public middle schools in North Carolina and to estimate the cost associated with providing an AED to all public middle schools currently without one. All 547 middle schools in North Carolina's 117 public school systems were surveyed in 2009 via e-mail, fax, and, when necessary, telephone about whether an AED was present on site. For middle schools without AEDs, we estimated the cost of purchase and for 1 year of maintenance. A total 66.6% of public middle schools responded to 1 of 3 survey mailings. The remaining schools were contacted by telephone, so that 100% were included in data collection. At the time of the survey, at least 1 AED was present in 334 schools (61.1%). Of the 213 schools without AEDs, 57 (26.8%) were in school systems in which some middle schools had AEDs, and 156 (73.2%) were in systems in which no middle school had an AED. On the basis of a start-up cost of $1,200 per AED, the cost of providing an AED to each school without one is approximately $255,600. These data are based on self-report, and we could not verify whether AEDs were functional. Cost estimates do not include charges for ongoing maintenance and staff training. Two hundred and thirteen North Carolina public middle schools (38.9%) do not have an AED on site.

  5. Use and benefits of public access defibrillation in a nation-wide network

    DEFF Research Database (Denmark)

    Nielsen, Anne Møller; Folke, Fredrik; Lippert, Freddy Knudsen

    2013-01-01

    BACKGROUND: Automated External Defibrillators (AEDs) are known to increase survival after out-of-hospital cardiac arrest (OHCA). The aim of this study was to examine the use and benefit of public-access defibrillation (PAD) in a nation-wide network. We primarily sought to assess survival at 1 month...... to exercise (42% vs. 0%), and with improved 30-day survival (69% vs. 15%, p=0.001). Among those presenting with a shockable rhythm, 20 (65%) had Return of Spontaneous Circulation upon arrival of EMS and 8 (26%) were conscious, which emphasizes the diagnostic value of ECG downloads from AEDs. Survival could...

  6. Systematic downloading and analysis of data from automated external defibrillators used in out-of-hospital cardiac arrest

    DEFF Research Database (Denmark)

    Hansen, Marco Bo; Lippert, Freddy Knudsen; Rasmussen, Lars Simon

    2014-01-01

    BACKGROUND: Valuable information can be retrieved from automated external defibrillators (AEDs) used in victims of out-of-hospital cardiac arrest (OHCA). We describe our experience with systematic downloading of data from deployed AEDs. The primary aim was to compare the proportion of shockable...... rhythm from AEDs used by laypersons with the corresponding proportion recorded by the Emergency Medical Services (EMS) on arrival. METHODS: In a 20-month study, we collected data on OHCAs in the Capital Region of Denmark where an AED was deployed prior to arrival of EMS. The AEDs were brought...... to the emergency medical dispatch centre for data downloading and rhythm analysis. Patient data were retrieved from the medical records from the admitting hospital, whereas data on EMS rhythm analyses were obtained from the Danish Cardiac Arrest Register between 2001 and 2010. RESULTS: A total of 121 AEDs were...

  7. Public Claims about Automatic External Defibrillators: An Online Consumer Opinions Study

    Directory of Open Access Journals (Sweden)

    Barnett Julie

    2011-05-01

    Full Text Available Abstract Background Patients are no longer passive recipients of health care, and increasingly engage in health communications outside of the traditional patient and health care professional relationship. As a result, patient opinions and health related judgements are now being informed by a wide range of social, media, and online information sources. Government initiatives recognise self-delivery of health care as a valuable means of responding to the anticipated increased global demand for health resources. Automated External Defibrillators (AEDs, designed for the treatment of Sudden Cardiac Arrest (SCA, have recently become available for 'over the counter' purchase with no need for a prescription. This paper explores the claims and argumentation of lay persons and health care practitioners and professionals relating to these, and how these may impact on the acceptance, adoption and use of these devices within the home context. Methods We carry out a thematic content analysis of a novel form of Internet-based data: online consumer opinions of AED devices posted on Amazon.com, the world's largest online retailer. A total of #83 online consumer reviews of home AEDs are analysed. The analysis is both inductive, identifying themes that emerged from the data, exploring the parameters of public debate relating to these devices, and also driven by theory, centring around the parameters that may impact upon the acceptance, adoption and use of these devices within the home as indicated by the Technology Acceptance Model (TAM. Results Five high-level themes around which arguments for and against the adoption of home AEDs are identified and considered in the context of TAM. These include opinions relating to device usability, usefulness, cost, emotional implications of device ownership, and individual patient risk status. Emotional implications associated with AED acceptance, adoption and use emerged as a notable factor that is not currently reflected

  8. Public claims about automatic external defibrillators: an online consumer opinions study.

    Science.gov (United States)

    Money, Arthur G; Barnett, Julie; Kuljis, Jasna

    2011-05-18

    Patients are no longer passive recipients of health care, and increasingly engage in health communications outside of the traditional patient and health care professional relationship. As a result, patient opinions and health related judgements are now being informed by a wide range of social, media, and online information sources. Government initiatives recognise self-delivery of health care as a valuable means of responding to the anticipated increased global demand for health resources. Automated External Defibrillators (AEDs), designed for the treatment of Sudden Cardiac Arrest (SCA), have recently become available for 'over the counter' purchase with no need for a prescription. This paper explores the claims and argumentation of lay persons and health care practitioners and professionals relating to these, and how these may impact on the acceptance, adoption and use of these devices within the home context. We carry out a thematic content analysis of a novel form of Internet-based data: online consumer opinions of AED devices posted on Amazon.com, the world's largest online retailer. A total of #83 online consumer reviews of home AEDs are analysed. The analysis is both inductive, identifying themes that emerged from the data, exploring the parameters of public debate relating to these devices, and also driven by theory, centring around the parameters that may impact upon the acceptance, adoption and use of these devices within the home as indicated by the Technology Acceptance Model (TAM). Five high-level themes around which arguments for and against the adoption of home AEDs are identified and considered in the context of TAM. These include opinions relating to device usability, usefulness, cost, emotional implications of device ownership, and individual patient risk status. Emotional implications associated with AED acceptance, adoption and use emerged as a notable factor that is not currently reflected within the existing TAM. The value, credibility and

  9. A patch in the pectoral position lowers defibrillation threshold.

    Science.gov (United States)

    Karasik, P; Solomon, A; Verdino, R; Moore, H; Rodak, D; Hannan, R; Fletcher, R

    1997-06-01

    Implantable pacemaker cardioverter defibrillators are now available with biphasic waveforms, which have been shown to markedly improve defibrillation thresholds (DFTs). However, in a number of patients the DFT remains high. Also, DFT may increase after implantation, especially if antiarrhythmic drugs are added. We report on the use of a subcutaneous patch in the pectoral position in 15 patients receiving a transvenous defibrillator as a method of easily reducing the DFT. A 660-mm2 patch electrode was placed beneath the generator in a pocket created on the pectoral fascia. The energy required for defibrillation was lowered by 56% on average, and the system impedance was lowered by a mean of 25%. This maneuver allowed all patients to undergo a successful implant with adequate safety margin.

  10. Use a defibrillator, save a life

    CERN Multimedia

    Joannah Caborn Wengler

    2012-01-01

    With the work for Long Shutdown 1 looming on the horizon, the CERN Fire Brigade is anticipating a heavy workload: more people working at CERN means more call-outs. So the more trained first-aiders around to help out before the paramedics arrive, the better. Would you know what to do in a medical emergency?   It could happen at any time: two colleagues are having a coffee at work, when one suddenly clutches his or her chest and falls to the floor unconscious. What would you do? Run to find a first-aider? Call the ambulance and wait, finishing your coffee? Neither response is entirely correct. On Monday 11 June in Building 40 the CMS safety group, in collaboration with the Fire Brigade and the Medical Service, demonstrated the recommended, potentially life-saving response to cardiac arrest (see the video), including the correct use of a defibrillator, ten of which were recently installed in key CERN locations (the Bulletin reported).     “In countries where...

  11. Neighborhood characteristics, bystander automated external defibrillator use, and patient outcomes in public out-of-hospital cardiac arrest.

    Science.gov (United States)

    Andersen, Lars W; Holmberg, Mathias J; Granfeldt, Asger; Løfgren, Bo; Vellano, Kimberly; McNally, Bryan F; Siegerink, Bob; Kurth, Tobias; Donnino, Michael W

    2018-05-01

    Automated external defibrillators (AEDs) can be used by bystanders to provide rapid defibrillation for patients with out-of-hospital cardiac arrest (OHCA). Whether neighborhood characteristics are associated with AED use is unknown. Furthermore, the association between AED use and outcomes has not been well characterized for all (i.e. shockable and non-shockable) public OHCAs. We included public, non-911-responder witnessed OHCAs registered in the Cardiac Arrest Registry to Enhance Survival (CARES) between 2013 and 2016. The primary patient outcome was survival to hospital discharge with a favorable functional outcome. We first assessed the association between neighborhood characteristics and bystander AED use using logistic regression and then assessed the association between bystander AED use and patient outcomes in a propensity score matched cohort. 25,182 OHCAs were included. Several neighborhood characteristics, including the proportion of people living alone, the proportion of white people, and the proportion with a high-school degree or higher, were associated with bystander AED use. 5132 OHCAs were included in the propensity score-matched cohort. Bystander AED use was associated with an increased risk of a favorable functional outcome (35% vs. 25%, risk difference: 9.7% [95% confidence interval: 7.2%, 12.2%], risk ratio: 1.38 [95% confidence interval: 1.27, 1.50]). This was driven by increased favorable functional outcomes with AED use in patients with shockable rhythms (58% vs. 39%) but not in patients with non-shockable rhythms (10% vs. 10%). Specific neighborhood characteristics were associated with bystander AED use in OHCA. Bystander AED use was associated with an increase in favorable functional outcome. Copyright © 2018 Elsevier B.V. All rights reserved.

  12. Public Access Defibrillation

    DEFF Research Database (Denmark)

    Agerskov, Marianne; Nielsen, Anne Møller; Hansen, Carolina Malta

    2015-01-01

    BACKGROUND: In Copenhagen, a volunteer-based Automated External Defibrillator (AED) network provides a unique opportunity to assess AED use. We aimed to determine the proportion of Out-of-Hospital Cardiac Arrest (OHCA) where an AED was applied before arrival of the ambulance, and the proportion o...

  13. Transmural recording of shock potential gradient fields, early postshock activations, and refibrillation episodes associated with external defibrillation of long-duration ventricular fibrillation in swine.

    Science.gov (United States)

    Allred, James D; Killingsworth, Cheryl R; Allison, J Scott; Dosdall, Derek J; Melnick, Sharon B; Smith, William M; Ideker, Raymond E; Walcott, Gregory P

    2008-11-01

    Knowledge of the shock potential gradient (nablaV) and postshock activation is limited to internal defibrillation of short-duration ventricular fibrillation (SDVF). The purpose of this study was to determine these variables after external defibrillation of long-duration VF (LDVF). In six pigs, 115-20 plunge needles with three to six electrodes each were inserted to record throughout both ventricles. After the chest was closed, the biphasic defibrillation threshold (DFT) was determined after 20 seconds of SDVF with external defibrillation pads. After 7 minutes of LDVF, defibrillation shocks that were less than or equal to the SDVF DFT strength were given. For DFT shocks (1632 +/- 429 V), the maximum minus minimum ventricular voltage (160 +/- 100 V) was 9.8% of the shock voltage. Maximum cardiac nablaV (28.7 +/- 17 V/cm) was 4.7 +/- 2.0 times the minimum nablaV (6.2 +/- 3.5 V/cm). Although LDVF did not increase the DFT in five of the six pigs, it significantly lengthened the time to earliest postshock activation following defibrillation (1.6 +/- 2.2 seconds for SDVF and 4.9 +/- 4.3 seconds for LDVF). After LDVF, 1.3 +/- 0.8 episodes of spontaneous refibrillation occurred per animal, but there was no refibrillation after SDVF. Compared with previous studies of internal defibrillation, during external defibrillation much less of the shock voltage appears across the heart and the shock field is much more even; however, the minimum nablaV is similar. Compared with external defibrillation of SDVF, the biphasic external DFT for LDVF is not increased; however, time to earliest postshock activation triples. Refibrillation is common after LDVF but not after SDVF in these normal hearts, indicating that LDVF by itself can cause refibrillation without requiring preexisting heart disease.

  14. [Research and Design of a System for Detecting Automated External Defbrillator Performance Parameters].

    Science.gov (United States)

    Wang, Kewu; Xiao, Shengxiang; Jiang, Lina; Hu, Jingkai

    2017-09-30

    In order to regularly detect the performance parameters of automated external defibrillator (AED), to make sure it is safe before using the instrument, research and design of a system for detecting automated external defibrillator performance parameters. According to the research of the characteristics of its performance parameters, combing the STM32's stability and high speed with PWM modulation control, the system produces a variety of ECG normal and abnormal signals through the digital sampling methods. Completed the design of the hardware and software, formed a prototype. This system can accurate detect automated external defibrillator discharge energy, synchronous defibrillation time, charging time and other key performance parameters.

  15. Temporal Trends in Coverage of Historical Cardiac Arrests Using a Volunteer-Based Network of Automated External Defibrillators Accessible to Laypersons and Emergency Dispatch Centers

    DEFF Research Database (Denmark)

    Hansen, Carolina Malta; Lippert, Freddy Knudsen; Wissenberg, Mads

    2014-01-01

    public cardiac arrest coverage in high- and low-risk areas. METHODS AND RESULTS: All public cardiac arrests (1994-2011) and all registered AEDs (2007-2011) in Copenhagen, Denmark, were identified and geocoded. AED coverage of cardiac arrests was defined as historical arrests ≤100 m from an AED. High...

  16. The Effect of the Duration of Basic Life Support Training on the Learners’ Cardiopulmonary and Automated External Defibrillator Skills

    Directory of Open Access Journals (Sweden)

    Jin Hyuck Lee

    2016-01-01

    Full Text Available Background. Basic life support (BLS training with hands-on practice can improve performance during simulated cardiac arrest, although the optimal duration for BLS training is unknown. This study aimed to assess the effectiveness of various BLS training durations for acquiring cardiopulmonary resuscitation (CPR and automated external defibrillator (AED skills. Methods. We randomised 485 South Korean nonmedical college students into four levels of BLS training: level 1 (40 min, level 2 (80 min, level 3 (120 min, and level 4 (180 min. Before and after each level, the participants completed questionnaires regarding their willingness to perform CPR and use AEDs, and their psychomotor skills for CPR and AED use were assessed using a manikin with Skill-Reporter™ software. Results. There were no significant differences between levels 1 and 2, although levels 3 and 4 exhibited significant differences in the proportion of overall adequate chest compressions (p<0.001 and average chest compression depth (p=0.003. All levels exhibited a greater posttest willingness to perform CPR and use AEDs (all, p<0.001. Conclusions. Brief BLS training provided a moderate level of skill for performing CPR and using AEDs. However, high-quality skills for CPR required longer and hands-on training, particularly hands-on training with AEDs.

  17. The Effect of the Duration of Basic Life Support Training on the Learners' Cardiopulmonary and Automated External Defibrillator Skills

    Science.gov (United States)

    Kang, Ku Hyun; Song, Keun Jeong; Lee, Chang Hee

    2016-01-01

    Background. Basic life support (BLS) training with hands-on practice can improve performance during simulated cardiac arrest, although the optimal duration for BLS training is unknown. This study aimed to assess the effectiveness of various BLS training durations for acquiring cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) skills. Methods. We randomised 485 South Korean nonmedical college students into four levels of BLS training: level 1 (40 min), level 2 (80 min), level 3 (120 min), and level 4 (180 min). Before and after each level, the participants completed questionnaires regarding their willingness to perform CPR and use AEDs, and their psychomotor skills for CPR and AED use were assessed using a manikin with Skill-Reporter™ software. Results. There were no significant differences between levels 1 and 2, although levels 3 and 4 exhibited significant differences in the proportion of overall adequate chest compressions (p CPR and use AEDs (all, p training provided a moderate level of skill for performing CPR and using AEDs. However, high-quality skills for CPR required longer and hands-on training, particularly hands-on training with AEDs. PMID:27529066

  18. Worldwide experience with a totally subcutaneous implantable defibrillator

    DEFF Research Database (Denmark)

    Lambiase, Pier D; Barr, Craig; Theuns, Dominic A M J

    2014-01-01

    AIMS: The totally subcutaneous implantable-defibrillator (S-ICD) is a new alternative to the conventional transvenous ICD system to minimize intravascular lead complications. There are limited data describing the long-term performance of the S-ICD. This paper presents the first large internationa...

  19. Azygos Vein Lead Implantation For High Defibrillation Thresholds In Implantable Cardioverter Defibrillator Placement

    Directory of Open Access Journals (Sweden)

    Naga VA Kommuri

    2010-01-01

    Full Text Available Evaluation of defibrillation threshold is a standard of care during implantation of implantable cardioverter defibrillator. High defibrillation thresholds are often encountered and pose a challenge to electrophysiologists to improve the defibrillation threshold. We describe a case series where defibrillation thresholds were improved after implanting a defibrillation lead in the azygos vein.

  20. Early Outcomes of Out-of-Hospital Cardiac Arrest after Early Defibrillation: a 24 Months Retrospective Analysis

    Directory of Open Access Journals (Sweden)

    Paolo Terranova

    2006-10-01

    Full Text Available Introduction: Cardiovascular disease remains the most common cause of death in the United States and most other Western nations. Among these deaths, sudden, out-of-hospital cardiac arrest claims approximately 1000 lives each day in the United States alone. Most of these cardiac arrests are due to ventricular fibrillation. Though highly reversible with the rapid application of a defibrillator, ventricular fibrillation is otherwise fatal within minutes, even when cardiopulmonary resuscitation is provided immediately. The overall survival rate in the United States is estimated to be less than 5 percent. Recent developments in automated-external-defibrillator technology have provided a means of increasing the rate of prompt defibrillation after out-of-hospital cardiac arrest. After minimal training, nonmedical personnel (e.g., flight attendants and casino workers are also able to use defibrillators in the workplace, with lifesaving effects. Nonetheless, such programs have involved designated personnel whose job description includes assisting persons who have had sudden cardiac arrest. Data are still lacking on the success of programs in which automated external defibrillators have been installed in public places to be used by persons who have no specific training or duty to act. Materials and Methods: All patients who had an out-of-hospital cardiac arrest between January 2003 and December 2004 and who received early defibrillation for ventricular fibrillation were included. We conducted a 24 months retrospective population-based analysis of the outcome in our population. Results: Over a 24 month period, 446 people had non–traumatic cardiac arrest, and in all of them it was observed to be ventricular fibrillation. In a very few cases, the defibrillator operators were good Samaritans, acting voluntarily. Eighty-nine patients (about 19% with ventricular fibrillation were successfully resuscitated, including eighteen who regained consciousness before

  1. Systematic downloading and analysis of data from automated external defibrillators used in out-of-hospital cardiac arrest.

    Science.gov (United States)

    Hansen, Marco Bo; Lippert, Freddy Knudsen; Rasmussen, Lars Simon; Nielsen, Anne Møller

    2014-12-01

    Valuable information can be retrieved from automated external defibrillators (AEDs) used in victims of out-of-hospital cardiac arrest (OHCA). We describe our experience with systematic downloading of data from deployed AEDs. The primary aim was to compare the proportion of shockable rhythm from AEDs used by laypersons with the corresponding proportion recorded by the Emergency Medical Services (EMS) on arrival. In a 20-month study, we collected data on OHCAs in the Capital Region of Denmark where an AED was deployed prior to arrival of EMS. The AEDs were brought to the emergency medical dispatch centre for data downloading and rhythm analysis. Patient data were retrieved from the medical records from the admitting hospital, whereas data on EMS rhythm analyses were obtained from the Danish Cardiac Arrest Register between 2001 and 2010. A total of 121 AEDs were deployed, of which 91 cases were OHCAs with presumed cardiac origin. The prevalence of initial shockable rhythm was 55.0% (95% CI [44.7-64.8%]). This was significantly greater than the proportion recorded by the EMS (27.6%, 95% CI [27.0-28.3%], p<0.0001). Shockable arrests were significantly more likely to be witnessed (92% vs. 34%, p<0.0001) and the bystander CPR rate was higher (98% vs. 85%, p=0.04). More patients with initial shockable rhythm achieved return of spontaneous circulation upon hospital arrival (88% vs. 7%, p<0.0001) and had higher 30-day survival rate (72% vs. 5%, p<0.0001). AEDs used by laypersons revealed a higher proportion of shockable rhythms compared to the EMS rhythm analyses. Copyright © 2014 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

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

    Science.gov (United States)

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

    2018-07-01

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

  3. Acute cardiac events and deployment of emergency medical teams and automated external defibrillators in large football stadiums in the Netherlands.

    Science.gov (United States)

    van de Sandt, Femke; Umans, Victor

    2009-10-01

    The incidence of acute cardiac events - including out-of-hospital cardiac arrest - may be increased in visitors of large sports stadiums when compared with the general population. This study sought to investigate the incidence of acute cardiac events inside large Dutch football stadiums, as well as the emergency response systems deployed in these stadiums and the success rate for in-stadium resuscitation. Retrospective cohort study using a questionnaire sent to the 20 Dutch stadiums that hosted professional matches during the 2006-2007 and 2007-2008 football seasons. Stadium capacity ranged from 3600 to 51 600 spectators. Nearly 13 million spectators attended 686 'Eredivisie' (Honorary Division) and European football matches. All stadiums distribute multiple emergency medical teams among the spectators. Eighty-five percent of the stadiums have an ambulance standby during matches, 95% of the stadiums were equipped with automated external defibrillators (AEDs) during the study period. On an average, one AED was available for every 7576 spectators (range 1800-29 600). Ninety-three cardiac events were reported (7.3 per 1 million spectators). An AED was used 22 times (1.7 per 1 million spectators). Resuscitation was successful in 18 cases (82%, 95% confidence interval: 61-93). The incidence of out-of-hospital cardiac arrest inside large football stadiums in the Netherlands, albeit increased when compared with the general population, is low. The success rate for in-stadium resuscitation by medical teams equipped with AEDs is high. Dutch stadiums appear vigilant in regard to acute cardiac events. This report highlights the importance of adequate emergency medical response systems (including AEDs) in large sports venues.

  4. Factors associated with delayed defibrillation in cardiopulmonary resuscitation: A prospective simulation study.

    Directory of Open Access Journals (Sweden)

    Christoph Castan

    Full Text Available Early defibrillation is an important factor of survival in cardiac arrest. However, novice resuscitators often struggle with cardiac arrest patients. We investigated factors leading to delayed defibrillation performed by final-year medical students within a simulated bystander cardiac arrest situation.Final-year medical students received a refresher lecture and basic life support training before being confronted with a simulated cardiac arrest situation in a simulation ambulance. The scenario was analyzed for factors leading to delayed defibrillation. We compared the time intervals the participants needed for various measures with a benchmark set by experienced resuscitators. After training, the participants were interviewed regarding challenges and thoughts during the scenario.The median time needed for defibrillation was 158 s (n = 49, interquartile range: 107-270 s, more than six-fold of the benchmark time. The major part of total defibrillation time (49%; median, n = 49 was between onset of ventricular fibrillation and beginning to prepare the defibrillator, more specifically the time between end of preparation of the defibrillator and actual delivery of the shock, with a mean proportion of 26% (n = 49, SD = 17% of the overall time needed for defibrillation (maximum 67%. Self-reported reasons for this delay included uncertainty about the next step to take, as reported by 73% of the participants. A total of 35% were unsure about which algorithm to follow. Diagnosing the patient was subjectively difficult for 35% of the participants. Overall, 53% of the participants felt generally confused.Our study shows that novice resuscitators rarely achieve guideline-recommended defibrillation times. The most relative delays were observed when participants had to choose what to do next or which algorithm to follow, and thus i.e. performed extensive airway management before a life-saving defibrillation. Our data provides a first insight in the process of

  5. Live defibrillation in simulation-based medical education--a survey of simulation center practices and attitudes.

    Science.gov (United States)

    Turban, Joseph W; Peters, Deborah P; Berg, Benjamin W

    2010-02-01

    Resuscitation from cardiac arrhythmia, requiring cardioversion/defibrillation is a common simulation training scenario. Use of live defibrillation enhances simulation fidelity but is not without risk. This survey was conducted to describe the prevalence of live defibrillation use during training scenarios in healthcare simulation centers, and when used, if safety training was required before using live defibrillation. A convenience sample of attendees at the 7th annual International Meeting on Simulation in Healthcare (January 2007) was surveyed using a closed-ended 23-item survey instrument. Survey domains included responder and simulation center demographics, simulation center defibrillation safety policies, and attitudes toward defibrillation practices in simulation training environments. Fifty-seven individuals representing 39 simulation centers returned surveys, 29 of which were in the United States. Live defibrillation was used in 35 of the 39 centers (90%). A defibrillation safety training policy was in effect at 14 of 39 centers (36%). Formal training before using live defibrillation was considered necessary by 48 of 55 responders (87%). Forty-eight of 54 responders (89%) strongly agreed or agreed with the statement, "I feel using live defibrillation plays an important role in simulation-based education." Although most responders consider use of live defibrillation important and believe formal defibrillator safety training should be conducted before use, only about one third of the centers had a training policy in effect. It remains to be determined whether safety training before the use of live defibrillation during simulation-based education increases user safety.

  6. Radius of Care in Secondary Schools in the Midwest: Are Automated External Defibrillators Sufficiently Accessible to Enable Optimal Patient Care?

    Science.gov (United States)

    Osterman, Michael; Claiborne, Tina; Liberi, Victor

    2018-04-25

      Sudden cardiac arrest is the leading cause of death among young athletes. According to the American Heart Association, an automated external defibrillator (AED) should be available within a 1- to 1.5-minute brisk walk from the patient for the highest chance of survival. Secondary school personnel have reported a lack of understanding about the proper number and placement of AEDs for optimal patient care.   To determine whether fixed AEDs were located within a 1- to 1.5-minute timeframe from any location on secondary school property (ie, radius of care).   Cross-sectional study.   Public and private secondary schools in northwest Ohio and southeast Michigan.   Thirty schools (24 public, 6 private) volunteered.   Global positioning system coordinates were used to survey the entire school properties and determine AED locations. From each AED location, the radius of care was calculated for 3 retrieval speeds: walking, jogging, and driving a utility vehicle. Data were analyzed to expose any property area that fell outside the radius of care.   Public schools (37.1% ± 11.0%) possessed more property outside the radius of care than did private schools (23.8% ± 8.0%; F 1,28 = 8.35, P = .01). After accounting for retrieval speed, we still observed differences between school types when personnel would need to walk or jog to retrieve an AED ( F 1.48,41.35 = 4.99, P = .02). The percentages of school property outside the radius of care for public and private schools were 72.6% and 56.3%, respectively, when walking and 34.4% and 12.2%, respectively, when jogging. Only 4.2% of the public and none of the private schools had property outside the radius of care when driving a utility vehicle.   Schools should strategically place AEDs to decrease the percentage of property area outside the radius of care. In some cases, placement in a centralized location that is publicly accessible may be more important than the overall number of AEDs on site.

  7. Law Enforcement Agency Defibrillation (LEA-D): proceedings of the National Center for Early Defibrillation Police AED Issues Forum.

    Science.gov (United States)

    Mosesso, Vincent N; Newman, Mary M; Ornato, Joseph P; Paris, Paul M; Andersen, Leon; Brinsfield, Kathryn; Dunnavant, Gregory R; Frederick, Jay; Groh, William J; Johnston, Steven; Lerner, E Brooke; Murphy, George P; Myerburg, Robert J; Rosenberg, Donald G; Savino, Mitchell; Sayre, Michael R; Sciammarella, Joseph; Schoen, Valerie; Vargo, Philip; van Alem, Anouk; White, Roger D

    2002-01-01

    Why does LEA-D intervention seem to work in some systems but not others? Panelists agreed that some factors that delay rapid access to treatment, such as long travel distances in rural areas, may represent insurmountable barriers. Other factors, however, may be addressed more readily. These include: absence of a medical response culture, discomfort with the role of medical intervention, insecurity with the use of medical devices, a lack of proactive medical direction, infrequent refresher training, and dependence on EMS intervention. Panelists agreed that successful LEA-D programs possess ten key attributes (Table 6). In the end, the goal remains "early" defibrillation, not "police" defibrillation. It does not matter whether the rescuer wears a blue uniform--or any uniform, for that matter--so long as the defibrillator reaches the victim quickly. If LEA personnel routinely arrive at medical emergencies after other emergency responders or after 8 minutes have elapsed from the time of collapse, an LEA-D program will be unlikely to provide added value. Similarly, if police frequently arrive first, but the department is unwilling or unable to cultivate the attributes of successful LEA-D programs, efforts to improve survival may not be realized. In most communities, however, LEA-D programs have tremendous lifesaving potential and are well worth the investment of time and resources. Law enforcement agencies considering adoption of AED programs should review the frequency with which police arrive first at medical emergencies and LEA response intervals to determine whether AED programs might help improve survival in their communities. It is time for law enforcement agency defibrillation to become the rule, not the exception.

  8. The NO Regular Defibrillation testing In Cardioverter Defibrillator Implantation (NORDIC ICD) trial: concept and design of a randomized, controlled trial of intra-operative defibrillation testing during de novo defibrillator implantation.

    Science.gov (United States)

    Bänsch, Dietmar; Bonnemeier, Hendrik; Brandt, Johan; Bode, Frank; Svendsen, Jesper Hastrup; Felk, Angelika; Hauser, Tino; Wegscheider, Karl

    2015-01-01

    Although defibrillation (DF) testing is still considered a standard procedure during implantable cardioverter-defibrillator (ICD) insertion and has been an essential element of all trials that demonstrated the survival benefit of ICD therapy, there are no large randomized clinical trials demonstrating that DF testing improves clinical outcome and if the outcome would remain the same by omitting DF testing. Between February 2011 and July 2013, we randomly assigned 1077 patients to ICD implantation with (n = 540) or without (n = 537) DF testing. The intra-operative DF testing was standardized across all participating centres. After inducing a fast ventricular tachycardia (VT) with a heart rate ≥240 b.p.m. or ventricular fibrillation (VF) with a low-energy T-wave shock, DF was attempted with an initial 15 J shock. If the shock reversed the VT or VF, DF testing was considered successful and terminated. If unsuccessful, two effective 24 J shocks were administered. If DF was unsuccessful, the system was reconfigured and another DF testing was performed. An ICD shock energy of 40 J had to be programmed in all patients for treatment of spontaneous VT/VF episodes. The primary endpoint was the average efficacy of the first ICD shock for all true VT/VF episodes in each patient during follow-up. The secondary endpoints included the frequency of system revisions, total fluoroscopy, implantation time, procedural serious adverse events, and all-cause, cardiac, and arrhythmic mortality during follow-up. Home Monitoring was used in all patients to continuously monitor the system integrity, device programming and performance. The NO Regular Defibrillation testing In Cardioverter Defibrillator Implantation (NORDIC ICD) trial is one of two large prospective randomized trials assessing the effect of DF testing omission during ICD implantation. NCT01282918. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2014. For permissions please email

  9. Impact of community-wide police car deployment of automated external defibrillators on survival from out-of-hospital cardiac arrest.

    Science.gov (United States)

    Myerburg, Robert J; Fenster, Jeffrey; Velez, Mauricio; Rosenberg, Donald; Lai, Shenghan; Kurlansky, Paul; Newton, Starbuck; Knox, Melenda; Castellanos, Agustin

    2002-08-27

    Disappointing survival rates from out-of-hospital cardiac arrests encourage strategies for faster defibrillation, such as use of automated external defibrillators (AEDs) by nonconventional responders. AEDs were provided to all Miami-Dade County, Florida, police. AED-equipped police (P-AED) and conventional emergency medical rescue (EMS) responders are simultaneously deployed to possible cardiac arrests. Times from 9-1-1 contact to the scene were compared for P-AED and concurrently deployed EMS, and both were compared with historical EMS experience. Survival with P-AED was compared with outcomes when EMS was the sole responder. Among 420 paired dispatches of P-AED and EMS, the mean+/-SD P-AED time from 9-1-1 call to arrival at the scene was 6.16+/-4.27 minutes, compared with 7.56+/-3.60 minutes for EMS (P<0.001). Police arrived first to 56% of the calls. The time to first responder arrival among P-AED and EMS was 4.88+/-2.88 minutes (P<0.001), compared with a historical response time of 7.64+/-3.66 minutes when EMS was the sole responder. A 17.2% survival rate was observed for victims with ventricular fibrillation or pulseless ventricular tachycardia (VT/VF), compared with 9.0% for standard EMS before P-AED implementation (P=0.047). However, VT/VF benefit was diluted by the observation that 61% of the initial rhythms were nonshockable, reducing the absolute survival benefit among the total study population to 1.6% (P-AED, 7.6%; EMS, 6.0%). P-AED establishes a layer of responders that generate improved response times and survival from VT/VF. There was no benefit for victims with nonshockable rhythms.

  10. A first city-wide early defibrillation project in a German city: 5-year results of the Bochum against sudden cardiac arrest study

    Directory of Open Access Journals (Sweden)

    Hanefeld Christoph

    2010-06-01

    Full Text Available Abstract Background Immediate defibrillation is the decisive determinant of prognosis in patients suffering from cardiac/circulatory arrest caused by ventricular fibrillation (VF. Therefore, various national and international associations recommend that first responders use defibrillators as soon as possible and also recommend public access to early defibrillation programmes. Here we report the results of the first city-wide early defibrillation project in a large German urban area. Methods There were 155 automated external defibrillators (AEDs put into operation in the Bochum municipal area, and 6,294 people took part in cardiopulmonary resuscitation (CPR and AED training. Free, accessible AEDs were installed in places with large volumes of people. Additionally, emergency forces were progressively equipped with AEDs. Results Twelve AED administrations prior to the arrival of an emergency physician were recorded and analysed over a period of 5 years (08/2004-08/2009. Rhythm analysis via AED demonstrated VF in seven cases, non-malignant dysrhythmias in four cases and asystole in one case. Two of the seven patients with VF were successfully defibrillated and survived cardiac/circulatory arrest without any neurological sequelae. Eight of the 12 AED applications were performed by laymen. The mean time between switching the unit on and applying the electrodes to the patient was 39 seconds (SD +/-20 sec. On average, another 20 seconds elapsed before the AED recommendation of "shock delivery" was displayed, and a total of 96 seconds elapsed before shock administration (± 56 sec. Conclusion Consistent with other reports, our findings show that the organisation of a city-wide initiative by a project office combining public access and first-responder defibrillation programmes can be safe, feasible and successful. Our experiences confirm that strategic planning of AED placement is a prerequisite for successful, cost-effective resuscitation.

  11. Uso do desfibrilador automático externo no ambiente pré-hospitalar peruano: melhorando a resposta a emergências na América Latina Use of automated external defibrillator in Peruvian out-of-hospital environment: improving emergency response in Latin America

    Directory of Open Access Journals (Sweden)

    Pablo Lister

    2009-08-01

    Full Text Available Este relato de caso reporta o atendimento pré-hospitalar de um paciente com fatores de risco atendido pelo serviço pré-hospitalar ao ser acometido por uma parada cardíaca e apresentar fibrilação ventricular. O paciente foi atendido seguindo os padrões de suporte básico de vida e suporte cardiovascular avançado. Um desfibrilador automático externo (DAE foi aplicado com resultados favoráveis e o paciente se recuperou do quadro de perigo de vida com sucesso. Este é o primeiro relato documentado com resultados favoráveis no Peru, na área de atendimento pré-hospitalar e enfatiza a necessidade de serem adotadas políticas de acesso público à desfibrilação precoce.El presente reporte de caso, relata la atencion prehospitalaria de un paciente con factores de riesgo atendido en el area prehospitalaria al sufrir arresto cardiaco y presentar fibrilacion ventricular. El paciente fue atendido bajo estandares de Soporte Basico Vital y Soporte Cardiovascular Avanzado Vital, se aplico un Desfibrilador Automatizado Externo (DEA con resultado favorable y exito al recuperar al paciente de su condicion de compromiso de vida. Este es el primer reporte documentado con resultado favorable en el pais, en el area prehospitalaria y refuerza la conveniencia de adoptar politicas de Acceso Publico a la Desfibrilacion Temprana.This case report relates out-of-hospital care to a patient with risk factors treated in the out-of-hospital services after cardiac arrest and ventricular fibrillation. The patient was treated according to the standards of basic life support and advanced cardiovascular life support; by applying an automated external defibrillator (AED with favorable outcome and successful recovery of the patient from his risk of life condition. This is the first documented report with a favorable outcome in Peru, in out-of-hospital services and stresses the desirability of adopting policies for public access to early defibrillation.

  12. Saving lives with public access defibrillation: A deadly game of hide and seek.

    Science.gov (United States)

    Sidebottom, David B; Potter, Ryan; Newitt, Laura K; Hodgetts, Gillian A; Deakin, Charles D

    2018-07-01

    Early defibrillation is a critical link in the chain of survival. Public access defibrillation (PAD) programmes utilising automated external defibrillators (AEDs) aim to decrease the time-to-first-shock, and improve survival from out-of-hospital cardiac arrest. Effective use of PADs requires rapid location of the device, facilitated by adequate signage. We aimed to therefore assess the quality of signage for PADs in the community. From April 2017 to January 2018 we surveyed community PADs available for public use on the 'Save a Life' AED locator mobile application in and around Southampton, UK. Location and signage characteristics were collected, and the distance from the furthest sign to the AED was measured. Researchers evaluated 201 separate PADs. All devices visited were included in the final analysis. No signage at all was present for 135 (67.2%) devices. Only 15/201 (7.5%) AEDs had signage at a distance from AED itself. In only 5 of these cases (2.5%) was signage mounted more than 5.0 m from the AED. When signage was present, 46 used 2008 ILCOR signage and 15 used 2006 Resuscitation Council (UK) signage. Signage visibility was partially or severely obstructed at 27/66 (40.9%) sites. None of the 45 GP surgeries surveyed used exterior signage or an exterior 24/7 access box. Current signage of PADs is poor and limits the device effectiveness by impeding public awareness and location of AEDs. Recommendations should promote visible signage within the operational radius of each AED. Copyright © 2018 Elsevier B.V. All rights reserved.

  13. PA/Lateral chest X-ray is equivalent to cine-fluoroscopy for the detection of conductor externalization in defibrillation leads.

    Science.gov (United States)

    Steinberg, Christian; Sarrazin, Jean-François; Philippon, François; Champagne, Jean; Molin, Franck; Nault, Isabelle; Blier, Louis; Bouchard, Marc-André; Arsenault, Jean; O'Hara, Gilles

    2015-01-01

    Riata™ and Riata ST defibrillation leads (St. Jude Medical, Sylmar, CA, USA) are susceptible to insulation defects with conductor externalization. Cine-fluoroscopy is considered to be the gold standard for the documentation of insulation defects, but similar detection rates have been reported for posterior-anterior (PA)/lateral chest x-ray (CXR) with zooming. Prospective single-center study to assess the diagnostic equivalence of a PA/lateral CXR with zooming for the detection of Riata insulation defects in a direct comparison to cine-fluoroscopy. Seventy-eight consecutive patients underwent 3-view cine-fluoroscopy and a PA/lateral CXR. All CXRs and cine-fluoroscopy images were reviewed by blinded electrophysiologists and staff radiologists. Forty-four of 78 patients had an abnormal cine-fluoroscopy (56%). The diagnostic correlation between PA/lateral CXR and cine-fluoroscopy was excellent (κ = 0.90; 95% confidence interval 0.80-1.00). PA/lateral CXR was equivalent to cine-fluoroscopy for the detection of conductor externalization showing a sensitivity of 97.7% and a specificity of 91.2%. The mean radiation effective dose of CXR was significantly lower compared to cine-fluoroscopy (0.09 millisievert [mSV] vs 0.85 ± 0.47 mSv; P cine-fluoroscopy for the detection of Riata insulation defects and should be considered as the preferred screening method. ©2014 Wiley Periodicals, Inc.

  14. Surviving out-of-hospital cardiac arrest: just a matter of defibrillators?

    Science.gov (United States)

    Zorzi, Alessandro; Gasparetto, Nicola; Stella, Federica; Bortoluzzi, Andrea; Cacciavillani, Luisa; Basso, Cristina

    2014-08-01

    Out-of-hospital sudden cardiac arrest (OHCA) is a leading cause of death all over the world. Although the outcome of OHCA resulting from 'nonshockable' rhythms (asystole and pulseless electrical activity) is poor regardless of resuscitation efforts, 'shockable' rhythms such as ventricular tachycardia or fibrillation may carry a good prognosis if early defibrillation is performed. At present, simplified cardiopulmonary resuscitation techniques (hands-only cardiopulmonary resuscitation) and automated external defibrillators (AEDs) offer lay people the possibility to provide lifesaving treatment to OHCA victims in the critical minutes before the arrival of the emergency medical system. Programs aimed at increasing provision of cardiopulmonary resuscitation and use of AEDs by lay people have been set up in different countries, including Italy, and have contributed to improve survival rates. However, success of these programs critically depends on appropriate planning and design, and on cultural predisposition of witnesses to undertake immediate measures of resuscitation in the case of OHCA. Placement of a large number of AEDs may carry high costs and little benefits if it is uncoordinated and not preceded by educational campaigns to spread widely the 'culture of resuscitation' in the population.

  15. Genoplivning med automatisk ekstern defibrillator på hospital

    DEFF Research Database (Denmark)

    Løfgren, Bo; Wahlgreen, Claus; Hoffmann, Anne Mette

    2009-01-01

    Early defibrillation is a determinant of survival in cardiac arrest. We report a Danish case of successful in-hospital resuscitation using an automated external defibrillator (AED). This case illustrates important aspects of implementation of in-hospital use of an AED, i.e. location of the AED......, education of the staff, systematic registration and data collection and technical aspects of AED use. If in-hospital AED implementation is carefully executed, its use may provide a safe and effective way of obtaining early defibrillation. Udgivelsesdato: 2009-Jan-26...

  16. The Effects of Public Access Defibrillation on Survival After Out-of-Hospital Cardiac Arrest: A Systematic Review of Observational Studies.

    Science.gov (United States)

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

    2017-09-05

    Despite recent advances, the average survival after out-of-hospital cardiac arrest (OHCA) remains 50%. Accordingly, placement of automated external defibrillators in the community as part of a public access defibrillation program (PAD) is recommended by international guidelines. However, different strategies have been proposed on how exactly to increase and make use of publicly available automated external defibrillators. This systematic review aimed to evaluate the effect of PAD and the different PAD strategies on survival after OHCA. PubMed, Embase, and the Cochrane Library were systematically searched on August 31, 2015 for observational studies reporting survival to hospital discharge in OHCA patients where an automated external defibrillator had been used by nonemergency medical services. PAD was divided into 3 groups according to who applied the defibrillator: nondispatched lay first responders, professional first responders (firefighters/police) dispatched by the Emergency Medical Dispatch Center (EMDC), or lay first responders dispatched by the EMDC. A total of 41 studies were included; 18 reported PAD by nondispatched lay first responders, 20 reported PAD by EMDC-dispatched professional first responders (firefighters/police), and 3 reported both. We identified no qualified studies reporting survival after PAD by EMDC-dispatched lay first responders. The overall survival to hospital discharge after OHCA treated with PAD showed a median survival of 40.0% (range, 9.1-83.3). Defibrillation by nondispatched lay first responders was associated with the highest survival with a median survival of 53.0% (range, 26.0-72.0), whereas defibrillation by EMDC-dispatched professional first responders (firefighters/police) was associated with a median survival of 28.6% (range, 9.0-76.0). A meta-analysis of the different survival outcomes could not be performed because of the large heterogeneity of the included studies. This systematic review showed a median overall

  17. Cardioverter-Defibrillator: A Treatment for Arrhythmia

    Science.gov (United States)

    ... abdomen (stomach area). It can go in a “pocket” under your skin or in a muscle. The ... counter Products Procedures & Devices Prescription Medicines Health Tools Dictionary Symptom Checker BMI Calculator myhealthfinder Immunization Schedules Nutrient ...

  18. Defibrillation probability and impedance change between shocks during resuscitation from out-of-hospital cardiac arrest

    NARCIS (Netherlands)

    Walker, Robert G.; Koster, Rudolph W.; Sun, Charles; Moffat, George; Barger, Joseph; Dodson, Pamela P.; Chapman, Fred W.

    2009-01-01

    Objective: Technical data now gathered by automated external defibrillators (AEDs) allows closer evaluation of the behavior of defibrillation shocks administered during out-of-hospital cardiac arrest. We analyzed technical data from a large case series to evaluate the change in transthoracic

  19. Bystander defibrillation for out-of-hospital cardiac arrest in Public vs Residential Locations

    DEFF Research Database (Denmark)

    Hansen, Steen Møller; Hansen, Carolina Malta; Folke, Fredrik

    2017-01-01

    Importance: Bystander-delivered defibrillation (hereinafter referred to as bystander defibrillation) of patients with out-of-hospital cardiac arrests (OHCAs) remains limited despite the widespread dissemination of automated external defibrillators (AEDs). Objective: To examine calendar changes...... in bystander defibrillation and subsequent survival according to a public or a residential location of the cardiac arrest after nationwide initiatives in Denmark to facilitate bystander-mediated resuscitative efforts, including bystander defibrillation. Design, Setting, and Participants: This nationwide study......, 2016. Exposures: Nationwide initiatives to facilitate bystander resuscitative efforts, including bystander defibrillation, consisted of resuscitation training of Danish citizens, dissemination of on-site AEDs, foundation of an AED registry linked to emergency medical dispatch centers, and dispatcher...

  20. A Study on Performance and Safety Tests of Defibrillator Equipment

    Directory of Open Access Journals (Sweden)

    Tavakoli Golpaygani A.

    2017-12-01

    Full Text Available Introduction: Nowadays, more than 10,000 different types of medical devices can be found in hospitals. This way, medical electrical equipment is being employed in a wide variety of fields in medical sciences with different physiological effects and measurements. Hospitals and medical centers must ensure that their critical medical devices are safe, accurate, reliable and operational at the required level of performance. Defibrillators are critical resuscitation devices. The use of reliable defibirillators has led to more effective treatments and improved patient safety through better control and management of complications during Cardiopulmonary Resuscitation (CPR. Materials and Methods: The metrological reliability of twenty frequent use, manual defibrillators in use ten hospitals (4 private and 6 public in one of the provinces of Iran according to international and national standards was evaluated. Results: Quantitative analysis of control and instrument accuracy showed the amount of the obtained results in many units are critical which had less value over the standard limitations especially in devices with poor battery. For the accuracy of delivered energy analysis, only twelve units delivered acceptable output values and the precision in the output energy measurements especialy in weak battry condition, after activation of discharge alarm, were low. Conclusion: Obtained results indicate a need for new and severe regulations on periodic performance verifications and medical equipment quality control program especially for high risk instruments. It is also necessary to provide training courses on the fundumentals of operation and performane parameters for medical staff in the field of meterology in medicine and how one can get good accuracy results especially in high risk medical devices.

  1. A Study on Performance and Safety Tests of Defibrillator Equipment.

    Science.gov (United States)

    Tavakoli Golpaygani, A; Movahedi, M M; Reza, M

    2017-12-01

    Nowadays, more than 10,000 different types of medical devices can be found in hospitals. This way, medical electrical equipment is being employed in a wide variety of fields in medical sciences with different physiological effects and measurements. Hospitals and medical centers must ensure that their critical medical devices are safe, accurate, reliable and operational at the required level of performance. Defibrillators are critical resuscitation devices. The use of reliable defibirillators has led to more effective treatments and improved patient safety through better control and management of complications during Cardiopulmonary Resuscitation (CPR). The metrological reliability of twenty frequent use, manual defibrillators in use ten hospitals (4 private and 6 public) in one of the provinces of Iran according to international and national standards was evaluated. Quantitative analysis of control and instrument accuracy showed the amount of the obtained results in many units are critical which had less value over the standard limitations especially in devices with poor battery. For the accuracy of delivered energy analysis, only twelve units delivered acceptable output values and the precision in the output energy measurements especialy in weak battry condition, after activation of discharge alarm, were low. Obtained results indicate a need for new and severe regulations on periodic performance verifications and medical equipment quality control program especially for high risk instruments. It is also necessary to provide training courses on the fundumentals of operation and performane parameters for medical staff in the field of meterology in medicine and how one can get good accuracy results especially in high risk medical devices.

  2. Hands-On Defibrillation Skills of Pediatric Acute Care Providers During a Simulated Ventricular Fibrillation Cardiac Arrest Scenario.

    Science.gov (United States)

    Bhalala, Utpal S; Balakumar, Niveditha; Zamora, Maria; Appachi, Elumalai

    2018-01-01

    Introduction: Timely defibrillation in ventricular fibrillation cardiac arrest (VFCA) is associated with good outcome. While defibrillation skills of pediatric providers have been reported to be poor, the factors related to poor hands-on defibrillation skills of pediatric providers are largely unknown. The aim of our study was to evaluate delay in individual steps of the defibrillation and human and non-human factors associated with poor hands-on defibrillation skills among pediatric acute care providers during a simulated VFCA scenario. Methods: We conducted a prospective observational study of video evaluation of hands-on defibrillation skills of pediatric providers in a simulated VFCA in our children's hospital. Each provider was asked to use pads followed by paddles to provide 2 J/kg shock to an infant mannequin in VFCA. The hands-on skills were evaluated for struggle with any step of defibrillation, defined a priori as >10 s delay with particular step. The data was analyzed using chi-square test with significant p -value 10 s delay) with each of connecting the pads/paddles to the device, using pads/paddles on the mannequin and using buttons on the machine was 34 (50%), 26 (38%), and 31 (46%), respectively. Conclusions: The defibrillation skills of providers in a tertiary care children's hospital are poor. Both human and machine-related factors are associated with delay in defibrillation. Prior use of the study defibrillator is associated with a significantly shorter time-to-first shock as compared to prior use of any other defibrillator or no prior use of any defibrillator.

  3. Peer-led training in basic life support and resuscitation using an automatic external defibrillator

    DEFF Research Database (Denmark)

    Løfgren, Bo; Petersen, Christina Børlum; Mikkelsen, Ronni

    2009-01-01

    Peer-led training has been identified as a useful tool for delivering undergraduate healthcare training. In this paper we describe the implementation of the European Resuscitation Council BLS/AED Course as a peer-led training program for medical students....

  4. Basic life support and automated external defibrillator skills among ambulance personnel

    DEFF Research Database (Denmark)

    Nielsen, Anne Møller; Isbye, Dan Lou; Lippert, Freddy Knudsen

    2012-01-01

    Ambulance personnel play an essential role in the 'Chain of Survival'. The prognosis after out-of-hospital cardiac arrest was dismal on a rural Danish island and in this study we assessed the cardiopulmonary resuscitation performance of ambulance personnel on that island.......Ambulance personnel play an essential role in the 'Chain of Survival'. The prognosis after out-of-hospital cardiac arrest was dismal on a rural Danish island and in this study we assessed the cardiopulmonary resuscitation performance of ambulance personnel on that island....

  5. 78 FR 17890 - Effective Date of Requirement for Premarket Approval for Automated External Defibrillator System.

    Science.gov (United States)

    2013-03-25

    ... requiring this device to meet the statute's premarket approval requirements and the benefits to the public... requiring the device to have an approved PMA or a declared completed PDP and the benefit to the public from... consider exercising enforcement discretion for devices lawfully distributed before the requirement to have...

  6. Out-of-hospital cardiac arrest and placement of automated external defibrillators in the community

    DEFF Research Database (Denmark)

    Folke, Fredrik

    2010-01-01

    forskelle i patientkarakteristika afhængigt af hvor hjertestoppet forekommer (boligområde versus offentligt rum); 4) at estimere omkostnings-effektiviteten for PAD programmer i boligområder og det offentligt rum afhængigt af valgte AED placeringsstrategi. METODE OG RESULTATER I perioden 1994-2005 blev alle...

  7. The challenges and possibilities of public access defibrillation.

    Science.gov (United States)

    Ringh, M; Hollenberg, J; Palsgaard-Moeller, T; Svensson, L; Rosenqvist, M; Lippert, F K; Wissenberg, M; Malta Hansen, C; Claesson, A; Viereck, S; Zijlstra, J A; Koster, R W; Herlitz, J; Blom, M T; Kramer-Johansen, J; Tan, H L; Beesems, S G; Hulleman, M; Olasveengen, T M; Folke, F

    2018-03-01

    Out-of-hospital cardiac arrest (OHCA) is a major health problem that affects approximately four hundred and thousand patients annually in the United States alone. It is a major challenge for the emergency medical system as decreased survival rates are directly proportional to the time delay from collapse to defibrillation. Historically, defibrillation has only been performed by physicians and in-hospital. With the development of automated external defibrillators (AEDs), rapid defibrillation by nonmedical professionals and subsequently by trained or untrained lay bystanders has become possible. Much hope has been put to the concept of Public Access Defibrillation with a massive dissemination of public available AEDs throughout most Western countries. Accordingly, current guidelines recommend that AEDs should be deployed in places with a high likelihood of OHCA. Despite these efforts, AED use is in most settings anecdotal with little effect on overall OHCA survival. The major reasons for low use of public AEDs are that most OHCAs take place outside high incidence sites of cardiac arrest and that most OHCAs take place in residential settings, currently defined as not suitable for Public Access Defibrillation. However, the use of new technology for identification and recruitment of lay bystanders and nearby AEDs to the scene of the cardiac arrest as well as new methods for strategic AED placement redefines and challenges the current concept and definitions of Public Access Defibrillation. Existing evidence of Public Access Defibrillation and knowledge gaps and future directions to improve outcomes for OHCA are discussed. In addition, a new definition of the different levels of Public Access Defibrillation is offered as well as new strategies for increasing AED use in the society. © 2018 The Association for the Publication of the Journal of Internal Medicine.

  8. Antitachycardia pacing programming in implantable cardioverter defibrillator: A systematic review.

    Science.gov (United States)

    De Maria, Elia; Giacopelli, Daniele; Borghi, Ambra; Modonesi, Letizia; Cappelli, Stefano

    2017-05-26

    Implantable cardioverter defibrillator (ICD) programming involves several parameters. In recent years antitachycardia pacing (ATP) has gained an increasing importance in the treatment of ventricular arrhythmias, whether slow or fast. It reduces the number of unnecessary and inappropriate shocks and improves both patient's quality of life and device longevity. There is no clear indication regarding the type of ATP to be used, except for the treatment of fast ventricular tachycardias (188 bpm-250 bpm) where it has been shown a greater efficacy and safety of burst compared to ramp; 8 impulses in each sequence of ATP appears to be the best programming option in this setting. Beyond ATP use, excellent clinical results were obtained with programming standardization following these principles: extended detection time in ventricular fibrillation (VF) zone; supraventricular discrimination criteria up to 200 bpm; first shock in VF zone at the maximum energy in order to reduce the risk of multiple shocks. The MADIT-RIT trial and some observational registries have also recently demonstrated that programming with a widespread use of ATP, higher cut-off rates or delayed intervention reduces the number of inappropriate and unnecessary therapies and improves the survival of patients during mid-term follow-up.

  9. Teaching basic life support with an automated external defibrillator using the two-stage or the four-stage teaching technique.

    Science.gov (United States)

    Bjørnshave, Katrine; Krogh, Lise Q; Hansen, Svend B; Nebsbjerg, Mette A; Thim, Troels; Løfgren, Bo

    2018-02-01

    Laypersons often hesitate to perform basic life support (BLS) and use an automated external defibrillator (AED) because of self-perceived lack of knowledge and skills. Training may reduce the barrier to intervene. Reduced training time and costs may allow training of more laypersons. The aim of this study was to compare BLS/AED skills' acquisition and self-evaluated BLS/AED skills after instructor-led training with a two-stage versus a four-stage teaching technique. Laypersons were randomized to either two-stage or four-stage teaching technique courses. Immediately after training, the participants were tested in a simulated cardiac arrest scenario to assess their BLS/AED skills. Skills were assessed using the European Resuscitation Council BLS/AED assessment form. The primary endpoint was passing the test (17 of 17 skills adequately performed). A prespecified noninferiority margin of 20% was used. The two-stage teaching technique (n=72, pass rate 57%) was noninferior to the four-stage technique (n=70, pass rate 59%), with a difference in pass rates of -2%; 95% confidence interval: -18 to 15%. Neither were there significant differences between the two-stage and four-stage groups in the chest compression rate (114±12 vs. 115±14/min), chest compression depth (47±9 vs. 48±9 mm) and number of sufficient rescue breaths between compression cycles (1.7±0.5 vs. 1.6±0.7). In both groups, all participants believed that their training had improved their skills. Teaching laypersons BLS/AED using the two-stage teaching technique was noninferior to the four-stage teaching technique, although the pass rate was -2% (95% confidence interval: -18 to 15%) lower with the two-stage teaching technique.

  10. Basic life support and external defibrillation competences after instruction and at 6 months comparing face-to-face and blended training. Randomised trial.

    Science.gov (United States)

    Castillo, Jordi; Gallart, Aberto; Rodríguez, Encarnación; Castillo, Jorge; Gomar, Carmen

    2018-06-01

    The objective of this study was to compare the immediate and 6-month efficacy of basic life support (BLS) and automatic external defibrillation (AED) training using standard or blended methods. First-year students of medicine and nursing (n = 129) were randomly assigned to a control group (face-to-face training based on the European Resuscitation Council [ERC] Guidelines) or to an experimental group that trained with a self-training video, a new website, a Moodle platform, an intelligent manikin, and 45 min of instructor presence. Both groups were homogeneous and were evaluated identically. Theoretical knowledge was evaluated using a multi-choice questionnaire (MCQ). Skill performance was evaluated by the instructor's rubric and on a high-fidelity Resusci Anne QCPR manikin. Immediately after the course, there were no statistically significant differences in knowledge between the two groups. The median score of practical evaluation assessed by the instructor was significantly better in the experimental group (8.15, SD 0.93 vs 7.7, SD 1.18; P = 0.02). No differences between groups were found when using a high-fidelity manikin to evaluate chest compressions and lung inflations. At six months, the scores in knowledge and skill performance were significantly lower compared to the evaluations at the end of the instruction, but they remained still higher compared to baseline. The experimental group had higher scores in practical skills evaluated by the instructor than the control group (7.44, SD 1.85 vs 6.10, SD 2.6; P = 0.01). The blended method provides the same or even higher levels of knowledge and skills than standard instruction both immediately after the course and six months later. Copyright © 2018 Elsevier Ltd. All rights reserved.

  11. Attrition and Adherence in a Web-Based Distress Management Program for Implantable Cardioverter Defibrillator Patients (WEBCARE): Randomized Controlled Trial

    DEFF Research Database (Denmark)

    Habibovic, M.; Cuijpers, P.; Alings, M.

    2014-01-01

    Background: WEB-Based Distress Management Program for Implantable CARdioverter defibrillator Patients (WEBCARE) is a Web-based randomized controlled trial, designed to improve psychological well-being in patients with an implantable cardioverter defibrillator (ICD). As in other Web-based trials, ...

  12. Basic study on a lower-energy defibrillation method using computer simulation and cultured myocardial cell models.

    Science.gov (United States)

    Yaguchi, A; Nagase, K; Ishikawa, M; Iwasaka, T; Odagaki, M; Hosaka, H

    2006-01-01

    Computer simulation and myocardial cell models were used to evaluate a low-energy defibrillation technique. A generated spiral wave, considered to be a mechanism of fibrillation, and fibrillation were investigated using two myocardial sheet models: a two-dimensional computer simulation model and a two-dimensional experimental model. A new defibrillation technique that has few side effects, which are induced by the current passing into the patient's body, on cardiac muscle is desired. The purpose of the present study is to conduct a basic investigation into an efficient defibrillation method. In order to evaluate the defibrillation method, the propagation of excitation in the myocardial sheet is measured during the normal state and during fibrillation, respectively. The advantages of the low-energy defibrillation technique are then discussed based on the stimulation timing.

  13. Will medical examination gloves protect rescuers from defibrillation voltages during hands-on defibrillation?

    Science.gov (United States)

    Sullivan, Joseph L; Chapman, Fred W

    2012-12-01

    Continuing compressions during a defibrillation shock has been proposed as a method of reducing pauses in cardiopulmonary resuscitation (CPR) but the safety of this procedure is unproven. The medical examination gloves worn by rescuers play an important role in protecting the rescuer yet the electrical characteristics of these gloves are unknown. This study examined the response of medical examination gloves to defibrillation voltages. Part 1 of this study measured voltage-current curves for a small sample (8) of gloves. Part 2 tested more gloves (460) to determine the voltage required to produce a specific amount of current flow. Gloves were tested at two current levels: 0.1 mA and 10 mA. Testing included four glove materials (chloroprene, latex, nitrile, and vinyl) in a single layer and double-gloved. All gloves tested in part 1 allowed little current to flow (gloves and 93 of 120 (77%) double gloves allowed at least 0.1 mA of current flow at voltages within the external defibrillation voltage range. Also, 6 of 80 (7.5%) single gloves and 5 of 80 (6.2%) double gloves allowed over 10 mA. Few of the gloves tested limited the current to levels proven to be safe. A lack of sensation during hands-on defibrillation does not guarantee that a safety margin exists. As such, we encourage rescuers to minimize rather than eliminate the pause in compressions for defibrillation. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  14. Defibrillator patients should not be denied a peaceful death.

    Science.gov (United States)

    Westerdahl, Annika Kinch; Sutton, Richard; Frykman, Viveka

    2015-03-01

    Implantable defibrillators (ICDs) prevent sudden cardiac death. With declining health, ICD therapy may prolong death and expose the patient to unnecessary pain and anxiety. Few studies have addressed end of life care in ICD patients. The objective of this study was to investigate end of life in ICD patients, with respect to location of death; duration between do-not-resuscitate (DNR)-orders and deactivation of ICD therapy or DNR and time of death. A descriptive analysis of 65 deceased ICD patients, all whom had a written DNR-order before death, is presented. The majority (86%) was treated in hospitals, mainly (63%) university hospitals, and many (33%) in cardiology wards. Despite DNR-order, ICD shock therapy was active in 51% of all patients. In those with therapy deactivated at death, therapy deactivation was carried out two days or more after DNR-order in more than a third (38%). The time from DNR decision to death in patients with therapy active had a median of four days (IQR 1-38). During the last 24h of life, 24% of the patients experienced shock treatment. The majority of ICD patients with a DNR-order were treated in university hospitals. More than half still had shock treatment active at time of death with a median of four days or more between DNR decision and death. Patients with therapy deactivated, two days or more elapsed in more than a third from DNR decision to deactivation of therapy, exposing patients to a high risk of painful shocks before death. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  15. Cardiogenic Shock and Lung Injury as a Complication of Defibrillation

    Directory of Open Access Journals (Sweden)

    Hasan Serdar Kıhtır

    2017-12-01

    Full Text Available Local burns, embolism, and arrhythmia are the most common side effects observed after electrical shock treatments. However, systolic function may be rarely affected and pulmonary edema may develop. The cases of pulmonary edema after electrical shock treatments have been reported since 1960s and the proposed mechanism is the inadequacy of the left atrium cuff and ventricle. It was learned that a 7-year-old-girl without any known disease except vesicoureteral reflux had a ventricular fibrillation during general anesthesia induction and defibrillation at 2 joule/kg was attempted. It was also learned that the procedure was delayed and the patient was diagnosed with a long QT (QTc: 0.47 ms and had respiratory distress and circulatory disturbances after four hours. Pulmonary edema and heart failure was determined, and due to hipoxemia (SpO2 <88% not getting any better with non-invasive ventilation, the patient was intubated and followed with mechanical ventilation. A thermodilution catheter was inserted into the femoral artery and a low cardiac index (CI: 1.58 L/min/m2, elevated extravascular lung water index (EVLWI: 18 mL/kg and high pulmonary vascular permeability index (PVPI: 7.6 were determined. The patient was treated by mechanical ventilation and vasoactive/inotropic management and discharged at the fifth day of hospitalization without any sequela. Having high EVLWI with high PVPI suggest that the pulmonary edema mechanism may also be caused by alveolocapillary membrane damage, which is not accompanied by heart failure alone. This case is presented to show that it is the first child in the literature and that the results of transpulmonary thermodilution can also give information about lung function as well as cardiac function.

  16. AED (Automated External Defibrillator) Programs: Questions and Answers

    Science.gov (United States)

    ... In Schools Training Kits RQI AHA Blended Learning & eLearning Guide AHA Instructors ECC Educational Conferences Programs CPR ... In Schools Training Kits RQI AHA Blended Learning & eLearning Guide AHA Instructors ECC Educational Conferences Programs CPR ...

  17. Automated External Defibrillators: Do You Need an AED?

    Science.gov (United States)

    ... places, including malls, office buildings, sports arenas and airplanes. However, many cardiac arrests occur at home, so ... Accessed Jan. 30, 2017. April 19, 2017 Original article: http://www.mayoclinic.org/diseases-conditions/heart-arrhythmia/ ...

  18. Success and failure of the defibrillation shock: insights from a simulation study.

    Science.gov (United States)

    Skouibine, K; Trayanova, N; Moore, P

    2000-07-01

    This simulation study presents a further inquiry into the mechanisms by which a strong electric shock fails to halt life-threatening cardiac arrhythmias. The research uses a model of the defibrillation process that represents a sheet of myocardium as a bidomain. The tissue consists of nonuniformly curved fibers in which spiral wave reentry is initiated. Monophasic defibrillation shocks are delivered via two line electrodes that occupy opposite tissue boundaries. In some simulation experiments, the polarity of the shock is reversed. Electrical activity in the sheet is compared for failed and successful shocks under controlled conditions. The maps of transmembrane potential and activation times calculated during and after the shock demonstrate that weak shocks fail to terminate the reentrant activity via two major mechanisms. As compared with strong shocks, weak shocks result in (1) smaller extension of refractoriness in the areas depolarized by the shock, and (2) slower or incomplete activation of the excitable gap created by deexcitation of the negatively polarized areas. In its turn, mechanism 2 is associated with one or more of the following events: (a) lack of some break excitations, (b) latency in the occurrence of the break excitations, and (c) slower propagation through deexcited areas. Reversal of shock polarity results in a change of the extent of the regions of deexcitation, and thus, in a change in defibrillation threshold. The results of this study indicate the paramount importance of shock-induced deexcitation in both defibrillation and postshock arrhythmogenesis.

  19. Experiences of patients with implantable cardioverter defibrillator in Turkey: A qualitative study

    Directory of Open Access Journals (Sweden)

    Özgür Aslan

    2012-01-01

    Full Text Available Background. There has been an increase in the number of patients with implantable cardioverter defibrillator (ICD. It isimportant to understand ICD patients’ experiences with it.Aim. The aim of this study was to describe experiences of patients with implantable cardioverter defibrillator (ICD.Methodology. A qualitative approach was used. Focus group interviews were used to obtain data from 19 patients whowere implanted cardioverter defibrillator at two centers in Izmir, Turkey. The patients were assigned into four groups. Thedata was analyzed using qualitative content analysis.Results. The analysis revealed six main themes: activities of daily living, social life, familial relationships, emotionalchanges, implantable cardioverter defibrillator shocks and experiences with receiving information and counselling fromhealth care providers.Conclusions. It can be concluded that patients with ICD experience physical and psychological problems and are not offeredthe education they need. To reduce the fears of the patients and their families and to prepare them for possible life stylechanges, comprehensive training programs that start in the pre-implantation period and continue into the post-implantationperiod should be organized.

  20. Hvor er den automatiske eksterne defibrillator? Udvikling og uddannelse

    DEFF Research Database (Denmark)

    Løfgren, Bo; Grove, Erik; Krarup, Niels Henrik

    2009-01-01

    The International Liaison Committee on Resuscitation has presented a universal sign to indicate the presence of automated external defibrillators (AED). To disseminate the knowledge of this important signage, a review in a Danish context is presented. It is essential that the public in general...

  1. Evaluation of a novel ventricular support device with defibrillation capabilities in canine and porcine animal models.

    Science.gov (United States)

    Killingsworth, Cheryl R; Rippy, Marian K; Virmani, Renu; Rollins, Dennis L; McGiffin, David C; Ideker, Raymond E

    2008-08-01

    Sudden death is prevalent in heart failure patients. We tested an implantable ventricular support device consisting of a wireform harness with one or two pairs of integrated defibrillation electrode coils. The device was implanted into six pigs (36-44 kg) through a subxiphoid incision. Peak voltage (V) defibrillation thresholds (DFT) were determined for five test configurations compared with a control transvenous lead (RV to CanPect). Defibrillator can location (abdominal or pectoral) and common coil separation on the implant (0 degrees or 60 degrees ) were studied.(.) The DFT for RV60 to LV60 + CanPect was significantly less than control (348 +/- 57 vs 473 +/- 27 V, P < 0.05). The DFTs for other vectors were similar to control except for RV0 to LV0 + CanAbd (608 +/- 159 V). The device was implanted into 12 adult dogs for 42, 90, or 180 days with DFT and pathological examination performed at the terminal study. Cardiac pressures were determined at baseline, after implantation, and at the terminal study. The DFT was also determined in a separate group of four dogs at 42 days following implantation of the support device with one pair of defibrillation electrodes. The DFTs at implant and explant in dogs with one pair (8 +/- 1.5 Joules [J] and 6 +/- 1.9 J) or two pairs (8 +/- 3.4 J and 7 +/- 1.9 J) of defibrillation electrodes were not significantly different from each other but significantly less than control measured at the terminal study (18 +/- 3.4 J). Left-sided pressures were significantly decreased at explant but within expected normal ranges. Right-sided pressures were not different except for RV systolic. Histopathology indicated mild to moderate epicardial inflammation and fibrosis, consistent with a foreign body healing response. This defibrillation-enabled ventricular support system maintained mechanical functionality for up to 6 months while inducing typical chronic healing responses. The DFT was equal to or lower than a standard transvenous vector.

  2. Wearable cardioverter defibrillator: A life vest till the life boat (ICD arrives

    Directory of Open Access Journals (Sweden)

    Johnson Francis

    2014-01-01

    Full Text Available It is well established that implantable cardioverter defibrillator (ICD is a life saving device ensuring protection against life threatening ventricular arrhythmias. But there are certain situations like a recent myocardial infarction where the standard guidelines do not recommend the implantation of an ICD while the patient can still be at a risk of demise due to a life threatening ventricular arrhythmia. There could also be a temporary indication for protection while explanting an infected ICD system. The wearable cardioverter defibrillator (WCD is a device which comes to the rescue in such situations. In this brief review, we discuss the historical aspects of the development of a WCD, technical aspects as well as the clinical trial data and real world scenario of its use.

  3. Rise and Shock: Optimal Defibrillator Placement in a High-rise Building.

    Science.gov (United States)

    Chan, Timothy C Y

    2017-01-01

    Out-of-hospital cardiac arrests (OHCA) in high-rise buildings experience lower survival and longer delays until paramedic arrival. Use of publicly accessible automated external defibrillators (AED) can improve survival, but "vertical" placement has not been studied. We aim to determine whether elevator-based or lobby-based AED placement results in shorter vertical distance travelled ("response distance") to OHCAs in a high-rise building. We developed a model of a single-elevator, n-floor high-rise building. We calculated and compared the average distance from AED to floor of arrest for the two AED locations. We modeled OHCA occurrences using floor-specific Poisson processes, the risk of OHCA on the ground floor (λ 1 ) and the risk on any above-ground floor (λ). The elevator was modeled with an override function enabling direct travel to the target floor. The elevator location upon override was modeled as a discrete uniform random variable. Calculations used the laws of probability. Elevator-based AED placement had shorter average response distance if the number of floors (n) in the building exceeded three quarters of the ratio of ground-floor OHCA risk to above-ground floor risk (λ 1 /λ) plus one half (n ≥ 3λ 1 /4λ + 0.5). Otherwise, a lobby-based AED had shorter average response distance. If OHCA risk on each floor was equal, an elevator-based AED had shorter average response distance. Elevator-based AEDs travel less vertical distance to OHCAs in tall buildings or those with uniform vertical risk, while lobby-based AEDs travel less vertical distance in buildings with substantial lobby, underground, and nearby street-level traffic and OHCA risk.

  4. Bystander Defibrillation for Out-of-Hospital Cardiac Arrest in Public vs Residential Locations.

    Science.gov (United States)

    Hansen, Steen Møller; Hansen, Carolina Malta; Folke, Fredrik; Rajan, Shahzleen; Kragholm, Kristian; Ejlskov, Linda; Gislason, Gunnar; Køber, Lars; Gerds, Thomas A; Hjortshøj, Søren; Lippert, Freddy; Torp-Pedersen, Christian; Wissenberg, Mads

    2017-05-01

    Bystander-delivered defibrillation (hereinafter referred to as bystander defibrillation) of patients with out-of-hospital cardiac arrests (OHCAs) remains limited despite the widespread dissemination of automated external defibrillators (AEDs). To examine calendar changes in bystander defibrillation and subsequent survival according to a public or a residential location of the cardiac arrest after nationwide initiatives in Denmark to facilitate bystander-mediated resuscitative efforts, including bystander defibrillation. This nationwide study identified 18 688 patients in Denmark with first-time OHCA from June 1, 2001, to December 31, 2012, using the Danish Cardiac Arrest Registry. Patients had a presumed cardiac cause of arrest that was not witnessed by emergency medical services personnel. Data were analyzed from April 1, 2015, to December 10, 2016. Nationwide initiatives to facilitate bystander resuscitative efforts, including bystander defibrillation, consisted of resuscitation training of Danish citizens, dissemination of on-site AEDs, foundation of an AED registry linked to emergency medical dispatch centers, and dispatcher-assisted guidance of bystander resuscitation efforts. The proportion of patients who received bystander defibrillation according to the location of the cardiac arrest and their subsequent 30-day survival. Of the 18 688 patients with OHCAs (67.8% men and 32.2% women; median [interquartile range] age, 72 [62-80] years), 4783 (25.6%) had a cardiac arrest in a public location and 13 905 (74.4%) in a residential location. The number of registered AEDs increased from 141 in 2007 to 7800 in 2012. The distribution of AED location was consistently skewed in favor of public locations. Bystander defibrillation increased in public locations from 3 of 245 (1.2%; 95% CI, 0.4%-3.5%) in 2001 to 78 of 510 (15.3%; 95% CI, 12.4%-18.7%) in 2012 (P bystander defibrillation increased in public locations from 8.3% (95% CI, 1.5%-35.4%) in 2001/2002 to 57

  5. Ressuscitação cardiopulmonar com a utilização do desfibrilador externo semi-automático: avaliação do processo ensino-aprendizagem Resucitador cardiopulmonar con utilización del disfibrilador externo semiautomático: evaluación del proceso enseñanza-aprendizaje Cardiopulmonary resuscitation with semi-automated external defibrillator: assessment of the teaching-learning process

    Directory of Open Access Journals (Sweden)

    Ana Maria Kazue Miyadahira

    2008-09-01

    that, for every minute delayed on defibrillating a heart arrest patient, survival chances decrease by 10%, and that the same chances of survival are 98% effective when it is employed within 30 seconds. While attending a heart arrest patient, it is crucial that the use of external semi-automated defibrillator (AED is included in the training. The purpose of the present study is to compare Psychomotor Ability and the Theoretical Knowledge of lay people on cardiopulmonary resuscitation (CPR using AED, before and after training. This sample was composed of 40 administrative workers of a public institution that were trained on CPR technique using EAD, as an experiment. The significantly higher scores in the assessment instrument items of Psychomotor Ability and Theoretical Knowledge, after training, indicates that the participants have presented improvements in their performances.

  6. Interaction of defibrillation waveform with the time to defibrillation or the number of defibrillation attempts on survival from out-of-hospital cardiac arrest.

    Science.gov (United States)

    Hagihara, Akihito; Onozuka, Daisuke; Ono, Junko; Nagata, Takashi; Hasegawa, Manabu

    2018-01-01

    Early biphasic defibrillation is effective in out-of-hospital cardiac arrest (OHCA) cases. In the resuscitation of patients with OHCA, it is not clear how the defibrillation waveform interacts with the time to defibrillation to influence patient survival. The second, and any subsequent, shocks need to be administered by an on-line physician in Japan. Thus, we investigated the interaction between the defibrillation waveform and time to or the number of defibrillation on resuscitation outcomes. This prospective observational study used data for all OHCAs that occurred between 2005 and 2014 in Japan. To investigate the interaction effect between the defibrillation waveform and the time to defibrillation or the number of defibrillations on the return to spontaneous circulation (ROSC), 1-month survival, and cerebral performance category (CPC) (1, 2), we assessed the modifying effects of the defibrillation waveform and the time to or the number of defibrillation on additive scale (i.e., the relative excessive risk due to interaction, RERI) and multiplicative scale (i.e., ratio of odds ratios (ORs)). In total, 71,566 cases met the inclusion criteria. For the measure of interaction between the defibrillation waveform and the time to defibrillation, ratio of ORs for ROSC was 0.84 (0.75-0.94), implying that the effect of time to first defibrillation on ROSC was negatively modified by defibrillation waveform. For the interaction between the defibrillation waveform and the number of defibrillations, RERI and ratio of ORs for CPC (1, 2) was -0.25 (-0.47 to -0.06) and 0.79 (0.67-0.93), respectively. It is implied that the effect of number of defibrillation on CPC (1, 2) was negatively modified by defibrillation waveform. An increased number of defibrillations was associated with a decreased ROSC in the case of biphasic and monophasic defibrillation, while an increased number of defibrillations was related to an increased 1-month survival rate and CPC (1, 2) only in the case of

  7. del Nido versus St. Thomas Cardioplegia Solutions: A Single-Center Retrospective Analysis of Post Cross-Clamp Defibrillation Rates.

    Science.gov (United States)

    Buel, Shane T; Striker, Carrie Whittaker; O'Brien, James E

    2016-06-01

    There are many cardioplegia solutions currently in use for pediatric cardiopulmonary bypass (CPB). The most common being del Nido solution. Another common cardioplegia solution used for pediatric CPB is St. Thomas. In October 2014, Children's Mercy Kansas City changed from the use of modified St. Thomas to del Nido. This study compared rates of post cross-clamp fibrillation requiring defibrillation between del Nido solution and modified St. Thomas solution stratified by weight at Children's Mercy Kansas City. This retrospective study consisted of 394 patients who underwent cardiac surgery requiring cardioplegia between January 1, 2014 and July 31, 2015. The outcome measured was defibrillation upon cross-clamp removal. Statistical significance was determined using Fishers exact test with a two-sided significance level of .05. Incidence of defibrillation post cross-clamp removal was 4.4% in the del Nido group and 26.8% in the St. Thomas group (p Thomas group (p Thomas group (p Thomas group (p 60-kg category had an incidence of defibrillation of 16.7% in the del Nido group and 63% in the St. Thomas group (p Thomas and del Nido cardioplegia solutions. Analyses of weight stratifications demonstrate a decrease in the rate of defibrillation post cross-clamp removal in all categories within the del Nido group.

  8. 41 CFR 102-79.115 - What guidelines must an agency follow if it elects to establish a public access defibrillation...

    Science.gov (United States)

    2010-07-01

    ... SPACE Assignment and Utilization of Space Public Access Defibrillation Programs § 102-79.115 What... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false What guidelines must an agency follow if it elects to establish a public access defibrillation program in a Federal facility? 102...

  9. The oral cavity is not a primary source for implantable pacemaker or cardioverter defibrillator infections

    Science.gov (United States)

    2013-01-01

    Background To test the hypothesis that the oral cavity is a potential source for implantable pacemaker and cardioverter defibrillators infections, the bacterial diversity on explanted rhythm heart management devices was investigated and compared to the oral microbiome. Methods A metagenomic approach was used to analyze the bacterial diversity on the surfaces of non-infected and infected pacemakers. The DNA from surfaces swaps of 24 non-infected and 23 infected pacemaker were isolated and subjected to bacterial-specific DNA amplification, single strand conformation polymorphism- (SSCP) and sequencing analysis. Species-specific primer sets were used to analyze for any correlation between bacterial diversity on pacemakers and in the oral cavity. Results DNA of bacterial origin was detected in 21 cases on infected pacemakers and assigned to the bacterial phylotypes Staphylococcus epidermidis, Propionibacterium acnes, Staphylococcus aureus, Staphylococcus schleiferi and Stapyhlococcus. In 17 cases bacterial DNA was found on pacemakers with no clinical signs of infections. On the basis of the obtained sequence data, the phylotypes Propionibacterium acnes, Staphylococcus and an uncultured bacterium were identified. Propionibacterium acnes and Staphylococcus epidermidis were the only bacteria detected in pacemeaker (n = 25) and oral samples (n = 11). Conclusions The frequency of the coincidental detection of bacteria on infected devices and in the oral cavity is low and the detected bacteria are highly abundant colonizers of non-oral human niches. The transmission of oral bacteria to the lead or device of implantable pacemaker or cardioverter defibrillators is unlikely relevant for the pathogenesis of pacemaker or cardioverter defibrillators infections. PMID:23575037

  10. Comparison of instructor-led automated external defibrillation training and three alternative DVD-based training methods

    NARCIS (Netherlands)

    de Vries, Wiebe; Turner, Nigel M.; Monsieurs, Koenraad G.; Bierens, Joost J. L. M.; Koster, Rudolph W.

    2010-01-01

    Background: Self-directed BLS-training, using a personal training manikin with video has been shown to be as effective as instructor-led training. This has not previously been investigated for AED-training. Materials and methods: This prospective, randomized study with a non-inferiority design

  11. Return of spontaneous circulation and long-term survival according to feedback provided by automated external defibrillators

    DEFF Research Database (Denmark)

    Agerskov, M; Hansen, M B; Nielsen, A M

    2017-01-01

    levels. METHODS: We collected data on OHCA occurring between 2011 and 2014 in the Capital Region of Denmark where an AED was applied prior to ambulance arrival. Patient data were obtained from the Danish Cardiac Arrest Registry and medical records. AED data were retrieved from the Emergency Medical...... Dispatch Centre (EMDC) and information on feedback mechanisms, energy waveform and energy level was downloaded from the applied AEDs. RESULTS: A total of 196 OHCAs had an AED applied prior to ambulance arrival; 62 of these (32%) provided audio visual (AV) feedback while no feedback was provided in 134 (68...

  12. Lay Bystanders' Perspectives on What Facilitates Cardiopulmonary Resuscitation and Use of Automated External Defibrillators in Real Cardiac Arrests

    DEFF Research Database (Denmark)

    Malta Hansen, Carolina; Rosenkranz, Simone Mørk; Folke, Fredrik

    2017-01-01

    factors encourage lay bystanders to initiate CPR and AED use in a cohort of bystanders previously trained in CPR techniques who were present at an out-of-hospital cardiac arrest. METHODS AND RESULTS: One-hundred and twenty-eight semistructured qualitative interviews with CPR-trained lay bystanders...... obligation to act. CONCLUSIONS: Several factors other than previous hands-on CPR training facilitate lay bystander instigation of CPR and AED use. The recognition and modification of these factors may increase lay bystander CPR rates and patient survival following an out-of-hospital cardiac arrest....

  13. Patient-reported outcomes in Danish implantable cardioverter defibrillator patients with a Sprint Fidelis lead advisory notification

    DEFF Research Database (Denmark)

    Pedersen, Susanne S; Versteeg, Henneke; Nielsen, Jens Cosedis

    2011-01-01

    Few studies have investigated the association between implantable cardioverter defibrillators (ICDs) and lead advisory notifications and patient-reported outcomes (PROs). We examined (i) whether the mode used to inform patients about a device advisory is associated with PROs, and (ii) whether...... patients with a lead subject to a device advisory report poorer PROs than non-advisory controls....

  14. Dutch outcome in implantable cardioverter-defibrillator therapy (DO-IT) : Registry design and baseline characteristics of a prospective observational cohort study to predict appropriate indication for implantable cardioverter-defibrillator

    NARCIS (Netherlands)

    Van Barreveld, M. (M.); M.G.W. Dijkgraaf (Marcel); Hulleman, M. (M.); L. Boersma (Lucas); P.P.H.M. Delnoy (Peter Paul); M. Meine (Mathias); Tuinenburg, A.E. (A. E.); D.A.M.J. Theuns (Dominic); P. van der Voort (Pepijn); G-J.P. Kimman (Geert-Jan); E. Buskens (Erik); Tijssen, J.P.G. (J. P.G.); Bruinsma, N. (N.); Verstraelen, T.E. (T. E.); A.H. Zwinderman (Ailko); Van Dessel, P.H.F.M. (P. H.F.M.); A.A.M. Wilde (Arthur)

    2017-01-01

    textabstractBackground Implantable cardioverter-defibrillators (ICDs) are widely used for the prevention of sudden cardiac death. At present, both clinical benefit and cost-effectiveness of ICD therapy in primary prevention patients are topics of discussion, as only a minority of these patients will

  15. Emotions and health: findings from a randomized clinical trial on psychoeducational nursing to patients with implantable cardioverter defibrillator.

    Science.gov (United States)

    Kikkenborg Berg, Selina; Støier, Louise; Moons, Philip; Zwisler, Ann-Dorthe; Winkel, Per; Ulrich Pedersen, Preben

    2015-01-01

    Serious illness will inevitably lead to a fundamental emotional reaction. Traditionally, in interventional treatment or rehabilitation trials, the psychological status of patients with implantable cardioverter defibrillators has been evaluated with anxiety and depression as outcome measures. In caring for these patients, the aim of nursing is to help patients manage life with complex heart disease. The early detection and management of negative emotional response might prevent the development of pathological conditions such as depression. The aims of this study were to (a) describe the trajectory of primary emotions over time in patients with implantable cardioverter defibrillators and (b) examine the potential effects of psychoeducational nursing on primary emotions. During the inclusion period (October 2007 to November 2009), 196 patients with implantable cardioverter defibrillator were randomized (1:1) to rehabilitation versus usual care. Rehabilitation consisted of a psychoeducational nursing component and an exercise training component. This article concerns phase 1, psychoeducational nursing, guided by a theory of nursing, Rosemary Rizzo Parses Human Becoming Practice Methodologies. The outcome measure is the Emotions and Health Scale. The scale consists of 8 primary emotions: joy, agreeableness, surprise, fear, sadness, disgust, anger, and anticipation. Mean (SD) age was 58 (13) years, and 79% of the participants were men. Significant improvements were found in primary emotional responses over time (P .05). Primary emotions are affected after implantable cardioverter defibrillator implantation. Improvements over time were found. However, it was not possible to detect any effect of a short-term psychoeducational nursing intervention. Evaluating the primary emotions might be a good way for nurses to monitor patients' psychological outcomes because the instrument is sensitive to changes over a short period. Further development of early psychoeducational nursing

  16. Wearable cardioverter defibrillators for the prevention of sudden cardiac arrest: a health technology assessment and patient focus group study

    Directory of Open Access Journals (Sweden)

    Ettinger S

    2017-11-01

    Full Text Available Sabine Ettinger,1 Michal Stanak,1 Piotr Szymański,2 Claudia Wild,1 Romana Tandara Haček,3 Darija Erčević,3 Renata Grenković,3 Mirjana Huić3 1Ludwig Boltzmann Institute for Health Technology Assessment, Vienna, Austria; 2Institute of Cardiology, Warsaw, Poland; 3Department for Development, Research and Health Technology Assessment, Agency for Quality and Accreditation in Health Care and Social Welfare, Zagreb, Croatia Aim: To summarize the evidence on clinical effectiveness and safety of wearable cardioverter defibrillator (WCD therapy for primary and secondary prevention of sudden cardiac arrest in patients at risk. Methods: We performed a systematic literature search in databases including MEDLINE via OVID, Embase, the Cochrane Library, and CRD (DARE, NHS-EED, HTA. The evidence obtained was summarized according to GRADE methodology. A health technology assessment (HTA was conducted using the HTA Core Model® for rapid relative effectiveness assessment. Primary outcomes for the clinical effectiveness domain were all-cause and disease-specific mortality. Outcomes for the safety domain were adverse events (AEs and serious adverse events (SAEs. A focus group with cardiac disease patients was conducted to evaluate ethical, organizational, patient, social, and legal aspects of the WCD use. Results: No randomized- or non-randomized controlled trials were identified. Non-comparative studies (n=5 reported AEs including skin rash/itching (6%, false alarms (14%, and palpitations/light-headedness/fainting (9% and discontinuation due to comfort/lifestyle issues (16–22%, and SAEs including inappropriate shocks (0–2%, unsuccessful shocks (0–0.7%, and death (0–0.3%. The focus group results reported that experiencing a sense of security is crucial to patients and that the WCD is not considered an option for weeks or even months due to expected restrictions in living a “normal” life. Conclusion: The WCD appears to be relatively safe for short

  17. Cardiac Resynchronization Therapy Defibrillator Treatment in a Child with Heart Failure and Ventricular Arrhythmia

    Directory of Open Access Journals (Sweden)

    Hak Ju Kim

    2016-08-01

    Full Text Available Cardiac resynchronization therapy (CRT is a new treatment for refractory heart failure. However, most patients with heart failure treated with CRT are adults, middle-aged or older with idiopathic or ischemic dilated cardiomyopathy. We treated a 12-year-old boy, who was transferred after cardiac arrest, with dilated cardiomyopathy, left bundle-branch block, and ventricular tachycardia. We performed cardiac resynchronization therapy with a defibrillator (CRT-D. After CRT-D, left ventricular ejection fraction improved from 22% to 4 4% a ssessed by e chocardiog ram 1 year p ostoperatively. On e lectrocardiog ram, Q RS d uration was shortened from 206 to 144 ms. The patient’s clinical symptoms also improved. For pediatric patients with refractory heart failure and ventricular arrhythmia, CRT-D could be indicated as an effective therapeutic option.

  18. The Subcutaneous Implantable Cardioverter-Defibrillator: A Practical Review and Real-World Use and Application

    Directory of Open Access Journals (Sweden)

    Mark E. Panna Jr, MD, FACC, FHRS

    2016-02-01

    Full Text Available The subcutaneous implantable cardioverter-defibrillator (ICD is a novel technology using a subcutaneous (extrathoracic system for treatment of potential lethal ventricular arrhythmias. It avoids many of the risks of transvenous ICD implantation. It may be considered in patients having an ICD indication who do not have a pacing and/or cardiac resynchronization therapy indication, and who are unlikely to benefit from antitachycardia pacing therapy. We review patient selection, system components, the implantation technique, and screening considerations for subcutaneous ICD implantation. Its uses in specific patient populations, including children, patients with congenital heart disease, hypertrophic cardiomyopathy, or end-stage renal disease, and patients with preexisting pacemakers, are highlighted. Areas of future investigation are reviewed, including potential use with leadless pacing and magnetic resonance imaging.

  19. Device orientation of a leadless pacemaker and subcutaneous implantable cardioverter-defibrillator in canine and human subjects and the effect on intrabody communication

    NARCIS (Netherlands)

    Quast, Anne-Floor B. E.; Tjong, Fleur V. Y.; Koop, Brendan E.; Wilde, Arthur A. M.; Knops, Reinoud E.; Burke, Martin C.

    2018-01-01

    The development of communicating modular cardiac rhythm management systems relies on effective intrabody communication between a subcutaneous implantable cardioverter-defibrillator (S-ICD) and a leadless pacemaker (LP), using conducted communication. Communication success is affected by the LP and

  20. [Full dental rehabilitation of a patient with implantable cardioverter defibrillator].

    Science.gov (United States)

    Imre, Ildikó; Tóth, Zsuzsanna

    2012-06-01

    During dental rehabilitation of a patient with ICD, an upper telescope retained overdenture with acrylic baseplate and lower cantilever bridges were constructed. In the consultation following the anamnesis and the clinical examination, the cardiologist did not believe antibiotic profilaxis to be necessary, adding that it is advisable to avoid the use of ultrasonic depurator and electrocauter. Nowadays after saving the life the improving of patient's better quality of life is an important aspect. The risk of ICD-implantation is minimal however, not negligible, the patient can pursue a way of life free of limitation. According to the latest trends, the number of ICD-implantations will increase exponentially in the near future, due to the aging of the population, the simplification and safeness of implantation and the increase of patients who can be treated with the device. In case of arritmia or putative dysfunction, the latest ICD-s are able to send emergency alert to the arritmia centre with the help of an outer transmitter. Probably the system will completely change the follow-up of patients with ICD within the next few years, clinical researches of its efficiency are going on at present.

  1. "Pseudo" Faraday cage: a solution for telemetry link interaction between a left ventricular assist device and an implantable cardioverter defibrillator.

    Science.gov (United States)

    Jacob, Sony; Cherian, Prasad K; Ghumman, Waqas S; Das, Mithilesh K

    2010-09-01

    Patients implanted with left ventricular assist devices (LVAD) may have implantable cardioverter defibrillators (ICD) implanted for sudden cardiac death prevention. This opens the possibility of device-device communication interactions and thus interferences. We present a case of such interaction that led to ICD communication failure following the activation of an LVAD. In this paper, we describe a practical solution to circumvent the communication interference and review the communication links of ICDs and possible mechanisms of ICD-LVAD interactions.

  2. A patient with severely reduced LV function and electrical storm saved by wearable cardioverter-defibrillator: a case report.

    Science.gov (United States)

    Strauss, Margit; Kouraki, Kleopatra; Skarlos, Alexandros; Zahn, Ralf; Kleemann, Thomas

    2013-06-01

    The wearable cardioverter-defibrillator (WCD) is indicated in patients who are considered to be at temporarily high risk for sudden cardiac death (SCD), when an implantable defibrillator is not yet clearly indicated. We report the case of a 41-year-old patient with a newly diagnosed severely reduced left ventricular (LV) function for suspected myocarditis and repeated nonsustained ventricular tachycardia (VT). This patient was supplied with a WCD who came back to the hospital 4 weeks after discharge with an electrical storm and adequate discharge of the WCD. After application of amiodarone, no further arrhythmias were detected during intrahospital course. For further risk stratification, we performed a magnetic field imaging (MFI), that was reported to be useful in risk assessment of SCD in patients with ischemic cardiomyopathy. This measurement showed a normal result, but we decided to give an implantable cardioverter-defibrillator (ICD) to the patient. During a follow-up of 1 year, no further arrhythmias occurred. With this case, we report the efficacy of a WCD, which is a novel tool in patients at temporarily high risk of SCD and we report a novel method of risk stratification in patients with a high risk of SCD.

  3. Outcomes with single-coil versus dual-coil implantable cardioverter defibrillators: a meta-analysis.

    Science.gov (United States)

    Sunderland, Nicholas; Kaura, Amit; Murgatroyd, Francis; Dhillon, Para; Scott, Paul A

    2018-03-01

    Dual-coil implantable cardioverter defibrillator (ICD) leads have traditionally been used over single-coil leads due to concerns regarding high defibrillation thresholds (DFT) and consequent poor shock efficacy. However, accumulating evidence suggests that this position may be unfounded and that dual-coil leads may also be associated with higher complication rates during lead extraction. This meta-analysis collates data comparing dual- and single-coil ICD leads. Electronic databases were systematically searched for randomized controlled trials (RCT) and non-randomized studies comparing single-coil and dual-coil leads. The mean differences in DFT and summary estimates of the odds-ratio (OR) for first-shock efficacy and the hazard-ratio (HR) for all-cause mortality were calculated using random effects models. Eighteen studies including a total of 138,124 patients were identified. Dual-coil leads were associated with a lower DFT compared to single coil leads (mean difference -0.83J; 95% confidence interval [CI] -1.39--0.27; P = 0.004). There was no difference in the first-shock success rate with dual-coil compared to single-coil leads (OR 0.74; 95%CI 0.45-1.21; P=0.22). There was a significantly lower risk of all-cause mortality associated with single-coil leads (HR 0.91; 95%CI 0.86-0.95; P dual-coil leads. The mortality benefit with single-coil leads most likely represents patient selection bias. Given the increased risk and complexity of extracting dual-coil leads, centres should strongly consider single-coil ICD leads as the lead of choice for routine new left-sided ICD implants. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2017. For permissions, please email: journals.permissions@oup.com.

  4. Access to automatic defibrillation at airports on an example of Warsaw Chopin Airport

    Directory of Open Access Journals (Sweden)

    Witold Pawłowski

    2017-08-01

    Full Text Available Sudden cardiac arrest and cessation of blood circulation is the most common cause of death of people around the world. Immediate notification of emergency services and cardiopulmonary resuscitation combined with an automatic external defibrillator (AED increases the chances of survivors. Warsaw Chopin Airport is the only public place in Poland and the third one in Europe where a complex and integrated life saving system has been implemented in the ICC. The paper presents an analysis of the access to automatic defibrillation at airports at the Warsaw Chopin Airport

  5. Internal defibrillation: where we have been and where we should be going?

    Science.gov (United States)

    Lévy, Samuel

    2005-08-01

    Internal cardioversion has been developed as an alternative technique for patients who are resistant to external DC cardioversion of atrial fibrillation (AF) and was found to be associated with higher success rates. It used initially high energies (200-300 J) delivered between an intracardiac catheter and a backplate. Subsequent studies have shown that it is possible to terminate with energies of 1 to 6 Joules, paroxysmal or induced AF in 90 percent of patients and persistent AF in 75 percent of patients, using biphasic shocks delivered between a right atrium-coronary sinus vectors. Consequently, internal atrial defibrillation can be performed under sedation only without the need for general anesthesia. Recently developed external defibrillators, capable of delivering biphasic shocks, have increased the success rates of external cardioversion and reduced the need for internal cardioversion. However, internal defibrillation is still useful in overweight or obese patients, in patients with chronic obstructive pulmonary disease or asthma who are more difficult to defibrillate, and in patients with implanted devices which may be injured by high energy shocks. Low energy internal defibrillation has also proven to be safe and this has prompted the development of implantable devices for terminating AF. The first device used was the Metrix system, a stand-alone atrial defibrillator (without ventricular defibrillation) which was found to be safe and effective in selected groups of patients. Unfortunately, this device is no longer being marketed. Only double chamber defibrillators with pacing capabilities are presently available: the Medtronic GEM III AT, an updated version of the Jewel AF and the Guidant PRIZM AVT. These devices can be patient-activated or programmed to deliver automatically ounce atrial tachyarrhythmias are detected, therapies including pacing or/and shocks. Attempts to define the group of patients who might benefit from these devices are described but the

  6. General anaesthesia for insertion of an automated implantable cardioverter defibrillator in a child with Brugada and autism

    Directory of Open Access Journals (Sweden)

    Shwetal Goraksha

    2010-01-01

    Full Text Available A 14-year-old autistic boy presented with acute gastroenteritis and hypotension. The electrocardiogram showed a ventricular fibrillation rhythm - he went into cardiorespiratory arrest and was immediately resuscitated. On investigation, the electrocardiogram showed a partial right bundle branch block with a "coved" pattern of ST elevation in leads v 1 -v 3 . A provisional diagnosis of Brugada syndrome was made, for which an automated implantable cardioverter defibrillator (AICD implantation was advised. Although the automated implantable cardioverter defibrillator implantation is usually performed under sedation, because this was an autistic child, he needed general anaesthesia. We performed the procedure uneventfully under general anaesthesia and he was discharged after a short hospital stay.

  7. Ascending-ramp biphasic waveform has a lower defibrillation threshold and releases less troponin I than a truncated exponential biphasic waveform.

    Science.gov (United States)

    Huang, Jian; Walcott, Gregory P; Ruse, Richard B; Bohanan, Scott J; Killingsworth, Cheryl R; Ideker, Raymond E

    2012-09-11

    We tested the hypothesis that the shape of the shock waveform affects not only the defibrillation threshold but also the amount of cardiac damage. Defibrillation thresholds were determined for 11 waveforms-3 ascending-ramp waveforms, 3 descending-ramp waveforms, 3 rectilinear first-phase biphasic waveforms, a Gurvich waveform, and a truncated exponential biphasic waveform-in 6 pigs with electrodes in the right ventricular apex and superior vena cava. The ascending, descending, and rectilinear waveforms had 4-, 8-, and 16-millisecond first phases and a 3.5-millisecond rectilinear second phase that was half the voltage of the first phase. The exponential biphasic waveform had a 60% first-phase and a 50% second-phase tilt. In a second study, we attempted to defibrillate after 10 seconds of ventricular fibrillation with a single ≈30-J shock (6 pigs successfully defibrillated with 8-millisecond ascending, 8-millisecond rectilinear, and truncated exponential biphasic waveforms). Troponin I blood levels were determined before and 2 to 10 hours after the shock. The lowest-energy defibrillation threshold was for the 8-milliseconds ascending ramp (14.6±7.3 J [mean±SD]), which was significantly less than for the truncated exponential (19.6±6.3 J). Six hours after shock, troponin I was significantly less for the ascending-ramp waveform (0.80±0.54 ng/mL) than for the truncated exponential (1.92±0.47 ng/mL) or the rectilinear waveform (1.17±0.45 ng/mL). The ascending ramp has a significantly lower defibrillation threshold and at ≈30 J causes 58% less troponin I release than the truncated exponential biphasic shock. Therefore, the shock waveform affects both the defibrillation threshold and the amount of cardiac damage.

  8. Using left-ventricular-only pacing to eliminate T-wave oversensing in a biventricular implantable cardiac defibrillator.

    Science.gov (United States)

    Khoo, Clarence; Bennett, Matthew; Chakrabarti, Santabhanu; LeMaitre, John; Tung, Stanley K K

    2013-02-01

    A man aged 75 years and with nonischemic cardiomyopathy had implantation of a biventricular implantable cardiac defibrillator (ICD). Consistent biventricular pacing was limited by intermittent T-wave oversensing (TWOS). A strategy of left-ventricular-only pacing was used to eliminate TWOS. This strategy obviates the need to reduce ventricular sensitivity and thus may be an effective alternative to biventricular pacing complicated by TWOS. Copyright © 2013 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

  9. Using a Combined Platform of Swarm Intelligence Algorithms and GIS to Provide Land Suitability Maps for Locating Cardiac Rehabilitation Defibrillators

    Science.gov (United States)

    KAFFASH-CHARANDABI, Neda; SADEGHI-NIARAKI, Abolghasem; PARK, Dong-Kyun

    2015-01-01

    Background: Cardiac arrest is a condition in which the heart is completely stopped and is not pumping any blood. Although most cardiac arrest cases are reported from homes or hospitals, about 20% occur in public areas. Therefore, these areas need to be investigated in terms of cardiac arrest incidence so that places of high incidence can be identified and cardiac rehabilitation defibrillators installed there. Methods: In order to investigate a study area in Petersburg, Pennsylvania State, and to determine appropriate places for installing defibrillators with 5-year period data, swarm intelligence algorithms were used. Moreover, the location of the defibrillators was determined based on the following five evaluation criteria: land use, altitude of the area, economic conditions, distance from hospitals and approximate areas of reported cases of cardiac arrest for public places that were created in geospatial information system (GIS). Results: The A-P HADEL algorithm results were more precise about 27.36%. The validation results indicated a wider coverage of real values and the verification results confirmed the faster and more exact optimization of the cost function in the PSO method. Conclusion: The study findings emphasize the necessity of applying optimal optimization methods along with GIS and precise selection of criteria in the selection of optimal locations for installing medical facilities because the selected algorithm and criteria dramatically affect the final responses. Meanwhile, providing land suitability maps for installing facilities across hot and risky spots has the potential to save many lives. PMID:26587471

  10. Programa de capacitação em ressuscitação cardiorrespiratória com uso do desfibrilador externo automático em uma universidade Programa de formación en reanimación cardiopulmonar con el uso del desfibrilador externo automático en una universidad Training program on cardiopulmonary resuscitation with the use of automated external defibrillator in a university

    Directory of Open Access Journals (Sweden)

    Ana Paula Boaventura

    2012-03-01

    .Early defibrillation in cardiopulmonary resuscitation (CPR receives increasing emphasis on its priority and rapidity. This is an experience report about the implementation of a training program in CPR using a defibrillator in a private university. The training program in basic CPR maneuvers was based on global guidelines, including a theorical course with practical demonstration of CPR maneuvers with the defibrillator, individual practical training and theoretical and practical assessments. About the performance of students in the practical assessment, the mean scores obtained by students in the first stage of the course was 26.4 points, while in the second stage the mean was 252.8 points; in the theoretical assessment the mean in the first stage was 3.06 points and in the second 9.0 points. The implementation of programs like this contribute to the effective acquisition of knowledge (theory and skill (pratice for the care of CPR victims.

  11. Extended charge banking model of dual path shocks for implantable cardioverter defibrillators.

    Science.gov (United States)

    Dosdall, Derek J; Sweeney, James D

    2008-08-01

    Single path defibrillation shock methods have been improved through the use of the Charge Banking Model of defibrillation, which predicts the response of the heart to shocks as a simple resistor-capacitor (RC) circuit. While dual path defibrillation configurations have significantly reduced defibrillation thresholds, improvements to dual path defibrillation techniques have been limited to experimental observations without a practical model to aid in improving dual path defibrillation techniques. The Charge Banking Model has been extended into a new Extended Charge Banking Model of defibrillation that represents small sections of the heart as separate RC circuits, uses a weighting factor based on published defibrillation shock field gradient measures, and implements a critical mass criteria to predict the relative efficacy of single and dual path defibrillation shocks. The new model reproduced the results from several published experimental protocols that demonstrated the relative efficacy of dual path defibrillation shocks. The model predicts that time between phases or pulses of dual path defibrillation shock configurations should be minimized to maximize shock efficacy. Through this approach the Extended Charge Banking Model predictions may be used to improve dual path and multi-pulse defibrillation techniques, which have been shown experimentally to lower defibrillation thresholds substantially. The new model may be a useful tool to help in further improving dual path and multiple pulse defibrillation techniques by predicting optimal pulse durations and shock timing parameters.

  12. Chest compressions before defibrillation for out-of-hospital cardiac arrest: A meta-analysis of randomized controlled clinical trials

    Directory of Open Access Journals (Sweden)

    Meier Pascal

    2010-09-01

    Full Text Available Abstract Background Current 2005 guidelines for advanced cardiac life support strongly recommend immediate defibrillation for out-of-hospital cardiac arrest. However, findings from experimental and clinical studies have indicated a potential advantage of pretreatment with chest compression-only cardiopulmonary resuscitation (CPR prior to defibrillation in improving outcomes. The aim of this meta-analysis is to evaluate the beneficial effect of chest compression-first versus defibrillation-first on survival in patients with out-of-hospital cardiac arrest. Methods Main outcome measures were survival to hospital discharge (primary endpoint, return of spontaneous circulation (ROSC, neurologic outcome and long-term survival. Randomized, controlled clinical trials that were published between January 1, 1950, and June 19, 2010, were identified by a computerized search using SCOPUS, MEDLINE, BIOS, EMBASE, the Cochrane Central Register of Controlled Trials, International Pharmaceutical Abstracts database, and Web of Science and supplemented by conference proceedings. Random effects models were used to calculate pooled odds ratios (ORs. A subgroup analysis was conducted to explore the effects of response interval greater than 5 min on outcomes. Results A total of four trials enrolling 1503 subjects were integrated into this analysis. No difference was found between chest compression-first versus defibrillation-first in the rate of return of spontaneous circulation (OR 1.01 [0.82-1.26]; P = 0.979, survival to hospital discharge (OR 1.10 [0.70-1.70]; P = 0.686 or favorable neurologic outcomes (OR 1.02 [0.31-3.38]; P = 0.979. For 1-year survival, however, the OR point estimates favored chest compression first (OR 1.38 [0.95-2.02]; P = 0.092 but the 95% CI crossed 1.0, suggesting insufficient estimate precision. Similarly, for cases with prolonged response times (> 5 min point estimates pointed toward superiority of chest compression first (OR 1.45 [0

  13. Cardiac e-learning: Development of a web-based implantable cardioverter defibrillator educational system.

    Science.gov (United States)

    Hickey, Kathleen T; Johnson, Mary P; Biviano, Angelo; Aboelela, Sally; Thomas, Tami; Bakken, Suzanne; Garan, Hasan; Zimmerman, John L; Whang, William

    2011-04-01

    The objective of this study was to design a Web-based implantable cardioverter defibrillator (ICD) module that would allow greater access to learning which could occur at an individual's convenience outside the fast-paced clinical environment. A Web-based ICD software educational program was developed to provide general knowledge of the function of the ICD and the interpretation of the stored electrocardiograms. This learning tool could be accessed at any time via the Columbia University Internet server, using a unique, password protected login. A series of basic and advanced ICD terms were presented using actual ICD screenshots and videos that simulated scenarios the practitioner would most commonly encounter in the fast-paced clinical setting. To determine the usefulness of the site and improve the module, practitioners were asked to complete a brief (less than 5 min) online survey at the end of the module. Twenty-six practitioners have logged into our Web site: 20 nurses/nurse practitioners, four cardiac fellows, and two other practitioners. The majority of respondents rated the program as easy to use and useful. The success of this module has led to it becoming part of the training for student nurse practitioners before a clinical electrophysiology rotation, and the module is accessed by our cardiac entry level fellows before a rotation in the intensive care unit or electrophysiology service. Remote electronic arrhythmia learning is a successful example of the melding of technology and education to enhance clinical learning.

  14. Electrical storm in patients with an implanted defibrillator: a matter of definition.

    Science.gov (United States)

    Israel, Carsten W; Barold, S Serge

    2007-10-01

    The term "electrical storm" (ES) indicates a state of cardiac electrical instability manifested by several episodes of ventricular tachyarrhythmias (VTs) within a short time. In patients with an implantable cardioverter defibrillator (ICD), ES is best defined as 3 appropriate VT detections in 24 h, treated by antitachycardia pacing, shock or eventually untreated but sustained in a VT monitoring zone. The number of shocks and inappropriate detections are irrelevant for the definition. ES occurs in approximately 25% of ICD patients within 3 years, with typically 5-55 individual VTs within one storm. Potential triggers can be found in approximately 66% of patients and include new/worsened heart failure, changes in antiarrhythmic medication, context with other illness, psychological stress, diarrhea, and hypokalemia. In most patients, ES consists of monomorphic VT indicating the presence of reentry while ventricular fibrillation indicating acute ischemia is rare. ES seems to have a low immediate mortality (1%) but frequently (50-80%) leads to hospitalization. Long-term prognostic implications of ES are unclear. The key intervention in ES is reduction of the elevated sympathetic tone by beta blockers and frequently benzodiazepines. Amiodarone i.v. has also been successful and azimilide seems promising while class I antiarrhythmic drugs are usually unsuccessful. Substrate mapping and VT ablation may be useful in treatment and prevention of ES. Prevention of ES requires ICD programming systematically avoiding unnecessary shocks (long VT detection, antitachycardia pacing where ever possible) which otherwise can fuel the sympathetic tone and prolong ES.

  15. Cardiac pacing systems and implantable cardiac defibrillators (ICDs): a radiological perspective of equipment, anatomy and complications

    Energy Technology Data Exchange (ETDEWEB)

    Burney, K. E-mail: apqz59@dsl.pipex.comk1511@hotmail.com; Burchard, F.; Papouchado, M.; Wilde, P

    2004-08-01

    Cardiac pacing is a proven and effective treatment in the management of many cardiac arrhythmias. Implantable cardiac defibrillators (ICDs) are beneficial for certain patient groups with a history of serious, recurrent ventricular dysrhythmias, with a high risk of sudden cardiac death. Pacemaker devices take many forms and are highly visible on the chest radiograph. The radiographic appearances of ICDs and pacemakers can be similar and are subject to similar complications. The anatomical approach to the implantation, the type of device used and anatomical variations will all affect the appearance of these devices on the chest film. Pacemaker complications identified radiographically include pneumothorax, lead malpositioning, lead displacement or fracture, fracture of outer conductor coil, loose connection between the lead and pacemaker connector block, lack of redundant loops in paediatric patients and excessive manipulation of the device by the patient (Twiddler's syndrome). This pictorial review highlights the role of chest radiography in the diagnosis of post-cardiac pacing and ICD insertion complications, as well as demonstrating the normal appearances of the most frequently implanted devices.

  16. Evidence of Cognitive Bias in Decision Making Around Implantable-Cardioverter Defibrillators: A Qualitative Framework Analysis.

    Science.gov (United States)

    Matlock, Daniel D; Jones, Jacqueline; Nowels, Carolyn T; Jenkins, Amy; Allen, Larry A; Kutner, Jean S

    2017-11-01

    Studies have demonstrated that patients with primary prevention implantable cardioverter-defibrillators (ICDs) often misunderstand the ICD. Advances in behavioral economics demonstrate that some misunderstandings may be due to cognitive biases. We aimed to explore the influence of cognitive bias on ICD decision making. We used a qualitative framework analysis including 9 cognitive biases: affect heuristic, affective forecasting, anchoring, availability, default effects, halo effects, optimism bias, framing effects, and state dependence. We interviewed 48 patients from 4 settings in Denver. The majority were male (n = 32). Overall median age was 61 years. We found frequent evidence for framing, default, and halo effects; some evidence of optimism bias, affect heuristic, state dependence, anchoring and availability bias; and little or no evidence of affective forecasting. Framing effects were apparent in overestimation of benefits and downplaying or omitting potential harms. We found evidence of cognitive bias in decision making for ICD implantation. The majority of these biases appeared to encourage ICD treatment. Published by Elsevier Inc.

  17. Increased anxiety in partners of patients with a cardioverter-defibrillator

    DEFF Research Database (Denmark)

    Pedersen, Susanne S.; VAN DEN Berg, Martha; Erdman, Ruud A M

    2009-01-01

    The partner of the implantable cardioverter-defibrillator (ICD) patient serves as an important source of support for the patient, which may be hampered if the partner experiences increased distress. We examined (1) potential differences in anxiety and depressive symptoms in ICD patients compared...

  18. Manuell arytmitolkning och defibrillering prehospitalt för att minska avbrott i bröstkompressioner

    OpenAIRE

    Mattsson, Andreas; Erling, Kristofer

    2014-01-01

    Abstract Background Todays guidelines for advanced CPR emphasize chest compressions with good quality and early defibrillation. Prehospital CPR performed by ambulance crew, an automated external defibrillator (AED) is used. The AED analyzes the heart rhythm and the performer is following the advice to chock the heart or not, given by the AED. During on-going CPR there are sequences when no chest compression is performed known as hands-off time. Hands-off time includes the time for the AED to ...

  19. Implantable defibrillator therapy: more than defibrillation...

    NARCIS (Netherlands)

    D.A.M.J. Theuns (Dominic)

    2005-01-01

    textabstractDuring the past 25 years, the implantable cardioverter-defibrillator (ICD) has evolved from the treatment of last resort to the gold standard for patients at high risk for life­threatening ventricular tachyarrhythmias. Patients at high risk include those who survived life-threatening

  20. The number of prehospital defibrillation shocks and 1-month survival in patients with out-of-hospital cardiac arrest.

    Science.gov (United States)

    Hasegawa, Manabu; Abe, Takeru; Nagata, Takashi; Onozuka, Daisuke; Hagihara, Akihito

    2015-04-17

    The relationship between the number of pre-hospital defibrillation shocks and treatment outcome in patients with out-of-hospital cardiac arrest (OHCA) presenting with ventricular fibrillation (VF) is unknown currently. We examined the association between the number of pre-hospitalization defibrillation shocks and 1-month survival in OHCA patients. We conducted a prospective observational study using national registry data obtained from patients with OHCA between January 1, 2009 and December 31, 2012 in Japan. The study subjects were ≥ 18-110 years of age, had suffered from an OHCA before arrival of EMS personnel, had a witnessed collapse, had an initial rhythm that was shockable [VF/ventricular tachycardia (pulseless VT)], were not delivered a shock using a public automated external defibrillator (AED), received one or more shocks using a biphasic defibrillator by EMS personnel, and were transported to a medical institution between January 1, 2009 and December 31, 2012. There were 20,851 OHCA cases which met the inclusion criteria during the study period. Signal detection analysis was used to identify the cutoff point in the number of prehospital defibrillation shocks most closely related to one-month survival. Variables related to the number of defibrillations or one-month survival in OHCA were identified using multiple logistic regression analysis. A cutoff point in the number of pre-hospital defibrillation shocks most closely associated with 1-month OHCA survival was between two and three (χ(2) = 209.61, p < 0.0001). Among those patients who received two shocks or less, 34.48% survived for at least 1 month, compared with 24.75% of those who received three shocks or more. The number of defibrillations (odds ratio [OR] = 1.19, 95% CI: 1.03, 1.38), OHCA origin (OR = 2.81, 95% CI: 2.26, 3.49), use of ALS devices (OR = 0.68, 95% CI: 0.59, 0.79), use of epinephrine (OR = 0.33, 95% C: 0.28, 0.39), interval between first defibrillation and first ROSC (OR = 1.45, 95

  1. Definition of successful defibrillation

    NARCIS (Netherlands)

    Koster, Rudolph W.; Walker, Robert G.; van Alem, Anouk P.

    2006-01-01

    OBJECTIVES: The definition of defibrillation shock "success" endorsed by the International Liaison Committee on Resuscitation since the publication of Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiac Care has been removal of ventricular fibrillation at 5 secs after shock

  2. Assessing the Risks Associated with MRI in Patients with a Pacemaker or Defibrillator.

    Science.gov (United States)

    Russo, Robert J; Costa, Heather S; Silva, Patricia D; Anderson, Jeffrey L; Arshad, Aysha; Biederman, Robert W W; Boyle, Noel G; Frabizzio, Jennifer V; Birgersdotter-Green, Ulrika; Higgins, Steven L; Lampert, Rachel; Machado, Christian E; Martin, Edward T; Rivard, Andrew L; Rubenstein, Jason C; Schaerf, Raymond H M; Schwartz, Jennifer D; Shah, Dipan J; Tomassoni, Gery F; Tominaga, Gail T; Tonkin, Allison E; Uretsky, Seth; Wolff, Steven D

    2017-02-23

    The presence of a cardiovascular implantable electronic device has long been a contraindication for the performance of magnetic resonance imaging (MRI). We established a prospective registry to determine the risks associated with MRI at a magnetic field strength of 1.5 tesla for patients who had a pacemaker or implantable cardioverter-defibrillator (ICD) that was "non-MRI-conditional" (i.e., not approved by the Food and Drug Administration for MRI scanning). Patients in the registry were referred for clinically indicated nonthoracic MRI at a field strength of 1.5 tesla. Devices were interrogated before and after MRI with the use of a standardized protocol and were appropriately reprogrammed before the scanning. The primary end points were death, generator or lead failure, induced arrhythmia, loss of capture, or electrical reset during the scanning. The secondary end points were changes in device settings. MRI was performed in 1000 cases in which patients had a pacemaker and in 500 cases in which patients had an ICD. No deaths, lead failures, losses of capture, or ventricular arrhythmias occurred during MRI. One ICD generator could not be interrogated after MRI and required immediate replacement; the device had not been appropriately programmed per protocol before the MRI. We observed six cases of self-terminating atrial fibrillation or flutter and six cases of partial electrical reset. Changes in lead impedance, pacing threshold, battery voltage, and P-wave and R-wave amplitude exceeded prespecified thresholds in a small number of cases. Repeat MRI was not associated with an increase in adverse events. In this study, device or lead failure did not occur in any patient with a non-MRI-conditional pacemaker or ICD who underwent clinically indicated nonthoracic MRI at 1.5 tesla, was appropriately screened, and had the device reprogrammed in accordance with the prespecified protocol. (Funded by St. Jude Medical and others; MagnaSafe ClinicalTrials.gov number, NCT

  3. Psychometric properties of HeartQoL, a core heart disease-specific health-related quality of life questionnaire, in Danish implantable cardioverter defibrillator recipients

    DEFF Research Database (Denmark)

    Zangger, Graziella; Zwisler, Ann-Dorthe; Kikkenborg Berg, Selina

    2018-01-01

    disease-specific health-related quality of life questionnaire, in implantable cardioverter defibrillator recipients. Design This study involved cross-sectional and test-retest study designs. Method Implantable cardioverter defibrillator recipients in the cross-sectional study completed the Heart......QoL, the Short-Form 36 Health Survey, and the Hospital Anxiety and Depression Scale. The HeartQoL structure, construct-related validity (convergent and discriminative) and reliability (internal consistency) were assessed. HeartQoL reproducibility (test-retest) was assessed in an independent sample of implantable...... psychometric attributes of validity and reliability in this implantable cardioverter defibrillator population. This study adds support for the HeartQoL as a core heart-specific health-related quality of life questionnaire in a broad group of patients with heart disease including implantable cardioverter...

  4. Safety and interaction of patients with implantable cardiac defibrillators driving a hybrid vehicle.

    Science.gov (United States)

    Tondato, Fernando; Bazzell, Jane; Schwartz, Linda; Mc Donald, Bruce W; Fisher, Robert; Anderson, S Shawn; Galindo, Arcenio; Dueck, Amylou C; Scott, Luis R

    2017-01-15

    Electromagnetic interference (EMI) can affect the function of implantable cardioverter defibrillators (ICD). Hybrid electric vehicles (HEV) have increased popularity and are a potential source of EMI. Little is known about the in vivo effects of EMI generated by HEV on ICD. This study evaluated the in vivo interaction between EMI generated by HEV with ICD. Thirty patients (73±9 y/o; 80% male) with stable ICD function were exposed to EMI generated by a Toyota Prius Hybrid®. The vehicle was lifted above the ground, allowing safe changes in engine rotation and consequent variations in electromagnetic emission. EMI was measured (NARDA STS® model EHP-50C) and expressed in A/m (magnetic), Volts/m (electrical), and Hertz (frequency). Six positions were evaluated: driver, front passenger, right and left back seats, outside, at the back and front of the car. Each position was evaluated at idle, 30 mph, 60 mph and variable speeds (acceleration-deceleration-brake). All ICD devices were continuously monitored during the study. The levels of EMI generated were low (highest mean levels: 2.09A/m at right back seat at 30 mph; and 3.5V/m at driver seat at variable speeds). No episode of oversensing or inadvertent change in ICD programming was observed. It is safe for patients with ICD to interact with HEV. This is the first study to address this issue using an in vivo model. Further studies are necessary to evaluate the interaction of different models of HEV or electric engine with ICD or unipolar pacemakers. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  5. Cost-effectiveness of a risk-stratified approach to cardiac resynchronisation therapy defibrillators (high versus low) at the time of generator change.

    Science.gov (United States)

    Claridge, Simon; Sebag, Frederic A; Fearn, Steven; Behar, Jonathan M; Porter, Bradley; Jackson, Tom; Sieniewicz, Benjamin; Gould, Justin; Webb, Jessica; Chen, Zhong; O'Neill, Mark; Gill, Jaswinder; Leclercq, Christophe; Rinaldi, Christopher A

    2018-03-01

    Responders to cardiac resynchronisation therapy whose device has a defibrillator component and who do not receive a therapy in the lifetime of the first generator have a very low incidence of appropriate therapy after box change. We investigated the cost implications of using a risk stratification tool at the time of generator change resulting in these patients being reimplanted with a resynchronisation pacemaker. A decision tree was created using previously published data which had demonstrated an annualised appropriate defibrillator therapy risk of 2.33%. Costs were calculated at National Health Service (NHS) national tariff rates (2016-2017). EQ-5D utility values were applied to device reimplantations, admissions and mortality data, which were then used to estimate quality-adjusted life-years (QALYs) over 5 years. At 5 years, the incremental cost of replacing a resynchronisation defibrillator device with a second resynchronisation defibrillator versus resynchronisation pacemaker was £5045 per patient. Incremental QALY gained was 0.0165 (defibrillator vs pacemaker), resulting in an incremental cost-effectiveness ratio (ICER) of £305 712 per QALYs gained. Probabilistic sensitivity analysis resulted in an ICER of £313 612 (defibrillator vs pacemaker). For reimplantation of all patients with a defibrillator rather than a pacemaker to yield an ICER of less than £30 000 per QALY gained (current NHS cut-off for approval of treatment), the annual arrhythmic event rate would need to be 9.3%. The budget impact of selective replacement was a saving of £2 133 985 per year. Implanting low-risk patients with a resynchronisation defibrillator with the same device at the time of generator change is not cost-effective by current NHS criteria. Further research is required to understand the impact of these findings on individual patients at the time of generator change. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018

  6. Cognitive behavioral therapy (CBT in a Patient with Implantable Cardioverter Defibrillator (ICD and Posttraumatic stress disorder(PTSD.

    Directory of Open Access Journals (Sweden)

    Sahar Ansari

    2014-09-01

    Full Text Available The implantable cardioverter defibrillator (ICD has currently become the standard treatment for preventing sudden cardiac death. There are some psychological consequences in patients with ICD such as posttraumatic stress disorder (PTSD after the shocks induced by ICD. This report aimed to present the case of a 54-year-old man with ICD who had developed PTSD; his PTSD was treated, using cognitive-behavioral psychotherapy consisting of relaxation, mindfulness and problem solving techniques. In patients with ICD who are experiencing PTSD using cognitive behavioral interventions may be helpful to reduce their psychological sufferings.

  7. The role of conductivity discontinuities in design of cardiac defibrillation

    Science.gov (United States)

    Lim, Hyunkyung; Cun, Wenjing; Wang, Yue; Gray, Richard A.; Glimm, James

    2018-01-01

    Fibrillation is an erratic electrical state of the heart, of rapid twitching rather than organized contractions. Ventricular fibrillation is fatal if not treated promptly. The standard treatment, defibrillation, is a strong electrical shock to reinitialize the electrical dynamics and allow a normal heart beat. Both the normal and the fibrillatory electrical dynamics of the heart are organized into moving wave fronts of changing electrical signals, especially in the transmembrane voltage, which is the potential difference between the cardiac cellular interior and the intracellular region of the heart. In a normal heart beat, the wave front motion is from bottom to top and is accompanied by the release of Ca ions to induce contractions and pump the blood. In a fibrillatory state, these wave fronts are organized into rotating scroll waves, with a centerline known as a filament. Treatment requires altering the electrical state of the heart through an externally applied electrical shock, in a manner that precludes the existence of the filaments and scroll waves. Detailed mechanisms for the success of this treatment are partially understood, and involve local shock-induced changes in the transmembrane potential, known as virtual electrode alterations. These transmembrane alterations are located at boundaries of the cardiac tissue, including blood vessels and the heart chamber wall, where discontinuities in electrical conductivity occur. The primary focus of this paper is the defibrillation shock and the subsequent electrical phenomena it induces. Six partially overlapping causal factors for defibrillation success are identified from the literature. We present evidence in favor of five of these and against one of them. A major conclusion is that a dynamically growing wave front starting at the heart surface appears to play a primary role during defibrillation by critically reducing the volume available to sustain the dynamic motion of scroll waves; in contrast, virtual

  8. Vernakalant selectively prolongs atrial refractoriness with no effect on ventricular refractoriness or defibrillation threshold in pigs.

    Science.gov (United States)

    Bechard, Jeff; Gibson, John Ken; Killingsworth, Cheryl R; Wheeler, Jeffery J; Schneidkraut, Marlowe J; Huang, Jian; Ideker, Raymond E; McAfee, Donald A

    2011-03-01

    Vernakalant is a novel antiarrhythmic agent that has demonstrated clinical efficacy for the treatment of atrial fibrillation. Vernakalant blocks, to various degrees, cardiac sodium and potassium channels with a pattern that suggests atrial selectivity. We hypothesized, therefore, that vernakalant would affect atrial more than ventricular effective refractory period (ERP) and have little or no effect on ventricular defibrillation threshold (DFT). Atrial and ventricular ERP and ventricular DFT were determined before and after treatment with vernakalant or vehicle in 23 anesthetized male mixed-breed pigs. Vernakalant was infused at a rate designed to achieve stable plasma levels similar to those in human clinical trials. Atrial and ventricular ERP were determined by endocardial extrastimuli delivered to the right atria or right ventricle. Defibrillation was achieved using external biphasic shocks delivered through adhesive defibrillation patches placed on the thorax after 10 seconds of electrically induced ventricular fibrillation. The DFT was estimated using the Dixon "up-and-down" method. Vernakalant significantly increased atrial ERP compared with vehicle controls (34 ± 8 versus 9 ± 7 msec, respectively) without significantly affecting ventricular ERP or DFT. This is consistent with atrial selective actions and supports the conclusion that vernakalant does not alter the efficacy of electrical defibrillation.

  9. Hydropower externalities: a meta analysis

    NARCIS (Netherlands)

    Mattmann, M.; Logar, I.; Brouwer, R.

    2016-01-01

    This paper presents a meta-analysis of existing research related to the economic valuation of the external effects of hydropower. A database consisting of 81 observations derived from 29 studies valuing the non-market impacts of hydropower electricity generation is constructed with the main aim to

  10. Implantation of a cardiac resynchronization therapy-defibrillator device in a patient with persistent left superior vena cava.

    Science.gov (United States)

    Atar, İlyas; Karaçağlar, Emir; Özçalık, Emre; Özin, Bülent; Müderrisoğlu, Haldun

    2015-06-01

    Presence of a persistent left superior vena cava (PLSVC) is generally clinically asymptomatic and discovered incidentally during central venous catheterization. However, PLSVC may cause technical difficulties during cardiac device implantation. An 82-year-old man with heart failure symptoms and an ejection fraction (EF) of 20% was scheduled for resynchronization therapy-defibrillator device (CRT-D) implantation. A PLSVC draining via a dilated coronary sinus into an enlarged right atrium was diagnosed. First, an active-fixation right ventricular lead was inserted into the right atrium through the PLSVC. The stylet was preshaped to facilitate its passage to the right ventricular apex. An atrial lead was positioned on the right atrium free wall, and an over-the-wire coronary sinus lead deployed to a stable position. CRT-D implantation procedure was successfully completed.

  11. Pacemaker System Malfunction Resulting from External Electrical Cardioversion: A Case Report

    Directory of Open Access Journals (Sweden)

    Taku Nishida, MD

    2009-01-01

    Full Text Available In May 2005 a 68-year-old woman received a VDD pacemaker implantation in the right pectoral region at our hospital for the treatment of complete atrioventricular block. In July 2008, she was diagnosed with dilated cardiomyopathy based on histological testing. In November 2008, she developed syncope due to ventricular tachycardia while at another hospital. She underwent external electrical cardioversion with an anterior-lateral paddle position using a single shock of 100 J. This shock led to severe bradycardia resulting in a transfer to our hospital. The physician who provided the shock could not have been aware that the patient had an implanted pacemaker. The skin above the pulse generator was burned. The electrocardiogram showed no pacing spikes or ventricular escape rhythm. Investigation of the pacemaker 3 hours after cardioversion revealed reprogramming of the device and a marked rise in the lead impedance (>3,000 ohm. Removal of the generator and implantation of a biventricular cardioverter defibrillator were required. The emergency situation, the small size of the generator, the small incision made using the buried suture method, and the patient's obesity all probably contributed to the physician's not noticing the implanted pacemaker. It is important to increase awareness of the severe consequences that may follow if the physician administering external defibrillation does not know about the patient's implanted pacemaker.

  12. Differences between out-of-hospital cardiac arrest in residential and public locations and implications for public-access defibrillation

    DEFF Research Database (Denmark)

    Folke, Fredrik; Gislason, Gunnar H; Lippert, Freddy

    2010-01-01

    The majority of out-of-hospital cardiac arrests (OHCAs) occur in residential locations, but knowledge about strategic placement of automated external defibrillators in residential areas is lacking. We examined whether residential OHCA areas suitable for placement of automated external defibrillat...... defibrillators could be identified on the basis of demographic characteristics and characterized individuals with OHCA in residential locations....

  13. A protocol for patients with cardiovascular implantable devices undergoing magnetic resonance imaging (MRI): should defibrillation threshold testing be performed post-(MRI).

    Science.gov (United States)

    Burke, Peter Thomas; Ghanbari, Hamid; Alexander, Patrick B; Shaw, Michael K; Daccarett, Marcos; Machado, Christian

    2010-06-01

    Magnetic resonance imaging (MRI) in patients with Cardiovascular Implantable Electronic Devices (CIED) has not been approved by the Food and Drug Administration. Recent data suggests MRI as a relative rather than absolute contraindication in CIED patients. Recently, the American Heart Association has recommended defibrillation threshold testing (DFTT) in implantable cardioverter defibrillator (ICD) patients undergoing MRI. We evaluated the feasibility and safety of a protocol for MRI in CIED patients, incorporating the new recommendations on DFTT. Consecutive patients with CIED undergoing MRI were included. The protocol consisted of continuous monitoring during imaging, device interrogation pre- and post-MRI, reprogramming of the pacemaker to an asynchronous mode in pacemaker-dependent (PMD) patients and a non-tracking/sensing mode for non-PMD patients. All tachyarrhythmia therapies were disabled. Devices were interrogated for lead impedance, battery life, pacing, and sensing thresholds. All patients with ICD underwent DFTT/defibrillator safety margin testing (DSMT) post-MRI. A total of 92 MRI's at 1.5 Tesla were performed in 38 patients. A total of 13 PMD patients, ten ICD patients, four cardiac resynchronization therapy with defibrillator (CRT-D) patients, and 11 non-PMD patients were scanned from four major manufacturers. No device circuitry damage, programming alterations, inappropriate shocks, failure to pace, or changes in sensing, pacing, or defibrillator thresholds were found on single or multiple MRI sessions. Our protocol for MRI in CIED patients appears safe, feasible, and reproducible. This is irrespective of the type of CIED, pacemaker dependancy or multiple 24-h scanning sessions. Our protocol addresses early detection of potential complications and establishes a response system for potential device-related complications. Our observation suggests that routine DFTT/DSMT post-MRI may not be necessary.

  14. Impact of programming strategies aimed at reducing nonessential implantable cardioverter defibrillator therapies on mortality: a systematic review and meta-analysis.

    Science.gov (United States)

    Tan, Vern Hsen; Wilton, Stephen B; Kuriachan, Vikas; Sumner, Glen L; Exner, Derek V

    2014-02-01

    Patients who receive implantable cardioverter defibrillator therapies are at higher risk of death versus those who do not. Programmed settings to reduce nonessential implantable cardioverter defibrillator therapies (therapy reduction programming) have been developed but may have adverse effects. This systematic review and meta-analysis assessed the relationship between therapy reduction programming with the risks of death from any cause, implantable cardioverter defibrillator shocks, and syncope. MEDLINE, EMBASE, and clinicaltrials.gov databases were searched to identify relevant studies. Those that followed patients for ≥6 months and reported mortality were included. Six met the inclusion criteria; 4 randomized (Comparison of Empiric to Physician-Tailored Programming of ICDs [EMPIRIC], Multicenter Automatic Defibrillator Implantation Trial-Reduce Inappropriate Therapy [MADIT-RIT], Avoid Delivering Therapies for Non-sustained Arrhythmias in ICD Patients III [ADVANCE III], and Programming Implantable Cardioverter-Defibrillators in Patients with Primary Prevention Indication to Prolong Time to First Shock [PROVIDE]) and 2 prospective studies (Role of Long Detection Window Programming in Patients With Left Ventricular Dysfunction, Non-ischemic Etiology in Primary Prevention Treated with a Biventricular ICD [RELEVANT] and Primary Prevention Parameters Evaluation [PREPARE]). These 6 studies included 7687 (3598 conventional and 4089 therapy reduction programming) patients. Most (77%) participants were men, had a history of ischemic heart disease (56%), and were prescribed β-blockers (84%). Therapy reduction programming was associated with a 30% relative reduction in mortality (95% confidence interval, 16%-41%; Pprogramming (P=0.5). Therapy reduction programming results in a large, significant, and consistent reduction in mortality, with no apparent increase in the risk of syncope.

  15. Do clinical examination gloves provide adequate electrical insulation for safe hands-on defibrillation? I: Resistive properties of nitrile gloves.

    Science.gov (United States)

    Deakin, Charles D; Lee-Shrewsbury, Victoria; Hogg, Kitwani; Petley, Graham W

    2013-07-01

    Uninterrupted chest compressions are a key factor in determining resuscitation success. Interruptions to chest compression are often associated with defibrillation, particularly the need to stand clear from the patient during defibrillation. It has been suggested that clinical examination gloves may provide adequate electrical resistance to enable safe hands-on defibrillation in order to minimise interruptions. We therefore examined whether commonly used nitrile clinical examination gloves provide adequate resistance to current flow to enable safe hands-on defibrillation. Clinical examination gloves (Kimberly Clark KC300 Sterling nitrile) worn by members of hospital cardiac arrest teams were collected immediately following termination of resuscitation. To determine the level of protection afforded by visually intact gloves, electrical resistance across the glove was measured by applying a DC voltage across the glove and measuring subsequent resistance. Forty new unused gloves (control) were compared with 28 clinical (non-CPR) gloves and 128 clinical (CPR) gloves. One glove in each group had a visible tear and was excluded from analysis. Control gloves had a minimum resistance of 120 kΩ (median 190 kΩ) compared with 60 kΩ in clinical gloves (both CPR (median 140 kΩ) and non-CPR groups (median 160 kΩ)). Nitrile clinical examination gloves do not provide adequate electrical insulation for the rescuer to safely undertake 'hands-on' defibrillation and when exposed to the physical forces of external chest compression, even greater resistive degradation occurs. Further work is required to identify gloves suitable for safe use for 'hands-on' defibrillation. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  16. Thoracoscopic Left Cardiac Sympathetic Denervation for a Patient with Catecholaminergic Polymorphic Ventricular Tachycardia and Recurrent Implantable Cardioverter-Defibrillator Shocks

    Directory of Open Access Journals (Sweden)

    Woo-Sik Yu

    2015-06-01

    Full Text Available A patient presented with loss of consciousness and conversion. During an exercise test, catecholaminergic polymorphic ventricular tachycardia (CPVT resulted in cardiac arrest. He started taking medication (a beta-blocker and flecainide and an implantable cardioverter defibrillator (ICD was inserted, but the ventricular tachycardia did not resolve. Left cardiac sympathetic denervation (LCSD was then performed under general anesthesia, and the patient was discharged on the second postoperative day without complications. One month after the operation, no shock had been administered by the ICD, and an exercise stress test did not induce ventricular tachycardia. Although beta- blockers are the gold standard of therapy in patients with CPVT, thoracoscopic LCSD is safe and can be an effective alternative treatment option for patients with intractable CPVT.

  17. Use of implantable cardioverter defibrillators after out-of-hospital cardiac arrest: a prospective follow-up study

    Science.gov (United States)

    Parkash, Ratika; Tang, Anthony; Wells, George; Blackburn, Josée; Stiell, Ian; Simpson, Christopher; Dorian, Paul; Yee, Raymond; Cameron, Doug; Connolly, Stuart; Birnie, David; Nichol, Graham

    2004-01-01

    Background Survivors of out-of-hospital cardiac arrest are at high risk of recurrent arrests, many of which could be prevented with implantable cardioverter defibrillators (ICDs). We sought to determine the ICD insertion rate among survivors of out-of-hospital cardiac arrest and to determine factors associated with ICD implantation. Methods The Ontario Prehospital Advanced Life Support (OPALS) study is a prospective, multiphase, before–after study assessing the effectiveness of prehospital interventions for people experiencing cardiac arrest, trauma or respiratory arrest in 19 Ontario communities. We linked OPALS data describing survivors of cardiac arrest with data from all defibrillator implantation centres in Ontario. Results From January 1997 to April 2002, 454 patients in the OPALS study survived to hospital discharge after experiencing an out-of-hospital cardiac arrest. The mean age was 65 (standard deviation 14) years, 122 (26.9%) were women, 398 (87.7%) had a witnessed arrest, 372 (81.9%) had an initial rhythm of ventricular tachycardia or ventricular fibrillation (VT/VF), and 76 (16.7%) had asystole or another arrhythmia. The median cerebral performance category at discharge (range 1–5, 1 = normal) was 1. Only 58 (12.8%) of the 454 patients received an ICD. Patients with an initial rhythm of VT/VF were more likely than those with an initial rhythm of asystole or another rhythm to undergo device insertion (adjusted odds ratio [OR] 9.63, 95% confidence interval [CI] 1.31–71.50). Similarly, patients with a normal cerebral performance score were more likely than those with abnormal scores to undergo ICD insertion (adjusted OR 12.52, 95% CI 1.74–92.12). Interpretation A minority of patients who survived cardiac arrest underwent ICD insertion. It is unclear whether this low usage rate reflects referral bias, selection bias by electrophysiologists, supply constraint or patient preference. PMID:15505267

  18. Attitudes towards implantable cardioverter-defibrillator therapy: a national survey in Danish health-care professionals

    DEFF Research Database (Denmark)

    Johansen, Jens B; Mortensen, Peter T; Videbæk, Regitze

    2011-01-01

    Aims The aim of this study was to examine health-care professionals attitudes towards implantable cardioverter-defibrillator (ICD) therapy and issues discussed with patients. Methods and results Survey of 209 health-care professionals providing specialized treatment and care of ICD patients......-physicians. Physicians were less likely to believe that their personal attitude towards ICD treatment has no influence on how they deal professionally with patients (27.8 vs. 43.6%; P = 0.04). Physicians and non-physicians were equally positive towards ICD therapy as primary prophylaxis in ischaemic cardiomyopathy (87...... discussing ICD treatment with candidate patients. At the same time, physicians are more aware that their attitude towards ICD treatment may influence how they deal professionally with patients compared with non-physicians....

  19. Optimal Implantable Cardioverter Defibrillator Programming.

    Science.gov (United States)

    Shah, Bindi K

    Optimal programming of implantable cardioverter defibrillators (ICDs) is essential to appropriately treat ventricular tachyarrhythmias and to avoid unnecessary and inappropriate shocks. There have been a series of large clinical trials evaluating tailored programming of ICDs. We reviewed the clinical trials evaluating ICD therapies and detection, and the consensus statement on ICD programming. In doing so, we found that prolonged ICD detection times, higher rate cutoffs, and antitachycardia pacing (ATP) programming decreases inappropriate and painful therapies in a primary prevention population. The use of supraventricular tachyarrhythmia discriminators can also decrease inappropriate shocks. Tailored ICD programming using the knowledge gained from recent ICD trials can decrease inappropriate and unnecessary ICD therapies and decrease mortality.

  20. A Case of a Cardiac Resynchronization Therapy-Defibrillator Exhibiting a Lower and Alternately Variable Basic Rate.

    Science.gov (United States)

    Iwazaki, Keigo; Kojima, Toshiya; Murasawa, Takahide; Yokota, Jun; Tanimoto, Hikaru; Matsuda, Jun; Fukuma, Nobuaki; Matsubara, Takumi; Shimizu, Yu; Oguri, Gaku; Hasumi, Eriko; Kubo, Hitoshi; Chang, Kyungho; Fujiu, Katsuhito; Komuro, Issei

    2018-04-06

    A cardiac resynchronization therapy defibrillator (CRT-D) (Medtronic Inc. Protecta XT) was implanted in a 67-year-old man who had cardiac sarcoidosis with extremely low cardiac function. He had ventricular tachycardia which was controlled by catheter ablation, medication and pacing. The programmed mode was DDI, lower rate was 90 beats/minute, paced AV delay was 150 ms, and the noncompetitive atrial pacing (NCAP) function was programmed as 300 ms.After his admission for pneumonia and heart failure, we changed his DDI mode to a DDD mode because he had atrial tachycardia, which led to inadequate bi-ventricular pacing. After a while, there were cycle lengths which were longer than his device setting and alternately varied. We were able to avoid this phenomenon with AV delay of 120 ms and NCAP of 200 ms.NCAP is an algorithm which creates a gap above a certain period after the detection of an atrial signal during the postventricular atrial refractory period of the pacemaker. This is to prevent atrial tachycardia and repetitive non-reentrant ventriculoatrial (VA) synchrony in the presence of retrograde VA conduction. But in this case, NCAP algorithm induced much lower rate than the programmed basic lower rate. This situation produced some arrhythmias and exacerbated symptoms of heart failure. This had to be paid attention to, especially when the device was programmed at high basic heart rate.

  1. Ranking Businesses and Municipal Locations by Spatiotemporal Cardiac Arrest Risk to Guide Public Defibrillator Placement.

    Science.gov (United States)

    Sun, Christopher L F; Brooks, Steven C; Morrison, Laurie J; Chan, Timothy C Y

    2017-03-21

    Efforts to guide automated external defibrillator placement for out-of-hospital cardiac arrest (OHCA) treatment have focused on identifying broadly defined location categories without considering hours of operation. Broad location categories may be composed of many businesses with varying accessibility. Identifying specific locations for automated external defibrillator deployment incorporating operating hours and time of OHCA occurrence may improve automated external defibrillator accessibility. We aim to identify specific businesses and municipal locations that maximize OHCA coverage on the basis of spatiotemporal assessment of OHCA risk in the immediate vicinity of franchise locations. This study was a retrospective population-based cohort study using data from the Toronto Regional RescuNET Epistry cardiac arrest database. We identified all nontraumatic public OHCAs occurring in Toronto, ON, Canada, from January 2007 through December 2015. We identified 41 unique businesses and municipal location types with ≥20 locations in Toronto from the YellowPages, Canadian Franchise Association, and the City of Toronto Open Data Portal. We obtained their geographic coordinates and hours of operation from Web sites, by phone, or in person. We determined the number of OHCAs that occurred within 100 m of each location when it was open (spatiotemporal coverage) for Toronto overall and downtown. The businesses and municipal locations were then ranked by spatiotemporal OHCA coverage. To evaluate temporal stability of the rankings, we calculated intraclass correlation of the annual coverage values. There were 2654 nontraumatic public OHCAs. Tim Hortons ranked first in Toronto, covering 286 OHCAs. Starbucks ranked first in downtown, covering 110 OHCAs. Coffee shops and bank machines from the 5 largest Canadian banks occupied 8 of the top 10 spots in both Toronto and downtown. The rankings exhibited high temporal stability with intraclass correlation values of 0.88 (95

  2. Psychometric properties of HeartQoL, a core heart disease-specific health-related quality of life questionnaire, in Danish implantable cardioverter defibrillator recipients

    DEFF Research Database (Denmark)

    Zangger, Graziella; Zwisler, Ann-Dorthe; Kikkenborg Berg, Selina

    2017-01-01

    Background Patient-reported health-related quality of life is increasingly used as an outcome measure in clinical trials and as a performance measure to evaluate quality of care. The objective of this study was to assess the psychometric properties of the Danish HeartQoL questionnaire, a core heart...... disease-specific health-related quality of life questionnaire, in implantable cardioverter defibrillator recipients. Design This study involved cross-sectional and test-retest study designs. Method Implantable cardioverter defibrillator recipients in the cross-sectional study completed the Heart......QoL, the Short-Form 36 Health Survey, and the Hospital Anxiety and Depression Scale. The HeartQoL structure, construct-related validity (convergent and discriminative) and reliability (internal consistency) were assessed. HeartQoL reproducibility (test-retest) was assessed in an independent sample of implantable...

  3. A Pregnancy with Severe Hypertrophic Obstructive Cardiomyopathy after Surgery for an Implantable Cardioverter Defibrillator: A Case Report and Literature Review

    Directory of Open Access Journals (Sweden)

    Takashi Mitsui

    2016-01-01

    Full Text Available Hypertrophic obstructive cardiomyopathy (HOCM is cardiac hypertrophy of ventricular myocardium with left ventricular outflow tract obstruction. We report a pregnancy with HOCM after defibrillator implantation surgery. The patient was a 33-year-old nulligravida and was categorized as New York Heart Association class II. Her brain natriuretic peptide (BNP level was 724.6 pg/dL at preconception. She received careful pregnancy management. However, because frequent uterine contractions were observed at 25 weeks and 6 days of pregnancy, she was hospitalized, and magnesium sulfate was started as a tocolytic agent. At 27 weeks and 5 days of pregnancy, she had respiratory discomfort and orthopnea with a sudden decrease in peripheral oxygen saturation. Cardiac ultrasonography showed a worsened condition of HOCM and her BNP level was 1418.0 pg/mL. We performed an emergent cesarean section and she delivered a boy weighing 999 g. The Apgar score was 8 and 9 points at 1 and 5 minutes, respectively. The mother’s heart failure quickly improved after birth and she was discharged at 10 days postoperatively. Fluctuations in circulatory dynamics during pregnancy may sometimes exacerbate heart disease. Therefore, the risks should be fully explained and careful assessment of cardiac function should be performed during pregnancy in patients with severe HOCM.

  4. 75 FR 70015 - External Defibrillators; Public Workshop

    Science.gov (United States)

    2010-11-16

    ... different environments (hospital, community, home)? 4. What features of next generation devices can be... present written material or to make oral presentations at the public workshop, please call the contact...

  5. What Is an Automated External Defibrillator?

    Science.gov (United States)

    ... such as police, fire service personnel, flight attendants, security guards and other lay rescuers who have been ... venues, shopping malls, airports, airplanes, businesses, convention centers, hotels, schools and doctors’ offices. They should also be ...

  6. A comparative study of defibrillation and cardiopulmonary resuscitation performance during simulated cardiac arrest in nursing student teams

    Directory of Open Access Journals (Sweden)

    Eikeland Husebø Sissel I

    2012-04-01

    Full Text Available Abstract Background Although nurses must be able to respond quickly and effectively to cardiac arrest, numerous studies have demonstrated poor performance. Simulation is a promising learning tool for resuscitation team training but there are few studies that examine simulation for training defibrillation and cardiopulmonary resuscitation (D-CPR in teams from the nursing education perspective. The aim of this study was to investigate the extent to which nursing student teams follow the D-CPR-algorithm in a simulated cardiac arrest, and if observing a simulated cardiac arrest scenario and participating in the post simulation debriefing would improve team performance. Methods We studied video-recorded simulations of D-CPR performance in 28 nursing student teams. Besides describing the overall performance of D-CPR, we compared D-CPR performance in two groups. Group A (n = 14 performed D-CPR in a simulated cardiac arrest scenario, while Group B (n = 14 performed D-CPR after first observing performance of Group A and participating in the debriefing. We developed a D-CPR checklist to assess team performance. Results Overall there were large variations in how accurately the nursing student teams performed the specific parts of the D-CPR algorithm. While few teams performed opening the airways and examination of breathing correctly, all teams used a 30:2 compression: ventilation ratio. We found no difference between Group A and Group B in D-CPR performance, either in regard to total points on the check list or to time variables. Conclusion We found that none of the nursing student teams achieved top scores on the D-CPR-checklist. Observing the training of other teams did not increase subsequent performance. We think all this indicates that more time must be assigned for repetitive practice and reflection. Moreover, the most important aspects of D-CPR, such as early defibrillation and hands-off time in relation to shock, must be highlighted in team

  7. Is it safe to allow patients with implantable cardioverter-defibrillators to drive? Learnings from a single center experience.

    Science.gov (United States)

    Curnis, Antonio; Mascioli, Giosue; Bontempi, Luca; Cerini, Manuel; Bignotti, Tommaso; Bonetti, Gabriele; Dei Cas, Livio

    2008-12-01

    Implantable cardioverter-defibrillator (ICD) implant indications have widened in recent years after the publication of the Multicenter Automatic Defibrillator Implantation Trial 2 and the Sudden Cardiac Death in Heart Failure Trial. On the contrary, guidelines on resumption of driving after ICD implant were published almost 10 years ago when the ICD implant rate was much lower and candidates were generally older. The overall objective of our study was to evaluate whether patients implanted with ICDs have higher risk than the general driving population. The specific aim of the study was to verify the rate of car accidents in patients implanted with an ICD, both for primary and secondary indication, and compare this with the rate of accidents in the general population. The primary end point of the study was the annual car accident rate; the secondary end point was to determine if there were subgroups of patients with a higher risk of car accidents. All patients (612) followed up in our outpatient clinic were sent a questionnaire in which they were asked five questions regarding their driving habits before and after ICD implant and, specifically, whether they had been involved in a car accident after the implant. Two hundred eighty-six patients (47%) responded to the questionnaire. Seventy-one patients had never driven; two patients were forbidden to drive for professional reasons (one bus and one truck driver). Two hundred thirteen (74.5% of all responding) patients (201 men, mean age 62 +/- 11 years) continued to drive after ICD implant. During the follow-up (1430 +/- 920 days) 11 patients had been involved in car accidents and, importantly 10 out of 11 were innocent bystanders. Thus, in 996 patient-years, 11 events happened, yielding an annual event rate of 1.1% per patient-years (and only 0.1% in which the driver could had been responsible). Car accidents are infrequent in patients implanted with an ICD, and - in any case - not more frequent than in the general

  8. Psychological intervention following implantation of an implantable defibrillator

    DEFF Research Database (Denmark)

    Pedersen, Susanne S.; van den Broek, Krista C; Sears, Samuel F

    2007-01-01

    The medical benefits of the implantable cardioverter defibrillator (ICD) are unequivocal, but a subgroup of patients experiences emotional difficulties following implantation. For this subgroup, some form of psychological intervention may be warranted. This review provides an overview of current ...

  9. Towards Low Energy Atrial Defibrillation

    Directory of Open Access Journals (Sweden)

    Philip Walsh

    2015-09-01

    Full Text Available A wireless powered implantable atrial defibrillator consisting of a battery driven hand-held radio frequency (RF power transmitter (ex vivo and a passive (battery free implantable power receiver (in vivo that enables measurement of the intracardiac impedance (ICI during internal atrial defibrillation is reported. The architecture is designed to operate in two modes: Cardiac sense mode (power-up, measure the impedance of the cardiac substrate and communicate data to the ex vivo power transmitter and cardiac shock mode (delivery of a synchronised very low tilt rectilinear electrical shock waveform. An initial prototype was implemented and tested. In low-power (sense mode, >5 W was delivered across a 2.5 cm air-skin gap to facilitate measurement of the impedance of the cardiac substrate. In high-power (shock mode, >180 W (delivered as a 12 ms monophasic very-low-tilt-rectilinear (M-VLTR or as a 12 ms biphasic very-low-tilt-rectilinear (B-VLTR chronosymmetric (6ms/6ms amplitude asymmetric (negative phase at 50% magnitude shock was reliably and repeatedly delivered across the same interface; with >47% DC-to-DC (direct current to direct current power transfer efficiency at a switching frequency of 185 kHz achieved. In an initial trial of the RF architecture developed, 30 patients with AF were randomised to therapy with an RF generated M-VLTR or B-VLTR shock using a step-up voltage protocol (50–300 V. Mean energy for successful cardioversion was 8.51 J ± 3.16 J. Subsequent analysis revealed that all patients who cardioverted exhibited a significant decrease in ICI between the first and third shocks (5.00 Ω (SD(σ = 1.62 Ω, p < 0.01 while spectral analysis across frequency also revealed a significant variation in the impedance-amplitude-spectrum-area (IAMSA within the same patient group (|∆(IAMSAS1-IAMSAS3[1 Hz − 20 kHz] = 20.82 Ω-Hz (SD(σ = 10.77 Ω-Hz, p < 0.01; both trends being absent in all patients that failed to cardiovert

  10. Elektrokirurgi hos patienter med pacemaker og implanterbar kardioverter-defibrillator

    DEFF Research Database (Denmark)

    Lønnberg, Ann Sophie Claire; Philberts, Berit Thornvig; Bonde, Christian

    2017-01-01

    Electrosurgery is a very useful tool and one of the most commonly used techniques. However, the technique can interfere with pacemakers and implantable cardioverter defibrillators. This article provides practical recommendations for the use of electrosurgery in these patients.......Electrosurgery is a very useful tool and one of the most commonly used techniques. However, the technique can interfere with pacemakers and implantable cardioverter defibrillators. This article provides practical recommendations for the use of electrosurgery in these patients....

  11. Knowledge and attitudes towards cardiopulmonary resuscitation and defibrillation amongst Asian primary health care physicians

    Directory of Open Access Journals (Sweden)

    Marcus Eh Ong

    2009-11-01

    Full Text Available Marcus Eh Ong1, Susan Yap1, Kim P Chan1, Papia Sultana2, Venkataraman Anantharaman11Department of Emergency Medicine, 2Department of Clinical Research, Singapore General Hospital, SingaporeObjective: To assess the knowledge and attitudes of local primary health care physicians in relation to cardiopulmonary resuscitation (CPR and defibrillation.Methods: We conducted a survey on general practitioners in Singapore by using a self-administered questionnaire that comprised 29 questions.Results: The response rate was 80%, with 60 of 75 physicians completing the questionnaire. The average age of the respondents was 52 years. Sixty percent of them reported that they knew how to operate an automated external defibrillator (AED, and 38% had attended AED training. Only 36% were willing to perform mouth-to-mouth ventilation during CPR, and 53% preferred chest compression-only resuscitation (CCR to standard CPR. We found those aged <50 years were more likely to be trained in basic cardiac life support (BCLS (P < 0.001 and advanced cardiac life support (P = 0.005 or to have ever attended to a patient with cardiac arrest (P = 0.007. Female physicians tended to agree that all clinics should have AEDs (P = 0.005 and support legislation to make AEDs compulsory in clinics (P < 0.001. We also found that a large proportion of physicians who were trained in BCLS (P = 0.006 were willing to perform mouth-to-mouth ventilation.Conclusion: Most local primary care physicians realize the importance of defibrillation, and the majority prefer CCR to standard CPR.Keywords: general practitioners, cardiac arrest, resuscitation, defibrillation, attitude, knowledge

  12. Safety of sports participation in patients with implantable cardioverter defibrillators: a survey of heart rhythm society members.

    Science.gov (United States)

    Lampert, Rachel; Cannom, David; Olshansky, Brian

    2006-01-01

    Safety of Sports for ICD Patients. The safety of sports participation for patients with implantable cardioverter defibrillators (ICDs) is unknown, and recommendations among physicians may vary widely. The purposes of this study were to determine current practice among patients with ICDs and their physicians regarding sports participation, and to determine how many physicians have cared for patients who have sustained adverse events during sports participation. A survey was mailed to all 1,687 U.S. physician members of the Heart Rhythm Society. Among 614 respondent physicians, recommendations varied widely. Only 10% recommended avoidance of all sports more vigorous than golf. Seventy-six percent recommended avoidance of contact, and 45% recommend avoidance of competitive sports. Most (71%) based restrictions on patients' underlying heart disease. Regardless of recommendations, most physicians (71%) reported caring for patients who participated in sports, including many citing vigorous, competitive sports, most commonly cited were basketball, running, and skiing. ICD shocks during sports were common, cited by 40% of physicians. However, few adverse consequences were reported. One percent of physicians reported known injury to patient (all but 3 minor); 5%, injury to the ICD system, and weightlifting and golf. Physician recommendations for sports participation for patients with ICDs varies widely. Many patients with ICDs do participate in vigorous and even competitive sports. While shocks were common, significant adverse events were rare.

  13. A review of economic evaluation models for cardiac resynchronization therapy with implantable cardioverter defibrillators in patients with heart failure

    NARCIS (Netherlands)

    Tomini, F.; van Asselt, A. D.

    OBJECTIVES: Cardiac resynchronization therapy with biventricular pacemaker (CRT-P) is considered an effective treatment for heart failure (HF). Adding implantable cardioverter defibrillators (CRT-D) may further reduce the risk of sudden cardiac death (SCD). However, economic evaluations have shown

  14. A review of economic evaluation models for cardiac resynchronization therapy with implantable cardioverter defibrillators in patients with heart failure

    NARCIS (Netherlands)

    Tomini, F.; van Asselt, A. D.

    2012-01-01

    OBJECTIVES: Cardiac resynchronization therapy with biventricular pacemaker (CRT-P) is considered an effective treatment for heart failure (HF). Adding implantable cardioverter defibrillators (CRT-D) may further reduce the risk of sudden cardiac death (SCD). However, economic evaluations have shown

  15. 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...

  16. Electromagnetic interference from welding and motors on implantable cardioverter-defibrillators as tested in the electrically hostile work site.

    Science.gov (United States)

    Fetter, J G; Benditt, D G; Stanton, M S

    1996-08-01

    This study was designed to determine the susceptibility of an implanted cardioverter-defibrillator to electromagnetic interference in an electrically hostile work site environment, with the ultimate goal of allowing the patient to return to work. Normal operation of an implanted cardioverter-defibrillator depends on reliable sensing of the heart's electrical activity. Consequently, there is concern that external electromagnetic interference from external sources in the work place, especially welding equipment or motor-generator systems, may be sensed and produce inappropriate shocks or abnormal reed switch operation, temporarily suspending detection of ventricular tachycardia or ventricular fibrillation. The effects of electromagnetic interference on the operation of one type of implantable cardioverter-defibrillator (Medtronic models 7217 and 7219) was measured by using internal event counter monitoring in 10 patients operating arc welders at up to 900 A or working near 200-hp motors and 1 patient close to a locomotive starter drawing up to 400 A. The electromagnetic interference produced two sources of potential interference on the sensing circuit or reed switch operation, respectively: 1) electrical fields with measured frequencies up to 50 MHz produced by the high currents during welding electrode activation, and 2) magnetic fields produced by the current in the welding electrode and cable. The defibrillator sensitivity was programmed to the highest (most sensitive) value: 0.15 mV (model 7219) or 0.3 mV (model 7217). The ventricular tachycardia and ventricular fibrillation therapies were temporarily turned off but the detection circuits left on. None of the implanted defibrillators tested were affected by oversensing of the electric field as verified by telemetry from the detection circuits. The magnetic field from 225-A welding current produced a flux density of 1.2 G; this density was not adequate to close the reed switch, which requires approximately 10 G

  17. Single-Coil Defibrillator Leads Yield Satisfactory Defibrillation Safety Margin in Hypertrophic Cardiomyopathy.

    Science.gov (United States)

    Okamura, Hideo; Friedman, Paul A; Inoue, Yuko; Noda, Takashi; Aiba, Takeshi; Yasuda, Satoshi; Ogawa, Hisao; Kamakura, Shiro; Kusano, Kengo; Espinosa, Raul E

    2016-09-23

    Single-coil defibrillator leads have gained favor because of their potential ease of extraction. However, a high defibrillation threshold remains a concern in patients with hypertrophic cardiomyopathy (HCM), and in many cases, dual-coil leads have been used for this patient group. There is little data on using single-coil leads for HCM patients. We evaluated 20 patients with HCM who received an implantable cardioverter-defibrillator (ICD) on the left side in combination with a dual-coil lead. Two sets of defibrillation tests were performed in each patient, one with the superior vena cava (SVC) coil "on" and one with the SVC coil "off". ICDs were programmed to deliver 25 joules (J) for the first attempt followed by maximum energy (35 J or 40 J). Shock impedance and shock pulse width at 25 J in each setting as well as the results of the shock were analyzed. All 25-J shocks in both settings successfully terminated ventricular fibrillation. However, shock impedance and pulse width increased substantially with the SVC coil programmed "off" compared with "on" (66.4±6.1 ohm and 14.0±1.3 ms "off" vs. 41.9±5.0 ohm and 9.3±0.8 ms "on", Psatisfactory safety margin for 35-J devices. Single-coil leads appear appropriate for left-sided implantation in this patient group. (Circ J 2016; 80: 2199-2203).

  18. Wind power externalities: A meta-analysis

    NARCIS (Netherlands)

    Mattmann, M.; Logar, I.; Brouwer, R.

    2016-01-01

    This study presents the first quantitative meta-analysis of the non-market valuation literature on the external effects associated with wind power production. A data set of 60 observations drawn from 32 studies is constructed. The relative economic values of different types of externalities as well

  19. A clinical example of extreme dose exposure for an implanted cardioverter-defibrillator. Beyond the DEGRO guidelines

    Energy Technology Data Exchange (ETDEWEB)

    Hristova, Yoana; Koehn, Janett; Preuss, Stefanie [Johann Wolfgang Goethe University Frankfurt, Department of Radiation Oncology, University Hospital, Frankfurt (Germany); Roedel, Claus; Balermpas, Panagiotis [Johann Wolfgang Goethe University Frankfurt, Department of Radiation Oncology, University Hospital, Frankfurt (Germany); German Cancer Research Center (DKFZ), Heidelberg (Germany); German Cancer Consortium (DKTK), Frankfurt am Main (Germany)

    2017-09-15

    Considering that the number of malignant diseases in patients over 65 years of age is increasing, it often occurs that patients who carry a cardiac implanted electronic device must undergo radiotherapy. Ionizing radiation can disturb the function of the implantable cardioverter-defibrillator (ICD). As a result of this, an update of the DEGRO/DKG guidelines for radiotherapy of this patient group has been published. We report the case of a patient with an ICD and T-lymphoblastic lymphoma with cardiac involvement, who received i.a. a total body irradiation with 8 Gy followed by a consolidating radiotherapy of the pericardium with 14 Gy as well as additional radiotherapy courses after consecutive recurrences. For the purposes of the treatment, the antitachyarrhythmia (ATA) therapy was deactivated and temporarily replaced through a life vest. According to the current DEGRO guidelines for irradiation of patients with cardiac implanted electronic devices, a categorization of the patient in the ''high-risk'' group was made. Furthermore, regular telemetric checks of the ICD device were performed before and after treatment. Despite unavailable declaration of the manufacturer regarding the cumulative tolerable dose and DEGRO recommendation for a cumulative dose <2 Gy, the aftercare was unproblematic and normal values were assessed for all relevant ICD parameters, despite a cumulative dose >10 Gy in the device. This case shows that if the cardiac implanted electronic devices are not directly irradiated und the energy used is reduced to 6 MV, irradiation-induced damage is less likely and can possibly be prevented. (orig.) [German] Vor dem Hintergrund der steigenden Zahl von Krebserkrankungen bei Patienten ueber 65 Jahren kommt es haeufig vor, dass sich Patienten mit einem kardialen implantierten elektronischen Geraet einer Strahlentherapie unterziehen muessen. Ionisierende Strahlung kann die Funktion des implantierbaren Kardioverter-Defibrillators (ICD

  20. Hydropower externalities: A meta-analysis

    International Nuclear Information System (INIS)

    Mattmann, Matteo; Logar, Ivana; Brouwer, Roy

    2016-01-01

    This paper presents a meta-analysis of existing research related to the economic valuation of the external effects of hydropower. A database consisting of 81 observations derived from 29 studies valuing the non-market impacts of hydropower electricity generation is constructed with the main aim to quantify and explain the economic values for positive and negative hydropower externalities. Different meta-regression model specifications are used to test the robustness of significant determinants of non-market values, including different types of hydropower impacts. The explanatory and predictive power of the estimated models is relatively high. Whilst controlling for sample and study characteristics, we find significant evidence for public aversion towards deteriorations of landscape, vegetation and wildlife caused by hydropower projects. There is however only weak evidence of willingness to pay for mitigating these effects. The main positive externality of hydropower generation, the avoidance of greenhouse gas emission, positively influences welfare estimates when combined with the share of hydropower in national energy production. Sensitivity to scope is detected, but not linked to specific externalities or non-market valuation methods. - Highlights: • A global meta-analysis of valuation studies of hydropower externalities is presented. • Positive and negative externalities are distinguished. • Welfare losses due to environmental deteriorations outweigh gains of GHG reductions. • There is only weak evidence of public WTP for mitigating negative externalities. • The non-market values of hydropower externalities are sensitive to scope.

  1. Attitudes of older adults with serious competing health risks toward their implantable cardioverter-defibrillators: a pilot study.

    Science.gov (United States)

    Green, Ariel R; Boyd, Cynthia M; Rickard, John; Gomon, Robert; Leff, Bruce

    2015-12-23

    In elderly heart failure patients, the survival benefit of implantable cardioverter-defibrillators (ICDs) may be attenuated due to competing health risks, and the risk of adverse outcomes magnified. Our objective was to examine older adults' attitudes towards ICD implantation in the context of competing health risks, exploring the determinants of ICD decision-making among a group of patients who had faced the decision in the past. Telephone survey with a qualitative component. Patients were age ≥70 with single- or dual-chamber ICDs from a single academic cardiac device clinic. Health status was assessed with the Vulnerable Elders Survey (VES-13). Responses to open-ended questions were transcribed verbatim; an "editing analysis" approach was used to extract themes. Forty-four ICD recipients participated (mean age 77.5 years). Nineteen participants (43%) had VES-13 scores ≥3, indicating a 50% likelihood of death or functional decline within 2 years. Twenty-one participants (48%) had received prior ICD shocks. Forty participants (91%) said they would "definitely" choose to get an ICD again in their current health. By and large, patients revealed a strong desire to extend life, expressed complete confidence in the lifesaving capabilities of their ICDs, and did not describe consideration of competing health risks. In this pilot telephone survey with a qualitative component, nearly all older adults with ICDs would still choose to get an ICD despite high short-term risk of death or health deterioration. These findings suggest the need to partner more effectively with patients and families to decide how best to use medical technologies, particularly for older adults with competing risks.

  2. Safety of implantable pacemakers and cardioverter defibrillators in the magnetic field of a novel remote magnetic navigation system.

    Science.gov (United States)

    Jilek, Clemens; Tzeis, Stylianos; Reents, Tilko; Estner, Heidi-Luise; Fichtner, Stephanie; Ammar, Sonia; Wu, Jinjin; Hessling, Gabriele; Deisenhofer, Isabel; Kolb, Christof

    2010-10-01

    Electromagnetic interference with pacemaker and implantable cardioverter defibrillator (ICD) systems may cause temporary or permanent system malfunction of implanted devices. The aim of this study was to evaluate potential interference of a novel magnetic navigation system with implantable rhythm devices. A total of 121 devices (77 pacemakers, 44 ICDs) were exposed to an activated NIOBE II® Magnetic Navigation System (Stereotaxis, St. Louis, MO, USA) at the maximal magnetic field strength of 0.1 Tesla and evaluated in vitro with respect to changes in parameter settings of the device, changes of the battery status/detection of elective replacement indication, or alterations of data stored in the device. A total of 115 out of 121 (95%) devices were free of changes in parameter settings, battery status, and internally stored data after repeated exposition to the electromagnetic field of the remote magnetic navigation system. Interference with the magnetic navigation field was observed in 6 pacemakers, resulting in reprogramming to a power-on-reset mode with or without detection of the elective replacement indication in 5 devices and abnormal variance of battery status in one device. All pacemakers could be reprogrammed to the initial modes and the battery status proved to be normal some minutes after the pacemakers had been removed from the magnetic field. Interference of a remote magnetic navigation system (at maximal field strength) with pacemakers and ICDs not connected to leads with antitachycardic detection and therapies turned off is rare. Occurring functional abnormalities could be reprogrammed in our sample. An in vitro study will give information about interference of devices connected to leads. © 2010 Wiley Periodicals, Inc.

  3. Concerns about the implantable cardioverter defibrillator

    DEFF Research Database (Denmark)

    Pedersen, Susanne S.; van Domburg, Ron T; Theuns, Dominic A M J

    2005-01-01

    Patients with an implantable cardioverter defibrillator (ICD) are at increased risk of anxiety disorders. In turn, anxiety has been identified as a precipitant of ventricular arrhythmias. Anxiety may in part be attributed to concerns about the ICD firing, but the relationship between ICD concerns......, psychological morbidity, and shocks has not been systematically investigated. We examined the relative importance of experienced shocks versus subjective concerns about the ICD as determinants of anxiety and depressive symptoms in ICD patients....

  4. Fast Electrocardiogram Amplifier Recovery after Defibrillation Shock

    Directory of Open Access Journals (Sweden)

    Ivan Dotsinsky

    2005-04-01

    Full Text Available A procedure for fast ECG amplifier recovery after defibrillation shocks was developed and simulated in the MATLAB environment. Exponentially decaying post-shock voltages have been recorded. Signals from the AHA database are taken and mixed with the recorded exponential disturbances. The algorithm applies moving averaging (comb filter on the compound input signal, thereby obtaining the samples of the disturbance. They are currently subtracted from the input signal. The results obtained show that its recovery is practically instantaneous.

  5. Efficacy of cardiac resynchronization with defibrillator insertion in patients undergone coronary artery bypass graft: A cohort study of cardiac function

    Directory of Open Access Journals (Sweden)

    Reza Karbasi Afshar

    2015-01-01

    Full Text Available Introduction: Cardiac resynchronization therapy (CRT is a proven therapeutic method in selected patients with heart failure and systolic dysfunction which increases left ventricular function and patient survival. We designed a study that included patients undergoing coronary artery bypass graft (CABG, with and without CRT-defibrillator (CRT-D inserting and then measured its effects on these two groups. Patients and Methods: Between 2010 and 2013, we conducted a prospective cohort study on 100 coronary artery disease patients where candidate for CABG. Then based on the receiving CRT-D, the patients were categorized in two groups; Group 1 ( n = 48, with CRT-D insertion before CABG and Group 2 ( n = 52 without receiving CRT-D. Thereafter both of these groups were followed-up at 1-3 months after CABG for mortality, hospitalization, atrial fibrillation (AF, echocardiographic assessment, and New York Heart Association (NYHA class level. Results: The mean age of participants in Group 1 (48 male and in Group 2 (52 male was 58 ± 13 and 57 ± 12 respectively. Difference between Groups 1 and 2 in cases of mean left ventricular ejection fraction (LVEF changes and NYHA class level was significant ( P > 0.05. Hospitalization ( P = 0.008, mortality rate ( P = 0.007, and AF were significantly different between these two groups. Conclusions: The results showed that the increase in LVEF and patient′s improvement according to NYHA-class was significant in the first group, and readmission, mortality rate and AF was increased significantly in the second group.

  6. Simple and effective solution for diaphragm pacing by that uses the transvenous femoral approach in a patient treated with cardiac resynchronization-defibrillator therapy: The wrapping method

    Directory of Open Access Journals (Sweden)

    Ahmet Taha Alper, Prof.

    2017-08-01

    Full Text Available The use of cardiac resynchronization therapy (CRT has become widespread in patients with heart failure who meet the criteria for implantation. Coronary sinus lead positioning is important to provide the intended biventricular stimulation. Diaphragm pacing is a lead-related complication which occurs secondary to phrenic nerve stimulation. We present the case of a 58-year-old male patient who had diaphragm pacing after CRT with defibrillator implantation. The complication was resolved by using the transvenous femoral approach with the wrapping method.

  7. Can machine learning complement traditional medical device surveillance? A case-study of dual-chamber implantable cardioverter–defibrillators

    Directory of Open Access Journals (Sweden)

    Ross JS

    2017-08-01

    Full Text Available Joseph S Ross,1–4 Jonathan Bates,4 Craig S Parzynski,4 Joseph G Akar,4,5 Jeptha P Curtis,4,5 Nihar R Desai,4,5 James V Freeman,4,5 Ginger M Gamble,4 Richard Kuntz,6 Shu-Xia Li,4 Danica Marinac-Dabic,7 Frederick A Masoudi,8 Sharon-Lise T Normand,9,10 Isuru Ranasinghe,11 Richard E Shaw,12 Harlan M Krumholz2–5 1Section of General Medicine, Department of Medicine, 2Robert Wood Johnson Foundation Clinical Scholars Program, Yale School of Medicine, 3Department of Health Policy and Management, Yale School of Public Health, 4Center for Outcomes Research and Evaluation, Yale–New Haven Hospital, 5Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT, 6Medtronic Inc, Minneapolis, MN, 7Division of Epidemiology, Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD, 8Division of Cardiology, Department of Medicine, University of Colorado, Aurora, CO, 9Department of Health Care Policy, Harvard Medical School, 10Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, MA, USA; 11Discipline of Medicine, University of Adelaide, Adelaide, SA, Australia; 12Department of Clinical Informatics, California Pacific Medical Center, San Francisco, CA, USA Background: Machine learning methods may complement traditional analytic methods for medical device surveillance.Methods and results: Using data from the National Cardiovascular Data Registry for implantable cardioverter–defibrillators (ICDs linked to Medicare administrative claims for longitudinal follow-up, we applied three statistical approaches to safety-signal detection for commonly used dual-chamber ICDs that used two propensity score (PS models: one specified by subject-matter experts (PS-SME, and the other one by machine learning-based selection (PS-ML. The first approach used PS-SME and cumulative incidence (time-to-event, the second approach used PS-SME and cumulative risk (Data Extraction and

  8. Prospective Randomized Evaluation of Implantable Cardioverter-Defibrillator Programming in Patients With a Left Ventricular Assist Device.

    Science.gov (United States)

    Richardson, Travis D; Hale, Leslie; Arteaga, Christopher; Xu, Meng; Keebler, Mary; Schlendorf, Kelly; Danter, Matthew; Shah, Ashish; Lindenfeld, JoAnn; Ellis, Christopher R

    2018-02-23

    Ventricular arrhythmias are common in patients with left ventricular assist devices (LVADs) but are often hemodynamically tolerated. Optimal implantable cardioverter defibrillator (ICD) tachy-programming strategies in patients with LVAD have not been determined. We sought to determine if an ultra-conservative ICD programming strategy in patients with LVAD affects ICD shocks. Adult patients with an existing ICD undergoing continuous flow LVAD implantation were randomized to standard ICD programming by their treating physician or an ultra-conservative ICD programming strategy utilizing maximal allowable intervals to detection in the ventricular fibrillation and ventricular tachycardia zones with use of ATP. Patients with cardiac resynchronization therapy (CRT) devices were also randomized to CRT ON or OFF. Patients were followed a minimum of 6 months. The primary outcome was time to first ICD shock. Among the 83 patients studied, we found no statistically significant difference in time to first ICD shock or total ICD shocks between groups. In the ultra-conservative group 16% of patients experienced at least one shock compared with 21% in the control group ( P =0.66). There was no difference in mortality, arrhythmic hospitalization, or hospitalization for heart failure. In the 41 patients with CRT ICDs fewer shocks were observed with CRT-ON but this was not statistically significant: 10% of patients with CRT-ON (n=21) versus 38% with CRT-OFF (n=20) received shocks ( P =0.08). An ultra-conservative programming strategy did not reduce ICD shocks. Programming restrictions on ventricular tachycardia and ventricular fibrillation zone therapy should be reconsidered for the LVAD population. The role of CRT in patients with LVAD warrants further investigation. URL: https://www.clinicaltrials.gov. Unique identifier: NCT01977703. © 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

  9. Implantable cardioverter defibrillator therapy in pediatric and congenital heart disease patients: a single tertiary center experience in Korea

    Directory of Open Access Journals (Sweden)

    Bo Kyung Jin

    2013-03-01

    Full Text Available Purpose: The use of implantable cardioverter defibrillators (ICDs to prevent sudden cardiac death is increasing in children and adolescents. This study investigated the use of ICDs in children with congenital heart disease. Methods: This retrospective study was conducted on the clinical characteristics and effectiveness of ICD implantation at the department of pediatrics of a single tertiary center between 2007 and 2011. Results: Fifteen patients underwent ICD implantation. Their mean age at the time of implantation was 14.5±5.4 years (range, 2 to 22 years. The follow-up duration was 28.9±20.4 months. The cause of ICD implantation was cardiac arrest in 7, sustained ventricular tachycardia in 6, and syncope in 2 patients. The underlying disorders were as follows: ionic channelopathy in 6 patients (long QT type 3 in 4, catecholaminergic polymorphic ventricular tachycardia [CPVT] in 1, and J wave syndrome in 1, cardiomyopathy in 5 patients, and postoperative congenital heart disease in 4 patients. ICD coils were implanted in the pericardial space in 2 children (ages 2 and 6 years. Five patients received appropriate ICD shock therapy, and 2 patients received inappropriate shocks due to supraventricular tachycardia.During follow-up, 2 patients required lead dysfunction-related revision. One patient with CPVT suffered from an ICD storm that was resolved using sympathetic denervation surgery. Conclusion: The overall ICD outcome was acceptable in most pediatric patients. Early diagnosis and timely ICD implantation are recommended for preventing sudden death in high-risk children and patients with congenital heart disease.

  10. Endoscopic versus external approach dacryocystorhinostomy: A ...

    African Journals Online (AJOL)

    Endoscopic versus external approach dacryocystorhinostomy: A comparative analysis. Rinki Saha, Anuradha Sinha, Jyoti Prakash Phukan. Abstract. Background: Dacryocystorhinostomy (DCR) consists of creating a lacrimal drainage pathway to the nasal cavity to restore permanent drainage of previously obstructed ...

  11. Pacemakers and implantable cardioverter defibrillators - general and anesthetic considerations

    Directory of Open Access Journals (Sweden)

    Amy G. Rapsang

    2014-06-01

    Full Text Available A pacemaking system consists of an impulse generator and lead or leads to carry the electrical impulse to the patient's heart. Pacemaker and implantable cardioverter defibrillator codes were made to describe the type of pacemaker or implantable cardioverter defibrillator implanted. Indications for pacing and implantable cardioverter defibrillator implantation were given by the American College of Cardiologists. Certain pacemakers have magnet-operated reed switches incorporated; however, magnet application can have serious adverse effects; hence, devices should be considered programmable unless known otherwise. When a device patient undergoes any procedure (with or without anesthesia, special precautions have to be observed including a focused history/physical examination, interrogation of pacemaker before and after the procedure, emergency drugs/temporary pacing and defibrillation, reprogramming of pacemaker and disabling certain pacemaker functions if required, monitoring of electrolyte and metabolic disturbance and avoiding certain drugs and equipments that can interfere with pacemaker function. If unanticipated device interactions are found, consider discontinuation of the procedure until the source of interference can be eliminated or managed and all corrective measures should be taken to ensure proper pacemaker function should be done. Post procedure, the cardiac rate and rhythm should be monitored continuously and emergency drugs and equipments should be kept ready and consultation with a cardiologist or a pacemaker-implantable cardioverter defibrillator service may be necessary.

  12. Environmental externalities and renewables: A policy perspective

    International Nuclear Information System (INIS)

    Sanghi, A.K.

    1992-01-01

    New York state electric utilities are required to incorporate the consideration of environmental externality costs in their bidding programs for new capacity. A natural extension of this policy would be to consider environmental externality costs in the state's implementation of federal regulations under the Public Utilities Regulatory Policies Act (PURPA). A more direct but more politically difficult approach would be the use of environmental taxes. These two approaches are discussed for more fully incorporating environmental externalities in New York's energy planning process. Under PURPA, utilities have a general obligation to purchase energy from interconnected qualifying facilities on the basis of long-run avoided cost (LRAC) estimates. The New York State Public Service Commission is currently updating the LRAC estimates, which do not account for the costs of complying with the 1990 amendments of the Clean Air Act (CAA) or for environmental externality costs associated with underlying generation sources. Environmental externality LRACs are estimated based on SO 2 , NO x , and CO 2 emissions; estimates of CAA compliance are relatively small in comparison. The use of taxes to reduce emissions by making pollution more expensive than abatement is analyzed, with reference to both general revenue and trust fund types of tax mechanisms. The ways the two mechanisms affect development of wind power resources is illustrated to provide further insight into the correct application of environmental externalities in energy planning. 8 refs., 3 figs., 2 tabs

  13. Nurse- and peer-led self-management programme for patients with an implantable cardioverter defibrillator; a feasibility study

    Directory of Open Access Journals (Sweden)

    van Eijk Jacques

    2007-09-01

    Full Text Available Abstract Background The prevalence of cardiovascular disease is increasing. Improved treatment options increase survival after an acute myocardial infarction or sudden cardiac arrest, although patients often have difficulty adjusting and regaining control in daily life. In particular, patients who received an implantable cardioverter defibrillator (ICD experience physical and psychological problems. Interventions to enhance perceived control and acceptance of the device are therefore necessary. This paper describes a small-scale study to explore the feasibility and the possible benefits of a structured nurse- and peer-led self-management programme ('Chronic Disease Self-Management Program' – CDSMP among ICD patients. Methods Ten male ICD patients (mean age = 65.5 years participated in a group programme, consisting of six sessions, led by a team consisting of a nurse specialist and a patient with cardiovascular disease. Programme feasibility was evaluated among patients and leaders by measuring performance of the intervention according to protocol, attendance and adherence of the participating ICD patients, and patients' and leaders' opinions about the programme. In addition, before and directly after attending the intervention, programme benefits (e.g. perceived control, symptoms of anxiety and depression, and quality of life were assessed. Results The programme was conducted largely according to protocol. Eight patients attended at least four sessions, and adherence ranged from good to very good. On average, the patients reported to have benefited very much from the programme, which they gave an overall report mark of 8.4. The leaders considered the programme feasible as well. Furthermore, improvements were identified for general self-efficacy expectancies, symptoms of anxiety, physical functioning, social functioning, role limitations due to physical problems, and pain. Conclusion This study suggests that a self-management programme led by a

  14. Methodological limitations of psychosocial interventions in patients with an implantable cardioverter-defibrillator (ICD A systematic review

    Directory of Open Access Journals (Sweden)

    Ockene Ira S

    2009-12-01

    Full Text Available Abstract Background Despite the potentially life-saving benefits of the implantable cardioverter-defibrillator (ICD, a significant group of patients experiences emotional distress after ICD implantation. Different psychosocial interventions have been employed to improve this condition, but previous reviews have suggested that methodological issues may limit the validity of such interventions. Aim: To review the methodology of previously published studies of psychosocial interventions in ICD patients, according to CONSORT statement guidelines for non-pharmacological interventions, and provide recommendations for future research. Methods We electronically searched the PubMed, PsycInfo and Cochrane databases. To be included, studies needed to be published in a peer-reviewed journal between 1980 and 2008, to involve a human population aged 18+ years and to have an experimental design. Results Twelve studies met the eligibility criteria. Samples were generally small. Interventions were very heterogeneous; most studies used cognitive behavioural therapy (CBT and exercise programs either as unique interventions or as part of a multi-component program. Overall, studies showed a favourable effect on anxiety (6/9 and depression (4/8. CBT appeared to be the most effective intervention. There was no effect on the number of shocks and arrhythmic events, probably because studies were not powered to detect such an effect. Physical functioning improved in the three studies evaluating this outcome. Lack of information about the indication for ICD implantation (primary vs. secondary prevention, limited or no information regarding use of anti-arrhythmic (9/12 and psychotropic (10/12 treatment, lack of assessments of providers' treatment fidelity (12/12 and patients' adherence to the intervention (11/12 were the most common methodological limitations. Conclusions Overall, this review supports preliminary evidence of a positive effect of psychosocial interventions

  15. The healthcare utilization and cost of treating patients experiencing inappropriate implantable cardioverter defibrillator shocks: a propensity score study.

    Science.gov (United States)

    Bhavnani, Sanjeev P; Giedrimiene, Dalia; Coleman, Craig I; Guertin, Danette; Azeem, Meena; Kluger, Jeffrey

    2014-10-01

    Inappropriate shocks (IASs) from implantable cardioverter defibrillators (ICDs) are associated with decreased quality of life, but whether they increase healthcare utilization and treatment costs is unknown. We sought to determine the impact of IASs on subsequent healthcare utilization and treatment costs. We conducted a case-control analysis of ICD patients at a single institution from 1997 to 2010 and who had ≥12 months of post-ICD implant follow-up. Cases included all patients experiencing an IAS during the first 12 months after implantation. Eligible control patients did not receive a shock of any kind during the 12 months after implantation. Propensity scores based on 36 covariates (area under curve = 0.78) were used to match cases to controls. We compared the rate (occurrences/person year [PY]) of healthcare utilization immediately following IAS to the end of the 12-month follow-up period to the rate in the no-shock group over 12 months of follow-up. We also compared 12-month postimplant treatment (outpatient clinic, emergency room, and hospitalization) costs in both groups. A total of 76 patients experiencing ≥1 IAS during the first 12 months after implant (contributing 48 PYs) were matched to 76 no-shock patients (contributing 76 PYs). Cardiovascular (CV)-related clinic visit and hospitalization rates were increased following an IAS compared to those not receiving a shock (4.0 vs 3.3 and 0.7 vs 0.5, respectively, P = 0.02 for both). CV-related emergency room visitation (0.15 vs 0.08) rates were also numerically higher following an IAS, but did not reach statistical significance (P = 0.26). Patients experiencing an IAS accrued greater treatment costs during the 12 months postimplant compared to no-shock patients ($13,973 ± $46,345 vs $6,790 ± $19,091, P = 0.001). Recipients of IAS utilize the healthcare system more frequently following an IAS than patients not experiencing a shock. This increased utilization results in higher costs of treating IAS

  16. Evaluation of acute cardiac and chest wall damage after shocks with a subcutaneous implantable cardioverter defibrillator in Swine.

    Science.gov (United States)

    Killingsworth, Cheryl R; Melnick, Sharon B; Litovsky, Silvio H; Ideker, Raymond E; Walcott, Gregory P

    2013-10-01

    A subcutaneous implantable cardioverter defibrillator (S-ICD) could ease placement and reduce complications of transvenous ICDs, but requires more energy than transvenous ICDs. Therefore we assessed cardiac and chest wall damage caused by the maximum energy shocks delivered by both types of clinical devices. During sinus rhythm, anesthetized pigs (38 ± 6 kg) received an S-ICD (n = 4) and five 80-Joule (J) shocks, or a transvenous ICD (control, n = 4) and five 35-J shocks. An inactive S-ICD electrode was implanted into the same control pigs to study implant trauma. All animals survived 24 hours. Troponin I and creatine kinase muscle isoenzyme (CK-MM) were measured as indicators of myocardial and skeletal muscle injury. Histopathological injury of heart, lungs, and chest wall was assessed using semiquantitative scoring. Troponin I was significantly elevated at 4 hours and 24 hours (22.6 ± 16.3 ng/mL and 3.1 ± 1.3 ng/mL; baseline 0.07 ± 0.09 ng/mL) in control pigs but not in S-ICD pigs (0.12 ± 0.11 ng/mL and 0.13 ± 0.13 ng/mL; baseline 0.06 ± 0.03 ng/mL). CK-MM was significantly elevated in S-ICD pigs after shocks (6,544 ± 1,496 U/L and 9,705 ± 6,240 U/L; baseline 704 ± 398 U/L) but not in controls. Electrocardiogram changes occurred postshock in controls but not in S-ICD pigs. The myocardium and lungs were histologically normal in both groups. Subcutaneous injury was greater in S-ICD compared to controls. Although CK-MM suggested more skeletal muscle injury in S-ICD pigs, significant cardiac, lung, and chest wall histopathological changes were not detected in either group. Troponin I data indicate significantly less cardiac injury from 80-J S-ICD shocks than 35-J transvenous shocks. ©2013, The Authors. Journal compilation ©2013 Wiley Periodicals, Inc.

  17. Evaluation of acute cardiac and chest wall damage after shocks with a subcutaneous implantable cardioverter-defibrillator in swine

    Science.gov (United States)

    KILLINGSWORTH, CHERYL R.; MELNICK, SHARON B.; LITOVSKY, SILVIO H.; IDEKER, RAYMOND E.; WALCOTT, GREGORY P.

    2013-01-01

    Background A subcutaneous implantable cardioverter defibrillator (S-ICD) could ease placement and reduce complications of transvenous ICDs, but requires more energy than transvenous ICDs. Therefore we assessed cardiac and chest wall damage caused by the maximum energy shocks delivered by both types of clinical devices. Methods During sinus rhythm, anesthetized pigs (38±6 kg) received an S-ICD (n = 4) and five 80-Joule (J) shocks, or a transvenous ICD (control, n = 4) and five 35-J shocks. An inactive S-ICD electrode was implanted into the same control pigs to study implant trauma. All animals survived 24-hours. Troponin I and creatine kinase muscle isoenzyme (CK-MM) were measured as indicators of myocardial and skeletal muscle injury. Histopathological injury of heart, lungs, and chest wall was assessed using semi-quantitative scoring. Results Troponin I was significantly elevated at 4- and 24-hours (22.6±16.3 and 3.1±1.3 ng/ml; baseline 0.07±0.09 ng/ml) in control pigs but not in S-ICD pigs (0.12±0.11 and 0.13±0.13 ng/ml; baseline 0.06±0.03 ng/ml). CK-MM was significantly elevated in S-ICD pigs after shocks (6544±1496 and 9705±6240 U/L; baseline 704±398 U/L) but not in controls. ECG changes occurred post-shock in controls but not in S-ICD pigs. The myocardium and lungs were histologically normal in both groups. Subcutaneous injury was greater in S-ICD compared to controls. Conclusion Although CK-MM suggested more skeletal muscle injury in S-ICD pigs, significant cardiac, lung, and chest wall histopathological changes were not detected in either group. Troponin I data indicate significantly less cardiac injury from 80-J S-ICD shocks than 35-J transvenous shocks. PMID:23713608

  18. The challenges and possibilities of public access defibrillation

    DEFF Research Database (Denmark)

    Ringh, Mattias; Hollenberg, Jacob; Palsgaard-Moeller, Thea

    2018-01-01

    . Much hope has been put to the concept of Public Access Defibrillation with a massive dissemination of public available AEDs throughout most western countries. Accordingly, current guidelines recommend that AEDs should be deployed in places with a high likelihood of OHCA. Despite these efforts, AED use...... is in most settings anecdotal with little effect on overall OHCA survival. The major reasons for low use of public AEDs are that most OHCA take place outside high incidence sites of cardiac arrest and that most OHCAs take place in residential settings, currently defined as not suitable for Public Access...... Defibrillation. However, the use of new technology for identification and recruitment of lay bystanders and nearby AEDs to the scene of the cardiac arrest as well as new methods for strategic AED placement redefines and challenges the current concept and definitions of Public Access Defibrillation. Existing...

  19. Praehospital-hjertestopbehandling med semiautomatisk defibrillator--Heartstart 2000

    DEFF Research Database (Denmark)

    Fonsmark, L; Sandøe, E; Kastrup, J

    1989-01-01

    %. No practical problems of note occurred in connection with employment of the defibrillator. The ambulance staffs underwent six hours of training and this appeared to be adequate. It is concluded that Heartstart 2000 functions well and effectively in connection with revival of patients with cardiac arrest......In order to test the efficacy of a semiautomatic defibrillator (Heartstart 2000) in connection with cardiac arrest outside hospital, the apparatus was installed in two of the ambulances belonging to the Copenhagen Fire Service. The ambulance district involved was also equipped with an ambulance...... staffed by a doctor. A total of 48 patients with cardiac arrest were found and 16 of these had ventricular fibrillation. Six of the 16 patients have since been discharged from hospital (37.5%). The defibrillator had a high diagnostic certainty with a sensitivity of 96.5% and a specificity of 100...

  20. A model for external dosimetry

    International Nuclear Information System (INIS)

    Henderson, R.W.; Coleman, J.B.

    1984-01-01

    This model was designed to estimate possible exposures from atmospheric testing. The FORTRAN 77 code follows an individual's living pattern as he or she moves about in a radiation field. The primary input is the time sequence of location changes relative to the individual's exposure. The changes from one shielding situation to another are stored and appropriate exposure modifiers assigned. These input data may be supplied directly, or assigned as generic information. Provision is made for following the individual through a series of changes representative of weekdays, Saturdays and Sundays. These data are also seasonally specific (one set each for spring, summer, fall and winter). The use of free formatting and item counting allows entry of the data on a day-by-day basis of any number of changes up to a given maximum. Exposure modifiers are currently input for five separate locations (bedroom, living room, public building, outdoors and a closed car). The model enters the tabulated data at any given time, selects the exposure modifier, the next change and calculates the free-in-air gamma exposure during the period from an exposure rate versus time function. The code then calculates the expected exposure using the exposure modifier. Accumulated exposures are converted to organ doses. The model estimates skin doses from beta particles as well as gamma radiation by accounting for periods of time out-of-doors and direct skin contamination. This entire program may be run deterministically (all input parameters constant) or stochastically with the various parameters selected from appropriate distributions, or as a combination of the two. Statistical information is derived from multiple executions of the stochastic version of the code. Results of representative executions are presented

  1. A comparison of the health status and psychological distress of partners of patients with a left ventricular assist device versus an implantable cardioverter defibrillator

    DEFF Research Database (Denmark)

    Brouwers, Corline; Caliskan, Kadir; de Jonge, Nicolaas

    2014-01-01

    (F = 10.71, p = .001) but poorer mental health status (F = 14.82, p depression scores compared to ICD partners (F = 3.68, p = .05) at 6 months follow-up, also in adjusted analyses. There was no significant difference between groups on anxiety. CONCLUSION: Caregivers of LVAD......OBJECTIVE: To examine if the caregiving for patients with a left ventricular assist device (LVAD) is related to a poorer health status and more distress compared to patients with an implantable cardioverter defibrillator (ICD). BACKGROUND: Partners distress may influence patient outcomes...... and is therefore an important aspect in the care of LVAD and ICD patients. METHODS: Multi-center prospective observational study with 6 months follow-up of 33 LVAD partners (27% men; mean age = 54 ± 10 years) and 414 ICD partners (22% men; mean age = 60 ± 12 years). RESULTS: LVAD partners reported better physical...

  2. External radiotherapy in a pleural mesothelioma tumor

    International Nuclear Information System (INIS)

    Fernandez, M.C.; Garcia, J.L.; Gomez, A.; Simon, J.L.; Maillo, M.; Jimenez Torres, M. J.

    1994-01-01

    Pleural mesothelioma is an uncommon tumor compared with other thoracic malignancies and a 80% of the cases have asbestos exposure. From 1983 to 1992 we have examined patients suffering from malignant pleural mesothelioma treated with external radiotherapy. We treated 11 patients of which 9 were males and 2 were females. The most frequent symptom was the chest pain and all these patients underwent a torascoscopy followed by a pleasured. Of the 11 cases: 10 were malignant epithelial mesothelioma and 1 was a mixed pleural case. Afterwards, they were treated with external radiotherapy between 30 and 55 Gy, with few complications. At the moment, 5 patients are still alive and there is a survival rate of 50% at 24 and 60 months and of 25% at 120 months. We think that external radiotherapy is a good palliative treatment with few complications. (Author) 28 refs

  3. Underutilisation of public access defibrillation is related to retrieval distance and time-dependent availability.

    Science.gov (United States)

    Deakin, Charles D; Anfield, Steve; Hodgetts, Gillian A

    2018-05-14

    Public access defibrillation doubles the chances of neurologically intact survival following out-of-hospital cardiac arrest (OHCA). Although there are increasing numbers of defibrillators (automated external defibrillator (AEDs)) available in the community, they are used infrequently, despite often being available. We aimed to match OHCAs with known AED locations in order to understand AED availability, the effects of reduced AED availability at night and the operational radius at which they can be effectively retrieved. All emergency calls to South Central Ambulance Service from April 2014 to April 2016 were screened to identify cardiac arrests. Each was mapped to the nearest AED, according to the time of day. Mapping software was used to calculate the actual walking distance for a bystander between each OHCA and respective AED, when travelling at a brisk walking speed (4 mph). 4012 cardiac arrests were identified and mapped to one of 2076 AEDs. All AEDs were available during daytime hours, but only 713 at night (34.3%). 5.91% of cardiac arrests were within a retrieval (walking) radius of 100 m during the day, falling to 1.59% out-of-hours. Distances to rural AEDs were greater than in urban areas (P<0.0001). An AED could potentially have been retrieved prior to actual ambulance arrival in 25.3% cases. Existing AEDs are underused; 36.4% of OHCAs are located within 500 m of an AED. Although more AEDs will improve availability, greater use can be made of existing AEDs, particularly by ensuring they are all available on a 24/7 basis. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  4. Praehospital-hjertestopbehandling med semiautomatisk defibrillator--Heartstart 2000

    DEFF Research Database (Denmark)

    Fonsmark, L; Sandøe, E; Kastrup, J

    1989-01-01

    staffed by a doctor. A total of 48 patients with cardiac arrest were found and 16 of these had ventricular fibrillation. Six of the 16 patients have since been discharged from hospital (37.5%). The defibrillator had a high diagnostic certainty with a sensitivity of 96.5% and a specificity of 100......%. No practical problems of note occurred in connection with employment of the defibrillator. The ambulance staffs underwent six hours of training and this appeared to be adequate. It is concluded that Heartstart 2000 functions well and effectively in connection with revival of patients with cardiac arrest...

  5. Higher defibrillation threshold in methamphetamine cardiomyopathy patients with implantable cardioverter-defibrillator

    Directory of Open Access Journals (Sweden)

    Rakesh Malhotra

    2017-11-01

    Full Text Available Introduction: Identification of patients with an increased risk of high defibrillation thresholds (DFTs is important in planning implantable cardioverter-defibrillator (ICD procedures. Clinical observations have suggested that patients with methamphetamine cardiomyopathy (MACMP have significantly elevated defibrillation thresholds. We hypothesized that MACMP patients would have higher DFT thresholds than controls and would require procedural changes during ICD implantation to accommodate higher thresholds. Methods: We identified consecutive patients with MACMP undergoing ICD implantation at the academic center from 2003 to 2007. We then compared DFTs against age-and sex-matched controls. Results: The MACMP (n = 10 group showed significantly increased DFT thresholds (23.7 ± 6.7 J compared with age and sex-matched controls (14.5 ± 4.6 J, p < 0.005. Additionally, patients with MACMP had evidence of more severe congestive heart failure, with increased B-type natrieutic protein (BNP levels (1173 ± 784 vs 260 ± 349, p = 0.02 and decreased left ventricular ejection fraction (LVEF (17.8 ± 9.4 vs 35.9 ± 15.2, p = 0.02. MACMP patients required high output devices than controls (50% versus 0%, p = 0.03. Differences between groups remained significant despite adjusting for LVEF. Conclusions: Planning for ICD implantation should take into consideration a history of methamphetamine abuse, mandating DFT testing and empiric consideration of high output devices for such patients. Keywords: Methamphetamine cardiomyopathy, Implantable cardioverter-defibrillatior, Defibrillation threshold testing, B-type natriuretic peptide, Ejection fraction

  6. Implantable cardioverter defibrillators in the context of hypertrophic cardiomyopathy: a lesson in patient autonomy.

    Science.gov (United States)

    Bray, Jonathan James Hyett; Bucciarelli-Ducci, Chiara; Stuart, Graham

    2018-02-05

    Hypertrophiccardiomyopathy (HCM) is common, whereas the decision not to have an implantable cardioverterdefibrillator (ICD) when probably falling into a 'high-risk' category is not. A solicitor aged 45 years attended the inherited cardiac conditions clinic for review of her HCM and discussion about ICD implantation for primary prevention of sudden cardiac death (SCD). Despite a predicted 7% risk of SCD within the next 5 years, according to the European Society of Cardiology endorsed HCM Risk-SCD risk stratification tool, the patient opted against implantation of an ICD and comprehensively justifies her decision. This report discusses ethical aspects of a consultation offering ICD protection against SCD in the context of HCM and emphasises the clinicians' role in respecting patient autonomy. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  7. Clinical and psychological impact of prophylactic implantable cardioverter-defibrillators in a community heart failure population.

    LENUS (Irish Health Repository)

    Arnous, S

    2012-02-01

    AIMS: ICD implantation for primary prevention of sudden cardiac death in patients with left ventricular systolic dysfunction (ejection fraction <\\/= 35%) has increased since the publication of the SCD-HEFT and MADIT-II data. The aim of this study is to examine the effectiveness and safety of prophylactic ICD use in a community heart failure population and to assess the impact on patient\\'s quality of life. METHODS AND RESULTS: Seventy-one ICDs were inserted between the years 2002 and 2006. The mean follow-up from time of insertion was 24 +\\/- 11 months. Eighteen patients (25%) had potentially life-saving therapy. Seven (10%) patients received inappropriate shocks. Complications were encountered in five patients (7%). CONCLUSION: In a community heart failure population, prophylactic ICD implantation is associated with a high incidence of life-saving therapy, a low complication rate and a high level of tolerability. These data indicate translation of clinical trial benefits to the general heart failure population.

  8. Shock as a determinant of poor patient-centered outcomes in implantable cardioverter defibrillator patients

    DEFF Research Database (Denmark)

    Pedersen, Susanne S.; Van Den Broek, Krista C; Van Den Berg, Martha

    2010-01-01

    as an outcome, and compare the influence of ICD shock with other factors (e.g., heart failure and psychological factors) as determinants of outcomes, with a view to providing recommendations for clinical practice and future research. Based on the large-scale primary and secondary prevention trials (i.e., CABG......-PATCH, CIDS, AVID, AMIOVIRT, SCD-HeFT, MADIT-II, and DEFINITE), evidence for an association between ICD shocks and quality of life is mixed, with some indication that the influence of shocks may depend largely on the interval between shocks and assessment of quality of life. In order to improve the clinical...... management of ICD patients, we need to adopt a more rigorous and standardized methodology in future studies in order to be able to draw firm conclusions about the impact of ICD shocks on individual patients. We also need to acknowledge that the impact of shocks on psychological functioning and quality...

  9. External CSR Communication in a Strategic Approach

    Directory of Open Access Journals (Sweden)

    Diana Corina GLIGOR-CIMPOIERU

    2014-12-01

    Full Text Available As part of a strategic approach, aimed at assuring mutual benefits for the social cause and the business organization, a good CSR - Corporate Social Responsibility communication is vital for the success of a CSR program. We argue that there is not a problem with the legitimacy of the CSR concept, but rather to its implementation. If a business organization implementing socially responsible initiatives is focusing only on reaping the image benefits from a simple public relations perspective, then it loses all the potential business benefits it could gain from a strategic approach focused on long term real results in a win-win perspective. The fact that the image benefit is one of the most important incentives that a business organization could obtain for engaging in CSR activities cannot be ignored, and that is the reason why we have chosen to analyse the topic of CSR communication, mainly external communication, as an important link in the process of implementing a CSR program, that plays an important part for the success of a CSR program. The approach on CSR communication should definitely be a strategic one, and long already common forms of external CSR communication like web pages or CSR annual reports new means of social media networks have an increasing importance. For the practical part of the paper, we were interested in analyzing how much of the external CSR communication in the Romanian business environment is oriented toward a traditional or a strategic approach.

  10. Daily remote monitoring of implantable cardioverter-defibrillators

    DEFF Research Database (Denmark)

    Hindricks, Gerhard; Varma, Niraj; Kacet, Salem

    2017-01-01

    Aims: Remote monitoring of implantable cardioverter-defibrillators may improve clinical outcome. A recent meta-analysis of three randomized controlled trials (TRUST, ECOST, IN-TIME) using a specific remote monitoring system with daily transmissions [Biotronik Home Monitoring (HM)] demonstrated...

  11. Shock whilst gardening--implantable defibrillators & lawn mowers.

    Science.gov (United States)

    Von Olshausen, G; Lennerz, C; Grebmer, C; Pavaci, H; Kolb, C

    2014-02-01

    Electromagnetic interference with implantable cardioverter defibrillators (ICDs) can cause inappropriate shock delivery or temporary inhibition of ICD functions. We present a case of electromagnetic interference between a lawn mower and an ICD resulting in an inappropriate discharge of the device due to erroneous detection of ventricular fibrillation.

  12. Computational cardiology: the bidomain based modified Hill model incorporating viscous effects for cardiac defibrillation

    Science.gov (United States)

    Cansız, Barış; Dal, Hüsnü; Kaliske, Michael

    2017-10-01

    Working mechanisms of the cardiac defibrillation are still in debate due to the limited experimental facilities and one-third of patients even do not respond to cardiac resynchronization therapy. With an aim to develop a milestone towards reaching the unrevealed mechanisms of the defibrillation phenomenon, we propose a bidomain based finite element formulation of cardiac electromechanics by taking into account the viscous effects that are disregarded by many researchers. To do so, the material is deemed as an electro-visco-active material and described by the modified Hill model (Cansız et al. in Comput Methods Appl Mech Eng 315:434-466, 2017). On the numerical side, we utilize a staggered solution method, where the elliptic and parabolic part of the bidomain equations and the mechanical field are solved sequentially. The comparative simulations designate that the viscoelastic and elastic formulations lead to remarkably different outcomes upon an externally applied electric field to the myocardial tissue. Besides, the achieved framework requires significantly less computational time and memory compared to monolithic schemes without loss of stability for the presented examples.

  13. External Validation of a Prediction Model for Successful External Cephalic Version

    NARCIS (Netherlands)

    de Hundt, Marcella; Vlemmix, Floortje; Kok, Marjolein; van der Steeg, Jan W.; Bais, Joke M.; Mol, Ben W.; van der Post, Joris A.

    2012-01-01

    We sought external validation of a prediction model for the probability of a successful external cephalic version (ECV). We evaluated the performance of the prediction model with calibration and discrimination. For clinical practice, we developed a score chart to calculate the probability of a

  14. Risk of chronic anxiety in implantable defibrillator patients

    DEFF Research Database (Denmark)

    Pedersen, Susanne S.; den Broek, Krista C van; Theuns, Dominic A M J

    2011-01-01

    Little is known about the prevalence of chronic anxiety in patients with an implantable cardioverter defibrillator (ICD). In a multi-center, prospective study, we examined 1) the prevalence of chronic anxiety (i.e., patients anxious at implantation and 12 months), and 2) predictors of chronic...... anxiety....

  15. Testing of Anesthesia Machines and Defibrillators in Healthcare Institutions.

    Science.gov (United States)

    Gurbeta, Lejla; Dzemic, Zijad; Bego, Tamer; Sejdic, Ervin; Badnjevic, Almir

    2017-09-01

    To improve the quality of patient treatment by improving the functionality of medical devices in healthcare institutions. To present the results of the safety and performance inspection of patient-relevant output parameters of anesthesia machines and defibrillators defined by legal metrology. This study covered 130 anesthesia machines and 161 defibrillators used in public and private healthcare institutions, during a period of two years. Testing procedures were carried out according to international standards and legal metrology legislative procedures in Bosnia and Herzegovina. The results show that in 13.84% of tested anesthesia machine and 14.91% of defibrillators device performance is not in accordance with requirements and should either have its results be verified, or the device removed from use or scheduled for corrective maintenance. Research emphasizes importance of independent safety and performance inspections, and gives recommendations for the frequency of inspection based on measurements. Results offer implications for adequacy of preventive and corrective maintenance performed in healthcare institutions. Based on collected data, the first digital electronical database of anesthesia machines and defibrillators used in healthcare institutions in Bosnia and Herzegovina is created. This database is a useful tool for tracking each device's performance over time.

  16. Implantable cardioverter defibrillator specific rehabilitation improves health cost outcomes

    DEFF Research Database (Denmark)

    Berg, Selina Kikkenborg; Zwisler, Ann-Dorthe; Koch, Mette Bjerrum

    2015-01-01

    OBJECTIVE: The Copenhagen Outpatient ProgrammE - implantable cardioverter defibrillator (COPE-ICD) trial included patients with implantable cardioverter defibrillators in a randomized controlled trial of rehabilitation. After 6-12 months significant differences were found in favour of the rehabil...... was -6,789 USD/-5,593 Euro in favour of rehabilitation. CONCLUSION: No long-term health outcome benefits were found for the rehabilitation programme. However, the rehabilitation programme resulted in a reduction in total attributable direct costs....... of the rehabilitation group for exercise capacity, general and mental health. The aim of this paper is to explore the long-term health effects and cost implications associated with the rehabilitation programme; more specifically, (i) to compare implantable cardioverter defibrillator therapy history and mortality...... between rehabilitation and usual care groups; (ii) to examine the difference between rehabilitation and usual care groups in terms of time to first admission; and (iii) to determine attributable direct costs. METHODS: Patients with first-time implantable cardioverter defibrillator implantation (n = 196...

  17. Design and Methods for a Pilot Study of a Phone-Delivered, Mindfulness-Based Intervention in Patients with Implantable Cardioverter Defibrillators

    Directory of Open Access Journals (Sweden)

    Elena Salmoirago-Blotcher

    2012-01-01

    Full Text Available Background. Meditation practices are associated with a reduction in adrenergic activity that may benefit patients with severe cardiac arrhythmias. This paper describes the design and methods of a pilot study testing the feasibility of a phone-delivered mindfulness-based intervention (MBI for treatment of anxiety in patients with implantable cardioverter defibrillators (ICDs. Design and Methods. Consecutive, clinically stable outpatients (n=52 will be screened for study eligibility within a month of an ICD-related procedure or ICD shock and will be randomly assigned to MBI or to usual care. MBI patients will receive eight weekly individual phone sessions based on two mindfulness practices (awareness of breath and body scan plus home practice with a CD for 20 minutes daily. Patients assigned to usual care will be offered the standard care planned by the hospital. Assessments will occur at baseline and at the completion of the intervention (between 9 and 12 weeks after randomization. The primary study outcome is feasibility; secondary outcomes include anxiety, mindfulness, and number of administered shocks during the intervention period. Conclusions. If proven feasible and effective, phone-delivered mindfulness-based interventions could improve psychological distress in ICD outpatients with serious cardiovascular conditions.

  18. Effects of postshock atrial pacing on atrial defibrillation outcome in the isolated sheep heart

    NARCIS (Netherlands)

    Skanes, A. C.; Gray, R. A.; Zuur, C. L.; Jalife, J.

    1998-01-01

    BACKGROUND: Failed atrial defibrillation shocks are associated with organization of postshock activity and a substantial postshock electrical quiescence. We investigated the ability of a train of pacing stimuli to capture or locally entrain atrial myocardium during the quiescent period after

  19. A Methodology Proposal to Calculate the Externalities of Liquid Biofuels

    Energy Technology Data Exchange (ETDEWEB)

    Galan, A.; Gonzalez, R.; Varela, M. [Ciemat. Madrid (Spain)

    1999-05-01

    The aim of the survey is to propose a methodology to calculate the externalities associated with the liquid bio fuels cycle. The report defines the externalities from a theoretical point of view and classifies them. The reasons to value the externalities are explained as well as the existing methods. Furthermore, an evaluation of specific environmental and non-environmental externalities is also presented. The report reviews the current situation of the transport sector, considering its environmental effects and impacts. The progress made by the ExternE and ExternE-transport projects related the externalities of transport sector is assessed. Finally, the report analyses the existence of different economic instruments to internalize the external effects of the transport sector as well as other aspects of this internalization. (Author) 58 refs.

  20. Regional Externalities

    NARCIS (Netherlands)

    Heijman, W.J.M.

    2007-01-01

    The book offers practical and theoretical insights in regional externalities. Regional externalities are a specific subset of externalities that can be defined as externalities where space plays a dominant role. This class of externalities can be divided into three categories: (1) externalities

  1. Catheter ablation for the treatment of electrical storm in patients with implantable cardioverter-defibrillators: short- and long-term outcomes in a prospective single-center study.

    Science.gov (United States)

    Carbucicchio, Corrado; Santamaria, Matteo; Trevisi, Nicola; Maccabelli, Giuseppe; Giraldi, Francesco; Fassini, Gaetano; Riva, Stefania; Moltrasio, Massimo; Cireddu, Manuela; Veglia, Fabrizio; Della Bella, Paolo

    2008-01-29

    Electrical storm (ES) caused by recurrent episodes of ventricular tachycardia (VT) can cause sudden death in patients with implantable cardioverter-defibrillators and adversely affects prognosis in survivors. Catheter ablation has been proposed for treating ES, but its long-term effect in a large population has never been verified. Ninety-five consecutive patients with coronary artery disease (72 patients), idiopathic dilated cardiomyopathy (10 patients), and arrhythmogenic right ventricular dysplasia/cardiomyopathy (13 patients) undergoing catheter ablation for drug-refractory ES were prospectively evaluated. Short-term efficacy was defined by a complete protocol of programmed electric stimulation and by in-hospital outcome; long-term analysis addressed ES recurrence, cardiac mortality, and VT recurrence. Pleomorphic/nontolerated VTs required electroanatomic and noncontact mapping in 48 and 22 patients, respectively, and percutaneous cardiopulmonary support in 10 patients. An epicardial approach was used in 10 patients. After 1 to 3 procedures, induction of any clinical VT(s) by programmed electrical stimulation was prevented in 85 patients (89%). ES was acutely suppressed in all patients; a minimum period of 7 days with stable rhythm was required before hospital discharge. At a median follow-up of 22 months (range, 1 to 43 months), 87 patients (92%) were free of ES and 63 patients (66%) were free of VT recurrence. Eight of 10 patients with persistent inducibility of clinical VT(s) had ES recurrence; 4 of them died suddenly despite appropriate implantable cardioverter-defibrillator intervention. All together, 11 of 95 patients (12%) died of cardiac-related reasons. In the group of patients presenting with all clinical VTs acutely abolished, no ES recurrence was documented, and cardiac mortality was significantly lower compared with the group of patients showing > or = 1 clinical VT still inducible after catheter ablation. Advanced strategies of catheter ablation

  2. Externalities and the Coase Theorem: A Diagrammatic Presentation

    Science.gov (United States)

    Halteman, James

    2005-01-01

    In intermediate microeconomic textbooks the reciprocal nature of externalities is presented using numerical examples of costs and benefits. This treatment of the Coase theorem obscures the fact that externality costs and benefits are best understood as being on a continuum where costs vary with the degree of intensity of the externality. When…

  3. The Role of Implantable Cardioverter Defibrillators in Patients Bridged to Transplantation with a Continuous Flow Left Ventricular Assist Device: A Propensity Score Matched Analysis

    Science.gov (United States)

    Clerkin, Kevin J.; Topkara, Veli K.; Mancini, Donna M.; Yuzefpolskaya, Melana; Demmer, Ryan T.; Dizon, Jose M.; Takeda, Koji; Takayama, Hiroo; Naka, Yoshifumi; Colombo, Paolo C.; Garan, A. Reshad

    2016-01-01

    Background Implantable cardioverter defibrillators (ICD) provide a significant mortality benefit for appropriately selected patients with advanced heart failure. ICDs are associated with a mortality benefit when used in patients with a pulsatile left ventricular assist device (LVAD). However it is unclear whether patients with a continuous flow LVAD (CF-LVAD) derive the same benefit. This study sought to determine if the presence of an ICD provided a mortality benefit during CFLVAD support as a bridge to transplantation. Methods Patients were identified in the United Network for Organ Sharing (UNOS) registry that underwent LVAD implantation as bridge to transplantation from May 2004 and April 2014, with follow-up through June 2014. The primary outcome was freedom from death while on CF-LVAD support with adjustment for complications requiring UNOS listing status upgrade. Secondary endpoints included freedom from delisting while on CF-LVAD support and incidence of transplantation. Results 2,990 patients composed the study cohort and propensity score matching identified 1,012 patients with similar propensity scores. There was no difference in survival during device support between patients with and without an ICD (Hazard Ratio [HR] 1.20, 95% Confidence Interval [CI] 0.66-2.17, p=0.55). Adjusting for device complications requiring a UNOS listing status upgrade had minimal influence (HR 1.11, 95% CI 0.60-2.05, p=0.74). There was no increased risk of delisting due to being too sick for those with an ICD (HR 1.08, 95% CI 0.63-1.86, p=0.78). Likewise, the probability of transplantation was similar (HR 1.05, 95% CI 0.87-1.27, p=0.62). Conclusions Among patients bridged to transplantation with a CF-LVAD, the presence of an ICD did not reduce mortality. PMID:28089072

  4. The role of implantable cardioverter defibrillators in patients bridged to transplantation with a continuous-flow left ventricular assist device: A propensity score matched analysis.

    Science.gov (United States)

    Clerkin, Kevin J; Topkara, Veli K; Mancini, Donna M; Yuzefpolskaya, Melana; Demmer, Ryan T; Dizon, Jose M; Takeda, Koji; Takayama, Hiroo; Naka, Yoshifumi; Colombo, Paolo C; Garan, A Reshad

    2017-06-01

    Implantable cardioverter defibrillators (ICDs) provide a significant mortality benefit for appropriately selected patients with advanced heart failure. ICDs are associated with a mortality benefit when used in patients with a pulsatile left ventricular assist device (LVAD). It is unclear whether patients with a continuous-flow LVAD (CF-LVAD) derive the same benefit. We sought to determine if the presence of an ICD provided a mortality benefit during CF-LVAD support as a bridge to transplantation. Patients were identified in the United Network for Organ Sharing (UNOS) registry who underwent LVAD implantation as bridge to transplantation between May 2004 and April 2014, with follow-up through June 2014. Primary outcome was freedom from death while on CF-LVAD support with adjustment for complications requiring UNOS listing status upgrade. Secondary end-points included freedom from delisting while on CF-LVAD support and incidence of transplantation. The study cohort comprised 2,990 patients, and propensity score matching identified 1,012 patients with similar propensity scores. There was no difference in survival during device support between patients with and without an ICD (hazard ratio [HR] = 1.20; 95% confidence interval [CI], 0.66-2.17; p = 0.55). Adjusting for device complications requiring a UNOS listing status upgrade had minimal influence (HR = 1.11; 95% CI, 0.60-2.05; p = 0.74). There was no increased risk of delisting owing to being too sick for patients with an ICD (HR = 1.08; 95% CI, 0.63-1.86; p = 0.78). Likewise, the probability of transplantation was similar (HR = 1.05; 95% CI, 0.87-1.27; p = 0.62). Among patients bridged to transplantation with a CF-LVAD, the presence of an ICD did not reduce mortality. Copyright © 2017 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.

  5. Effect of psycho-educational interventions on quality of life in patients with implantable cardioverter defibrillators: a meta-analysis of randomized controlled trials.

    Science.gov (United States)

    Kao, Chi-Wen; Chen, Miao-Yi; Chen, Ting-Yu; Lin, Pai-Hui

    2016-09-30

    Implantable cardioverter defibrillators (ICD) were developed for primary and secondary prevention of sudden cardiac death. However, ICD recipients' mortality is significantly predicted by their quality of life (QOL). The aim of this meta-analysis was to evaluate the effects of psycho-educational interventions on QOL in patients with ICDs. We systematically searched PubMed, Medline, Cochrane Library, and CINAHL through April 2015 and references of relevant articles. Studies were reviewed if they met following criteria: (1) randomized controlled trial, (2) participants were adults with an ICD, and (3) data were sufficient to evaluate the effect of psychological or educational interventions on QOL measured by the SF-36 or SF-12. Studies were independently selected and their data were extracted by two reviewers. Study quality was evaluated using a modified Jadad scale. The meta-analysis was conducted using the Cochrane Collaboration's Review Manager Software Package (RevMan 5). Study heterogeneity was assessed by Q statistics and I 2 statistic. Depending on heterogeneity, data were pooled across trials using fixed-effect or random-effect modeling. Seven randomized controlled trials fulfilled the inclusion and exclusion criteria, and included 1017 participants. The psycho-educational interventions improved physical component summary (PCS) scores in the intervention groups more than in control groups (mean difference 2.08, 95 % CI 0.86 to 3.29, p educational interventions improved the physical component, but not the mental component of QOL in patients with ICDs.

  6. A common language in external radiotherapy

    International Nuclear Information System (INIS)

    Gerard, J.P.; Sentenac, I.; Carrie, C.; Barbet, N.

    1990-01-01

    In June 1989, an International meeting with the joint participation of Radiation Oncologists and Radiophysicists took place in Lyon. The aim of the meeting was to reach a common language in external radiotherapy. The ICRU report no 29 is the gold standard in that field. However it appears that it is not always used in practice. Some ambiguous points require further clarification. A consensus can be reached for the definition of concepts like, tumour volume, target volume, safety margin. A clear distinction must be made between prescribed dose (dose that the radiation oncologist wants to deliver in the target volume) and the reported or specified dose (dose used to describe the treatment after completion). With the modern techniques of irradiation, a rather homogeneous dose can be delivered in the target volume. It seems possible that a variation of -5% and +7-10% can be accepted in relation to a mean dose in the center of the target volume. A very important question remains unsolved. What is the dose which governs the likelihood of local control in the target volume. Is it a minimal dose at the periphery of the target volume or a mean dose in the center. The last hypothesis would have the advantage to simplify the relation between the prescribed and the reported dose. The reported or specified dose should always be mentioned according to the recommendation of the future revised ICRU report 29 [fr

  7. Cardioverter-defibrillator implantation in myeloma-associated cardiac amyloidosis.

    Science.gov (United States)

    Campanile, Alfonso; Sozzi, Fabiola B; Canetta, Ciro; Danzi, Gian Battista

    2013-01-01

    A 62-year-old woman with multiple myeloma and light-chain amyloidosis with significant heart involvement developed an in-hospital cardiac arrest. After cardiopulmonary resuscitation, a stable sinus rhythm without any cerebral damage was restored, and the patient was admitted to the coronary care unit. A cardioverter-defibrillator was implanted, and it successfully intervened in two sustained ventricular tachycardia episodes and one ventricular fibrillation episode, which were recorded during hospitalization. After achieving discrete cardiac compensation, the patient was transferred to the emergency medicine department where she underwent chemotherapy for multiple myeloma. The patient died 40 days after admission from refractory heart failure. In the literature, there are studies that describe the use of cardioverter-defibrillator implantation in cardiac amyloidosis; however, at present, there is no evidence of a beneficial effect on survival with the use of this intervention. A high index of suspicion for amyloid heart disease and early diagnosis are critical to improving outcomes.

  8. Implantable Cardioverter Defibrillator

    Science.gov (United States)

    ... interfere with an ICD include: Cell phones and MP3 players (for example, iPods) Household appliances, such as ... experts recommend not putting your cell phone or MP3 player in a shirt pocket over your ICD ( ...

  9. Pacemaker, implanted cardiac defibrillator and irradiation: Management proposal in 2010 depending on the type of cardiac stimulator and prognosis and location of cancer; Pacemaker, defibrillateur et radiotherapie: propositions de conduite a tenir en 2010 en fonction du type de stimulateur cardiaque, du pronostic et du site du cancer

    Energy Technology Data Exchange (ETDEWEB)

    Lambert, P. [Service d' anesthesie reanimation, hopital Nord, centre hospitalier universitaire de Saint-etienne, 42055 Saint-etienne cedex 2 (France); Da Costa, A. [Service de cardiologie, hopital Nord, centre hospitalier universitaire de Saint-etienne, 42055 Saint-etienne cedex 2 (France); Marcy, P.Y. [Departement de radiologie, centre Antoine-Lacassagne, 33, avenue de Valombrose, 06189 Nice cedex 2 (France); Universite Nice Sophia-Antipolis, 33, avenue de Valombrose, 06189 Nice cedex 2 (France); Kreps, S. [Service de radiotherapie Corad, centre regional universitaire de cancerologie Henry-S.-Kaplan, hopital Bretonneau-2, CHU de Tours, boulevard Tonnelle, 37000 Tours (France); Angellier, G.; Marcie, S.; Bondiau, P.Y. [Universite Nice Sophia-Antipolis, 33, avenue de Valombrose, 06189 Nice cedex 2 (France); Departement de radiotherapie oncologie, centre CyberKnife, centre Antoine-Lacassagne, 33, avenue de Valombrose, 06189 Nice cedex 2 (France); Briand-Amoros, C. [Service de radiotherapie, hopital europeen Georges-Pompidou, 20, rue Leblanc, 75015 Paris (France); Thariat, J. [Universite Nice Sophia-Antipolis, 33, avenue de Valombrose, 06189 Nice cedex 2 (France); Departement de radiotherapie oncologie, centre CyberKnife, centre Antoine-Lacassagne, 33, avenue de Valombrose, 06189 Nice cedex 2 (France); IBDC CNRS UMR 6543, centre Antoine-Lacassagne, universite Sophia-Antipolis, 33, avenue de Valombrose, 06189 Nice cedex 2 (France)

    2011-06-15

    Ionizing radiation may interfere with electric components of pacemakers or implantable cardioverter defibrillators. The type, severity and extent of radiation damage to pacemakers, have previously been shown to depend on the total dose and dose rate. Over 300,000 new cancer cases are treated yearly in France, among which 60% are irradiated in the course of their disease. One among 400 of these patients has an implanted pacemaker or defibrillator. The incidence of pacemaker and implanted cardioverter defibrillator increases in an ageing population. The oncologic prognosis must be weighted against the cardiologic prognosis in a multidisciplinary and transversal setting. Innovative irradiation techniques and technological sophistications of pacemakers and implantable cardioverter-defibrillators (with the introduction of more radiosensitive complementary metal-oxide-semiconductors since 1970) have potentially changed the tolerance profiles. This review of the literature studied the geometric, dosimetric and radiobiological characteristics of the radiation beams for high energy photons, stereotactic irradiation, proton-therapy. Standardized protocols and radiotherapy optimization (particle, treatment fields, energy) are advisable in order to improve patient management during radiotherapy and prolonged monitoring is necessary following radiation therapy. The dose received at the pacemaker/heart should be calculated. The threshold for the cumulated dose to the pacemaker/implantable cardioverter-defibrillator (2 to 5 Gy depending on the brand), the necessity to remove/displace the device based on the dose-volume histogram on dosimetry, as well as the use of lead shielding and magnet are discussed. (authors)

  10. Intra-operative defibrillation testing and clinical shock efficacy in patients with implantable cardioverter-defibrillators

    DEFF Research Database (Denmark)

    Bänsch, Dietmar; Bonnemeier, Hendrik; Brandt, Johan

    2015-01-01

    AIMS: This trial was designed to test the hypothesis that shock efficacy during follow-up is not impaired in patients implanted without defibrillation (DF) testing during first implantable cardioverter-defibrillator (ICD) implantation. METHODS AND RESULTS: Between February 2011 and July 2013, 107...

  11. Management of Implantable Cardioverter Defibrillator Recipients: Care Beyond Guidelines.

    Science.gov (United States)

    Philippon, François; Sterns, Laurence D; Nery, Pablo B; Parkash, Ratika; Birnie, David; Rinne, Claus; Mondesert, Blandine; Exner, Derek; Bennett, Matthew

    2017-08-01

    This companion article is intended to address common clinical scenarios in patients with implantable defibrillators that were not addressed in the 2016 Canadian Cardiovascular Society/Canadian Heart Rhythm Society implantable cardioverter defibrillator guidelines including recommendations for device programming to improve detection, to minimize shocks (appropriate and inappropriate), and to minimize ventricular pacing. Important issues at the time of replacement such as device prescription, technical aspects (vascular access, extraction), and management of components on advisories are also discussed. Finally, common clinical scenarios such as management of patients with terminal illnesses, recurrent ventricular tachycardia, electrical storms, catheter ablation for ventricular tachycardia, and system infection management are considered. The management of these patients requires a team approach and comprehensive knowledge surrounding these common clinical scenarios. Copyright © 2017 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

  12. 長野県内の病院におけるAED 普及状況

    OpenAIRE

    岩下, 具美; 二木, 智子; 関口, 幸男; 今村, 浩; 手塚, 理絵; 飯ケ濱, 実; 岡元, 和文

    2006-01-01

    Ventricular fibrillation (VF) is the main cause of sudden cardiac arrest. Because the mortality rate of patients with VF is extremely time-dependent, it is essential to perform defibrillation without delay. The automated external defibrillator (AED) is an instrument that laypeople can use anytime and anywhere. We surveyed the installation of AEDs in the 138 hospitals in Nagano Prefecture, and received 113 replies from the 138 hospitals. Fifty-nine hospitals (52%) have installed AEDs. Out of t...

  13. Behavioral interventions in patients with an implantable cardioverter defibrillator

    DEFF Research Database (Denmark)

    Habibović, Mirela; Burg, Matthew M; Pedersen, Susanne S.

    2013-01-01

    The implantable cardioverter defibrillator (ICD) is the first-line treatment for primary and secondary prevention of sudden cardiac death. A subgroup of patients experience psychological distress postimplant, and no clear evidence base exists regarding how best to address patients' needs. The aim...... of this critical review is to provide an overview of behavioral interventions in ICD patients to date, and to delineate directions for future research using lessons learned from the ongoing RISTA and WEBCARE trials....

  14. The natural history of new-onset heart failure with a severely depressed left ventricular ejection fraction: implications for timing of implantable cardioverter-defibrillator implantation.

    Science.gov (United States)

    Teeter, William A; Thibodeau, Jennifer T; Rao, Krishnasree; Brickner, M Elizabeth; Toto, Kathleen H; Nelson, Lauren L; Mishkin, Joseph D; Ayers, Colby R; Miller, Justin G; Mammen, Pradeep P A; Patel, Parag C; Markham, David W; Drazner, Mark H

    2012-09-01

    Guidelines recommend that patients with new-onset systolic heart failure (HF) receive a trial of medical therapy before an implantable cardiac defibrillator (ICD). This strategy allows for improvement of left ventricular ejection fraction (LVEF), thereby avoiding an ICD, but exposes patients to risk of potentially preventable sudden cardiac death during the trial of medical therapy. We reviewed a consecutive series of patients with HF of <6 months duration with a severely depressed LVEF (<30%) evaluated in a HF clinic (N = 224). The ICD implantation was delayed with plans to reassess LVEF approximately 6 months after optimization of β-blockers. Mortality was ascertained by the National Death Index. Follow-up echocardiograms were performed in 115 of the 224 subjects. Of these, 50 (43%) had mildly depressed or normal LVEF at follow-up ("LVEF recovery") such that an ICD was no longer indicated. In a conservative sensitivity analysis (using the entire study cohort, whether or not a follow-up echocardiogram was obtained, as the denominator), 22% of subjects had LVEF recovery. Mortality at 6, 12, and 18 months in the entire cohort was 2.3%, 4.5%, and 6.8%, respectively. Of 87 patients who tolerated target doses of β-blockers, only 1 (1.1%) died during the first 18 months. Patients with new-onset systolic HF have both a good chance of LVEF recovery and low 6-month mortality. Achievement of target β-blocker dose identifies a very low-risk population. These data support delaying ICD implantation for a trial of medical therapy. Copyright © 2012 Mosby, Inc. All rights reserved.

  15. Detection of atrial fibrillation and flutter by a dual-chamber implantable cardioverter-defibrillator. For the Worldwide Jewel AF Investigators.

    Science.gov (United States)

    Swerdlow, C D; Schsls, W; Dijkman, B; Jung, W; Sheth, N V; Olson, W H; Gunderson, B D

    2000-02-29

    To distinguish prolonged episodes of atrial fibrillation (AF) that require cardioversion from self-terminating episodes that do not, an atrial implantable cardioverter-defibrillator (ICD) must be able to detect AF continuously for extended periods. The ICD should discriminate between atrial tachycardia/flutter (AT), which may be terminated by antitachycardia pacing, and AF, which requires cardioversion. We studied 80 patients with AT/AF and ventricular arrhythmias who were treated with a new atrial/dual-chamber ICD. During a follow-up period lasting 6+/-2 months, we validated spontaneous, device-defined AT/AF episodes by stored electrograms in all patients. In 58 patients, we performed 80 Holter recordings with telemetered atrial electrograms, both to validate the continuous detection of AT/AF and to determine the sensitivity of the detection of AT/AF. Detection was appropriate in 98% of 132 AF episodes and 88% of 190 AT episodes (98% of 128 AT episodes with an atrial cycle length 1 hour, for a total of 2697 hours of continuous detection of AT/AF. During Holter monitoring, the sensitivity of the detection of AT/AF (116 hours) was 100%; the specificity of the detection of non-AT/AF rhythms (1290 hours) was 99.99%. Of 166 appropriate episodes detected as AT, 45% were terminated by antitachycardia pacing. A new ICD detects AT/AF accurately and continuously. Therapy may be programmed for long-duration AT/AF, with a low risk of underdetection. Discrimination of AT from AF permits successful pacing therapy for a significant fraction of AT.

  16. Device orientation of a leadless pacemaker and subcutaneous implantable cardioverter-defibrillator in canine and human subjects and the effect on intrabody communication.

    Science.gov (United States)

    Quast, Anne-Floor B E; Tjong, Fleur V Y; Koop, Brendan E; Wilde, Arthur A M; Knops, Reinoud E; Burke, Martin C

    2018-02-14

    The development of communicating modular cardiac rhythm management systems relies on effective intrabody communication between a subcutaneous implantable cardioverter-defibrillator (S-ICD) and a leadless pacemaker (LP), using conducted communication. Communication success is affected by the LP and S-ICD orientation. This study is designed to evaluate the orientation of the LP and S-ICD in canine subjects and measure success and threshold of intrabody communication. To gain more human insights, we will explore device orientation in LP and S-ICD patients. Canine subjects implanted with a prototype S-ICD and LP (both Boston Scientific, MA, USA) with anterior-posterior fluoroscopy images were included in this analysis. For comparison, a retrospective analysis of human S-ICD and LP patients was performed. The angle of the long axis of the LP towards the vertical axis of 0°, and distance between the coil and LP were measured. Twenty-three canine subjects were analysed. Median angle of the LP was 29° and median distance of the S-ICD coil to LP was 0.8 cm. All canine subjects had successful communication. The median communicating threshold was 2.5 V. In the human retrospective analysis, 72 LP patients and 100 S-ICD patients were included. The mean angle of the LP was 56° and the median distance between the S-ICD coil and LP was 4.6 cm. Despite the less favourable LP orientation in canine subjects, all communication attempts were successful. In the human subjects, we observed a greater and in theory more favourable LP angle towards the communication vector. These data suggests suitability of human anatomy for conductive intrabody communication.

  17. Towards a Classification of Architecture Initiatives: Outlining the External Factors

    DEFF Research Database (Denmark)

    Hansen, Christian Lindschou; Mortensen, Niels Henrik; Hvam, Lars

    2012-01-01

    or bad, without including the contextual differences. The purpose of the external factors is to improve scoping and goal setting of architecture initiatives, and improve comparability between- and transferability of knowledge from architecture initiatives. The external factors are a first step towards......This paper introduced a set of external factors capturing the contextual differences that set the stage for architecture initiatives. These are derived from a systems theoretical approach recognizing the fact that architecture initiatives should respond the challenges posed by the external...

  18. The EPR-a comprehensive design concept against external events

    International Nuclear Information System (INIS)

    Stoll, U.; Waas, U.

    2006-01-01

    The main objective of design provisions against external hazards is to ensure that the safety functions required to bring the plant to safe shutdown are not inadmissibly affected by any external hazards that might be postulated for the intended site of the plant. In the design of the European Pressurized Water Reactor (EPR) particular attention was paid to external hazards such as earthquake, airplane crash, and explosion pressure wave. The standard EPR covers a large range of possible site conditions, the design earthquake enveloping safe shutdown earthquakes (SSE) to be expected for potential sites. The loads for the design basis airplane crash and - if required - for the design extension airplane crash as well as for external Explosion Pressure Wave are defined depending on site specific requirements. Protection against other external load cases such as extreme winds and external flooding is also included in the standard design

  19. “Atrial torsades de pointes” Induced by Low-Energy Shock From Implantable-Cardioverter Defibrillator

    Directory of Open Access Journals (Sweden)

    Ilknur Can, MD

    2013-09-01

    Full Text Available A 58 year-old-patient developed an episode of polymorphic atrial tachycardia which looked like "atrial torsades de pointes" after a 5J shock from implantable cardioverter defibrillator.

  20. Post-external radiotherapy hypothyroidism: 15 cases; Hypothyroidie apres radiotherapie externe. A propos de 15 cas

    Energy Technology Data Exchange (ETDEWEB)

    Kaffel, N.; Mnif, M.; Abid, M. [Centre Hospitalier Universitaire Hedi Chaker, Sfax (Tunisia); Daoud, J. [Centre Hospitalier Universitaire Habib Bourguiba, Sfax (Tunisia)

    2001-06-01

    Post-external radiotherapy hypothyroidism: 15 cases. Hypothyroidism frequency is estimated to be between 10 and 45% after radiotherapy alone, and 40 to 67% after radiotherapy associated with thyroidectomy. This hypothyroidism is infra-clinical in 60% of the cases. Our study concerned 15 cases of hypothyroidism after external radiotherapy delivered between and 1991 and 1999. An irradiation of the cervical, cerebral and thorax regions was indicated for different types of cancers. Larynx carcinoma epidermoid was the most frequent cancer (seven cases); the radiation treatment used cobalt 60 with conventional fractionation, i.e., 2 Gy per treatment, five treatments a week. In nine cases, the hypothyroidism was discovered during a systematic examination; it was clinically evident in the six remaining cases. Hypothyroidism appeared after an irradiation dose average of 50 Gy (extremes 30-65 Gy). The average duration of the irradiation was about 7 weeks and the hypothyroidism appeared in a mean 22 months. In all cases, the substituting treatment was initiated with a favorable progression. Faced with the risk of hypothyroidism, it is necessary to check patients who have undergone external irradiation of the neck. (authors)

  1. Operationalizing Proneness to Externalizing Psychopathology as a Multivariate Psychophysiological Phenotype

    Science.gov (United States)

    Nelson, Lindsay D.; Patrick, Christopher J.; Bernat, Edward M.

    2010-01-01

    The externalizing dimension is viewed as a broad dispositional factor underlying risk for numerous disinhibitory disorders. Prior work has documented deficits in event-related brain potential (ERP) responses in individuals prone to externalizing problems. Here, we constructed a direct physiological index of externalizing vulnerability from three ERP indicators and evaluated its validity in relation to criterion measures in two distinct domains: psychometric and physiological. The index was derived from three ERP measures that covaried in their relations with externalizing proneness the error-related negativity and two variants of the P3. Scores on this ERP composite predicted psychometric criterion variables and accounted for externalizing-related variance in P3 response from a separate task. These findings illustrate how a diagnostic construct can be operationalized as a composite (multivariate) psychophysiological variable (phenotype). PMID:20573054

  2. New signal processing algorithms for automated external defibrillators

    OpenAIRE

    Irusta Zarandona, Unai

    2017-01-01

    [ES]La fibrilación ventricular (VF) es el primer ritmo registrado en el 40\\,\\% de las muertes súbitas por paro cardiorrespiratorio extrahospitalario (PCRE). El único tratamiento eficaz para la FV es la desfibrilación mediante una descarga eléctrica. Fuera del hospital, la descarga se administra mediante un desfibrilador externo automático (DEA), que previamente analiza el electrocardiograma (ECG) del paciente y comprueba si presenta un ritmo desfibrilable. La supervivencia en un caso de PCRE ...

  3. Late Ratchet syndrome involving isolated left ventricular lead dislodgement post-cardiac resynchronization therapy defibrillator generator change.

    Science.gov (United States)

    Tan, Vern Hsen; Wong, Kelvin

    2018-04-01

    Lead dislodgement following cardiac implantable electronic device (CIED) generator change is rare. We report a case including the postulate mechanism of an isolated left ventricular lead dislodgement 3 months after cardiac resynchronization therapy defibrillator pulse generator change.

  4. Introducing external cephalic version in a Malaysian setting.

    Science.gov (United States)

    Yong, Stephen P Y

    2007-02-01

    To assess the outcome of external cephalic version for routine management of malpresenting foetuses at term. Prospective observational study. Tertiary teaching hospital, Malaysia. From September 2003 to June 2004, a study involving 41 pregnant women with malpresentation at term was undertaken. An external cephalic version protocol was implemented. Data were collected for identifying characteristics associated with success or failure of external cephalic version. Maternal and foetal outcome measures including success rate of external cephalic version, maternal and foetal complications, and characteristics associated with success or failure; engagement of presenting part, placental location, direction of version, attempts at version, use of intravenous tocolytic agent, eventual mode of delivery, Apgar scores, birth weights, and maternal satisfaction with the procedure. Data were available for 38 women. External cephalic version was successful in 63% of patients; the majority (75%) of whom achieved a vaginal delivery. Multiparity (odds ratio=34.0; 95% confidence interval, 0.67-1730) and high amniotic fluid index (4.9; 1.3-18.2) were associated with successful external cephalic version. Engagement of presenting part (odds ratio=0.0001; 95% confidence interval, 0.00001-0.001) and a need to resort to backward somersault (0.02; 0.00001-0.916) were associated with poor success rates. Emergency caesarean section rate for foetal distress directly resulting from external cephalic version was 8%, but there was no perinatal or maternal adverse outcome. The majority (74%) of women were satisfied with external cephalic version. External cephalic version has acceptable success rates. Multiparity, liquor volume, engagement of presenting part, and the need for backward somersault were strong predictors of outcome. External cephalic version is relatively safe, simple to learn and perform, and associated with maternal satisfaction. Modern obstetric units should routinely offer the

  5. Implantable Cardioverter-Defibrillators in Patients With a Continuous-Flow Left Ventricular Assist Device: An Analysis of the INTERMACS Registry.

    Science.gov (United States)

    Clerkin, Kevin J; Topkara, Veli K; Demmer, Ryan T; Dizon, Jose M; Yuzefpolskaya, Melana; Fried, Justin A; Mai, Xingchen; Mancini, Donna M; Takeda, Koji; Takayama, Hiroo; Naka, Yoshifumi; Colombo, Paolo C; Garan, A Reshad

    2017-12-01

    This study sought to determine if the presence of implantable cardioverter-defibrillators (ICD) provided a mortality benefit during continuous-flow left ventricular assist device (LVAD) support. An ICD decreases mortality in selected patients with advanced heart failure and have been associated with reduced mortality in patients with pulsatile LVAD. However, it is unclear whether that benefit extends to patients with a contemporary continuous-flow LVAD. Propensity score matching was used to generate a cohort of patients with similar baseline characteristics. The primary outcome was freedom from death during LVAD support. Secondary endpoints included freedom from unexpected death, likelihood of transplantation and recovery, and adverse events. Among 16,384 eligible patients in the Interagency Registry for Mechanically Assisted Circulatory Support registry, 2,209 patients with an ICD and 2,209 patients without one had similar propensity scores and were included. The presence of an ICD was associated with an increased mortality risk (hazard ratio: 1.20; 95% confidence interval [CI]: 1.04 to 1.39; p = 0.013) and an increased risk of unexpected death during device support (HR: 1.33; 95% CI: 1.03 to 1.71; p = 0.03). Patients with an ICD were more likely to undergo transplantation (HR: 1.16; 95% CI: 0.99 to 1.35; p = 0.06) and less likely to have LVAD explant for recovery (HR: 0.53, 95% CI: 0.29 to 0.98; p = 0.04). Patients with an ICD had a higher rate of treated ventricular arrhythmias (rate ratio: 1.27; 95% CI: 1.10 to 1.48; p = 0.001) and rehospitalization (rate ratio: 1.08; 95% CI: 1.04 to 1.12; p < 0.0001), but rates of hemorrhagic stroke were similar (rate ratio: 1.01; 95% CI: 0.81 to 1.26; p = 0.98). Among patients with a continuous flow LVAD, the presence of an ICD was not associated with reduced mortality. Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  6. Integration of Attributes from Non-Linear Characterization of Cardiovascular Time-Series for Prediction of Defibrillation Outcomes.

    Directory of Open Access Journals (Sweden)

    Sharad Shandilya

    Full Text Available The timing of defibrillation is mostly at arbitrary intervals during cardio-pulmonary resuscitation (CPR, rather than during intervals when the out-of-hospital cardiac arrest (OOH-CA patient is physiologically primed for successful countershock. Interruptions to CPR may negatively impact defibrillation success. Multiple defibrillations can be associated with decreased post-resuscitation myocardial function. We hypothesize that a more complete picture of the cardiovascular system can be gained through non-linear dynamics and integration of multiple physiologic measures from biomedical signals.Retrospective analysis of 153 anonymized OOH-CA patients who received at least one defibrillation for ventricular fibrillation (VF was undertaken. A machine learning model, termed Multiple Domain Integrative (MDI model, was developed to predict defibrillation success. We explore the rationale for non-linear dynamics and statistically validate heuristics involved in feature extraction for model development. Performance of MDI is then compared to the amplitude spectrum area (AMSA technique.358 defibrillations were evaluated (218 unsuccessful and 140 successful. Non-linear properties (Lyapunov exponent > 0 of the ECG signals indicate a chaotic nature and validate the use of novel non-linear dynamic methods for feature extraction. Classification using MDI yielded ROC-AUC of 83.2% and accuracy of 78.8%, for the model built with ECG data only. Utilizing 10-fold cross-validation, at 80% specificity level, MDI (74% sensitivity outperformed AMSA (53.6% sensitivity. At 90% specificity level, MDI had 68.4% sensitivity while AMSA had 43.3% sensitivity. Integrating available end-tidal carbon dioxide features into MDI, for the available 48 defibrillations, boosted ROC-AUC to 93.8% and accuracy to 83.3% at 80% sensitivity.At clinically relevant sensitivity thresholds, the MDI provides improved performance as compared to AMSA, yielding fewer unsuccessful defibrillations

  7. Validation of defibrillator lead performance registry data

    DEFF Research Database (Denmark)

    Kristensen, Anders Elgaard; Larsen, Jacob Moesgaard; Nielsen, Jens Cosedis

    2017-01-01

    all reported surgical interventions due to defibrillator lead events in the Danish Pacemaker and ICD Register (DPIR) from 2000 to 2013. Medical records of all patients (n = 753) were examined blinded for 5 predefined intervention types and 18 reasons for lead intervention. The overall level...

  8. External flood probabilistic safety analysis of a coastal NPP

    International Nuclear Information System (INIS)

    Pisharady, Ajai S.; Chakraborty, M.K.; Acharya, Sourav; Roshan, A.D.; Bishnoi, L.R.

    2015-01-01

    External events pose a definitive challenge to safety of NPP, solely due to their ability to induce common cause failures. Flooding incidents at Le Blayais NPP, France, Fort Calhoun NPP, USA and Fukushima Daiichi have pointed to the importance of external flooding as an important contributor to NPP risk. A methodology developed for external flood PSA of a coastal NPP vulnerable to flooding due to tsunami, cyclonic storm and intense local precipitation is presented in this paper. Different tasks for EFPSA has been identified along with general approach for completing each task

  9. Spinal cord stimulation for refractory angina in patients implanted with cardioverter defibrillators: five case reports

    DEFF Research Database (Denmark)

    Enggaard, Thomas P; Andersen, Claus; Scherer, Christian

    2010-01-01

    Patients implanted with a cardioverter defibrillator (ICD) who are suffering from refractory angina pectoris could benefit from spinal cord stimulation (SCS) due to the well-documented pain relieving effect. However, the combined treatment remains controversial. The aim of the study is to report...... successful long-term treatment with SCS in five patients implanted with cardioverter defibrillators. The combined treatments with ICD and thoracic epidural electrical stimulation were used in five patients with refractory angina pectoris. During the procedure of the implantation, testing with the maximal...... for refractory angina pectoris can be performed in patients implanted with cardioverter defibrillators without interference. However, individual testing during implantation or re-programming the devices is mandatory in order to assess optimal safety in each patient....

  10. Intravenous nitroglycerin for external cephalic version: a randomized controlled trial.

    Science.gov (United States)

    Hilton, Jennifer; Allan, Bruce; Swaby, Cheryl; Wahba, Raouf; Wah, Raouf; Jarrell, John; Wood, Stephen; Ross, Sue; Tran, Quynh

    2009-09-01

    To estimate whether treatment with intravenous nitroglycerin for uterine relaxation increases the chance of successful external cephalic version. Two double-blind, randomized clinical trials were undertaken: one in nulliparous women and a second in multiparous women. Women presenting for external cephalic version at term were eligible to participate. The primary outcome was immediate success of external cephalic version. Other outcomes were presentation at delivery, cesarean delivery rate, and side effects and complications. Sample size calculations were based on a 100% increase in success of external cephalic version with a one-sided analysis and alpha=0.05 (80% power). In total, 126 women were recruited-82 in the nulliparous trial and 44 in the multiparous trial. Seven patients did not have external cephalic version before delivery but were included in the analysis of success of external cephalic version. One patient was lost to follow-up. The external cephalic version success rate for nulliparous patients was 24% (10 of 42) in patients who received nitroglycerin compared with 8% (3 of 40) in those who receive placebo (P=.04, one-sided Fisher exact test, odds ratio 3.85, lower bound 1.22). In multiparous patients, the external cephalic version success rate did not differ significantly between groups: 44% (10 of 23) in the nitroglycerin group compared with 43% (9 of 21) in the placebo group (P=.60). Treatment with intravenous nitroglycerin increased the rate of successful external cephalic version in nulliparous, but not in multiparous, women. Treatment with intravenous nitroglycerin appeared to be safe, but our numbers were too small to rule out rare serious adverse effects. I.

  11. Current state of knowledge and experts' perspective on the subcutaneous implantable cardioverter-defibrillator.

    Science.gov (United States)

    Santini, Massimo; Cappato, Riccardo; Andresen, Dietrich; Brachmann, Johannes; Davies, D Wyn; Cleland, John; Filippi, Alessandro; Gronda, Edoardo; Hauer, Richard; Steinbeck, Gerhard; Steinhaus, David

    2009-06-01

    ICD implantation is today a well-recognized therapy to prevent sudden cardiac death. The available implantable devices at present need the use of permanent endocavitary leads which may cause, in some instances, serious troubles to the patients (lead dislodgement, ventricular perforation, lead infections, etc.). A new implantable defibrillator provided by only a subcutaneous lead is at present under evaluation. Its potential indications, usefulness benefits, and problems represent an interesting field of investigation and discussion. This paper describes the conclusions recently reached by a panel of experts, with regard to the potential role of an implantable subcutaneous defibrillator in the prevention of sudden cardiac death.

  12. Detecting asset misappropriation: a framework for external auditors

    OpenAIRE

    Kassem, Rasha

    2014-01-01

    Fraud is a major concern for investors, regulators, and external auditors. Of particular concern is asset misappropriation because it was given less attention in prior audit literature as well as the audit practice though it is the most common type of occupational fraud. This motivated the current study to examine areas related to asset misappropriation that had never been examined before and alert external auditors in Egypt to a type of fraud which was given less attention. The current study...

  13. Diagnostic Value of MRI in Patients With Implanted Pacemakers and Implantable Cardioverter-Defibrillators Across a Cross Population: Does the Benefit Justify the Risk? A Proof of Concept Study.

    Science.gov (United States)

    Samar, Huma; Yamrozik, June A; Williams, Ronald B; Doyle, Mark; Shah, Moneal; Bonnet, Christopher A; Biederman, Robert W W

    2017-09-01

    The objective of this study was to assess the diagnostic usefulness of thoracic and nonthoracic magnetic resonance imaging (MRI) imaging in patients with implantable cardiac devices (permanent pacemaker or implantable cardioverter-defibrillators [ICDs]) to determine if there was a substantial benefit to patients with regard to diagnosis and/or management. MRI is infrequently performed on patients with conventional pacemakers or ICDs. Multiple studies have documented the safety of MRI scans in patients with implanted devices, yet the diagnostic value of this approach has not been established. Evaluation data were acquired in 136 patients with implanted cardiac devices who underwent MRIs during a 10-year period at a single institution. Specific criteria were followed for all patients to objectively define if the diagnosis by MRI enhanced patient care; 4 questions were answered after scan interpretation by both MRI technologists and MRI physicians who performed the scan. 1) Did the primary diagnosis change? 2) Did the MRI provide additional information to the existing diagnosis? 3) Was the pre-MRI (tentative) diagnosis confirmed? 4) Did patient management change? If "Yes" was answered to any of the preceding questions, the MRI scan was considered to be of value to patient diagnosis and/or therapy. In 97% (n = 132) of patients, MR added value to patient diagnosis and management. In 49% (n = 67) of patients, MRI added additional valuable information to the primary diagnosis, and in 30% (n = 41) of patients, MRI changed the principle diagnosis and subsequent management of the patient. No safety issues were encountered, and no adverse effects of undergoing the MRI scan were noted in any patient. MRI in patients with implanted pacemakers and defibrillators added value to patient diagnosis and management, which justified the risk of the procedure. Published by Elsevier Inc.

  14. Self-injury and externalizing pathology: a systematic literature review.

    Science.gov (United States)

    Meszaros, Gergely; Horvath, Lili Olga; Balazs, Judit

    2017-05-03

    During the last decade there is a growing scientific interest in nonsuicidal self-injury (NSSI). The aim of the current paper was to review systematically the literature with a special focus on the associations between self-injurious behaviours and externalizing psychopathology. An additional aim was to review terminology and measurements of self-injurious behaviour and the connection between self-injurious behaviours and suicide in the included publications. A systematic literature search was conducted on 31st December 2016 in five databases (PubMed, OVID Medline, OVID PsycINFO, Scopus, Web of Science) with two categories of search terms (1. nonsuicidal self-injury, non-suicidal self-injury, NSSI, self-injurious behaviour, SIB, deliberate self-harm, DSH, self-injury; 2. externalizing disorder, attention deficit hyperactivity disorder, ADHD, conduct disorder, CD, oppositional defiant disorder, OD, ODD). Finally 35 papers were included. Eleven different terms were found for describing self-injurious behaviours and 20 methods for measuring it. NSSI has the clearest definition. All the examined externalizing psychopathologies had strong associations with self-injurious behaviours according to: higher prevalence rates in externalizing groups than in control groups, higher externalizing scores on the externalizing scales of questionnaires, higher symptom severity in self-injurious groups. Eight studies investigated the relationship between suicide and self-injurious behaviours and found high overlap between the two phenomena and similar risk factors. Based on the current findings the association between externalizing psychopathology and self-injurious behaviours has been proven by the scientific literature. Similarly to other reviews on self-injurious behaviours the confusion in terminology and methodology was noticed. NSSI is suggested for use as a distinct term. Further studies should investigate the role of comorbid conditions in NSSI, especially when internalizing

  15. A new external microbeam system in Fudan University

    International Nuclear Information System (INIS)

    Zheng, Y.; Shen, H.; Li, Y.Q.; Li, X.Y.; Yang, M.J.; Mi, Y.

    2013-01-01

    A cost-effective and removable external beam system is set up based on the Oxford Microbeam system in Fudan University. In our external beam system, 7.5-μm-thick Kapton film is used as exit window with a diameter of 3.5 mm. The spatial resolution is about 18 μm full width at half maximum (FWHM) on a copper grid. As an example, calcium distribution in otolith is present by the external micro-PIXE. In addition, little change can be done to the external system mentioned above for radiobiology experiments. The exit window can be changed from the focal plane to the observation window of vacuum chamber. By calculation, the beam spot size can reach less than 30 μm. Since the Oxford type octagonal target chamber is popular among the nuclear microprobe facilities, this method can be provided to easily replace the in-vacuum system with the external system, extending the in-vacuum analysis to external beam analysis

  16. A new external microbeam system in Fudan University

    Energy Technology Data Exchange (ETDEWEB)

    Zheng, Y.; Shen, H., E-mail: haoshen@fudan.edu.cn; Li, Y.Q.; Li, X.Y.; Yang, M.J.; Mi, Y.

    2013-07-01

    A cost-effective and removable external beam system is set up based on the Oxford Microbeam system in Fudan University. In our external beam system, 7.5-μm-thick Kapton film is used as exit window with a diameter of 3.5 mm. The spatial resolution is about 18 μm full width at half maximum (FWHM) on a copper grid. As an example, calcium distribution in otolith is present by the external micro-PIXE. In addition, little change can be done to the external system mentioned above for radiobiology experiments. The exit window can be changed from the focal plane to the observation window of vacuum chamber. By calculation, the beam spot size can reach less than 30 μm. Since the Oxford type octagonal target chamber is popular among the nuclear microprobe facilities, this method can be provided to easily replace the in-vacuum system with the external system, extending the in-vacuum analysis to external beam analysis.

  17. A new external microbeam system in Fudan University

    Energy Technology Data Exchange (ETDEWEB)

    Zheng, Y. [Applied Ion Beam Physics Laboratory, Institute of Modern Physics, Fudan University, Shanghai 200433 (China); Shen, H., E-mail: haoshen@fudan.edu.cn [Applied Ion Beam Physics Laboratory, Institute of Modern Physics, Fudan University, Shanghai 200433 (China); Li, Y.Q.; Li, X.Y.; Yang, M.J.; Mi, Y. [Applied Ion Beam Physics Laboratory, Institute of Modern Physics, Fudan University, Shanghai 200433 (China)

    2013-02-01

    A cost-effective and removable external beam system is set up based on the Oxford Microbeam system in Fudan University. In our external beam system, 7.5-μm-thick Kapton film is used as exit window with a diameter of 3.5 mm. The spatial resolution is about 18 μm full width at half maximum (FWHM) on a copper grid. As an example, calcium distribution in otolith is present by the external micro-PIXE. In addition, little change can be done to the external system mentioned above for radiobiology experiments. The exit window can be changed from the focal plane to the observation window of vacuum chamber. By calculation, the beam spot size can reach less than 30 μm. Since the Oxford type octagonal target chamber is popular among the nuclear microprobe facilities, this method can be provided to easily replace the in-vacuum system with the external system, extending the in-vacuum analysis to external beam analysis.

  18. Making post-mortem implantable cardioverter defibrillator explantation safe

    DEFF Research Database (Denmark)

    Räder, Sune B E W; Zeijlemaker, Volkert; Pehrson, Steen

    2009-01-01

    that the resting voltage over the operating person would not exceed 50 V. CONCLUSION: The use of intact medical gloves made of latex, neoprene, or plastic eliminates the potential electrical risk during explantation of an ICD. Two gloves on each hand offer sufficient protection. We will recommend the use......AIMS: The aim of this study is to investigate whether protection with rubber or plastic gloves during post-mortem explantation of an implantable cardioverter defibrillator (ICD) offers enough protection for the explanting operator during a worst-case scenario (i.e. ICD shock). METHODS AND RESULTS...

  19. External cephalic version-related risks: a meta-analysis.

    Science.gov (United States)

    Grootscholten, Kim; Kok, Marjolein; Oei, S Guid; Mol, Ben W J; van der Post, Joris A

    2008-11-01

    To systematically review the literature on external cephalic version-related complications and to assess if the outcome of a version attempt is related to complications. In March 2007 we searched MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials. Studies reporting on complications from an external cephalic version attempt for singleton breech pregnancies after 36 weeks of pregnancy were selected. We calculated odds ratios (ORs) from studies that reported both on complications as well as on the position of the fetus immediately after the procedure. We found 84 studies, reporting on 12,955 version attempts that reported on external cephalic version-related complications. The pooled complication rate was 6.1% (95% CI 4.7-7.8), 0.24% for serious complications (95% confidence interval [CI] 0.17-0.34) and 0.35% for emergency cesarean deliveries (95% CI 0.26-0.47). Complications were not related to external cephalic version outcome (OR 1.2 (95% CI 0.93-1.7). External cephalic version is a safe procedure. Complications are not related to the fetal position after external cephalic version.

  20. Neuraxial blockade for external cephalic version: a systematic review.

    Science.gov (United States)

    Sultan, P; Carvalho, B

    2011-10-01

    The desire to decrease the number of cesarean deliveries has renewed interest in external cephalic version. The rationale for using neuraxial blockade to facilitate external cephalic version is to provide abdominal muscular relaxation and reduce patient discomfort during the procedure, so permitting successful repositioning of the fetus to a cephalic presentation. This review systematically examined the current evidence to determine the safety and efficacy of neuraxial anesthesia or analgesia when used for external cephalic version. A systematic literature review of studies that examined success rates of external cephalic version with neuraxial anesthesia was performed. Published articles written in English between 1945 and 2010 were identified using the Medline, Cochrane, EMBASE and Web of Sciences databases. Six, randomized controlled studies were identified. Neuraxial blockade significantly improved the success rate in four of these six studies. A further six non-randomized studies were identified, of which four studies with control groups found that neuraxial blockade increased the success rate of external cephalic version. Despite over 850 patients being included in the 12 studies reviewed, placental abruption was reported in only one patient with a neuraxial block, compared with two in the control groups. The incidence of non-reassuring fetal heart rate requiring cesarean delivery in the anesthesia groups was 0.44% (95% CI 0.15-1.32). Neuraxial blockade improved the likelihood of success during external cephalic version, although the dosing regimen that provides optimal conditions for successful version is unclear. Anesthetic rather than analgesic doses of local anesthetics may improve success. The findings suggest that neuraxial blockade does not compromise maternal or fetal safety during external cephalic version. Crown Copyright © 2011. Published by Elsevier Ltd. All rights reserved.

  1. Cardiac pacemaker battery discharge after external electrical cardioversion for broad QRS Complex Tachycardia.

    Science.gov (United States)

    Annamaria, Martino; Andrea, Scapigliati; Michela, Casella; Tommaso, Sanna; Gemma, Pelargonio; Antonio, Dello Russo; Roberto, Zamparelli; Stefano, De Paulis; Fulvio, Bellocci; Rocco, Schiavello

    2008-08-01

    External electrical cardioversion or defibrillation may be necessary in patients with implanted cardiac pacemaker (PM) or implantable cardioverter defibrillator (ICD). Sudden discharge of high electrical energy employed in direct current (DC) transthoracic countershock may damage the PM/ICD system resulting in a series of possible device malfunctions. For this reason, when defibrillation or cardioversion must be attempted in a patient with a PM or ICD, some precautions should be taken, particularly in PM dependent patients, in order to prevent damage to the device. We report the case of a 76-year-old woman with a dual chamber PM implanted in the right subclavicular region, who received two consecutive transthoracic DC shocks to treat haemodynamically unstable broad QRS complex tachycardia after cardiac surgery performed with a standard sternotomic approach. Because of the sternal wound and thoracic drainage tubes together with the severe clinical compromise, the anterior paddle was positioned near the pulse generator. At the following PM test, a complete battery discharge was detected.

  2. Pollution externalities in a Schumpeterian growth model

    OpenAIRE

    Koesler, Simon

    2010-01-01

    This paper extends a standard Schumpeterian growth model to include an environmental dimension. Thereby, it explicitly links the pollution intensity of economic activity to technological progress. In a second step, it investigates the effect of pollution on economic growth under the assumption that pollution intensities are related to technological progress. Several conclusions emerge from the model. In equilibrium, the economy follows a balanced growth path. The effect of pollution on the ec...

  3. Clinical safety of an MRI conditional implantable cardioverter defibrillator system: A prospective Monocenter ICD-Magnetic resonance Imaging feasibility study (MIMI).

    Science.gov (United States)

    Kypta, Alexander; Blessberger, Hermann; Hoenig, Simon; Saleh, Karim; Lambert, Thomas; Kammler, Juergen; Fellner, Franz; Lichtenauer, Michael; Steinwender, Clemens

    2016-03-01

    The aim of this study was to evaluate the safety and efficacy of the Lumax 740(®) Implantable Cardioverter Defibrillator (ICD) system in patients undergoing a defined 1.5 Tesla (T) MRI. Between November 2013 and April 2014, eighteen patients (age range, 41-78 years; mean age, 64 years) implanted with a Lumax 740(®) ICD system for at least 6 weeks before an MRI were enrolled into this single-center feasibility study. The local ethics committee approved the study before patients gave written informed consent. Patients underwent defined MRI 1.5T of the brain and lower lumbar spine with three safety follow-up evaluations obtained during the 3-month study period. Data were analyzed descriptively. Study endpoints were the absence of either MRI and pacing system related serious adverse device effects (SADE), or of a ventricular pacing threshold increase >0.5V, or of an R-wave amplitude attenuation battery status. Sixteen patients completed the MRI and the follow-up period. As no SADE occurred, the SADE free rate was 100%. Freedom from ventricular pacing threshold increase was 100% (16/16; 95%CI: 82.9%; 100.0%). There were no significant differences between baseline and follow-up measurements of sensing amplitudes (-0.58 ± 2.07 mV, P = 0.239, -0.41 ± 1.04 mV, P = 0.133, and -0.25 ± 1.36 mV, P = 0.724, for immediately after, 1 month and 3 months after MRI scan, respectively) and pacing thresholds (-0.047 ± 0.18 V, P = 0.317, -0.019 ± 0.11 V, P = 0.490, and 0.075 ± 0.19 V, P = 0.070, for immediately after, 1 month and 3 months after MRI scan, respectively). Lead impedances after the MRI scan were significantly lower as compared with baseline values (-22.8 ± 21.69 Ω, P = 0.001, -21.62 ± 39.71 Ω, P = 0.040, and -33.68 ± 57.73 Ω, P = 0.018, for immediately after, 1 month and 3 months after MRI scan, respectively). MRI scans in patients with MRI conditional ICD system (Lumax 740(

  4. [University-external sector linkage: a managerial strategy].

    Science.gov (United States)

    Campos, Gilberto

    2004-06-01

    The University-External Sector vinculation is an increasing phenomenon in Latin America as in the rest of the world. The universities through its investigation processes actively participate in the creation and incorporation of science and technology to produce technological processes, to bring foreign technology into national reality, and also to create and transmit innovation for the productive sector. In those ways these institutions achieve bonds with the external sector which provide them with additional income and allows them to have certain relief for their tight teaching and investigation budgets. Several studies in university organizations have been made to identify the motivations and barriers for de adequate development of the interaction between the university and the external sector. The lack of vinculation between these institutions could be due in part to the lack of knowledge that the external sector has of the possibility to obtain services from the university, and also the lack of knowledge that the university has about the needs of potential users of their services. The goals achieved by public Venezuelan universities, in the last years, in their search of a vinculation with the external sector could grow and consolidate through an adequate strategic management plan that allows a mayor diffusion and promotion of the results of their investigations and services, to reach in a wider and more direct way, and to a greater number of potential clients.

  5. A framework for considering externalities in urban water asset management.

    Science.gov (United States)

    Marlow, David; Pearson, Leonie; Macdonald, Darla Hatton; Whitten, Stuart; Burn, Stewart

    2011-01-01

    Urban communities rely on a complex network of infrastructure assets to connect them to water resources. There is considerable capital investment required to maintain, upgrade and extend this infrastructure. As the remit of a water utility is broader than just financial considerations, infrastructure investment decisions must be made in light of environmental and societal issues. One way of facilitating this is to integrate consideration of externalities into decision making processes. This paper considers the concept of externalities from an asset management perspective. A case study is provided to show the practical implications to a water utility and asset managers. A framework for the inclusion of externalities in asset management decision making is also presented. The potential for application of the framework is highlighted through a brief consideration of its key elements.

  6. Development and evaluation of the EOL-ICDQ as a measure of experiences, attitudes and knowledge in end-of-life in patients living with an implantable cardioverter defibrillator.

    Science.gov (United States)

    Thylén, Ingela; Wenemark, Marika; Fluur, Christina; Strömberg, Anna; Bolse, Kärstin; Årestedt, Kristofer

    2014-04-01

    Due to extended indications and resynchronization therapy, many implantable cardioverter defibrillator (ICD) recipients will experience progressive co-morbid conditions and will be more likely to die of causes other than cardiac death. It is therefore important to elucidate the ICD patients' preferences when nearing end-of-life. Instead of avoiding the subject of end-of-life, a validated questionnaire may be helpful to explore patients' experiences and attitudes about end-of-life concerns and to assess knowledge of the function of the ICD in end-of-life. Validated instruments assessing patients' perspective concerning end-of-life issues are scarce. The purpose of this study was to develop and evaluate respondent satisfaction and measurement properties of the 'Experiences, Attitudes and Knowledge of End-of-Life Issues in Implantable Cardioverter Defibrillator Patients' Questionnaire' (EOL-ICDQ). The instrument was tested for validity, respondent satisfaction, and for homogeneity and stability in the Swedish language. An English version of the EOL-ICDQ was validated, but has not yet been pilot tested. The final instrument contained three domains, which were clustered into 39 items measuring: experiences (10 items), attitudes (18 items), and knowledge (11 items) of end-of-life concerns in ICD patients. In addition, the questionnaire also contained items on socio-demographic background (six items) and ICD-specific background (eight items). The validity and reliability properties were considered sufficient. The EOL-ICDQ has the potential to be used in clinical practice and future research. Further studies are needed using this instrument in an Anglo-Saxon context with a sample of English-speaking ICD recipients.

  7. Meningitis and Pneumocephalus. A rare complication of external dacryocystorhinostomy.

    Science.gov (United States)

    Usul, Haydar; Kuzeyli, Kayhan; Cakir, Ertugrul; Caylan, Refik; Imamoglu, H Ibrahim; Yazar, Ugur; Arslan, Erhan; Sayin, O Caglar; Arslan, Selcuk

    2004-11-01

    Meningitis due to fracture of the fovea ethmoidalis during external dacryocystorhinostomy is a rare complication. We report a case of pneumocephalus and meningitis in a 51-year-old female who underwent an external dacryocystorhinostomy (DCR). Although extracranial complications during or after external DCR have been well-described, only one case of meningitis has been reported in the literature. Physical examination, computerised tomography, lumbar puncture, and bacteriologic cultures were used to make the diagnosis. The patient responded well to antibiotic therapy. Her symptoms resolved immediately and she was discharged on the 21st post-operative day. This complication emphasises the importance of careful surgical technique and a thorough knowledge of regional anatomy, during DCR and similar procedures.

  8. Undertreatment of anxiety and depression in patients with an implantable cardioverter-defibrillator

    DEFF Research Database (Denmark)

    Hoogwegt, Madelein T; Kupper, Nina; Theuns, Dominic A M J

    2012-01-01

    Twenty-five to 33% of patients with an implantable cardioverter-defibrillator (ICD) experience anxiety and depression, but it is not known whether their symptoms are adequately treated. We investigated (a) whether patients with clinically relevant symptoms of distress received appropriate treatme......, and (b) whether patients not treated for their emotional distress reported poorer health status using a prospective study design....

  9. Ventricular Tachyarrhythmias and Mortality in Patients With an Implantable Cardioverter Defibrillator

    DEFF Research Database (Denmark)

    Mastenbroek, Mirjam H; Versteeg, Henneke; Jordaens, Luc

    2014-01-01

    Objective We examined whether depression is independently associated with implantable cardioverter defibrillator (ICD) therapy for ventricular tachyarrhythmias and mortality. Methods A cohort of 430 consecutive patients with a first-time ICD (79% men; mean [standard deviation] age = 57.8 [12.1] y...

  10. Inappropriate shock delivery by implantable cardioverter defibrillator due to electrical interference with washing machine.

    Science.gov (United States)

    Chongtham, Dhanaraj Singh; Bahl, Ajay; Kumar, Rohit Manoj; Talwar, K K

    2007-05-31

    We report a patient with hypertrophic cardiomyopathy who received an inappropriate implantable cardioverter defibrillator shock due to electrical interference from a washing machine. This electrical interference was detected as an episode of ventricular fibrillation with delivery of shock without warning symptoms.

  11. The Influence of an External Transaction on a BPEL Scope

    Science.gov (United States)

    Kopp, Oliver; Mietzner, Ralph; Leymann, Frank

    Business processes constitute an integral part of today's IT applications. They contain transactions as essential building blocks to ensure integrity and all-or-nothing behavior. The Business Process Execution Language is the dominant standard for modeling and execution of business processes in a Web service environment. BPEL itself contains a transaction model based on compensation, that describes the (local) transactions in a business process. The WS-Coordination framework deals with (external) transactions between Web services and is used to define the transaction behavior between a BPEL process and its partners. In this paper, we investigate how external transactions between Web services interrelate with local transactions of BPEL.

  12. A method for external measurement of toroidal equilibrium parameters

    International Nuclear Information System (INIS)

    Brunsell, P.; Hellblom, G.; Brynolf, J.

    1992-01-01

    A method has been developed for determining from external magnetic field measurements the horizontal shift, the vertical shift and the poloidal field asymmetry parameter (Λ) of a toroidal plasma in force equilibrium. The magnetic measurements consist of two toroidal differential flux loops, giving the average vertical magnetic field and the average radial magnetic field respectively, together with cosine-coils for obtaining the m=1 cosine harmonic of the external poloidal magnetic field component. The method is used to analyse the evolution of the toroidal equilibrium during reversed-field pinch discharges in the Extrap T1-U device. We find that good equilibrium control is needed for long plasma pulses. For non-optimized externally applied vertical fields, the diagnostic clearly shows a horizontal drift motion of the pinch resulting in earlier discharge termination. (au)

  13. What motivates money donation? A study on external motivators

    Directory of Open Access Journals (Sweden)

    Nivea Coelho Degasperi

    Full Text Available Abstract The objective of this study is to identify external motivating factors that favor individual money donation. Methodologically, we adopted a descriptive and quantitative cross-sectional study. In order to collect data, we prepared a questionnaire containing 49 statements based on external motivating variables of regular individual money donation found in the literature on the subject. After testing the questionnaire, we applied it to 1073 Brazilians, regular money donors and we performed an exploratory factor analysis. Conclusively, we identified 8 external factors that motivate individual money donation: Trust, Reward, Leadership influences, Characteristics of the organization, Environmental influences, Personal benefits, Characteristics of beneficiaries and Future Interests. We expect that these 8 factors combined, could become a useful tool to improve the management of charitable organizations, especially in defining campaigns or other marketing strategies to attract new donors and raise funds on occasions that are favorable to individual money donation.

  14. [Electrical storm in patients with prophylactic defibrillator implantation].

    Science.gov (United States)

    Rodríguez-Mañero, Moisés; González-Cambeiro, Cristina; Moreno-Arribas, Jose; Expósito-García, Víctor; Sánchez-Gómez, Juan Miguel; González-Torres, Luis; Arce-León, Álvaro; Arguedas-Jiménez, Hugo; Gaztañaga, Larraitz; Salvador-Montañés, Oscar; Iglesias-Bravo, Jose Antonio; Huerta, Ana Andrés La; Fernández-Armenta, Juan; Arias, Miguel Ángel; Martínez-Sande, Luis

    2016-01-01

    Little is known about the prevalence of electrical storm, baseline characteristics and mortality implications of patients with implantable cardioverter defibrillator in primary prevention versus those patients without electrical storm. We sought to assess the prevalence, baseline risk profile and survival significance of electrical storm in patients with implantable defibrillator for primary prevention. Retrospective multicenter study performed in 15 Spanish hospitals. Consecutives patients referred for desfibrillator implantation, with or without left ventricular lead (at least those performed in 2010 and 2011), were included. Over all 1,174 patients, 34 (2,9%) presented an electrical storm, mainly due to ventricular tachycardia (82.4%). There were no significant baseline differences between groups, with similar punctuation in the mortality risk scores (SHOCKED, MADIT and FADES). A clear trigger was identified in 47% of the events. During the study period (38±21 months), long-term total mortality (58.8% versus 14.4%, pstorm patients. Rate of inappropriate desfibrillator intervention was also higher (14.7 versus 8.6%, pstorm was 2.9%. There were no baseline differences in the cardiovascular risk profile versus those without electrical storm. However, all cause mortality and cardiovascular mortality was increased in these patients versus control desfibrillator patients without electrical storm, as was the rate of inappropriate desfibrillator intervention. Copyright © 2015 Instituto Nacional de Cardiología Ignacio Chávez. Published by Masson Doyma México S.A. All rights reserved.

  15. Gender disparities in anxiety and quality of life in patients with an implantable cardioverter-defibrillator

    DEFF Research Database (Denmark)

    Habibović, Mirela; van den Broek, Krista C; Theuns, Dominic A M J

    2011-01-01

    A paucity of studies in implantable cardioverter-defibrillator (ICD) patients has examined gender disparities in patient-reported outcomes, such as anxiety and quality of life (QoL). We investigated (i) gender disparities in anxiety and QoL and (ii) the magnitude of the effect of gender vs. New...

  16. The learning curve associated with the introduction of the subcutaneous implantable defibrillator

    NARCIS (Netherlands)

    Knops, Reinoud E.; Brouwer, Tom F.; Barr, Craig S.; Theuns, Dominic A.; Boersma, Lucas; Weiss, Raul; Neuzil, Petr; Scholten, Marcoen; Lambiase, Pier D.; Leon, Angel R.; Hood, Margaret; Jones, Paul W.; Wold, Nicholas; Grace, Andrew A.; Olde Nordkamp, Louise R. A.; Burke, Martin C.

    2016-01-01

    Aims The subcutaneous implantable cardioverter defibrillator (S-ICD) was introduced to overcome complications related to transvenous leads. Adoption of the S-ICD requires implanters to learn a new implantation technique. The aim of this study was to assess the learning curve for S-ICD implanters

  17. The learning curve associated with the introduction of the subcutaneous implantable defibrillator

    NARCIS (Netherlands)

    R.E. Knops (Reinoud); T.F. Brouwer (Tom F.); C.S. Barr (Craig); D.A.M.J. Theuns (Dominic); L. Boersma (Lucas); R. Weiss (Ram); P. Neuzil (Petr); M.F. Scholten (Marcoen); P.D. Lambiase (Pier); A. Leon (Angel); A.M. Hood (Margaret); P. Jones; Wold, N. (Nicholas); Grace, A.A. (Andrew A.); L.R.A. Olde Nordkamp (Louise R.A.); M.C. Burke (Martin)

    2016-01-01

    textabstractAims: The subcutaneous implantable cardioverter defibrillator (S-ICD) was introduced to overcome complications related to transvenous leads. Adoption of the S-ICD requires implanters to learn a new implantation technique. The aim of this study was to assess the learning curve for S-ICD

  18. Anxiety and risk of ventricular arrhythmias or mortality in patients with an implantable cardioverter defibrillator

    DEFF Research Database (Denmark)

    Habibović, Mirela; Pedersen, Susanne S.; van den Broek, Krista C

    2013-01-01

    A subgroup of patients with an implantable cardioverter defibrillator (ICD) experiences anxiety after device implantation. The purpose of the present study was to evaluate whether anxiety is predictive of ventricular arrhythmias and all-cause mortality 1 year post ICD implantation....

  19. End-tidal carbon dioxide and defibrillation success in out-of-hospital cardiac arrest.

    Science.gov (United States)

    Savastano, Simone; Baldi, Enrico; Raimondi, Maurizio; Palo, Alessandra; Belliato, Mirko; Cacciatore, Elisa; Corazza, Valentina; Molinari, Simone; Canevari, Fabrizio; Danza, Aurora I; De Ferrari, Gaetano M; Iotti, Giorgio Antonio; Visconti, Luigi Oltrona

    2017-12-01

    Basing on the relationship between the quality of cardiopulmonary resuscitation (CPR) and the responsiveness of VF to the defibrillation we aimed to assess whether the values of ETCO2 in the minute before defibrillation could predict the effectiveness of the shock. We retrospectively evaluated the reports generated by the manual monitor/defibrillator (Corpuls by GS Elektromedizinische Geräte G. Stemple GmbH, Germany) used for cases of VF cardiac arrest from January 2015 to December 2016. The mean ETCO2 value of the minute preceding the shock (METCO2 60 ) was computed. A blind evaluation of the effectiveness of each shock was provided by three cardiologists. A total amount of 207 shocks were delivered for 62 patients. When considering the three tertiles of METCO2 60 (T1:METCO2 60 ≤ 20mmHg; T2: 20mmHg 31mmHg) a statistically significant difference between the percentages of shock success was found (T1: 50%; T2: 63%; T3: 78%; Chi square p=0.003; p for trend CPR, monitored via ETCO2, and suggest ETCO2 monitoring as an additional weapon to guide defibrillation. Copyright © 2017 Elsevier B.V. All rights reserved.

  20. Interfacing external quantum devices to a universal quantum computer.

    Directory of Open Access Journals (Sweden)

    Antonio A Lagana

    Full Text Available We present a scheme to use external quantum devices using the universal quantum computer previously constructed. We thereby show how the universal quantum computer can utilize networked quantum information resources to carry out local computations. Such information may come from specialized quantum devices or even from remote universal quantum computers. We show how to accomplish this by devising universal quantum computer programs that implement well known oracle based quantum algorithms, namely the Deutsch, Deutsch-Jozsa, and the Grover algorithms using external black-box quantum oracle devices. In the process, we demonstrate a method to map existing quantum algorithms onto the universal quantum computer.

  1. External auditory canal leech: a rare case report of paediatric ...

    African Journals Online (AJOL)

    Leeches are blood sucking organism feed on human blood. While human bites are common, they rarely cause human internal infestation. We describe a rare case of a parasitic leech infestation of the External Auditory Canal (EAC). A two month old child presented to the Emergency department with a seven day history of ...

  2. Dielectric permittivity of a plasma in an external electric field

    International Nuclear Information System (INIS)

    Schweigert, V.A.

    2001-01-01

    The ion contribution to the dielectric function of a plasma in an external electric field is determined by applying a kinetic approach to the ions in a parent gas in which the main mechanism for ion scattering is resonant charge exchange. The ion scattering frequency is assumed to be constant

  3. A Novel Handmade External Fixator for Phalangeal and Metacarpal Fractures

    Directory of Open Access Journals (Sweden)

    Davod Jafari

    2016-12-01

    Full Text Available Background The value of external fixation in complex hand injuries is well established. Expenses and technical difficulties of commercial mini external fixator sets have led to the innovation of handmade external fixators. These fixators are used as versatile facilities to treat certain hand fractures. Usually, these structures are made by k-wires crossed filled with cement plastic tube. However, these fixators have multiple deficiencies that should be addressed. Objectives In this study, we described in detail the surgical technique of a handmade concrete like mini external fixator and report its clinical use and results. Methods Our handmade external fixator was applied for 52 patients with 56 fractures. Only 5% of the fractures were closed, non-comminuted extra-articular, and the other 51 fractures were more complex injuries. The mean follow up time was 9.3 months. At the end of the follow up, radiologic and functional assessment (DASH: Disability of arm, shoulder and hand and TAM: Total active motion was evaluated. Results All 56 fractures were united completely. None of the cases experienced pin loosening or reduction loss. Of the fractures, 8.9% malunited due to fracture complexity. The mean dash score was 3.76. TAM was excellent in 45% of the fractures; it was good in 7% and fair in 4%. Conclusions This type of handmade external fixator is simple, lightweight, and cheap. Furthermore, all implements are readily available in most operating fields. The probability of loosening has been greatly diminished because of the concrete like structure. Easy and fast assembly and good clinical and functional results are the other advantages of this technique. Due to the less complication and benefits, this technique could be used for many phalangeal and metacarpal fractures with confidence.

  4. Development and external validation of a new PTA assessment scale

    NARCIS (Netherlands)

    Jacobs, B.; van Ekert, J.; Vernooy, L.P.; Dieperink, P.; Andriessen, T.M.J.C.; Hendriks, M.P.; van Vugt, A.B.; Emons, M.A.; Borm, G.F.; Vos, P.E.

    2012-01-01

    BACKGROUND: Post-traumatic amnesia (PTA) is a key symptom of traumatic brain injury (TBI). Accurate assessment of PTA is imperative in guiding clinical decision making. Our aim was to develop and externally validate a short, examiner independent and practical PTA scale, by selecting the most

  5. Experimental validation of a radio frequency photogun as external electron

    NARCIS (Netherlands)

    Stragier, X.F.D.; Luiten, O.J.; Geer, van der S.B.; Wiel, van der M.J.

    2011-01-01

    A purpose-built RF-photogun as external electron injector for a laser wakefield accelerator has been thoroughly tested. Different properties of the RF-photogun have been measured such as energy, energy spread and transverse emittance. The focus of this study is the investigation of the smallest

  6. Human Immunodeficiency virus and invasive external otitis- A case ...

    African Journals Online (AJOL)

    Acute invasive external otitis is an uncommon life-threatening infection of the exteernal auditory canal (EAC), most often affecting the elderly diabetic patients. Although few reports have been made in HIV-positive/Aids patients among the caucasians. We present here a 25 year old nursing mother with a month history of ...

  7. Effects of advanced life support on patients who suffered cardiac arrest outside of hospital and were defibrillated.

    Science.gov (United States)

    Hagihara, Akihito; Onozuka, Daisuke; Nagata, Takashi; Hasegawa, Manabu

    2018-01-01

    The effects and relative benefits of advanced airway management and epinephrine on patients with out-of-hospital cardiac arrest (OHCA) who were defibrillated are not well understood. This was a prospective observational study. Using data of all out-of-hospital cardiac arrest cases occurring between 2005 and 2013 in Japan, hierarchical logistic regression and conditional logistic regression along with time-dependent propensity matching were performed. Outcome measures were survival and minimal neurological impairment [cerebral performance category (CPC) 1 or 2] at 1month after the event. We analyzed 37,873 cases that met the inclusion criteria. Among propensity-matched patients, advanced airway management and/or prehospital epinephrine use was related to decreased rates of 1-month survival (adjusted odds ratio 0.88, 95% confidence interval 0.80 to 0.97) and CPC (1, 2) (adjusted odds ratio 0.56, 95% confidence interval 0.48 to 0.66). Advanced airway management was related to decreased rates of 1-month survival (adjusted odds ratio 0.89, 95% confidence interval 0.81to 0.98) and CPC (1, 2) (adjusted odds ratio 0.54, 95% confidence interval 0.46 to 0.64) in patients who did not receive epinephrine, whereas epinephrine use was not related to the outcome measures. In defibrillated patients with OHCA, advanced airway management and/or epinephrine are related to reduced long-term survival, and advanced airway management is less beneficial than epinephrine. However, the proportion of patients with OHCA who responded to an initial shock was very low in the study subjects, and the external validity of our findings might be limited. Copyright © 2017 Elsevier Inc. All rights reserved.

  8. Ranking businesses and municipal locations by spatiotemporal cardiac arrest risk to guide public defibrillator placement

    Science.gov (United States)

    Sun, Christopher L. F.; Brooks, Steven C.; Morrison, Laurie J.; Chan, Timothy C.Y.

    2017-01-01

    Background Efforts to guide automated external defibrillator (AED) placement for out-of-hospital cardiac arrest (OHCA) treatment have focused on identifying broadly defined location categories without considering hours of operation. Broad location categories may be composed of many businesses with varying accessibility. Identifying specific locations for AED deployment incorporating operating hours and time of OHCA occurrence may improve AED accessibility. We aim to identify specific businesses and municipal locations that maximize OHCA coverage based on spatiotemporal assessment of OHCA risk in the immediate vicinity of franchise locations. Methods This study was a retrospective population-based cohort study using data from the Toronto Regional RescuNET Epistry cardiac arrest database. We identified all non-traumatic public OHCAs occurring in Toronto, Canada from Jan. 2007–Dec. 2015. We identified 41 unique businesses and municipal location types with 20 or more locations in Toronto from the YellowPages, Canadian Franchise Association, and the City of Toronto Open Data Portal. We obtained their geographic coordinates and hours of operation from websites, phone, or in-person. We determined the number of OHCAs that occurred within 100 m of each location when it was open (spatiotemporal coverage) for Toronto overall and downtown. The businesses and municipal locations were then ranked by spatiotemporal OHCA coverage. To evaluate temporal stability of the rankings, we calculated intra-class correlation (ICC) of the annual coverage values. Results There were 2,654 non-traumatic public OHCAs. Tim Hortons ranked first in Toronto covering 286 OHCAs. Starbucks ranked first in downtown covering 110 OHCAs. Coffee shops and bank machines from the five largest Canadian banks occupied eight of the top 10 spots in both Toronto and downtown. The rankings exhibited high temporal stability with ICC values of 0.88 (95% CI, 0.83–0.93) in Toronto and 0.79 (95% CI, 0.71–0.86) in

  9. Implantable Cardioverter-defibrillator Therapy for Hypertrophic Cardiomyopathy: Usefulness in Primary and Secondary Prevention.

    Science.gov (United States)

    Sarrias, Axel; Galve, Enrique; Sabaté, Xavier; Moya, Àngel; Anguera, Ignacio; Núñez, Elaine; Villuendas, Roger; Alcalde, Óscar; García-Dorado, David

    2015-06-01

    Hypertrophic cardiomyopathy is a frequent cause of sudden death. Clinical practice guidelines indicate defibrillator implantation for primary prevention in patients with 1 or more risk factors and for secondary prevention in patients with a history of aborted sudden death or sustained ventricular arrhythmias. The aim of the present study was to analyze the follow-up of patients who received an implantable defibrillator following the current guidelines in nonreferral centers for this disease. This retrospective observational study included all patients who underwent defibrillator implantation between January 1996 and December 2012 in 3 centers in the province of Barcelona. The study included 69 patients (mean age [standard deviation], 44.8 [17] years; 79.3% men), 48 in primary prevention and 21 in secondary prevention. The mean number of risk factors per patient was 1.8 in the primary prevention group and 0.5 in the secondary prevention group (P=.029). The median follow-up duration was 40.5 months. The appropriate therapy rate was 32.7/100 patient-years in secondary prevention and 1.7/100 patient-years in primary prevention (P<.001). Overall mortality was 10.1%. Implant-related complications were experienced by 8.7% of patients, and 13% had inappropriate defibrillator discharges. In patients with a defibrillator for primary prevention, the appropriate therapy rate is extremely low, indicating the low predictive power of the current risk stratification criteria. Copyright © 2014 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

  10. External cephalic version-related risks: a meta-analysis

    NARCIS (Netherlands)

    Grootscholten, K.; Kok, M.; Oei, S.G.; Mol, B.W.J.; Post, van der J.A.

    2008-01-01

    OBJECTIVE: To systematically review the literature on external cephalic version–related complications and to assess if the outcome of a version attempt is related to complications. DATA SOURCES: In March 2007 we searched MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials.

  11. External Cephalic Version-Related Risks A Meta-analysis

    NARCIS (Netherlands)

    Grootscholten, Kim; Kok, Marjolein; Oei, S. Guid; Mol, Ben W. J.; van der Post, Joris A.

    2008-01-01

    OBJECTIVE: To systematically review the literature on external cephalic version-related complications and to assess if the outcome of a version attempt is related to complications. DATA SOURCES: In March 2007 we searched MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials.

  12. AN EXTERNAL SHOCK ORIGIN OF GRB 141028A

    Energy Technology Data Exchange (ETDEWEB)

    Burgess, J. Michael; Bégué, Damien; Ryde, Felix [The Oskar Klein Centre for Cosmoparticle Physics, AlbaNova, SE-106 91 Stockholm (Sweden); Omodei, Nicola [W. W. Hansen Experimental Physics Laboratory, Kavli Institute for Particle Astrophysics and Cosmology, Department of Physics and SLAC National Accelerator Laboratory, Stanford University, Stanford, CA 94305 (United States); Pe’er, Asaf [Physics Department, University College Cork, Cork (Ireland); Racusin, J. L.; Cucchiara, A., E-mail: jamesb@kth.se, E-mail: damienb@kth.se [NASA Goddard Space Flight Center, Greenbelt, MD 20771 (United States)

    2016-05-10

    The prompt emission of the long, smooth, and single-pulsed gamma-ray burst, GRB 141028A, is analyzed under the guise of an external shock model. First, we fit the γ -ray spectrum with a two-component photon model, namely, synchrotron+blackbody, and then fit the recovered evolution of the synchrotron νF{sub ν} peak to an analytic model derived considering the emission of a relativistic blast wave expanding into an external medium. The prediction of the model for the νF{sub ν} peak evolution matches well with the observations. We observe the blast wave transitioning into the deceleration phase. Furthermore, we assume the expansion of the blast wave to be nearly adiabatic, motivated by the low magnetic field deduced from the observations. This allows us to recover within an order of magnitude the flux density at the νF{sub ν} peak, which is remarkable considering the simplicity of the analytic model. Under this scenario we argue that the distinction between prompt and afterglow emission is superfluous as both early-time emission and late-time emission emanate from the same source. While the external shock model is clearly not a universal solution, this analysis opens the possibility that at least some fraction of GRBs can be explained with an external shock origin of their prompt phase.

  13. External stimuli response on a novel chitosan hydrogel crosslinked ...

    Indian Academy of Sciences (India)

    The influence of external stimuli such as pH, temperature, and ionic strength of the swelling media on equilibrium swelling properties has been observed. Hydrogels showed a typical pH and temperature responsive behaviour such as low pH and high temperature has maximum swelling while high pH and low temperature ...

  14. Managing heterogeneous knowledge: A Theory of External Knowledge Integration

    NARCIS (Netherlands)

    Kraaijenbrink, Jeroen; Wijnhoven, Alphonsus B.J.M.

    2008-01-01

    Knowledge integration has been theorised at the levels of organisations and inter-organisational dyads. However, no theory exists yet of the integration of knowledge from an organisation's environment. This paper addresses this void in the literature by presenting a theory of external knowledge

  15. Pathways to Children's Externalizing Behavior: A Three-Generation Study

    Science.gov (United States)

    Brook, Judith S.; Zhang, Chenshu; Balka, Elinor B.; Brook, David W.

    2012-01-01

    In this study, based on Family Interactional Theory (FIT), the authors tested a longitudinal model of the intergenerational effects of the grandmothers' parent-child relationships and the grandparents' smoking on the grandchildren's externalizing behavior via parents' psychological symptoms, tobacco use, and child rearing. Using Mplus, the authors…

  16. Internal and external communication. A tool for value creation

    International Nuclear Information System (INIS)

    Cruz, J.

    2009-01-01

    Communication both internal and external in the Cofrentes Nuclear Power plant has become an essential element. In fact, it always has been. Over the past 25 years, we have strived to consolidate communication plans that, today, provided us with a large body of knowledge in this field. (Author)

  17. External marketing. How it can build a dental practice.

    Science.gov (United States)

    Ascher, S

    1988-01-01

    This article gives a general introduction to external marketing as it befits the image of the dental professional. Research and various media opportunities are discussed, highlighting their advantages and pointing out the pros and cons of each. The latest trends in advertising philosophy are intertwined with concrete advice regarding cost effectiveness. This article is helpful to solo as well as group practitioners.

  18. Nonlinear vibration of a hemispherical dome under external water pressure

    International Nuclear Information System (INIS)

    Ross, C T F; McLennan, A; Little, A P F

    2011-01-01

    The aim of this study was to analyse the behaviour of a hemi-spherical dome when vibrated under external water pressure, using the commercial computer package ANSYS 11.0. In order to achieve this aim, the dome was modelled and vibrated in air and then in water, before finally being vibrated under external water pressure. The results collected during each of the analyses were compared to the previous studies, and this demonstrated that ANSYS was a suitable program and produced accurate results for this type of analysis, together with excellent graphical displays. The analysis under external water pressure, clearly demonstrated that as external water pressure was increased, the resonant frequencies decreased and a type of dynamic buckling became likely; because the static buckling eigenmode was similar to the vibration eigenmode. ANSYS compared favourably with the in-house software, but had the advantage that it produced graphical displays. This also led to the identification of previously undetected meridional modes of vibration; which were not detected with the in-house software.

  19. Nonlinear vibration of a hemispherical dome under external water pressure

    Science.gov (United States)

    Ross, C. T. F.; McLennan, A.; Little, A. P. F.

    2011-07-01

    The aim of this study was to analyse the behaviour of a hemi-spherical dome when vibrated under external water pressure, using the commercial computer package ANSYS 11.0. In order to achieve this aim, the dome was modelled and vibrated in air and then in water, before finally being vibrated under external water pressure. The results collected during each of the analyses were compared to the previous studies, and this demonstrated that ANSYS was a suitable program and produced accurate results for this type of analysis, together with excellent graphical displays. The analysis under external water pressure, clearly demonstrated that as external water pressure was increased, the resonant frequencies decreased and a type of dynamic buckling became likely; because the static buckling eigenmode was similar to the vibration eigenmode. ANSYS compared favourably with the in-house software, but had the advantage that it produced graphical displays. This also led to the identification of previously undetected meridional modes of vibration; which were not detected with the in-house software.

  20. A multiple sampling ionization chamber for the External Target Facility

    International Nuclear Information System (INIS)

    Zhang, X.H.; Tang, S.W.; Ma, P.; Lu, C.G.; Yang, H.R.; Wang, S.T.; Yu, Y.H.; Yue, K.; Fang, F.; Yan, D.; Zhou, Y.; Wang, Z.M.; Sun, Y.; Sun, Z.Y.; Duan, L.M.; Sun, B.H.

    2015-01-01

    A multiple sampling ionization chamber used as a particle identification device for high energy heavy ions has been developed for the External Target Facility. The performance of this detector was tested with a 239 Pu α source and RI beams. A Z resolution (FWHM) of 0.4–0.6 was achieved for nuclear fragments of 18 O at 400 AMeV

  1. Educational and psychological interventions to improve outcomes for recipients of implantable cardioverter defibrillators and their families: a scientific statement from the American Heart Association.

    Science.gov (United States)

    Dunbar, Sandra B; Dougherty, Cynthia M; Sears, Samuel F; Carroll, Diane L; Goldstein, Nathan E; Mark, Daniel B; McDaniel, George; Pressler, Susan J; Schron, Eleanor; Wang, Paul; Zeigler, Vicki L

    2012-10-23

    Significant mortality benefits have been documented in recipients of implantable cardioverter defibrillators (ICDs); however, the psychosocial distress created by the underlying arrhythmia and its potential treatments in patients and family members may be underappreciated by clinical care teams. The disentanglement of cardiac disease and device-related concerns is difficult. The majority of ICD patients and families successfully adjust to the ICD, but optimal care pathways may require additional psychosocial attention to all ICD patients and particularly those experiencing psychosocial distress. This state-of-the-science report was developed on the basis of an analysis and critique of existing science to (1) describe the psychological and quality-of-life outcomes after receipt of an ICD and describe related factors, such as patient characteristics; (2) describe the concerns and educational/informational needs of ICD patients and their family members; (3) outline the evidence that supports interventions for improving educational and psychological outcomes for ICD patients; (4) provide recommendations for clinical approaches for improving patient outcomes; and (5) identify priorities for future research in this area. The ultimate goal of this statement is to improve the precision of identification and care of psychosocial distress in ICD patients to maximize the derived benefit of the ICD.

  2. Elephantiasis of the external genitalia: A sequel to cutaneous tuberculosis

    Directory of Open Access Journals (Sweden)

    Padmavathy L

    2009-01-01

    Full Text Available Tuberculosis continues to be an important public health problem and cutaneous tuberculosis constitutes a minor proportion of extra pulmonary manifestations of tuberculosis. Elephantiasis of the external genitalia, as a sequel to cutaneous tuberculosis, in a 40-year-old diabetic lady is being reported for its rarity. The patient also had lesions of healed scrofuloderma of 27 years′ duration, in both axillae, with residual pedunculated nodules.

  3. Failure Analysis of a Helicopter External Fuel-Tank Pylon

    Science.gov (United States)

    Newman, John A.; Piascik, Robert S.; Lindenberg, Richard A.

    2002-01-01

    An eight-inch-long (0.2 m) crack was found in an external fuel-tank pylon of a U.S. Coast Guard HH-60 helicopter. The damaged pylon was removed from service and destructively examined at NASA Langley Research Center (LaRC) to determine the cause of the crack. Results of the analysis revealed that crack initiation occurred at corrosion pits in a fastener hole and crack propagation was a result of cyclic loading.

  4. Self-injury and externalizing pathology: a systematic literature review

    OpenAIRE

    Meszaros, Gergely; Horvath, Lili Olga; Balazs, Judit

    2017-01-01

    Background During the last decade there is a growing scientific interest in nonsuicidal self-injury (NSSI). The aim of the current paper was to review systematically the literature with a special focus on the associations between self-injurious behaviours and externalizing psychopathology. An additional aim was to review terminology and measurements of self-injurious behaviour and the connection between self-injurious behaviours and suicide in the included publications. Methods A systematic l...

  5. Polarization of the vacuum by a stochastic external field

    International Nuclear Information System (INIS)

    Krive, I.V.; Pastur, L.A.; Rozhavskii, A.S.

    1988-01-01

    The effect of disorder, realized in the form of a fluctuating extra mass term, on the bosonic vacuum and fermionic vacuum of models of quantum field theory is studied. A method is developed for calculating the mean effective potential in the stochastic external field. For a model of interacting scalar and fermion fields in (3+1)-dimensional space-time it is shown that random fluctuations of the mass lead to an increase of the equilibrium mean scalar field in the system

  6. Security of supply: a neglected fossil fuel externality

    International Nuclear Information System (INIS)

    Cavallo, A.J.

    1995-01-01

    Various groups have attempted to set a monetary value on the externalities of fossil fuel usage based on damages caused by emissions of particulates, sulfur dioxide, and oxides of nitrogen and carbon. One externality that has been neglected in this type of analysis, however, is the cost of maintaining a secure supply of fossil fuels. Military expenditures for this purpose are relatively easy to quantify based on US Department of Defense and Office of Management and Budget figures, and amount to between $1 and more than $3 per million Btu, based on total fossil fuel consumption in the US. Open acknowledgment of such expenses would, at the very least, have a profound effect on the perceived competitiveness of all non-fossil fuel technologies. It should also provide a simple and easily comprehended rationale for an energy content (Btu) charge on all fossil fuels. (Author)

  7. Externalities in a life cycle model with endogenous survival☆

    Science.gov (United States)

    Kuhn, Michael; Wrzaczek, Stefan; Prskawetz, Alexia; Feichtinger, Gustav

    2011-01-01

    We study socially vs individually optimal life cycle allocations of consumption and health, when individual health care curbs own mortality but also has a spillover effect on other persons’ survival. Such spillovers arise, for instance, when health care activity at aggregate level triggers improvements in treatment through learning-by-doing (positive externality) or a deterioration in the quality of care through congestion (negative externality). We combine an age-structured optimal control model at population level with a conventional life cycle model to derive the social and private value of life. We then examine how individual incentives deviate from social incentives and how they can be aligned by way of a transfer scheme. The age-patterns of socially and individually optimal health expenditures and the transfer rate are derived. Numerical analysis illustrates the working of our model. PMID:28298810

  8. Hybrid computing using a neural network with dynamic external memory.

    Science.gov (United States)

    Graves, Alex; Wayne, Greg; Reynolds, Malcolm; Harley, Tim; Danihelka, Ivo; Grabska-Barwińska, Agnieszka; Colmenarejo, Sergio Gómez; Grefenstette, Edward; Ramalho, Tiago; Agapiou, John; Badia, Adrià Puigdomènech; Hermann, Karl Moritz; Zwols, Yori; Ostrovski, Georg; Cain, Adam; King, Helen; Summerfield, Christopher; Blunsom, Phil; Kavukcuoglu, Koray; Hassabis, Demis

    2016-10-27

    Artificial neural networks are remarkably adept at sensory processing, sequence learning and reinforcement learning, but are limited in their ability to represent variables and data structures and to store data over long timescales, owing to the lack of an external memory. Here we introduce a machine learning model called a differentiable neural computer (DNC), which consists of a neural network that can read from and write to an external memory matrix, analogous to the random-access memory in a conventional computer. Like a conventional computer, it can use its memory to represent and manipulate complex data structures, but, like a neural network, it can learn to do so from data. When trained with supervised learning, we demonstrate that a DNC can successfully answer synthetic questions designed to emulate reasoning and inference problems in natural language. We show that it can learn tasks such as finding the shortest path between specified points and inferring the missing links in randomly generated graphs, and then generalize these tasks to specific graphs such as transport networks and family trees. When trained with reinforcement learning, a DNC can complete a moving blocks puzzle in which changing goals are specified by sequences of symbols. Taken together, our results demonstrate that DNCs have the capacity to solve complex, structured tasks that are inaccessible to neural networks without external read-write memory.

  9. A relativistic colored spinning particle in an external color field

    International Nuclear Information System (INIS)

    Heinz, U.

    1984-01-01

    I derive fully covariant equations of motion for a classical colored spinning particle in an external SU(3) color field. Although the total color charge and total spin of the particle are found to be separately constants of motion (here I disagree with a recent paper by Arodz), the dynamics of the orientation of the color and spin vectors are coupled to each other through interaction with the color field, even if the latter is homogeneous. (orig.)

  10. Aetiology of thrombosed external haemorrhoids: a questionnaire study

    OpenAIRE

    Gebbensleben, Ole; Hilger, York; Rohde, Henning

    2009-01-01

    Abstract Background It is important to better understand the aetiology of thrombosed external haemorrhoids (TEH) because recurrence rates are high, prophylaxis is unknown, and optimal therapy is highly debated. Findings We conducted a questionnaire study of individuals with and without TEH. Aetiology was studied by comparison of answers to a questionnaire given to individuals with and without TEH concerning demography, history, and published aetiologic hypotheses. Participants were evaluated ...

  11. The external use of comfrey: a practitioner survey.

    Science.gov (United States)

    Frost, Rachael; O'Meara, Susan; MacPherson, Hugh

    2014-11-01

    The survey aimed to assess how often and in what ways herbal practitioners use comfrey (Symphytum officinale L.) externally in everyday practice. A 2-sided A4 survey was sent to all UK members of the National Institute of Medical Herbalists, the College of Practitioners of Phytotherapy and the Association of Master Herbalists with viable practice addresses (n = 598). 239 herbalists responded, of whom 179 (75%) reported regularly using comfrey, in 15% of their consultations. It was most commonly prescribed as a cream for tendon, ligament and muscle problems, for fractures, and for wounds, the indications for which it was also perceived to be most effective. Comfrey was rated least effective for haemorrhoids, varicose veins and boils and was considered to carry the greatest risk when prescribed for ulcers, wounds and boils. Practitioner experience suggests that comfrey can be used safely and effectively externally for certain indications. Copyright © 2014 Elsevier Ltd. All rights reserved.

  12. Vulnerability analysis of a PWR to an external event

    International Nuclear Information System (INIS)

    Aruety, S.; Ilberg, D.; Hertz, Y.

    1980-01-01

    The Vulnerability of a Nuclear Power Plant (NPP) to external events is affected by several factors such as: the degree of redundancy of the reactor systems, subsystems and components; the separation of systems provided in the general layout; the extent of the vulnerable area, i.e., the area which upon being affected by an external event will result in system failure; and the time required to repair or replace the systems, when allowed. The present study offers a methodology, using Probabilistic Safety Analysis, to evaluate the relative importance of the above parameters in reducing the vulnerability of reactor safety systems. Several safety systems of typical PWR's are analyzed as examples. It was found that the degree of redundancy and physical separation of the systems has the most prominent effect on the vulnerability of the NPP

  13. The external costs of a sedentary life-style.

    Science.gov (United States)

    Keeler, E B; Manning, W G; Newhouse, J P; Sloss, E M; Wasserman, J

    1989-01-01

    Using data from the National Health Interview Survey and the RAND Health Insurance Experiment, we estimated the external costs (costs borne by others) of a sedentary life-style. External costs stem from additional payments received by sedentary individuals from collectively financed programs such as health insurance, sick-leave coverage, disability insurance, and group life insurance. Those with sedentary life-styles incur higher medical costs, but their life expectancy at age 20 is 10 months less so they collect less public and private pensions. The pension costs come late in life, as do some of the medical costs, and so the estimate of the external cost is sensitive to the discount rate used. At a 5 percent rate of discount, the lifetime subsidy from others to those with a sedentary life style is $1,900. Our estimate of the subsidy is also sensitive to the assumed effect of exercise on mortality. The subsidy is a rationale for public support of recreational facilities such as parks and swimming pools and employer support of programs to increase exercise. PMID:2502036

  14. Towards a better understanding of helicopter external noise

    Science.gov (United States)

    Damongeot, A.; Dambra, F.; Masure, B.

    The problem of helicopter external noise generation is studied taking into consideration simultaneously the multiple noise sources: rotor rotational-, rotor broadband -, and engine noise. The main data are obtained during flight tests of the rather quiet AS 332 Super Puma. The flight procedures settled by ICAO for noise regulations are used: horizontal flyover at 90 percent of the maximum speed, approach at minimum power velocity, take-off at best rate of climb. Noise source levels are assessed through narrow band analysis of ground microphone recordings, ground measurements of engine noise and theoretical means. With the perceived noise level unit used throughout the study, relative magnitude of noise sources is shown to be different from that obtained with linear noise unit. A parametric study of the influence of some helicopter parameters on external noise has shown that thickness-tapered, chord-tapered, and swept-back blade tips are good means to reduce the overall noise level in flyover and approach.

  15. Trade misinvoicing, external debt and sustainable development: A Nigerian example

    Directory of Open Access Journals (Sweden)

    Collins C. Ngwakwe

    2015-06-01

    Full Text Available This paper evaluated how trade misinvoicing orchestrates external debt in Nigeria and its obstructive tendencies on Nigeria’s sustainable economic development. The paper is pertinent, given that Nigeria is among the top ten developing countries in the world who are victims of substantial illicit trade misinvoicing outflows. The methodological approach is a mix of descriptive analysis (using tables and graphs and a t-test of difference in means between trade misinvoicing outflow from Nigeria, external debt and official development assistance (OD in Nigeria for the period 2003 – 2012. Findings indicate that as trade misinvoicing outflow increased during the period 2003 -2012, Nigeria’s external debt increased yearly. Results from the statistical t-test showed that the mean difference in trade misinvoicing outflow is significantly greater than the mean differences in external debt and official development assistance received into Nigeria. This finding attests to the huge internal financial resources that Nigeria lost during the period 2003 - 2012 through illicit trade misinvoicing outflow. The analysis further disclosed that trade misinvoicing outflow has hampered Nigeria’s stride to sustainable economic development given the record increases in unemployment, poverty, lack of access to sanitation facilities, low percentage of qualified health staff to child birth and a widening income inequality as measured by GINI index. The paper concludes that the drainage of Nigeria’s internal financial resources through illicit trade misinvoicing has denied Nigeria the needed finance to enhance the actualisation of sustainable economic development. Recommendations are proffered to assist in halting trade misinvoicing outflow from Nigeria.

  16. Pacing and Defibrillators in Complex Congenital Heart Disease

    Science.gov (United States)

    Chubb, Henry; O’Neill, Mark; Rosenthal, Eric

    2016-01-01

    Device therapy in the complex congenital heart disease (CHD) population is a challenging field. There is a myriad of devices available, but none designed specifically for the CHD patient group, and a scarcity of prospective studies to guide best practice. Baseline cardiac anatomy, prior surgical and interventional procedures, existing tachyarrhythmias and the requirement for future intervention all play a substantial role in decision making. For both pacing systems and implantable cardioverter defibrillators, numerous factors impact on the merits of system location (endovascular versus non-endovascular), lead positioning, device selection and device programming. For those with Fontan circulation and following the atrial switch procedure there are also very specific considerations regarding access and potential complications. This review discusses the published guidelines, device indications and the best available evidence for guidance of device implantation in the complex CHD population. PMID:27403295

  17. Decommissioning nuclear power plants: a case for external funding

    International Nuclear Information System (INIS)

    Hendren, C.B.

    1987-01-01

    In deciding how to finance the decommissioning of nuclear power plants, there are five basic criteria for choosing between internal and external funding methods: (1) the desire for financial assurance, (2) the cost of the assurance, (3) the degree of equity in the recovery program, (4) the program's ability to respond to changes, and (5) the program's adaptability to different utilities. To fulfill its obligations to protect long-term public interests, the Missouri Public Service Commission decided it had to assure, to the maximum extent possible, that sufficient decommissioning funds were available when needed. For this reason, it chose the external funding method. In an external fund, the money currently collected from ratepayers to cover decommissioning costs is placed in an independent trust fund comprised of low-risk investments. The funds and the interest they accrue are available to the utility only at the time of decommissioning (and only for that purpose), thus assuring a certain amount of money will be on-hand to cover decommissioning costs as they arise. Such a fund may prove critical to the financial well-being of the utility, particularly if one considers that the utility would need additional generating facilities to replace the capacity lost through the retirement of its nuclear plant. 3 references

  18. Prediction models for successful external cephalic version: a systematic review.

    Science.gov (United States)

    Velzel, Joost; de Hundt, Marcella; Mulder, Frederique M; Molkenboer, Jan F M; Van der Post, Joris A M; Mol, Ben W; Kok, Marjolein

    2015-12-01

    To provide an overview of existing prediction models for successful ECV, and to assess their quality, development and performance. We searched MEDLINE, EMBASE and the Cochrane Library to identify all articles reporting on prediction models for successful ECV published from inception to January 2015. We extracted information on study design, sample size, model-building strategies and validation. We evaluated the phases of model development and summarized their performance in terms of discrimination, calibration and clinical usefulness. We collected different predictor variables together with their defined significance, in order to identify important predictor variables for successful ECV. We identified eight articles reporting on seven prediction models. All models were subjected to internal validation. Only one model was also validated in an external cohort. Two prediction models had a low overall risk of bias, of which only one showed promising predictive performance at internal validation. This model also completed the phase of external validation. For none of the models their impact on clinical practice was evaluated. The most important predictor variables for successful ECV described in the selected articles were parity, placental location, breech engagement and the fetal head being palpable. One model was assessed using discrimination and calibration using internal (AUC 0.71) and external validation (AUC 0.64), while two other models were assessed with discrimination and calibration, respectively. We found one prediction model for breech presentation that was validated in an external cohort and had acceptable predictive performance. This model should be used to council women considering ECV. Copyright © 2015. Published by Elsevier Ireland Ltd.

  19. Effect of defibrillation threshold testing on effectiveness of the subcutaneous implantable cardioverter defibrillator.

    Science.gov (United States)

    Peddareddy, Lakshmi; Merchant, Faisal M; Leon, Angel R; Smith, Paige; Patel, Akshar; El-Chami, Mikhael F

    2018-06-12

    Defibrillation threshold (DFT) testing is recommended with the subcutaneous ICD (SICD). To describe first shock efficacy for appropriate SICD therapies stratified by the presence of implant DFT testing. We reviewed all patients receiving SICDs at our institution and stratified them based on whether implant DFT testing was performed. Appropriate shocks were reviewed to see if ventricular tachycardia/ventricular fibrillation (VT/VF) terminated with a single shock. First shock efficacy was stratified by implant DFT status. 178 patients implanted with SICDs and followed in our center were included in this study. Of these, 135 (76 %) underwent DFT testing (DFT (+) group). In the DFT (+) 80 appropriate shocks were needed to treat 69 episodes of VT/VF. The first shock was effective in 61 out of 69 episodes (88.4 %), whereas multiple shocks were required to terminate VT/VF in the remaining 8 episodes. Among 43 patients without implant DFT testing (DFT (-) group), 20 appropriate shocks to treat 17 episodes of VT/VF occurred in 7 patients. VT/VF was successfully terminated with the first shock in 16 out of 17 episodes (first shock efficacy 94.1 %). There was no significant difference in first shock effectiveness between those with and without implant DFT testing (p = 0.97). A strategy that omits DFT testing at implant did not appear to compromise the effictiveness of the SICD. These data suggest that routine DFT testing at SICD implant might not be necessary. Randomized trials are needed to confirm this finding. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  20. Tricuspid Valve Dysfunction Following Pacemaker or Cardioverter-Defibrillator Implantation.

    Science.gov (United States)

    Chang, James D; Manning, Warren J; Ebrille, Elisa; Zimetbaum, Peter J

    2017-05-09

    The potential for cardiac implantable electronic device leads to interfere with tricuspid valve (TV) function has gained increasing recognition as having hemodynamic and clinical consequences associated with incremental morbidity and death. The diagnosis and treatment of lead-related (as distinct from functional) tricuspid regurgitation pose unique challenges. Because of pitfalls in routine diagnostic imaging, a high level of clinical suspicion must be maintained to avoid overlooking the possibility that worsening heart failure is a consequence of mechanical interference with TV leaflet mobility or coaptation and is amenable to lead extraction or valve repair or replacement. The future of cardiac implantable electronic devices includes pacing and perhaps defibrillation without a lead traversing the TV. Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  1. Driving safety among patients with automatic implantable cardioverter defibrillators.

    Science.gov (United States)

    Finch, N J; Leman, R B; Kratz, J M; Gillette, P C

    1993-10-06

    To determine the driving behavior of patients following the placement of automatic implantable cardioverter defibrillators (AICDs). Forty patients with AICDs (33 men, seven women; mean age, 62.7 years) responded to a questionnaire designed to ascertain driving behavior after hospital discharge. Despite medical advice never to drive again, 28 patients (70%) resumed driving, with the majority doing so by 8 months after AICD implantation. Of these, 11 (40%) identified themselves as the primary driver in their household. Fourteen (50%) drove daily. Two (7%) were driving and continued to drive during discharge of their AICDs. Twenty-five (91%) reported that they felt comfortable and safe while driving. A majority of patients with AICDs continue to drive after a proscription of this activity by health care workers.

  2. Defibrillator Implantation in Patients with Nonischemic Systolic Heart Failure

    DEFF Research Database (Denmark)

    Køber, Lars; Thune, Jens J; Nielsen, Jens C

    2016-01-01

    Background The benefit of an implantable cardioverter-defibrillator (ICD) in patients with symptomatic systolic heart failure caused by coronary artery disease has been well documented. However, the evidence for a benefit of prophylactic ICDs in patients with systolic heart failure that is not due...... to coronary artery disease has been based primarily on subgroup analyses. The management of heart failure has improved since the landmark ICD trials, and many patients now receive cardiac resynchronization therapy (CRT). Methods In a randomized, controlled trial, 556 patients with symptomatic systolic heart.......6%) in the control group (P=0.29). Conclusions In this trial, prophylactic ICD implantation in patients with symptomatic systolic heart failure not caused by coronary artery disease was not associated with a significantly lower long-term rate of death from any cause than was usual clinical care. (Funded by Medtronic...

  3. The EPR-a comprehensive design concept against external events

    International Nuclear Information System (INIS)

    Waas, U.; Stoll, U.

    2005-01-01

    The main objective of design provisions against external hazards is to ensure that the safety functions required to bring the plant to safe shutdown are not inadmissible affected. In the design of the EPR particular attention was paid to the following external hazards: Earthquake, Airplane crash, Explosion pressure wave. The design concept for these events is discussed below. The standard EPR covers a large range of possible site conditions, the design earthquake enveloping safe shutdown earthquakes (SSE) to be expected for potential sites. The Basic Design was developed for the seismic loads given in the European Utility Requirements with a horizontal free field Peak Ground Acceleration (PGA) for all site conditions of 0.25 g. The seismic protection is based on a deterministic design approach, with the intention of ensuring the safety functions in case of SSE. The loads for the design basis airplane crash and - if required - for the design extension airplane crash are defined depending on site specific requirements. For the design basis airplane crash as defined in Finland the safety goals are fulfilled for postulated single failure and preventive maintenance as well as for specific unlikely scenarios with local impacts where one redundant train is assumed to be lost. For the design extension airplane crash no single failure and preventive maintenance are assumed. Reactor building (RB), fuel building (FB), safeguard building (SB) 2 and 3 are protected by design against airplane crash. The common base mat of the RB, FB and SBs ensures global stability. To avoid penetration the wall thickness of the outer building structures of RB, FB and SB2/3 is set at 1.80 m (result of an optimization process). To rule out major induced vibrations due to airplane crash the inner building structures are decoupled from the outer walls. The SB 1 and SB4, the main steam and feedwater valve compartments, the diesel buildings and the service water pump buildings are protected against

  4. Economic impact of longer battery life of cardiac resynchronization therapy defibrillators in Sweden

    Directory of Open Access Journals (Sweden)

    Gadler F

    2016-10-01

    Full Text Available Fredrik Gadler,1 Yao Ding,2 Nathalie Verin,3 Martin Bergius,4 Jeffrey D Miller,5 Gregory M Lenhart,5 Mason W Russell5 1Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden; 2Truven Health Analytics, an IBM Company, Bethesda, MD, USA; 3Boston Scientific Corporation, Hemel Hempstead, Hertfordshire, UK; 4Boston Scientific Nordic AB, Helsingborg, Sweden; 5Truven Health Analytics, an IBM Company, Cambridge, MA, USA Objective: The objective of this study was to quantify the impact that longer battery life of cardiac resynchronization therapy defibrillator (CRT-D devices has on reducing the number of device replacements and associated costs of these replacements from a Swedish health care system perspective.Methods: An economic model based on real-world published data was developed to estimate cost savings and avoided device replacements for CRT-Ds with longer battery life compared with devices with industry-standard battery life expectancy. Base-case comparisons were performed among CRT-Ds of three manufacturers – Boston Scientific Corporation, St. Jude Medical, and Medtronic – over a 6-year time horizon, as per the available clinical data. As a sensitivity analysis, we evaluated CRT-Ds as well as single-chamber implantable cardioverter defibrillator (ICD-VR and dual-chamber implantable cardioverter defibrillator (ICD-DR devices over a longer 10-year period. All costs were in 2015 Swedish Krona (SEK discounted at 3% per annum.Results: Base-case analysis results show that up to 603 replacements and up to SEK 60.4 million cumulative-associated costs could be avoided over 6 years by using devices with extended ­battery life. The pattern of savings over time suggests that savings are modest initially but increase rapidly beginning in the third year of follow-up with each year’s cumulative savings two to three times the previous year. Evaluating CRT-D, ICD-VR, and ICD-DR devices together over a longer 10-year period, the

  5. A device for external γ-irradiation of experimental animals

    International Nuclear Information System (INIS)

    Ivanitskaya, N.F.; Talakin, Yu.N.; Lekakh, V.A.

    1992-01-01

    A device was developed for external gamma-irradiation of experimental animals including a radiation source, a device for fixation of the total animal or a segment of its body in the focus of irradiation, and a shilding screen. To widen the sphere of this device application by making possible a simultaneous radiation exposure of a group of animals under various radiation schedules, the device involves two discs with a common axis. The lower disc is provided with an electric drive and containers with animals are placed on it, and the upper disc is for the shielding screen. The device is supplied with an operation block

  6. Clinical performance of different DF-4 implantable cardioverter defibrillator leads.

    Science.gov (United States)

    Sarrazin, Jean-François; Philippon, François; Sellier, Romain; André, Philippe; O'Hara, Gilles; Molin, Franck; Nault, Isabelle; Blier, Louis; Champagne, Jean

    2018-06-01

    Implantable cardioverter-defibrillator (ICD) DF-4 connectors have been introduced to facilitate defibrillator lead connection and to reduce the size of device header. There are limited data regarding the overall performance of those leads and no comparison between different ICD DF-4 leads. This is a cohort study of consecutive patients implanted with ICD DF-4 lead system at one University Centre between October 2010 and February 2015. A historical control group of patients with ICD DF-1 lead implantation was used for comparison. The following ICD DF-4 leads were evaluated: St. Jude Medical Durata 7122Q (St. Jude Medical, St. Paul, MN, USA), Medtronic Sprint Quattro Secure 6935 M (Medtronic Inc., Minneapolis, MN, USA), Boston Scientific Endotak Reliance 4-Site 0293 (Boston Scientific, Marlborough, MA, USA), and Boston Scientific Reliance 4-Front 0693. This study evaluated the acute and mid-term performances of those leads as well as complications. A total of 812 patients (age 63 ± 12 years, 80% male, left ventricular ejection fraction 31 ± 12%) underwent implantation of an ICD DF-4 lead. Acute and follow-up R-wave sensing and threshold were excellent. Compared to implantation, intrinsic R waves were higher at follow-up for Boston Scientific and Medtronic leads, and pacing lead impedances were lower for all leads at first follow-up (P < 0.001). The number of lead dislodgement or failure was similar between all leads. The estimated lead survival rates at 3 years were 95.6% for Boston Scientific Endotak 4-Site, 97.1% for Boston Scientific 4-Front, 97.7% for Medtronic Sprint Quattro, and 97.5% for St. Jude Durata (P  =  0.553). All ICD DF-4 leads had excellent acute and mid-term electrical performances. Longer follow-up will be necessary to confirm their sustained performance. © 2018 Wiley Periodicals, Inc.

  7. Externality and framing effects in a bribery experiment

    OpenAIRE

    Abigail Barr; Danila Serra

    2007-01-01

    Using a simple one-shot bribery game, we find evience of a negative externality effect and a framing effect. When the losses suffered by a third parties due to a bribe being offered and accepted are increased bribes are less likely to be offered and accepted. And when the game is presented as a bribery scenario instead of in abstract terms bribes are less likely to be offered and accepted. We discuss two possible reasons as to why our experiment leads to the identification of these effects wh...

  8. Implantable cardioverter defibrillator implantation in children in The Netherlands

    NARCIS (Netherlands)

    Ten Harkel, ADJ; Blom, NA; Reimer, AG; Tukkie, R; Sreeram, N; Bink-Boelkens, MTE

    To evaluate the indications, underlying cardiac disorders, efficacy and complications involved with implantable cardioverter-defibrillators (ICDs) in paediatric patients in The Netherlands, the records of all patients aged 18 years or younger who underwent ICD placement were reviewed

  9. Implantable cardioverter defibrillator implantation in children in The Netherlands

    NARCIS (Netherlands)

    ten Harkel, A. Derk Jan; Blom, Nico A.; Reimer, Annette G.; Tukkie, Raymond; Sreeram, Narayanswami; Bink-Boelkens, Margreet T. E.

    2005-01-01

    To evaluate the indications, underlying cardiac disorders, efficacy and complications involved with implantable cardioverter-defibrillators (ICDs) in paediatric patients in The Netherlands, the records of all patients aged 18 years or younger who underwent ICD placement were reviewed

  10. A decay heat removal system requiring no external energy

    International Nuclear Information System (INIS)

    Costes, D.; Fermandjian, J.

    1983-12-01

    A new Decay heat Removal System is described for PWR's with dry containment, i.e. a containment building which encloses no permanent reserve of cooling water. This new system is intended to provide a high level of safety since it uses no external energy, but only the thermodynamic energy of the air-steam-liquid water mixture generated in the containment after the failure of the primary circuit (''LOCA'') or of the secondary circuit. Thermodynamics of the system is evaluated first: after some design considerations, the use of the system for protecting actual PWR's is addressed

  11. External rhinoplasty for the Arabian nose: a columellar scar analysis.

    Science.gov (United States)

    Foda, Hossam M T

    2004-01-01

    This study aimed to evaluate columellar scar problems after external rhinoplasty in the Arabian population, and to analyze the technical factors that help prevent such problems and maximize the scar cosmesis. The investigation was conducted in university and private practice settings of the author in Alexandria, Egypt. A total of 600 Arab patients who underwent external rhinoplasty were included in the study. All the patients underwent surgery using the external rhinoplasty approach, in which bilateral alar marginal incisions were connected by an inverted V-shaped transcolumellar incision. At completion of the procedure, a two-layer closure of the columellar incision was performed. At a minimum of 1 year postoperatively, the columellar scar was evaluated subjectively by means of a patient questionnaire, and objectively by clinical examination and comparison of the close-up pre- and postoperative basal view photographs. Objectively, anything less than a barely visible, leveled, thin, linear scar was considered unsatisfactory. Subjectively, 95.5% of the patients rated the scar as unnoticeable, 3% as noticeable but acceptable, and 1.5% as unacceptable. Objectively, the scar was unsatisfactory in 7% of the cases. This was because of scar widening with or without depression (5%), hyperpigmentation (1.5%), and columellar rim notching (0.5%). The use of a deep 6/0 polydioxanon (PDS) suture significantly decreased the incidence of scar widening (p < 0.005).The columellar incision can be used safely in the Arab population regardless of their thick, dark, and oily skin. Technical factors that contributed to the favorable outcome of the columellar scar included proper planning of location and design of the incision used, precise execution, meticulous multilayered closure, and good postoperative care.

  12. External radiation assessment in a wet phosphoric acid production plant

    Energy Technology Data Exchange (ETDEWEB)

    Bolivar, J.P.; Perez-Moreno, J.P. [Dept. Fisica Aplicada, Facultad de Ciencias Experimentales, Universidad de Huelva, 21012 Huelva (Spain); Mas, J.L. [Dept. Fisica Aplicada I, Escuela Universitaria Politecnica, Universidad de Sevilla, 41012 Sevilla (Spain)], E-mail: ppmasb@us.es; Martin, J.E.; San Miguel, E.G. [Dept. Fisica Aplicada, Facultad de Ciencias Experimentales, Universidad de Huelva, 21012 Huelva (Spain); Garcia-Tenorio, R. [Dept. Fisica Aplicada II, Escuela Tecnica Superior de Arquitectura, Universidad de Sevilla, 41012 Sevilla (Spain)

    2009-10-15

    The factories dedicated to the production of phosphoric acid by the so-called wet acid method are usually considered typical NORM industries, because the phosphate rock used as raw material usually contains high concentrations of {sup 238}U-series radionuclides. The magnitude and behaviour of the radionuclides involved in the production process revealed the need to determine its dosimetric impact on workers. This work aims to partially compensate this lack of knowledge through the determination of external effective dose rates at different zones in the process at a typical plant located in the southwest of Spain. To this end, two dosimetric sampling campaigns have been carried out at this phosphoric acid production plant. The first sampling was carried out when phosphate rocks originating in Morocco were processed, and the second one when phosphate rock processed came from the Kola Peninsula (Russia Federation). This differentiation was necessary because the activity concentrations are almost one order of magnitude higher in Moroccan phosphate rock than in Kola phosphate rock. The results obtained have reflected external dose rate enhancements as high as 1.4 {mu}Sv h{sup -1} (i.e., up to thirty times the external exposition due to radionuclides in unperturbed soils) at several points in the facility, particularly where the digested rock (pulp) is filtered. However, the most problematic points are characterised by a small occupation factor. That means that the increment in the annual effective external gamma dose received by the most-exposed worker is clearly below 1 mSv (European Commission limit for the general population) under normal production. Nevertheless, special care in the design and schedule of cleaning and maintaining work in the areas with high doses should be taken in order to avoid any possibility of exceeding the previously mentioned general population limit. In addition, the results of the dosimetric campaign showed no clear correlation between {sup

  13. Gender differences in anxiety and concerns about the cardioverter defibrillator

    DEFF Research Database (Denmark)

    Spindler, Helle; Johansen, Jens B; Andersen, Kirsten Krogh

    2009-01-01

    Little is known about gender differences in the response to implantable cardioverter defibrillator (ICD) therapy. We compared female and male ICD patients on anxiety, depression, health-related quality of life (HRQL), ICD concerns, and ICD acceptance.......Little is known about gender differences in the response to implantable cardioverter defibrillator (ICD) therapy. We compared female and male ICD patients on anxiety, depression, health-related quality of life (HRQL), ICD concerns, and ICD acceptance....

  14. A clinical treatment intervention for dysphoria: externalizing metaphors therapy.

    Science.gov (United States)

    McGuinty, Everett; Armstrong, David; Carrière, Anne-Marie

    2014-01-01

    The purpose of this article is to explore a novel, short-term treatment intervention for internalizing behaviours. This intervention is primarily based upon an externalizing process, transforming of metaphoric imagery, and shifting of underlying maladaptive emotional schemas. This article addresses the clinical population of children and youth, specifically through outlining the protocol, externalizing metaphors therapy. A selective review of significant works regarding the efficacy of short-term therapy was conducted, including the process of change within narrative therapy. It is proposed that two specific processes account for the mental health change experienced by clients who receive this new treatment intervention: (1) externalization of problems and (2) purposeful client-generated metaphor manipulation, impacting upon underlying schemas. From these theoretical constructs, the present article outlines a three-session treatment protocol that manualizes these key clinical processes. A case study is presented to illustrate this intervention for anxiety and depression. Further clinical research is underway to address the testable hypotheses resulting from the current theoretical model. Clinical trials in brief psychotherapy are suggested to empirically evaluate the efficacy of this new treatment intervention for dysphoria. This article outlines a short-term treatment intervention for anxiety and depression (dysphoira) through a novel 3-session model, where the clinician-practitioner can obtain competency through a one-day workshop.Its relevance for the clinical researcher and the mental health community is in its versatility in addressing internalizing behavior for four clinical populations: (1) children and adolescents; (2) children and adolescents on the autism spectrum; (3) adults in general; and, (4) adults with a dual-diagnosis. The treatment protocol described within is based upon the externalizing and deconstructive properties of Narrative Therapy, and the

  15. External ophthalmomyiasis by Oestrus ovis: A case report from Davangere

    Directory of Open Access Journals (Sweden)

    Sridhar Rao

    2018-01-01

    Full Text Available External ophthalmomyiasis is an infestation of the eye with larvae of Dermatobia hominis or Oestrus ovis (sheep bot fly. We describe a case of ophthalmomyiasis in a 38-year-old male, who presented with ocular foreign body sensation, redness, pain, and watering of the eye. The causative larvae were removed and sent to the laboratory for identification. By studying morphological features, it was identified as the first instar larvae of O. ovis. The patient was put on topical and oral antibiotics but was lost to follow-up. This is probably the first report from this part of Karnataka.

  16. Primary Synovial Sarcoma of External Auditory Canal: A Case Report.

    Science.gov (United States)

    Devi, Aarani; Jayakumar, Krishnannair L L

    2017-07-20

    Synovial sarcoma is a rare malignant tumor of mesenchymal origin. Primary synovial sarcoma of the ear is extremely rare and to date only two cases have been published in English medical literature. Though the tumor is reported to have an aggressive nature, early diagnosis and treatment may improve the outcome. Here, we report a rare case of synovial sarcoma of the external auditory canal in an 18-year-old male who was managed by chemotherapy and referred for palliation due to tumor progression.

  17. Intensity of primary emotions in patients after implantation of an implantable cardioverter defibrillator

    DEFF Research Database (Denmark)

    Stoier, Louise; Pedersen, Preben Ulrich; Berg, Selina Kikkenborg

    2013-01-01

    Background: Experienced emotions can affect the outcome of, and adherence to a cardiac rehabilitation program, and patients coping with an illness. With more awareness of the expressed emotions, health professionals might be better able to understand the reactions of patients and to improve...... the support needed for coping. Living with an Implantable Cardi- overter Defibrillator can lead to anxiety and depression. Focus on the intensity of the primary emotions might be a potential to prevent development of these psychological states. Objectives: The aim of this paper are 1) to describe...... the intensity of primary emotions in patients after implantation of an Implantable Cardioverter Defibrillator and 2) to compare them with both the intensity of primary emotions in patients with a recent Myocardial Infarction and with a healthy population. Method: The intensity of primary emotions in patients...

  18. Ratchet effect on a relativistic particle driven by external forces

    International Nuclear Information System (INIS)

    Quintero, Niurka R; Alvarez-Nodarse, Renato; Cuesta, Jose A

    2011-01-01

    We study the ratchet effect of a damped relativistic particle driven by both asymmetric temporal bi-harmonic and time-periodic piecewise constant forces. This system can be formally solved for any external force, providing the ratchet velocity as a nonlinear functional of the driving force. This allows us to explicitly illustrate the functional Taylor expansion formalism recently proposed for this kind of systems. The Taylor expansion reveals particularly useful to obtain the shape of the current when the force is periodic, piecewise constant. We also illustrate the somewhat counterintuitive effect that introducing damping may induce a ratchet effect. When the force is symmetric under time-reversal and the system is undamped, under symmetry principles no ratchet effect is possible. In this situation increasing damping generates a ratchet current which, upon increasing the damping coefficient eventually reaches a maximum and decreases toward zero. We argue that this effect is not specific of this example and should appear in any ratchet system with tunable damping driven by a time-reversible external force. (paper)

  19. Ratchet effect on a relativistic particle driven by external forces

    Energy Technology Data Exchange (ETDEWEB)

    Quintero, Niurka R [Departamento de Fisica Aplicada I, Escuela Universitaria Politecnica, Universidad de Sevilla, Calle Virgen de Africa 7, E-41011 Sevilla (Spain); Alvarez-Nodarse, Renato [Departamento de Analisis Matematico, Facultad de Matematicas, Universidad de Sevilla, Apdo 1160, E-41080 Sevilla (Spain); Cuesta, Jose A, E-mail: niurka@us.es, E-mail: ran@us.es, E-mail: cuesta@math.uc3m.es [Grupo Interdisciplinar de Sistemas Complejos (GISC), Departamento de Matematicas, Universidad Carlos III de Madrid, Avenida de la Universidad 30, E-28911 Leganes, Madrid (Spain)

    2011-10-21

    We study the ratchet effect of a damped relativistic particle driven by both asymmetric temporal bi-harmonic and time-periodic piecewise constant forces. This system can be formally solved for any external force, providing the ratchet velocity as a nonlinear functional of the driving force. This allows us to explicitly illustrate the functional Taylor expansion formalism recently proposed for this kind of systems. The Taylor expansion reveals particularly useful to obtain the shape of the current when the force is periodic, piecewise constant. We also illustrate the somewhat counterintuitive effect that introducing damping may induce a ratchet effect. When the force is symmetric under time-reversal and the system is undamped, under symmetry principles no ratchet effect is possible. In this situation increasing damping generates a ratchet current which, upon increasing the damping coefficient eventually reaches a maximum and decreases toward zero. We argue that this effect is not specific of this example and should appear in any ratchet system with tunable damping driven by a time-reversible external force. (paper)

  20. Development and external validation of a new PTA assessment scale

    Directory of Open Access Journals (Sweden)

    Jacobs Bram

    2012-08-01

    Full Text Available Abstract Background Post-traumatic amnesia (PTA is a key symptom of traumatic brain injury (TBI. Accurate assessment of PTA is imperative in guiding clinical decision making. Our aim was to develop and externally validate a short, examiner independent and practical PTA scale, by selecting the most discriminative items from existing scales and using a three-word memory test. Methods Mild, moderate and severe TBI patients and control subjects were assessed in two separate cohorts, one for derivation and one for validation, using a questionnaire comprised of items from existing PTA scales. We tested which individual items best discriminated between TBI patients and controls, represented by sensitivity and specificity. We then created our PTA scale based on these results. This new scale was externally evaluated for its discriminative value using Receiver Operating Characteristic (ROC analysis and compared to existing PTA scales. Results The derivation cohort included 126 TBI patients and 31 control subjects; the validation cohort consisted of 132 patients and 30 controls. A set of seven items was eventually selected to comprise the new PTA scale: age, name of hospital, time, day of week, month, mode of transport and recall of three words. This scale demonstrated adequate discriminative values compared to existing PTA scales on three consecutive administrations in the validation cohort. Conclusion We introduce a valid, practical and examiner independent PTA scale, which is suitable for mild TBI patients at the emergency department and yet still valuable for the follow-up of more severely injured TBI patients.

  1. Electroconvulsive therapy in patients with cardiac pacemakers and implantable cardioverter defibrillators.

    Science.gov (United States)

    Dolenc, Tamara J; Barnes, Roxann D; Hayes, David L; Rasmussen, Keith G

    2004-09-01

    Electroconvulsive therapy (ECT) is used to treat major depressive illness, especially in elderly and medically frail patients. Not uncommonly, these patients have cardiac pacemakers or implantable cardioverter defibrillators (ICDs). Only a few case reports in the literature describe the use of ECT in such patients. Herein we review our ECT experience treating 26 pacemaker patients and 3 ICD patients. All patients obtained significant antidepressant benefits with ETC. Only one serious cardiac event occurred, a case of supraventricular tachycardia (SVT) requiring a stay on the cardiac intensive care unit. The SVT resolved and the patient went on to receive further uncomplicated ECT treatments. We conclude from this experience that with proper pre-ECT cardiac and pacemaker/defibrillator assessment, ECT can be safely and effectively administered to patients with an implanted cardiac device.

  2. Functional outcome of knee arthrodesis with a monorail external fixator.

    Science.gov (United States)

    Roy, Alfred Cyril; Albert, Sandeep; Gouse, Mohamad; Inja, Dan Barnabas

    2016-04-01

    Several methods for obtaining knee arthrodesis have been described in the literature and world; over, the commonest cause for arthrodesis is a failed arthroplasty. Less commonly, as in this series, post-infective or traumatic causes may also require a knee fusion wherein arthroplasty may not be indicated. We present salient advantages along with the radiological and functional outcome of twenty four patients treated with a single monorail external fixator. All patients went on develop fusion at an average of 5.4 months with an average limb length discrepancy of 3 cm (1.5-6 cm). Improvements in functional outcome as assessed by the lower extremity functional score (LEFS), and the SF-36 was significant (p = 0.000). Knee arthrodesis with a single monorail external fixator is a reasonable single-staged salvage option in patients wherein arthroplasty may not be the ideal choice. The outcome, though far from ideal, is definitely positive and predictable.

  3. A reconfigurable image tube using an external electronic image readout

    Science.gov (United States)

    Lapington, J. S.; Howorth, J. R.; Milnes, J. S.

    2005-08-01

    We have designed and built a sealed tube microchannel plate (MCP) intensifier for optical/NUV photon counting applications suitable for 18, 25 and 40 mm diameter formats. The intensifier uses an electronic image readout to provide direct conversion of event position into electronic signals, without the drawbacks associated with phosphor screens and subsequent optical detection. The Image Charge technique is used to remove the readout from the intensifier vacuum enclosure, obviating the requirement for additional electrical vacuum feedthroughs and for the readout pattern to be UHV compatible. The charge signal from an MCP intensifier is capacitively coupled via a thin dielectric vacuum window to the electronic image readout, which is external to the sealed intensifier tube. The readout pattern is a separate item held in proximity to the dielectric window and can be easily detached, making the system easily reconfigurable. Since the readout pattern detects induced charge and is external to the tube, it can be constructed as a multilayer, eliminating the requirement for narrow insulator gaps and allowing it to be constructed using standard PCB manufacturing tolerances. We describe two readout patterns, the tetra wedge anode (TWA), an optimized 4 electrode device similar to the wedge and strip anode (WSA) but with a factor 2 improvement in resolution, and an 8 channel high speed 50 ohm device, both manufactured as multilayer PCBs. We present results of the detector imaging performance, image resolution, linearity and stability, and discuss the development of an integrated readout and electronics device based on these designs.

  4. Infectious endocardial intracardiac defibrillator lead, infectious pericarditis, and delayed constrictive pericarditis

    Directory of Open Access Journals (Sweden)

    Mohsen Mir Mohammad Sadeghi

    2013-01-01

    Full Text Available The usage of Implantable Cardiac Defibrillator (ICD since 1980s is becoming more popular these days. The rate of both, endocarditis and constrictive pericarditis are low but it still needs attention. We are reporting a rare case of ICD endocarditis as a result of toe infection in a diabetic patient. This was followed by infectious pericarditis after device removal by open heart surgery and then delayed constrictive pericarditis.

  5. Development of a relationship between external measurements and reinforcement stress

    Science.gov (United States)

    Brault, Andre; Hoult, Neil A.; Lees, Janet M.

    2015-03-01

    As many countries around the world face an aging infrastructure crisis, there is an increasing need to develop more accurate monitoring and assessment techniques for reinforced concrete structures. One of the challenges associated with assessing existing infrastructure is correlating externally measured parameters such as crack widths and surface strains with reinforcement stresses as this is dependent on a number of variables. The current research investigates how the use of distributed fiber optic sensors to measure reinforcement strain can be correlated with digital image correlation measurements of crack widths to relate external crack width measurements to reinforcement stresses. An initial set of experiments was undertaken involving a series of small-scale beam specimens tested in three-point bending with variable reinforcement properties. Relationships between crack widths and internal reinforcement strains were observed including that both the diameter and number of bars affected the measured maximum strain and crack width. A model that uses measured crack width to estimate reinforcement strain was presented and compared to the experimental results. The model was found to provide accurate estimates of load carrying capacity for a given crack width, however, the model was potentially less accurate when crack widths were used to estimate the experimental reinforcement strains. The need for more experimental data to validate the conclusions of this research was also highlighted.

  6. Short- and long-term performance of a tripolar down-sized single lead for implantable cardioverter defibrillator treatment: a randomized prospective European multicenter study. European Endotak DSP Investigator Group.

    Science.gov (United States)

    Sandstedt, B; Kennergren, C; Schaumann, A; Herse, B; Neuzner, J

    1998-11-01

    A new, thinner (10 Fr) and more flexible, single-pass transvenous endocardial ICD lead, Endotak DSP, was compared with a conventional lead, Endotak C, as a control in a prospective randomized multicenter study in combination with a nonactive can ICD. A total of 123 patients were enrolled, 55 of whom received a down-sized DSP lead. Lead-alone configuration was successfully implanted in 95% of the DSP patients vs 88% in the control group. The mean defibrillation threshold (DFT) was determined by means of a step-down protocol, and was identical in the two groups, 10.5 +/- 4.8 J in the DSP group versus 10.5 +/- 4.8 J in the control group. At implantation, the DSP mean pacing threshold was lower, 0.51 +/- 0.18 V versus 0.62 +/- 0.35 V (p < 0.05) in the control group, and the mean pacing impedance higher, 594 +/- 110 omega vs 523 +/- 135 omega (p < 0.05). During the follow-up period, the statistically significant difference in thresholds disappeared, while the difference in impedance remained. Tachyarrhythmia treatment by shock or antitachycardia pacing (ATP) was delivered in 53% and 41%, respectively, of the patients with a 100% success rate. In the DSP group, all 28 episodes of polymorphic ventricular tachycardia or ventricular fibrillation were converted by the first shock as compared to 57 of 69 episodes (83%) in the control group (p < 0.05). Monomorphic ventricular tachycardias were terminated by ATP alone in 96% versus 94%. Lead related problems were minor and observed in 5% and 7%, respectively. In summary, both leads were safe and efficacious in the detection and treatment of ventricular tachyarrhythmias. There were no differences between the DSP and control groups regarding short- or long-term lead related complications.

  7. Impact of external events on site evaluation: a probabilistic approach

    International Nuclear Information System (INIS)

    Jaccarino, E.; Giuliani, P.; Zaffiro, C.

    1975-01-01

    A probabilistic method is proposed for definition of the reference external events of nuclear sites. The external events taken into account are earthquakes, floods and tornadoes. On the basis of the available historical data for each event it is possible to perform statistical analyses to determine the probability of occurrence on site of events of given characteristics. For earthquakes, the method of analysis takes into consideration both the annual frequency of seismic events in Italy and the probabilistic distribution of areas stricken by each event. For floods, the methods of analysis of hydrological data and the basic criteria for the determination of design events are discussed and the general lines of the hydraulic analysis of a nuclear site are shown. For tornadoes, the statistical analysis has been performed for the events which occurred in Italy during the last 40 years; these events have been classified according to an empirical intensity scale. The probability of each reference event should be a function of the potential radiological damage associated with the particular type of plant which must be installed on the site. Thus the reference event could be chosen such that for the whole of the national territory the risk for safety and environmental protection is the same. (author)

  8. ENHANCEMENT OF A SUNSPOT LIGHT WALL WITH EXTERNAL DISTURBANCES

    Energy Technology Data Exchange (ETDEWEB)

    Yang, Shuhong; Zhang, Jun [Key Laboratory of Solar Activity, National Astronomical Observatories, Chinese Academy of Sciences, Beijing 100012 (China); Erdélyi, Robert, E-mail: shuhongyang@nao.cas.cn [Solar Physics and Space Plasma Research Centre, School of Mathematics and Statistics, University of Sheffield, Hicks Building, Hounsfield Road, Sheffield S3 7RH (United Kingdom)

    2016-12-20

    Based on the Interface Region Imaging Spectrograph observations, we study the response of a solar sunspot light wall to external disturbances. A flare occurrence near the light wall caused material to erupt from the lower solar atmosphere into the corona. Some material falls back to the solar surface and hits the light bridge (i.e., the base of the light wall), then sudden brightenings appear at the wall base followed by the rise of wall top, leading to an increase of the wall height. Once the brightness of the wall base fades, the height of the light wall begins to decrease. Five hours later, another nearby flare takes place, and a bright channel is formed that extends from the flare toward the light bridge. Although no obvious material flow along the bright channel is found, some ejected material is conjectured to reach the light bridge. Subsequently, the wall base brightens and the wall height begins to increase again. Once more, when the brightness of the wall base decays, the wall top fluctuates to lower heights. We suggest, based on the observed cases, that the interaction of falling material and ejected flare material with the light wall results in the brightenings of wall base and causes the height of the light wall to increase. Our results reveal that the light wall can be not only powered by the linkage of p -mode from below the photosphere, but may also be enhanced by external disturbances, such as falling material.

  9. Sustaining cyborgs: sensing and tuning agencies of pacemakers and implantable cardioverter defibrillators.

    Science.gov (United States)

    Oudshoorn, Nelly

    2015-02-01

    Recently there has been a renewed interest in cyborgs, and particularly in new and emerging fusions of humans and technologies related to the development of human enhancement technologies. These studies reflect a trend to follow new and emerging technologies. In this article, I argue that it is important to study 'older' and more familiar cyborgs as well. Studying 'the old' is important because it enables us to recognize hybrids' embodied experiences. This article addresses two of these older hybrids: pacemakers and implantable cardioverter defibrillators inserted in the bodies of people suffering from heart-rhythm disturbances. My concern with hybrid bodies is that internal devices seem to present a complex and neglected case if we wish to understand human agency. Their 'users' seem to be passive because they cannot exert any direct control over the working of their devices. Technologies inside bodies challenge a longstanding tradition of theorizing human-technology relations only in terms of technologies external to the body. Cyborg theory is problematic as well because most studies tend to conceptualize the cyborg merely as a discursive entity and silence the voices of people living as cyborgs. Inspired by feminist research that foregrounds the materiality of the lived and intimate relations between bodies and technologies, I argue that creating these intimate relations requires patients' active involvement in sustaining their hybrid bodies. Based on observations of these monitoring practices in a Dutch hospital and interviews with patients and technicians, the article shows that heart cyborgs are far from passive. On the contrary, their unique experience in sensing the entangled agencies of technologies and their own heart plays a crucial role in sustaining their hybrid bodies.

  10. Optimization of External Envelope Insulation Thickness: A Parametric Study

    Directory of Open Access Journals (Sweden)

    Eleftheria Touloupaki

    2017-02-01

    Full Text Available Almost four years after the implementation deadline of the energy performance of buildings Directive recast (2010/31/EU and after being referred to the Court of Justice of the EU by the European Commission, Greece has not yet proceeded with the necessary calculations and legislative measures on the minimum, cost-optimal energy performance requirements for buildings. This paper aims to identify the optimal thickness of insulation that is cost-effective to apply in urban multi-family domestic buildings in the four climate zones of Greece. A reference building is selected in order to perform calculations over ten scenarios of external insulation thickness for each climate zone on a basic and three sensitivity analysis calculations according to the EU comparative methodology framework. The resulting energy savings for each insulation scenario are calculated, and then the cost-effectiveness of the measure is examined in financial and macroeconomic perspective for an economic lifecycle of 30 years. The results demonstrate the inadequacy of the national regulation’s current insulation limits and the externalities (funding gaps that need to be addressed in order to achieve the effective improvement of energy efficiency in Greek homes.

  11. Beam Profile Disturbances from Implantable Pacemakers or Implantable Cardioverter-Defibrillator Interactions

    Energy Technology Data Exchange (ETDEWEB)

    Gossman, Michael S., E-mail: mgossman@tsrcc.com [Tri-State Regional Cancer Center, Medical Physics Section, Ashland, KY (United States); Comprehensive Heart and Vascular Associates, Heart and Vascular Center, Ashland, KY (United States); Medtronic, Inc., External Research Program, Mounds View, MN (United States); Nagra, Bipinpreet; Graves-Calhoun, Alison; Wilkinson, Jeffrey [Tri-State Regional Cancer Center, Medical Physics Section, Ashland, KY (United States); Comprehensive Heart and Vascular Associates, Heart and Vascular Center, Ashland, KY (United States); Medtronic, Inc., External Research Program, Mounds View, MN (United States)

    2011-01-01

    The medical community is advocating for progressive improvement in the design of implantable cardioverter-defibrillators and implantable pacemakers to accommodate elevations in dose limitation criteria. With advancement already made for magnetic resonance imaging compatibility in some, a greater need is present to inform the radiation oncologist and medical physicist regarding treatment planning beam profile changes when such devices are in the field of a therapeutic radiation beam. Treatment plan modeling was conducted to simulate effects induced by Medtronic, Inc.-manufactured devices on therapeutic radiation beams. As a continuation of grant-supported research, we show that radial and transverse open beam profiles of a medical accelerator were altered when compared with profiles resulting when implantable pacemakers and cardioverter-defibrillators are placed directly in the beam. Results are markedly different between the 2 devices in the axial plane and the sagittal planes. Vast differences are also presented for the therapeutic beams at 6-MV and 18-MV x-ray energies. Maximum changes in percentage depth dose are observed for the implantable cardioverter-defibrillator as 9.3% at 6 MV and 10.1% at 18 MV, with worst distance to agreement of isodose lines at 2.3 cm and 1.3 cm, respectively. For the implantable pacemaker, the maximum changes in percentage depth dose were observed as 10.7% at 6 MV and 6.9% at 18 MV, with worst distance to agreement of isodose lines at 2.5 cm and 1.9 cm, respectively. No differences were discernible for the defibrillation leads and the pacing lead.

  12. Spiritual well-being may buffer psychological distress in patients with implantable cardioverter defibrillators (ICD)

    OpenAIRE

    Salmoirago-Blotcher, Elena; Crawford, Sybil; Tran, Chau; Goldberg, Robert; Rosenthal, Lawrence; Ockene, Ira

    2012-01-01

    Psychological distress is common in patients with implantable cardioverter defibrillators (ICDs) and has been associated with a worse prognosis. The authors examined whether spiritual wellbeing is associated with reduced psychological distress in patients with ICDs. The Functional Assessment of Chronic Illness Therapy-Spiritual Wellbeing (FACIT-SWB) questionnare and the Hospital Anxiety and Depression Scale (HADS) were used to measure spiritual wellbeing and overall psychological distress. Mu...

  13. Gauge invariance of a particle in an external magnetic field

    International Nuclear Information System (INIS)

    Ekstein, H.

    1978-12-01

    In the accepted theory of a nonrelativistic particle in an external field, as well as in the Dirac equation, the canonical momentum p plays a strangely elusive role: contrary to the position q, it has no physical interpretation, yet it is a member of the algebra of observables; nor does it have a well-defined meaning as a translation generator. This paper proposes an observation procedure for p which entails a definite choice for the vector potential A: the radiation gauge divergence of A=0. The canonical momentum, so defined operationally, is shown to be the image of the generator of space translations, in the sense of presymmetry, as the position q is the image of the generator of Galilei boosts in nonrelativistic theories

  14. Is Distance to the Nearest Registered Public Automated Defibrillator Associated with the Probability of Bystander Shock for Victims of Out-of-Hospital Cardiac Arrest?

    Science.gov (United States)

    Neves Briard, Joel; de Montigny, Luc; Ross, Dave; de Champlain, François; Segal, Eli

    2018-04-01

    Introduction Rapid access to defibrillation is a key element in the management of out-of-hospital cardiac arrests (OHCAs). Public automated external defibrillators (PAEDs) are becoming increasingly available, but little information exists regarding the relation between the proximity to the arrest and their usage in urban areas. This study is a retrospective, observational, cross-sectional analysis of non-traumatic OHCA during a 24-month period in the greater Montreal area (Quebec, Canada). Using logistic regression, bystander shock odds are described with regards to distance from the OHCA scene to the nearest PAED, adjusted for prehospital care arrival delay and time of day, and stratifying for type of location. Out of a total of 2,443 OHCA victims identified, 77 (3%) received bystander PAED shock, 622 (26%) occurred out-of-home, and 743 (30%) occurred during business hours. When controlling for time (business hours versus other hours) and minimum response delay for prehospital care arrival, a marginal negative association was found between bystander shock and distance to the nearest PAED in logged meters (aOR=0.80; CI, 0.64-0.99) for out-of-home cardiac arrests. No significant association was found between distance and bystander shock for at-home arrests. Out-of-home victims had significantly higher odds of receiving bystander shock up to 175 meters of distance to a PAED inclusively (aOR=2.52; CI, 1.07-5.89). For out-of-home cardiac arrests, proximity to a PAED was associated with bystander shock in the greater Montreal area. Strategies aiming to increase accessibility and use of these life-saving devices could further expand this advantage by assisting bystanders in rapidly locating nearby PAEDs. Neves Briard J , de Montigny L , Ross D , de Champlain F , Segal E . Is distance to the nearest registered public automated defibrillator associated with the probability of bystander shock for victims of out-of-hospital cardiac arrest? Prehosp Disaster Med. 2018;33(2):153-159.

  15. Externally heated valve engine a new approach to piston engines

    CERN Document Server

    Kazimierski, Zbyszko

    2016-01-01

    This book reports on a novel approach for generating mechanical energy from different, external heat sources using the body of a typical piston engine with valves. By presenting simple yet effective numerical models, the authors show how this new approach, which combines existing internal combustion technology with a lubrication system, is able to offer an economic solution to the problem of mechanical energy generation in piston engines. Their results also show that a stable heat generation process can be guaranteed outside of the engine. The book offers a detailed report on physical and numerical models of 4-stroke and 2-stroke versions of the EHVE together with different models of heat exchange, valves and results of their simulations. It also delivers the test results of an engine prototype run in laboratory conditions. By presenting a novel theoretical framework and providing readers with extensive knowledge of both the advantages and challenges of the method, this book is expected to inspire academic re...

  16. Frequent Home Monitoring of ICD Is Effective to Prevent Inappropriate Defibrillator Shock Delivery

    Directory of Open Access Journals (Sweden)

    Paolo Bifulco

    2014-01-01

    Full Text Available Recently, in the context of telemedicine, telemonitoring services are gaining attention. They are offered, for example, to patients with implantable cardioverter defibrillators (ICDs. A major problem associated with ICD therapy is the occurrence of inappropriate shocks which impair patients’ quality of life and may also be arrhythmogenic. The telemonitoring can provide a valid support to intensify followup visits, in order to improve the prevention of inappropriate defibrillator shock, thus enhancing patient safety. Inappropriate shock generally depends on atrial fibrillation, supraventricular tachycardia, and abnormal sensing (such as those caused by electromagnetic interferences. As a practical example, an unusual case of an ICD patient who risked an inappropriate shock while taking a shower is reported. Continuous remote telemonitoring was able to timely warn cardiologist via GSM-SMS, who were able to detect improper sensing examining the intracardiac electrogram via Web. Patient was promptly contacted and warned to not further come in contact with the hydraulic system and any electrical appliance to prevent an inappropriate defibrillator shock. This demonstrates the effectiveness and usefulness of continuous remote telemonitoring in supporting ICD patients.

  17. Impact of carvedilol and metoprolol on inappropriate implantable cardioverter-defibrillator therapy

    DEFF Research Database (Denmark)

    Ruwald, Martin H; Abu-Zeitone, Abeer; Jons, Christian

    2013-01-01

    The goal of this study was to evaluate the effects of carvedilol and metoprolol on the endpoint of inappropriate implantable cardioverter-defibrillator therapy in the MADIT-CRT (Multicenter Automatic Defibrillator Implantation With Cardiac Resynchronization Therapy) study....

  18. A comparative study of external radiotherapy alone versus external radiotherapy + brachytherapy in carcinoma cervix stage III B

    International Nuclear Information System (INIS)

    Bardia, M.R.; Bhargava, S.C.; Chaudhary, R.K.; Agrawal, V.K.; Singh, K.; Vyas, R.

    1987-01-01

    Carcinoma of the cervix is the commonest cancer seen in women at Sardar Patel Medical College, Bikaner (Rajasthan). In the present study external radio-therapy and brachytherapy are used in carcinoma cervix stage III B. After 4000 to 4500 rads to pelvis by external radio-therapy, patient was assessed for intra cavitary application. Total given dose to point A was 7500 rads, to point B was 5000 rads. If patient was not suitable a split course was given where patient was asked to come after 3 weeks for intracavitary application. A comparative study of both methods was done. There was significant improvement in the control of central disease by applying intracavitary source. Radiation reactions were comparable. (author). 4 tables, 10 refs

  19. A Legal Institutional Perspective on the European External Action Service

    DEFF Research Database (Denmark)

    Van Vooren, Bart

    2011-01-01

    the EEAS be drawn into proceedings before the Court of Justice? In answering those questions, this article then examines to which extent the legal-institutional choices on the structure of the EU External Action Service reflects the age-old tension entrenched in EU external relations law: the EU’s nature...

  20. External Dynamics Influencing Tattooing among College Students: A Qualitative Analysis

    Science.gov (United States)

    Firmin, Michael; Tse, Luke; Foster, Janna; Angelini, Tammy

    2012-01-01

    The study utilized qualitative research methodology to assess external dynamics and their influences on tattooing practices among college students. Twenty-four undergraduates supplied in-depth interviews regarding the external variables related to college students' decisions to tattoo. The present research follows (Tse, Firmin, Angelini, &…

  1. Synchronizing a single-electron shuttle to an external drive

    Science.gov (United States)

    Moeckel, Michael J.; Southworth, Darren R.; Weig, Eva M.; Marquardt, Florian

    2014-04-01

    The nanomechanical single-electron shuttle is a resonant system in which a suspended metallic island oscillates between and impacts at two electrodes. This setup holds promise for one-by-one electron transport and the establishment of an absolute current standard. While the charge transported per oscillation by the nanoscale island will be quantized in the Coulomb blockade regime, the frequency of such a shuttle depends sensitively on many parameters, leading to drift and noise. Instead of considering the nonlinearities introduced by the impact events as a nuisance, here we propose to exploit the resulting nonlinear dynamics to realize a highly precise oscillation frequency via synchronization of the shuttle self-oscillations to an external signal. We link the established phenomenological description of synchronization based on the Adler equation to the microscopic nonlinear dynamics of the electron shuttle by calculating the effective Adler constant analytically in terms of the microscopic parameters.

  2. Synchronizing a single-electron shuttle to an external drive

    International Nuclear Information System (INIS)

    Moeckel, Michael J; Southworth, Darren R; Weig, Eva M; Marquardt, Florian

    2014-01-01

    The nanomechanical single-electron shuttle is a resonant system in which a suspended metallic island oscillates between and impacts at two electrodes. This setup holds promise for one-by-one electron transport and the establishment of an absolute current standard. While the charge transported per oscillation by the nanoscale island will be quantized in the Coulomb blockade regime, the frequency of such a shuttle depends sensitively on many parameters, leading to drift and noise. Instead of considering the nonlinearities introduced by the impact events as a nuisance, here we propose to exploit the resulting nonlinear dynamics to realize a highly precise oscillation frequency via synchronization of the shuttle self-oscillations to an external signal. We link the established phenomenological description of synchronization based on the Adler equation to the microscopic nonlinear dynamics of the electron shuttle by calculating the effective Adler constant analytically in terms of the microscopic parameters

  3. The use of guideline recommended beta-blocker therapy in primary prevention implantable cardioverter defibrillator patients

    DEFF Research Database (Denmark)

    Ruwald, Anne Christine; Gislason, Gunnar Hilmar; Vinther, Michael

    2017-01-01

    Aims: We aimed to examine the use of guideline recommended beta-blocker therapy prior to and after primary prevention implantable cardioverter defibrillator (ICD) implantation in a 'real-life' setting. Methods and results: From the Danish Pacemaker and ICD Registry we identified all 1st-time prim......Aims: We aimed to examine the use of guideline recommended beta-blocker therapy prior to and after primary prevention implantable cardioverter defibrillator (ICD) implantation in a 'real-life' setting. Methods and results: From the Danish Pacemaker and ICD Registry we identified all 1st......-time primary prevention ICD and cardiac resynchronization therapy defibrillator (CRT-D) implantations in Denmark from 2007-12 (n = 2935). Use of beta-blocker, type and dose was acquired through the Danish Prescription Registry. According to guideline recommendations, we defined target daily doses as ≥50 mg...... carvedilol and ≥200 mg metoprolol. Prior to implantation 2427 of 2935 (83%) patients received beta-blocker therapy, with 2166 patients (89%) having initiated treatment 3 months or more prior to implantation. The majority of patients was prescribed carvedilol (52%) or metoprolol (41%). Patients on carvedilol...

  4. External Ophthalmomyiasis Caused by a Rare Infesting Larva, Sarcophaga argyrostoma

    Directory of Open Access Journals (Sweden)

    Shmuel Graffi

    2013-01-01

    Full Text Available Purpose. External ophthalmomyiasis (EO is caused by infesting larvae belonging to various species of flies. Most documented cases result from sheep (Oestrus ovis and Russian (Rhinoestrus purpureus botfly larvae, but we recently discovered a rare case of EO caused by flesh fly (Sarcophaga argyrostoma larvae. Here, we report the case of a patient with EO who had been hospitalized and sedated for 1 week because of unrelated pneumonia. Methods. Case report. Results. A total of 32 larvae were removed from the adnexae of both eyes. Larvae identification was confirmed through DNA analysis. Treatment with topical tobramycin resulted in complete resolution of EO. Conclusion. EO can be caused by S. argyrostoma, and the elderly and debilitated may require extra ocular protection against flies during sedation.

  5. Life cycle assessment of a wind farm and related externalities

    DEFF Research Database (Denmark)

    Schleisner, Liselotte

    2000-01-01

    This paper concentrates on the assessment of energy and emissions related to the production and manufacture of materials for an offshore wind farm as well as a wind farm on land based on a life cycle analysis (LCA) model. In Denmark a model has been developed for life cycle assessments of different...... materials. The model is able to assess the energy use related to the production, transportation and manufacture of 1 kg of material. The energy use is divided into fuels used in order to estimate the emissions through the life cycle. In the paper the model and the attached assumptions are described......, and the model is demonstrated for two wind farms. The externalities for the wind farms are reported, showing the importance of life cycle assessment for renewable energy technologies. (C) 2000 Elsevier Science Ltd. All rights reserved....

  6. Breath analysis using external cavity diode lasers: a review

    Science.gov (United States)

    Bayrakli, Ismail

    2017-04-01

    Most techniques that are used for diagnosis and therapy of diseases are invasive. Reliable noninvasive methods are always needed for the comfort of patients. Owing to its noninvasiveness, ease of use, and easy repeatability, exhaled breath analysis is a very good candidate for this purpose. Breath analysis can be performed using different techniques, such as gas chromatography mass spectrometry (MS), proton transfer reaction-MS, and selected ion flow tube-MS. However, these devices are bulky and require complicated procedures for sample collection and preconcentration. Therefore, these are not practical for routine applications in hospitals. Laser-based techniques with small size, robustness, low cost, low response time, accuracy, precision, high sensitivity, selectivity, low detection limit, real-time, and point-of-care detection have a great potential for routine use in hospitals. In this review paper, the recent advances in the fields of external cavity lasers and breath analysis for detection of diseases are presented.

  7. Subclavian Vein Stenosis/Occlusion Following Transvenous Cardiac Pacemaker and Defibrillator Implantation: Incidence, Pathophysiology and Current Management

    Directory of Open Access Journals (Sweden)

    Brian O'Leary

    2015-08-01

    Full Text Available Subclavian vein stenosis is a common, but usually asymptomatic, complication following cardiac device placement. In addition to reviewing the literature on incidence, pathogenesis and management options for this important clinical problem, we describe two cases of symptomatic subclavian vein occlusion following pacemaker/defibrillator placement and successful treatment with venoplasty and stenting.

  8. Shock and patient preimplantation type D personality are associated with poor health status in patients with implantable cardioverter-defibrillator

    DEFF Research Database (Denmark)

    Pedersen, Susanne S.; Tekle, Fetene B; Hoogwegt, Madelein T

    2012-01-01

    Implantable cardioverter-defibrillator (ICD) shock is a critical event to patients associated with well-being after implantation, although other factors may play an equally important role. We compared the association of shock and the patient's preimplantation personality with health status, using...

  9. Charting Multidisciplinary Team External Dynamics Using a Systems Thinking Approach

    Science.gov (United States)

    Barthelemy, Jean-Francois; Waszak, Martin R.; Jones, Kenneth M.; Silcox, Richard J.; Silva, Walter A.; Nowaczyk, Ronald H.

    1998-01-01

    Using the formalism provided by the Systems Thinking approach, the dynamics present when operating multidisciplinary teams are examined in the context of the NASA Langley Research and Technology Group, an R&D organization organized along functional lines. The paper focuses on external dynamics and examines how an organization creates and nurtures the teams and how it disseminates and retains the lessons and expertise created by the multidisciplinary activities. Key variables are selected and the causal relationships between the variables are identified. Five "stories" are told, each of which touches on a different aspect of the dynamics. The Systems Thinking Approach provides recommendations as to interventions that will facilitate the introduction of multidisciplinary teams and that therefore will increase the likelihood of performing successful multidisciplinary developments. These interventions can be carried out either by individual researchers, line management or program management.

  10. Non-linear dynamical signal characterization for prediction of defibrillation success through machine learning

    Directory of Open Access Journals (Sweden)

    Shandilya Sharad

    2012-10-01

    Full Text Available Abstract Background Ventricular Fibrillation (VF is a common presenting dysrhythmia in the setting of cardiac arrest whose main treatment is defibrillation through direct current countershock to achieve return of spontaneous circulation. However, often defibrillation is unsuccessful and may even lead to the transition of VF to more nefarious rhythms such as asystole or pulseless electrical activity. Multiple methods have been proposed for predicting defibrillation success based on examination of the VF waveform. To date, however, no analytical technique has been widely accepted. We developed a unique approach of computational VF waveform analysis, with and without addition of the signal of end-tidal carbon dioxide (PetCO2, using advanced machine learning algorithms. We compare these results with those obtained using the Amplitude Spectral Area (AMSA technique. Methods A total of 90 pre-countershock ECG signals were analyzed form an accessible preshosptial cardiac arrest database. A unified predictive model, based on signal processing and machine learning, was developed with time-series and dual-tree complex wavelet transform features. Upon selection of correlated variables, a parametrically optimized support vector machine (SVM model was trained for predicting outcomes on the test sets. Training and testing was performed with nested 10-fold cross validation and 6–10 features for each test fold. Results The integrative model performs real-time, short-term (7.8 second analysis of the Electrocardiogram (ECG. For a total of 90 signals, 34 successful and 56 unsuccessful defibrillations were classified with an average Accuracy and Receiver Operator Characteristic (ROC Area Under the Curve (AUC of 82.2% and 85%, respectively. Incorporation of the end-tidal carbon dioxide signal boosted Accuracy and ROC AUC to 83.3% and 93.8%, respectively, for a smaller dataset containing 48 signals. VF analysis using AMSA resulted in accuracy and ROC AUC of 64

  11. Comparison of low-energy versus high-energy biphasic defibrillation shocks following prolonged ventricular fibrillation.

    Science.gov (United States)

    Walcott, Gregory P; Melnick, Sharon B; Killingsworth, Cheryl R; Ideker, Raymond E

    2010-01-01

    Since the initial development of the defibrillator, there has been concern that, while delivery of a large electric shock would stop fibrillation, it would also cause damage to the heart. This concern has been raised again with the development of the biphasic defibrillator. To compare defibrillation efficacy, postshock cardiac function, and troponin I levels following 150-J and 360-J shocks. Nineteen swine were anesthetized with isoflurane and instrumented with pressure catheters in the left ventricle, aorta, and right atrium. The animals were fibrillated for 6 minutes, followed by defibrillation with either low-energy (n = 8) or high-energy (n = 11) shocks. After defibrillation, chest compressions were initiated and continued until return of spontaneous circulation (ROSC). Epinephrine, 0.01 mg/kg every 3 minutes, was given for arterial blood pressure < 50 mmHg. Hemodynamic parameters were recorded for four hours. Transthoracic echocardiography was performed and troponin I levels were measured at baseline and four hours following ventricular fibrillation (VF). Survival rates at four hours were not different between the two groups (low-energy, 5 of 8; high-energy, 7 of 11). Results for arterial blood pressure, positive dP/dt (first derivative of pressure measured over time, a measure of left ventricular contractility), and negative dP/dt at the time of lowest arterial blood pressure (ABP) following ROSC were not different between the two groups (p = not significant [NS]), but were lower than at baseline. All hemodynamic measures returned to baseline by four hours. Ejection fractions, stroke volumes, and cardiac outputs were not different between the two groups at four hours. Troponin I levels at four hours were not different between the two groups (12 +/- 11 ng/mL versus 21 +/- 26 ng/mL, p = NS) but were higher at four hours than at baseline (19 +/- 19 ng/mL versus 0.8 +/- 0.5 ng/mL, p < 0.05, groups combined). Biphasic 360-J shocks do not cause more cardiac damage

  12. Exposure of a liquefied gas container to an external fire

    International Nuclear Information System (INIS)

    Raj, Phani K.

    2005-01-01

    In liquefied gas, bulk-storage facilities and plants, the separation distances between storage tanks and between a tank and a line of adjoining property that can be built are governed by local regulations and/or codes (e.g. National Fire Protection Association (NFPA) 58, 2004). Separation distance requirements have been in the NFPA 58 Code for over 60 years; however, no scientific foundations (either theoretical or experimental) are available for the specified distances. Even though the liquefied petroleum gas (LPG) industry has operated safely over the years, there is a question as to whether the code-specified distances provide sufficient safety to LPG-storage tanks, when they are exposed to large external fires. A radiation heat-transfer-based model is presented in this paper. The temporal variation of the vapor-wetted tank-wall temperature is calculated when exposed to thermal radiation from an external, non-impinging, large, 30.5 m (100 ft) diameter, highly radiative, hydrocarbon fuel (pool) fire located at a specified distance. Structural steel wall of a pressurized, liquefied gas container (such as the ASME LP-Gas tank) begins to lose its strength, when the wall temperature approaches a critical temperature, 810 K (1000 deg F). LP-Gas tank walls reaching close to this temperature will be a cause for major concern because of increased potential for tank failure, which could result in catastrophic consequences. Results from the model for exposure of different size ASME (LP-Gas) containers to a hydrocarbon pool fire of 30.5 m (100 ft) in diameter, located with its base edge at the separation distances specified by NFPA 58 [NFPA 58, Liquefied Petroleum Gas Code, Table 6.3.1, 2004 ed., National Fire Protection Association, Quincy, MA, 2004] indicate that the vapor-wetted wall temperature of the containers never reach the critical temperature under common wind conditions (0, 5 and 10 m/s), with the flame tilting towards the tank. This indicates that the separation

  13. Aetiology of thrombosed external haemorrhoids: a questionnaire study

    Directory of Open Access Journals (Sweden)

    Rohde Henning

    2009-10-01

    Full Text Available Abstract Background It is important to better understand the aetiology of thrombosed external haemorrhoids (TEH because recurrence rates are high, prophylaxis is unknown, and optimal therapy is highly debated. Findings We conducted a questionnaire study of individuals with and without TEH. Aetiology was studied by comparison of answers to a questionnaire given to individuals with and without TEH concerning demography, history, and published aetiologic hypotheses. Participants were evaluated consecutively at our institution from March 2004 through August 2005. One hundred forty-eight individuals were enrolled, including 72 patients with TEH and 76 individuals without TEH but with alternative diagnoses, such as a screening colonoscopy or colonic polyps. Out of 38 possible aetiologic factors evaluated, 20 showed no significant bivariate correlation to TEH and were no longer traced, and 16 factors showed a significant bivariate relationship to TEH. By multivariate analysis, six independent variables were found to predict TEH correctly in 79.1% of cases: age of 46 years or younger, use of excessive physical effort, and use of dry toilet paper combined with wet cleaning methods after defaecation were associated with a significantly higher risk of developing TEH; use of bathtub, use of the shower, and genital cleaning before sleep at least once a week were associated with a significantly lower risk of developing TEH. Conclusion Six hypotheses on the causes of TEH have a high probability of being correct and should be considered in future studies on aetiology, prophylaxis, and therapy of TEH.

  14. Natural convection in a porous medium: External flows

    International Nuclear Information System (INIS)

    Cheng, P.

    1985-01-01

    Early theoretical work on heat transfer in porous media focussed its attention on the onset of natural convection and cellular convection in rectangular enclosures with heating from below. Recently, increased attention has been directed to the study of natural convection in a porous medium external to heated surfaces and bodies. Boundary layer approximations were introduced, and similarly solutions have been obtained for steady natural convection boundary layers adjacent to a heated flat plate, a horizontal cylinder and a sphere as well as other two-dimensional and axisymmetric bodies of arbitrary shape. Higher order boundary layer theories have been carried out to assess the accuracy of the boundary layer approximation. The effects of entrainments at the edge of the boundary layer, the inclination angle of the heated inclined plate, and the upstream geometry on the heat transfer characteristics have been investigated based on the method of matched asymptotic expansions. The conditions for the onset of vortex instability in porous layers heated from below were determined based on linear stability analyses. The effects of no-slip boundary conditions, non-Darcy and thermal dispersion, which were neglected in all of the previous theoretical investigations, have recently been re-examined. Experimental investigations on natural convection about a vertical and inclined heated plate, a horizontal cylinder, as well as plume rise from a horizontal line source of heat have been conducted. All of this work is reviewed in this paper

  15. Implications for a Wireless, External Device System to Study Electrocorticography

    Directory of Open Access Journals (Sweden)

    David Rotermund

    2017-04-01

    Full Text Available Implantable neuronal interfaces to the brain are an important keystone for future medical applications. However, entering this field of research is difficult since such an implant requires components from many different areas of technology. Since the complete avoidance of wires is important due to the risk of infections and other long-term problems, means for wirelessly transmitting data and energy are a necessity which adds to the requirements. In recent literature, many high-tech components for such implants are presented with remarkable properties. However, these components are typically not freely available for such a system. Every group needs to re-develop their own solution. This raises the question if it is possible to create a reusable design for an implant and its external base-station, such that it allows other groups to use it as a starting point. In this article, we try to answer this question by presenting a design based exclusively on commercial off-the-shelf components and studying the properties of the resulting system. Following this idea, we present a fully wireless neuronal implant for simultaneously measuring electrocorticography signals at 128 locations from the surface of the brain. All design files are available as open source.

  16. External forcing as a metronome for Atlantic multidecadal variability

    Science.gov (United States)

    Otterå, Odd Helge; Bentsen, Mats; Drange, Helge; Suo, Lingling

    2010-10-01

    Instrumental records, proxy data and climate modelling show that multidecadal variability is a dominant feature of North Atlantic sea-surface temperature variations, with potential impacts on regional climate. To understand the observed variability and to gauge any potential for climate predictions it is essential to identify the physical mechanisms that lead to this variability, and to explore the spatial and temporal characteristics of multidecadal variability modes. Here we use a coupled ocean-atmosphere general circulation model to show that the phasing of the multidecadal fluctuations in the North Atlantic during the past 600 years is, to a large degree, governed by changes in the external solar and volcanic forcings. We find that volcanoes play a particularly important part in the phasing of the multidecadal variability through their direct influence on tropical sea-surface temperatures, on the leading mode of northern-hemisphere atmosphere circulation and on the Atlantic thermohaline circulation. We suggest that the implications of our findings for decadal climate prediction are twofold: because volcanic eruptions cannot be predicted a decade in advance, longer-term climate predictability may prove challenging, whereas the systematic post-eruption changes in ocean and atmosphere may hold promise for shorter-term climate prediction.

  17. Monetary valorization of the sanitary and environmental impacts of a nuclear accident: synthesis of ''ExternE'' studies, interests and limits of complementary developments

    International Nuclear Information System (INIS)

    Schieber, C.; Schneider, Th.

    2002-09-01

    This document constitutes a synthesis of the various available methods for the monetary evaluation of the nuclear accidents impacts in order to reveal the already evaluated impacts, those which need complementary developments and those for which the monetary approach currently seems to come up against limits. It is based primarily on the approach realized by the ''ExternE'' project of the European Commission, consisting in the evaluation of the external costs of the nuclear energy industry. (A.L.B.)

  18. Conversion of neurons and glia to external-cell fates in the external sensory organs of Drosophila hamlet mutants by a cousin-cousin cell-type respecification.

    Science.gov (United States)

    Moore, Adrian W; Roegiers, Fabrice; Jan, Lily Y; Jan, Yuh-Nung

    2004-03-15

    The Drosophila external sensory organ forms in a lineage elaborating from a single precursor cell via a stereotypical series of asymmetric divisions. HAMLET transcription factor expression demarcates the lineage branch that generates two internal cell types, the external sensory neuron and thecogen. In HAMLET mutant organs, these internal cells are converted to external cells via an unprecedented cousin-cousin cell-fate respecification event. Conversely, ectopic HAMLET expression in the external cell branch leads to internal cell production. The fate-determining signals NOTCH and PAX2 act at multiple stages of lineage elaboration and HAMLET acts to modulate their activity in a branch-specific manner.

  19. A Mediation Model of Interparental Collaboration, Parenting Practices, and Child Externalizing Behavior in a Clinical Sample

    Science.gov (United States)

    Kjobli, John; Hagen, Kristine Amlund

    2009-01-01

    The present study examined maternal and paternal parenting practices as mediators of the link between interparental collaboration and children's externalizing behavior. Parent gender was tested as a moderator of the associations. A clinical sample consisting of 136 children with externalizing problems and their families participated in the study.…

  20. External rhinoplasty: a critical analysis of 500 cases.

    Science.gov (United States)

    Foda, Hossam M T

    2003-06-01

    The study presents a comprehensive statistical analysis of a series of 500 consecutive rhinoplasties of which 380 (76 per cent) were primary and 120 (24 per cent) were secondary cases. All cases were operated upon using the external rhinoplasty technique; simultaneous septal surgery was performed in 350 (70 per cent) of the cases. Deformities of the upper two-thirds of the nose that occurred significantly more in the secondary cases included; dorsal saddling, dorsal irregularities, valve collapse, open roof and pollybeak deformities. In the lower third of the nose; secondary cases showed significantly higher incidences of depressed tip, tip over-rotation, tip asymmetry, retracted columella, and alar notching. Suturing techniques were used significantly more in primary cases, while in secondary cases grafting techniques were used significantly more. The complications encountered intra-operatively included; septal flap tears (2.8 per cent) and alar cartilage injury (1.8 per cent), while post-operative complications included; nasal trauma (one per cent), epistaxis (two per cent), infection (2.4 per cent), prolonged oedema (17 per cent), and nasal obstruction (0.8 per cent). The overall patient satisfaction rate was 95.6 per cent and the transcolumellar scar was found to be unacceptable in only 0.8 per cent of the patients.

  1. Pacemaker, implanted cardiac defibrillator and irradiation: Management proposal in 2010 depending on the type of cardiac stimulator and prognosis and location of cancer

    International Nuclear Information System (INIS)

    Lambert, P.; Da Costa, A.; Marcy, P.Y.; Kreps, S.; Angellier, G.; Marcie, S.; Bondiau, P.Y.; Briand-Amoros, C.; Thariat, J.

    2011-01-01

    Ionizing radiation may interfere with electric components of pacemakers or implantable cardioverter defibrillators. The type, severity and extent of radiation damage to pacemakers, have previously been shown to depend on the total dose and dose rate. Over 300,000 new cancer cases are treated yearly in France, among which 60% are irradiated in the course of their disease. One among 400 of these patients has an implanted pacemaker or defibrillator. The incidence of pacemaker and implanted cardioverter defibrillator increases in an ageing population. The oncologic prognosis must be weighted against the cardiologic prognosis in a multidisciplinary and transversal setting. Innovative irradiation techniques and technological sophistications of pacemakers and implantable cardioverter-defibrillators (with the introduction of more radiosensitive complementary metal-oxide-semiconductors since 1970) have potentially changed the tolerance profiles. This review of the literature studied the geometric, dosimetric and radiobiological characteristics of the radiation beams for high energy photons, stereotactic irradiation, proton-therapy. Standardized protocols and radiotherapy optimization (particle, treatment fields, energy) are advisable in order to improve patient management during radiotherapy and prolonged monitoring is necessary following radiation therapy. The dose received at the pacemaker/heart should be calculated. The threshold for the cumulated dose to the pacemaker/implantable cardioverter-defibrillator (2 to 5 Gy depending on the brand), the necessity to remove/displace the device based on the dose-volume histogram on dosimetry, as well as the use of lead shielding and magnet are discussed. (authors)

  2. Accuracy of a hexapod parallel robot kinematics based external fixator.

    Science.gov (United States)

    Faschingbauer, Maximilian; Heuer, Hinrich J D; Seide, Klaus; Wendlandt, Robert; Münch, Matthias; Jürgens, Christian; Kirchner, Rainer

    2015-12-01

    Different hexapod-based external fixators are increasingly used to treat bone deformities and fractures. Accuracy has not been measured sufficiently for all models. An infrared tracking system was applied to measure positioning maneuvers with a motorized Precision Hexapod® fixator, detecting three-dimensional positions of reflective balls mounted in an L-arrangement on the fixator, simulating bone directions. By omitting one dimension of the coordinates, projections were simulated as if measured on standard radiographs. Accuracy was calculated as the absolute difference between targeted and measured positioning values. In 149 positioning maneuvers, the median values for positioning accuracy of translations and rotations (torsions/angulations) were below 0.3 mm and 0.2° with quartiles ranging from -0.5 mm to 0.5 mm and -1.0° to 0.9°, respectively. The experimental setup was found to be precise and reliable. It can be applied to compare different hexapod-based fixators. Accuracy of the investigated hexapod system was high. Copyright © 2014 John Wiley & Sons, Ltd.

  3. Atrial therapies reduce atrial arrhythmia burden in defibrillator patients.

    Science.gov (United States)

    Friedman, P A; Dijkman, B; Warman, E N; Xia, H A; Mehra, R; Stanton, M S; Hammill, S C

    2001-08-28

    Approximately 25% of patients who receive an implantable cardioverter-defibrillator (ICD) to treat ventricular tachyarrhythmias have documented atrial tachyarrhythmias before implantation. This study assessed the ability of device-based prevention and termination therapies to reduce the burden of spontaneous atrial tachyarrhythmias. Patients with a standard indication for the implantation of an ICD and 2 episodes of atrial tachyarrhythmias in the preceding year received a dual-chamber ICD (Medtronic 7250 Jewel AF) that uses pacing and shock therapies for prevention and/or termination of atrial tachyarrhythmias. In a multicenter trial, patients were randomized to 3-month periods with atrial therapies "on" or "off" and subsequently crossed over. Analysis was performed on the 52 of 269 patients who had episodes of atrial tachyarrhythmia and had >/=30 days of follow-up with atrial therapies on and off. The atrial therapies resulted in a reduction of atrial tachyarrhythmia burden from a mean of 58.5 to 7.8 h/mo. A paired analysis (Wilcoxon signed-rank test) showed that the median difference in burden (1.1 h/mo) was highly significant (P=0.007). When the subgroup of 41 patients treated only with atrial pacing therapies was analyzed, the reduction in burden persisted (P=0.01). In this study, patients with a standard ICD indication and atrial tachyarrhythmias had a significant reduction in atrial tachyarrhythmia burden with use of atrial pacing and shock therapies.

  4. A pilot study evaluating "Dojo", a videogame intervention for youths with externalizing and anxiety problems

    NARCIS (Netherlands)

    Schuurmans, A.T.; Nijhof, K.S.; Vermaes, I.P.R.; Engels, R.C.M.E.; Granic, I.

    2015-01-01

    OBJECTIVE: Externalizing problems, which are the main reason for youth referrals to mental health agencies, are highly persistent and predict a range of negative outcomes. Youths with externalizing problems are also frequently comorbid with anxiety. Among the most widely recognized evidence-based

  5. Implanted Cardiac Defibrillator Care in Radiation Oncology Patient Population

    International Nuclear Information System (INIS)

    Gelblum, Daphna Y.; Amols, Howard

    2009-01-01

    Purpose: To review the experience of a large cancer center with radiotherapy (RT) patients bearing implantable cardiac defibrillators (ICDs) to propose some preliminary care guidelines as we learn more about the devices and their interaction with the therapeutic radiation environment. Methods and Materials: We collected data on patients with implanted ICDs treated with RT during a 2.5-year period at any of the five Memorial Sloan-Kettering clinical campuses. Information regarding the model, location, and dose detected from the device, as well as the treatment fields, fraction size, and treatment energy was collected. During this time, a new management policy for these patients had been implemented requiring treatment with low-energy beams (6 MV) and close surveillance of the patients in partnership with their electrophysiologist, as they received RT. Results: During the study period, 33 patients were treated with an ICD in place. One patient experienced a default of the device to its initial factory setting that was detected by the patient hearing an auditory signal from the device. This patient had initially been treated with a 15-MV beam. After this episode, his treatment was replanned to be completed with 6-MV photons, and he experienced no further events. Conclusion: Patients with ICDs and other implanted computer-controlled devices will be encountered more frequently in the RT department, and proper management is important. We present a policy for the safe treatment of these patients in the radiation oncology environment.

  6. An eight-year prospective controlled study about the safety and diagnostic value of cardiac and non-cardiac 1.5-T MRI in patients with a conventional pacemaker or a conventional implantable cardioverter defibrillator.

    Science.gov (United States)

    Lupo, Pierpaolo; Cappato, Riccardo; Di Leo, Giovanni; Secchi, Francesco; Papini, Giacomo D E; Foresti, Sara; Ali, Hussam; De Ambroggi, Guido M G; Sorgente, Antonio; Epicoco, Gianluca; Cannaò, Paola M; Sardanelli, Francesco

    2018-06-01

    To investigate safety and diagnostic value of 1.5-T MRI in carriers of conventional pacemaker (cPM) or conventional implantable defibrillator (cICD). We prospectively compared cPM/cICD-carriers undergoing MRI (study group, SG), excluding those device-dependent or implanted cPM/cICD-carriers undergoing chest x-ray, CT or follow-up (reference group, RG). 142 MRI (55 cardiac) were performed in 120 patients with cPM (n=71) or cICD (n=71). In the RG 98 measurements were performed in 95 patients with cPM (n=40) or cICD (n=58). No adverse events were observed. No MRI prolonged/interrupted. All cPM/cICD were correctly reprogrammed after MRI without malfunctions. One temporary communication failure was observed in one cPM-carrier. Immediately after MRI, 12/14 device interrogation parameters did not change significantly (clinically negligible changes of battery voltage and cICD charging time), without significant variations for SG versus RG. Three-12 months after MRI, 9/11 device interrogation parameters did not change significantly (clinically negligible changes of battery impedance/voltage). Non-significant changes of three markers of myocardial necrosis. Non-cardiac MRI: 82/87 diagnostic without artefacts; 4/87 diagnostic with artefacts; 1/87 partially diagnostic. Cardiac MRI: in cPM-carriers, 14/15 diagnostic with artefacts, 1/15 partially diagnostic; in cICD-carriers, 9/40 diagnostic with artefacts, 22 partially diagnostic, nine non-diagnostic. A favourable risk-benefit ratio of 1.5-T MRI in cPM/cICD carriers was reported. • Cooperation between radiologists and cardiac electrophysiologists allowed safe 1.5-T MRI in cPM/cICD-carriers. • No adverse events for 142 MRI in 71 cPM-carriers and 71 cICD-carriers. • Ninety-nine per cent (86/87) of non-cardiac MRI in cPM/cICD-carriers were diagnostic. • All cPM-carrier cardiac MRIs had artefacts, 14 examinations diagnostic, 1 partially diagnostic. • Twenty-three per cent (9/40) of cardiac MRI in cICD-carriers were non-diagnostic.

  7. Performance tests of external moderators of a PGNAA setup

    International Nuclear Information System (INIS)

    Naqvi, A.A.; Fazal-ur-Rehman,; Al-Jarallah, M.I.; Abu-Jarad, F.; Maslehuddin, M.

    2003-01-01

    Performance tests of external cylindrical moderators of an accelerator-based prompt gamma ray neutron activation analysis (PGNAA) setup have been carried out through thermal neutrons and prompt γ-ray yield measurements. The PGNAA setup is to be used for analysis of cement samples. This study was conducted to investigate the effects of geometry of cylindrical moderator on yield of thermal neutrons and prompt γ-rays for two different types of moderator assemblies. One of the moderators was to be used with a small sample and the other to be used with a large sample. Fast and thermal neutron yield was measured inside the sample volume as a function of the front moderator thickness as well as sample length. Neutron yield measurement was carried out at the King Fahd University of Petroleum and Minerals 350 keV pulsed beam accelerator using nuclear track detectors. The pulsed 200 keV deuteron beam with 5 ns pulse width and 31.25 kHz frequency was used to produce 2.8 MeV neutrons via D(d,n) reaction. Neutron yield measurements showed that the large sample moderator has a smaller yield of thermal neutrons as compared to the small sample moderator, which is in complete agreement with the results of Monte Carlo yield calculations of the thermal and fast neutrons from both the moderators. Finally, the prompt γ-ray yield from a Portland cement sample was measured using the two moderators and was compared with each other. As predicted by Monte Carlo simulations, in spite of a smaller yield of thermal neutrons, the large sample moderator has a higher yield of prompt γ-rays

  8. Performance tests of external moderators of a PGNAA setup

    Energy Technology Data Exchange (ETDEWEB)

    Naqvi, A.A. E-mail: aanaqvi@kfupm.edu.sa; Fazal-ur-Rehman,; Al-Jarallah, M.I.; Abu-Jarad, F.; Maslehuddin, M

    2003-01-01

    Performance tests of external cylindrical moderators of an accelerator-based prompt gamma ray neutron activation analysis (PGNAA) setup have been carried out through thermal neutrons and prompt {gamma}-ray yield measurements. The PGNAA setup is to be used for analysis of cement samples. This study was conducted to investigate the effects of geometry of cylindrical moderator on yield of thermal neutrons and prompt {gamma}-rays for two different types of moderator assemblies. One of the moderators was to be used with a small sample and the other to be used with a large sample. Fast and thermal neutron yield was measured inside the sample volume as a function of the front moderator thickness as well as sample length. Neutron yield measurement was carried out at the King Fahd University of Petroleum and Minerals 350 keV pulsed beam accelerator using nuclear track detectors. The pulsed 200 keV deuteron beam with 5 ns pulse width and 31.25 kHz frequency was used to produce 2.8 MeV neutrons via D(d,n) reaction. Neutron yield measurements showed that the large sample moderator has a smaller yield of thermal neutrons as compared to the small sample moderator, which is in complete agreement with the results of Monte Carlo yield calculations of the thermal and fast neutrons from both the moderators. Finally, the prompt {gamma}-ray yield from a Portland cement sample was measured using the two moderators and was compared with each other. As predicted by Monte Carlo simulations, in spite of a smaller yield of thermal neutrons, the large sample moderator has a higher yield of prompt {gamma}-rays.

  9. Battery longevity in cardiac resynchronization therapy implantable cardioverter defibrillators.

    Science.gov (United States)

    Alam, Mian Bilal; Munir, Muhammad Bilal; Rattan, Rohit; Flanigan, Susan; Adelstein, Evan; Jain, Sandeep; Saba, Samir

    2014-02-01

    Cardiac resynchronization therapy (CRT) implantable cardioverter defibrillators (ICDs) deliver high burden ventricular pacing to heart failure patients, which has a significant effect on battery longevity. The aim of this study was to investigate whether battery longevity is comparable for CRT-ICDs from different manufacturers in a contemporary cohort of patients. All the CRT-ICDs implanted at our institution from 1 January 2008 to 31 December 2010 were included in this analysis. Baseline demographic and clinical data were collected on all patients using the electronic medical record. Detailed device information was collected on all patients from scanned device printouts obtained during routine follow-up. The primary endpoint was device replacement for battery reaching the elective replacement indicator (ERI). A total of 646 patients (age 69 ± 13 years), implanted with CRT-ICDs (Boston Scientific 173, Medtronic 416, and St Jude Medical 57) were included in this analysis. During 2.7 ± 1.5 years follow-up, 113 (17%) devices had reached ERI (Boston scientific 4%, Medtronic 25%, and St Jude Medical 7%, P battery was significantly worse for Medtronic devices compared with devices from other manufacturers (94% for Boston scientific, 67% for Medtronic, and 92% for St Jude Medical, P battery longevity by manufacturer was independent of pacing burden, lead parameters, and burden of ICD therapy. There are significant discrepancies in CRT-ICD battery longevity by manufacturer. These data have important implications on clinical practice and patient outcomes.

  10. Y2K: effects on pacemaker and implantable defibrillator programmers.

    Science.gov (United States)

    Flynn, D P; Daubert, J P; Huang, D T; Ocampo, C M; O'Gorman, E

    1999-01-01

    All permanent pacemakers and implantable defibrillators (PPM/ICDs) will continue to function as programmed without regard to the date in the year 2000 (Y2K). All manufacturers contacted reassured us that some of these devices incorporate a day/year clock in the circuitry; however, these are not involved in sensing or delivering programmed therapy. Some manufacturers' device programmers will roll over to the year 2000 without any problems at all, whereas others may have difficulty with date and time stamping on printed reports. We tested 14 different types of PPM/ICD programmers for Y2K compliance using 8 tests. Five of the 14 models passed each test and were labeled at our institution with a green "Y2K" sticker to identify them as Y2K compatible and needing no special attention after December 31, 1999. The most common test failed was the ability to roll the date forward from December 31, 1999, with the programmer power off. Organizations should consider testing and replacing noncompliant device programmers or placing a red sticker with "Y2K" crossed out on noncompliant pieces. The red sticker alerts the advanced practice nurse or physician to the need to confirm the appropriate date and time in the programmer after startup in the year 2000 and before interrogating or programming any PPM/ICD, to avoid inappropriate date and time stamping on printed reports from that programmer.

  11. Internalising external costs of electricity and heat production in a municipal energy system

    International Nuclear Information System (INIS)

    Holmgren, Kristina; Amiri, Shahnaz

    2007-01-01

    Both energy supply and waste treatment give rise to negative effects on the environment, so-called external effects. In this study, monetary values on external costs collected from the EU's ExternE project are used to evaluate inclusion of these costs in comparison with an energy utility perspective including present policy instruments. The studied object is a municipal district heating system with a waste incineration plant as the base supplier of heat. The evaluation concerns fuels used for heat production and total electricity production, for scenarios with external costs included and for a scenario using the present policy instrument. Impacts of assumptions on marginal power producers (coal or natural gas power plants) are investigated, since locally produced electricity is assumed to replace marginal power and thus is credited for the avoided burden. Varying levels of external costs for carbon dioxide emissions are analysed. The method used is an economic optimisation model, MODEST. The conclusion is that present policy instruments are strong incentives for cogeneration, even when external costs are included. Waste is fully utilised in all scenarios. In cases where coal is the marginal power producer, more electricity is produced; when natural gas is the marginal power producer, less is produced. There are several uncertainties in the data for external costs, both methodological and ethical. In the ExternE data, not all environmental impacts are included. For waste incineration, ashes are not included, and another difficulty is how to treat the avoided burden of other waste treatment methods

  12. Possible pathways between depression, emotional and external eating. A structural equation model.

    Science.gov (United States)

    Ouwens, Machteld A; van Strien, Tatjana; van Leeuwe, Jan F J

    2009-10-01

    Emotional and external eating appear to co-occur and both have been shown to correlate to neuroticism, especially depression. However, there is evidence suggesting that emotional and external eating are independent constructs. In this study we revisited the relation between depression, emotional, and external eating. Using structural equation modelling, we examined whether depression, emotional and external eating are directly related and also indirectly related through the intervening concepts alexithymia and impulsivity. Participants were 549 females concerned about their weight. They filled out instruments on emotional and external eating, depression, alexithymia, and impulse regulation. The relational structure between the model variables was explored for one half of the participants and this solution was checked using the other half. Our data showed a moderate relationship between emotional and external eating. Depression was positively and directly associated with emotional eating, but not with external eating. In addition, depression was indirectly related to emotional eating through both alexithymia and impulsivity. A significant relation was found between impulsivity and external eating. Results suggest potential mediating pathways between depression and emotional eating, while no relation appeared to exist between depression and external eating. Emotional and external eating would appear to be different constructs.

  13. A study of risk evaluation methodology selection for the external hazards

    International Nuclear Information System (INIS)

    Kuramoto, Takahiro; Yamaguchi, Akira; Narumiya, Yosiyuki

    2014-01-01

    Since the accident at Fukushima Daiichi Nuclear Power Plant caused by the Great East Japan Earthquake in March 2011, there has been growing demands for assessing the effects of external hazards, including natural events, such as earthquake and tsunami, and external human behaviors, and taking actions to address those external hazards. The newly established Japanese regulatory requirements claim design considerations associated with external hazards. The primary objective of the risk assessment for external hazards is to establish countermeasures against such hazards rather than grasping the risk figures. Therefore, applying detailed risk assessment methods, such as probabilistic risk assessment (PRA), to all the external hazards is not always the most appropriate. Risk assessment methods can vary in types including qualitative evaluation, hazard analysis (analyzing hazard frequencies or their influence), and margin assessment. To resolve these issues, a process has been established that enables us to identify the external hazards in a comprehensive and systematic manner, which have potential risks leading to core damage and to select an appropriate evaluation method according to the risks associated with each of the external hazards. This paper discusses the comprehensive and systematic identification process for the external hazards which have potential risks leading to core damage, and the approaches of selecting an appropriate evaluation method for each external hazard. This paper also describes some applications of specific risk evaluation methods. (author)

  14. Atrial electrogram quality in single-pass defibrillator leads with floating atrial bipole in patients with permanent atrial fibrillation and cardiac resynchronization therapy.

    Science.gov (United States)

    Sticherling, Christian; Müller, Dirk; Schaer, Beat A; Krüger, Silke; Kolb, Christof

    2018-03-27

    Many patients receiving cardiac resynchronization therapy (CRT) suffer from permanent atrial fibrillation (AF). Knowledge of the atrial rhythm is important to direct pharmacological or interventional treatment as well as maintaining AV-synchronous biventricular pacing if sinus rhythm can be restored. A single pass single-coil defibrillator lead with a floating atrial bipole has been shown to obtain reliable information about the atrial rhythm but has never been employed in a CRT-system. The purpose of this study was to assess the feasibility of implanting a single coil right ventricular ICD lead with a floating atrial bipole and the signal quality of atrial electrograms (AEGM) in CRT-defibrillator recipients with permanent AF. Seventeen patients (16 males, mean age 73 ± 6 years, mean EF 25 ± 5%) with permanent AF and an indication for CRT-defibrillator placement were implanted with a designated CRT-D system comprising a single pass defibrillator lead with a atrial floating bipole. They were followed-up for 103 ± 22 days using remote monitoring for AEGM transmission. All patients had at last one AEGM suitable for atrial rhythm diagnosis and of 100 AEGM 99% were suitable for visual atrial rhythm assessment. Four patients were discharged in sinus rhythm and one reverted to AF during follow-up. Atrial electrograms retrieved from a single-pass defibrillator lead with a floating atrial bipole can be reliably used for atrial rhythm diagnosis in CRT recipients with permanent AF. Hence, a single pass ventricular defibrillator lead with a floating bipole can be considered in this population. Copyright © 2018 Indian Heart Rhythm Society. Production and hosting by Elsevier B.V. All rights reserved.

  15. Pacemakers and Implantable Defibrillators: MedlinePlus Health Topic

    Science.gov (United States)

    ... ClinicalTrials.gov: Pacemaker, Artificial (National Institutes of Health) Journal Articles References and abstracts from MEDLINE/PubMed (National ... Leadless Cardiac Pacemakers: The Next Evolution in Pacemaker Technology. ... on Pacemakers and Implantable Defibrillators is the National Heart, Lung, and Blood Institute Other Languages Find health information in languages other than English on Pacemakers and ...

  16. A compact chaotic laser device with a two-dimensional external cavity structure

    International Nuclear Information System (INIS)

    Sunada, Satoshi; Adachi, Masaaki; Fukushima, Takehiro; Shinohara, Susumu; Arai, Kenichi; Harayama, Takahisa

    2014-01-01

    We propose a compact chaotic laser device, which consists of a semiconductor laser and a two-dimensional (2D) external cavity for delayed optical feedback. The overall size of the device is within 230 μm × 1 mm. A long time delay sufficient for chaos generation can be achieved with the small area by the multiple reflections at the 2D cavity boundary, and the feedback strength is controlled by the injection current to the external cavity. We experimentally demonstrate that a variety of output properties, including chaotic output, can be selectively generated by controlling the injection current to the external cavity.

  17. RECOMMENDATIONS OF PILOTING A HELICOPTER AND FIGHTING AGAINST EXTERNAL GOODS OSCILLATIONS DURING THE CONDUCT OF URGENT AERIAL WORKS WITH EXTERNAL SUSPENSION

    Directory of Open Access Journals (Sweden)

    A. A. Lebedev

    2014-01-01

    Full Text Available Сonsidered question of reducing oscillations of cargo on helicopter external sling to improve the safety and efficiency of flight operations during the conduct of urgent aerial works. Offered practical recommendations of piloting a helicopter and effective maneuvers to eliminate oscillations of cargo on external sling.

  18. A study of the external cooling capability for the prevention of reactor vessel failure

    Energy Technology Data Exchange (ETDEWEB)

    Chang, S H; Baek, W P; Moon, S K; Yang, S H; Kim, S H [Korea Advanced Institute of Science and Technology, Taejon (Korea, Republic of)

    1995-07-15

    This study (a 3-year program) aims to perform a comprehensive assessment of the feasibility of external vessel flooding with respect to advanced pressurized water reactor plants to be built in Korea. During the second year, appropriate correlations have been chosen to describe the phenomena resulted from the external flooding on the basis of review works. Also performed is to develop the computer program using the chosen correlations and to accomplish the thermal analysis for assessment of the cooling capability of external flooding. Accomplished works for second year are as follows. Review of analytical and experimental works related to the external flooding are performed, appropriate correlations are chosen to describe the phenomena resulted from the external flooding on the basis of first and second year review works. A computer program is also developed to predict the temperature distribution of reactor vessel lower head. Thermal analyses are performed to judge the feasibility of external flooding using developed computer program.

  19. On a Heat Exchange Problem under Sharply Changing External Conditions

    Science.gov (United States)

    Khishchenko, K. V.; Charakhch'yan, A. A.; Shurshalov, L. V.

    2018-02-01

    The heat exchange problem between carbon particles and an external environment (water) is stated and investigated based on the equations of heat conducting compressible fluid. The environment parameters are supposed to undergo large and fast variations. In the time of about 100 μs, the temperature of the environment first increases from the normal one to 2400 K, is preserved at this level for about 60 μs, and then decreases to 300 K during approximately 50 μs. At the same periods of time, the pressure of the external environment increases from the normal one to 67 GPa, is preserved at this level, and then decreases to zero. Under such external conditions, the heating of graphite particles of various sizes, their phase transition to the diamond phase, and the subsequent unloading and cooling almost to the initial values of the pressure and temperature without the reverse transition from the diamond to the graphite phase are investigated. Conclusions about the maximal size of diamond particles that can be obtained in experiments on the shock compression of the mixture of graphite with water are drawn.

  20. Stability properties of a toroidal z-pinch in an external magnetic multipole field

    International Nuclear Information System (INIS)

    Eriksson, H.G.

    1987-01-01

    MHD stability of m=1, axisymmetric, external modes of a toroidal z-pinch immersed in an external multipole field (Extrap configuration) is studied. The description includes the effects of a weak toroidicity, a non-circular plasma cross-section and the influence of induced currents in the external conductors. It is found that the non-circularity of the plasma cross-section always has a destabilizing effect but that the m=1 mode can be stabilized by the external feedback if the non-circularity is small. (author)

  1. Management of functional Sprint Fidelis leads at cardiac resynchronization therapy-defibrillator generator replacement: a novel option for preventing inappropriate shocks from lead failure in fragile patients with high risk of sudden death.

    Science.gov (United States)

    Zhu, Dennis W X; Chu, Matthew M; House, Chad M

    2017-12-01

    In patients with a functional Sprint Fidelis lead at generator replacement, the manufacturer recommended to either continue to use the existing lead or replace it with a new lead. For those patients who continue to use a functional Fidelis lead, the risk of inappropriate shocks remains present if the lead fails in the future. We evaluated the feasibility of an alternative approach at the time of cardiac resynchronization therapy-defibrillator (CRT-D) generator replacement in patients with a functional bipolar left ventricular (LV) lead for prevention of inappropriate shocks from future Fidelis lead failure. During the procedure, the pace/sense IS-1 connection pin of the functional Fidelis lead was intentionally inserted into the LV port of the new CRT-D generator, while the existing bipolar LV lead IS-1 connection pin was inserted into the right ventricular (RV) pace/sense port. After such switching, the existing bipolar LV lead was used for functional LV pacing/sensing, while the Fidelis lead was used for functional RV pacing and high voltage shock only and could no longer be used for the purpose of sensing and detecting. This approach precluded oversensing and inappropriate shocks should the functional Fidelis lead fail in the future. Six fragile patients, who were not considered suitable candidates for lead replacement, underwent the alternative approach. During a follow-up of 35 ± 23 months, the CRT-D system functioned normally in five patients. The Fidelis lead fractured in one patient 7 months after generator replacement. The malfunction was detected promptly and the defected lead was replaced. No inappropriate detections or shock was triggered. In CRT-D patients with a functional Fidelis lead and a bipolar LV lead, switching of the Fidelis lead pace/sense IS-1 pin with the bipolar LV lead IS-1 pin at generator replacement did not affect normal system function. This novel approach may be valuable in fragile patients with high risk of sudden death for

  2. Prompt prediction of successful defibrillation from 1-s ventricular fibrillation waveform in patients with out-of-hospital sudden cardiac arrest.

    Science.gov (United States)

    Endoh, Hiroshi; Hida, Seiji; Oohashi, Satomi; Hayashi, Yusuke; Kinoshita, Hidenori; Honda, Tadayuki

    2011-02-01

    Ventricular fibrillation (VF) is a common cardiac arrest rhythm that can be terminated by electrical defibrillation. During cardiopulmonary resuscitation, there is a strong need for a prompt and reliable predictor of successful defibrillation because myocardial damage can result from repeated futile defibrillation attempts. Continuous wavelet transform (CWT) provides excellent time and frequency resolution of signals. The purpose of this study was to evaluate whether features based on CWT could predict successful defibrillation. VF electrocardiogram (ECG) waveforms stored in ambulance-located defibrillators were collected. Predefibrillation waveforms were divided into 1.0- or 5.12-s VF waveforms. Indices in frequency domain or nonlinear analysis were calculated on the 5.12-s waveform. Simultaneously, CWT was performed on the 1.0-s waveform, and total low-band (1-3 Hz), mid-band (3-10 Hz), and high-band (10-32 Hz) energy were calculated. In 152 patients with out-of-hospital cardiac arrest, a total of 233 ECG predefibrillation recordings, consisting of 164 unsuccessful and 69 successful episodes, were analyzed. Indices of frequency domain analysis (peak frequency, centroid frequency, and amplitude spectral area), nonlinear analysis (approximate entropy and Hurst exponent, detrended fluctuation analysis), and CWT analysis (mid-band and high-band energy) were significantly different between unsuccessful and successful episodes (P centroid frequency and total mid-band energy were effective predictors (P < 0.01 for both). Energy spectrum analysis based on CWT as short as a 1.0-s VF ECG waveform enables prompt and reliable prediction of successful defibrillation.

  3. Effects of external field on elastic electron-ion collision in a plasma

    International Nuclear Information System (INIS)

    Na, Sang-Chul; Jung, Young-Dae

    2008-01-01

    The field effects on elastic electron-ion collision are investigated in a plasma with the presence of the external field. The eikonal method and effective interaction potential including the far-field term caused by the external field is employed to obtain the eikonal phase shift and eikonal cross section as functions of the field strength, external frequency, impact parameter, collision energy, thermal energy and Debye length. The result shows that the effect of the external field on the eikonal cross section is given by the second-order eikonal phase. In addition, the external field effects suppress the eikonal cross section as well as eikonal phase for the elastic electron-ion collision. The eikonal phase and cross section are found to be increased with an increase of the frequency of the external field. It is also shown that the eikonal cross section increases with an increase of the thermal energy and Debye length.

  4. Knowledge Complementarity of a Firm’s Internal and External R&D Capabilities

    OpenAIRE

    Koski, Heli; Svento, Rauli

    2014-01-01

    We use data from over 1500 Finnish companies for the years 2006-2008 and 2008-2010 to explore complementarity of a firm’s R&D strategy with its external knowledge acquisition and innovation collaboration strategies. We define knowledge complementarity (tacit knowledge complementarity) of R&D capabilities to exist when increase in investments in R&D also increases marginal returns from broader external knowledge search (deeper innovation collaboration with external partners). Our estimation re...

  5. Principles for Private and Public Internalisation of Externalities. A Synoptic View

    Directory of Open Access Journals (Sweden)

    Tatiana Mosteanu

    2009-10-01

    Full Text Available Externalities represent a market failure situation and they appear when one person´s activities influence other person´s welfare in a way that is outside the market mechanism. In contrast to the effects transmitted by market prices, externalities negatively affect the economic efficiency. They arise in everyday life and are noticed only if the effects are obvious. Ronald Coase´s approach started from the premises that externalities can be internalized. His model provides private sector means to defend against market failure. Coase´s solution to internalize externalities based on negotiation between the involved parties, given the property rights, has influenced the free market approach of market failures and today many economists consider that governments should work with the market and not against it using taxes and regulations. In the mainstream literature it is said that if for small local externalities the private sector can find solutions to solve problems, big scale externalities, such as global warming, need government intervention. As far as the last ones are concerned, we can talk about: a the Pigouvian tax, which is a tax levied on polluting activities; b the Pigouvian subsidy, given to those who suffer from negative externalities; c the subsidy paid to individuals or firms to conduct activities with positive externalities; d legal regulations, such as limits for emitting polluters and restrictions regarding the time of day or year when negative externalities can be legally produced.

  6. A legal institutional perspective on the European Union External Action Service

    DEFF Research Database (Denmark)

    Van Vooren, Bart

    2010-01-01

    It is beyond doubt that setting up the European External Action Service will have a deep impact on EU external policy making. Both in legal and policy terms, this new player thoroughly changes the institutional balance in EU external relations. The goal of this paper is to examine the legal side...... of that coin, by exploring the legal and institutional nature and position of the EEAS in the EU’s external relations machinery. To that end, it queries the meaning of the EEAS’ sui generis status in the EU institutional set-up: what does it mean to say that the EEAS is ‘functionally autonomous’ from...

  7. Nifedipine as a uterine relaxant for external cephalic version: a randomized controlled trial.

    Science.gov (United States)

    Kok, Marjolein; Bais, Joke M; van Lith, Jan M; Papatsonis, Dimitri M; Kleiverda, Gunilla; Hanny, Dahrs; Doornbos, Johannes P; Mol, Ben W; van der Post, Joris A

    2008-08-01

    To estimate the effectiveness of nifedipine as a uterine relaxant during external cephalic version to correct breech presentation. In this randomized, double-blind, placebo-controlled trial, women with a singleton fetus in breech presentation and a gestational age of 36 weeks or more were eligible for enrollment. Participating women received two doses of either nifedipine 10 mg or placebo, 30 and 15 minutes before the external cephalic version attempt. The primary outcome was a cephalic-presenting fetus immediately after the procedure. Secondary outcome measures were cephalic presentation at delivery, mode of delivery, and adverse events. A sample size of 292 was calculated to provide 80% power to detect a 17% improvement of the external cephalic version success rate, assuming a placebo group rate of 40% and alpha of .05. Outcome data for 310 of 320 randomly assigned participants revealed no significant difference in external cephalic version success rates between treatment (42%) and control group (37%) (relative risk 1.1, 95%; 95% confidence interval 0.85-1.5). The cesarean delivery rate was 51% in the treatment group and 46% in the control group (relative risk 1.1, 95% confidence interval 0.88-1.4). Nifedipine did not significantly improve the success of external cephalic version. Future use of nifedipine to improve the outcome of external cephalic version should be limited to large clinical trials.

  8. Stay Cool Kids?! Effectiveness, Moderation and Mediation of a Preventive Intervention for Externalizing Behavior

    NARCIS (Netherlands)

    Stoltz, S.E.M.J.

    2012-01-01

    Stable externalizing behavior in childhood places children at risk for the development of a chronic and persistent pattern of externalizing behavior problems. Preventive interventions that aim to interrupt this developmental trajectory are crucial. Until now, no evidence-based intervention for

  9. The ability of external immobilizers to restrict movement of the cervical spine: a systematic review

    NARCIS (Netherlands)

    Holla, M.; Huisman, J.M.; Verdonschot, N.; Goosen, J.; Hosman, A.J.; Hannink, G.

    2016-01-01

    PURPOSE: To review the ability of various types of external immobilizers to restrict cervical spine movement. METHODS: With a systematical review of original scientific articles, data on range of motion, type of used external immobilization device and risk of bias were extracted. The described

  10. The ability of external immobilizers to restrict movement of the cervical spine: a systematic review

    NARCIS (Netherlands)

    Holla, M.; Huisman, J.M.; Verdonschot, Nicolaas Jacobus Joseph; Goosen, J.; Hosman, A.J.; Hannink, G.

    2016-01-01

    Purpose To review the ability of various types of external immobilizers to restrict cervical spine movement. Methods With a systematical review of original scientific articles, data on range of motion, type of used external immobilization device and risk of bias were extracted. The described

  11. Harsh Parenting and Child Externalizing Behavior: Skin Conductance Level Reactivity as a Moderator

    Science.gov (United States)

    Erath, Stephen A.; El-Sheikh, Mona; Cummings, E. Mark

    2009-01-01

    Skin conductance level reactivity (SCLR) was examined as a moderator of the association between harsh parenting and child externalizing behavior. Participants were 251 boys and girls (8-9 years). Mothers and fathers provided reports of harsh parenting and their children's externalizing behavior; children also provided reports of harsh parenting.…

  12. Optical neuron by use of a laser diode with injection seeding and external optical feedback

    NARCIS (Netherlands)

    Mos, E.C.; Hoppenbrouwers, J.J.L.; Hill, M.T.; Blum, M.W.; Schleipen, J.J.H.B.; Waardt, de H.

    2000-01-01

    We present an all-optical neuron by use of a multimode laser diode that is subjected to external optical feedback and light injection. The shape of the threshold function, that is needed for neural operation, is controlled by adjusting the external feedback level for two longitudinal cavity modes of

  13. Manufacturing Challenges Implementing Material Changes for the Super Light Weight External Tank: A Welding Process Perspective

    Science.gov (United States)

    Lawless, K.; Jones, C.

    2001-01-01

    A viewgraph presentation gives an overview of the manufacturing challenges in implementing welding material changes for the super lightweight external tank. Details are given on the external tank configuration, the weld purging equipment used, planning the selection of weld filler wire alloy, the initial weld microstructure, the wide panel tensile testing, and the dome cap welding.

  14. Management of A Rare Case of Communicating Internal-External Inflammatory Resorption.

    Science.gov (United States)

    Arora, Suraj; Gill, Gurdeep Singh; Saluja, Priyanka; Setia, Vikas

    2015-05-01

    The present case describes the successful management of a rare case of communicating internal-external resorption in which both internal and external resorption seem to develop independent of each other. The case report highlights the importance of correct diagnosis and need of revision of classification system of resorptive defects.

  15. Impact of Parenting Styles on Adolescent Externalizing and Substance Use: A Longitudinal Study.

    Science.gov (United States)

    Stice, Eric; Barrera, Manuel, Jr.

    Past research examining the influence of parenting styles on adolescent externalizing behaviors and substance use has left questions with regard to whether there is a relation between parental social support and adolescent externalizing symptomatology. This study examined the influence of parental control and social support on adolescent…

  16. Cervical external root resorption: 3-year follow-up of a case.

    NARCIS (Netherlands)

    Nikolidakis, D.; Nikou, G.; Meijer, G.J.; Jansen, J.A.

    2008-01-01

    Cervical external root resorption can be present in natural teeth, involving one or more teeth in the same patient. The incidence of these lesions appears random and the etiology remains unclear. Cervical external root resorption has been considered a difficult clinical situation, and its diagnosis

  17. The Impact of External Debt on Economic Growth in Ghana: A ...

    African Journals Online (AJOL)

    A plethora of both cross-country and country-specific studies have been undertaken to estimate the impact of external debt on growth in developing countries. Their general findings though revealing need to be confirmed in Ghana. This paper estimates empirically the impact of external debt on economic growth in Ghana to ...

  18. Impact of basic life-support training on the attitudes of health-care workers toward cardiopulmonary resuscitation and defibrillation.

    Science.gov (United States)

    Abolfotouh, Mostafa A; Alnasser, Manal A; Berhanu, Alamin N; Al-Turaif, Deema A; Alfayez, Abdulrhman I

    2017-09-22

    Cardiopulmonary resuscitation (CPR) increases the probability of survival of a person with cardiac arrest. Repeating training helps staff retain knowledge in CPR and in use of automated external defibrillators (AEDs). Retention of knowledge and skills during and after training in CPR is difficult and requires systematic training with appropriate methodology. The aim of this study was to determine the effect of basic life-support (BLS) training on the attitudes of health-care providers toward initiating CPR and on use of AEDs, and to investigate the factors that influence these attitudes. A quasi-experimental study was conducted in two groups: health-care providers who had just attended a BLS-AED course (post-BLS group, n = 321), and those who had not (pre-BLS group, n = 421). All participants had previously received BLS training. Both groups were given a validated questionnaire to evaluate the status of life-support education and certification, attitudes toward use of CPR and AED and concerns regarding use of CPR and AED. Multiple linear regression analyses were applied to identify significant predictors of the attitude and concern scores. Overall positive attitudes were seen in 53.4% of pre-BLS respondents and 64.8% of post-BLS respondents (χ 2  = 9.66, p = 0.002). Positive attitude was significantly predicted by the recent completion of BLS training (β = 5.15, p attitudes toward CPR performance and the use of AEDs. Training that addressed the concerns of health-care workers could further improve these attitudes.

  19. Stabilisation of a mandibular fracture in a cow by means of a pinless external fixator

    International Nuclear Information System (INIS)

    Lischer, C.J.; Fluri, E.; Auer, J.A.

    1997-01-01

    A four months pregnant, four-year-old Brown Swiss cow with mandibular fractures of the right horizontal ramus and the symphysis was treated surgically with a new pinless external fixator. Healing was complicated by the sequestration of bone at the fracture site. After the sequestrum had been removed a radiographic examination revealed that the fracture had healed completely

  20. Integrated torrefaction vs. external torrefaction – A thermodynamic analysis for the case of a thermochemical biorefinery

    International Nuclear Information System (INIS)

    Clausen, Lasse R.

    2014-01-01

    Integrated and external torrefaction is analyzed and compared via thermodynamic modeling. In this paper, integrated torrefaction is defined as torrefaction integrated with entrained flow gasification. External torrefaction is defined as the decentralized production of torrefied wood pellets and centralized conversion of the pellets by entrained flow gasification. First, the syngas production of the two methods was compared. Second, the two methods were compared by considering complete biorefineries with either integrated torrefaction or external torrefaction. The first part of the analysis showed that the biomass to syngas efficiency can be increased from 63% to 86% (LHV-dry) when switching from external torrefaction to integrated torrefaction. The second part of the analysis showed that the total energy efficiency (biomass to methanol + net electricity) could be increased from 53% to 63% when switching from external torrefaction to integrated torrefaction. The costs of this increase in energy efficiency are as follows: 1) more difficult transport, storage and handling of the biomass feedstock (wood chips vs. torrefied wood pellets); 2) reduced plant size; 3) no net electricity production; and 4) a more complex plant design. - Highlights: • Integrated torrefaction is compared with external torrefaction. • Biomass to syngas energy efficiencies of 63–86% are achieved. • Two thermochemical biorefinery are designed and analysed by thermodynamic modeling. • Biomass to fuel + electricity energy efficiencies of 53–63% are achieved. • The pros and cons of integrated torrefaction are described

  1. Comparison of Sprint Fidelis and Riata defibrillator lead failure rates.

    Science.gov (United States)

    Fazal, Iftikhar A; Shepherd, Ewen J; Tynan, Margaret; Plummer, Christopher J; McComb, Janet M

    2013-09-30

    Sprint Fidelis and Riata defibrillator leads are prone to early failure. Few data exist on the comparative failure rates and mortality related to lead failure. The aims of this study were to determine the failure rate of Sprint Fidelis and Riata leads, and to compare failure rates and mortality rates in both groups. Patients implanted with Sprint Fidelis leads and Riata leads at a single centre were identified and in July 2012, records were reviewed to ascertain lead failures, deaths, and relationship to device/lead problems. 113 patients had Sprint Fidelis leads implanted between June 2005 and September 2007; Riata leads were implanted in 106 patients between January 2003 and February 2008. During 53.0 ± 22.3 months of follow-up there were 13 Sprint Fidelis lead failures (11.5%, 2.60% per year) and 25 deaths. Mean time to failure was 45.1 ± 15.5 months. In the Riata lead cohort there were 32 deaths, and 13 lead failures (11.3%, 2.71% per year) over 54.8 ± 26.3 months follow-up with a mean time to failure of 53.5 ± 24.5 months. There were no significant differences in the lead failure-free Kaplan-Meier survival curve (p=0.77), deaths overall (p=0.17), or deaths categorised as sudden/cause unknown (p=0.54). Sprint Fidelis and Riata leads have a significant but comparable failure rate at 2.60% per year and 2.71% per year of follow-up respectively. The number of deaths in both groups is similar and no deaths have been identified as being related to lead failure in either cohort. Copyright © 2012. Published by Elsevier Ireland Ltd.

  2. Long-dated evaluation of the external costs of the nuclear; L'evaluation des couts externes a long terme de la filiere nucleaire: interets et limites

    Energy Technology Data Exchange (ETDEWEB)

    Le Dars, A.; Schneider, T

    2002-09-01

    Since the middle of the years 1990, the European Commission developed an ''ExternE'' methodology to propose an homogenous evaluation of the sanitary and environmental external costs of the various energy sectors in Europe. This document discusses the taking into account of the long-dated and analyzes the interests and the limits of the monetary evaluation, in terms of external costs, of the nuclear choice. It is organized in three chapters: 1. a presentation and a discussion on the various evaluation of the ''ExternE'' methodology; 2. a description of the available methods for the monetary evaluation of the long-dated impacts and more particularly the analysis of the monetary values actualization principle; 3. highlighted of the impacts for which the monetary evaluations exist. (A.L.B.)

  3. [External cephalic version in cases of breech presentation: renaissance of a well-known procedure?].

    Science.gov (United States)

    Schmidt, M; Callies, R; Kuhn, U; Willruth, A; Kimmig, R

    2009-01-01

    About 3-4% of all pregnant women will have a fetus presenting by the breech at term. External cephalic version offers the opportunity to reduce the rate of caesarean sections caused by breech presentation. We analysed retrospectively 51 cases of external cephalic version at our clinic. External cephalic version was performed 51 times between 37 and 41 weeks of pregnancy. External cephalic version was successful in 32/51 cases (62,7%) with a consecutive rate of vaginal delivery of 71,9%. The best results were seen at 37 weeks of pregnancy with 81,25% of successful versions followed by 76,9% of vaginal deliveries. Complications were rare. There was just 1 case of emergency caesarean section due to persisting fetal bradycardia. External cephalic version is an effective and safe treatment to enable vaginal delivery of cephalic presentation. For this operation, 37 weeks of pregnancy can be considered the best time. 2009 S. Karger AG, Basel.

  4. Radiotherapy and risk of implantable cardioverter-defibrillator malfunctions: experimental data from direct exposure at increasing doses.

    Science.gov (United States)

    Zecchin, Massimo; Artico, Jessica; Morea, Gaetano; Severgnini, Mara; Bianco, Elisabetta; De Luca, Antonio; Fantasia, Anna Zorzin; Salvatore, Luca; Milan, Vittorino; Lucarelli, Matteo; Dissegna, Roberta; Cannatà, Antonio; Sinagra, Gianfranco

    2018-04-01

    During radiotherapy, in patients with implantable cardioverter-defibrillators (ICDs) malfunctions are considered more likely if doses more than 2 Gy reach the ICD site; however, most malfunctions occur with high-energy (>10 MV) radiations, and the risk is less defined using 6-MV linear accelerators. The purpose of the study is to experimentally evaluate the occurrence of malfunctions in ICDs radiated with a 6-MV linear accelerator at increasing photon doses. Thirty-two ICDs from all manufacturers (31 explanted and one demo) were evaluated; all devices with a sufficient battery charge underwent multiple radiations with a 6-MV photon beam reaching a cumulative dose at ICD site of 0.5, 1, 2, 3, 5 and 10 Gy and interrogated after every session. All antitachycardia therapies were left enabled; two ICDs were connected to a rhythm simulator (one simulating a complete atrioventricular block without ventricular activity) and visually monitored by external ECG and the ICD programmer during radiation. Thirteen ICDs were excluded before radiation because of battery depletion; after radiation up to the cumulative dose at the cardiac implantable electronic device site of 10 Gy, in the remaining 19 devices, programmation and battery charge remained unchanged and no switch to safety mode was observed; oversensing, pacing inhibition or inappropriate antitachycardia therapy were neither recorded nor visually observed during radiation. With a low-energy accelerator, neither malfunctions nor electromagnetic interferences were detected radiating the ICDs at doses usually reaching the ICD pocket during radiotherapy sessions. In this context, magnet application to avoid oversensing and inappropriate therapy seems, therefore, useless.

  5. Dual chamber arrhythmia detection in the implantable cardioverter defibrillator.

    Science.gov (United States)

    Dijkman, B; Wellens, H J

    2000-10-01

    Dual chamber implantable cardioverter defibrillator (ICD) technology extended ICD therapy to more than termination of hemodynamically unstable ventricular tachyarrhythmias. It created the basis for dual chamber arrhythmia management in which dependable detection is important for treatment and prevention of both ventricular and atrial arrhythmias. Dual chamber detection algorithms were investigated in two Medtronic dual chamber ICDs: the 7250 Jewel AF (33 patients) and the 7271 Gem DR (31 patients). Both ICDs use the same PR Logic algorithm to interpret tachycardia as ventricular tachycardia (VT), supraventricular tachycardia (SVT), or dual (VT+ SVT). The accuracy of dual chamber detection was studied in 310 of 1,367 spontaneously occurring tachycardias in which rate criterion only was not sufficient for arrhythmia diagnosis. In 78 episodes there was a double tachycardia, in 223 episodes SVT was detected in the VT or ventricular fibrillation zone, and in 9 episodes arrhythmia was detected outside the boundaries of the PR Logic functioning. In 100% of double tachycardias the VT was correctly diagnosed and received priority treatment. SVT was seen in 59 (19%) episodes diagnosed as VT. The causes of inappropriate detection were (1) algorithm failure (inability to fulfill the PRa subset of diagnostically difficult arrhythmias allow safe detection of double tachycardias but require further extension and programmability to

  6. Transcanal endoscopic resection for leiomyoma of the external auditory canal and a review of the literature.

    Science.gov (United States)

    Ikeda, Ryoukichi; Tateda, Masaru; Okoshi, Akira; Morita, Shinkichi; Suzuki, Hiroyoshi; Hashimoto, Sho

    2016-02-01

    Leiomyoma usually originates from the uterus and alimentary tract, but in extremely rare cases leiomyoma can appear in the external auditory canal. Here we present a 37-year-old man with right auricular fullness. Preoperative findings suggested benign tumor or cholesteatoma in the right external auditory canal. We performed total resection using an endoauricular approach with transcanal endoscopic ear surgery. Histopathological and immunohistochemistry examination confirmed the diagnosis of leiomyoma of external auditory canal. Leiomyoma arising from soft tissue, including that in the external auditory canal, is classified into two types: that from the arrectores pilorum muscles and that from the muscle coats of blood vessels. Only four cases of leiomyoma of external auditor canal have been published in the English literature. The other four cases demonstrated vascular leiomyomas. This is the first report of leiomyoma of the EAC arising from arrectores pilorum muscles. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  7. Regulating multiple externalities

    DEFF Research Database (Denmark)

    Waldo, Staffan; Jensen, Frank; Nielsen, Max

    2016-01-01

    Open access is a well-known externality problem in fisheries causing excess capacity and overfishing. Due to global warming, externality problems from CO2 emissions have gained increased interest. With two externality problems, a first-best optimum can be achieved by using two regulatory instrume......Open access is a well-known externality problem in fisheries causing excess capacity and overfishing. Due to global warming, externality problems from CO2 emissions have gained increased interest. With two externality problems, a first-best optimum can be achieved by using two regulatory...

  8. [Ethics in intensive care and euthanasia : With respect to inactivating defibrillators at the end of life in terminally ill patients].

    Science.gov (United States)

    Trappe, H-J

    2017-04-01

    In critically ill patients, intensive care medical procedures allow diseases to be cured or controlled that were considered incurable many years ago. For patients with terminal heart failure or heart disease with other severe comorbidities (cancer, stroke), the questions whether the deactivation of defibrillators is appropriate or must be regarded as active euthanasia may arise. Notable cases from the author's hospital are analyzed. The literature on the topic euthanasia and basic literature regarding defibrillator therapy are discussed. It is undisputed that patients as part of their self-determination have the right to renounce treatment. Active euthanasia and the thereby deliberate induction of death is prohibited by law in Germany and will be prosecuted. Passive euthanasia is the omission or reduction of possibly life-prolonging treatment measures. Passive euthanasia requires the patient's consent and is legally and ethically permissible. Indirect euthanasia takes into account acceleration of death as a side effect of a medication. Unpunishable assisted suicide ("assisted suicide") is the mere assistance of self-controlled and self-determined death. Assisted suicide is fundamentally not a criminal offense in Germany. Deactivation of a defibrillator is a treatment discontinuation, which is only permitted in accordance with the wishes of the patient. It is not a question of passive or active euthanasia. Involvement of a local ethics committee and/or legal consultation is certainly useful and sometimes also allows previously unrecognized questions to be answered.

  9. Mode of delivery after successful external cephalic version: a systematic review and meta-analysis.

    Science.gov (United States)

    de Hundt, Marcella; Velzel, Joost; de Groot, Christianne J; Mol, Ben W; Kok, Marjolein

    2014-06-01

    To assess the mode of delivery in women after a successful external cephalic version by performing a systematic review and meta-analysis. We searched MEDLINE, Embase, ClinicalTrials.gov, Cumulative Index to Nursing and Allied Health Literature, and the Cochrane Library for studies reporting on the mode of delivery in women after successful external cephalic version at term and women with a spontaneous cephalic-presenting fetus. Two reviewers independently selected studies, extracted data, and assessed study quality. The association between mode of delivery and successful external cephalic version was expressed as a common odds ratio with a 95% confidence interval (CI). We identified three cohort studies and eight case-control studies, reporting on 46,641 women. The average cesarean delivery rate for women with a successful external cephalic version was 21%. Women after successful external cephalic version were at increased risk for cesarean delivery for dystocia (odds ratio [OR] 2.2, 95% CI 1.6-3.0), cesarean delivery for fetal distress (OR 2.2, 95% CI 1.6-2.9), and instrumental vaginal delivery (OR 1.4, 95% CI 1.1-1.7). Women who have had a successful external cephalic version for breech presentation are at increased risk for cesarean delivery and instrumental vaginal delivery as compared with women with a spontaneous cephalic presentation. Nevertheless, with a number needed to treat of three, external cephalic version still remains a very efficient procedure to prevent a cesarean delivery.

  10. Ocular complications after external-beam irradiation - a literature overview

    International Nuclear Information System (INIS)

    Ziolkowska, E.; Zarzycka, M.; Wisniewski, T.; Meller, A.

    2009-01-01

    Radiotherapy is one of the treatment methods applied to patients suffering from head and neck cancer. The efficiency of this method is comparable to surgery, yet it allows one to save the organ and avoid its permanent deformation. In the case of radiation not only the tumour is influenced but the surrounding, normal structures as well. Radiation causes deformation of normal structures as early or side effects. The aim of this study is to present plausible ocular complications after external beam irradiation of head and neck cancer, such as radiation- induced cataract, radiation retinopathy, dry-eye syndrome or radiation neuropathy. By the use of basic principles of radiotherapy planning we can avoid or minimize possible ocular complications occurring after irradiation. The treatment of ocular complications is difficult and very often does not give the expected outcome. Therefore, in such cases in order to restore vision surgery is required. This study shows that radiotherapy can be helpful but can increase the risk of occurrence of some ocular complications. (authors)

  11. Decalogue of electric defibrillation Decálogo de la desfibrilación eléctrica

    Directory of Open Access Journals (Sweden)

    Elkín Ferdinand Cardona Duque

    2001-03-01

    Full Text Available Defibrillation is an emergency procedure and the only effective therapy for ventricular fibrillation. Electrical defibrillation delivers large amounts of current to the myocardium and thus depolarizes it, terminating ventricular fibrillation and other arrhythmias. A defibrillator is a device that administers a controlled electrical shock, allowing the operator to select a variable current at the precise moment, according to patient‘s condition. Understanding defibrillator‘s operation leads to more effective resuscitation rates and more therapeutic alternatives in patients with any cardiac electric disturbance. La desfibrilación es un procedimiento de emergencia y es la única terapia efectiva para el manejo de la fibrilación ventricular. La desfibrilación eléctrica libera corriente en gran cantidad al miocardio, despolarizándolo y terminando la fibrilación ventricular y otras arritmias. Un desfibrilador es un aparato que suministra un choque eléctrico en forma controlada, permitiendo al operador seleccionar una corriente variable en el momento oportuno, de acuerdo con la condición del paciente. El entendimiento del manejo del desfibrilador permite tasas de resucitación más efectivas y más alternativas terapéuticas en pacientes con trastornos del ritmo cardíaco.

  12. Optimum location of external markers using feature selection algorithms for real-time tumor tracking in external-beam radiotherapy: a virtual phantom study.

    Science.gov (United States)

    Nankali, Saber; Torshabi, Ahmad Esmaili; Miandoab, Payam Samadi; Baghizadeh, Amin

    2016-01-08

    In external-beam radiotherapy, using external markers is one of the most reliable tools to predict tumor position, in clinical applications. The main challenge in this approach is tumor motion tracking with highest accuracy that depends heavily on external markers location, and this issue is the objective of this study. Four commercially available feature selection algorithms entitled 1) Correlation-based Feature Selection, 2) Classifier, 3) Principal Components, and 4) Relief were proposed to find optimum location of external markers in combination with two "Genetic" and "Ranker" searching procedures. The performance of these algorithms has been evaluated using four-dimensional extended cardiac-torso anthropomorphic phantom. Six tumors in lung, three tumors in liver, and 49 points on the thorax surface were taken into account to simulate internal and external motions, respectively. The root mean square error of an adaptive neuro-fuzzy inference system (ANFIS) as prediction model was considered as metric for quantitatively evaluating the performance of proposed feature selection algorithms. To do this, the thorax surface region was divided into nine smaller segments and predefined tumors motion was predicted by ANFIS using external motion data of given markers at each small segment, separately. Our comparative results showed that all feature selection algorithms can reasonably select specific external markers from those segments where the root mean square error of the ANFIS model is minimum. Moreover, the performance accuracy of proposed feature selection algorithms was compared, separately. For this, each tumor motion was predicted using motion data of those external markers selected by each feature selection algorithm. Duncan statistical test, followed by F-test, on final results reflected that all proposed feature selection algorithms have the same performance accuracy for lung tumors. But for liver tumors, a correlation-based feature selection algorithm, in

  13. A Route to Chaotic Behavior of Single Neuron Exposed to External Electromagnetic Radiation.

    Science.gov (United States)

    Feng, Peihua; Wu, Ying; Zhang, Jiazhong

    2017-01-01

    Non-linear behaviors of a single neuron described by Fitzhugh-Nagumo (FHN) neuron model, with external electromagnetic radiation considered, is investigated. It is discovered that with external electromagnetic radiation in form of a cosine function, the mode selection of membrane potential occurs among periodic, quasi-periodic, and chaotic motions as increasing the frequency of external transmembrane current, which is selected as a sinusoidal function. When the frequency is small or large enough, periodic, and quasi-periodic motions are captured alternatively. Otherwise, when frequency is in interval 0.778 electromagnetic radiation. The frequency apparently plays a more important role in determining the system behavior.

  14. Acute external otitis as debut of acute myeloid leukemia - A case and review of the literature.

    Science.gov (United States)

    Slengerik-Hansen, Joachim; Ovesen, Therese

    2018-03-01

    Acute leukemia is a well known childhood cancer. The relation between leukemia and otological symptoms has long been established but is highly rare as a debut symptom of leukemia. External otitis is a common condition affecting many children, and most cases are successively treated with topical medicine. Here we present a child with acute external otitis later shown to be the debut symptom of acute myeloid leukemia, to our knowledge the first specific case described. We have reviewed the literature to find red flags for suspicion of severe disease in case of acute external otitis. Copyright © 2018 Elsevier B.V. All rights reserved.

  15. Two-stream instability for a light ion beam-plasma system with external magnetic field

    International Nuclear Information System (INIS)

    Okada, T.; Tazawa, H.

    1992-12-01

    For inertial confinement fusion, a focused light ion beam (LIB) is required to propagate stably through a chamber to a target. We have pointed out that the applied external magnetic field is important for LIB propagation. To investigate the influence of the external magnetic field on the LIB propagation, we analysed the electrostatic dispersion relation of magnetized light ion beam-plasma system. The particle in-cell (PIC) simulation results are presented for a light ion beam-plasma system with external magnetic field. (author)

  16. Physical activity in primary versus secondary prevention indication implantable cardioverter defibrillator recipients 6-12 months after implantation - a cross-sectional study with register follow up

    DEFF Research Database (Denmark)

    Berg, S. K.; Thygesen, L. C.; Svendsen, J. H.

    2015-01-01

    OBJECTIVE: To describe (i) physical activity status among ICD patients according to the indication for ICD implant compared to international guidelines and compared to a matched normal population in order to detect potentials for improved physical outcomes, (ii) patients' beliefs regarding...... and participation in physical exercise by ICD indication, (iii) factors predicting low physical activity, and (iv) physical activity as a predictor of mortality. DESIGN: National survey with register follow-up. Comparisons were made to a matched healthy reference population and patients were followed in registers...... MEASURES: Questions regarding physical activity and the IPAQ questionnaire were used to assess physical activity. RESULTS: The response rate was 71.7%. Mean age 65.5 years with 82% males. 37% participated in a rehabilitation programme. 21 % were sedentary compared to 8 % in the reference population (p

  17. Towards a beyond 1 GHz solid-state nuclear magnetic resonance: External lock operation in an external current mode for a 500 MHz nuclear magnetic resonance

    International Nuclear Information System (INIS)

    Takahashi, Masato; Maeda, Hideaki; Ebisawa, Yusuke; Tennmei, Konosuke; Yanagisawa, Yoshinori; Nakagome, Hideki; Hosono, Masami; Takasugi, Kenji; Hase, Takashi; Miyazaki, Takayoshi; Fujito, Teruaki; Kiyoshi, Tsukasa; Yamazaki, Toshio

    2012-01-01

    Achieving a higher magnetic field is important for solid-state nuclear magnetic resonance (NMR). But a conventional low temperature superconducting (LTS) magnet cannot exceed 1 GHz (23.5 T) due to the critical magnetic field. Thus, we started a project to replace the Nb 3 Sn innermost coil of an existing 920 MHz NMR (21.6 T) with a Bi-2223 high temperature superconducting (HTS) innermost coil. Unfortunately, the HTS magnet cannot be operated in persistent current mode; an external dc power supply is required to operate the NMR magnet, causing magnetic field fluctuations. These fluctuations can be stabilized by a field-frequency lock system based on an external NMR detection coil. We demonstrate here such a field-frequency lock system in a 500 MHz LTS NMR magnet operated in an external current mode. The system uses a 7 Li sample in a microcoil as external NMR detection system. The required field compensation is calculated from the frequency of the FID as measured with a frequency counter. The system detects the FID signal, determining the FID frequency, and calculates the required compensation coil current to stabilize the sample magnetic field. The magnetic field was stabilized at 0.05 ppm/3 h for magnetic field fluctuations of around 10 ppm. This method is especially effective for a magnet with large magnetic field fluctuations. The magnetic field of the compensation coil is relatively inhomogeneous in these cases and the inhomogeneity of the compensation coil can be taken into account.

  18. Good Functional Recovery of Complex Elbow Dislocations Treated With Hinged External Fixation: A Multicenter Prospective Study

    NARCIS (Netherlands)

    Iordens, Gijs I. T.; den Hartog, Dennis; van Lieshout, Esther M. M.; Tuinebreijer, Wim E.; de Haan, Jeroen; Patka, Peter; Verhofstad, Michael H. J.; Schep, Niels W. L.; Bronkhorst, M. W. G. A.; de Vries, M. R.; Goslings, J. C.; Rhemrev, S. J.; Roukema, G. R.; van der Meulen, H. G. W. M.; Verleisdonk, E. J. M. M.; Vroemen, J. P. A. M.; Wittich, Ph

    2015-01-01

    After a complex dislocation, some elbows remain unstable after closed reduction or fracture treatment. Function after treatment with a hinged external fixator theoretically allows collateral ligaments to heal without surgical reconstruction. However, there is a lack of prospective studies that

  19. Good Functional Recovery of Complex Elbow Dislocations Treated With Hinged External Fixation: A Multicenter Prospective Study

    NARCIS (Netherlands)

    G.I.T. Iordens (Gijs); D. den Hartog (Dennis); E.M.M. van Lieshout (Esther); W.E. Tuinebreijer (Wim); J. de Haan (Jeroen); P. Patka (Peter); M.H.J. Verhofstad (Michiel); N.W.L. Schep (Niels)

    2015-01-01

    textabstractBackground: After a complex dislocation, some elbows remain unstable after closed reduction or fracture treatment. Function after treatment with a hinged external fixator theoretically allows collateral ligaments to heal without surgical reconstruction. However, there is a lack of

  20. External excitation of ion cyclotron drift waves in a two-ion species plasma

    International Nuclear Information System (INIS)

    Kando, M.; Ikezawa, S.; Sugai, H.

    1984-01-01

    Ion cyclotron drift waves propagating across a density gradient and a magnetic field have been excited externally in a two-ion species plasma, with its concentration ratio controlled. The measured dispersion relations agree with the theoretical predictions. (author)

  1. Use of a pocket compression device for the prevention and treatment of pocket hematoma after pacemaker and defibrillator implantation (STOP-HEMATOMA-I).

    Science.gov (United States)

    Turagam, Mohit K; Nagarajan, Darbhamulla V; Bartus, Krzysztof; Makkar, Akash; Swarup, Vijay

    2017-08-01

    Pocket hematoma is a recognized complication after placement of cardiac implantable electronic devices and is associated with increased device infection, length of hospitalization, and morbidity especially with uninterrupted antiplatelet agents and anticoagulants. We assessed the use of a post-surgical vest to decrease the incidence of pocket hematoma in patients undergoing device implantation with uninterrupted antiplatelet and anticoagulants. In this observational study, a vest was used by 20 consecutive patients who were compared to 20 age-, gender-, procedure-matched patients who received standard care. All patients were continued on antiplatelet and anticoagulants in the perioperative period. The pocket was assessed at post procedure day 0, 2, and 7, respectively. There were no significant differences in the baseline characteristics between both groups. Baseline mean international normalized ratio (INR) was significantly higher in the vest group when compared with the control group (2.7 ± 0.4 vs. 2.2 ± 0.3 = hematoma was significantly lower in the vest group than the control group (0 vs 30%, p = 0.02) at the end of 7 days. Control group had a total of six hematomas with one patient requiring evacuation and blood transfusion. The vest group had three hematomas on day 2 that resolved by day 7. The risk of moderate or large pocket hematoma is significantly reduced with the use of this vest in high-risk patients undergoing implantable devices on uninterrupted antiplatelet and anticoagulants.

  2. Externalizing symptoms, effortful control, and intrusive parenting: A test of bidirectional longitudinal relations during early childhood.

    Science.gov (United States)

    Eisenberg, Nancy; Taylor, Zoe E; Widaman, Keith F; Spinrad, Tracy L

    2015-11-01

    At approximately 30, 42, and 54 months of age (N = 231), the relations among children's externalizing symptoms, intrusive maternal parenting, and children's effortful control (EC) were examined. Both intrusive parenting and low EC have been related to psychopathology, but children's externalizing problems and low EC might affect the quality of parenting and one another. Mothers' intrusive behavior with their children was assessed with observations, children's EC was measured with mothers' and caregivers' reports, and children's externalizing symptoms were assessed with mothers', fathers', and caregivers' reports. In a structural equation panel model, bidirectional relations between intrusive parenting and EC were found: EC at 30 and 42 months predicted low levels of intrusive parenting a year later, controlling for prior levels of parenting and vice versa. Moreover, high levels of children's externalizing problems at both 30 and 42 months negatively predicted EC a year later, controlling for prior levels of EC. Although externalizing problems positively predicted high EC over time, this appeared to be a suppression effect because these variables had a strong negative pattern in the zero-order correlations. Moreover, when controlling for the stability of intrusive parenting, EC, and externalizing (all exhibited significant stability across time) and the aforementioned cross-lagged predictive paths, EC and externalizing problems were still negatively related within the 54-month assessment. The findings are consistent with the view that children's externalizing behavior undermines their EC and contributes to intrusive mothering and that relations between intrusive parenting and EC are bidirectional across time. Thus, interventions that focus on modifying children's externalizing problems (as well as the quality of parenting) might affect the quality of parenting they receive and, hence, subsequent problems with adjustment.

  3. Desfibrilador automático implantado en pacientes con miocardiopatía hipertrófica: criterios de selección, evolución y predictores de terapia apropiada Automatic defibrillator implanted in patients with hypertrophic myocardiopathy: selection criteria, evolution and appropriate therapy predictors

    Directory of Open Access Journals (Sweden)

    Guillermo Mora

    Full Text Available Introducción y objetivos: la miocardiopatía hipertrófica es una enfermedad de origen genético con prevalencia de 1% al 2%. La mitad de los pacientes fallecen por muerte súbita cardiaca, la mayoría por arritmias ventriculares. Todavía no está claro a qué pacientes se les debe implantar un desfibrilador automático. El objetivo de este trabajo es describir una serie de pacientes con implante, los criterios empleados y los resultados obtenidos, así como analizar los predictores de terapia apropiada por el desfibrilador. Métodos: se incluyeron 20 pacientes que recibieron un desfibrilador de tercera generación. En todos se realizó estudio electrofisiológico y seguimiento prospectivo con registro de eventos. En 18 (90% se hizo estudio genético. Resultados: el 55% eran hombres con edad promedio de 40 [11-78] años. Seis (30% recibieron implantante por prevención secundaria y 14 (70% por prevención primaria; los últimos por presentar varios factores de riesgo. Se indujo una arritmia sostenida en 15 (75% y en 3 (15% taquicardia ventricular monomórfica sostenida. A 22 meses de seguimiento 4 (20% sufrieron terapia apropiada y 2 (10% fallecieron. La taquicardia ventricular monomórfica clínica (p=0,03 y la inducida (pIntroduction and objectives: hypertrophic myocardiopathy is a genetic entity with 1% to 2% prevalence. Half patients die of sudden cardiac death, most due to ventricular arrhythmias. There is still no clarity with regard to the patients to whom an automatic defibrillator has to be implanted. The objective of this work is to describe a series of patients with implant, the criteria used and the results obtained, as well as to analyze the predictors of appropriate therapy with the defibrillator. Methods: 20 patients that received a third generation defibrillator were included. Electrophysiological study and prospective follow-up with register of events was performed in all. Genetic study was done in 18 (90%. Results: 55% were

  4. Is there an Optimal Shape of the Defibrillation Shock: Constant Current vs. Pulsed Biphasic Waveforms

    Directory of Open Access Journals (Sweden)

    Ivan Dotsinsky

    2013-04-01

    Full Text Available Three waveforms for transthoracic defibrillation are assessed and compared: the Pulsed Biphasic Waveform (PBW, the Rectilinear Biphasic Waveform (RBW, and the "lossless" constant current (LLCC pulses. Two indices are introduced: 1 kf = W/W0 - the ratio between the delivered energy W and the energy W0 of a rectangular pulse with the same duration and electric charge; 2 ηC = W/WC0 - the level of utilizing the initially loaded capacitor energy WC0. The envisioned comparative study shows that ηC index is favorable for both PBW and LLCC, while kf of both RBW and LLCC demonstrates advantage over the PBW in the range of small inter-electrode thoracic impedances below 80 Ω. Some design considerations are also discussed. The attractive LLCC concept needs large and heavy inductive coil to support the constant current amplitude, besides it is capable to induce strong electromagnetic influences due to the complex current control. The RBW technology controls the delivery of current through a series of internal resistors which are, however, a source of high heat losses. The PBW implements controlled duty cycle of high-frequency chopped pulses to adapt the energy delivery in respect of the patient impedance measured at the beginning of the shock. PBW technology makes use of small capacitors which allows the construction of light weight and small-size portable devices for transthoracic defibrillation.

  5. The external costs of electricity generation: a comparison of generation technologies

    Energy Technology Data Exchange (ETDEWEB)

    Ozdemiroglu, E [Economics for the Environment Consultancy, London (United Kingdom)

    1995-12-01

    Electricity generation, like any economic activity, leads to costs that can be grouped in two categories: (a) private or internal and (b) external. Private costs are those paid by the buyers and sellers of energy within the market system. The external costs, however, are not included in the market price mechanism as they accrue to third parties other than the buyer and the seller. External costs include environmental external costs and non-environmental external costs. There are two conditions for the existence of external costs: (a) market failure, or the inability of markets to account for the cost of environmental impacts of energy generation and the market structure and (b) government or policy failure, or the policies that cause private generators to pay either higher or lower costs than they would if these interventions did not exist. A third reason can be added for the existence of non-environmental externalities: energy security, or certain costs faced by society as a result of over-reliance on imported energy. Section A introduces the concept of external costs and benefits. Section B looks at the environmental externalities of energy generation. The procedure is to develop the methodology to estimate what are known as externality adders, i.e. a monetary value for the environmental costs and benefits associated with selected generation technologies, expressed in pence per kilowatt-hour. The result is an `adder` because, in principle, the sum can be added to the private cost of generating electricity to obtain a measure of the `full` or `social` cost. The selected generation technologies are conventional coal, wind power, small-scale hydro, energy crops, incineration of municipal solid waste and energy recovery from landfill. The data reported are based on the application of the technologies in Scotland, but the methodology can be applied anywhere. Section C takes a brief look at the non-environmental externalities including the general theory and evidence

  6. The external costs of electricity generation: a comparison of generation technologies

    International Nuclear Information System (INIS)

    Ozdemiroglu, E.

    1995-01-01

    Electricity generation, like any economic activity, leads to costs that can be grouped in two categories: (a) private or internal and (b) external. Private costs are those paid by the buyers and sellers of energy within the market system. The external costs, however, are not included in the market price mechanism as they accrue to third parties other than the buyer and the seller. External costs include environmental external costs and non-environmental external costs. There are two conditions for the existence of external costs: (a) market failure, or the inability of markets to account for the cost of environmental impacts of energy generation and the market structure and (b) government or policy failure, or the policies that cause private generators to pay either higher or lower costs than they would if these interventions did not exist. A third reason can be added for the existence of non-environmental externalities: energy security, or certain costs faced by society as a result of over-reliance on imported energy. Section A introduces the concept of external costs and benefits. Section B looks at the environmental externalities of energy generation. The procedure is to develop the methodology to estimate what are known as externality adders, i.e. a monetary value for the environmental costs and benefits associated with selected generation technologies, expressed in pence per kilowatt-hour. The result is an 'adder' because, in principle, the sum can be added to the private cost of generating electricity to obtain a measure of the 'full' or 'social' cost. The selected generation technologies are conventional coal, wind power, small-scale hydro, energy crops, incineration of municipal solid waste and energy recovery from landfill. The data reported are based on the application of the technologies in Scotland, but the methodology can be applied anywhere. Section C takes a brief look at the non-environmental externalities including the general theory and evidence

  7. Prediction of Success in External Cephalic Version under Tocolysis: Still a Challenge.

    Science.gov (United States)

    Vaz de Macedo, Carolina; Clode, Nuno; Mendes da Graça, Luís

    2015-01-01

    External cephalic version is a procedure of fetal rotation to a cephalic presentation through manoeuvres applied to the maternal abdomen. There are several prognostic factors described in literature for external cephalic version success and prediction scores have been proposed, but their true implication in clinical practice is controversial. We aim to identify possible factors that could contribute to the success of an external cephalic version attempt in our population. We retrospectively examined 207 consecutive external cephalic version attempts under tocolysis conducted between January 1997 and July 2012. We consulted the department's database for the following variables: race, age, parity, maternal body mass index, gestational age, estimated fetal weight, breech category, placental location and amniotic fluid index. We performed descriptive and analytical statistics for each variable and binary logistic regression. External cephalic version was successful in 46.9% of cases (97/207). None of the included variables was associated with the outcome of external cephalic version attempts after adjustment for confounding factors. We present a success rate similar to what has been previously described in literature. However, in contrast to previous authors, we could not associate any of the analysed variables with success of the external cephalic version attempt. We believe this discrepancy is partly related to the type of statistical analysis performed. Even though there are numerous prognostic factors identified for the success in external cephalic version, care must be taken when counselling and selecting patients for this procedure. The data obtained suggests that external cephalic version should continue being offered to all eligible patients regardless of prognostic factors for success.

  8. Beta-blocker therapy is not associated with symptoms of depression and anxiety in patients receiving an implantable cardioverter-defibrillator

    NARCIS (Netherlands)

    M.T. Hoogwegt (Madelein); N. Kupper (Nina); D.A.M.J. Theuns (Dominic); L.J.L.M. Jordaens (Luc); S.S. Pedersen (Susanne)

    2012-01-01

    textabstractBeta-blockers are frequently prescribed to implantable cardioverter-defibrillator (ICD) patients. Beta-blocker therapy has been proposed to induce emotional distress such as depression and anxiety, but a paucity of studies has examined the relationship between beta-blockers and distress.

  9. A TCP model for external beam treatment of intermediate-risk prostate cancer.

    LENUS (Irish Health Repository)

    Walsh, Seán

    2013-03-01

    Biological models offer the ability to predict clinical outcomes. The authors describe a model to predict the clinical response of intermediate-risk prostate cancer to external beam radiotherapy for a variety of fractionation regimes.

  10. External ophthalmomyiasis presenting to an emergency department: corneal findings as a sign of Oestrus ovis.

    Science.gov (United States)

    Gholamhossein, Yaghoubi; Behrouz, Heydari

    2013-10-01

    This study aims to determine the frequency of opthalmyomyiasis externa and the ocular findings of disease in Southern Khorasan. All patients referred to the emergency department of Valiaser hospital during the year 2011 with external ophthalmomyiasis were enrolled in this study. The diagnosis of external ophthalmomyiasis was made according to clinical findings and the presence of Oestrus ovis larvae. There were 18 cases of external ophthalmomyiasis in the emergency department of Valiaser hospital in 2011. Most cases had the common signs and symptoms of allergic conjunctivitis, except for three males who were referred with respective complaints of red eye, foreign body sensation, and swelling around the eyelids after contact injury the previous day; corneal infiltration was present in three cases. The visual acuity among the three cases that had peripheral corneal involvement was 20 / 30 in both eyes. The bulbar conjunctiva showed chemosis in all cases and a ropy pattern discharge that was clinically compatible with external ophthalmomyiasis. However, in one case, microscopic slit lamp examination did not show Oestrus ovis larvae. The frequency of external ophthalmomyiasis was high in this region. Although external ophthalmomyiasis usually manifests as allergic conjunctivitis, coronary-like corneal infiltration may be considered in the differential diagnosis of external ophthalmomyiasis or toxic insult.

  11. The effects of externalities and framing on bribery in a petty corruption experiment

    OpenAIRE

    Abigail Barr; Danila Serra

    2008-01-01

    Using a simple one-shot bribery game, we find evidence of a negative externality effect and a framing effect. When the losses suffered by third parties due to a bribe being offered and accepted are high and the game is presented as a petty corruption scenario instead of in abstract terms bribes are less likely to be offered. Higher negative externalities are also associated with less bribe acceptance. However, framing has no effect on bribe acceptance, suggesting that the issue of artificiali...

  12. Numerical simulation of a backward-facing step flow in a microchannel with external electric field

    Directory of Open Access Journals (Sweden)

    Qing-He Yao

    2015-03-01

    Full Text Available A backward-facing step flow in the microchannel with external electric field was investigated numerically by a high-order accuracy upwind compact difference scheme in this work. The Poisson–Boltzmann and Navier–Stokes equations were computed by the high-order scheme, and the results confirmed the ability of the new solver in simulation of micro-scale electric double layer effects. The flow fields were displayed for different Reynolds numbers; the positions of the vortex saddle point of model with external electric field and model without external electric field were compared. The average velocity increases linearly with the electric field intensity; however, the Joule heating effects cannot be neglected when the electric field intensity increases to a certain level.

  13. How does an implantable cardioverter defibrillator (ICD) affect the lives of patients and their families?

    Science.gov (United States)

    Eckert, Marion; Jones, Tina

    2002-06-01

    This study aimed to identify the lived experience of patients with implantable cardioverter defibrillators (ICD) and their families. The methodology used was interpretative phenomenology. Unstructured interviews were conducted with three family members and three ICD recipients. Using a methodological approach outlined by van Manen, the participants transcribed texts were analysed looking for similar concepts and ideas that developed into themes that explicated the meaning of this phenomena. The themes that emerged were: dependence, which encompassed their perceptions about the life-saving device; the memory of their first defibrillation experience; lifestyle changes, which incorporated modification techniques; lack of control, which highlighted feelings such as fear, anxiety and powerlessness; mind game, which illustrated psychological challenges; and the issue of security, demonstrating how 'being there' and not 'being there' impacted on their everyday lives. The long-term outcomes of living with an ICD are important considerations for all health-care providers. This research highlights the everyday activities of recipients, the lifestyle changes they have made, the emotional significance of the device and the psychological coping strategies that the participants have adopted. The findings of this research will allow health-care professionals to be better prepared to provide education and support for ICD recipients and their families in regards to issues related to insertion of the device during the postinsertion recovery period and for long-term management after hospital discharge.

  14. A COMPARATIVE STUDY OF CONSERVATIVE MANAGEMENT VS. EXTERNAL FIXATION OF COMMINUTED DISTAL RADIUS FRACTURES

    Directory of Open Access Journals (Sweden)

    Sanjeev Kumar Kare

    2016-12-01

    Full Text Available BACKGROUND Fracture of the distal radius (‘broken wrist’ is a common clinical problem. It can be treated conservatively usually involving wrist immobilisation in a plaster cast or surgically. A key method of surgical fixation is external fixation. MATERIALS AND METHODS A prospective study was carried out on 66 patients admitted between June 2014 to May 2016 for evaluation of conservative and surgical management of distal radius fractures. RESULTS Excellent, fair or good result was noticed in around 85% of cases managed conservatively and in above 90% of cases managed by external fixator. CONCLUSION There is some evidence to support the use of external fixation for dorsally displaced fractures of the distal radius in adults. Though, there is insufficient evidence to confirm a better functional outcome, external fixation reduces redisplacement gives improved anatomical results and most of the excess surgically-related complications are minor.

  15. A mode-locked external-cavity quantum-dot laser with a variable repetition rate

    International Nuclear Information System (INIS)

    Wu Jian; Jin Peng; Li Xin-Kun; Wei Heng; Wu Yan-Hua; Wang Fei-Fei; Chen Hong-Mei; Wu Ju; Wang Zhan-Guo

    2013-01-01

    A mode-locked external-cavity laser emitting at 1.17-μm wavelength using an InAs/GaAs quantum-dot gain medium and a discrete semiconductor saturable absorber mirror is demonstrated. By changing the external-cavity length, repetition rates of 854, 912, and 969 MHz are achieved respectively. The narrowest −3-dB radio-frequency linewidth obtained is 38 kHz, indicating that the laser is under stable mode-locking operation. (electromagnetism, optics, acoustics, heat transfer, classical mechanics, and fluid dynamics)

  16. A risk-informed framework for establishing a beyond design basis safety basis for external hazards

    Energy Technology Data Exchange (ETDEWEB)

    Amico, P. [Hughes Associates, Inc, Baltimore, MD (United States); Anoba, R. [Hughes Associates, Inc, Raleigh, NC (United States); Najafi, B. [Hughes Associates, Inc., Los Gatos, CA (United States)

    2014-07-01

    The events at Fukushima Daiichi taught us that meeting a deterministic design basis requirement for external hazards does not assure that the risk is low. As observed at the plant, the two primary reasons for this are failure cliffs above the design basis event and that combined hazard effects are not considered in design. Because the possible combinations of design basis exceedences and external hazard combinations are very large and complex, an approach focusing only on the most important ones is needed. For this reason, a risk informed approach is the most effective approach, which is discussed in this paper. (author)

  17. A multicenter prospective randomized study comparing the efficacy of escalating higher biphasic versus low biphasic energy defibrillations in patients presenting with cardiac arrest in the in-hospital environment

    Directory of Open Access Journals (Sweden)

    Anantharaman V

    2017-01-01

    Full Text Available Venkataraman Anantharaman,1 Seow Yian Tay,2 Peter George Manning,3 Swee Han Lim,1 Terrance Siang Jin Chua,4 Mohan Tiru,5 Rabind Antony Charles,1 Vidya Sudarshan1 1Department of Emergency Medicine, Singapore General Hospital, 2Department of Emergency Medicine, Tan Tock Seng Hospital, 3Emergency Medicine Department, National University Hospital, 4Department of Cardiology, National Heart Centre, 5Accident and Emergency Department, Changi General Hospital, Singapore Background: Biphasic defibrillation has been practiced worldwide for >15 years. Yet, consensus does not exist on the best energy levels for optimal outcomes when used in patients with ventricular fibrillation (VF/pulseless ventricular tachycardia (VT.Methods: This prospective, randomized, controlled trial of 235 adult cardiac arrest patients with VF/VT was conducted in the emergency and cardiology departments. One group received low-energy (LE shocks at 150–150–150 J and the other escalating higher-energy (HE shocks at 200–300–360 J. If return of spontaneous circulation (ROSC was not achieved by the third shock, LE patients crossed over to the HE arm and HE patients continued at 360 J. Primary end point was ROSC. Secondary end points were 24-hour, 7-day, and 30-day survival.Results: Both groups were comparable for age, sex, cardiac risk factors, and duration of collapse and VF/VT. Of the 118 patients randomized to the LE group, 48 crossed over to the HE protocol, 24 for persistent VF, and 24 for recurrent VF. First-shock termination rates for HE and LE patients were 66.67% and 64.41%, respectively (P=0.78, confidence interval: 0.65–1.89. First-shock ROSC rates were 25.64% and 29.66%, respectively (P=0.56, confidence interval: 0.46–1.45. The 24-hour, 7-day, and 30-day survival rates were 85.71%, 74.29%, and 62.86% for first-shock ROSC LE patients and 70.00%, 50.00%, and 46.67% for first-shock ROSC HE patients, respectively. Conversion rates for further shocks at 200 J and

  18. Anticipated chaos in a nonsymmetric coupled external-cavity-laser system

    International Nuclear Information System (INIS)

    Rees, Paul; Spencer, Paul S.; Pierce, Iestyn; Sivaprakasam, S.; Shore, K. Alan

    2003-01-01

    We explain how the anticipation of chaos in a coupled external cavity laser system described by Sivaprakasam, Shahverdiev, Spencer, and Shore [Phys. Rev. Lett. 87, 154101 (2001)] is obtained. We show that the external cavity induces the required symmetry breaking necessary for the existence of a time delay between the synchronized output of the two laser diodes. The inclusion of a detuning between the two lasers causes one laser to anticipate the chaotic dynamics of the other

  19. Harsh Parenting and Child Externalizing Behavior: Skin Conductance Level Reactivity as a Moderator

    OpenAIRE

    Erath, Stephen A.; El-Sheikh, Mona; Cummings, E. Mark

    2009-01-01

    Skin conductance level reactivity (SCLR) was examined as a moderator of the association between harsh parenting and child externalizing behavior. Participants were 251 boys and girls (8–9 years). Mothers and fathers provided reports of harsh parenting and their children’s externalizing behavior; children also provided reports of harsh parenting. SCLR was assessed in response to a socioemotional stress task and a problem-solving challenge task. Regression analyses revealed that the association...

  20. Treatment of external hazards in probabilistic safety assessment for nuclear power plants. A Safety Practice

    International Nuclear Information System (INIS)

    1995-01-01

    This Safety Practice provides guidance on conducting a PSA for external hazards in nuclear power plants. Emphasis is placed on the procedural steps of the PSA rather then on the details of corresponding methods. The publication is intended to assist technical persons managing or performing PSAs. A particular aim is to promote a standardized framework, terminology and form of documentation for external hazards PSA so as to facilitate external review of the results of such studies. For those specialists who are already involved in related studies, such as a Level 1 PSA dealing only with internal events, this publication provides an indication of how additional external events could be integrated into an existing PSA. 16 refs, 5 figs, 2 tabs

  1. Digital Control of External Devices through the Parallel Port of a ...

    African Journals Online (AJOL)

    Digital Control of External Devices through the Parallel Port of a Computer Using Visual Basic. ... Nigerian Journal of Technology ... Keywords: device controller, digital switching, digital interfacing, visual basic, computer parallel port ...

  2. Sensitivity of a fibre scattered-light interferometer to external phase perturbations in an optical fibre

    Energy Technology Data Exchange (ETDEWEB)

    Alekseev, A E; Potapov, V T [V.A.Kotel' nikov Institute of Radio Engineering and Electronics, Russian Academy of Sciences, Fryazino Branch, Fryazino, Moscow region (Russian Federation); Gorshkov, B G [OOO ' Petrofaiber' , Russia, Tula region, Novomoskovsk (Russian Federation)

    2015-10-31

    Sensitivity of a fibre scattered-light interferometer to external phase perturbations is studied for the first time. An expression is derived for an average power of a useful signal at the interferometer output under external harmonic perturbations in a signal fibre of the interferometer. It is shown that the maximum sensitivity of the scattered-light interferometer depends on the dispersion of the interferogram intensity. An average signal-to-noise ratio is determined theoretically and experimentally at the output of the interferometer at different amplitudes of external perturbations. Using the measured dependences of the signal-to-noise ratio, the threshold sensitivity of the fibre scattered-light interferometer to external phase perturbations is found. The results obtained can be used to optimise characteristics of optical time-domain reflectometers and to design individual phase-sensitive fibre-optic sensors. (laser applications and other topics in quantum electronics)

  3. Scale Economies and Industry Agglomeration E