Sample records for provisions limited arrest

  1. The 2006 National Labor Day impaired driving enforcement crackdown : Drunk driving. Over the limit. Under arrest. (United States)


    The National Highway Traffic Safety Administrations 2006 Drunk Driving. Over the Limit. Under Arrest. Labor Day holiday campaign had three main components: (1) DWI enforcement, (2) public awareness efforts, and (3) evaluation. The 2006 program use...

  2. Identification of Fitness Determinants during Energy-Limited Growth Arrest in Pseudomonas aeruginosa. (United States)

    Basta, David W; Bergkessel, Megan; Newman, Dianne K


    Microbial growth arrest can be triggered by diverse factors, one of which is energy limitation due to scarcity of electron donors or acceptors. Genes that govern fitness during energy-limited growth arrest and the extent to which they overlap between different types of energy limitation are poorly defined. In this study, we exploited the fact that Pseudomonas aeruginosa can remain viable over several weeks when limited for organic carbon (pyruvate) as an electron donor or oxygen as an electron acceptor. ATP values were reduced under both types of limitation, yet more severely in the absence of oxygen. Using transposon-insertion sequencing (Tn-seq), we identified fitness determinants in these two energy-limited states. Multiple genes encoding general functions like transcriptional regulation and energy generation were required for fitness during carbon or oxygen limitation, yet many specific genes, and thus specific activities, differed in their relevance between these states. For instance, the global regulator RpoS was required during both types of energy limitation, while other global regulators such as DksA and LasR were required only during carbon or oxygen limitation, respectively. Similarly, certain ribosomal and tRNA modifications were specifically required during oxygen limitation. We validated fitness defects during energy limitation using independently generated mutants of genes detected in our screen. Mutants in distinct functional categories exhibited different fitness dynamics: regulatory genes generally manifested a phenotype early, whereas genes involved in cell wall metabolism were required later. Together, these results provide a new window into how P. aeruginosa survives growth arrest. IMPORTANCE Growth-arrested bacteria are ubiquitous in nature and disease yet understudied at the molecular level. For example, growth-arrested cells constitute a major subpopulation of mature biofilms, serving as an antibiotic-tolerant reservoir in chronic

  3. 7 CFR 247.13 - Provisions for non-English or limited-English speakers. (United States)


    ... 7 Agriculture 4 2010-01-01 2010-01-01 false Provisions for non-English or limited-English speakers... § 247.13 Provisions for non-English or limited-English speakers. (a) What must State and local agencies do to ensure that non-English or limited-English speaking persons are aware of their rights and...

  4. 7 CFR 1980.311 - Loan limitations and special provisions. (United States)


    ... furniture or other personal property except for essential equipment and materials authorized in accordance... limited to 90 percent of the present market value. (c) Subdivisions. Housing units may be financed in...

  5. Liberty through limits: The bill of rights as limited government provisions

    Directory of Open Access Journals (Sweden)

    Patrick M. Garry


    Full Text Available Under the modern view, individual autonomy has become the primary if not exclusive focus of the Bill of Rights. But the Bill of Rights came about not because of a desire to preserve individual autonomy, nor to insulate the individual from the democratic community. The impetus for the Bill of Rights arose from the same set of concerns that motivated the original Constitution. These concerns involved creating the appropriate structures so as to keep the new central government in check. The Bill of Rights sought to further ensure that the federal government would have limited power and operate in a limited role. Not only does this limited government model coincide with the original intent underlying the Bill of Rights, but it also provides for a more objective and manageable application. Under an individual autonomy view of the Bill of Rights, courts must define the ingredients necessary for such autonomy. However, this endeavor is fraught with ambiguity, and courts must constantly pit the individual against democratic society. But under the limited government model, the judicial role is more objective. Instead of trying to define an ambiguous individual autonomy, courts simply need to focus on whether a particular right is needed so as to maintain limited government. In addition, the limited government model does not put the Bill of Rights in conflict with democratic society. Instead, it just uses the Bill of Rights to maintain a check on government, just as the original Constitution seeks to do.

  6. 40 CFR 63.500 - Back-end process provisions-carbon disulfide limitations for styrene butadiene rubber by emulsion... (United States)


    ... 40 Protection of Environment 9 2010-07-01 2010-07-01 false Back-end process provisions-carbon disulfide limitations for styrene butadiene rubber by emulsion processes. 63.500 Section 63.500 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) NATIONAL EMISSION STANDARDS FOR HAZARDOUS AIR POLLUTANTS FOR...

  7. Daily Arrests (United States)

    Montgomery County of Maryland — This dataset provides the public with arrest information from the Montgomery County Central Processing Unit (CPU) systems. The data presented is derived from every...

  8. Cardiac arrest (United States)

    ... magnesium. These minerals help your heart's electrical system work. Abnormally high or low levels can cause cardiac arrest. Severe physical stress. Anything that causes a severe stress on your ...

  9. 40 CFR 63.494 - Back-end process provisions-residual organic HAP limitations. (United States)


    ... organic HAP limitations. 63.494 Section 63.494 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY... § 63.494 Back-end process provisions—residual organic HAP limitations. (a) The monthly weighted average residual organic HAP content of all grades of elastomer processed, measured after the stripping operation...

  10. Co-Occurring Risk Factors for Arrest among Persons with Opioid Abuse and Dependence: Implications for Developing Interventions to Limit Criminal Justice Involvement (United States)

    Fisher, William H.; Clark, Robin; Baxter, Jeffrey; Barton, Bruce; O’Connell, Elizabeth; Aweh, Gideon


    Persons who abuse opioids or are dependent on opioids are at elevated risk for arrest. Co-occurring behavioral health problems may exacerbate that risk, although the extent of any such increase has not been described. This study examines such risk factors among 40,238 individuals with a diagnosis of opioid abuse or dependence who were enrolled in the Massachusetts Medicaid program in 2010. Medicaid data were merged with statewide arrest data to assess the effects of co-existing mental illness, substance abuse, and previous arrests on arrest during 2010. Persons with serious mental illnesses (psychotic and bipolar disorders) and those with two or more pre-2010 arrests had significantly increased greater odds of arrest. We believe this to be the first study examining effects of co-occurring risk factors on arrest in a large population with opioid dependency/abuse. These findings identify predictors of arrest that could be used to design interventions targeting specific co-occurring risk factors. PMID:25012550

  11. Short communication: Limit feeding dairy heifers: effect of feed bunk space and provision of a low-nutritive feedstuff. (United States)

    Greter, A M; Kitts, B L; Devries, T J


    The objectives of this study were to examine the behavioral effects of providing limit-fed dairy heifers an increased amount of feed bunk space compared with recommended feed bunk allowance, and to determine if the effects of provision of extra bunk space would be comparable to those seen when limit-fed heifers are provided a low-nutritive feedstuff. Twelve Holstein dairy heifers (381.1 ± 44.8 d of age, 417.3 ± 47.9 kg), divided into groups of 4, were exposed to each of 3 treatments using a 3 × 3 Latin square design with 7-d periods. The treatments were (1) 0.68 m of feed bunk space/heifer (TMR-0.68), (2) 0.34 m of feed bunk space/heifer (TMR-0.34), and (3) 0.34 m of feed bunk space/heifer with an additional 0.34 m of feed bunk space available for free-choice straw (TMR-S). The total mixed ration was fed once daily at a restricted level (1.83% of body weight) and contained (dry matter basis) 19.9% alfalfa/grass haylage, 20.1% corn silage, 49.6% high-moisture corn, and 10.4% protein supplement. Group dry matter intake (DMI) was recorded daily. Behavior at the feed bunk was recorded for the last 4 d of each treatment period. Due to the provision of straw, DMI was highest on the TMR-S treatment compared with the other treatments (9.4 vs. 7.8 kg/d). Heifers spent the most time feeding when on the TMR-S treatment (147.7 min/d), with no difference in feeding time between the limit-fed TMR treatments (64.5 min/d). Within the TMR-S treatment, feeding time on the straw was 76.9 min/d; thus, the rate of consumption of only the TMR was similar across all treatments. Unrewarded time at the feed bunk (when no feed was present) did not differ between treatments. Heifers did not differ in competitive behavior when on the limit-fed TMR treatments (13.1 displacements/heifer per day). However, while on the TMR-S treatment, heifers displaced each other more frequently (23.8 displacements/heifer per day) than while on the other 2 treatments. Overall, results suggest that neither

  12. La Provision de una Igualdad de Oportunidades Educativas para los Estudiantes con Conocimientos Limitados del Idioma Ingles (The Provision of an Equal Education Opportunity to Limited English Proficient Students). (United States)

    Office for Civil Rights (ED), Washington, DC.

    This federal policy statement outlines policy on provision of education to limited-English-speaking school children. First, it describes briefly the demographics of this population and the academic difficulties faced by them, and the recent federal initiative for broadened educational opportunity, America 2000: An Education Strategy. Then,…

  13. Circulatory Arrest, Brain Arrest and Death Determination

    Directory of Open Access Journals (Sweden)

    Sam David Shemie


    Full Text Available Technological advances, particularly in the capacity to support, replace or transplant failing organs, continue to challenge and refine our understanding of human death. Given the ability to reanimate organs before and after death, both inside and outside of the body, through reinstitution of oxygenated circulation, concepts related to death of organs (e.g. cardiac death are no longer valid. This paper advances the rationale for a single conceptual determination of death related to permanent brain arrest, resulting from primary brain injury or secondary to circulatory arrest. The clinical characteristics of brain arrest are the permanent loss of capacity for consciousness and loss of all brainstem functions. In the setting of circulatory arrest, death occurs after the arrest of circulation to the brain rather than death of the heart. Correspondingly, any intervention that resumes oxygenated circulation to the brain after circulatory arrest would invalidate the determination of death.

  14. A scoping literature review of the provision of orthoses and prostheses in resource-limited environments 2000-2010. Part one: considerations for success. (United States)

    Ikeda, Andrea J; Grabowski, Alena M; Lindsley, Alida; Sadeghi-Demneh, Ebrahim; Reisinger, Kim D


    Literature Review We estimate that over 29 million people worldwide in resource-limited environments (RLEs) are in need of orthotic and prosthetic (O&P) devices and services. Our goal was to ascertain the current state of O&P provision in RLEs and identify factors that may lead to more successful O&P provision. We conducted a comprehensive scoping literature review of all information related to O&P provision in RLEs published from 2000 to 2010. We targeted Vietnam, Cambodia, Tanzania, Malawi, Colombia, and the Navajo Nation, but also included information about developing countries in general. We searched academic databases and grey literature. We extracted information from each article in the areas of design, manufacturing, distribution, service provision, and technology transfer. We identified commonly reported considerations and strategies for O&P provision from 431 articles. Analysis of expert consensus documents revealed recurring themes for improving O&P provision. We found that some suggestions from the consensus documents are being followed, but many are overlooked or have not yet been implemented. Areas for improvement include conducting field testing during the design process, providing services to rural environments, offering follow-up services, considering government collaboration, and encouraging an active role of the orthosis/prosthesis user. Outcomes and research studies will be further discussed in Part Two. © The International Society for Prosthetics and Orthotics 2013.

  15. Sudden cardiac arrest in a young patient with hypertrophic cardiomyopathy and zero canonical risk factors: the inherent limitations of risk stratification in hypertrophic cardiomyopathy. (United States)

    Kohorst, John J; Bos, J Martijn; Hagler, Donald J; Ackerman, Michael J


    Hypertrophic cardiomyopathy is the most common heritable cardiovascular disease and a common cause of sudden cardiac death (SCD) in young adolescents and athletes. Clinical risk stratification for SCD is predicated on the presence of established risk factors; however, this assessment is far from perfect. Herein, we present a 16-year-old male who was resuscitated successfully from his sentinel event of out-of-hospital cardiac arrest. Prior to this event, he was asymptomatic and lacked all traditional SCD-predisposing risk factors for hypertrophic cardiomyopathy. © 2013 Wiley Periodicals, Inc.

  16. Antenatal care and opportunities for quality improvement of service provision in resource limited settings: A mixed methods study (United States)

    van der Eem, Lisette; Nyanza, Elias C.; van Pelt, Sandra; Ndaki, Pendo; Basinda, Namanya; Sundby, Johanne


    Antenatal care is essential to improve maternal and newborn health and wellbeing. The majority of pregnant women in Tanzania attend at least one visit. Since implementation of the focused antenatal care model, quality of care assessments have mostly focused on utilization and coverage of routine interventions for antenatal care. This study aims to assess the quality of antenatal care provision from a holistic perspective in a rural district in Tanzania. Structure, process and outcome components of quality are explored. This paper reports on data collected over several periods from 2012 to 2015 through facility audits of supplies and services, ANC observations and exit interviews with pregnant women. Additional qualitative methods were used such as interviews, focus group observations and participant observations. Findings indicate variable performance of routine ANC services, partly explained by insufficient resources. Poor performance was also observed for appropriate history taking, attention for client’s wellbeing, basic physical examination and adequate counseling and education. Achieving quality improvement for ANC requires increased attention for the process of care provision beyond coverage, including attention for response-based services, which should be assessed based on locally determined criteria. PMID:29236699

  17. Improving the provision of language services at an academic medical center: ensuring high-quality health communication for limited-English-proficient patients. (United States)

    Standiford, Connie J; Nolan, Elizabeth; Harris, Michelle; Bernstein, Steven J


    To evaluate and improve the provision of language services at an academic medicine center caring for a diverse population including many limited-English-proficient (LEP) patients. The authors performed a prospective observational study between November 2006 and December 2008 evaluating the provision of language services at the University of Michigan Health System. The primary performance measures were (1) screening patients for their preferred language for health care, (2) assessing the proportion of LEP patients receiving language services from a qualified language services provider, and (3) assessing whether there were any disparities in diabetes care for LEP patients compared with English-speaking patients. The proportion of patients screened for preferred language increased from 59% to 96% with targeted inventions, such as training staff to capture preferred language for health care and correcting prior inaccurate primary language data entry. The proportion of LEP outpatients with a qualified language services provider increased from 19% to 83% through the use of staff and contract interpreters, over-the-phone interpreting and bilingual providers. There were no systematic differences in diabetes quality performance measures between LEP and English-proficient patients. Academic medical centers should measure their provision of language services and compare quality and safety data (e.g., performance measures and adverse events) between LEP and English-speaking patients to identify disparities in care. Leadership support and ongoing training are needed to ensure language-specific services are embedded into clinical care to meet the needs of our diverse patient populations.

  18. Witnessed arrest, but not delayed bystander cardiopulmonary resuscitation improves prehospital cardiac arrest survival. (United States)

    Vukmir, R B


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

  19. 75 FR 73972 - Medicaid Program; Cost Limit for Providers Operated by Units of Government and Provisions To... (United States)


    ... District Court for the District of Columbia on May 23, 2008 in Alameda County Medical Center, et al. v... limit on reimbursement. On May 23, 2008, the United States District Court for the District of Columbia...), DHHS is removing the word ``nursing facilities'' replacing it with ``NFs.'' In Sec. 447.272(a)(1), DHHS...

  20. Pittsburgh Police Arrest Data (United States)

    Allegheny County / City of Pittsburgh / Western PA Regional Data Center — Arrest data contains information on people taken into custody by City of Pittsburgh police officers. More serious crimes such as felony offenses are more likely to...

  1. Runway Arrested Landing Site (RALS) (United States)

    Federal Laboratory Consortium — The Runway Arrested Landing Site includes an underground complex located on a Mod 2, Mod 3, and Mod 3+ arresting gear and are located under the runway and accurately...

  2. Epidemiology and Outcomes After In-Hospital Cardiac Arrest After Pediatric Cardiac Surgery (United States)

    Gupta, Punkaj; Jacobs, Jeffrey P.; Pasquali, Sara K.; Hill, Kevin D.; Gaynor, J. William; O’Brien, Sean M.; He, Max; Sheng, Shubin; Schexnayder, Stephen M.; Berg, Robert A.; Nadkarni, Vinay M.; Imamura, Michiaki; Jacobs, Marshall L.


    Background Multicenter data regarding cardiac arrest in children undergoing heart operations are limited. We describe epidemiology and outcomes associated with postoperative cardiac arrest in a large multiinstitutional cohort. Methods Patients younger than 18 years in the Society of Thoracic Surgeons Congenital Heart Surgery Database (2007 through 2012) were included. Patient factors, operative characteristics, and outcomes were described for patients with and without postoperative cardiac arrest. Multivariable models were used to evaluate the association of center volume with cardiac arrest rate and mortality after cardiac arrest, adjusting for patient and procedural factors. Results Of 70,270 patients (97 centers), 1,843 (2.6%) had postoperative cardiac arrest. Younger age, lower weight, and presence of preoperative morbidities (all p < 0.0001) were associated with cardiac arrest. Arrest rate increased with procedural complexity across common benchmark operations, ranging from 0.7% (ventricular septal defect repair) to 12.7% (Norwood operation). Cardiac arrest was associated with significant mortality risk across procedures, ranging from 15.4% to 62.3% (all p < 0.0001). In multivariable analysis, arrest rate was not associated with center volume (odds ratio, 1.06; 95% confidence interval, 0.71 to 1.57 in low- versus high-volume centers). However, mortality after cardiac arrest was higher in low-volume centers (odds ratio, 2.00; 95% confidence interval, 1.52 to 2.63). This association was present for both high- and low-complexity operations. Conclusions Cardiac arrest carries a significant mortality risk across the stratum of procedural complexity. Although arrest rates are not associated with center volume, lower-volume centers have increased mortality after cardiac arrest. Further study of mechanisms to prevent cardiac arrest and to reduce mortality in those with an arrest is warranted. PMID:25443018

  3. Cardiac arrest – cardiopulmonary resuscitation

    Directory of Open Access Journals (Sweden)

    Basri Lenjani


    Conclusions: All survivors from cardiac arrest have received appropriate medical assistance within 10 min from attack, which implies that if cardiac arrest occurs near an institution health care (with an opportunity to provide the emergent health care the rate of survival is higher.

  4. Cardiac Arrest: MedlinePlus Health Topic (United States)

    ... Handouts Cardiac arrest (Medical Encyclopedia) Also in Spanish Topic Image MedlinePlus Email Updates Get Cardiac Arrest updates ... this? GO MEDICAL ENCYCLOPEDIA Cardiac arrest Related Health Topics Arrhythmia CPR Pacemakers and Implantable Defibrillators National Institutes ...

  5. "House Arrest" or "Developmental Arrest"? A Study of Youth Under House Arrest. (United States)

    Chamiel, Elad; Walsh, Sophie D


    Studies have examined the potential benefits and risks of alternative forms of detention, such as house arrest, for adults but, despite its growing use, little research has examined the implications of house arrest for juveniles. The current research examined the experience of 14 adolescents under house arrest. Six main themes were identified in the narratives of the participants: the experience of detention, daily schedule and utilization of time, emotions and self-reflection, relationships with peers, relation to parents and supervisor(s), and contact with professionals. Findings emphasized the potential developmental dangers of house arrest at the critical stage of adolescence. Yet, analysis also showed that the period of house arrest has the potential to be a period of positive changes, and can be used for successful rehabilitation.

  6. Activity and Life After Survival of a Cardiac Arrest (ALASCA and the effectiveness of an early intervention service: design of a randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Bakx Wilbert GM


    Full Text Available Abstract Background Cardiac arrest survivors may experience hypoxic brain injury that results in cognitive impairments which frequently remain unrecognised. This may lead to limitations in daily activities and participation in society, a decreased quality of life for the patient, and a high strain for the caregiver. Publications about interventions directed at improving quality of life after survival of a cardiac arrest are scarce. Therefore, evidence about effective rehabilitation programmes for cardiac arrest survivors is urgently needed. This paper presents the design of the ALASCA (Activity and Life After Survival of a Cardiac Arrest trial, a randomised, controlled clinical trial to evaluate the effects of a new early intervention service for survivors of a cardiac arrest and their caregivers. Methods/design The study population comprises all people who survive two weeks after a cardiac arrest and are admitted to one of the participating hospitals in the Southern part of the Netherlands. In a two-group randomised, controlled clinical trial, half of the participants will receive an early intervention service. The early intervention service consists of several consultations with a specialised nurse for the patient and their caregiver during the first three months after the cardiac arrest. The intervention is directed at screening for cognitive problems, provision of informational, emotional and practical support, and stimulating self-management. If necessary, referral to specialised care can take place. Persons in the control group will receive the care as usual. The primary outcome measures are the extent of participation in society and quality of life of the patient one year after a cardiac arrest. Secondary outcome measures are the level of cognitive, emotional and cardiovascular impairment and daily functioning of the patient, as well as the strain for and quality of life of the caregiver. Participants and their caregivers will be followed

  7. Provisions distributed

    NARCIS (Netherlands)

    Martin Olsthoorn; Evert Pommer; Michiel Ras; Ab van der Torre; Jean Marie Wildeboer Schut


    Original title: Voorzieningen verdeeld Citizens ‘profit’ from the government when they receive income support because they are unable to generate an income themselves. They also profit when they make use of provisions such as care, support, education, public transport, sport, culture

  8. Metoclopramide-induced cardiac arrest

    Directory of Open Access Journals (Sweden)

    Martha M. Rumore


    Full Text Available The authors report a case of cardiac arrest in a patient receiving intravenous (IV metoclopramide and review the pertinent literature. A 62-year-old morbidly obese female admitted for a gastric sleeve procedure, developed cardiac arrest within one minute of receiving metoclopramide 10 mg via slow intravenous (IV injection. Bradycardia at 4 beats/min immediately appeared, progressing rapidly to asystole. Chest compressions restored vital function. Electrocardiogram (ECG revealed ST depression indicative of myocardial injury. Following intubation, the patient was transferred to the intensive care unit. Various cardiac dysrrhythmias including supraventricular tachycardia (SVT associated with hypertension and atrial fibrillation occurred. Following IV esmolol and metoprolol, the patient reverted to normal sinus rhythm. Repeat ECGs revealed ST depression resolution without pre-admission changes. Metoclopramide is a non-specific dopamine receptor antagonist. Seven cases of cardiac arrest and one of sinus arrest with metoclopramide were found in the literature. The metoclopramide prescribing information does not list precautions or adverse drug reactions (ADRs related to cardiac arrest. The reaction is not dose related but may relate to the IV administration route. Coronary artery disease was the sole risk factor identified. According to Naranjo, the association was possible. Other reports of cardiac arrest, severe bradycardia, and SVT were reviewed. In one case, five separate IV doses of 10 mg metoclopramide were immediately followed by asystole repeatedly. The mechanism(s underlying metoclopramide’s cardiac arrest-inducing effects is unknown. Structural similarities to procainamide may play a role. In view of eight previous cases of cardiac arrest from metoclopramide having been reported, further elucidation of this ADR and patient monitoring is needed. Our report should alert clinicians to monitor patients and remain diligent in surveillance and

  9. Comparison of crack arrest methodologies

    International Nuclear Information System (INIS)



    The ASTM Cooperative Test Program Data were used to compare the static (K/sub Ia/) and dynamic (K/sud ID/, K/sub IDm/) approaches to crack arrest. K/sub Ia/ is not dependent on K/sub Q/. This is consistent with the requirements of the static approach, but not the dynamic one which requires that K/sub Ia/ decrease with K/sub Q/ if K/sub ID/ (= K/sub IDm/) is a constant. K/sub ID/ increases systematically with K/sub Q/ at a rate that is consistent with calculations based on the use of a constant value for K/sub Ia/ which is equal to its measured mean value. Only in the limiting case of very short crack jumps (associated with very low average crack speeds) can K/sub ID/ be identified as a minimum value at which K/sub ID/ = K/sub IDm/. In this case K/sub IDm/ approx. K/sub Ia/ approx. K/sub Im/. The latter is the idealized minimum value of K that will support the continued propagation of a running crack

  10. Associates of Cardiopulmonary Arrest in the Perihemodialytic Period (United States)

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


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

  11. Associates of Cardiopulmonary Arrest in the Perihemodialytic Period

    Directory of Open Access Journals (Sweden)

    Jennifer E. Flythe


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

  12. A model of survival following pre-hospital cardiac arrest based on the Victorian Ambulance Cardiac Arrest Register. (United States)

    Fridman, Masha; Barnes, Vanessa; Whyman, Andrew; Currell, Alex; Bernard, Stephen; Walker, Tony; Smith, Karen L


    This study describes the epidemiology of sudden cardiac arrest patients in Victoria, Australia, as captured via the Victorian Ambulance Cardiac Arrest Register (VACAR). We used the VACAR data to construct a new model of out-of-hospital cardiac arrest (OHCA), which was specified in accordance with observed trends. All cases of cardiac arrest in Victoria that were attended by Victorian ambulance services during the period of 2002-2005. Overall survival to hospital discharge was 3.8% among 18,827 cases of OHCA. Survival was 15.7% among 1726 bystander witnessed, adult cardiac arrests of presumed cardiac aetiology, presenting in ventricular fibrillation or ventricular tachycardia (VF/VT), where resuscitation was attempted. In multivariate logistic regression analysis, bystander CPR, cardiac arrest (CA) location, response time, age and sex were predictors of VF/VT, which, in turn, was a strong predictor of survival. The same factors that affected VF/VT made an additional contribution to survival. However, for bystander CPR, CA location and response time this additional contribution was limited to VF/VT patients only. There was no detectable association between survival and age younger than 60 years or response time over 15min. The new model accounts for relationships among predictors of survival. These relationships indicate that interventions such as reduced response times and bystander CPR act in multiple ways to improve survival.

  13. Sudden Cardiac Arrest (SCA) Risk Assessment (United States)

    ... HRS Find a Specialist Share Twitter Facebook SCA Risk Assessment Sudden Cardiac Arrest (SCA) occurs abruptly and without ... people of all ages and health conditions. Start Risk Assessment The Sudden Cardiac Arrest (SCA) Risk Assessment Tool ...

  14. Successful cardiopulmonary resuscitation following cardiopulmonary arrest in a geriatric chinchilla. (United States)

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


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

  15. Hydroxylated PBDEs induce developmental arrest in zebrafish

    Energy Technology Data Exchange (ETDEWEB)

    Usenko, Crystal Y., E-mail:; Hopkins, David C.; Trumble, Stephen J., E-mail:; Bruce, Erica D., E-mail:


    The ubiquitous spread of polybrominated diphenyl ethers (PBDEs) has led to concerns regarding the metabolites of these congeners, in particular hydroxylated PBDEs. There are limited studies regarding the biological interactions of these chemicals, yet there is some concern they may be more toxic than their parent compounds. In this study three hydroxylated PBDEs were assessed for toxicity in embryonic zebrafish: 3-OH-BDE 47, 5-OH-BDE 47, and 6-OH-BDE 47. All three congeners induced developmental arrest in a concentration-dependent manner; however, 6-OH-BDE 47 induced adverse effects at lower concentrations than the other congeners. Furthermore, all three induced cell death; however apoptosis was not observed. In short-term exposures (24–28 hours post fertilization), all hydroxylated PBDEs generated oxidative stress in the region corresponding to the cell death at 5 and 10 ppm. To further investigate the short-term effects that may be responsible for the developmental arrest observed in this study, gene regulation was assessed for embryos exposed to 0.625 ppm 6-OH-BDE 47 from 24 to 28 hpf. Genes involved in stress response, thyroid hormone regulation, and neurodevelopment were significantly upregulated compared to controls; however, genes related to oxidative stress were either unaffected or downregulated. This study suggests that hydroxylated PBDEs disrupt development, and may induce oxidative stress and potentially disrupt the cholinergic system and thyroid hormone homeostasis. -- Highlights: ► OH-PBDEs induce developmental arrest in a concentration-dependent manner. ► Hydroxyl group location influences biological interaction. ► OH-PBDEs induce oxidative stress. ► Thyroid hormone gene regulation was disrupted following exposure. ► To our knowledge, this is the first whole organism study of OH-PBDE toxicity.

  16. Multiple contacts with diversion at the point of arrest. (United States)

    Riordan, Sharon; Wix, Stuart; Haque, M Sayeed; Humphreys, Martin


    A diversion at the point of arrest (DAPA) scheme was set up in five police stations in South Birmingham in 1992. In a study of all referrals made over a four-year period a sub group of multiple contact individuals was identified. During that time four hundred and ninety-two contacts were recorded in total, of which 130 were made by 58 individuals. The latter group was generally no different from the single contact group but did have a tendency to be younger. This research highlights the need for a re-evaluation of service provision and associated education of police officers and relevant mental health care professionals.

  17. The effectiveness of silver diamine fluoride in arresting caries. (United States)

    Richards, Derek


    Data sourcesPubMed, Embase, Scopus, China National Knowledge Infrastructure (CNKI), Ichushi-web, Biblioteca Virtual en Salud Espana (BVSE) and Biblioteca Virtual em Saude (BVS) databases. There were no limits on language or publication dates.Study selectionTwo reviewers selected prospective clinical studies investigating SDF treatment for caries prevention in children.Data extraction and synthesisData was abstracted independently by two reviewers and risk of bias assessed. Meta-analysis was performed on studies in which the caries-arresting rate using 38% SDF solution on primary teeth could be obtained or calculated.ResultsNineteen studies were included; 16 were conducted in the primary dentition and three in permanent dentition. Fourteen studies used 38% SDF, three 30% SDF, and two 10% SDF. Eight studies using 38% SDF contributed to a meta-analysis and the overall proportion of arrested caries was 81% (95% CI; 68-89%). Percentage reductions were also calculated for 6,12,18,24 and >30 months. Arrested carious lesions stained black but no other adverse effects were reported.ConclusionsSDF commonly used at a high concentration (38%, 44,800ppm fluoride) is effective in arresting caries among children. There is no consensus on its number and frequency of application to arrest caries. Further studies are necessary to develop evidence-based guidelines on its use in children.

  18. Estudo da função simpático-adrenal em crianças submetidas a cirurgia cardíaca com hipotermia de superfície, perfusão limitada e parada circulatória Simpathoadrenal function during cardiac surgery in infants using the technique of surface cooling, limited cardiopulmonary bypass and circulatory arrest

    Directory of Open Access Journals (Sweden)

    Richard K Firmin


    Full Text Available Os níveis de catecolamina plasmática foram medidos em 20 crianças (idade média de 6,00 ± 5,86 meses; peso médio 5,3 ± 1,82 kg, durante a correção de defeitos cardíacos congênitos, usando-se a hipotermia de superfície (26ºC, perfusão cardiopulmonar limitada e parada circulatória (15ºC. Adrenalina e noradrenalina plasmática foram dosadas em amostras sangüíneas arteriais seriadas, usando-se a cromatografia. A hipotermia de superfície produziu um significante aumento de ambas as catecolaminas. Durante o resfriamento central, os níveis caíram devido à hemodiluição. Após o período de parada circulatória (23/64 minutos, média de 41,3, ocorreu um aumento das catecolaminas plasmáticas, que persistiu durante o reaquecimento. Após o reaquecimento, as catecolaminas plasmáticas permaneceram elevadas até o final do ato cirúrgico. Nossos resultados mostram que a técnica de hipotermia de superfície, perfusão cardiopulmonar limitada e parada circulatória, sob as nossas condições de anestesia, produziu significante aumento da concentração de adrenalina e noradrenalina plasmática, porém o significado biológico é, ainda, inseguro.Plasma catecholamine levels were measured in 20 infants (mean age 6.0 ± 5.86 months; mean weigh 5.3 ± 1.82 Kg, undergoing correction of congenital heart defects using surface cooling (26ºC, limited cardiopulmonary bypass and circulatory arrest (15ºC. Plasma adrenaline and noradrenaline were assayed in serial arterial blood samples using cromatography and electrochemical techniques. Surface cooling produced a significant rise in adrenaline and noradrenaline: the levels of both catecholamines fell, however, during core-cooling on cardiopulmonary bypass. Following the period of circulatory arrest (23/64 min, mean 41.3 min, there was a further increase in plasma catecholamines, which persisted during rewarming. Following rewarming, plasma catecholamines remained elevated untill the end of the

  19. The real performance of radioactive lightning arrester

    International Nuclear Information System (INIS)

    Leite, D.M.


    The study of the performance of radioactive lightning arrester comparing to the performance of conventional one are presented. Measurements of currents between lightning arrester and an energyzed plate with wind simulation were done for radioactive and conventional lightning arresters, separately. The attraction range of radioactive and conventional lightning arresters using atmospheric pulses produced by a generator of 3MV were verified, separately and simultaneously. The influence of ionization produced by radioactive lightning arrester on critical disruptive tension of a spark plate, testing two lightning arresters for differents nominal attraction distances with applications of atmospheric pulses (positive and negative polarity) and tensions of 60 Hz was verified. The radiation emitted by a radioactive lightning had used in a building was retired and handled without special carefullness by a personnel without worthy of credence to evaluate the hazard in handling radioactive lightning arrester was measured. Critical disruptive tensions of radioactive and conventional lightning arrester using a suspensed electrode and external pulse generator of 6MV was measured. The effect of attraction of a radioactive and conventional lightning arresters disposed symmetrically regarding the same suspensed electrode was verified simultaneously. Seven cases on faults of radioactive lightning arrester in external areas are present. (M.C.K.) [pt

  20. The relevance of crack arrest phenomena for pressure vessel structural integrity assessment

    International Nuclear Information System (INIS)

    Connors, D.C.; Dowling, A.R.; Flewitt, P.E.J.


    The potential role of a crack arrest argument for the structural integrity assessments of steel pressure vessels and the relationship between crack initiation and crack arrest philosophies are described. A typical structural integrity assessment using crack initiation fracture mechanics is illustrated by means of a case study based on assessment of the steel pressure vessels for Magnox power stations. Evidence of the occurrence of crack arrest in structures is presented and reviewed, and the applications to pressure vessels which are subjected to similar conditions are considered. An outline is given of the material characterisation that would be required to undertake a crack arrest integrity assessment. It is concluded that crack arrest arguments could be significant in the structural integrity assessment of PWR reactor pressure vessels under thermal shock conditions, whereas for Magnox steel pressure vessels it would be limited in its potential to supporting existing arguments. (author)

  1. An engineering interpretation of pop-in arrest and tearing arrest in terms of static crack arrest, Ksub(Ia)

    International Nuclear Information System (INIS)

    Witt, F.J.


    When fracture toughness specimens are tested under displacement controlled conditions, they are often observed to exhibit unstable cleavage fracture followed by arrest of the cleavage mode wherein a significant load remains on the specimen (pop-in arrest). This behavior carries over into the ductile tearing regime wherein tearing may occur rapidly identified by load reduction and then proceeds at a discernible less rate (tearing arrest). Both these behaviors represent an initiation condition followed by an arrest condition. In this paper it is demonstrated that from either of the arrest conditions an arrest value may be determined which, for available experimental data, is shown to be an engineering estimate for the static crack arrest toughness, Ksub(Ia). A data analysis procedure is outlined and Ksub(Ic) and Ksub(Ia) estimates from sixty-eight 1/2, 1 and 2 in. thick compact specimens from two steels (A533 Grade B Class 1 and AISI 1018) tested between -40 deg F and 200 deg F are summarized. The crack arrest estimates are seen to compare favorably with Ksub(Ia) results obtained by other investigators using 2 in. thick specimens. Also it is demonstrated that when failure is by fully ductile tearing, the crack arrest toughness is at least equal to the estimate for Ksub(Ic) for the specimen. (author)

  2. Same-Sex and Race-Based Disparities in Statutory Rape Arrests. (United States)

    Chaffin, Mark; Chenoweth, Stephanie; Letourneau, Elizabeth J


    This study tests a liberation hypothesis for statutory rape incidents, specifically that there may be same-sex and race/ethnicity arrest disparities among statutory rape incidents and that these will be greater among statutory rape than among forcible sex crime incidents. 26,726 reported incidents of statutory rape as defined under state statutes and 96,474 forcible sex crime incidents were extracted from National Incident-Based Reporting System data sets. Arrest outcomes were tested using multilevel modeling. Same-sex statutory rape pairings were rare but had much higher arrest odds. A victim-offender romantic relationship amplified arrest odds for same-sex pairings, but damped arrest odds for male-on-female pairings. Same-sex disparities were larger among statutory than among forcible incidents. Female-on-male incidents had uniformly lower arrest odds. Race/ethnicity effects were smaller than gender effects and more complexly patterned. The findings support the liberation hypothesis for same-sex statutory rape arrest disparities, particularly among same-sex romantic pairings. Support for race/ethnicity-based arrest disparities was limited and mixed. © The Author(s) 2014.

  3. Submission of Republica Oriental del Uruguay to the Commission on the limits of the continental shelf pursuant to provisions of article 76, paragraph 8, of the United Nations Convention on the Law of the Sea: executive summary

    International Nuclear Information System (INIS)

    Mata Prates, C.; Tajes, J.; Burgos, M.; Caamaño; Lamartheé; Montiel, D.; Preciozzi, F.; De Santa Ana, H.


    Pursuant to provisions of article 76 of the United Nations Convention on the Law of the Sea (hereinafter the Convention), and to article 4 of Annex II of same, República Oriental del Uruguay (Uruguay) hereby submits to the Commission on the Limits of the Continental Shelf (the Commission) particulars on the outer limit of its continental shelf, extending beyond 200 nautical miles (M) from the baselines from which the breadth of territorial sea is measured. On December 10, 1982 Uruguay signed the Convention, which was subsequently approved by Uruguayan Law Nº 16,287, and ratified on December 10, 1992. The porvisions of article 76 invoked in Uruguay submission fixed points delimiting Uruguay’s Continental Shelf. There exist, at present, no unresolved disputes over the maritime border with either of Uruguay’s neighbouring countries, Argentina or Brazil. It was received assistance in the elaboration of this Submission April 2008, from member of the Commission and also assistance from other, non-member consultants and institutions from Germany, Brazil, Portugal and Norway

  4. Dynamic photoelastic investigation of crack arrest

    International Nuclear Information System (INIS)

    Irwin, G.R.; Dally, J.W.; Kobayashi, T.; Fourney, W.L.


    Crack arrest and crack arrest toughness are of great interest, particularly for studies pertaining to safety of nuclear reactor pressure vessels. Investigations are needed in which the instantaneous values of stress intensity factor (K) can be observed during crack propagation and arrest. Such observations are possible if the test specimens are made from plates of a transparent photoelastic sensitive material. Values of K as a function of crack speed are shown for Homalite 100 and various epoxy blends. 9 figures

  5. Simulated Cardiopulmonary Arrests in a Hospital Setting. (United States)

    Mishkin, Barbara H.; And Others


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

  6. Arresting relaxation in Pickering Emulsions (United States)

    Atherton, Tim; Burke, Chris


    Pickering emulsions consist of droplets of one fluid dispersed in a host fluid and stabilized by colloidal particles absorbed at the fluid-fluid interface. Everyday materials such as crude oil and food products like salad dressing are examples of these materials. Particles can stabilize non spherical droplet shapes in these emulsions through the following sequence: first, an isolated droplet is deformed, e.g. by an electric field, increasing the surface area above the equilibrium value; additional particles are then adsorbed to the interface reducing the surface tension. The droplet is then allowed to relax toward a sphere. If more particles were adsorbed than can be accommodated by the surface area of the spherical ground state, relaxation of the droplet is arrested at some non-spherical shape. Because the energetic cost of removing adsorbed colloids exceeds the interfacial driving force, these configurations can remain stable over long timescales. In this presentation, we present a computational study of the ordering present in anisotropic droplets produced through the mechanism of arrested relaxation and discuss the interplay between the geometry of the droplet, the dynamical process that produced it, and the structure of the defects observed.

  7. Metazoan operons accelerate recovery from growth arrested states (United States)

    Zaslaver, Alon; Baugh, L. Ryan; Sternberg, Paul W.


    Summary Existing theories explain why operons are advantageous in prokaryotes, but their occurrence in metazoans is an enigma. Nematode operon genes, typically consisting of growth genes, are significantly up-regulated during recovery from growth-arrested states. This expression pattern is anti-correlated to non-operon genes consistent with a competition for transcriptional resources. We find that transcriptional resources are initially limiting during recovery, and that recovering animals are highly sensitive to any additional decrease in transcriptional resources. Operons become advantageous because by clustering growth genes into operons, fewer promoters compete for the limited transcriptional machinery, effectively increasing the concentration of transcriptional resources, and accelerating recovery. Mathematical modeling reveals how a moderate increase in transcriptional resources can substantially enhance transcription rate and recovery. This design principle occurs in different nematodes and the chordate C. intestinalis. As transition from arrest to rapid growth is shared by many metazoans, operons could have evolved to facilitate these processes. PMID:21663799

  8. Mandatory Arrest Law in domestic violence cases and its implementation in New York City

    Directory of Open Access Journals (Sweden)

    Milivojević Sanja K.


    Full Text Available This paper contains the analysis of the Mandatory Arrest Law in domestic violence cases in New York State. Introduction includes the subject and main goals of the paper. Second chapter starts with historical development of the police response in domestic violence cases in New York before and after the Mandatory Arrest Law is passed, than analysis of the Law, and ends with one of the programs which Safe Horizon, Victim Service organization, developed in New York City. Third chapter gives the analysis of pro et contra arguments for mandatory arrest provision and results of surveys and studies, which were conducted in United States. In fourth chapter we present the analysis of the research conducted in two police precincts in New York City this year. Paper also contains the list of main problems in implementation of this Law in New York City.

  9. Therapeutic Hypothermia after In-Hospital Cardiac Arrest in Children. (United States)

    Moler, Frank W; Silverstein, Faye S; Holubkov, Richard; Slomine, Beth S; Christensen, James R; Nadkarni, Vinay M; Meert, Kathleen L; Browning, Brittan; Pemberton, Victoria L; Page, Kent; Gildea, Marianne R; Scholefield, Barnaby R; Shankaran, Seetha; Hutchison, Jamie S; Berger, John T; Ofori-Amanfo, George; Newth, Christopher J L; Topjian, Alexis; Bennett, Kimberly S; Koch, Joshua D; Pham, Nga; Chanani, Nikhil K; Pineda, Jose A; Harrison, Rick; Dalton, Heidi J; Alten, Jeffrey; Schleien, Charles L; Goodman, Denise M; Zimmerman, Jerry J; Bhalala, Utpal S; Schwarz, Adam J; Porter, Melissa B; Shah, Samir; Fink, Ericka L; McQuillen, Patrick; Wu, Theodore; Skellett, Sophie; Thomas, Neal J; Nowak, Jeffrey E; Baines, Paul B; Pappachan, John; Mathur, Mudit; Lloyd, Eric; van der Jagt, Elise W; Dobyns, Emily L; Meyer, Michael T; Sanders, Ronald C; Clark, Amy E; Dean, J Michael


    Targeted temperature management is recommended for comatose adults and children after out-of-hospital cardiac arrest; however, data on temperature management after in-hospital cardiac arrest are limited. In a trial conducted at 37 children's hospitals, we compared two temperature interventions in children who had had in-hospital cardiac arrest. Within 6 hours after the return of circulation, comatose children older than 48 hours and younger than 18 years of age were randomly assigned to therapeutic hypothermia (target temperature, 33.0°C) or therapeutic normothermia (target temperature, 36.8°C). The primary efficacy outcome, survival at 12 months after cardiac arrest with a score of 70 or higher on the Vineland Adaptive Behavior Scales, second edition (VABS-II, on which scores range from 20 to 160, with higher scores indicating better function), was evaluated among patients who had had a VABS-II score of at least 70 before the cardiac arrest. The trial was terminated because of futility after 329 patients had undergone randomization. Among the 257 patients who had a VABS-II score of at least 70 before cardiac arrest and who could be evaluated, the rate of the primary efficacy outcome did not differ significantly between the hypothermia group and the normothermia group (36% [48 of 133 patients] and 39% [48 of 124 patients], respectively; relative risk, 0.92; 95% confidence interval [CI], 0.67 to 1.27; P=0.63). Among 317 patients who could be evaluated for change in neurobehavioral function, the change in VABS-II score from baseline to 12 months did not differ significantly between the groups (P=0.70). Among 327 patients who could be evaluated for 1-year survival, the rate of 1-year survival did not differ significantly between the hypothermia group and the normothermia group (49% [81 of 166 patients] and 46% [74 of 161 patients], respectively; relative risk, 1.07; 95% CI, 0.85 to 1.34; P=0.56). The incidences of blood-product use, infection, and serious adverse

  10. Cardiac arrest while exercising on mountains in national or provincial parks: A national observational study from 2012 to 2015. (United States)

    Jung, Eujene; Park, Jeong Ho; Kong, So Yeon; Hong, Ki Jeong; Ro, Young Sun; Song, Kyoung Jun; Ryu, Hyun Ho; Shin, Sang Do


    Previous studies on cardiac arrest in mountainous areas were focused on environmental features such as altitude and temperature. However, those are limited to factors affecting the prognosis of patients after cardiac arrest. We analyzed the cardiac arrests in national or provincial parks located in the mountains and determined the factors affecting the prognosis of patients after cardiac arrest. This study included all emergency medical service (EMS) treated patients over the age of 40 experiencing out-of-hospital cardiac arrests (OHCAs) of presumed cardiac etiology during exercise, between January 2012 and December 2015. The main focus of interest was the location of cardiac arrest occurrence (national mountain parks and provincial parks vs. other sites). The main outcome was survival to discharge and multivariable logistic regression was performed to adjust for possible confounding effects. A total 1835 patients who suffered a cardiac arrest while exercising were included. From these, 68 patients experienced cardiac arrest in national or provincial parks, and 1767 occurred in other locations. The unadjusted and adjusted ORs (95% CI) for a good cerebral performance scale (CPC) were 0.09 (0.01-0.63) and 0.08(0.01-0.56), survival discharges were 0.13(0.03-0.53) and 0.11 (0.03-0.48). Cardiac arrests occurring while exercising in the mountainous areas have worse prognosis compared to alternative locations. Copyright © 2017. Published by Elsevier Inc.

  11. Extracorporeal membrane oxygenation for refractory cardiac arrest

    Directory of Open Access Journals (Sweden)

    Steven A Conrad


    Full Text Available Extracorporeal cardiopulmonary resuscitation (ECPR is the use of rapid deployment venoarterial (VA extracorporeal membrane oxygenation to support systemic circulation and vital organ perfusion in patients in refractory cardiac arrest not responding to conventional cardiopulmonary resuscitation (CPR. Although prospective controlled studies are lacking, observational studies suggest improved outcomes compared with conventional CPR when ECPR is instituted within 30-60 min following cardiac arrest. Adult and pediatric patients with witnessed in-hospital and out-of-hospital cardiac arrest and good quality CPR, failure of at least 15 min of conventional resuscitation, and a potentially reversible cause for arrest are candidates. Percutaneous cannulation where feasible is rapid and can be performed by nonsurgeons (emergency physicians, intensivists, cardiologists, and interventional radiologists. Modern extracorporeal systems are easy to prime and manage and are technically easy to manage with proper training and experience. ECPR can be deployed in the emergency department for out-of-hospital arrest or in various inpatient units for in-hospital arrest. ECPR should be considered for patients with refractory cardiac arrest in hospitals with an existing extracorporeal life support program, able to provide rapid deployment of support, and with resources to provide postresuscitation evaluation and management.

  12. Interrater variability of EEG interpretation in comatose cardiac arrest patients

    DEFF Research Database (Denmark)

    Westhall, Erik; Rosén, Ingmar; Rossetti, Andrea O


    OBJECTIVE: EEG is widely used to predict outcome in comatose cardiac arrest patients, but its value has been limited by lack of a uniform classification. We used the EEG terminology proposed by the American Clinical Neurophysiology Society (ACNS) to assess interrater variability in a cohort...... who were blinded for patient outcome. Percent agreement and kappa (κ) for the categories in the ACNS EEG terminology and for prespecified malignant EEG-patterns were calculated. RESULTS: There was substantial interrater agreement (κ 0.71) for highly malignant patterns and moderate agreement (κ 0.......42) for malignant patterns. Substantial agreement was found for malignant periodic or rhythmic patterns (κ 0.72) while agreement for identifying an unreactive EEG was fair (κ 0.26). CONCLUSIONS: The ACNS EEG terminology can be used to identify highly malignant EEG-patterns in post cardiac arrest patients...

  13. Design provisions for safety

    International Nuclear Information System (INIS)

    Birkhofer, A.


    Design provisions for safety of nuclear power plants are based on a well balanced concept: the public is protected against a release of radioactive material by multiple barriers. These barriers are protected according to a 'defence-in-depth' principle. The reactor safety concept is primarily aimed at the prevention of accidents, especially fuel damage. Additionally, measures for consequence limitation are provided in order to prevent a severe release of radioactivity to the environment. However, it is difficult to judge the overall effectiveness of such devices. In a comprehensive safety analysis it has to be shown that the protection systems and safeguards work with sufficient reliability in the event of an accident. For the reliability assessment deterministic criteria (single failure, redundancy, fail-safe, demand for diversity) play an important role. Increasing efforts have been made to assess reliability quantitatively by means of probabilistic methods. It is now usual to perform reliability analyses of essential systems of nuclear power plants in the course of licensing procedures. As an additional level of emergency measures for a further reduction of hazards a reasonable amount of accident information has to be transferred. Operational experience may be considered as an important feedback to the design of plant safety features. Operator training has to include, besides skill in performing of operating procedures, the training of a flexible response to different accident situations. Experience has shown that the design provisions for safety could prevent dangerous release of the radioactive material to the environment after an accident has occurred. For future developments of reactor safety, extensive analyses of operating experience are of great importance. The main goal should be to enhance the reliability of measures for accident prevention, which prevent the core from meltdown or other damages

  14. Estimating cost-effectiveness of mass cardiopulmonary resuscitation training strategies to improve survival from cardiac arrest in private locations. (United States)

    Swor, Robert; Compton, Scott


    Most cardiopulmonary resuscitation (CPR) trainees are young, and most cardiac arrests occur in private residences witnessed by older individuals. To estimate the cost-effectiveness of a CPR training program targeted at citizens over the age of 50 years compared with that of current nontargeted public CPR training. A model was developed using cardiac arrest and known demographic data from a single suburban zip code (population 36,325) including: local data (1997-1999) regarding cardiac arrest locations (public vs. private); incremental survival with CPR (historical survival rate 7.8%, adjusted odds ratio for CPR 2.0); arrest bystander demographics obtained from bystander telephone interviews; zip code demographics regarding population age and distribution; and 12.50 dollars per student for the cost of CPR training. Published rates of CPR training programs by age were used to estimate the numbers typically trained. Several assumptions were made: 1) there would be one bystander per. arrest; 2) the bystander would always perform CPR if trained; 3) cardiac arrest would be evenly distributed in the population; and 4) CPR training for a proportion of the population would proportionally increase CPR provision. Rates of arrest, bystanders by age, number of CPR trainees needed to result in increased arrest survival, and training cost per life saved for a one-year study period were calculated. There were 24.3 cardiac arrests per year, with 21.9 (90%) occurring in homes. In 66.5% of the home arrests, the bystander was more than 50 years old. To yield one additional survivor using the current CPR training strategy, 12,306 people needed to be trained (3,510 bystanders aged 50 years), which resulted in CPR provision to 7.14 additional patients. The training cost per life saved for a bystander aged 50 years was 785,040 dollars. Using a strategy of training only those cost of 53,383 dollars per life saved. Using these assumptions, current CPR training strategy is not a cost

  15. Crisis management during anaesthesia: cardiac arrest. (United States)

    Runciman, W B; Morris, R W; Watterson, L M; Williamson, J A; Paix, A D


    Cardiac arrest attributable to anaesthesia occurs at the rate of between 0.5 and 1 case per 10 000 cases, tends to have a different profile to that of cardiac arrest occurring elsewhere, and has an in-hospital mortality of 20%. However, as individual practitioners encounter cardiac arrest rarely, the rapidity with which the diagnosis is made and the consistency of appropriate management varies considerably. To examine the role of a previously described core algorithm "COVER ABCD-A SWIFT CHECK", supplemented by a sub-algorithm for cardiac arrest, in the management of cardiac arrest occurring in association with anaesthesia. The potential performance of this structured approach for each the relevant incidents among the first 4000 reported to the Australian Incident Monitoring Study (AIMS) was compared with the actual management as reported by the anaesthetists involved. There were 129 reports of cardiac arrest associated with anaesthesia among the first 4000 AIMS incident reports. Identified aetiological factors were grouped into five categories: (1) anaesthetic technique (11 cases with this category alone; 32 with this and one or more of the other categories, representing 25% of all 129 cardiac arrests); (2) drug related (16; 32, 25%); (3) associated with surgical procedure (9; 29, 22%); (4) associated with pre-existing medical or surgical disease (30; 82, 64%); (5) unknown (8; 14, 11%). The "real life" presentation and management of cardiac arrest in association with anaesthesia differs substantially from that detailed in general published guidelines. Cardiac rhythms at the time were sinus bradycardia (23%); asystole (22%); tachycardia/ventricular tachycardia/ventricular fibrillation (14%); and normal (7%), with a further third unknown. Details of treatment were recorded in 110 reports; modalities employed included cardiac compression (72%); adrenaline (61%); 100% oxygen (58%); atropine (38%); intravenous fluids (25%), and electrical defibrillation (17%). There

  16. Dental Calculus Arrest of Dental Caries


    Keyes, Paul H.; Rams, Thomas E.


    Background An inverse relationship between dental calculus mineralization and dental caries demineralization on teeth has been noted in some studies. Dental calculus may even form superficial layers over existing dental caries and arrest their progression, but this phenomenon has been only rarely documented and infrequently considered in the field of Cariology. To further assess the occurrence of dental calculus arrest of dental caries, this study evaluated a large number of extracted human t...

  17. Sex Disparities in Arrest Outcomes for Domestic Violence (United States)

    Hamilton, Melissa; Worthen, Meredith G. F.


    Domestic violence arrests have been historically focused on protecting women and children from abusive men. Arrest patterns continue to reflect this bias with more men arrested for domestic violence compared to women. Such potential gender variations in arrest patterns pave the way to the investigation of disparities by sex of the offender in…

  18. Cell cycle arrest in the jewel wasp Nasonia vitripennis in larval diapause. (United States)

    Shimizu, Yuta; Mukai, Ayumu; Goto, Shin G


    Insects enter diapause to synchronise their life cycle with biotic and abiotic environmental conditions favourable for their development, reproduction, and survival. One of the most noticeable characteristics of diapause is the blockage of ontogeny. Although this blockage should occur with the cessation of cellular proliferation, i.e. cell cycle arrest, it was confirmed only in a few insect species and information on the molecular pathways involved in cell cycle arrest is limited. In the present study, we investigated developmental and cell cycle arrest in diapause larvae of the jewel wasp Nasonia vitripennis. Developmental and cell cycle arrest occur in the early fourth instar larval stage of N. vitripennis under short days. By entering diapause, the S fraction of the cell cycle disappears and approximately 80% and 20% of cells arrest their cell cycle in the G0/G1 and G2 phases, respectively. We further investigated expression of cell cycle regulatory genes and some housekeeping genes to dissect molecular mechanisms underlying the cell cycle arrest. Copyright © 2016 Elsevier Ltd. All rights reserved.

  19. Arrested larval development in cattle nematodes. (United States)

    Armour, J; Duncan, M


    Most economically important cattle nematodes are able to arrest their larval development within the host - entering a period of dormancy or hypobiosis. Arrested larvae have a low death rate, and large numbers can accumulate in infected cattle during the grazing season. Because of this, outbreaks of disease caused by such nematodes can occur at times when recent infection with the parasites could not have occurred, for example during winter in temperature northern climates when cattle are normally housed. The capacity to arrest is a heritable trait. It is seen as an adaptation by the parasite to avoid further development to its free-living stages during times when the climate is unsuitable for free-living survival. But levels of arrestment can vary markedly in different regions, in different cattle, and under different management regimes. Climatic factors, previous conditioning, host immune status, and farm management all seem to affect arrestment levels. In this article, James Armour and Mary Duncan review the biological basis of the phenomenon, and discuss the apparently conflicting views on how it is controlled.

  20. Electroencephalography (EEG) for neurological prognostication after cardiac arrest and targeted temperature management; rationale and study design. (United States)

    Westhall, Erik; Rosén, Ingmar; Rossetti, Andrea O; van Rootselaar, Anne-Fleur; Kjaer, Troels Wesenberg; Horn, Janneke; Ullén, Susann; Friberg, Hans; Nielsen, Niklas; Cronberg, Tobias


    Electroencephalography (EEG) is widely used to assess neurological prognosis in patients who are comatose after cardiac arrest, but its value is limited by varying definitions of pathological patterns and by inter-rater variability. The American Clinical Neurophysiology Society (ACNS) has recently proposed a standardized EEG-terminology for critical care to address these limitations. In the TTM-trial, 399 post cardiac arrest patients who remained comatose after rewarming underwent a routine EEG. The presence of clinical seizures, use of sedatives and antiepileptic drugs during the EEG-registration were prospectively documented. A well-defined terminology for interpreting post cardiac arrest EEGs is critical for the use of EEG as a prognostic tool. The TTM-trial is registered at (NCT01020916).

  1. Location of cardiac arrest and impact of pre-arrest chronic disease and medication use on survival

    DEFF Research Database (Denmark)

    Granfeldt, Asger; Wissenberg, Mads; Hansen, Steen Møller


    location and a higher mortality can be explained by differences in chronic diseases and medication. METHODS: We identified 27,771 out-of-hospital cardiac arrest patients ≥18 years old from the Danish Cardiac Arrest Registry (2001-2012). Using National Registries, we identified pre-arrest chronic disease......INTRODUCTION: Cardiac arrest in a private location is associated with a higher mortality when compared to public location. Past studies have not accounted for pre-arrest factors such as chronic disease and medication. AIM: To investigate whether the association between cardiac arrest in a private...

  2. Cell cycle arrest induced by radiation

    International Nuclear Information System (INIS)

    Okaichi, Yasuo; Matsumoto, Hideki; Ohnishi, Takeo


    It is known that various chemical reactions, such as cell cycle arrest, DNA repair and cell killing, can occur within the cells when exposed to ionizing radiation and ultraviolet radiation. Thus protein dynamics involved in such chemical reactions has received considerable attention. In this article, cell cycle regulation is first discussed in terms of the G2/M-phase and the G1/S-phase. Then, radiation-induced cell cycle arrest is reviewed. Cell cycle regulation mechanism involved in the G2 arrest, which is well known to occur when exposed to radiation, has recently been investigated using yeasts. In addition, recent study has yielded a noticeable finding that the G1 arrest can occur with intracellular accumulation of p53 product following ionization radiation. p53 is also shown to play an extremely important role in both DNA repair and cell killing due to DNA damage. Studies on the role of genes in protein groups induced by radiation will hold promise for the elucidation of cell cycle mechanism. (N.K.) 57 refs

  3. Targeted temperature management at 33°C versus 36°C after cardiac arrest

    NARCIS (Netherlands)

    Nielsen, Niklas; Wetterslev, Jørn; Cronberg, Tobias; Erlinge, David; Gasche, Yvan; Hassager, Christian; Horn, Janneke; Hovdenes, Jan; Kjaergaard, Jesper; Kuiper, Michael; Pellis, Tommaso; Stammet, Pascal; Wanscher, Michael; Wise, Matt P.; Åneman, Anders; al-Subaie, Nawaf; Boesgaard, Søren; Bro-Jeppesen, John; Brunetti, Iole; Bugge, Jan Frederik; Hingston, Christopher D.; Juffermans, Nicole P.; Koopmans, Matty; Køber, Lars; Langørgen, Jørund; Lilja, Gisela; Møller, Jacob Eifer; Rundgren, Malin; Rylander, Christian; Smid, Ondrej; Werer, Christophe; Winkel, Per; Friberg, Hans; Pellis, Thomas; Køber, Lars V.; Annane, Djillali; Wernerman, Jan; Lange, Theis; Karlsson, Ulla-Britt; Jergle-Almqvist, Liz; Grevstad, Berit; Whitfield, Kate; Micallef, Sharon; Glass, Parisa; Myburgh, John; Saxena, Manoj; Stewart, Antony; Finfer, Simon; Bishop, Gillian; Rajbhandari, Dorrilyn


    Unconscious survivors of out-of-hospital cardiac arrest have a high risk of death or poor neurologic function. Therapeutic hypothermia is recommended by international guidelines, but the supporting evidence is limited, and the target temperature associated with the best outcome is unknown. Our

  4. Pleiotropic role of growth arrest-specific gene 6 in atherosclerosis

    NARCIS (Netherlands)

    Tjwa, Marc; Moons, Lieve; Lutgens, Esther


    Growth arrest-specific gene 6 (Gas6) belongs to the family of vitamin K-dependent coagulation proteins, but in contrast to its other members, has only a limited role in hemostasis. Instead, Gas6 plays a prominent role in conditions of injury, inflammation and repair. Gas6 amplifies the activation of

  5. 32 CFR 935.125 - Citation in place of arrest. (United States)


    ... 32 National Defense 6 2010-07-01 2010-07-01 false Citation in place of arrest. 935.125 Section 935... INSULAR REGULATIONS WAKE ISLAND CODE Peace Officers § 935.125 Citation in place of arrest. In any case in which a peace officer may make an arrest without a warrant, he may issue and serve a citation if he...

  6. Transient Central Diabetes Insipidus and Marked Hypernatremia following Cardiorespiratory Arrest

    Directory of Open Access Journals (Sweden)

    Sahar H. Koubar


    Full Text Available Central Diabetes Insipidus is often an overlooked complication of cardiopulmonary arrest and anoxic brain injury. We report a case of transient Central Diabetes Insipidus (CDI following cardiopulmonary arrest. It developed 4 days after the arrest resulting in polyuria and marked hypernatremia of 199 mM. The latter was exacerbated by replacing the hypotonic urine by isotonic saline.

  7. An Audit Of Perioperative Cardiac Arrest At Lagos University ...

    African Journals Online (AJOL)

    Objective: Intraoperative cardiac arrests are not uncommon and are related to both surgical and anaesthetic factors. This study aimed to examine the factors which predispose to a periopeartive cardiac arrest, to assess the appropriateness of therapy and the outcome. Materials and Methods: All perioperative cardiac arrests ...

  8. Abnormal mitosis triggers p53-dependent cell cycle arrest in human tetraploid cells. (United States)

    Kuffer, Christian; Kuznetsova, Anastasia Yurievna; Storchová, Zuzana


    Erroneously arising tetraploid mammalian cells are chromosomally instable and may facilitate cell transformation. An increasing body of evidence shows that the propagation of mammalian tetraploid cells is limited by a p53-dependent arrest. The trigger of this arrest has not been identified so far. Here we show by live cell imaging of tetraploid cells generated by an induced cytokinesis failure that most tetraploids arrest and die in a p53-dependent manner after the first tetraploid mitosis. Furthermore, we found that the main trigger is a mitotic defect, in particular, chromosome missegregation during bipolar mitosis or spindle multipolarity. Both a transient multipolar spindle followed by efficient clustering in anaphase as well as a multipolar spindle followed by multipolar mitosis inhibited subsequent proliferation to a similar degree. We found that the tetraploid cells did not accumulate double-strand breaks that could cause the cell cycle arrest after tetraploid mitosis. In contrast, tetraploid cells showed increased levels of oxidative DNA damage coinciding with the p53 activation. To further elucidate the pathways involved in the proliferation control of tetraploid cells, we knocked down specific kinases that had been previously linked to the cell cycle arrest and p53 phosphorylation. Our results suggest that the checkpoint kinase ATM phosphorylates p53 in tetraploid cells after abnormal mitosis and thus contributes to proliferation control of human aberrantly arising tetraploids.

  9. L1 arrest, daf-16/FoxO and nonautonomous control of post-embryonic development. (United States)

    Kaplan, Rebecca E W; Baugh, L Ryan


    Post-embryonic development is governed by nutrient availability. L1 arrest, dauer formation and aging illustrate how starvation, anticipation of starvation and caloric restriction have profound influence on C. elegans development, respectively. Insulin-like signaling through the Forkhead box O transcription factor daf-16/FoxO regulates each of these processes. We recently reported that ins-4, ins-6 and daf-28 promote L1 development from the intestine and chemosensory neurons, similar to their role in dauer development. daf-16 functions cell-nonautonomously in regulation of L1 arrest, dauer development and aging. Discrepancies in daf-16 sites of action have been reported in each context, but the consensus implicates epidermis, intestine and nervous system. We suggest technical limitations of the experimental approach responsible for discrepant results. Steroid hormone signaling through daf-12/NHR is known to function downstream of daf-16 in control of dauer development, but signaling pathways mediating cell-nonautonomous effects of daf-16 in aging and L1 arrest had not been identified. We recently showed that daf-16 promotes L1 arrest by inhibiting daf-12/NHR and dbl-1/TGF-β Sma/Mab signaling, two pathways that promote L1 development in fed larvae. We will review these results on L1 arrest and speculate on why there are so many signals and signaling centers regulating post-embryonic development.

  10. Archaeal RNA polymerase arrests transcription at DNA lesions. (United States)

    Gehring, Alexandra M; Santangelo, Thomas J


    Transcription elongation is not uniform and transcription is often hindered by protein-bound factors or DNA lesions that limit translocation and impair catalysis. Despite the high degree of sequence and structural homology of the multi-subunit RNA polymerases (RNAP), substantial differences in response to DNA lesions have been reported. Archaea encode only a single RNAP with striking structural conservation with eukaryotic RNAP II (Pol II). Here, we demonstrate that the archaeal RNAP from Thermococcus kodakarensis is sensitive to a variety of DNA lesions that pause and arrest RNAP at or adjacent to the site of DNA damage. DNA damage only halts elongation when present in the template strand, and the damage often results in RNAP arresting such that the lesion would be encapsulated with the transcription elongation complex. The strand-specific halt to archaeal transcription elongation on modified templates is supportive of RNAP recognizing DNA damage and potentially initiating DNA repair through a process akin to the well-described transcription-coupled DNA repair (TCR) pathways in Bacteria and Eukarya.

  11. Usefulness of emergency ultrasound in nontraumatic cardiac arrest. (United States)

    Volpicelli, Giovanni


    Treatment of nontraumatic cardiac arrest in the hospital setting depends on the recognition of heart rhythm and differential diagnosis of the underlying condition while maintaining a constant oxygenated blood flow by ventilation and chest compression. Diagnostic process relies only on patient's history, physical findings, and active electrocardiography. Ultrasound is not currently scheduled in the resuscitation guidelines. Nevertheless, the use of real-time ultrasonography during resuscitation has the potential to improve diagnostic accuracy and allows the physician a greater confidence in deciding aggressive life-saving therapeutic procedures. This article reviews the current opinions and literature about the use of emergency ultrasound during resuscitation of nontraumatic cardiac arrest. Cardiac and lung ultrasound have a great potential in identifying the reversible mechanical causes of pulseless electrical activity or asystole. Brief examination of the heart can even detect a real cardiac standstill regardless of electrical activity displayed on the monitor, which is a crucial prognostic indicator. Moreover, ultrasound can be useful to verify and monitor the tracheal tube placement. Limitation to the use of ultrasound is the need to minimize the no-flow intervals during mechanical cardiopulmonary resuscitation. However, real-time ultrasound can be successfully applied during brief pausing of chest compression and first pulse-check. Finally, lung sonographic examination targeted to the detection of signs of pulmonary congestion has the potential to allow hemodynamic noninvasive monitoring before and after mechanical cardiopulmonary maneuvers. Copyright © 2011 Elsevier Inc. All rights reserved.

  12. Non-equilibrium theory of arrested spinodal decomposition

    Energy Technology Data Exchange (ETDEWEB)

    Olais-Govea, José Manuel; López-Flores, Leticia; Medina-Noyola, Magdaleno [Instituto de Física “Manuel Sandoval Vallarta,” Universidad Autónoma de San Luis Potosí, Álvaro Obregón 64, 78000 San Luis Potosí, SLP (Mexico)


    The non-equilibrium self-consistent generalized Langevin equation theory of irreversible relaxation [P. E. Ramŕez-González and M. Medina-Noyola, Phys. Rev. E 82, 061503 (2010); 82, 061504 (2010)] is applied to the description of the non-equilibrium processes involved in the spinodal decomposition of suddenly and deeply quenched simple liquids. For model liquids with hard-sphere plus attractive (Yukawa or square well) pair potential, the theory predicts that the spinodal curve, besides being the threshold of the thermodynamic stability of homogeneous states, is also the borderline between the regions of ergodic and non-ergodic homogeneous states. It also predicts that the high-density liquid-glass transition line, whose high-temperature limit corresponds to the well-known hard-sphere glass transition, at lower temperature intersects the spinodal curve and continues inside the spinodal region as a glass-glass transition line. Within the region bounded from below by this low-temperature glass-glass transition and from above by the spinodal dynamic arrest line, we can recognize two distinct domains with qualitatively different temperature dependence of various physical properties. We interpret these two domains as corresponding to full gas-liquid phase separation conditions and to the formation of physical gels by arrested spinodal decomposition. The resulting theoretical scenario is consistent with the corresponding experimental observations in a specific colloidal model system.

  13. Out-of-hospital cardiac arrest

    DEFF Research Database (Denmark)

    Sondergaard, Kathrine B; Hansen, Steen Moller; Pallisgaard, Jannik L


    AIMS: 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. METHODS......: 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...... in public locations, the probability of bystander defibrillation at 0, 100 and 200meters 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...

  14. HSST crack-arrest studies overview

    International Nuclear Information System (INIS)

    Pugh, C.E.; Whitman, G.D.


    An overview is given of the efforts underway in the Heavy-Section Steel Technology (HSST) Program to better understand and model crack-arrest behavior in reactor pressure vessel steels. The efforts are both experimental and analytical. The experimental work provides K/sub Ia/ data from laboratory-sized specimens, from thick-wall cylinders which exhibit essentially-full restraint and from nonisothermal wide-plate specimens. These data serve to define toughness-temperature trends and to provide validation data under prototypical reactor conditions. The analytical efforts interpret and correlate the data, plus provide LEFM, elastodynamic and viscoplastic methods for analyzing crack run-arrest behavior in reactor vessels. The analysis methods are incorporated into finite element computer programs which are under development at three separate laboratories. 22 refs., 10 figs

  15. Decree of the State Office of Nuclear Safety No. 324/1999 of 6 December 1999 laying down limits of nuclear material concentrations and amounts that are exempt from nuclear liability provisions

    International Nuclear Information System (INIS)


    The limits are laid down for concentrations and amounts of nuclear material which, during the transport or use beyond a nuclear facility, is exempt from nuclear liability owing to the low extent of risk associated with it. The Annex lays down the following specifications: (1) Concentration limits for all radionuclides in terms of activity limits. (1a) The total activity of nuclear material containing one or more radionuclides in the same group shall not exceed the following limits (group, radionuclide in group with A 2 value, activity limit): 1, ≤ 370 MBq, 74 GBq; 2, > 370 MBq and ≤ 37 GBq, 740 GBq; 3, > 37 Bq and ≤ 3.7 TBq, 7.4 TBq; 4, >3.7 TBq and ≤ 37 TBq, 185 TBq; and 5, > 37 TBq, 1.85 PBq. (1b) Unidentified radionuclides are regarded as group 1. (1c) The total activity of radionuclides which are not special form radionuclide emitters shall not exceed 18.5 TBq. (1d) If the nuclear material involves special form radionuclide emitters and radionuclides other than special form radionuclide emitters or such radionuclides in different groups, irrespective of whether contained in separate packages or in a common package, the sum of quotients obtained by dividing the activity of each of the radionuclides by the corresponding limit shall not exceed 1. If the individual activities are unknown, the lowest of the above limits shall be applied to any of the radionuclides. (2) Limits for special fission materials and Pu 241. (2a) For nuclear material containing a single radionuclide (radionuclide, limit in grams): Pu 239, 375; Pu 241, 375; U 233, 375; U 235, 600. (2b) For nuclear material containing more than one radionuclide, the weight limit is determined by the sum of quotients obtained by dividing the weight of each of the radionuclides by the corresponding limit as given above. The sum of quotients shall not exceed 1. (P.A.)

  16. Dental Calculus Arrest of Dental Caries. (United States)

    Keyes, Paul H; Rams, Thomas E

    An inverse relationship between dental calculus mineralization and dental caries demineralization on teeth has been noted in some studies. Dental calculus may even form superficial layers over existing dental caries and arrest their progression, but this phenomenon has been only rarely documented and infrequently considered in the field of Cariology. To further assess the occurrence of dental calculus arrest of dental caries, this study evaluated a large number of extracted human teeth for the presence and location of dental caries, dental calculus, and dental plaque biofilms. A total of 1,200 teeth were preserved in 10% buffered formal saline, and viewed while moist by a single experienced examiner using a research stereomicroscope at 15-25× magnification. Representative teeth were sectioned and photographed, and their dental plaque biofilms subjected to gram-stain examination with light microscopy at 100× magnification. Dental calculus was observed on 1,140 (95%) of the extracted human teeth, and no dental carious lesions were found underlying dental calculus-covered surfaces on 1,139 of these teeth. However, dental calculus arrest of dental caries was found on one (0.54%) of 187 evaluated teeth that presented with unrestored proximal enamel caries. On the distal surface of a maxillary premolar tooth, dental calculus mineralization filled the outer surface cavitation of an incipient dental caries lesion. The dental calculus-covered carious lesion extended only slightly into enamel, and exhibited a brown pigmentation characteristic of inactive or arrested dental caries. In contrast, the tooth's mesial surface, without a superficial layer of dental calculus, had a large carious lesion going through enamel and deep into dentin. These observations further document the potential protective effects of dental calculus mineralization against dental caries.

  17. Dental Calculus Arrest of Dental Caries (United States)

    Keyes, Paul H.; Rams, Thomas E.


    Background An inverse relationship between dental calculus mineralization and dental caries demineralization on teeth has been noted in some studies. Dental calculus may even form superficial layers over existing dental caries and arrest their progression, but this phenomenon has been only rarely documented and infrequently considered in the field of Cariology. To further assess the occurrence of dental calculus arrest of dental caries, this study evaluated a large number of extracted human teeth for the presence and location of dental caries, dental calculus, and dental plaque biofilms. Materials and methods A total of 1,200 teeth were preserved in 10% buffered formal saline, and viewed while moist by a single experienced examiner using a research stereomicroscope at 15-25× magnification. Representative teeth were sectioned and photographed, and their dental plaque biofilms subjected to gram-stain examination with light microscopy at 100× magnification. Results Dental calculus was observed on 1,140 (95%) of the extracted human teeth, and no dental carious lesions were found underlying dental calculus-covered surfaces on 1,139 of these teeth. However, dental calculus arrest of dental caries was found on one (0.54%) of 187 evaluated teeth that presented with unrestored proximal enamel caries. On the distal surface of a maxillary premolar tooth, dental calculus mineralization filled the outer surface cavitation of an incipient dental caries lesion. The dental calculus-covered carious lesion extended only slightly into enamel, and exhibited a brown pigmentation characteristic of inactive or arrested dental caries. In contrast, the tooth's mesial surface, without a superficial layer of dental calculus, had a large carious lesion going through enamel and deep into dentin. Conclusions These observations further document the potential protective effects of dental calculus mineralization against dental caries. PMID:27446993

  18. 29 CFR 1926.900 - General provisions. (United States)


    ... conduct blasting operations shall use every reasonable precaution including, but not limited to, visual... alternative provisions may be made which are adequately designed to prevent any premature firing of electric...) Blasting operations in the proximity of overhead power lines, communication lines, utility services, or...

  19. Advance Provision of Emergency Contraception for Adolescents (United States)

    Adamji, Jehan-Marie; Swartwout, Kathryn


    Emergency contraception is most effective at preventing unintended pregnancy when taken as early as possible following unprotected sexual intercourse. Advance provision of this medication supports more timely and effective use. In the midst of rising teen pregnancy rates, current policies often limit access to emergency contraception for…

  20. An ex vivo study of arrested primary teeth caries with silver diamine fluoride therapy. (United States)

    Mei, May L; Ito, L; Cao, Y; Lo, Edward C M; Li, Q L; Chu, C H


    This ex vivo study compared the physico-chemical structural differences between primary carious teeth biannually treated with silver diamine fluoride (SDF) and carious teeth without such treatment. Twelve carious primary upper-central incisors were collected from 6-year-old children. Six teeth had arrested caries after 24-month biannual SDF applications and 6 had active caries when there was no topical fluoride treatment. The mineral density, elemental contents, surface morphology, and crystal characteristics were assessed by micro-computed tomography (micro-CT), energy-dispersive X-ray spectrometry (EDX), scanning electron microscopy (SEM), and transmission electron microscopy (TEM). Micro-CT examination revealed a superficial opaque band approximately 150μm on the arrested cavitated dentinal lesion. This band was limited in the active carious lesion. EDX examination detected a higher intensity of calcium and phosphate of 150μm in the surface zone than in the inner zone, but this zone was restricted in the active cavitated dentinal lesion. SEM examination indicated that the collagens were protected from being exposed in the arrested cavitated dentinal lesion, but were exposed in the active cavitated dentinal lesion. TEM examination suggested that remineralised hydroxyapatites were well aligned in the arrested cavitated dentinal lesion, while those in the active cavitated dentinal lesion indicated a random apatite arrangement. A highly remineralised zone rich in calcium and phosphate was found on the arrested cavitated dentinal lesion of primary teeth with an SDF application. The collagens were protected from being exposed in the arrested cavitated dentinal lesion. Clinical SDF application positively influences dentine remineralisation. Copyright © 2013 The Authors. Published by Elsevier Ltd.. All rights reserved.

  1. Distinct mechanisms act in concert to mediate cell cycle arrest. (United States)

    Toettcher, Jared E; Loewer, Alexander; Ostheimer, Gerard J; Yaffe, Michael B; Tidor, Bruce; Lahav, Galit


    In response to DNA damage, cells arrest at specific stages in the cell cycle. This arrest must fulfill at least 3 requirements: it must be activated promptly; it must be sustained as long as damage is present to prevent loss of genomic information; and after the arrest, cells must re-enter into the appropriate cell cycle phase to ensure proper ploidy. Multiple molecular mechanisms capable of arresting the cell cycle have been identified in mammalian cells; however, it is unknown whether each mechanism meets all 3 requirements or whether they act together to confer specific functions to the arrest. To address this question, we integrated mathematical models describing the cell cycle and the DNA damage signaling networks and tested the contributions of each mechanism to cell cycle arrest and re-entry. Predictions from this model were then tested with quantitative experiments to identify the combined action of arrest mechanisms in irradiated cells. We find that different arrest mechanisms serve indispensable roles in the proper cellular response to DNA damage over time: p53-independent cyclin inactivation confers immediate arrest, whereas p53-dependent cyclin downregulation allows this arrest to be sustained. Additionally, p21-mediated inhibition of cyclin-dependent kinase activity is indispensable for preventing improper cell cycle re-entry and endoreduplication. This work shows that in a complex signaling network, seemingly redundant mechanisms, acting in a concerted fashion, can achieve a specific cellular outcome.

  2. Cellular Senescence in Postmitotic Cells: Beyond Growth Arrest. (United States)

    Sapieha, Przemyslaw; Mallette, Frédérick A


    In mitotic cells, cellular senescence is a permanent state of G1 arrest, that may have evolved in parallel to apoptosis, to limit proliferation of damaged cells and oncogenesis. Recent studies have suggested that postmitotic cells are also capable of entering a state of senescence, although the repercussions of postmitotic cellular senescence (PoMiCS) on tissue health and function are currently ill-defined. In tissues made largely of post-mitotic cells, it is evolutionary advantageous to preserve cellular integrity and cellular senescence of post-mitotic cells may prevent stressor-induced tissue degeneration and promote tissue repair. Paradoxically, PoMiCS may also contribute to disease progression through the generation of inflammatory mediators, termed the senescence-associated secretory phenotype. Here, we discuss the potential roles of PoMiCS and propose to enlarge the current definition of cellular senescence to postmitotic terminally differentiated cells. Copyright © 2018 Elsevier Ltd. All rights reserved.

  3. Comparison of ANSI, IEC and CSA standards durability requirements on station-type metal oxide surge arresters for EHV power systems

    International Nuclear Information System (INIS)

    Hamel, A.; St-Jean, G.


    This paper presents an analysis of stresses applied to two actual types of station class surge arresters of the same voltage rating when tested for durability as prescribed by American (ANSI) International (IEC) and Canadian (CSA) standards for 315 kV and 734 kV power systems. The analysis which is made with an experimentally validated arrester model, reveals that the IEC duty cycle test is the most severe of all. In fact it can bring the varistors of an actual station-type arrester to a peak temperature of 129 degrees C, which leaves a margin of only 46 degrees C to its thermal stability limit at maximum continuous operating voltage (MCOV). Another actual arrester using lesser V-I-T varistor characteristics but larger varistor volume and better heat transfer from inside to outside the arrester, produces 103 degrees C which corresponds to a slightly better temperature margin of 49 degrees C. It is observed that even when using the lower performance V-I-T characteristics of the latter arrester, a thin-wall arrester housing design can improve heat transfer to a point where the margin improves to 101 degrees C on a hypothetical arrester

  4. A case of thyroid storm with cardiac arrest

    Directory of Open Access Journals (Sweden)

    Nakashima Y


    Full Text Available Yutaka Nakashima,1 Tsuneaki Kenzaka,2 Masanobu Okayama,3 Eiji Kajii31Department for Support of Rural Medicine, Yamaguchi Grand Medical Center, 2Division of General Medicine, Center for Community Medicine, Jichi Medical University School of Medicine, Shimotsuke, Japan; 3Division of Community and Family Medicine, Center for Community Medicine, Jichi Medical University School of Medicine, Shimotsuke, JapanAbstract: A 23-year-old man became unconscious while jogging. He immediately received basic life support from a bystander and was transported to our hospital. On arrival, his spontaneous circulation had returned from a state of ventricular fibrillation and pulseless electrical activity. Following admission, hyperthyroidism led to a suspicion of thyroid storm, which was then diagnosed as a possible cause of the cardiac arrest. Although hyperthyroidism-induced cardiac arrest including ventricular fibrillation is rare, it should be considered when diagnosing the cause of treatable cardiac arrest.Keywords: hyperthyroidism, ventricular fibrillation, treatable cardiac arrest, cardiac arrest, cardiopulmonary arrest

  5. Crack arrest concepts for failure prevention and life extension. Proceedings

    International Nuclear Information System (INIS)

    Wiesner, C.S.


    These proceedings contain the thirteen papers presented at a seminar on crack arrest concepts for failure prevention and life extension. They provide a picture of the current position of crack arrest testing, models and applications, discussion of the relevance of recent research to industrial problems, and an assessment of whether the application of crack arrest models provides additional safety. Separate abstracts have been prepared for seven papers of relevance to the nuclear industry and, in particular, reactor pressure vessels. (UK)

  6. European experiences of the proposed ASTM test method for crack arrest toughness of ferritic materials

    International Nuclear Information System (INIS)

    Jutla, T.; Lidbury, D.P.G.; Ziebs, J.; Zimmermann, C.


    The proposed ASTM test method for measuring the crack arrest toughness of ferritic materials using wedge-loaded, side-grooved, compact specimens was applied to three steels: A514 bridge steel, A588 bridge steel, and A533B pressure vessel steel. Five sets of results from different laboratories are discussed here. Notches were prepared by spark erosion, although root radii varied from ∝0.1-1.5 mm. Although fast fractures were successfully initiated, arrest did not occur in a significant number of cases. The results showed no obvious dependence of crack arrest toughness, K a , (determined by a static analysis) on crack initiation toughness, K 0 . It was found that K a decreases markedly with increasing crack jump distance. A limited amount of further work on smaller specimens of the A533B steel showed that lower K a values tended to be recorded. It is concluded that a number of points relating to the proposed test method and notch preparation are worthy of further consideration. It is pointed out that the proposed validity criteria may screen out lower bound data. Nevertheless, for present practical purposes, K a values may be regarded as useful in providing an estimate of arrest toughness - although not necessarily a conservative estimate. (orig./HP)

  7. F-MARC: promoting the prevention and management of sudden cardiac arrest in football. (United States)

    Kramer, Efraim Benjamin; Dvorak, J; Schmied, C; Meyer, T


    Sudden cardiac death is the most common cause of unnatural death in football. To prevent and urgently manage sudden cardiac arrest on the football field-of-play, F-MARC (FIFA Medical and Research Centre) has been fully committed to a programme of research, education, standardisation and practical implementation. This strategy has detected football players at medical risk during mandatory precompetition medical assessments. Additionally, FIFA has (1) sponsored internationally accepted guidelines for the interpretation of an athlete's ECG, (2) developed field-of-play-specific protocols for the recognition, response, resuscitation and removal of a football player having sudden cardiac arrest and (3) introduced and distributed the FIFA medical emergency bag which has already resulted in the successful resuscitation of a football player who had a sudden cardiac arrest on the field-of-play. Recently FIFA, in association with the Institute of Sports and Preventive Medicine in Saarbrücken, Germany, established a worldwide Sudden Death Registry with a view to documenting fatal events on the football field-of-play. These activities by F-MARC are testimony to FIFA's continued commitment to minimising sudden cardiac arrest while playing football. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to

  8. Mechanical Entrapment Is Insufficient and Intercellular Adhesion Is Essential for Metastatic Cell Arrest in Distant Organs

    Directory of Open Access Journals (Sweden)

    Olga V. Glinskii


    Full Text Available In this report, we challenge a common perception that tumor embolism is a size-limited event of mechanical arrest, occurring in the first capillary bed encountered by blood-borne metastatic cells. We tested the hypothesis that mechanical entrapment alone, in the absence of tumor cell adhesion to blood vessel walls, is not sufficient for metastatic cell arrest in target organ microvasculature. The in vivo metastatic deposit formation assay was used to assess the number and location of fluorescently labeled tumor cells lodged in selected organs and tissues following intravenous inoculation. We report that a significant fraction of breast and prostate cancer cells escapes arrest in a lung capillary bed and lodges successfully in other organs and tissues. Monoclonal antibodies and carbohydrate-based compounds (anti-Thomsen-Friedenreich antigen antibody, anti-galectin-3 antibody, modified citrus pectin, and lactulosyl-L-leucine, targeting specifically β-galactoside-mediated tumor-endothelial cell adhesive interactions, inhibited by >90% the in vivo formation of breast and prostate carcinoma metastatic deposits in mouse lung and bones. Our results indicate that metastatic cell arrest in target organ microvessels is not a consequence of mechanical trapping, but is supported predominantly by intercellular adhesive interactions mediated by cancer-associated Thomsen-Friedenreich glycoantigen and β-galactoside-binding lectin galectin-3. Efficient blocking of β-galactoside-mediated adhesion precludes malignant cell lodging in target organs.

  9. Withholding or termination of resuscitation in pediatric out-of-hospital traumatic cardiopulmonary arrest. (United States)

    Fallat, Mary E


    This multiorganizational literature review was undertaken to provide an evidence base for determining whether or not recommendations for out-of-hospital termination of resuscitation could be made for children who are victims of traumatic cardiopulmonary arrest. Although there is increasing acceptance of out-of-hospital termination of resuscitation for adult traumatic cardiopulmonary arrest when there is no expectation of a good outcome, children are routinely excluded from state termination-of-resuscitation protocols. The decision to withhold resuscitative efforts in a child under specific circumstances (decapitation or dependent lividity, rigor mortis, etc) is reasonable. If there is any doubt as to the circumstances or timing of the traumatic cardiopulmonary arrest, under the current status of limiting termination of resuscitation in the field to persons older than 18 years in most states, resuscitation should be initiated and continued until arrival to the appropriate facility. If the patient has arrested, resuscitation has already exceeded 30 minutes, and the nearest facility is more than 30 minutes away, involvement of parents and family of these children in the decision-making process with assistance and guidance from medical professionals should be considered as part of an emphasis on family-centered care, because the evidence suggests that either death or a poor outcome is inevitable.

  10. Pathological links between stroke and cardiac arrest

    Institute of Scientific and Technical Information of China (English)

    Shaila Ghanekar; Sydney Corey; Trenton Lippert; Cesar V.Borlongan


    There may be a pathological connection between cardiac failure and ischemic stroke.In this article we describe pertinent research that demonstrates subsequent death of cardiac and neural myocytes in the post ischemic stroke brain.Current stroke therapy overlooks the connection between cardiac and cerebrovascular events and fails to address the shared risk factors.Current pre-clinical stroke investigations have provided evidence that suggests the presence of an indirect cell death pathway in which toxic molecules emanate from the stroke brain and trigger cardiac cell death.On the other hand,other studies highlight the presence of a reverse cell death cascade in which toxic molecules from the heart,following cardiac arrest,travel to the brain and induce ischemic cell death.Further examination of these putative cell death pathways between ischemic stroke and cardiac arrest will prompt the advancement of innovative treatments specifically targeting both diseases,leading to ameliorated clinical results of patients diagnosed with heart failure and ischemic stroke.

  11. Cerebral intolerance during flow arrested carotid angioplasty. (United States)

    St Louis, Myron; Park, Brian D; Dahn, Michael; Bozeman, Patricia


    The use of flow arrest as a means of providing cerebral protection during carotid angioplasty offers the advantages of improved efficiency of debris removal and the ability to provide protection under unfavorable (tortuous) anatomic circumstances. However, in contrast to the filtration methods of cerebral protection, this modality requires complete interruption of antegrade carotid artery flow during balloon angioplasty and stent deployment. We report our experience with 9 patients undergoing carotid angioplasty with the Mo.Ma device, which utilizes common and external carotid artery balloon occlusion during the angioplasty procedure. We assessed the clinical outcomes and intraprocedural hemodynamic data. The average duration of carotid occlusion was 8.3 minutes. Of the 9 patients, 2 patients (22%) experienced cerebral intolerance. No stroke occurred in this patient cohort. There appeared to be a poor relationship between procedure intolerance and the presence of significant contralateral stenosis or low carotid back pressure. Furthermore, the incidence of postangioplasty hypotension was not clearly related to cerebral intolerance. Carotid angioplasty with stenting can be safely conducted with flow arrest as an alternative to filter-type cerebral protection devices. However, because cerebral intolerance is not an infrequent occurrence with this approach, clinicians must be cognizant of management strategies for transient cerebral intolerance.

  12. Association of National Initiatives to Improve Cardiac Arrest Management With Rates of Bystander Intervention and Patient Survival After Out-of-Hospital Cardiac Arrest

    DEFF Research Database (Denmark)

    Wissenberg, Mads; Lippert, Freddy K; Folke, Fredrik


    resuscitation was attempted were identified between 2001 and 2010 in the nationwide Danish Cardiac Arrest Registry. Of 29 111 patients with cardiac arrest, we excluded those with presumed noncardiac cause of arrest (n = 7390) and those with cardiac arrests witnessed by emergency medical services personnel (n...

  13. Performance of Surge Arrester Installation to Enhance Protection

    Directory of Open Access Journals (Sweden)

    Mbunwe Muncho Josephine


    Full Text Available The effects of abnormal voltages on power system equipment and appliances in the home have raise concern as most of the equipments are very expensive. Each piece of electrical equipment in an electrical system needs to be protected from surges. To prevent damage to electrical equipment, surge protection considerations are paramount to a well designed electrical system. Lightning discharges are able to damage electric and electronic devices that usually have a low protection level and these are influenced by current or voltage pulses with a relatively low energy, which are induced by lightning currents. This calls for proper designed and configuration of surge arresters for protection on the particular appliances. A more efficient non-linear surge arrester, metal oxide varistor (MOV, should be introduced to handle these surges. This paper shows the selection of arresters laying more emphasis on the arresters for residential areas. In addition, application and installation of the arrester will be determined by the selected arrester. This paper selects the lowest rated surge arrester as it provides insulation when the system is under stress. It also selected station class and distribution class of arresters as they act as an open circuit under normal system operation and to bring the system back to its normal operation mode as the transient voltage is suppressed. Thus, reduces the risk of damage, which the protection measures can be characterized, by the reduction value of the economic loss to an acceptable level.

  14. Cardiac arrest during anesthesia at a University Hospital in Nigeria ...

    African Journals Online (AJOL)

    Background: We assessed the incidence and outcomes of cardiac arrest during anesthesia in the operating room at our university hospital. A previous study on intraoperative cardiac arrests covered a period from 1994-1998 and since then; anesthetic personnel, equipment, and workload have increased remarkably.

  15. Efficacy of silver diamine fluoride for Arresting Caries Treatment.

    NARCIS (Netherlands)

    Yee, R.T.F.; Holmgren, C.J.; Mulder, J.; Lama, D.; Walker, D.; Palenstein Helderman, W.H. van


    Arresting Caries Treatment (ACT) has been proposed to manage untreated dental caries in children. This prospective randomized clinical trial investigated the caries-arresting effectiveness of a single spot application of: (1) 38% silver diamine fluoride (SDF) with tannic acid as a reducing agent;

  16. Cooling the crisis: Therapeutic hypothermia after sickle cardiac arrest

    NARCIS (Netherlands)

    Metske, Hennie A.; Postema, Pieter G.; Biemond, Bart J.; Bouman, Catherine S. C.


    Objective: The management of patients with sickle-cell disease and cardiac arrest presents special challenges. Mild therapeutic hypothermia may improve survival and neurologic outcome after cardiac arrest, however, it may also precipitate sickling in patients with sickle-cell disease. Rigorous

  17. 29 CFR 1915.159 - Personal fall arrest systems (PFAS). (United States)


    ... 29 Labor 7 2010-07-01 2010-07-01 false Personal fall arrest systems (PFAS). 1915.159 Section 1915... Protective Equipment (PPE) § 1915.159 Personal fall arrest systems (PFAS). The criteria of this section apply to PFAS and their use. Effective January 1, 1998, body belts and non-locking snaphooks are not...

  18. Outcomes after out-of-hospital cardiac arrest treated by basic vs advanced life support. (United States)

    Sanghavi, Prachi; Jena, Anupam B; Newhouse, Joseph P; Zaslavsky, Alan M


    Most out-of-hospital cardiac arrests receiving emergency medical services in the United States are treated by ambulance service providers trained in advanced life support (ALS), but supporting evidence for the use of ALS over basic life support (BLS) is limited. To compare the effects of BLS and ALS on outcomes after out-of-hospital cardiac arrest. Observational cohort study of a nationally representative sample of traditional Medicare beneficiaries from nonrural counties who experienced out-of-hospital cardiac arrest between January 1, 2009, and October 2, 2011, and for whom ALS or BLS ambulance services were billed to Medicare (31,292 ALS cases and 1643 BLS cases). Propensity score methods were used to compare the effects of ALS and BLS on patient survival, neurological performance, and medical spending after cardiac arrest. Survival to hospital discharge, to 30 days, and to 90 days; neurological performance; and incremental medical spending per additional survivor to 1 year. Survival to hospital discharge was greater among patients receiving BLS (13.1% vs 9.2% for ALS; 4.0 [95% CI, 2.3-5.7] percentage point difference), as was survival to 90 days (8.0% vs 5.4% for ALS; 2.6 [95% CI, 1.2-4.0] percentage point difference). Basic life support was associated with better neurological functioning among hospitalized patients (21.8% vs 44.8% with poor neurological functioning for ALS; 23.0 [95% CI, 18.6-27.4] percentage point difference). Incremental medical spending per additional survivor to 1 year for BLS relative to ALS was $154,333. Patients with out-of-hospital cardiac arrest who received BLS had higher survival at hospital discharge and at 90 days compared with those who received ALS and were less likely to experience poor neurological functioning.

  19. Identifying Important Gaps in Randomized Controlled Trials of Adult Cardiac Arrest Treatments: A Systematic Review of the Published Literature (United States)

    Sinha, Shashank S.; Sukul, Devraj; Lazarus, John J.; Polavarapu, Vivek; Chan, Paul S.; Neumar, Robert W.; Nallamothu, Brahmajee K.


    Background Cardiac arrests are a major public health concern worldwide. The extent and types of randomized controlled trials (RCTs) – our most reliable source of clinical evidence – conducted in these high-risk patients over recent years are largely unknown. Methods and Results We performed a systematic review, identifying all RCTs published in PubMed, EMBASE, Scopus, Web of Science, and the Cochrane Library from 1995 to 2014 that focused on acute treatment of non-traumatic cardiac arrest in adults. We then extracted data on the setting of study populations, types and timing of interventions studied, risk of bias, outcomes reported and how these factors have changed over time. Over this twenty-year period, 92 RCTs were published containing 64,309 patients (median, 225.5 per trial). Of these, 81 RCTs (88.0%) involved out-of-hospital cardiac arrest whereas 4 (4.3%) involved in-hospital cardiac arrest and 7 (7.6%) included both. Eighteen RCTs (19.6%) were performed in the U.S., 68 (73.9%) were performed outside the U.S., and 6 (6.5%) were performed in both settings. Thirty-eight RCTs (41.3%) evaluated drug therapy, 39 (42.4%) evaluated device therapy, and 15 (16.3%) evaluated protocol improvements. Seventy-four RCTs (80.4%) examined interventions during the cardiac arrest, 15 (16.3%) examined post-cardiac arrest treatment, and 3 (3.3%) studied both. Overall, reporting of risk of bias was limited. The most common outcome reported was ROSC: 86 (93.5%) with only 22 (23.9%) reporting survival beyond 6 months. Fifty-three RCTs (57.6%) reported global ordinal outcomes whereas 15 (16.3%) reported quality-of-life. RCTs in the last 5 years were more likely to be focused on protocol improvement and post-cardiac arrest care. Conclusions Important gaps in RCTs of cardiac arrest treatments exist, especially those examining in-hospital cardiac arrest, protocol improvement, post-cardiac arrest care, and long-term or quality-of-life outcomes. PMID:27756794

  20. [Cardiac arrest in spectators in German football stadiums. Precautionary measures, frequency and short-term outcome]. (United States)

    Luiz, T; Preisegger, T; Rombach, D; Madler, C


    Provision of medical care is an important element of safety precautions for visitors of sports arenas. The organizational requirements are especially high if cardiac arrest occurs; how this scenario is managed may thus serve as the ultimate indicator of the quality of stadium medical care. The objectives of this study were to analyze the structures and the resources available for the medical care of spectators in German professional soccer stadiums and to identify the frequency and the primary resuscitation success of cardiac arrest. In 2011 a questionnaire-based survey was performed among the clubs of the first and second German soccer leagues regarding medical care of spectators during the seasons 2008/2009 and 2009/2010. The focus was on the qualifications of emergency teams, the equipment and the incidence of cardiac arrest. A total of 15 stadiums were included (38%) in the survey. The mean number of physicians and emergency medical technicians on site was 0.6/10,000 seats and 16/10,000 seats, respectively. Of the latter, a mean of 82% (minimum 20% and maximum 100%) had received training with automatic external defibrillators. In 87% of the stadiums regular advanced life support training (ALS) was required. The mean number of defibrillators per stadium was 2.8/10,000 seats (minimum 1.3 and maximum 3.8) including 1.7 automatic defibrillators (minimum 0.4 and maximum 2.8). For patient transport, a mean of 0.65 ALS ambulance vehicles per 10,000 seats (minimum 0.14 and maximum 1.46) were available on site. In all stadiums staff members were connected via mobile radio communication with the stadium medical control room. A total of 52 cardiac arrests (=0.25/100,000 spectators) were recorded of which 96% of the patients were transported to hospitals with spontaneous circulation. Cardiac arrests are not a rare occurrence in German soccer stadiums. The participating stadiums are overall well prepared for such incidents in terms of organization, staff and technology and

  1. 50 CFR 660.320 - Open access fishery-crossover provisions. (United States)


    ... 50 Wildlife and Fisheries 9 2010-10-01 2010-10-01 false Open access fishery-crossover provisions... West Coast Groundfish-Open Access Fisheries § 660.320 Open access fishery—crossover provisions. (a) Operating in both limited entry and open access fisheries. See provisions at § 660.60, subpart C. (b...

  2. 7 CFR 457.154 - Processing sweet corn crop insurance provisions. (United States)


    ... policies: Processing Sweet Corn Crop Provisions If a conflict exists among the policy provisions, the order.... Processor. Any business enterprise regularly engaged in canning or freezing processing sweet corn for human... disease control measures or as otherwise limited by the Special Provisions; (5) Wildlife; (6) Earthquake...

  3. Maturation arrest of human oocytes at germinal vesicle stage

    Directory of Open Access Journals (Sweden)

    Zhi Qin Chen


    Full Text Available Maturation arrest of human oocytes may occur at various stages of the cell cycle. A total failure of human oocytes to complete meiosis is rarely observed during assisted conception cycles. We describe here a case of infertile couples for whom all oocytes repeatedly failed to mature at germinal vesicle (GV stage during in vitro fertilization/Intra cytoplasmic sperm injection (IVF/ICSI. The patient underwent controlled ovarian stimulation followed by oocyte retrieval and IVF/ICSI. The oocytes were stripped off cumulus cells prior to the ICSI procedure and their maturity status was defined. The oocyte maturation was repeatedly arrested at the GV. Oocyte maturation arrest may be the cause of infertility in this couple. The recognition of oocyte maturation arrest as a specific medical condition may contribute to the characterization of the currently known as "oocyte factor." The cellular and genetic mechanisms causing oocyte maturation arrest should be the subject for further investigation.

  4. Growth arrest specific protein (GAS) 6

    DEFF Research Database (Denmark)

    Haase, T N; Rasmussen, Morten; Jaksch, C A M


    using RNA microarray and quantitative PCR. The role of a differentially expressed gene, growth arrest specific protein 6 (GAS6), was evaluated in vitro using neonatal rat islets. Results The mRNA level of Gas6, known to be mitogenic in other tissues, was reduced in LP offspring. The mRNA content of Mafa...... was increased in LP offspring suggesting an early maturation of beta cells. When applied in vitro, GAS6 increased proliferation of neonatal pancreatic beta cells, while reducing glucose-stimulated insulin secretion without changing the total insulin content of the islets. In addition, GAS6 decreased the m......RNA content of Mafa. Conclusions/interpretation We propose a role for GAS6 in the regulation of pancreatic beta cells in the critical period around the time of birth. Our results support the hypothesis that the reduced beta cell mass seen in LP offspring is caused by a change in the intra-uterine environment...

  5. Structural arrest in an ideal gas. (United States)

    van Ketel, Willem; Das, Chinmay; Frenkel, Daan


    We report a molecular dynamics study of a simple model system that has the static properties of an ideal gas, yet exhibits nontrivial "glassy" dynamics behavior at high densities. The constituent molecules of this system are constructs of three infinitely thin hard rods of length L, rigidly joined at their midpoints. The crosses have random but fixed orientation. The static properties of this system are those of an ideal gas, and its collision frequency can be computed analytically. For number densities NL(3)/V>1, the single-particle diffusivity goes to zero. As the system is completely structureless, standard mode-coupling theory cannot describe the observed structural arrest. Nevertheless, the system exhibits many dynamical features that appear to be mode-coupling-like. All high-density incoherent intermediate scattering functions collapse onto master curves that depend only on the wave vector.

  6. ERC initiatives to reduce the burden of cardiac arrest: the European Cardiac Arrest Awareness Day. (United States)

    Georgiou, Marios; Lockey, Andrew S


    The rate of survival from out-of-hospital cardiac arrest in Europe remains unacceptably low and could be increased by better bystander cardiopulmonary resuscitation (CPR) rates. The European Resuscitation Council has announced that there will be a European Cardiac Arrest Awareness Day every year on the 16th of October. This is to coincide with the goals of the Written Declaration passed by the European Parliament in June 2012 that emphasised the importance of equal access to CPR and automated external defibrillator (AED) training. The topic of this year's Awareness Day is 'Children Saving Lives' and it is hoped that all national resuscitation councils will promote awareness of the benefits of training all children in CPR and AED use and lobby for legislative change to ensure that all children receive this training. Children are not just the adults of tomorrow - they are the lifesavers of today and tomorrow. Copyright © 2013 Elsevier Ltd. All rights reserved.

  7. Prehospital cardiac arrest survival and neurologic recovery. (United States)

    Hillis, M; Sinclair, D; Butler, G; Cain, E


    Many studies of prehospital defibrillation have been conducted but the effects of airway intervention are unknown and neurologic follow-up has been incomplete. A non-randomized cohort prospective study was conducted to determine the effectiveness of defibrillation in prehospital cardiac arrest. Two ambulance companies in the study area developed a defibrillation protocol and they formed the experimental group. A subgroup of these patients received airway management with an esophageal obturator airway (EOA) or endotracheal intubation (ETT). The control group was composed of patients who suffered a prehospital cardiac arrest and did not receive prehospital defibrillation. All survivors were assessed for residual deficits using the Sickness Impact Profile (SIP) and the Dementia Rating Scale (DRS). A total of 221 patients were studied over a 32-month period. Both the experimental group (N = 161) and the control group (N = 60) were comparable with respect to age, sex distribution, and ambulance response time. Survival to hospital discharge was 2/60 (3.3%) in the control group and 12/161 (6.3%) in the experimental group. This difference is not statistically significant. Survival in the experimental group by airway management technique was basic airway support (3/76 3.9%), EOA (3/67 4.5%), and ETT (6/48 12.5%). The improved effect on survival by ETT management was statistically significant. Survivors had minor differences in memory, work, and recreation as compared to ischemic heart disease patients as measured by the SIP and DRS. No effect of defibrillation was found on survival to hospital discharge. However, endotracheal intubation improved survival in defibrillated patients. Survivors had a good functional outcome.

  8. Cardiac arrest upon induction of anesthesia in children with cardiomyopathy: an analysis of incidence and risk factors.

    LENUS (Irish Health Repository)

    Lynch, Johanne


    INTRODUCTION: It is thought that patients with cardiomyopathy have an increased risk of cardiac arrest on induction of anesthesia, but there is little available data. The purpose of this study was to identify the incidence and potential risk factors for cardiac arrest upon induction of anesthesia in children with cardiomyopathy in our institution. METHODS: A retrospective chart review was performed. Eligible patients included patients admitted between 1998 and 2008 with the International Statistical Classification of Disease code for cardiomyopathy (ICD-9 code 425) who underwent airway intervention for sedation or general anesthesia in the operating room, cardiac diagnostic and interventional unit (CDIU) or intensive care unit. Patients undergoing emergency airway intervention following cardiovascular collapse were excluded. For each patient, we recorded patient demographics, disease severity, anesthesia location, and anesthetic technique. RESULTS: One hundred and twenty-nine patients with cardiomyopathy underwent a total of 236 anesthetic events, and four cardiac arrests were identified. One was related to bradycardia (HR<60), two were attributed to bradycardia in association with severe hypotension (systolic blood pressure<45), and the fourth arrest was related to isolated severe hypotension. Two occurred in the operating suite and two in the CDIU. There was no resulting mortality. One patient progressed to heart transplantation. Multiple combinations of anesthetic drugs were used for induction of anesthesia. CONCLUSION: We performed a review of the last 10 years of anesthesia events in children with cardiomyopathy. We report four cardiac arrests in two patients and 236 anesthetic events (1.7%). To the best of our knowledge, this is the largest review of these patients to date but is limited by its retrospective nature. The low cardiac arrest incidence prevents the identification of risk factors and the development of a cardiac arrest risk predictive clinical

  9. Sudden Cardiac Arrest during Participation in Competitive Sports. (United States)

    Landry, Cameron H; Allan, Katherine S; Connelly, Kim A; Cunningham, Kris; Morrison, Laurie J; Dorian, Paul


    The incidence of sudden cardiac arrest during participation in sports activities remains unknown. Preparticipation screening programs aimed at preventing sudden cardiac arrest during sports activities are thought to be able to identify at-risk athletes; however, the efficacy of these programs remains controversial. We sought to identify all sudden cardiac arrests that occurred during participation in sports activities within a specific region of Canada and to determine their causes. In this retrospective study, we used the Rescu Epistry cardiac arrest database (which contains records of every cardiac arrest attended by paramedics in the network region) to identify all out-of-hospital cardiac arrests that occurred from 2009 through 2014 in persons 12 to 45 years of age during participation in a sport. Cases were adjudicated as sudden cardiac arrest (i.e., having a cardiac cause) or as an event resulting from a noncardiac cause, on the basis of records from multiple sources, including ambulance call reports, autopsy reports, in-hospital data, and records of direct interviews with patients or family members. Over the course of 18.5 million person-years of observation, 74 sudden cardiac arrests occurred during participation in a sport; of these, 16 occurred during competitive sports and 58 occurred during noncompetitive sports. The incidence of sudden cardiac arrest during competitive sports was 0.76 cases per 100,000 athlete-years, with 43.8% of the athletes surviving until they were discharged from the hospital. Among the competitive athletes, two deaths were attributed to hypertrophic cardiomyopathy and none to arrhythmogenic right ventricular cardiomyopathy. Three cases of sudden cardiac arrest that occurred during participation in competitive sports were determined to have been potentially identifiable if the athletes had undergone preparticipation screening. In our study involving persons who had out-of-hospital cardiac arrest, the incidence of sudden cardiac

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


    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

  11. Hybrid resource provisioning for clouds

    International Nuclear Information System (INIS)

    Rahman, Mahfuzur; Graham, Peter


    Flexible resource provisioning, the assignment of virtual machines (VMs) to physical machine, is a key requirement for cloud computing. To achieve 'provisioning elasticity', the cloud needs to manage its available resources on demand. A-priori, static, VM provisioning introduces no runtime overhead but fails to deal with unanticipated changes in resource demands. Dynamic provisioning addresses this problem but introduces runtime overhead. To reduce VM management overhead so more useful work can be done and to also avoid sub-optimal provisioning we propose a hybrid approach that combines static and dynamic provisioning. The idea is to adapt a good initial static placement of VMs in response to evolving load characteristics, using live migration, as long as the overhead of doing so is low and the effectiveness is high. When this is no longer so, we trigger a revised static placement. (Thus, we are essentially applying local multi-objective optimization to tune a global optimization with reduced overhead.) This approach requires a complicated migration decision algorithm based on current and predicted:future workloads, power consumptions and memory usage in the host machines as well as network burst characteristics for the various possible VM multiplexings (combinations of VMs on a host). A further challenge is to identify those characteristics of the dynamic provisioning that should trigger static re-provisioning.

  12. Targeted Temperature Management at 33°C versus 36°C after Cardiac Arrest

    DEFF Research Database (Denmark)

    Nielsen, Niklas; Wetterslev, Jørn; Cronberg, Tobias


    Background Unconscious survivors of out-of-hospital cardiac arrest have a high risk of death or poor neurologic function. Therapeutic hypothermia is recommended by international guidelines, but the supporting evidence is limited, and the target temperature associated with the best outcome...... is unknown. Our objective was to compare two target temperatures, both intended to prevent fever. Methods In an international trial, we randomly assigned 950 unconscious adults after out-of-hospital cardiac arrest of presumed cardiac cause to targeted temperature management at either 33°C or 36°C....... The primary outcome was all-cause mortality through the end of the trial. Secondary outcomes included a composite of poor neurologic function or death at 180 days, as evaluated with the Cerebral Performance Category (CPC) scale and the modified Rankin scale. Results In total, 939 patients were included...

  13. 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


    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...

  14. Post-resuscitation care for survivors of cardiac arrest

    Directory of Open Access Journals (Sweden)

    Ashvarya Mangla


    Full Text Available Cardiac arrest can occur following a myriad of clinical conditions. With advancement of medical science and improvements in Emergency Medical Services systems, the rate of return of spontaneous circulation for patients who suffer an out-of-hospital cardiac arrest (OHCA continues to increase. Managing these patients is challenging and requires a structured approach including stabilization of cardiopulmonary status, early consideration of neuroprotective strategies, identifying and managing the etiology of arrest and initiating treatment to prevent recurrence. This requires a closely coordinated multidisciplinary team effort. In this article, we will review the initial management of survivors of OHCA, highlighting advances and ongoing controversies.

  15. The New START Treaty: Central Limits and Key Provisions (United States)


    article-by-article analysis can be found at avc /newstart/c44126.htm. 2 For a brief summary of the original START Treaty, as...2014, avc /rls/224236.htm . The fact sheet does not display warhead subtotals for each delivery system; it only includes an...of Strategic Offensive Forces, Fact Sheet, Washington, DC, April 1, 2014, avc /rls/228652.htm. The New START Treaty: Central

  16. [Provisions for potentially raising the age limit for oocyte donation

    NARCIS (Netherlands)

    Kasteren, Y.M. van; Braat, D.D.M.


    The introduction ofoocyte donation has provided a new perspective on reproduction for women with premature ovarian failure. In contrast to other forms ofassisted reproductive technology, the success ofoocyte donation is not affected by the age of the future mother. This has prompted a discussion on

  17. Therapeutic hypothermia after out-of-hospital cardiac arrest in children. (United States)

    Moler, Frank W; Silverstein, Faye S; Holubkov, Richard; Slomine, Beth S; Christensen, James R; Nadkarni, Vinay M; Meert, Kathleen L; Clark, Amy E; Browning, Brittan; Pemberton, Victoria L; Page, Kent; Shankaran, Seetha; Hutchison, Jamie S; Newth, Christopher J L; Bennett, Kimberly S; Berger, John T; Topjian, Alexis; Pineda, Jose A; Koch, Joshua D; Schleien, Charles L; Dalton, Heidi J; Ofori-Amanfo, George; Goodman, Denise M; Fink, Ericka L; McQuillen, Patrick; Zimmerman, Jerry J; Thomas, Neal J; van der Jagt, Elise W; Porter, Melissa B; Meyer, Michael T; Harrison, Rick; Pham, Nga; Schwarz, Adam J; Nowak, Jeffrey E; Alten, Jeffrey; Wheeler, Derek S; Bhalala, Utpal S; Lidsky, Karen; Lloyd, Eric; Mathur, Mudit; Shah, Samir; Wu, Theodore; Theodorou, Andreas A; Sanders, Ronald C; Dean, J Michael


    Therapeutic hypothermia is recommended for comatose adults after witnessed out-of-hospital cardiac arrest, but data about this intervention in children are limited. We conducted this trial of two targeted temperature interventions at 38 children's hospitals involving children who remained unconscious after out-of-hospital cardiac arrest. Within 6 hours after the return of circulation, comatose patients who were older than 2 days and younger than 18 years of age were randomly assigned to therapeutic hypothermia (target temperature, 33.0°C) or therapeutic normothermia (target temperature, 36.8°C). The primary efficacy outcome, survival at 12 months after cardiac arrest with a Vineland Adaptive Behavior Scales, second edition (VABS-II), score of 70 or higher (on a scale from 20 to 160, with higher scores indicating better function), was evaluated among patients with a VABS-II score of at least 70 before cardiac arrest. A total of 295 patients underwent randomization. Among the 260 patients with data that could be evaluated and who had a VABS-II score of at least 70 before cardiac arrest, there was no significant difference in the primary outcome between the hypothermia group and the normothermia group (20% vs. 12%; relative likelihood, 1.54; 95% confidence interval [CI], 0.86 to 2.76; P=0.14). Among all the patients with data that could be evaluated, the change in the VABS-II score from baseline to 12 months was not significantly different (P=0.13) and 1-year survival was similar (38% in the hypothermia group vs. 29% in the normothermia group; relative likelihood, 1.29; 95% CI, 0.93 to 1.79; P=0.13). The groups had similar incidences of infection and serious arrhythmias, as well as similar use of blood products and 28-day mortality. In comatose children who survived out-of-hospital cardiac arrest, therapeutic hypothermia, as compared with therapeutic normothermia, did not confer a significant benefit in survival with a good functional outcome at 1 year. (Funded by

  18. Early prognostication markers in cardiac arrest patients treated with hypothermia. (United States)

    Karapetkova, M; Koenig, M A; Jia, X


    Established prognostication markers, such as clinical findings, electroencephalography (EEG) and biochemical markers, used by clinicians to predict neurological outcome after cardiac arrest (CA) are altered under therapeutic hypothermia (TH) conditions and their validity remains uncertain. MEDLINE and Embase were searched for evidence on the current standards for neurological outcome prediction for out-of-hospital CA patients treated with TH and the validity of a wide range of prognostication markers. Relevant studies that suggested one or several established biomarkers and multimodal approaches for prognostication are included and reviewed. Whilst the prognostic accuracy of various tests after TH has been questioned, pupillary light reflexes and somatosensory evoked potentials are still strongly associated with negative outcome for early prognostication. Increasingly, EEG background activity has also been identified as a valid predictor for outcome after 72 h after CA and a preferred prognostic method in clinical settings. Neuroimaging techniques, such as magnetic resonance imaging and computed tomography, can identify functional and structural brain injury but are not readily available at the patient's bedside because of limited availability and high costs. A multimodal algorithm composed of neurological examination, EEG-based quantitative testing and somatosensory evoked potentials, in conjunction with newer magnetic resonance imaging sequences, if available, holds promise for accurate prognostication in CA patients treated with TH. In order to avoid premature withdrawal of care, prognostication should be performed more than 72 h after CA. © 2015 EAN.

  19. Adrenaline in cardiac arrest: Prefilled syringes are faster. (United States)

    Helm, Claire; Gillett, Mark


    Standard ampoules and prefilled syringes of adrenaline are widely available in Australasian EDs for use in cardiac arrest. We hypothesise that prefilled syringes can be administered more rapidly and accurately when compared with the two available standard ampoules. This is a triple arm superiority study comparing the time to i.v. administration and accuracy of dosing of three currently available preparations of adrenaline. In their standard packaging, prefilled syringes were on average more than 12 s faster to administer than the 1 mL 1:1000 ampoules and more than 16 s faster than the 10 mL 1:10,000 ampoules (P adrenaline utilising a Minijet (CSL Limited, Parkville, Victoria, Australia) is faster than using adrenaline in glass ampoules presented in their plastic packaging. Removing the plastic packaging from the 1 mL (1 mg) ampoule might result in more rapid administration similar to the Minijet. Resuscitation personnel requiring rapid access to adrenaline should consider storing it as either Minijets or ampoules devoid of packaging. These results might be extrapolatable to other clinical scenarios, including pre-hospital and anaesthesia, where other drugs are required for rapid use. © 2015 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  20. Poisson cluster analysis of cardiac arrest incidence in Columbus, Ohio. (United States)

    Warden, Craig; Cudnik, Michael T; Sasson, Comilla; Schwartz, Greg; Semple, Hugh


    Scarce resources in disease prevention and emergency medical services (EMS) need to be focused on high-risk areas of out-of-hospital cardiac arrest (OHCA). Cluster analysis using geographic information systems (GISs) was used to find these high-risk areas and test potential predictive variables. This was a retrospective cohort analysis of EMS-treated adults with OHCAs occurring in Columbus, Ohio, from April 1, 2004, through March 31, 2009. The OHCAs were aggregated to census tracts and incidence rates were calculated based on their adult populations. Poisson cluster analysis determined significant clusters of high-risk census tracts. Both census tract-level and case-level characteristics were tested for association with high-risk areas by multivariate logistic regression. A total of 2,037 eligible OHCAs occurred within the city limits during the study period. The mean incidence rate was 0.85 OHCAs/1,000 population/year. There were five significant geographic clusters with 76 high-risk census tracts out of the total of 245 census tracts. In the case-level analysis, being in a high-risk cluster was associated with a slightly younger age (-3 years, adjusted odds ratio [OR] 0.99, 95% confidence interval [CI] 0.99-1.00), not being white, non-Hispanic (OR 0.54, 95% CI 0.45-0.64), cardiac arrest occurring at home (OR 1.53, 95% CI 1.23-1.71), and not receiving bystander cardiopulmonary resuscitation (CPR) (OR 0.77, 95% CI 0.62-0.96), but with higher survival to hospital discharge (OR 1.78, 95% CI 1.30-2.46). In the census tract-level analysis, high-risk census tracts were also associated with a slightly lower average age (-0.1 years, OR 1.14, 95% CI 1.06-1.22) and a lower proportion of white, non-Hispanic patients (-0.298, OR 0.04, 95% CI 0.01-0.19), but also a lower proportion of high-school graduates (-0.184, OR 0.00, 95% CI 0.00-0.00). This analysis identified high-risk census tracts and associated census tract-level and case-level characteristics that can be used to

  1. Prediction of cardiac arrest recurrence using ensemble classifiers

    Indian Academy of Sciences (India)

    Nachiket Tapas

    ECG dataset from PhysioNet, Pima Indian Diabetes dataset from UCI Machine Learning Repository and gene expression ... electrical activity, medically the condition is known as cardiac arrest ... ing, (5) lack of physical exercise, etc. [9]. Using ...

  2. Arrest of cytoplasmic streaming induces algal proliferation in green paramecia.

    Directory of Open Access Journals (Sweden)

    Toshiyuki Takahashi

    Full Text Available A green ciliate Paramecium bursaria, bearing several hundreds of endosymbiotic algae, demonstrates rotational microtubule-based cytoplasmic streaming, in which cytoplasmic granules and endosymbiotic algae flow in a constant direction. However, its physiological significance is still unknown. We investigated physiological roles of cytoplasmic streaming in P. bursaria through host cell cycle using video-microscopy. Here, we found that cytoplasmic streaming was arrested in dividing green paramecia and the endosymbiotic algae proliferated only during the arrest of cytoplasmic streaming. Interestingly, arrest of cytoplasmic streaming with pressure or a microtubule drug also induced proliferation of endosymbiotic algae independently of host cell cycle. Thus, cytoplasmic streaming may control the algal proliferation in P. bursaria. Furthermore, confocal microscopic observation revealed that a division septum was formed in the constricted area of a dividing paramecium, producing arrest of cytoplasmic streaming. This is a first report to suggest that cytoplasmic streaming controls proliferation of eukaryotic cells.

  3. The outcome of anaesthesia related cardiac arrest in a

    Directory of Open Access Journals (Sweden)

    O.O. Adekola


    Conclusion: Anaesthesia related cardiac arrest and mortality were linked to cardiovascular depression from halothane overdose in our institution. The burden can be reduced by improving on establishing standard monitoring in the perioperative period, and a team approach to patients care.

  4. The law on the streets: Evaluating the impact of Mexico's drug decriminalization reform on drug possession arrests in Tijuana, Mexico. (United States)

    Arredondo, J; Gaines, T; Manian, S; Vilalta, C; Bañuelos, A; Strathdee, S A; Beletsky, L


    In 2009, Mexican Federal Government enacted "narcomenudeo" reforms decriminalizing possession of small amounts of drugs, delegating prosecution of retail drug sales to the state courts, and mandating treatment diversion for habitual drug users. There has been insufficient effort to formally assess the decriminalization policy's population-level impact, despite mounting interest in analagous reforms across the globe. Using a dataset of municipal police incident reports, we examined patterns of drug possession, and violent and non-violent crime arrests between January 2009 and December 2014. A hierarchical panel data analysis with random effects was conducted to assess the impact of narcomenudeo's drug decriminalization provision. The reforms had no significant impact on the number of drug possession or violent crime arrests, after controlling for other variables (e.g. time trends, electoral cycles, and precinct-level socioeconomic factors). Time periods directly preceding local elections were observed to be statistically associated with elevated arrest volume. Analysis of police statistics parallel prior findings that Mexico's reform decriminalizing small amounts of drugs does not appear to have significantly shifted drug law enforcement in Tijuana. More research is required to fully understand the policy transformation process for drug decriminalization and other structural interventions in Mexico and similar regional and international efforts. Observed relationship between policing and political cycles echo associations in other settings whereby law-and-order activities increase during mayoral electoral campaigns. Copyright © 2017 Elsevier B.V. All rights reserved.

  5. Dynamic propagation and cleavage crack arrest in bainitic steel

    International Nuclear Information System (INIS)

    Hajjaj, M.


    In complement of the studies of harmfulness of defects, generally realized in term of initiation, the concept of crack arrest could be used as complementary analyses to the studies of safety. The stop occurs when the stress intensity factor becomes lower than crack arrest toughness (KIa) calculated in elasto-statics (KI ≤ KIa). The aim of this thesis is to understand and predict the stop of a crack propagating at high speed in a 18MND5 steel used in the pressure water reactor (PWR). The test chosen to study crack arrest is the disc thermal shock test. The observations under the scanning electron microscope of the fracture surface showed that the crack arrest always occurs in cleavage mode and that the critical microstructural entity with respect to the propagation and crack arrest corresponds to at least the size of the prior austenitic grain. The numerical analyses in elasto-statics confirm the conservatism of the codified curve of the RCC-M with respect to the values of KIa. The dynamic numerical analyses show that the deceleration of the crack measured at the end of the propagation is related to the global dynamic of the structure (vibrations). The transferability to components of crack arrest toughness obtained from tests analysed in static is thus not assured. The disc thermal shock tests were also modelled by considering a criterion of propagation and arrest of the type 'RKR' characterized by a critical stress sc which depends on the temperature. The results obtained account well for the crack jump measured in experiments as well as the shape of the crack arrest front. (author)

  6. Al-Qaeda arrest casts shadow over the LHC

    CERN Multimedia

    Dacey, James


    "Cern remains on course for the imminent switch-on of the Large Hadron Collider (LHC) despite the media frenzy following the recent arrest of a physicist who had been working at the facility. The researcher in question is a 32-year-old man of Algerian descent who is expected to face trail in France - the country in which he was arrested" (0.5 page)

  7. 50 CFR 71.12 - General provisions. (United States)


    ....12 General provisions. The following provisions shall apply to public sport fishing on a national... fish hatchery area. (e) Each person shall comply with the provisions of any special notices governing...

  8. Cardiac arrest due to lymphocytic colitis: a case report

    Directory of Open Access Journals (Sweden)

    Groth Kristian A


    Full Text Available Abstract Introduction We present a case of cardiac arrest due to hypokalemia caused by lymphocytic colitis. Case presentation A 69-year-old Caucasian man presented four months prior to a cardiac arrest with watery diarrhea and was diagnosed with lymphocytic colitis. Our patient experienced a witnessed cardiac arrest at his general practitioner's surgery. Two physicians and the emergency medical services resuscitated our patient for one hour and four minutes before arriving at our university hospital. Our patient was defibrillated 16 times due to the recurrence of ventricular tachyarrhythmias. An arterial blood sample revealed a potassium level of 2.0 mmol/L (reference range: 3.5 to 4.6 mmol/L and pH 6.86 (reference range: pH 7.37 to 7.45. As the potassium level was corrected, the propensity for ventricular tachyarrhythmias ceased. Our patient recovered from his cardiac arrest without any neurological deficit. Further tests and examinations revealed no other reason for the cardiac arrest. Conclusion Diarrhea can cause life-threatening situations due to the excretion of potassium, ultimately causing cardiac arrest due to hypokalemia. Physicians treating patients with severe diarrhea should consider monitoring their electrolyte levels.

  9. The neighborhood context of racial and ethnic disparities in arrest. (United States)

    Kirk, David S


    This study assesses the role of social context in explaining racial and ethnic disparities in arrest, with afocus on how distinct neighborhood contexts in which different racial and ethnic groups reside explain variations in criminal outcomes. To do so, I utilize a multilevel, longitudinal research design, combining individual-level data with contextual data from the Project on Human Development in Chicago Neighborhoods (PHDCN). Findings reveal that black youths face multiple layers of disadvantage relative to other racial and ethnic groups, and these layers work to create differences in arrest. At the family level, results show that disadvantages in the form of unstable family structures explain much of the disparities in arrest across race and ethnicity. At the neighborhood level, black youths tend to reside in areas with both significantly higher levels of concentrated poverty than other youths as well as lower levels of collective efficacy than white youths. Variations in neighborhood tolerance of deviance across groups explain little of the arrest disparities, yet tolerance of deviance does influence the frequency with which a crime ultimately ends in an arrest. Even after accounting for relevant demographic, family, and neighborhood-level predictors, substantial residual arrest differences remain between black youths and youths of other racial and ethnic groups.

  10. Evaluation of the presence of constraint in crack run/arrest events

    International Nuclear Information System (INIS)

    Schwartz, C.W.; Bass, B.R.


    Crack arrest studies currently being conducted by the Heavy-Section Steel Technology Program are designed to improve our understanding of the conditions contributing to the arrest of a propagating fracture in a pressure vessel. These studies are generating data spanning a wide temperature range for a variety of experimental configurations. Dynamic crack arrest parameters are back-figured from these experiments through 'generation mode' dynamic viscoplastic finite element calculations driven by the measured crack tip history input. A major approximation in these analyses, which is dictated by the practical limitations of current supercomputer hardware, is the assumption of two-dimensional plane stress conditions. Although this approximation is reasonable over most of the problem domain for many test specimen geometries, it deteriorates at locations near the crack tip due to triaxial constraint effects. This paper describes plans for a fine-grained three-dimensional computational study to investigate the importance of these near-tip triaxial constraint effects on crack tip yielding and to develop appropriate algorithms for incorporating these effects into conventional two-dimensional plane stress approximations. (author)

  11. Preliminary observations in systemic oxygen consumption during targeted temperature management after cardiac arrest. (United States)

    Uber, Amy; Grossestreuer, Anne V; Ross, Catherine E; Patel, Parth V; Trehan, Ambica; Donnino, Michael W; Berg, Katherine M


    Limited data suggests low oxygen consumption (VO 2 ), driven by mitochondrial injury, is associated with mortality after cardiac arrest. Due to the challenges of measurement in the critically ill, post-arrest metabolism remains poorly characterized. We monitored VO 2 , carbon dioxide production (VCO 2 ) and the respiratory quotient (RQ) in post-arrest patients and explored associations with outcome. Using a gas exchange monitor, we measured continuous VO 2 and VCO 2 in post- arrest patients treated with targeted temperature management. We used area under the curve and medians over time to evaluate the association between VO 2 , VCO 2 , RQ and the VO 2 :lactate ratio with survival. In 17 patients, VO 2 in the first 12 h after return of spontaneous circulation (ROSC) was associated with survival (median in survivors 3.35 mL/kg/min [2.98,3.88] vs. non-survivors 2.61 mL/kg/min [2.21,2.94], p = .039). This did not persist over 24 h. The VO 2 :lactate ratio was associated with survival (median in survivors 1.4 [IQR: 1.1,1.7] vs. non-survivors 0.8 [IQR: 0.6,1.2] p  0.7 (p = .131). VCO 2 was not associated with survival. There was a significant association between VO 2 and mortality in the first 12 h after ROSC, but not over 24 h. Lower VO 2: lactate ratio was associated with mortality. A large percentage of patients had RQs below physiologic norms. Further research is needed to explore whether these parameters could have true prognostic value or be a potential treatment target. Copyright © 2018 Elsevier B.V. All rights reserved.

  12. A novel survival model of cardioplegic arrest and cardiopulmonary bypass in rats: a methodology paper

    Directory of Open Access Journals (Sweden)

    Podgoreanu Mihai V


    Full Text Available Abstract Background Given the growing population of cardiac surgery patients with impaired preoperative cardiac function and rapidly expanding surgical techniques, continued efforts to improve myocardial protection strategies are warranted. Prior research is mostly limited to either large animal models or ex vivo preparations. We developed a new in vivo survival model that combines administration of antegrade cardioplegia with endoaortic crossclamping during cardiopulmonary bypass (CPB in the rat. Methods Sprague-Dawley rats were cannulated for CPB (n = 10. With ultrasound guidance, a 3.5 mm balloon angioplasty catheter was positioned via the right common carotid artery with its tip proximal to the aortic valve. To initiate cardioplegic arrest, the balloon was inflated and cardioplegia solution injected. After 30 min of cardioplegic arrest, the balloon was deflated, ventilation resumed, and rats were weaned from CPB and recovered. To rule out any evidence of cerebral ischemia due to right carotid artery ligation, animals were neurologically tested on postoperative day 14, and their brains histologically assessed. Results Thirty minutes of cardioplegic arrest was successfully established in all animals. Functional assessment revealed no neurologic deficits, and histology demonstrated no gross neuronal damage. Conclusion This novel small animal CPB model with cardioplegic arrest allows for both the study of myocardial ischemia-reperfusion injury as well as new cardioprotective strategies. Major advantages of this model include its overall feasibility and cost effectiveness. In future experiments long-term echocardiographic outcomes as well as enzymatic, genetic, and histologic characterization of myocardial injury can be assessed. In the field of myocardial protection, rodent models will be an important avenue of research.

  13. A conceptual framework to assess effectiveness in wheelchair provision. (United States)

    Kamaraj, Deepan C; Bray, Nathan; Rispin, Karen; Kankipati, Padmaja; Pearlman, Jonathan; Borg, Johan


    Currently, inadequate wheelchair provision has forced many people with disabilities to be trapped in a cycle of poverty and deprivation, limiting their ability to access education, work and social facilities. This issue is in part because of the lack of collaboration among various stakeholders who need to work together to design, manufacture and deliver such assistive mobility devices. This in turn has led to inadequate evidence about intervention effectiveness, disability prevalence and subsequent costeffectiveness that would help facilitate appropriate provision and support for people with disabilities. In this paper, we describe a novel conceptual framework that can be tested across the globe to study and evaluate the effectiveness of wheelchair provision. The Comparative Effectiveness Research Subcommittee (CER-SC), consisting of the authors of this article, housed within the Evidence-Based Practice Working Group (EBP-WG) of the International Society of Wheelchair Professionals (ISWP), conducted a scoping review of scientific literature and standard practices used during wheelchair service provision. The literature review was followed by a series of discussion groups. The three iterations of the conceptual framework are described in this manuscript. We believe that adoption of this conceptual framework could have broad applications in wheelchair provision globally to develop evidence-based practices. Such a perspective will help in the comparison of different strategies employed in wheelchair provision and further improve clinical guidelines. Further work is being conducted to test the efficacy of this conceptual framework to evaluate effectiveness of wheelchair service provision in various settings across the globe.

  14. Interfacial crack arrest in sandwich beams subjected to fatigue loading using a novel crack arresting device – Numerical modelling

    DEFF Research Database (Denmark)

    Martakos, G.; Andreasen, J.H.; Berggreen, Christian


    A novel crack arresting device is implemented in foam-cored composite sandwich beams and tested using the Sandwich Tear Test (STT) configuration. A finite element model of the setup is developed, and the predictions are correlated with observations and results from a recently conducted experiment...... concept, as well as a design tool that can be used for the implementation of crack arresting devises in engineering applications of sandwich components and structures....

  15. Characterization of Mitochondrial Injury after Cardiac Arrest (COMICA) (United States)

    Donnino, Michael W.; Liu, Xiaowen; Andersen, Lars W.; Rittenberger, Jon C.; Abella, Benjamin S.; Gaieski, David F.; Ornato, Joseph P.; Gazmuri, Raúl J.; Grossestreur, Anne V.; Cocchi, Michaen N.; Abbate, Antonio; Uber, Amy; Clore, John; Peberdy, Mary Anne; Callaway, Clifton


    Introduction Mitochondrial injury post-cardiac arrest has been described in pre-clinical settings but the extent to which this injury occurs in humans remains largely unknown. We hypothesized that increased levels of mitochondrial biomarkers would be associated with mortality and neurological morbidity in post-cardiac arrest subjects. Methods We performed a prospective multicenter study of post-cardiac arrest subjects. Inclusion criteria were comatose adults who suffered an out-of-hospital cardiac arrest. Mitochondrial biomarkers were measured at 0, 12, 24, 36 and 48 hours after return of spontaneous circulation as well as in healthy controls. Results Out of 111 subjects enrolled, 102 had evaluable samples at 0 hours. Cardiac arrest subjects had higher baseline cytochrome c levels compared to controls (2.18 ng/mL [0.74, 7.74] vs. 0.16 ng/mL [0.03, 0.91], p<0.001), and subjects who died had higher 0 hours cytochrome c levels compared to survivors (3.66 ng/mL [1.40, 14.9] vs. 1.27 ng/mL [0.16, 2.37], p<0.001). There were significantly higher RNAase P (3.3 [1.2, 5.7] vs. 1.2 [0.8, 1.2], p<0.001) and B2M (12.0 [1.0, 22.9], vs. 0.6 [0.6, 1.3], p<0.001) levels in cardiac arrest subjects at baseline compared to the control subjects. There were no differences between survivors and non-survivors for mitochondrial DNA, nuclear DNA, or cell free DNA. Conclusions Cytochrome C was increased in post-cardiac arrest subjects compared to controls, and in post-cardiac arrest non-survivors compared to survivors. Nuclear DNA and cell free DNA was increased in plasma of post-cardiac arrest subjects. There were no differences in mitochondrial DNA, nuclear DNA, or cell free DNA between survivors and non-survivors. Mitochondrial injury markers showed mixed results in post-arrest period. Future research needs to investigate these differences. PMID:28126408

  16. Characterization of mitochondrial injury after cardiac arrest (COMICA). (United States)

    Donnino, Michael W; Liu, Xiaowen; Andersen, Lars W; Rittenberger, Jon C; Abella, Benjamin S; Gaieski, David F; Ornato, Joseph P; Gazmuri, Raúl J; Grossestreuer, Anne V; Cocchi, Michael N; Abbate, Antonio; Uber, Amy; Clore, John; Peberdy, Mary Anne; Callaway, Clifton W


    Mitochondrial injury post-cardiac arrest has been described in pre-clinical settings but the extent to which this injury occurs in humans remains largely unknown. We hypothesized that increased levels of mitochondrial biomarkers would be associated with mortality and neurological morbidity in post-cardiac arrest subjects. We performed a prospective multicenter study of post-cardiac arrest subjects. Inclusion criteria were comatose adults who suffered an out-of-hospital cardiac arrest. Mitochondrial biomarkers were measured at 0, 12, 24, 36 and 48h after return of spontaneous circulation as well as in healthy controls. Out of 111 subjects enrolled, 102 had evaluable samples at 0h. Cardiac arrest subjects had higher baseline cytochrome c levels compared to controls (2.18ng/mL [0.74, 7.74] vs. 0.16ng/mL [0.03, 0.91], p<0.001), and subjects who died had higher 0h cytochrome c levels compared to survivors (3.66ng/mL [1.40, 14.9] vs. 1.27ng/mL [0.16, 2.37], p<0.001). There were significantly higher Ribonuclease P (RNaseP) (3.3 [1.2, 5.7] vs. 1.2 [0.8, 1.2], p<0.001) and Beta-2microglobulin (B2M) (12.0 [1.0, 22.9], vs. 0.6 [0.6, 1.3], p<0.001) levels in cardiac arrest subjects at baseline compared to the control subjects. There were no differences between survivors and non-survivors for mitochondrial DNA, nuclear DNA, or cell free DNA. Cytochrome c was increased in post- cardiac arrest subjects compared to controls, and in post-cardiac arrest non-survivors compared to survivors. Nuclear DNA and cell free DNA was increased in plasma of post-cardiac arrest subjects. There were no differences in mitochondrial DNA, nuclear DNA, or cell free DNA between survivors and non-survivors. Mitochondrial injury markers showed mixed results in the post-cardiac arrest period. Future research needs to investigate these differences. Copyright © 2017 Elsevier B.V. All rights reserved.

  17. Visualizing Vpr-induced G2 arrest and apoptosis.

    Directory of Open Access Journals (Sweden)

    Tomoyuki Murakami

    Full Text Available Vpr is an accessory protein of human immunodeficiency virus type 1 (HIV-1 with multiple functions. The induction of G2 arrest by Vpr plays a particularly important role in efficient viral replication because the transcriptional activity of the HIV-1 long terminal repeat is most active in G2 phase. The regulation of apoptosis by Vpr is also important for immune suppression and pathogenesis during HIV infection. However, it is not known whether Vpr-induced apoptosis depends on the ability of Vpr to induce G2 arrest, and the dynamics of Vpr-induced G2 arrest and apoptosis have not been visualized. We performed time-lapse imaging to examine the temporal relationship between Vpr-induced G2 arrest and apoptosis using HeLa cells containing the fluorescent ubiquitination-based cell cycle indicator2 (Fucci2. The dynamics of G2 arrest and subsequent long-term mitotic cell rounding in cells transfected with the Vpr-expression vector were visualized. These cells underwent nuclear mis-segregation after prolonged mitotic processes and then entered G1 phase. Some cells subsequently displayed evidence of apoptosis after prolonged mitotic processes and nuclear mis-segregation. Interestingly, Vpr-induced apoptosis was seldom observed in S or G2 phase. Likewise, visualization of synchronized HeLa/Fucci2 cells infected with an adenoviral vector expressing Vpr clearly showed that Vpr arrests the cell cycle at G2 phase, but does not induce apoptosis at S or G2 phase. Furthermore, time-lapse imaging of HeLa/Fucci2 cells expressing SCAT3.1, a caspase-3-sensitive fusion protein, clearly demonstrated that Vpr induces caspase-3-dependent apoptosis. Finally, to examine whether the effects of Vpr on G2 arrest and apoptosis were reversible, we performed live-cell imaging of a destabilizing domain fusion Vpr, which enabled rapid stabilization and destabilization by Shield1. The effects of Vpr on G2 arrest and subsequent apoptosis were reversible. This study is the first to

  18. Serum tau and neurological outcome in cardiac arrest

    DEFF Research Database (Denmark)

    Mattsson, Niklas; Zetterberg, Henrik; Nielsen, Niklas


    OBJECTIVE: To test serum tau as a predictor of neurological outcome after cardiac arrest. METHODS: We measured the neuronal protein tau in serum at 24, 48, and 72 hours after cardiac arrest in 689 patients in the prospective international Target Temperature Management trial. The main outcome...... was poor neurological outcome, defined as Cerebral Performance Categories 3-5 at 6 months. RESULTS: Increased tau was associated with poor outcome at 6 months after cardiac arrest (median = 38.5, interquartile range [IQR] = 5.7-245ng/l in poor vs median = 1.5, IQR = 0.7-2.4ng/l in good outcome, for tau....... The accuracy in predicting outcome by serum tau was equally high for patients randomized to 33 °C and 36 °C targeted temperature after cardiac arrest. INTERPRETATION: Serum tau is a promising novel biomarker for prediction of neurological outcome in patients with cardiac arrest. It may be significantly better...

  19. Major life events as potential triggers of sudden cardiac arrest. (United States)

    Wicks, April F; Lumley, Thomas; Lemaitre, Rozenn N; Sotoodehnia, Nona; Rea, Thomas D; McKnight, Barbara; Strogatz, David S; Bovbjerg, Viktor E; Siscovick, David S


    We investigated the risk of sudden cardiac arrest in association with the recent loss of, or separation from, a family member or friend. Our case-crossover study included 490 apparently healthy married residents of King County, Washington, who suffered sudden cardiac arrest between 1988 and 2005. We compared exposure to spouse-reported family/friend events occurring ≤ 1 month before sudden cardiac arrest with events occurring in the previous 5 months. We evaluated potential effect modification by habitual vigorous physical activity. Recent family/friend events were associated with a higher risk of sudden cardiac arrest (odds ratio [OR] = 1.6; 95% confidence interval [CI] = 1.1-2.4). ORs for cases with and without habitual vigorous physical activity were 1.1 (0.6-2.2) and 2.0 (1.2-3.1), respectively (interaction P = 0.02). These results suggest family/friend events may trigger sudden cardiac arrest and raise the hypothesis that habitual vigorous physical activity may lower susceptibility to these potential triggers.

  20. Current Pharmacological Advances in the Treatment of Cardiac Arrest

    Directory of Open Access Journals (Sweden)

    Andry Papastylianou


    Full Text Available Cardiac arrest is defined as the sudden cessation of spontaneous ventilation and circulation. Within 15 seconds of cardiac arrest, the patient loses consciousness, electroencephalogram becomes flat after 30 seconds, pupils dilate fully after 60 seconds, and cerebral damage takes place within 90–300 seconds. It is essential to act immediately as irreversible damage can occur in a short time. Cardiopulmonary resuscitation (CPR is an attempt to restore spontaneous circulation through a broad range of interventions which are early defibrillation, high-quality and uninterrupted chest compressions, advanced airway interventions, and pharmacological interventions. Drugs should be considered only after initial shocks have been delivered (when indicated and chest compressions and ventilation have been started. During cardiopulmonary resuscitation, no specific drug therapy has been shown to improve survival to hospital discharge after cardiac arrest, and only few drugs have a proven benefit for short-term survival. This paper reviews current pharmacological treatment of cardiac arrest. There are three groups of drugs relevant to the management of cardiac arrest: vasopressors, antiarrhythmics, and other drugs such as sodium bicarbonate, calcium, magnesium, atropine, fibrinolytic drugs, and corticosteroids.

  1. Social Housing Provision in Copenhagen

    DEFF Research Database (Denmark)

    Tsenkova, Sasha; Vestergaard, Hedvig

    -profit housing providers, and a wide range of fiscal and regulatory instruments enhancing the competitive performance of the social housing sector. The research analyses recent housing policy measures and their impact on new social housing provision in Copenhagen. The emphasis is on the mix of housing policy......The paper provides an overview of trends and processes of change affecting new social housing provision in Denmark with a focus on Copenhagen. The local responses are reviewed within the context of changes to the unitary national housing system that functions with a robust range of private and non...... instruments implemented in three major policy domains-fiscal, financial and regulatory-to promote the production of new social housing. The system of new social housing provision is examined as a dynamic process of interaction between public and private institutions defining housing policy outcomes...

  2. Models of Public Service Provision

    DEFF Research Database (Denmark)

    Andersen, Lotte Bøgh; Kristensen, Nicolai; Pedersen, Lene Holm


    This article extends the framework of Le Grand (2003, 2010) to encompass responsiveness, and the main argument is that the combination of employee motivation, user capacity, and models of public service provision potentially has serious implications for responsiveness across service areas. Although...... research on employee motivation thrives, especially in the public service motivation (PSM) literature, few studies have investigated user capacity empirically, and we know little about the combination of PSM, user capacity and models of service provision. Analyzing four central service areas (day care......, schools, hospitals, and universities), we find variations in both user capacity and PSM. Taking this variation as a point of departure we discuss what implications different combinations of employee motivation, user capacity, and models of public service provision may have for responsiveness....

  3. Intraoperative care for aortic surgery using circulatory arrest. (United States)

    Fernández Suárez, Félix Ezequiel; Fernández Del Valle, David; González Alvarez, Adrián; Pérez-Lozano, Blanca


    The total circulatory arrest (CA) is necessary to achieve optimal surgical conditions in certain aortic pathologies, especially in those affecting the ascending aorta and aortic arch. During this procedure it is necessary to protect all the organs of ischemia, especially those of the central nervous system and for this purpose several strategies have been developed. The first and most important protective method is systemic hypothermia. The degree of hypothermia and the route of application have been evolving and currently tend to use moderate hypothermia (MH) (20.1-28 °C) associated with unilateral or bilateral selective cerebral perfusion methods. In this way the neurological results are better, the interval of security is greater and the times of extracorporeal circulation are smaller. Even so, it is necessary to take into account that there is the possibility of ischemia in the lower part of the body, especially of the abdominal viscera and the spinal cord, therefore the time of circulatory stop should be limited and not to exceed 80 minutes. Evidence of possible neurological drug protection is very weak and only mannitol, magnesium, and statins can produce some benefit. Inhalational anesthetics and some intravenous seem to have advantages, but more studies would be needed to test their long-term benefit. Other important parameters to be monitored during these procedures are blood glucose, anemia and coagulation disorders and acid-base balance. The recommended monitoring is common in complex cardiovascular procedures and it is of special importance the neurological monitoring that can be performed with several techniques, although currently the most used are Bispectral Index (BIS) and Near-Infrared Spectroscopy (NIRS). It is also essential to monitor the temperature routinely at the nasopharyngeal and bladder level and it is important to control coagulation with rotational thromboelastometry (ROTEM).

  4. Pattern of perioperative cardiac arrests at University of Maiduguri Teaching Hospital. (United States)

    Kwari, Y D; Bello, M R; Eni, U E


    Perioperative cardiac arrests and death on the table represent the most serious complications of surgery and anaesthesia. This paper was designed to study their pattern, causes and outcomes following cardiopulmonary resuscitation (CPR) and intensive care unit (ICU) management in our institution. Three year retrospective review of perioperative cardiac arrests and death on operating table following surgical procedure under anaesthesia. For each cardiac arrest or death on the table the sequence of events leading to the arrest was evaluated using case notes, anaesthetic chart and ICU records. Study variables which include demographic data, ASA score, anaesthetic technique, causes and outcome were analysed and discussed. Fourteen perioperative cardiac arrests were encountered following 4051 anaesthetics administered over the three year study period. Twelve out of the fourteen cardiac arrests occurred following general anaesthesia, while the remaining two occurred following spinal anaesthesia. There was no cardiac arrest following local anaesthesia. Children suffered more cardiac arrest than adults. ASA class III and IV risk status suffered more arrests than ASA I and II. Hypoxia from airway problems was the commonest cause of cardiac arrest followed by septic shock. Monitoring with pulse oximeter was done in only 4 out of the 14 cardiac arrests. Only 2 (14%) out of 14 cardiac arrests recovered to home discharge, one of them with significant neurological deficit. Majority of arrests were due to hypoxia from airway problems that were not detected early There is need to improve on patient monitoring, knowledge of CPR and intensive care so as to improve the outcome of perioperative cardiac arrest.

  5. Dynamic provisioning for community services

    CERN Document Server

    Qi, Li


    Dynamic Provisioning for Community Services outlines a dynamic provisioning and maintenance mechanism in a running distributed system, e.g. the grid, which can be used to maximize the utilization of computing resources and user demands. The book includes a complete and reliable maintenance system solution for the large-scale distributed system and an interoperation mechanism for the grid middleware deployed in the United States, Europe, and China. The experiments and evaluations have all been practically implemented for ChinaGrid, and the best practices established can help readers to construc

  6. Optimal Provision of Public Goods

    DEFF Research Database (Denmark)

    Kreiner, Claus Thustrup; Verdelin, Nicolaj


    There currently exist two competing approaches in the literature on the optimal provision of public goods. The standard approach highlights the importance of distortionary taxation and distributional concerns. The new approach neutralizes distributional concerns by adjusting the non-linear income...... for the optimal level of a public good without imposing strong assumptions on preferences. This formula shows that distortionary taxation may have a role to play as in the standard approach. However, the main determinants of optimal provision are completely different and the traditional formula with its emphasis...

  7. Fracture mechanical modeling of brittle crack propagation and arrest of steel. 3. Application to duplex-type test; Kozai no zeisei kiretsu denpa teisi no rikigaku model. 3. Konseigata shiken eno tekiyo

    Energy Technology Data Exchange (ETDEWEB)

    Aihara, S.; Tsuchida, Y. [Nippon Steel Corp., Tokyo (Japan); Machida, S.; Yoshinari, H. [The University of Tokyo, Tokyo (Japan). Faculty of Engineering


    A proposal was made previously on a model of brittle crack propagation and arrest that considers the effect of crack opening suppression by using unbroken ligaments generated on steel plate surface and the effect that cracks precede in the central part of the plate thickness, based on a local limit stress theory for brittleness fracture. This paper discusses applicability of this model to a mixed type test, and elucidates causes for difference in the arrest tenacity of both types in a double tensile test of the standard size. The brittle crack propagation and arrest model based on the local limit stress theory was found applicable to a simulation of the mixed type test. Experimental crack propagation speed history and behavior of the arrest were reproduced nearly completely by using this model. When load stress is increased, the arrests in the mixed type test may be classified into arrests of both inside the steel plate and near the surface, cracks in the former position or arrest in the latter position, and rush of cracks into both positions. Furthermore, at higher stresses, the propagation speed drops once after cracks rushed into the test plate, but turns to a rise, leading to propagation and piercing. 8 refs., 15 figs., 3 tabs.

  8. Fracture mechanical modeling of brittle crack propagation and arrest of steel. 3. Application to duplex-type test; Kozai no zeisei kiretsu denpa teisi no rikigaku model. 3. Konseigata shiken eno tekiyo

    Energy Technology Data Exchange (ETDEWEB)

    Aihara, S; Tsuchida, Y [Nippon Steel Corp., Tokyo (Japan); Machida, S; Yoshinari, H [The University of Tokyo, Tokyo (Japan). Faculty of Engineering


    A proposal was made previously on a model of brittle crack propagation and arrest that considers the effect of crack opening suppression by using unbroken ligaments generated on steel plate surface and the effect that cracks precede in the central part of the plate thickness, based on a local limit stress theory for brittleness fracture. This paper discusses applicability of this model to a mixed type test, and elucidates causes for difference in the arrest tenacity of both types in a double tensile test of the standard size. The brittle crack propagation and arrest model based on the local limit stress theory was found applicable to a simulation of the mixed type test. Experimental crack propagation speed history and behavior of the arrest were reproduced nearly completely by using this model. When load stress is increased, the arrests in the mixed type test may be classified into arrests of both inside the steel plate and near the surface, cracks in the former position or arrest in the latter position, and rush of cracks into both positions. Furthermore, at higher stresses, the propagation speed drops once after cracks rushed into the test plate, but turns to a rise, leading to propagation and piercing. 8 refs., 15 figs., 3 tabs.

  9. Arrester Resistive Current Measuring System Based on Heterogeneous Network (United States)

    Zhang, Yun Hua; Li, Zai Lin; Yuan, Feng; Hou Pan, Feng; Guo, Zhan Nan; Han, Yue


    Metal Oxide Arrester (MOA) suffers from aging and poor insulation due to long-term impulse voltage and environmental impact, and the value and variation tendency of resistive current can reflect the health conditions of MOA. The common wired MOA detection need to use long cables, which is complicated to operate, and that wireless measurement methods are facing the problems of poor data synchronization and instability. Therefore a novel synchronous measurement system of arrester current resistive based on heterogeneous network is proposed, which simplifies the calculation process and improves synchronization, accuracy and stability and of the measuring system. This system combines LoRa wireless network, high speed wireless personal area network and the process layer communication, and realizes the detection of arrester working condition. Field test data shows that the system has the characteristics of high accuracy, strong anti-interference ability and good synchronization, which plays an important role in ensuring the stable operation of the power grid.

  10. Cardiac arrest following ventilator fire: A rare cause

    Directory of Open Access Journals (Sweden)

    K Nazeer Ahmed


    Full Text Available Operating room fires are rare events, but when occur they result in serious and sometimes fatal consequences. Anaesthesia ventilator fire leading to cardiac arrest is a rare incident and has not been reported. We report a near catastrophic ventilator fire leading to cardiac arrest in a patient undergoing subtotal thyroidectomy. In the present case sparks due to friction or electrical short circuit within the ventilator might have acted as source of ignition leading to fire and explosion in the oxygen rich environment. The patient was successfully resuscitated and revived with uneventful recovery and no adverse sequelae. The cardiac arrest was possibly due to severe hypoxia resulting from inhalation of smoke containing high concentrations of carbon monoxide and other noxious gases.

  11. Crack arrest toughness measurements with A533B steel

    International Nuclear Information System (INIS)

    Salonen, Seppo.


    This work covers crack arrest toughness measurements on A533B steel done at the Technical Research Centre of Finland. These measurements are one part of a multinational effort, involving 30 laboratories. The aim of the cooperative test program is to examine two test procedures for measuring the crack arrest toughness, to give information about their reproducibility, and to identify the factors affecting the interpretation. The principles given for the testing were easy to apply in general and the results were satisfactory. Some factors in the test runs and in the specimen's behaviour are indicated which can cause error in the results or make implementation of the test more difficult. By comparing the results from our laboratory with average values from the test program a good agreement can be seen. Crack arrest toughness values derived from the compared procedures with a static analysis agree closely, but values calculated using a dynamic analysis differ considerably. (author)

  12. Provision of genetics services on Guam. (United States)

    McWalter, Kirsty; Hasegawa, Lianne; Au, Sylvia Mann


    Guam's geographic isolation and lack of community resources have resulted in unique healthcare needs. In 2006, the Western States Genetic Services Collaborative (WSGSC) conducted a genetics needs assessment and found that professional development is limited, families lack access to genetic services, and improved coverage of genetic testing is needed. With funding from the WSGSC, a Guam genetics outreach clinic was established and staffed by genetic counselors and a medical geneticist from Hawaii. Four clinics have been held to date. Although several challenges have been encountered, including minimal coverage of genetic testing by Guam insurance companies, limited referrals for families with private insurance, and inappropriate referral indications, the outreach clinic has been successful at increasing access to genetic services and improving professional development. With more collaborative work by staff from Guam, Hawaii, and the WSGSC, provision and reimbursement of genetic services and testing will continue to improve.

  13. A crack arrest test using a toughness gradient steel plate

    International Nuclear Information System (INIS)

    Okamura, H.; Yagawa, G.; Urabe, Y.; Satoh, M.; Sano, J.


    Pressurized thermal shock (PTS) is a phenomenon that can occur in the reactor pressure vessels (RPVs) with internal pressure and is one of the most severe stress conditions that can be applied to the vessel. Preliminary research has shown that no PTS concern is likely to exist on Japanese RPVs during their design service lives. However, public acceptance of vessel integrity requires analyses and experiment in order to establish an analytical method and a database for life extension of Japanese RPVs. The Japanese PTS integrity study was carried out from FY 1983 to FY 1991 as a national project by Japan Power Engineering and Inspection Corporation (JAPEIC) under contract with Ministry of International Trade and Industry (MITI) in cooperation with LWR utilities and vendors. Here, a crack arrest test was carried out using a toughness gradient steel plate with three layers to study the concept of crack arrest toughness. Four-point bending load with thermal shock was applied to the large flat plate specimen with a surface crack. Five crack initiations and arrests were observed during the test and the propagated crack bifurcated. Finally, cracks were arrested at the boundary of the first and the second layer, except for a small segment of the crack. The first crack initiation took place slightly higher than the lower bound of K Ic data obtained by ITCT specimens. That is, the K IC concept for brittle crack initiation was verified for heavy section steel plates. The first crack arrest took place within the scatter band of K Ia and K Id data for the first layer. That is, the K Ia concept appears applicable for crack arrest of a short crack jump

  14. Provisions for the dismantling of nuclear facilities are sufficient

    International Nuclear Information System (INIS)

    Le Ngoc, B.


    The European Union has assessed the provisions made by the nuclear plant operators to face the future costs of dismantling. The United-Kingdom and the Netherlands are the single E.U. members to have provisions covering the whole of the expenses (respectively 100% and 94%). The figure for France is very low 33% (far below the European average of 56%). According to French authorities the provisions for the dismantling of nuclear facilities are strictly defined by law: they must be made progressively till the decommissioning and they must be composed by dedicated assets. The costs of the dismantling is regularly re-assessed for taking into account technological progress and changes in regulation. Furthermore the French system limits the period in which provisions are made to the initial operating life of the plant: mostly 40 years which is a prudent measure. In other E.U. members like Germany, the provisions are not covered by dedicated assets which might endanger the capacity of the operator to face the future costs. The progressiveness of the French systems of provision-making is fair because the dismantling costs are spread equally over the entire operating period of the facility. (A.C.)

  15. 75 FR 15777 - Common Crop Insurance Regulations, Basic Provisions; and Various Crop Insurance Provisions (United States)


    ... (protection for production losses only) within one Basic Provisions and the applicable Crop Provisions to..., Macadamia Nut Crop Insurance Provisions, Onion Crop Insurance Provisions, Dry Pea Crop Insurance Provisions... (protection for production losses only) and revenue protection (protection against loss of revenue caused by...

  16. Complete maternal and fetal recovery after prolonged cardiac arrest. (United States)

    Selden, B S; Burke, T J


    A case of complete maternal and fetal recovery after prolonged cardiac arrest from massive lidocaine overdose is presented. A 27-year-old woman at 15 weeks gestation had a complete neurologic recovery after 22 minutes of CPR, including 19 minutes of electromechanical dissociation and asystole, with normal fetal heart function and fetal motion confirmed by ultrasound immediately after resuscitation. The patient delivered a healthy and neurologically normal infant at 40 weeks gestation. This is the longest cardiac arrest in early pregnancy reported in the medical literature with normal maternal and fetal outcome.

  17. Hemodynamics and vasopressor support in therapeutic hypothermia after cardiac arrest

    DEFF Research Database (Denmark)

    Bro-Jeppesen, John; Kjaergaard, Jesper; Søholm, Helle


    AIM: Inducing therapeutic hypothermia (TH) in Out-of-Hospital Cardiac Arrest (OHCA) can be challenging due to its impact on central hemodynamics and vasopressors are frequently used to maintain adequate organ perfusion. The aim of this study was to assess the association between level of vasopres......AIM: Inducing therapeutic hypothermia (TH) in Out-of-Hospital Cardiac Arrest (OHCA) can be challenging due to its impact on central hemodynamics and vasopressors are frequently used to maintain adequate organ perfusion. The aim of this study was to assess the association between level...

  18. Out-of-Hospital Cardiac Arrest in Denmark

    DEFF Research Database (Denmark)

    Wissenberg Jørgensen, Mads

    challenges, due to the victim’s physical location, which brings an inherent risk of delay (or altogether absence) of recognition and treatment of cardiac arrest. A low frequency of bystander cardiopulmonary resuscitation and low 30-day survival after out-of-hospital cardiac arrest were identified nearly ten...... years ago in Denmark. These findings led to several national initiatives to strengthen bystander resuscitation attempts and advance care. Despite these nationwide efforts, it was unknown prior to this project whether these efforts resulted in changes in resuscitation attempts by bystanders and changes...

  19. Bereavement Care Provision in Europe

    DEFF Research Database (Denmark)

    Guldin, Mai-Britt; Murphy, Irene; Keegan, Orla


    The Bereavement Care Taskforce of the EAPC has conducted a survey on bereavement care service provision in Europe. Mai-Britt Guldin, Irene Murphy, Orla Keegan, Barbara Monroe, Maria Antonia Lacasta Reverte and Inger Benkel report on the results. One of the key findings is that not all palliative...

  20. Recognising out-of-hospital cardiac arrest during emergency calls increases bystander cardiopulmonary resuscitation and survival. (United States)

    Viereck, Søren; Møller, Thea Palsgaard; Ersbøll, Annette Kjær; Bækgaard, Josefine Stokholm; Claesson, Andreas; Hollenberg, Jacob; Folke, Fredrik; Lippert, Freddy K


    Initiation of early bystander cardiopulmonary resuscitation (CPR) depends on bystanders' or medical dispatchers' recognition of out-of-hospital cardiac arrest (OHCA). The primary aim of our study was to investigate if OHCA recognition during the emergency call was associated with bystander CPR, return of spontaneous circulation (ROSC), and 30-day survival. Our secondary aim was to identify patient-, setting-, and dispatcher-related predictors of OHCA recognition. We performed an observational study of all OHCA patients' emergency calls in the Capital Region of Denmark from 01/01/2013-31/12/2013. OHCAs were collected from the Danish Cardiac Arrest Registry and the Mobile Critical Care Unit database. Emergency call recordings were identified and evaluated. Multivariable logistic regression analyses were applied to all OHCAs and witnessed OHCAs only to analyse the association between OHCA recognition and bystander CPR, ROSC, and 30-day survival. Univariable logistic regression analyses were applied to identify predictors of OHCA recognition. We included 779 emergency calls in the analyses. During the emergency calls, 70.1% (n=534) of OHCAs were recognised; OHCA recognition was positively associated with bystander CPR (odds ratio [OR]=7.84, 95% confidence interval [CI]: 5.10-12.05) in all OHCAs; and ROSC (OR=1.86, 95% CI: 1.13-3.06) and 30-day survival (OR=2.80, 95% CI: 1.58-4.96) in witnessed OHCA. Predictors of OHCA recognition were addressing breathing (OR=1.76, 95% CI: 1.17-2.66) and callers located by the patient's side (OR=2.16, 95% CI: 1.46-3.19). Recognition of OHCA during emergency calls was positively associated with the provision of bystander CPR, ROSC, and 30-day survival in witnessed OHCA. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.


    African Journals Online (AJOL)

    resistant design of structures in Ethiopia have been made available since the' time of release of the three-volume. Ethiopian Standard Code of Practice (ESCP) in. 1983. The seismic provisions in this code occupied only few pages in the small volume for loading,. 'ESCP 1, and were limited to pseudo-static analysis.

  2. 7 CFR 457.140 - Dry pea crop insurance provisions. (United States)


    ... of the Basic Provisions that limit the amount of a replant payment to the actual cost of replanting... present that are identified by the Food and Drug Administration or other public health organizations of... feasible. We may obtain prices from any buyer of our choice. If we obtain prices from one or more buyers...

  3. Provision of RPA advice to users of minor radioactive sources

    International Nuclear Information System (INIS)

    French, A.P.; Anderson, A.G.


    The problems of providing cost effective Radiation Protection Supervisor (RPS) training and appropriate storage for minor radioactive sources are discussed. Threshold limits of radioactive holdings are proposed, above which an RPS should be formally trained and specialised source storage facilities provided. Proposals are made for the provision of practical radiation protection advice without need of a detailed hazard assessment. (author)

  4. Cell fate after mitotic arrest in different tumor cells is determined by the balance between slippage and apoptotic threshold

    Energy Technology Data Exchange (ETDEWEB)

    Galán-Malo, Patricia; Vela, Laura; Gonzalo, Oscar; Calvo-Sanjuán, Rubén; Gracia-Fleta, Lucía; Naval, Javier; Marzo, Isabel, E-mail:


    Microtubule poisons and other anti-mitotic drugs induce tumor death but the molecular events linking mitotic arrest to cell death are still not fully understood. We have analyzed cell fate after mitotic arrest produced by the microtubule-destabilizing drug vincristine in a panel of human tumor cell lines showing different response to vincristine. In Jurkat, RPMI 8226 and HeLa cells, apoptosis was triggered shortly after vincristine-induced mitotic arrest. However, A549 cells, which express a great amount of Bcl-x{sub L} and undetectable amounts of Bak, underwent mitotic slippage prior to cell death. However, when Bcl-x{sub L} gene was silenced in A549 cells, vincristine induced apoptosis during mitotic arrest. Another different behavior was found in MiaPaca2 cells, where vincristine caused death by mitotic catastrophe that switched to apoptosis when cyclin B1 degradation was prevented by proteasome inhibition. Overexpression of Bcl-x{sub L} or silencing Bax and Bak expression delayed the onset of apoptosis in Jurkat and RPMI 8226 cells, enabling mitotic slippage and endoreduplication. In HeLa cells, overexpression of Bcl-x{sub L} switched cell death from apoptosis to mitotic catastrophe. Mcl-1 offered limited protection to vincristine-induced cell death and Mcl-1 degradation was not essential for vincristine-induced death. All these results, taken together, indicate that the Bcl-x{sub L}/Bak ratio and the ability to degrade cyclin B1 determine cell fate after mitotic arrest in the different tumor cell types. Highlights: ► Vincristine induces cell death by apoptosis or mitotic catastrophe. ► Apoptosis-proficient cells die by apoptosis during mitosis upon vincristine treatment. ► p53wt apoptosis-deficient cells undergo apoptosis from a G1-like tetraploid state. ► p53mt apoptosis-deficient cells can survive and divide giving rise to 8N cells.

  5. Standardized EEG interpretation accurately predicts prognosis after cardiac arrest

    NARCIS (Netherlands)

    Westhall, Erik; Rossetti, Andrea O.; van Rootselaar, Anne-Fleur; Wesenberg Kjaer, Troels; Horn, Janneke; Ullén, Susann; Friberg, Hans; Nielsen, Niklas; Rosén, Ingmar; Åneman, Anders; Erlinge, David; Gasche, Yvan; Hassager, Christian; Hovdenes, Jan; Kjaergaard, Jesper; Kuiper, Michael; Pellis, Tommaso; Stammet, Pascal; Wanscher, Michael; Wetterslev, Jørn; Wise, Matt P.; Cronberg, Tobias; Saxena, Manoj; Miller, Jennene; Inskip, Deborah; Macken, Lewis; Finfer, Simon; Eatough, Noel; Hammond, Naomi; Bass, Frances; Yarad, Elizabeth; O'Connor, Anne; Bird, Simon; Jewell, Timothy; Davies, Gareth; Ng, Karl; Coward, Sharon; Stewart, Antony; Micallef, Sharon; Parker, Sharyn; Cortado, Dennis; Gould, Ann; Harward, Meg; Thompson, Kelly; Glass, Parisa; Myburgh, John; Smid, Ondrej; Belholavek, Jan; Juffermans, Nicole P.; Boerma, EC


    To identify reliable predictors of outcome in comatose patients after cardiac arrest using a single routine EEG and standardized interpretation according to the terminology proposed by the American Clinical Neurophysiology Society. In this cohort study, 4 EEG specialists, blinded to outcome,

  6. Ventilation and gas exchange management after cardiac arrest. (United States)

    Sutherasan, Yuda; Raimondo, Pasquale; Pelosi, Paolo


    For several decades, physicians had integrated several interventions aiming to improve the outcomes in post-cardiac arrest patients. However, the mortality rate after cardiac arrest is still as high as 50%. Post-cardiac arrest syndrome is associated with high morbidity and mortality due to not only poor neurological outcome and cardiovascular failure but also respiratory dysfunction. To minimize ventilator-associated lung injury, protective mechanical ventilation by using low tidal volume ventilation and driving pressure may decrease pulmonary complications and improve survival. Low level of positive end-expiratory pressure (PEEP) can be initiated and titrated with careful cardiac output and respiratory mechanics monitoring. Furthermore, optimizing gas exchange by avoiding hypoxia and hyperoxia as well as maintaining normocarbia may improve neurological and survival outcome. Early multidisciplinary cardiac rehabilitation intervention is recommended. Minimally invasive monitoring techniques, that is, echocardiography, transpulmonary thermodilution method measuring extravascular lung water, as well as transcranial Doppler ultrasound, might be useful to improve appropriate management of post-cardiac arrest patients. Copyright © 2015 Elsevier Ltd. All rights reserved.

  7. Endothelial Dysfunction in Resuscitated Cardiac Arrest (ENDO-RCA)

    DEFF Research Database (Denmark)

    Meyer, Anna Sina P; Ostrowski, Sisse Rye; Kjærgaard, Jesper


    BACKGROUND: Morbidity and mortality following initial survival of cardiac arrest remain high despite great efforts to improve resuscitation techniques and post-resuscitation care, in part due to the ischemia-reperfusion injury secondary to the restoration of the blood circulation. Patients resusc...

  8. 19 CFR 162.63 - Arrests and seizures. (United States)


    ... 19 Customs Duties 2 2010-04-01 2010-04-01 false Arrests and seizures. 162.63 Section 162.63 Customs Duties U.S. CUSTOMS AND BORDER PROTECTION, DEPARTMENT OF HOMELAND SECURITY; DEPARTMENT OF THE TREASURY (CONTINUED) INSPECTION, SEARCH, AND SEIZURE Controlled Substances, Narcotics, and Marihuana § 162...

  9. Crack arrest toughness of structural steels evaluated by compact test

    International Nuclear Information System (INIS)

    Nakano, Yoshifumi; Tanaka, Michihiro


    Crack arrest tests such as compact, ESSO and DCB tests were made on SA533B Cl. 1, HT80 and KD32 steels to evaluate the crack arrest toughness. The main results obtained are as follows: (1) The crack arrest toughness could be evaluated by K sub(Ia) which was obtained by the static analysis of compact test. (2) K sub(ID) determined by the dynamic analysis of compact test was greater than K sub(Ia), though K sub(ID) became close to K sub(Ia)/K sub(Q) became a unity where K sub(Q) is the stress intensity factor at the crack initiation. (3) No significant difference was observed between K sub(Ia) and K sub(ca) obtained by ESSO and DCB tests, though K sub(ca) obtained by DCB test tended to be smaller than K sub(Ia) at lower temperatures. (4) K sub(Ia) was smaller than K sub(Ic) in the transition temperature range, while it was greater than K sub(Id). In the temperature range where K sub(Ic), which was determined from J sub(Ic), decreased with temperature increase, however, it was smaller than K sub(Ia). (5) The fracture appearance transition temperature and the absorbed energy obtained by 2 mm V-notch Charpy test were appropriate parameters for representing the crack arrest toughness, while the NDT temperature was not. (author)

  10. Growth arrest despite growth hormone replacement, post-craniopharyngioma surgery. (United States)

    DeVile, C J; Hayward, R D; Neville, B G; Grant, D B; Stanhope, R


    Children with growth failure, whether secondary to an endocrinopathy such as growth hormone deficiency or secondary to neurological handicap with poor nutrient intake, grow at a subnormal rate but it is most unusual for a child to have complete growth arrest. PMID:7745571

  11. Carbamazepine induces mitotic arrest in mammalian Vero cells

    International Nuclear Information System (INIS)

    Perez Martin, J.M.; Fernandez Freire, P.; Labrador, V.; Hazen, M.J.


    We reported recently that the anticonvulsant drug carbamazepine, at supratherapeutic concentrations, exerts antiproliferative effects in mammalian Vero cells, but the underlying mechanism has not been elucidated. This motivates us to examine rigorously whether growth arrest was associated with structural changes in cellular organization during mitosis. In the present work, we found that exposure of the cells to carbamazepine led to an increase in mitotic index, mainly due to the sustained block at the metaphase/anaphase boundary, with the consequent inhibition of cell proliferation. Indirect immunofluorescence, using antibodies directed against spindle apparatus proteins, revealed that mitotic arrest was associated with formation of monopolar spindles, caused by impairment of centrosome separation. The final consequence of the spindle defects induced by carbamazepine, depended on the duration of cell cycle arrest. Following the time course of accumulation of metaphase and apoptotic cells during carbamazepine treatments, we observed a causative relationship between mitotic arrest and induction of cell death. Conversely, cells released from the block of metaphase by removal of the drug, continued to progress through mitosis and resume normal proliferation. Our results show that carbamazepine shares a common antiproliferative mechanism with spindle-targeted drugs and contribute to a better understanding of the cytostatic activity previously described in Vero cells. Additional studies are in progress to extend these initial findings that define a novel mode of action of carbamazepine in cultured mammalian cells

  12. Cdc20 control of cell fate during prolonged mitotic arrest

    DEFF Research Database (Denmark)

    Nilsson, Jakob


    The fate of cells arrested in mitosis by antimitotic compounds is complex but is influenced by competition between pathways promoting cell death and pathways promoting mitotic exit. As components of both of these pathways are regulated by Cdc20-dependent degradation, I hypothesize that variations...

  13. Outcomes After Cardiac Arrest in an Adult Burn Center (United States)


    of in-hospital CA are likely to report widely varying survival rates as a result of study populations with characteristic but distinct demo- graphics ...Rehabil 1997;18:S119. [2] Sandroni C, Nolan J. In-hospital cardiac arrest: incidence, prognosis and possible measures to improve survival. Intens Care Med

  14. Trichostrongylus colubriformis rDNA polymorphism associated with arrested development

    Czech Academy of Sciences Publication Activity Database

    Langrová, I.; Zouhar, M.; Vadlejch, J.; Borovský, M.; Jankovská, I.; Lytvynets, Andrej


    Roč. 103, č. 2 (2008), s. 401-403 ISSN 0932-0113 Institutional research plan: CEZ:AV0Z50110509 Keywords : arrested development * polymorphism * rDNA Subject RIV: EB - Genetics ; Molecular Biology Impact factor: 1.473, year: 2008

  15. Carbamazepine induces mitotic arrest in mammalian Vero cells

    Energy Technology Data Exchange (ETDEWEB)

    Perez Martin, J.M.; Fernandez Freire, P.; Labrador, V. [Departamento de Biologia, Facultad de Ciencias, Universidad Autonoma de Madrid, Cantoblanco, 28049 Madrid (Spain); Hazen, M.J. [Departamento de Biologia, Facultad de Ciencias, Universidad Autonoma de Madrid, Cantoblanco, 28049 Madrid (Spain)], E-mail:


    We reported recently that the anticonvulsant drug carbamazepine, at supratherapeutic concentrations, exerts antiproliferative effects in mammalian Vero cells, but the underlying mechanism has not been elucidated. This motivates us to examine rigorously whether growth arrest was associated with structural changes in cellular organization during mitosis. In the present work, we found that exposure of the cells to carbamazepine led to an increase in mitotic index, mainly due to the sustained block at the metaphase/anaphase boundary, with the consequent inhibition of cell proliferation. Indirect immunofluorescence, using antibodies directed against spindle apparatus proteins, revealed that mitotic arrest was associated with formation of monopolar spindles, caused by impairment of centrosome separation. The final consequence of the spindle defects induced by carbamazepine, depended on the duration of cell cycle arrest. Following the time course of accumulation of metaphase and apoptotic cells during carbamazepine treatments, we observed a causative relationship between mitotic arrest and induction of cell death. Conversely, cells released from the block of metaphase by removal of the drug, continued to progress through mitosis and resume normal proliferation. Our results show that carbamazepine shares a common antiproliferative mechanism with spindle-targeted drugs and contribute to a better understanding of the cytostatic activity previously described in Vero cells. Additional studies are in progress to extend these initial findings that define a novel mode of action of carbamazepine in cultured mammalian cells.

  16. Anaphylactic shock and cardiac arrest caused by thiamine infusion

    DEFF Research Database (Denmark)

    Juel, Jacob; Pareek, Manan; Langfrits, Christian Sigvald


    intoxication and developed cardiac arrest due to anaphylactic shock following intravenous thiamine infusion. The patient was successfully resuscitated after 15 min and repeated epinephrine administrations. He was discharged in good health after 14 days. This case report emphasises both the importance...

  17. Lupeol induces S-phase arrest and mitochondria-mediated ...

    Indian Academy of Sciences (India)


    Lupeol induces S-phase arrest and mitochondria-mediated apoptosis in cervical cancer cells. Nupoor Prasad1, Akash Sabarwal2, Umesh C. S. Yadav1, Rana P. Singh2,*. 1School of Life Sciences, Central University of Gujarat, Gandhinagar, Gujarat, India. 2Cancer Biology Laboratory, School of Life Sciences, Jawaharlal ...

  18. Cardiac Arrest after Local Anaesthetic Toxicity in a Paediatric Patient

    Directory of Open Access Journals (Sweden)

    Liana Maria Torres de Araújo Azi


    Full Text Available We report a case of a paediatric patient undergoing urological procedure in which a possible inadvertent intravascular or intraosseous injection of bupivacaine with adrenaline in usual doses caused subsequent cardiac arrest, completely reversed after administration of 20% intravenous lipid emulsion. Early diagnosis of local anaesthetics toxicity and adequate cardiovascular resuscitation manoeuvres contribute to the favourable outcome.

  19. Offenders' Perceptions of House Arrest and Electronic Monitoring (United States)

    Martin, Jamie S.; Hanrahan, Kate; Bowers, James H., Jr.


    This article reports on a study designed to examine the perceptions of house arrest (HA) and electronic monitoring (EM) among offenders who have recently experienced this criminal sentence. Data were gathered via a self-administered questionnaire and follow-up interviews with a sample of offenders. Our primary areas of interest were to assess (a)…

  20. Is Ward Experience in Resuscitation Effort Related to the Prognosis of Unexpected Cardiac Arrest?

    Directory of Open Access Journals (Sweden)

    Sen-Kuang Hou


    Conclusion: Hospital wards with more than 5 cardiac arrests per year have a better patient survival rate than those with fewer arrests. This is despite all ward staff receiving the same level of training.

  1. The geometry of empty space is the key to arresting dynamics

    Energy Technology Data Exchange (ETDEWEB)

    Lawlor, Aonghus; De Gregorio, Paolo; Dawson, K A [Department of Chemistry, University College Dublin, Irish Centre for Colloid Science and Biomaterials, Belfield, Dublin 4 (Ireland)


    We present the concept of dynamically available volume as a suitable order parameter for dynamical arrest. We show that dynamical arrest can be understood as a de-percolation transition of a vacancy network or available space. Beyond the arrest transition we find that droplets of available space are disconnected and the dynamics is frozen. This connection of the dynamics to the underlying geometrical structure of empty space provides us with a rich framework for studying the arrest transition.

  2. Crack propagation and arrest simulation of X90 gas pipe

    International Nuclear Information System (INIS)

    Yang, Fengping; Huo, Chunyong; Luo, Jinheng; Li, He; Li, Yang


    To determine whether X90 steel pipe has enough crack arrest toughness or not, a damage model was suggested as crack arrest criterion with material parameters of plastic uniform percentage elongation and damage strain energy per volume. Fracture characteristic length which characterizes fracture zone size was suggested to be the largest mesh size on expected cracking path. Plastic uniform percentage elongation, damage strain energy per volume and fracture characteristic length of X90 were obtained by five kinds of tensile tests. Based on this criterion, a length of 24 m, Φ1219 × 16.3 mm pipe segment model with 12 MPa internal gas pressure was built and computed with fluid-structure coupling method in ABAQUS. Ideal gas state equation was used to describe lean gas behavior. Euler grid was used to mesh gas zone inside the pipe while Lagrangian shell element was used to mesh pipe. Crack propagation speed and gas decompression speed were got after computation. The result shows that, when plastic uniform percentage elongation is equal to 0.054 and damage strain energy per volume is equal to 0.64 J/mm"3, crack propagation speed is less than gas decompression speed, which means the simulated X90 gas pipe with 12 MPa internal pressure can arrest cracking itself. - Highlights: • A damage model was suggested as crack arrest criterion. • Plastic uniform elongation and damage strain energy density are material parameters. • Fracture characteristic length is suggested to be largest mesh size in cracking path. • Crack propagating simulation with coupling of pipe and gas was realized in ABAQUS. • A Chinese X90 steel pipe with 12 MPa internal pressure can arrest cracking itself.

  3. Experimental investigation of interfacial crack arrest in sandwich beams subjected to fatigue loading using a novel crack arresting device

    DEFF Research Database (Denmark)

    Martakos, G.; Andreasen, J.H.; Berggreen, Christian


    A recently proposed face-sheet–core interface crack arresting device is implemented in sandwich beams and tested using the Sandwich Tear Test configuration. Fatigue loading conditions are applied to propagate the crack and determine the effect of the crack stopper on the fatigue growth rate and a...

  4. 30 CFR 75.521 - Lightning arresters; ungrounded and exposed power conductors and telephone wires. (United States)


    ... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Lightning arresters; ungrounded and exposed... Electrical Equipment-General § 75.521 Lightning arresters; ungrounded and exposed power conductors and... leads underground shall be equipped with suitable lightning arresters of approved type within 100 feet...

  5. Gender and Relational-Distance Effects in Arrests for Domestic Violence (United States)

    Lally, William; DeMaris, Alfred


    This study tests two hypotheses regarding factors affecting arrest of the perpetrator in domestic violence incidents. Black's relational-distance thesis is that the probability of arrest increases with increasing relational distance between perpetrator and victim. Klinger's leniency principle suggests that the probability of arrest is lower for…

  6. Competition policy for health care provision in Norway. (United States)

    Brekke, Kurt R; Straume, Odd Rune


    Competition policy has played a very limited role for health care provision in Norway. The main reason is that Norway has a National Health Service (NHS) with extensive public provision and a wide set of sector-specific regulations that limit the scope for competition. However, the last two decades, several reforms have deregulated health care provision and opened up for provider competition along some dimensions. For specialised care, the government has introduced patient choice and (partly) activity (DRG) based funding, but also corporatised public hospitals and allowed for more private provision. For primary care, a reform changed the payment scheme to capitation and (a higher share of) fee-for-service, inducing almost all GPs on fixed salary contracts to become self-employed. While these reforms have the potential for generating competition in the Norwegian NHS, the empirical evidence is quite limited and the findings are mixed. We identify a set of possible caveats that may weaken the incentives for provider competition - such as the partial implementation of DRG pricing, the dual purchaser-provider role of regional health authorities, and the extensive consolidation of public hospitals - and argue that there is great scope for competition policy measures that could stimulate provider competition within the Norwegian NHS. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  7. Crack-arrest behavior in SEN wide plates of low-upper-shelf base metal tested under nonisothermal conditions: WP-2 series

    International Nuclear Information System (INIS)

    Naus, D.J.; Keeney-Walker, J.; Bass, B.R.; Robinson, G.C. Jr.; Iskander, S.K.; Alexander, D.J.; Fields, R.J.; deWit, R.; Low, S.R.; Schwartz, C.W.


    The Heavy-Section Steel Technology (HSST) Program at the Oak Ridge National Laboratory under the sponsorship of the Nuclear Regulatory Commission is conducting analytical and experimental studies aimed at understanding the circumstances that would initiate the growth of an existing crack in a reactor pressure vessel (RPV) and the conditions leading to arrest of a propagating crack. Objectives of these studies are to determine (1) if the material will exhibit crack-arrest behavior when the driving force on a crack exceeds the ASME limit, (2) the relationship between K Ia and temperature, and (3) the interaction of fracture modes (arrest, stable crack growth, unstable crack growth, and tensile instability) when arrest occurs at high temperatures. In meeting these objectives, crack-arrest data are being developed over an expanded temperature range through tests involving large thermally shocked cylinders, pressurized thermally shocked vessels, and wide-plate specimens. The wide-plate specimens provide the opportunity for a significant number of data points to be obtained at relatively affordable costs. These tests are designed to provide fracture-toughness measurements approaching or above the onset of the Charpy upper-shelf regime in a rising toughness region and with an increasing driving force. This document discusses test methodology and results. 23 refs., 92 figs., 25 tabs

  8. A conceptual framework to assess effectiveness in wheelchair provision (United States)

    Kankipati, Padmaja


    Background Currently, inadequate wheelchair provision has forced many people with disabilities to be trapped in a cycle of poverty and deprivation, limiting their ability to access education, work and social facilities. This issue is in part because of the lack of collaboration among various stakeholders who need to work together to design, manufacture and deliver such assistive mobility devices. This in turn has led to inadequate evidence about intervention effectiveness, disability prevalence and subsequent costeffectiveness that would help facilitate appropriate provision and support for people with disabilities. Objectives In this paper, we describe a novel conceptual framework that can be tested across the globe to study and evaluate the effectiveness of wheelchair provision. Method The Comparative Effectiveness Research Subcommittee (CER-SC), consisting of the authors of this article, housed within the Evidence-Based Practice Working Group (EBP-WG) of the International Society of Wheelchair Professionals (ISWP), conducted a scoping review of scientific literature and standard practices used during wheelchair service provision. The literature review was followed by a series of discussion groups. Results The three iterations of the conceptual framework are described in this manuscript. Conclusion We believe that adoption of this conceptual framework could have broad applications in wheelchair provision globally to develop evidence-based practices. Such a perspective will help in the comparison of different strategies employed in wheelchair provision and further improve clinical guidelines. Further work is being conducted to test the efficacy of this conceptual framework to evaluate effectiveness of wheelchair service provision in various settings across the globe. PMID:28936421

  9. Occupational health provision and health surveillance in the semiconductor industry. (United States)

    Kinoulty, Mary; Williams, Nerys


    To identify the nature of occupational health provision in UK semiconductor-manufacturing plants. To identify the level of industry compliance with legal health surveillance requirements. A national inspection programme was carried out by Health & Safety Executive inspectors using a developed protocol. A wide range of occupational health provision was identified from none to use of an accredited specialist. The majority of work was of a reactive nature even where there was specialist occupational health input. Seven companies were identified as not meeting legal compliance and one as having unacceptable compliance for health surveillance. The spectrum of occupational health provision was very wide. Where health surveillance was provided, it was poorly targeted with limited interpretation and feedback to management.

  10. 24 CFR 201.16 - Default provision. (United States)


    ... 24 Housing and Urban Development 2 2010-04-01 2010-04-01 false Default provision. 201.16 Section... PROPERTY IMPROVEMENT AND MANUFACTURED HOME LOANS Loan and Note Provisions § 201.16 Default provision. The... default by the borrower. ...

  11. A practical approach to Events Medicine provision. (United States)

    Smith, Susan P; Cosgrove, Joseph F; Driscoll, Peter J; Smith, Andrew; Butler, John; Goode, Peter; Waldmann, Carl; Vallis, Christopher J; Topham, Fiona; Mythen, Michael Monty


    In the past three decades, mass casualty incidents have occurred worldwide at multiple sporting events and other mass gatherings. Organisational safety and healthcare provision can consequently be scrutinised post-event. Within the UK, such incidents in the 1980s provided incentives to improve medical services and subsequent high profile UK-based international sporting events (London Olympics and Paralympics 2012, Glasgow Commonwealth Games 2014, Rugby World Cup 2015) added a further catalyst for developing services. Furthermore in the aftermath of the abandoned France versus Germany association football match at the Stade de France ( Paris Terrorist Attacks, November 2015) and the 2016 UK report from HM Coroner on the Hillsborough Inquest , medical cover at sporting events is being further reviewed. Doctors providing spectator cover therefore need to have an awareness of their likely roles at sporting venues. Formal guidance exists in many countries for the provision of such cover but remains generic even though Events Medicine is increasingly recognised as a necessary service. The current evidence base is limited with best practice examples often anecdotally cited by acute care specialists (eg, emergency medicine) who provide cover. This article is therefore intended to present an overview for doctors of the knowledge and skills required to treat ill and injured spectators and enable them to adequately risk-assess venues in cooperation with other health and safety providers, including preparation for a major incident. It also gives guidance on how activity can be adequately assessed and how doctors can have management roles in Events Medicine. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to

  12. Benefits of computer screen-based simulation in learning cardiac arrest procedures. (United States)

    Bonnetain, Elodie; Boucheix, Jean-Michel; Hamet, Maël; Freysz, Marc


    What is the best way to train medical students early so that they acquire basic skills in cardiopulmonary resuscitation as effectively as possible? Studies have shown the benefits of high-fidelity patient simulators, but have also demonstrated their limits. New computer screen-based multimedia simulators have fewer constraints than high-fidelity patient simulators. In this area, as yet, there has been no research on the effectiveness of transfer of learning from a computer screen-based simulator to more realistic situations such as those encountered with high-fidelity patient simulators. We tested the benefits of learning cardiac arrest procedures using a multimedia computer screen-based simulator in 28 Year 2 medical students. Just before the end of the traditional resuscitation course, we compared two groups. An experiment group (EG) was first asked to learn to perform the appropriate procedures in a cardiac arrest scenario (CA1) in the computer screen-based learning environment and was then tested on a high-fidelity patient simulator in another cardiac arrest simulation (CA2). While the EG was learning to perform CA1 procedures in the computer screen-based learning environment, a control group (CG) actively continued to learn cardiac arrest procedures using practical exercises in a traditional class environment. Both groups were given the same amount of practice, exercises and trials. The CG was then also tested on the high-fidelity patient simulator for CA2, after which it was asked to perform CA1 using the computer screen-based simulator. Performances with both simulators were scored on a precise 23-point scale. On the test on a high-fidelity patient simulator, the EG trained with a multimedia computer screen-based simulator performed significantly better than the CG trained with traditional exercises and practice (16.21 versus 11.13 of 23 possible points, respectively; p<0.001). Computer screen-based simulation appears to be effective in preparing learners to

  13. Community involvement in out of hospital cardiac arrest (United States)

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


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

  14. Exploring spatial patterns of sudden cardiac arrests in the city of Toronto using Poisson kriging and Hot Spot analyses. (United States)

    Przybysz, Raymond; Bunch, Martin


    Our study looked at out-of-hospital sudden cardiac arrest events in the City of Toronto. These are relatively rare events, yet present a serious global clinical and public health problem. We report on the application of spatial methods and tools that, although relatively well known to geographers and natural resource scientists, need to become better known and used more frequently by health care researchers. Our data came from the population-based Rescu Epistry cardiac arrest database. We limited it to the residents of the City of Toronto who experienced sudden arrest in 2010. The data was aggregated at the Dissemination Area level, and population rates were calculated. Poisson kriging was carried out on one year of data using three different spatial weights. Kriging estimates were then compared in Hot Spot analyses. Spatial analysis revealed that Poisson kriging can yield reliable rates using limited data of high quality. We observed the highest rates of sudden arrests in the north and central parts of Etobicoke, western parts of North York as well as the central and southwestern parts of Scarborough while the lowest rates were found in north and eastern parts of Scarborough, downtown Toronto, and East York as well as east central parts of North York. Influence of spatial neighbours on the results did not extend past two rings of adjacent units. Poisson kriging has the potential to be applied to a wide range of healthcare research, particularly on rare events. This approach can be successfully combined with other spatial methods. More applied research, is needed to establish a wider acceptance for this method, especially among healthcare researchers and epidemiologists.

  15. Multiple recruitment limitation causes arrested succession in mediterranean cork oak systems

    NARCIS (Netherlands)

    Acacio, Vanda; Holmgren, Milena; Jansen, Patrick A.; Schrotter, Ondrej


    Lack of tree regeneration and persistency of species-poor shrublands represent a growing problem across Mediterranean evergreen oak forests. What constrains forest regeneration is poorly understood, and restoration attempts have been largely unsuccessful. We assessed the contribution of four

  16. Summary of HSST wide-plate crack-arrest tests and analyses

    International Nuclear Information System (INIS)

    Naus, D.J.; Bass, B.R.; Keeney-Walker, J.; Fields, R.J.; DeWit, R.; Low, S.R. III


    Eleven wide-plate crack-arrest tests have been completed to date, seven utilizing specimens fabricated from A533B class 1 material (WP-1 series), and four fabricated from a low upper-shelf base material (WP-2 series). With the exception of one test in the WP-1 series and two tests in the WP-2 series which utilized 152-mm-thick specimens, each test utilized a single-edge notched (SEN) plate specimen 1 by 1 by 0.1 m that was subjected to a linear thermal gradient along the plane of crack propagation. Test results exhibit an increase in crack-arrest toughness with temperature, with the rate of increase becoming greater as the temperature increases. When the wide-place test results are combined with other large-specimen results (Japanese ESSO, thermal-shock experiments and pressurized-thermal-shock experiments) the data show a consistent trend in which the K Ia data extends above the limit provided in ASME Section XI. (author)

  17. Toughening of Thermoresponsive Arrested Networks of Elastin-Like Polypeptides To Engineer Cytocompatible Tissue Scaffolds. (United States)

    Glassman, Matthew J; Avery, Reginald K; Khademhosseini, Ali; Olsen, Bradley D


    Formulation of tissue engineering or regenerative scaffolds from simple bioactive polymers with tunable structure and mechanics is crucial for the regeneration of complex tissues, and hydrogels from recombinant proteins, such as elastin-like polypeptides (ELPs), are promising platforms to support these applications. The arrested phase separation of ELPs has been shown to yield remarkably stiff, biocontinuous, nanostructured networks, but these gels are limited in applications by their relatively brittle nature. Here, a gel-forming ELP is chain-extended by telechelic oxidative coupling, forming extensible, tough hydrogels. Small angle scattering indicates that the chain-extended polypeptides form a fractal network of nanoscale aggregates over a broad concentration range, accessing moduli ranging from 5 kPa to over 1 MPa over a concentration range of 5-30 wt %. These networks exhibited excellent erosion resistance and allowed for the diffusion and release of encapsulated particles consistent with a bicontinuous, porous structure with a broad distribution of pore sizes. Biofunctionalized, toughened networks were found to maintain the viability of human mesenchymal stem cells (hMSCs) in 2D, demonstrating signs of osteogenesis even in cell media without osteogenic molecules. Furthermore, chondrocytes could be readily mixed into these gels via thermoresponsive assembly and remained viable in extended culture. These studies demonstrate the ability to engineer ELP-based arrested physical networks on the molecular level to form reinforced, cytocompatible hydrogel matrices, supporting the promise of these new materials as candidates for the engineering and regeneration of stiff tissues.

  18. Crack Arrest Toughness of Two High Strength Steels (AISI 4140 and AISI 4340) (United States)

    Ripling, E. J.; Mulherin, J. H.; Crosley, P. B.


    The crack initiation toughness ( K c ) and crack arrest toughness ( K a ) of AISI 4140 and AISI 4340 steel were measured over a range of yield strengths from 965 to 1240 MPa, and a range of test temperatures from -53 to +74°C. Emphasis was placed on K a testing since these values are thought to represent the minimum toughness of the steel as a function of loading rate. At the same yield strengths and test temperatures, K a for the AISI 4340 was about twice as high as it was for the AISI 4140. In addition, the K a values showed a more pronounced transition temperature than the K c values, when the data were plotted as a function of test temperature. The transition appeared to be associated with a change in fracture mechanism from cleavage to dimpled rupture as the test temperature was increased. The occurrence of a “pop-in” behavior at supertransition temperatures has not been found in lower strength steels, and its evaluation in these high strength steels was possible only because they are not especially tough at their supertransition temperatures. There is an upper toughness limit at which pop-in will not occur, and this was found for the AISI 4340 steel when it was tempered to its lowest yield strength (965 MPa). All the crack arrest data were identified as plane strain values, while only about one-half of the initiation values could be classified this way.

  19. Ketamine infusion for refractory status epilepticus: A case report of cardiac arrest. (United States)

    Koffman, Lauren; Yan Yiu, Ho; Farrokh, Salia; Lewin, John; Geocadin, Romergryko; Ziai, Wendy


    Refractory status epilepticus (RSE) has a high mortality rate and is often difficult to treat. When traditional therapies fail ketamine may be considered. There are limited reports of adverse cardiac events with the use of ketamine for RSE and no reports of cardiac arrest in this context. Evaluate the occurrence of cardiac arrhythmias associated with the use of ketamine for RSE. Retrospective chart review of nine patients who underwent ketamine infusion for RSE. Etiology of refractory status epilepticus included autoimmune/infectious process (Zeiler et al., 2014), ischemic stroke (Bleck, 2005) and subarachnoid hemorrhage (Bleck, 2005). Of the nine patients who received ketamine, two had documented cardiac events; one remained clinically stable and the other developed multiple arrhythmias, including recurrent episodes of asystole. Once ketamine was discontinued the latter patient stabilized with the addition of anti arrhythmic therapy. Ketamine is utilized to treat refractory status epilepticus, but should be used with caution in patients with subarachnoid hemorrhage, as there may be an increased risk of life threatening arrhythmias and cardiac arrest. Copyright © 2017 Elsevier Ltd. All rights reserved.

  20. α-Mangostin Induces Apoptosis and Cell Cycle Arrest in Oral Squamous Cell Carcinoma Cell

    Directory of Open Access Journals (Sweden)

    Hyun-Ho Kwak


    Full Text Available Mangosteen has long been used as a traditional medicine and is known to have antibacterial, antioxidant, and anticancer effects. Although the effects of α-mangostin, a natural compound extracted from the pericarp of mangosteen, have been investigated in many studies, there is limited data on the effects of the compound in human oral squamous cell carcinoma (OSCC. In this study, α-mangostin was assessed as a potential anticancer agent against human OSCC cells. α-Mangostin inhibited cell proliferation and induced cell death in OSCC cells in a dose- and time-dependent manner with little to no effect on normal human PDLF cells. α-Mangostin treatment clearly showed apoptotic evidences such as nuclear fragmentation and accumulation of annexin V and PI-positive cells on OSCC cells. α-Mangostin treatment also caused the collapse of mitochondrial membrane potential and the translocation of cytochrome c from the mitochondria into the cytosol. The expressions of the mitochondria-related proteins were activated by α-mangostin. Treatment with α-mangostin also induced G1 phase arrest and downregulated cell cycle-related proteins (CDK/cyclin. Hence, α-mangostin specifically induces cell death and inhibits proliferation in OSCC cells via the intrinsic apoptosis pathway and cell cycle arrest at the G1 phase, suggesting that α-mangostin may be an effective agent for the treatment of OSCC.

  1. Variations in Mre11/Rad50/Nbs1 status and DNA damage-induced S-phase arrest in the cell lines of the NCI60 panel

    Directory of Open Access Journals (Sweden)

    Eastman Alan


    and S phase arrest, and a series of compounds that may preferentially target S phase-defective cells. We discuss limitations of the COMPARE program when attempting to identify compounds that selectively inhibit only a few cell lines.

  2. Variations in Mre11/Rad50/Nbs1 status and DNA damage-induced S-phase arrest in the cell lines of the NCI60 panel

    International Nuclear Information System (INIS)

    Garner, Kristen M; Eastman, Alan


    The Mre11/Rad50/Nbs1 (MRN) complex is a regulator of cell cycle checkpoints and DNA repair. Defects in MRN can lead to defective S-phase arrest when cells are damaged. Such defects may elicit sensitivity to selected drugs providing a chemical synthetic lethal interaction that could be used to target therapy to tumors with these defects. The goal of this study was to identify these defects in the NCI60 panel of cell lines and identify compounds that might elicit selective cytotoxicity. We screened the NCI60 panel in search of cell lines that express low levels of MRN proteins, or that fail to arrest in S-phase in response to the topisomerase I inhibitor SN38. The NCI COMPARE program was used to discover compounds that preferentially target cells with these phenotypes. HCT116 cells were initially identified as defective in MRN and S phase arrest. Transfection with Mre11 also elevated Rad50 and Nbs1, and rescued the defective S-phase arrest. Cells of the NCI60 panel exhibited a large range of protein expression but a strong correlation existed between Mre11, Rad50 and Nbs1 consistent with complex formation determining protein stability. Mre11 mRNA correlated best with protein level suggesting it was the primary determinant of the overall level of the complex. Three other cell lines failed to arrest in response to SN38, two of which also had low MRN. However, other cell lines with low MRN still arrested suggesting low MRN does not predict an inability to arrest. Many compounds, including a family of benzothiazoles, correlated with the failure to arrest in S phase. The activity of benzothiazoles has been attributed to metabolic activation and DNA alkylation, but we note several cell lines in which sensitivity does not correlate with metabolism. We propose that the checkpoint defect imposes an additional mechanism of sensitivity on cells. We have identified cells with possible defects in the MRN complex and S phase arrest, and a series of compounds that may

  3. Dispatcher instruction of chest compression-only CPR increases actual provision of bystander CPR. (United States)

    Shimamoto, Tomonari; Iwami, Taku; Kitamura, Tetsuhisa; Nishiyama, Chika; Sakai, Tomohiko; Nishiuchi, Tatsuya; Hayashi, Yasuyuki; Kawamura, Takashi


    A preceding randomized controlled trial demonstrated that chest compression-only cardiopulmonary resuscitation (CPR) instruction by dispatcher was more effective to increase bystander CPR than conventional CPR instruction. However, the actual condition of implementation of each type of dispatcher instruction (chest compression-only CPR [CCCPR] or conventional CPR with rescue breathing) and provision of bystander CPR in real prehospital settings has not been sufficiently investigated. This registry prospectively enrolled patients aged =>18 years suffering an out-of-hospital cardiac arrest (OHCA) of non-traumatic causes before emergency-medical-service (EMS) arrival, who were considered as target subjects of dispatcher instruction, resuscitated by EMS personnel, and transported to medical institutions in Osaka, Japan from January 2005 through December 2012. The primary outcome measure was provision of CPR by a bystander. Multiple logistic regression analysis was used to assess factors that were potentially associated with provision of bystander CPR. Among 37,283 target subjects of dispatcher instruction, 5743 received CCCPR instruction and 13,926 received conventional CPR instruction. The proportion of CCCPR instruction increased from 5.7% in 2005 to 25.6% in 2012 (p for trend bystander CPR more frequently than conventional CPR instruction group (70.0% versus 62.1%, pbystander CPR compared with conventional CPR instruction (adjusted odds ratio 1.44, 95% CI 1.34-1.55). CCCPR dispatcher instruction among adult OHCA patients significantly increased the actual provision of bystander CPR. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  4. Surviving out-of-hospital cardiac arrest: just a matter of defibrillators? (United States)

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


    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.

  5. Optimal Provision of Public Goods

    DEFF Research Database (Denmark)

    Kreiner, Claus Thustrup; Verdelin, Nicolaj


    The standard approach to the optimal provision of public goods highlights the importance of distortionary taxation and distributional concerns. A new approach neutralizes distributional concerns by adjusting the income tax schedule. We demonstrate that both approaches are derived from the same...... basic formula. We also take the new approach further by deriving an intuitive formula for the optimal level of public goods, without imposing strong assumptions on preferences. This formula shows that distortionary taxation has a role to play, as in the standard approach. However, the main determinants...

  6. Optimal Provision of Public Goods

    DEFF Research Database (Denmark)

    Kreiner, Claus Thustrup; Verdelin, Nicolaj

    There currently exist two competing approaches in the literature on the optimal provision of public goods. The standard approach highlights the importance of distortionary taxation and distributional concerns. The new approach neutralizes distributional concerns by adjusting the non-linear income...... tax, and finds that this reinvigorates the simple Samuelson rule when preferences are separable in goods and leisure. We provide a synthesis by demonstrating that both approaches derive from the same basic formula. We further develop the new approach by deriving a general, intuitive formula...

  7. Arrested of coalescence of emulsion droplets of arbitrary size (United States)

    Mbanga, Badel L.; Burke, Christopher; Blair, Donald W.; Atherton, Timothy J.


    With applications ranging from food products to cosmetics via targeted drug delivery systems, structured anisotropic colloids provide an efficient way to control the structure, properties and functions of emulsions. When two fluid emulsion droplets are brought in contact, a reduction of the interfacial tension drives their coalescence into a larger droplet of the same total volume and reduced exposed area. This coalescence can be partially or totally hindered by the presence of nano or micron-size particles that coat the interface as in Pickering emulsions. We investigate numerically the dependance of the mechanical stability of these arrested shapes on the particles size, their shape anisotropy, their polydispersity, their interaction with the solvent, and the particle-particle interactions. We discuss structural shape changes that can be induced by tuning the particles interactions after arrest occurs, and provide design parameters for the relevant experiments.

  8. Cardiac arrest during a twin birth caesarean delivery. (United States)

    Pampín-Huerta, F R; Moreira-Gómez, D; Lozano-Requelme, M L; Molina-Nieto, F; Fontán-García-Boente, L; Moreira-Pacheco, M


    The case of a 35 year-old pregnant woman with a right ovarian vein thrombosis complicated with a floating thrombus in the inferior vena cava reaching the right atrium, is presented. The patient had a cardiac arrest due to a pulmonary embolism during a twin-birth caesarean delivery. Discussion includes the pathophysiology of this condition and management options in a cardiac arrest secondary to this aetiology, recovered with stable blood pressure, highlighting the role of thrombolytic therapy in the Postoperative Care Unit in this situation. Copyright © 2015 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  9. Effectiveness of dispatcher training in increasing bystander chest compression for out-of-hospital cardiac arrest patients in Japan. (United States)

    Tsunoyama, Taichiro; Nakahara, Shinji; Yoshida, Masafumi; Kitamura, Maki; Sakamoto, Tetsuya


    The Japanese government has developed a standardized training program for emergency call dispatchers to improve their skills in providing oral guidance on chest compression to bystanders who have witnessed out-of-hospital cardiac arrests (OHCAs). This study evaluated the effects of such a training program for emergency call dispatchers in Japan. The analysis included all consecutive non-traumatic OHCA patients transported to hospital by eight emergency medical services, where the program was implemented as a pilot project. We compared the provision of oral guidance and the incidence of chest compression applications by bystanders in the 1-month period before and after the program. Data collection was undertaken from October 2014 to March 2015. The 532 non-traumatic OHCA cases were used for analysis: these included 249 cases before and 283 after the guidance intervention. Most patients were over 75 years old and were men. After the program, provision of oral guidance to callers slightly increased from 63% of cases to 69% ( P = 0.13) and implementation of chest compression on patients by bystanders significantly increased from 40% to 52% ( P = 0.01). Appropriate chest compression also increased from 34% to 47% ( P = 0.01). In analysis stratified by the provision of oral guidance, increased chest compressions were observed only under oral guidance. We found increased provision of oral guidance by dispatchers and increased appropriate chest compressions by bystanders after the training program for dispatchers had been rolled out. Long-term observation and further data analysis, including patient outcomes, are needed.

  10. Relationship between chest compression rates and outcomes from cardiac arrest. (United States)

    Idris, Ahamed H; Guffey, Danielle; Aufderheide, Tom P; Brown, Siobhan; Morrison, Laurie J; Nichols, Patrick; Powell, Judy; Daya, Mohamud; Bigham, Blair L; Atkins, Dianne L; Berg, Robert; Davis, Dan; Stiell, Ian; Sopko, George; Nichol, Graham


    Guidelines for cardiopulmonary resuscitation recommend a chest compression rate of at least 100 compressions per minute. Animal and human studies have reported that blood flow is greatest with chest compression rates near 120/min, but few have reported rates used during out-of-hospital (OOH) cardiopulmonary resuscitation or the relationship between rate and outcome. The purpose of this study was to describe chest compression rates used by emergency medical services providers to resuscitate patients with OOH cardiac arrest and to determine the relationship between chest compression rate and outcome. Included were patients aged ≥ 20 years with OOH cardiac arrest treated by emergency medical services providers participating in the Resuscitation Outcomes Consortium. Data were abstracted from monitor-defibrillator recordings during cardiopulmonary resuscitation. Multiple logistic regression analysis assessed the association between chest compression rate and outcome. From December 2005 to May 2007, 3098 patients with OOH cardiac arrest were included in this study. Mean age was 67 ± 16 years, and 8.6% survived to hospital discharge. Mean compression rate was 112 ± 19/min. A curvilinear association between chest compression rate and return of spontaneous circulation was found in cubic spline models after multivariable adjustment (P=0.012). Return of spontaneous circulation rates peaked at a compression rate of ≈ 125/min and then declined. Chest compression rate was not significantly associated with survival to hospital discharge in multivariable categorical or cubic spline models. Chest compression rate was associated with return of spontaneous circulation but not with survival to hospital discharge in OOH cardiac arrest.

  11. Arresting Strategy Based on Dynamic Criminal Networks Changing over Time

    Directory of Open Access Journals (Sweden)

    Junqing Yuan


    Full Text Available We investigate a sequence of dynamic criminal networks on a time series based on the dynamic network analysis (DNA. According to the change of networks’ structure, networks’ variation trend is analyzed to forecast its future structure. Finally, an optimal arresting time and priority list are designed based on our analysis. Better results can be expected than that based on social network analysis (SNA.

  12. Circulatory Arrest: A Surgical Option for Adult Window Ductus Closure

    Directory of Open Access Journals (Sweden)

    Vithalkumar Malleshi Betigeri


    Full Text Available The window ductus , an atypical type of patent ductus arteriosus(PDA is a characteristically large in size(>2cm with no recognizable length, characteristic continuation of main pulmonary artery with aortic arch and absence of internal ductal tissue. Surgical safety and effectiveness of its closure can be increased by using cardiopulmonary bypass (CPB and hypothermic total circulatory arrest (HTCA via median sternotomy.

  13. The Neighborhood Context of Racial and Ethnic Disparities in Arrest




    This study assesses the role of social context in explaining racial and ethnic disparities in arrest, with a focus on how distinct neighborhood contexts in which different racial and ethnic groups reside explain variations in criminal outcomes. To do so, I utilize a multilevel, longitudinal research design, combining individual-level data with contextual data from the Project on Human Development in Chicago Neighborhoods (PHDCN). Findings reveal that black youths face multiple layers of disad...

  14. Advances in crack-arrest technology for reactor pressure vessels

    International Nuclear Information System (INIS)

    Bass, B.R.; Pugh, C.E.


    The Heavy-Section Steel Technology (HSST) Program at the Oak Ridge National Laboratory (ORNL) under the sponsorship of the US Nuclear Regulatory Commission is continuing to improve the understanding of conditions that govern the initiation, rapid propagation, arrest, and ductile tearing of cracks in reactor pressure vessel (RPV) steels. This paper describes recent advances in a coordinated effort being conducted under the HSST Program by ORNL and several subcontracting groups to develop the crack-arrest data base and the analytical tools required to construct inelastic dynamic fracture models for RPV steels. Large-scale tests are being carried out to generate crack-arrest toughness data at temperatures approaching and above the onset of Charpy upper-shelf behavior. Small- and intermediate-size specimens subjected to static and dynamic loading are being developed and tested to provide additional fracture data for RPV steels. Viscoplastic effects are being included in dynamic fracture models and computer programs and their utility validated through analyses of data from carefully controlled experiments. Recent studies are described that examine convergence problems associated with energy-based fracture parameters in viscoplastic-dynamic fracture applications. Alternative techniques that have potential for achieving convergent solutions for fracture parameters in the context of viscoplastic-dynamic models are discussed. 46 refs., 15 figs., 3 tabs

  15. Initiation and arrest - two approaches to pressure vessel safety

    International Nuclear Information System (INIS)

    Brumovsky, M.; Filip, R.; Stepanek, S.


    The safety analysis is described of the reactor pressure vessel related to brittle fracture based on the fracture mechanics theory using two different approximations, i.e., the Crack Arrest Temperature (CAT) or Nil Ductility Temperature (NDT), and fracture toughness. The variation of CAT with stress was determined for different steel specimens of 120 to 200 mm in thickness. A diagram is shown of CAT variation with stress allowing the determination of crack arrest temperature for all types of commonly used steels independently of the NDT initial value. The diagram also shows that the difference between fracture transition elastic (FTE) and NDT depends on the type of material and determines the value of the ΔTsub(sigma) factor typical of the safety coefficient. The so-called fracture toughness reference value Ksub(IR) is recommended for the computation of pressure vessel criticality. Also shown is a defect analysis diagram which may be used for the calculation of pressure vessel safety prior to and during operation and which may also be used in making the decision on what crack sizes are critical, what cracks may be arrested and what cracks are likely to expand. The diagram is also important for the fact that it is material-independent and may be employed for the estimates of pre-operational and operational inspections and for pressure vessel life prediction. It is generally applicable to materials of greater thickness in the region where the validity of linear elastic fracture mechanics is guaranteed. (J.P.)

  16. Variations in demand and provision for publicly funded outpatient musculoskeletal physiotherapy services across Quebec, Canada. (United States)

    Deslauriers, Simon; Raymond, Marie-Hélène; Laliberté, Maude; Lavoie, Amélie; Desmeules, François; Feldman, Debbie E; Perreault, Kadija


    The prevalence of musculoskeletal disorders is high and expected to increase in the next decade. Persons suffering from musculoskeletal disorders benefit from early physiotherapy services. However, access to publicly funded physiotherapy services has been shown to be compromised by long waiting times and limited availability of resources in many countries around the world. Decisions on resource allocation may create geographic disparities in provision and access to services, which may result in inequity in access. This study aimed to assess variations in demand and provision of publicly funded outpatient physiotherapy services across the province of Quebec, Canada, as well as to assess the demand to provision relationship. We conducted a secondary analysis of data retrieved from the 2008 Quebec Health Survey and data obtained from a survey of hospitals in the province of Quebec in 2015. We used geographic information systems analyses and descriptive analyses to assess geographic variations and the relationship between demand and provision. Our results indicate substantial variations in the provision and demand for physiotherapy services in the province of Quebec. The variations in service provision did not follow the variations in demand. Long waiting times and insufficient provision of services were found in many regions. The variations in provision of physiotherapy services between regions reported in our study did not correspond to the variations in demand. Such geographic variations and demand to provision mismatches may create inequity in access to services, especially for those unable to afford private services. © 2017 John Wiley & Sons, Ltd.

  17. Descriptive Analysis of Medication Administration During Inpatient Cardiopulmonary Arrest Resuscitation (from the Mayo Registry for Telemetry Efficacy in Arrest Study). (United States)

    Snipelisky, David; Ray, Jordan; Matcha, Gautam; Roy, Archana; Dumitrascu, Adrian; Harris, Dana; Bosworth, Veronica; Clark, Brooke; Thomas, Colleen S; Heckman, Michael G; Vadeboncoeur, Tyler; Kusumoto, Fred; Burton, M Caroline


    Advanced cardiovascular life support guidelines exist, yet there are variations in clinical practice. Our study aims to describe the utilization of medications during resuscitation from in-hospital cardiopulmonary arrest. A retrospective review of patients who suffered a cardiopulmonary arrest from May 2008 to June 2014 was performed. Clinical and resuscitation data, including timing and dose of medications used, were extracted from the electronic medical record and comparisons made. A total of 94 patients were included in the study. Patients were divided into different groups based on the medication combination used during resuscitation: (1) epinephrine; (2) epinephrine and bicarbonate; (3) epinephrine, bicarbonate, and calcium; (4) epinephrine, bicarbonate, and epinephrine drip; and (5) epinephrine, bicarbonate, calcium, and epinephrine drip. No difference in baseline demographics or clinical data was present, apart from history of dementia and the use of calcium channel blockers. The number of medications given was correlated with resuscitation duration (Spearman's rank correlation = 0.50, p resuscitation durations compared to that of the other groups (p resuscitation efforts for in-hospital cardiopulmonary arrests. Increased duration and mortality rates were found in those resuscitations compared with epinephrine alone, likely due to the longer resuscitation duration in the former groups. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. Temporary arrest of fetal movement with pancuronium bromide to enable antenatal magnetic resonance imaging of holoprosencephaly. (United States)

    Horvath, L; Seeds, J W


    The well-known ability of real-time ultrasound to detect congenital abnormalities is often limited by acoustic artifact or fetal position or both. Magnetic resonance imaging can provide superior soft tissue resolution but is vulnerable to maternal and fetal motion artifact. Described and illustrated here is a case of fetal holoprosencephaly that was not of diagnostic clarity on ultrasound. The fetus was paralyzed with an intramuscular injection of pancuronium bromide before a resonance imaging study. Successful fetal paralysis with pancuronium bromide has been reported prior to a variety of fetal interventions for the temporary arrest of fetal movement. The resonance study illustrated here was of significantly superior clarity and improved the accuracy of prognosis and management counseling. It is concluded that in selected cases where ultrasound is not of diagnostic clarity due to acoustic artifact, fetal paralysis and magnetic resonance imaging may be considered.

  19. C.A.U.S.E.: Cardiac arrest ultra-sound exam--a better approach to managing patients in primary non-arrhythmogenic cardiac arrest. (United States)

    Hernandez, Caleb; Shuler, Klaus; Hannan, Hashibul; Sonyika, Chionesu; Likourezos, Antonios; Marshall, John


    Cardiac arrest is a condition frequently encountered by physicians in the hospital setting including the Emergency Department, Intensive Care Unit and medical/surgical wards. This paper reviews the current literature involving the use of ultrasound in resuscitation and proposes an algorithmic approach for the use of ultrasound during cardiac arrest. At present there is the need for a means of differentiating between various causes of cardiac arrest, which are not a direct result of a primary ventricular arrhythmia. Identifying the cause of pulseless electrical activity or asystole is important as the underlying cause is what guides management in such cases. This approach, incorporating ultrasound to manage cardiac arrest aids in the diagnosis of the most common and easily reversible causes of cardiac arrest not caused by primary ventricular arrhythmia, namely; severe hypovolemia, tension pneumothorax, cardiac tamponade, and massive pulmonary embolus. These four conditions are addressed in this paper using four accepted emergency ultrasound applications to be performed during resuscitation of a cardiac arrest patient with the aim of determining the underlying cause of a cardiac arrest. Identifying the underlying cause of cardiac arrest represents the one of the greatest challenges of managing patients with asystole or PEA and accurate determination has the potential to improve management by guiding therapeutic decisions. We include several clinical images demonstrating examples of cardiac tamponade, massive pulmonary embolus, and severe hypovolemia secondary to abdominal aortic aneurysm. In conclusion, this protocol has the potential to reduce the time required to determine the etiology of a cardiac arrest and thus decrease the time between arrest and appropriate therapy.

  20. Disturbances of sensation occasioned by experimental arrest of blood flow

    Directory of Open Access Journals (Sweden)

    Alfred Auersperg


    muscles during ischaemia, as observed by Matthews, weight discrimination and the capability of hitting targets with objects of different weights were not significantly altered, even during the painful phase of fatigue. V - A nervus digitalis volaris proprius was stimulated with A.C. current of 60 cycles at a just tolerable intensity. After three minutes of stimulation the initial paresthesias and pain had almost disappeared, and were followed by numbness and increased sensory thresholds in the field of distribution of that nerve. A few seconds after stimulation was interrupted, sensation was again normal in that field. Comparable phenomena were observed under normal conditions, in the absence of ischaemia. VI - Novocaine block of a finger in the ischaemic side did not influence "pins and needles", which appear after arrest of circulation is released. Therefore, the field of origin of the "pins and needles" does not seem to be the receptor field (Weddell and Sinclair but more probably the nerve fibers themselves (Lewis, Kugelberg. VII - As is well known, "pins and needles" are accentuated by tapping the fingers and, much less, by pressing them. Thermic and painful stimulation have no effect on these paresthesias. Tapping would probably stimulate muscle and touch receptors. On the basis of our observations and Kugelberg's physiological analysis, we are inclined to consider the nerve fibers of these receptors as the field of origin of these paresthesias. VIII - No accentuation of "pins and needles" was found by (a tapping an anesthetized finger, nor (b pressing the muscles; but (c tapping the fingers does reinforce these paresthesias, also during the phase when simple pressure has the opposite effect of extinguishing them. So, it seems that accentuation is related to specific nerve fibers, but it is only brought about when a special function is at play. Therefore, enhancement of those paresthesias is limited to the correlated function of proprioceptors and touch receptors

  1. Current limiters

    Energy Technology Data Exchange (ETDEWEB)

    Loescher, D.H. [Sandia National Labs., Albuquerque, NM (United States). Systems Surety Assessment Dept.; Noren, K. [Univ. of Idaho, Moscow, ID (United States). Dept. of Electrical Engineering


    The current that flows between the electrical test equipment and the nuclear explosive must be limited to safe levels during electrical tests conducted on nuclear explosives at the DOE Pantex facility. The safest way to limit the current is to use batteries that can provide only acceptably low current into a short circuit; unfortunately this is not always possible. When it is not possible, current limiters, along with other design features, are used to limit the current. Three types of current limiters, the fuse blower, the resistor limiter, and the MOSFET-pass-transistor limiters, are used extensively in Pantex test equipment. Detailed failure mode and effects analyses were conducted on these limiters. Two other types of limiters were also analyzed. It was found that there is no best type of limiter that should be used in all applications. The fuse blower has advantages when many circuits must be monitored, a low insertion voltage drop is important, and size and weight must be kept low. However, this limiter has many failure modes that can lead to the loss of over current protection. The resistor limiter is simple and inexpensive, but is normally usable only on circuits for which the nominal current is less than a few tens of milliamperes. The MOSFET limiter can be used on high current circuits, but it has a number of single point failure modes that can lead to a loss of protective action. Because bad component placement or poor wire routing can defeat any limiter, placement and routing must be designed carefully and documented thoroughly.

  2. Biomechanics of fall arrest using the upper extremity: age differences. (United States)

    Kim, Kyu-Jung; Ashton-Miller, James A


    This study tried to isolate critical biomechanical factors in fall arrests using the upper extremity during simulated forward falls. This study also attempted to find the differences in those factors between young and old age groups. The role of the upper extremity is not well defined despite its primary usage as a local shock absorber during fall impact. Comparative study in which two age groups underwent motion analysis.Methods. Ten healthy older males (mean age, 66.4 years) and 10 young males (mean age, 24.1 years) volunteered to perform self-initiated and cable-released falls at selected falling distances, while the joint motion and impact forces at the hand were recorded. Significant age differences were demonstrated in joint kinematics and impact force parameters at close distances. Excessive reflexive responses of the upper extremity in cable-released falls for the older adults resulted in 10-15 times higher peak impact forces and 2-3 times shorter body braking time than in self-initiated falls. Pre-impact activities of the upper extremity predispose the post-impact response during fall arrests. Suppressing excessive pre-impact reflexive activation of the arms could efficiently decrease the risk of fall-related injuries, which calls for securing sufficient arm movement time. Any fall prevention strategy that can increase arm movement time would be effective against injuries of the upper extremity during falling in the older adults. The findings will help to understand underlying mechanisms of fall arrest using the upper extremity for prevention of fall-related fractures.

  3. Calmodulin Mutations Associated with Recurrent Cardiac Arrest in Infants (United States)

    Crotti, Lia; Johnson, Christopher N.; Graf, Elisabeth; De Ferrari, Gaetano M.; Cuneo, Bettina F.; Ovadia, Marc; Papagiannis, John; Feldkamp, Michael D.; Rathi, Subodh G.; Kunic, Jennifer D.; Pedrazzini, Matteo; Wieland, Thomas; Lichtner, Peter; Beckmann, Britt-Maria; Clark, Travis; Shaffer, Christian; Benson, D. Woodrow; Kääb, Stefan; Meitinger, Thomas; Strom, Tim M.; Chazin, Walter J.; Schwartz, Peter J.; George, Alfred L.


    Background Life-threatening disorders of heart rhythm may arise during infancy and can result in the sudden and tragic death of a child. We performed exome sequencing on two unrelated infants presenting with recurrent cardiac arrest to discover a genetic cause. Methods and Results We ascertained two unrelated infants (probands) with recurrent cardiac arrest and dramatically prolonged QTc interval who were both born to healthy parents. The two parent-child trios were investigated using exome sequencing to search for de novo genetic variants. We then performed follow-up candidate gene screening on an independent cohort of 82 subjects with congenital long-QT syndrome without an identified genetic cause. Biochemical studies were performed to determine the functional consequences of mutations discovered in two genes encoding calmodulin. We discovered three heterozygous de novo mutations in either CALM1 or CALM2, two of the three human genes encoding calmodulin, in the two probands and in two additional subjects with recurrent cardiac arrest. All mutation carriers were infants who exhibited life-threatening ventricular arrhythmias combined variably with epilepsy and delayed neurodevelopment. Mutations altered residues in or adjacent to critical calcium binding loops in the calmodulin carboxyl-terminal domain. Recombinant mutant calmodulins exhibited several fold reductions in calcium binding affinity. Conclusions Human calmodulin mutations disrupt calcium ion binding to the protein and are associated with a life-threatening condition in early infancy. Defects in calmodulin function will disrupt important calcium signaling events in heart affecting membrane ion channels, a plausible molecular mechanism for potentially deadly disturbances in heart rhythm during infancy. PMID:23388215

  4. Survey on current practices for neurological prognostication after cardiac arrest. (United States)

    Friberg, Hans; Cronberg, Tobias; Dünser, Martin W; Duranteau, Jacques; Horn, Janneke; Oddo, Mauro


    To investigate current practices and timing of neurological prognostication in comatose cardiac arrest patients. An anonymous questionnaire was distributed to the 8000 members of the European Society of Intensive Care Medicine during September and October 2012. The survey had 27 questions divided into three categories: background data, clinical data, decision-making and consequences. A total of 1025 respondents (13%) answered the survey with complete forms in more than 90%. Twenty per cent of respondents practiced outside of Europe. Overall, 22% answered that they had national recommendations, with the highest percentage in the Netherlands (>80%). Eighty-nine per cent used induced hypothermia (32-34 °C) for comatose cardiac arrest patients, while 11% did not. Twenty per cent had separate prognostication protocols for hypothermia patients. Seventy-nine per cent recognized that neurological examination alone is not enough to predict outcome and a similar number (76%) used additional methods. Intermittent electroencephalography (EEG), brain computed tomography (CT) scan and evoked potentials (EP) were considered most useful. Poor prognosis was defined as cerebral performance category (CPC) 3-5 (58%) or CPC 4-5 (39%) or other (3%). When prognosis was considered poor, 73% would actively withdraw intensive care while 20% would not and 7% were uncertain. National recommendations for neurological prognostication after cardiac arrest are uncommon and only one physician out of five uses a separate protocol for hypothermia treated patients. A neurological examination alone was considered insufficient to predict outcome in comatose patients and most respondents advocated a multimodal approach: EEG, brain CT and EP were considered most useful. Uncertainty regarding neurological prognostication and decisions on level of care was substantial. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  5. 78 FR 18960 - Atlantic Coastal Fisheries Cooperative Management Act Provisions; General Provisions for Domestic... (United States)


    ... DEPARTMENT OF COMMERCE National Oceanic and Atmospheric Administration RIN 0648-XC586 Atlantic Coastal Fisheries Cooperative Management Act Provisions; General Provisions for Domestic Fisheries; Application for Exempted Fishing Permits AGENCY: National Marine Fisheries Service (NMFS), National Oceanic...


    Febres, Jeniimarie; Brasfield, Hope; Shorey, Ryan C.; Elmquist, Joanna; Ninnemann, Andrew; Schonbrun, Yael C.; Temple, Jeff R.; Recupero, Patricia R.; Stuart, Gregory L.


    Learning more about intimate partner violence (IPV) perpetrators could aid the development of more effective treatments. The prevalence of adulthood animal abuse (AAA) perpetration and its association with IPV perpetration, antisociality, and alcohol use in 307 men arrested for domestic violence was examined. 41% (n = 125) of the men committed at least one act of animal abuse since the age of 18, in contrast to the 3.0% prevalence rate reported by men in the general population. Controlling for antisociality and alcohol use, AAA showed a trend towards a significant association with physical and severe psychological IPV perpetration. PMID:25324474

  7. Elastodynamic fracture analyses of large crack-arrest experiments

    International Nuclear Information System (INIS)

    Bass, B.R.; Pugh, C.E.; Walker, J.K.


    Results obtained to date show that the essence of the run-arrest events, including dynamic behavior, is being modeled. Refined meshes and optimum solution algorithms are important parameters in elastodynamic analysis programs to give sufficient resolution to the geometric and time-dependent aspects of fracture analyses. Further refinements in quantitative representation of material parameters and the inclusion of rate dependence through viscoplastic modeling is expected to give an even more accurate basis for assessing the fracture behavior of reactor pressure vessels under PTS and other off-normal loading conditions


    Al Harbi, Mohammed; Al Rifai, Derar; Al Habeeb, Hassan; Wambi, Freddie; Geldhof, Georges; Dimitriou, Vassilios


    We report a case of intraoperative severe bradycardia that resulted in asystole and cardiac arrest shortly after (granisetron 1mg for postoperative nausea and vomiting prophylaxis, that occurred in a female patient who underwent an elective total thyroidectomy. After two cycles of cardiopulmonary resuscitation and defibrillation, spontaneous circulation and sinus rhythm returned successfully. Postoperatively, the patient was diagnosed with a drug-induced long QT syndrome. At the time of the event, granisetron was the only medication administered. Furthermore, there was no reason to suspect electrolyte abnormalities. We explore the association of the onset of severe sinus bradycardia with the intravenous administration of granisetron.

  9. Advanced life support for cardiac arrest beyond the algorithm

    DEFF Research Database (Denmark)

    Rudolph, Søren Steemann; Isbye, Dan Lou; Pfeiffer, Peter


    In an advanced emergency medical service all parts of the advanced life support (ALS) algorithm can be provided. This evidence-based algorithm outlines resuscitative efforts for the first 10-15 minutes after cardiac arrest, whereafter the algorithm repeats itself. Restoration of spontaneous...... circulation fails in most cases, but in some circumstances the patient may benefit from additional interventional approaches, in which case transport to hospital with ongoing cardiopulmonary resuscitation is indicated. This paper has summarized treatments outside the ALS algorithm, which may be beneficial...

  10. [Cerebral oximetry in pulmonary thromboendarterectomy with circulatory arrest]. (United States)

    Catalán Escudero, P; González Román, A; Serra Ruiz, C N; Barbero Mielgo, M; García Fernández, J


    Pulmonary thromboendarterectomy is an uncommon procedure and should be performed with circulatory arrest. One of the major concerns is the postoperative central neurological injuries. Perioperative brain oxygen monitoring is advisable in this surgical procedure for the early detection of brain hypoperfusion episodes and their intensity as well as any other postoperative episodes that can deteriorate the neurological outcome. Copyright © 2012 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Published by Elsevier España. All rights reserved.

  11. Dynamical arrest in dense short-ranged attractive colloids

    International Nuclear Information System (INIS)

    Foffi, G; Sciortino, F; Zaccarelli, E; Tartaglia, P


    We study thermodynamic and dynamic properties of model colloidal systems interacting with a hard core repulsion and a short-range attraction, and provide an overall picture of their phase diagrams which shows a very rich phenomenology. We focus on the slow dynamic properties of this model, investigating in detail the glass transition lines (both repulsive and attractive), the glass-glass transitions and the location of the higher order singularities. We discuss the relative location of the glass lines and of the metastable liquid-gas binodal, an issue relevant for the understanding of low density arrested states of matter

  12. Adulthood animal abuse among men arrested for domestic violence. (United States)

    Febres, Jeniimarie; Brasfield, Hope; Shorey, Ryan C; Elmquist, Joanna; Ninnemann, Andrew; Schonbrun, Yael C; Temple, Jeff R; Recupero, Patricia R; Stuart, Gregory L


    Learning more about intimate partner violence (IPV), perpetrators could aid the development of more effective treatments. The prevalence of adulthood animal abuse (AAA) perpetration and its association with IPV perpetration, antisociality, and alcohol use in 307 men arrested for domestic violence were examined. Forty-one percent (n = 125) of the men committed at least one act of animal abuse since the age of 18, in contrast to the 1.5% prevalence rate reported by men in the general population. Controlling for antisociality and alcohol use, AAA showed a trend toward a significant association with physical and severe psychological IPV perpetration. © The Author(s) 2014.

  13. Characteristics and possibilities of software tool for metal-oxide surge arresters selection

    Directory of Open Access Journals (Sweden)

    Đorđević Dragan


    Full Text Available This paper presents a procedure for the selection of metal-oxide surge arresters based on the instructions given in the Siemens and ABB catalogues, respecting their differences and the characteristics and possibilities of the software tool. The software tool was developed during the preparation of a Master's thesis titled, 'Automation of Metal-Oxide Surge Arresters Selection'. An example is presented of the selection of metal-oxide surge arresters using the developed software tool.

  14. Analysis of the G1 arrest position of senescent WI38 cells by quinacrine dihydrochloride nuclear fluorescence: evidence for a late G1 arrest

    International Nuclear Information System (INIS)

    Gorman, S.D.; Cristofalo, V.J.


    Senescence of the human diploid fibroblast-like cell line, W138, is characterized by a loss of proliferative activity and an arrest of cells with a 2C DNA content (G1 or G0). To examine the specific region within G1 in which senescent cells arrest, senescent cells were stained with quinacrine dihydrochloride (QDH) and their nuclear fluorescence was compared with that of young cultures arrested in early and late G1 by serum deprivation and hydroxyurea exposure, respectively. Release of these G1-arrested young cultures from their blocking conditions and timing the kinetics of their entry into the S phase by autoradiographic detection of [ 3 H]thymidine incorporation revealed that serum-deprived cells entered the S phase within 15-18h, whereas hydroxyurea-exposed cells entered the S phase within 1.5h, thus confirming their relative G1-arrest positions. QDH-stained, serum-deprived and hydroxyurea-exposed young cells exhibited relative nuclear fluorescence intensities of 51.7 and 23.9, respectively. Senescent cells exhibited a relative nuclear fluorescence intensity of 17.4, closely resembling the fluorescence of young cultures arrested in late G1 by hydroxyurea exposure. These data support the concept that senescent cells are arrested from further progression in the cell cycle in late G1

  15. Eccentric apical hypertrophic cardiomyopathy unmasked by multimodality imaging: an uncommon but missed cause of out of hospital cardiac arrest (United States)

    Towe, Eric; Sharma, Saurabh; Geske, Jeffrey; Ackerman, Michael J


    A woman in her late 50s experienced a witnessed, sudden out of hospital cardiac arrest. Initial workup included coronary angiography, transthoracic echocardiogram and a CT scan of the chest to rule out pulmonary embolus. She was subsequently discharged home without an implantable cardioverter defibrillator (ICD) or a life vest. On follow-up at another facility, an ICD was placed and a Holter monitor showed no ventricular ectopy. Further transthoracic echocardiographic images were obtained, which were suggestive of apical hypertrophic cardiomyopathy. A limited transthoracic echocardiogram with contrast was performed, which did not elucidate the hypertrophy. However, eccentric left ventricular apical wall hypertrophy was visualised by a coronary CT scan. PMID:26153133

  16. 7 CFR 761.8 - Loan Limitations. (United States)


    ... 7 Agriculture 7 2010-01-01 2010-01-01 false Loan Limitations. 761.8 Section 761.8 Agriculture... SPECIAL PROGRAMS GENERAL PROGRAM ADMINISTRATION General Provisions § 761.8 Loan Limitations. (a) Dollar... cannot exceed any of the following at the time of loan closing or assumption of indebtedness. If the...

  17. Quench limits

    International Nuclear Information System (INIS)

    Sapinski, M.


    With thirteen beam induced quenches and numerous Machine Development tests, the current knowledge of LHC magnets quench limits still contains a lot of unknowns. Various approaches to determine the quench limits are reviewed and results of the tests are presented. Attempt to reconstruct a coherent picture emerging from these results is taken. The available methods of computation of the quench levels are presented together with dedicated particle shower simulations which are necessary to understand the tests. The future experiments, needed to reach better understanding of quench limits as well as limits for the machine operation are investigated. The possible strategies to set BLM (Beam Loss Monitor) thresholds are discussed. (author)

  18. Methods for the sodium cooled fast reactor fire safety provisions

    International Nuclear Information System (INIS)

    Gryaznov, B.V.; Dergachev, N.P.


    Problems of fire safety provision on NPPs with sodium cooled fast reactor are under discussion. Methods of sodium leak localization, measures eliminating sodium flaring up during leaks and main means of sodium fire extinguishing are considered. An extinguishing of sodium flaring up is performed by means of sodium temperatUre decrease and by limitation of hydrogen access to the flaring up surface. A conclusion is made that the most effective methods of extinguishing are the following: self-extinguishing (due to hydrogen burning out in a limiting volume); extinguishing by a gas mixture of nitrogen and carbonic acid (initial filling and blowing of rooms during sodium flaring up); extinguishing by special powders

  19. G2 phase arrest of cell cycle induced by ionizing radiation

    International Nuclear Information System (INIS)

    Liu Guangwei; Gong Shouliang


    The exposure of mammalian cells to X rays results in the prolongation of the cell cycle, including the delay or the arrest in G 1 , S and G 2 phase. The major function of G 1 arrest may be to eliminate the cells containing DNA damage and only occurs in the cells with wild type p53 function whereas G 2 arrest following ionizing radiation has been shown to be important in protecting the cells from death and occurs in all cells regardless of p53 status. So the study on G 2 phase arrest of the cell cycle induced by ionizing radiation has currently become a focus at radiobiological fields

  20. An Exploratory Study of Functional Status in Post Cardiac Arrest Survivors Discharged To Home

    National Research Council Canada - National Science Library

    Whitcomb, John J


    .... Aims of the project were to describe perceived functional capacity, physical functional performance, mental health, symptom distress, and demographic factors in survivors of cardiopulmonary arrest...

  1. 9 CFR 93.916 - Special provisions. (United States)


    ... 9 Animals and Animal Products 1 2010-01-01 2010-01-01 false Special provisions. 93.916 Section 93... § 93.916 Special provisions. (a) Slaughter. Live VHS-regulated fish from VHS-regulated regions may be... establishment discharges its waste water to a municipal sewage system that includes waste water disinfection...

  2. 48 CFR 11.107 - Solicitation provision. (United States)


    ... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Solicitation provision. 11... transaction-based reporting method to report its use of voluntary consensus standards to the National... Use of Voluntary Consensus Standards and in Conformity Assessment Activities”). Use of the provision...

  3. Shelter provision and state sovereignty in Calais

    Directory of Open Access Journals (Sweden)

    Michael Boyle


    Full Text Available Government provision of shelter for Calais’ migrant population over the last twenty years has prioritised the assertion of state authority over the alleviation of human suffering. Policies in 2015-16, which involved the destruction of informal shelter and the provision of basic alternative accommodation, continued this trend.

  4. 22 CFR 63.9 - General provisions. (United States)


    ... 22 Foreign Relations 1 2010-04-01 2010-04-01 false General provisions. 63.9 Section 63.9 Foreign Relations DEPARTMENT OF STATE PUBLIC DIPLOMACY AND EXCHANGES PAYMENTS TO AND ON BEHALF OF PARTICIPANTS IN THE INTERNATIONAL EDUCATIONAL AND CULTURAL EXCHANGE PROGRAM § 63.9 General provisions. The following...

  5. 22 CFR 226.48 - Contract provisions. (United States)


    ... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Contract provisions. 226.48 Section 226.48 Foreign Relations AGENCY FOR INTERNATIONAL DEVELOPMENT ADMINISTRATION OF ASSISTANCE AWARDS TO U.S. NON-GOVERNMENTAL ORGANIZATIONS Post-award Requirements Procurement Standards § 226.48 Contract provisions. The...

  6. 30 CFR 847.2 - General provisions. (United States)


    ... 30 Mineral Resources 3 2010-07-01 2010-07-01 false General provisions. 847.2 Section 847.2 Mineral Resources OFFICE OF SURFACE MINING RECLAMATION AND ENFORCEMENT, DEPARTMENT OF THE INTERIOR PERMANENT PROGRAM... court of competent jurisdiction enters a judgment against or convicts a person under these provisions...

  7. 12 CFR 931.9 - Transition provision. (United States)


    ... 12 Banks and Banking 7 2010-01-01 2010-01-01 false Transition provision. 931.9 Section 931.9 Banks and Banking FEDERAL HOUSING FINANCE BOARD FEDERAL HOME LOAN BANK RISK MANAGEMENT AND CAPITAL STANDARDS FEDERAL HOME LOAN BANK CAPITAL STOCK § 931.9 Transition provision. (a) In general. Each Bank shall comply...

  8. 12 CFR 1261.2 - General provisions. (United States)


    ... 12 Banks and Banking 7 2010-01-01 2010-01-01 false General provisions. 1261.2 Section 1261.2 Banks and Banking FEDERAL HOUSING FINANCE AGENCY FEDERAL HOME LOAN BANKS FEDERAL HOME LOAN BANK DIRECTORS Federal Home Loan Bank Boards of Directors: Eligibility and Elections § 1261.2 General provisions. (a...

  9. 40 CFR 141.76 - Recycle provisions. (United States)


    ... 40 Protection of Environment 22 2010-07-01 2010-07-01 false Recycle provisions. 141.76 Section 141...) NATIONAL PRIMARY DRINKING WATER REGULATIONS Filtration and Disinfection § 141.76 Recycle provisions. (a... recycle spent filter backwash water, thickener supernatant, or liquids from dewatering processes must meet...

  10. Fast Flux Test Facility (FFTF) maintenance provisions

    International Nuclear Information System (INIS)

    Marshall, J.L.


    The Fast Flux Test Facility (FFTF) was designed with maintainability as a primary parameter, and facilities and provisions were designed into the plant to accommodate the maintenance function. This paper describes the FFTF and its systems. Special maintenance equipment and facilities for performing maintenance on radioactive components are discussed. Maintenance provisions designed into the plant to enhance maintainability are also described

  11. Energy provision under Obama administration

    Energy Technology Data Exchange (ETDEWEB)

    Gale, J. [IEA Greenhouse Gas R & D Programme, Cheltenham (United Kingdom)


    The new bill before the Senate, the American Recovery and Reinvestment Act of 2009, allows for an additional amount for 'Fossil Energy Research and Development' of $4.6 billion, to be available until 30 September 2010 and that $2 billion of that is available for one or more near zero emissions power plant(s). Two further provisions allow for an additional $1 billion for the Department's Clean Coal Power Initiative Round III and a further $1.5 billion for a competitive solicitations for projects that demonstrate carbon capture from industrial sources. Awards for such projects may include plant efficiency improvements for integration with carbon capture technology. The press seems to be divided whether this money will help revive the FutureGen project. The financial commitment should help the G8 achieve its objective of seeing 20 CCS demonstration projects around the world by 2020. An economic stimulus package proposed by the incoming Barack Obama administration include $150 billion to be spent over 10 years to spur next generation biofuels, plug in hybrid vehicles, a new digital electrical grid and new low emission coal plants. The proposal is intended to create jobs and address critical infrastructure in the US.

  12. Implementing the optimal provision of ecosystem services. (United States)

    Polasky, Stephen; Lewis, David J; Plantinga, Andrew J; Nelson, Erik


    Many ecosystem services are public goods whose provision depends on the spatial pattern of land use. The pattern of land use is often determined by the decisions of multiple private landowners. Increasing the provision of ecosystem services, though beneficial for society as a whole, may be costly to private landowners. A regulator interested in providing incentives to landowners for increased provision of ecosystem services often lacks complete information on landowners' costs. The combination of spatially dependent benefits and asymmetric cost information means that the optimal provision of ecosystem services cannot be achieved using standard regulatory or payment for ecosystem services approaches. Here we show that an auction that sets payments between landowners and the regulator for the increased value of ecosystem services with conservation provides incentives for landowners to truthfully reveal cost information, and allows the regulator to implement the optimal provision of ecosystem services, even in the case with spatially dependent benefits and asymmetric information.

  13. Perioperative cardiac arrest: an evolutionary analysis of the intra-operative cardiac arrest incidence in tertiary centers in Brazil

    Directory of Open Access Journals (Sweden)

    Matheus Fachini Vane


    Full Text Available Background: Great changes in medicine have taken place over the last 25 years worldwide. These changes in technologies, patient risks, patient profile, and laws regulating the medicine have impacted the incidence of cardiac arrest. It has been postulated that the incidence of intraoperative cardiac arrest has decreased over the years, especially in developed countries. The authors hypothesized that, as in the rest of the world, the incidence of intraoperative cardiac arrest is decreasing in Brazil, a developing country. Objectives: The aim of this study was to search the literature to evaluate the publications that relate the incidence of intraoperative cardiac arrest in Brazil and analyze the trend in the incidence of intraoperative cardiac arrest. Contents: There were 4 articles that met our inclusion criteria, resulting in 204,072 patients undergoing regional or general anesthesia in two tertiary and academic hospitals, totalizing 627 cases of intraoperative cardiac arrest. The mean intraoperative cardiac arrest incidence for the 25 years period was 30.72:10,000 anesthesias. There was a decrease from 39:10,000 anesthesias to 13:10,000 anesthesias in the analyzed period, with the related lethality from 48.3% to 30.8%. Also, the main causes of anesthesia-related cause of mortality changed from machine malfunction and drug overdose to hypovolemia and respiratory causes. Conclusions: There was a clear reduction in the incidence of intraoperative cardiac arrest in the last 25 years in Brazil. This reduction is seen worldwide and might be a result of multiple factors, including new laws regulating the medicine in Brazil, incorporation of technologies, better human development level of the country, and better patient care. Resumo: Justificativa: Nos últimos 25 anos ocorreram grandes mudanças na medicina em todo o mundo. Essas mudanças de tecnologias, riscos do paciente, perfil do paciente e leis que regulam medicamentos tiveram impacto na incid

  14. Provision of Patient-Centered Transgender Care. (United States)

    Selix, Nancy W; Rowniak, Stefan


    Transgender individuals have unique health care needs and experience health disparities. There is an increased need for transgender health care services and primary care for this underserved population. However, provision of appropriate health care services for transgender persons requires cultural competency and skill on the part of the health care provider, and providers need specific skills to address the needs of this population. A review of the literature was performed by accessing CINAHL, PsycINFO, and PubMed databases. Pertinent research was extracted and reviewed for relevance. References in these publications were reviewed to identify additional publications that address primary prevention, secondary prevention, and tertiary care of transgender individuals. Articles that include prevention, screening, and treatment of health problems of transgender persons were identified. Research on the health needs of the transgender population is limited. Whenever available, research findings that address this unique population should be incorporated into clinical practice. When research evidence is not available to address the unique needs of transgender individuals, research and clinical care guidelines from the general population may be applied for health screening and maintenance. This article provides information about primary care services for transgender individuals and seeks to improve awareness of the health disparities this underserved population experiences. Simple solutions to modify clinical settings to enhance care are provided. © 2016 by the American College of Nurse-Midwives.

  15. Dose limits

    International Nuclear Information System (INIS)

    Fitoussi, L.


    The dose limit is defined to be the level of harmfulness which must not be exceeded, so that an activity can be exercised in a regular manner without running a risk unacceptable to man and the society. The paper examines the effects of radiation categorised into stochastic and non-stochastic. Dose limits for workers and the public are discussed

  16. Electrophysiological Monitoring of Brain Injury and Recovery after Cardiac Arrest

    Directory of Open Access Journals (Sweden)

    Ruoxian Deng


    Full Text Available Reliable prognostic methods for cerebral functional outcome of post cardiac-arrest (CA patients are necessary, especially since therapeutic hypothermia (TH as a standard treatment. Traditional neurophysiological prognostic indicators, such as clinical examination and chemical biomarkers, may result in indecisive outcome predictions and do not directly reflect neuronal activity, though they have remained the mainstay of clinical prognosis. The most recent advances in electrophysiological methods—electroencephalography (EEG pattern, evoked potential (EP and cellular electrophysiological measurement—were developed to complement these deficiencies, and will be examined in this review article. EEG pattern (reactivity and continuity provides real-time and accurate information for early-stage (particularly in the first 24 h hypoxic-ischemic (HI brain injury patients with high sensitivity. However, the signal is easily affected by external stimuli, thus the measurements of EP should be combined with EEG background to validate the predicted neurologic functional result. Cellular electrophysiology, such as multi-unit activity (MUA and local field potentials (LFP, has strong potential for improving prognostication and therapy by offering additional neurophysiologic information to understand the underlying mechanisms of therapeutic methods. Electrophysiology provides reliable and precise prognostication on both global and cellular levels secondary to cerebral injury in cardiac arrest patients treated with TH.

  17. In-hospital pediatric cardiac arrest in Honduras. (United States)

    Matamoros, Martha; Rodriguez, Roger; Callejas, Allison; Carranza, Douglas; Zeron, Hilda; Sánchez, Carlos; Del Castillo, Jimena; López-Herce, Jesús


    The objective of this study was to analyze the characteristic and the prognostic factors of in-hospital pediatric cardiac arrest (CA) in a public hospital Honduras. A prospective observational study was performed on pediatric in-hospital CA as a part of a multicenter international study. One hundred forty-six children were studied. The primary end point was survival at hospital discharge. Univariate and multivariate logistic regression analyses were performed to assess the influence of each factor on mortality. Cardiac arrest occurred in the emergency department in 66.9%. Respiratory diseases and sepsis were predominant causes of CA. Return of spontaneous circulation was achieved in 60% of patients, and 22.6% survived to hospital discharge. The factors related with mortality were nonrespiratory cause of CA (odds ratio [OR], 2.55; P = 0.045), adrenaline administration (OR, 4.96; P = 0.008), and a duration of cardiopulmonary resuscitation more than 10 minutes (OR, 3.40; P = 0.012). In-hospital CA in children in a developing country has low survival. Patients with nonrespiratory causes and those who need adrenaline administration and prolonged resuscitation had worse prognosis.

  18. Andrographolide Induces Cell Cycle Arrest and Apoptosis of Chondrosarcoma by Targeting TCF-1/SOX9 Axis. (United States)

    Zhang, Huan-Tian; Yang, Jie; Liang, Gui-Hong; Gao, Xue-Juan; Sang, Yuan; Gui, Tao; Liang, Zu-Jian; Tam, Man-Seng; Zha, Zhen-Gang


    Chondrosarcoma is the second most malignant bone tumor with poor prognosis and limited treatment options. Thus, development of more effective treatments has become urgent. Recently, natural compounds derived from medicinal plants have emerged as promising therapeutic options via targeting multiple key cellular molecules. Andrographolide (Andro) is such a compound, which has previously been shown to induce cell cycle arrest and apoptosis in several human cancers. However, the molecular mechanism through which Andro exerts its anti-cancer effect on chondrosarcoma remains to be elucidated. In the present study, we showed that Andro-induced G2/M cell cycle arrest of chondrosarcoma by fine-tuning the expressions of several cell cycle regulators such as p21, p27, and Cyclins, and that prolonged treatment of cells with Andro caused pronounced cell apoptosis. Remarkably, we found that SOX9 was highly expressed in poor-differentiated chondrosarcoma, and that knockdown of SOX9 suppressed chondrosarcoma cell growth. Further, our results showed that Andro dose-dependently down-regulated SOX9 expression in chondrosarcoma cells. Concomitantly, an inhibition of T cell factor 1 (TCF-1) mRNA expression and an enhancement of TCF-1 protein degradation by Andro were observed. In contrast, the expression and subcellular localization of β-catenin were not altered upon the treatment of Andro, suggesting that β-catenin might not function as the primary target of Andro. Additionally, we provided evidence that there was a mutual regulation between TCF-1 and SOX9 in chondrosarcoma cells. In conclusion, these results highlight the potential therapeutic effects of Andro in treatment of chondrosarcoma via targeting the TCF-1/SOX9 axis. J. Cell. Biochem. 118: 4575-4586, 2017. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

  19. Cardiac arrest risk standardization using administrative data compared to registry data.

    Directory of Open Access Journals (Sweden)

    Anne V Grossestreuer

    Full Text Available Methods for comparing hospitals regarding cardiac arrest (CA outcomes, vital for improving resuscitation performance, rely on data collected by cardiac arrest registries. However, most CA patients are treated at hospitals that do not participate in such registries. This study aimed to determine whether CA risk standardization modeling based on administrative data could perform as well as that based on registry data.Two risk standardization logistic regression models were developed using 2453 patients treated from 2000-2015 at three hospitals in an academic health system. Registry and administrative data were accessed for all patients. The outcome was death at hospital discharge. The registry model was considered the "gold standard" with which to compare the administrative model, using metrics including comparing areas under the curve, calibration curves, and Bland-Altman plots. The administrative risk standardization model had a c-statistic of 0.891 (95% CI: 0.876-0.905 compared to a registry c-statistic of 0.907 (95% CI: 0.895-0.919. When limited to only non-modifiable factors, the administrative model had a c-statistic of 0.818 (95% CI: 0.799-0.838 compared to a registry c-statistic of 0.810 (95% CI: 0.788-0.831. All models were well-calibrated. There was no significant difference between c-statistics of the models, providing evidence that valid risk standardization can be performed using administrative data.Risk standardization using administrative data performs comparably to standardization using registry data. This methodology represents a new tool that can enable opportunities to compare hospital performance in specific hospital systems or across the entire US in terms of survival after CA.

  20. Prescription Monitoring Program Trends Among Individuals Arrested in Maine for Trafficking Prescription Drugs in 2014. (United States)

    McCall, Kenneth; Nichols, Stephanie D; Holt, Christina; Ochs, Leslie; Cattabriga, Gary; Tu, Chunhao


    To evaluate controlled substance prescribing trends available in the Maine Prescription Monitoring Program (PMP) among individuals arrested for prescription drug "trafficking." The demographic characteristics of the individuals who had matching prescription records in the PMP within 90 days of the arrest were identified. A population-based, retrospective cohort study using data from the Maine Diversion Alert Program (DAP) and the Maine PMP. The study population consisted of persons arrested for trafficking prescription drugs in Maine during the 2014 calendar year from January 1 to December 31. There were 594 trafficking arrests reported by the Maine DAP in 2014. The study population consisted of the 235 persons (40%) with arrests involving controlled prescription medications. The mean age of these persons was 33 years (range 18-77 yrs), and 156 (66%) were male. Arrests involved 154 prescription opioids (65%), seven stimulants (3%), seven benzodiazepines (3%), and 77 unspecified controlled prescription drugs (33%). A minority of individuals (n=57, 24%) had a prescription record in the PMP that matched the substance involved in the arrest. Only one person with matching PMP and arrest records utilized ≥ 5 prescribers, while none used ≥ 5 pharmacies within 90 days before the arrest. Payment methods for matching prescriptions were commercial insurance (n=28, 49%), Medicaid (n=19, 33%), Medicare (n=5, 9%), and cash (n=5, 9%). The majority (76%) of persons arrested for prescription drug trafficking did not have PMP records and did not directly obtain the diverted medication from a licensed pharmacy. Traditional red flags, like cash payment and using multiple prescribers or pharmacies, were uncommon. Therefore, arrest records for diversion and PMPs are distinct and complementary tools for identifying individuals at risk for substance misuse. © 2016 Pharmacotherapy Publications, Inc.

  1. Inverse Limits

    CERN Document Server

    Ingram, WT


    Inverse limits provide a powerful tool for constructing complicated spaces from simple ones. They also turn the study of a dynamical system consisting of a space and a self-map into a study of a (likely more complicated) space and a self-homeomorphism. In four chapters along with an appendix containing background material the authors develop the theory of inverse limits. The book begins with an introduction through inverse limits on [0,1] before moving to a general treatment of the subject. Special topics in continuum theory complete the book. Although it is not a book on dynamics, the influen

  2. Mental health court outcomes: a comparison of re-arrest and re-arrest severity between mental health court and traditional court participants. (United States)

    Moore, Marlee E; Hiday, Virginia Aldigé


    Mental health courts have been proliferating across the country since their establishment in the late 1990's. Although numerous advocates have proclaimed their merit, only few empirical studies have evaluated their outcomes. This paper evaluates the effect of one mental health court on criminal justice outcomes by examining arrests and offense severity from one year before to one year after entry into the court, and by comparing mental health court participants to comparable traditional criminal court defendants on these measures. Multivariate models support the prediction that mental health courts reduce the number of new arrests and the severity of such re-arrests among mentally ill offenders. Similar analysis of mental health court completers and non-completers supports the prediction that a "full dose" of mental health treatment and court monitoring produce even fewer re-arrests.

  3. [Limitations to the physician's discretionary and therapeutic freedom and to the provision of health care for the general population by a shortage of financial and human resources--the rules of Section 2 Para. 1 and 4 of the Medical Professional Code of conduct and how much they are really worth]. (United States)

    Hoppe, Jörg-Dietrich


    Up to the early 1990's the health care system was essentially characterised through:--the insured' right of choice of therapist,--therapeutic freedom of patients and physicians, and--the freedom of establishment for medical doctors.--In accordance with the Hospital Funding Act the hospital system was--in compliance with federal constitutional law using capacity requirements--based on the "fire-fighting" principle, i.e. that if required, every patient should have access to a suitable hospital bed within about 15 minutes.--The responsibility for ensuring the provision of general and specialist health care services had been conferred by the government to the National Association of Statutory Health Insurance Physicians (1955) in the legal form of a public corporation. In the face of a foreseeable rise in expenses as a result of advances in medicine and a higher demand for health care services because of the demographic development (long-life society) the Advisory Council for Concerted Action in Health Care concludes in its Annual Report that maintaining this level of health care for all people is not financially viable any longer. This is why the state--on the basis of the Health Care Reform Act of 2002 and the Statutory Health Insurance System Modernisation Act of 2004--retreated from the provision of services in the ambulatory and inpatient setting by privatising these sectors and by proclaiming competition (introduction of diagnosis-related groups). Presently, the once liberal performance tradition is more and more turning into a centrally planned system in the spirit of "From Therapeutic Freedom to Therapeutic Programmes". The guidelines that on the basis of the methods of evidence-based medicine were developed by the international community of physicians for the treatment of patients with defined diagnoses and intended to be decision aids for individual treatment decisions are now used to implement disease management programmes for the provision of health care to

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

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


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

  5. Cell cycle age dependence for radiation-induced G2 arrest: evidence for time-dependent repair

    International Nuclear Information System (INIS)

    Rowley, R.


    Exponentially growing eucaryotic cells, irradiated in interphase, are delayed in progression to mitosis chiefly by arrest in G 2 . The sensitivity of Chinese hamster ovary cells to G 2 arrest induction by X rays increases through the cell cycle, up to the X-ray transition point (TP) in G 2 . This age response can be explained by cell cycle age-dependent changes in susceptibility of the target(s) for G 2 arrest and/or by changes in capability for postirradiation recovery from G 2 arrest damage. Discrimination between sensitivity changes and repair phenomena is possible only if the level of G 2 arrest-causing damage sustained by a cell at the time of irradiation and the level ultimately expressed as arrest can be determined. The ability of caffeine to ameliorate radiation-induced G 2 arrest, while inhibiting repair of G 2 arrest-causing damage makes such an analysis possible. In the presence of caffeine, progression of irradiated cells was relatively unperturbed, but on caffeine removal, G 2 arrest was expressed. The duration of G 2 arrest was independent of the length of the prior caffeine exposure. This finding indicates that the target for G 2 arrest induction is present throughout the cell cycle and that the level of G 2 arrest damage incurred is initially constant for all cell cycle phases. The data are consistent with the existence of a time-dependent recovery mechanism to explain the age dependence for radiation induction of G 2 arrest

  6. EU Citizenship and European Arrest Warrant: The Same Rights for All?

    NARCIS (Netherlands)

    Marguery, T.P.


    In the case Wolzenburg, the principle of non-discrimination of European Union citizens is applied to the European arrest warrant. The implementation of the European arrest warrant by the Member States cannot escape a control of proportional- ity made by the Court. Member States may impose a period

  7. Return to Work in Out-of-Hospital Cardiac Arrest Survivors

    DEFF Research Database (Denmark)

    Kragholm, Kristian; Wissenberg, Mads; Mortensen, Rikke Normark


    BACKGROUND: Data on long-term function of out-of-hospital cardiac arrest survivors are sparse. We examined return to work as a proxy of preserved function without major neurologic deficits in survivors. METHODS AND RESULTS: In Denmark, out-of-hospital cardiac arrests have been systematically repo...

  8. 30 CFR 77.508 - Lightning arresters, ungrounded and exposed power conductors and telephone wires. (United States)


    ... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Lightning arresters, ungrounded and exposed... AND SURFACE WORK AREAS OF UNDERGROUND COAL MINES Electrical Equipment-General § 77.508 Lightning... conductors and telephone wires shall be equipped with suitable lightning arresters which are adequately...

  9. 8 CFR 287.3 - Disposition of cases of aliens arrested without warrant. (United States)


    ... 8 Aliens and Nationality 1 2010-01-01 2010-01-01 false Disposition of cases of aliens arrested without warrant. 287.3 Section 287.3 Aliens and Nationality DEPARTMENT OF HOMELAND SECURITY IMMIGRATION REGULATIONS FIELD OFFICERS; POWERS AND DUTIES § 287.3 Disposition of cases of aliens arrested without warrant...

  10. The Tendency to Arrest Victims of Domestic Violence: A Preliminary Analysis of Officer Characteristics. (United States)

    Saunders, Daniel G.


    Studied 111 police officers. Predicted that those inclined to arrest victims of domestic violence would have more negative stereotypes and attitudes toward victims and women. Results showed that those with an inclination to arrest victims believed domestic violence is justified situationally and that women stay in violent relationships for…

  11. The Influence of Peer and Educational Variables on Arrest Status among At-Risk Males. (United States)

    Bullis, Michael; Walker, Hill M.; Stieber, Steve


    A study examined the predictive power of selected social and academic variables regarding the arrest frequency for 11th-grade boys who seven years earlier had been judged to be at risk of developing antisocial behavior patterns. Antisocial measures on which participants scored higher were associated with more frequent arrests. (Author/CR)

  12. Mental Disorders, Comorbidity, and Postrunaway Arrests among Homeless and Runaway Adolescents (United States)

    Chen, Xiaojin; Thrane, Lisa; Whitbeck, Les B.; Johnson, Kurt


    This study examined the associations between lifetime mental disorder, comorbidity, and self-reported postrunaway arrests among 428 (187 males, 241 females) homeless and runaway youth. The analysis examined the pattern of arrests across five lifetime mental disorders (alcohol abuse, drug abuse, conduct disorder, major depressive episode, and…

  13. Interfacial Crack Arrest in Sandwich Panels with Embedded Crack Stoppers Subjected to Fatigue Loading

    DEFF Research Database (Denmark)

    Martakos, G.; Andreasen, J. H.; Berggreen, Christian


    A novel crack arresting device has been implemented in sandwich panels and tested using a special rig to apply out-of-plane loading on the sandwich panel face-sheets. Fatigue crack propagation was induced in the face-core interface of the sandwich panels which met the crack arrester. The effect o...

  14. 39 CFR 230.4 - Arrest and investigative powers of criminal investigators. (United States)


    ... 39 Postal Service 1 2010-07-01 2010-07-01 false Arrest and investigative powers of criminal... OFFICE OF INSPECTOR GENERAL General Policy and Authority § 230.4 Arrest and investigative powers of criminal investigators. (a) Under the authority of 18 U.S.C. 3061, criminal investigators employed by the...

  15. Mental Condition and Ventricular Size in Arrested Hydrocephalus: an Analysis of 29 Shunt‐independent Children

    NARCIS (Netherlands)



    textabstractMeasurement of the diameter of the ventricular system, in a series of 29 patients with arrested hydrocephalus who had become shunt‐independent, showed that enlargement of the ventricles does not necessarily play a part in the arrest of hydrocephalus, for in many of these cases the

  16. Outcome of out-of-hospital cardiac arrest--why do physicians withhold resuscitation attempts?

    DEFF Research Database (Denmark)

    Horsted, Tina I; Rasmussen, Lars S; Lippert, Freddy K


    To describe the outcome of out-of-hospital cardiac arrest (OHCA) with a focus on why physicians withhold resuscitation attempts.......To describe the outcome of out-of-hospital cardiac arrest (OHCA) with a focus on why physicians withhold resuscitation attempts....

  17. A Summary and Analysis of Warrantless Arrest Statutes for Domestic Violence in the United States (United States)

    Zeoli, April M.; Norris, Alexis; Brenner, Hannah


    In the United States, all 50 states and the District of Columbia have enacted statutes that allow police officers to make warrantless arrests for domestic violence given probable cause; however, state laws differ from one another in multiple, important ways. Research on domestic violence warrantless arrest laws rarely describe them as anything…

  18. Comparison of analysis and experimental data for a unique crack arrest specimen

    International Nuclear Information System (INIS)

    Ayres, D.J.; Fabi, R.J.; Schonenberg, R.Y.; Norris, D.M.


    A new fracture test specimen has been developed to study crack extension and arrest in nuclear reactor vessel steels subject to stress-intensity factor and toughness gradients similar to those in postulated pressurized thermal shock situations. A summary of the results of all the tests performed is presented to illustrate the range of crack arrest and crack reinitiation conditions observed. One test of this specimen with the corresponding stress analysis is described in detail. During this test the crack initiated, extended, arrested, reinitiated, extended again, and reached a final arrest. Comparison of detailed dynamic elastic-plastic finite-element analyses and dynamic strain and displacement measurements of the crack extension, arrest, and reinitiation events, combined with topographic analysis of the future surfaces, has led to a new understanding of the crack extension and arrest process. The results of the tests demonstrate crack arrest in rising stress-intensity field at near-upper-shelf temperature conditions and show that the toughness required for arrest is lower than would be predicted by the analysis procedures usually employed for pressurized thermal shock evaluations

  19. Low cerebral blood flow after cardiac arrest is not associated with anaerobic cerebral metabolism

    NARCIS (Netherlands)

    Hoedemaekers, C.W.E.; Ainslie, Philip N.; Hinssen, S.; Aries, M.J.; Bisschops, Laurens L.; Hofmeijer, Jeannette; van der Hoeven, J.G.


    Aim of the study Estimation of cerebral anaerobic metabolism in survivors and non-survivors after cardiac arrest. Methods We performed an observational study in twenty comatose patients after cardiac arrest and 19 healthy control subjects. We measured mean flow velocity in the middle cerebral artery

  20. The effect of ultraviolet light on arrested human diploid cell populations

    International Nuclear Information System (INIS)

    Kantor, G.J.; Warner, C.; Hull, D.R.


    The results of the experiments to determine an effect of UV (254 nm) on human diploid fibroblasts (HDF) arrested with respect to division by using 0.5% fetal calf serum in the culture medium are reported. A fraction of cells from irradiated arrested populations, maintained in the arrested state post-irradiation, was lost from the populations. The extent of cell loss was fluence-dependent and cell strain specific. A Xeroderma pigmentosum cell strain was more sensitive to UV than were normal HDF. No difference in sensitivity were observed when arrested populations established from normal HDF populations of various in vitro ages were used. The length of the pre-irradiation arrested period affected the sensitivity of normal HDF, which appeared more resistant at longer arrested periods, but not the sensitivity of arrested Xeroderma populations. These results suggest that DNA repair processes play a role in maintaining irradiated cells in the arrested state. The suggestion is made that the lethal event caused by UV is an effect on transcription leading to an inhibition of required protein synthesis. (author)

  1. A seed treatment to prevent shoot apical meristem arrest in Brassica oleracea

    NARCIS (Netherlands)

    Jonge, de J.; Goffman, Fernando D.; Kodde, J.; Angenent, G.C.; Groot, S.P.C.


    Brassica oleracea plants can suffer from shoot apical meristem arrest, when sown at cold temperatures, giving rise to so-called blind seedlings that stop development and the formation of new leaves. We developed a seed treatment that strongly reduces the occurrence of this meristem arrest in

  2. 38 CFR 3.375 - Determination of inactivity (complete arrest) in tuberculosis. (United States)


    ... inactivity (complete arrest) in tuberculosis. 3.375 Section 3.375 Pensions, Bonuses, and Veterans' Relief...) in tuberculosis. (a) Pulmonary tuberculosis. A veteran shown to have had pulmonary tuberculosis will...) Nonpulmonary disease. Determination of complete arrest of nonpulmonary tuberculosis requires absence of...

  3. Wogonin induced G1 cell cycle arrest by regulating Wnt/β-catenin signaling pathway and inactivating CDK8 in human colorectal cancer carcinoma cells

    International Nuclear Information System (INIS)

    He, Licheng; Lu, Na; Dai, Qinsheng; Zhao, Yue; Zhao, Li; Wang, Hu; Li, Zhiyu; You, Qidong; Guo, Qinglong


    Highlights: • Wogonin inhibited HCT116 cells growth and arrested at G1 phase of the cell cycle. • Wogonin down-regulated the canonical Wnt/β-catenin signaling pathway. • Wogonin interfered in the combination of β-catenin and TCF/Lef. • Wogonin limited the kinase activity of CDK8. - Abstract: Wogonin, a naturally occurring mono-flavonoid, has been reported to have tumor therapeutic potential and good selectivity both in vitro and in vivo. Herein, we investigated the anti-proliferation effects and associated mechanisms of wogonin in human colorectal cancer in vitro. The flow-cytometric analysis showed that wogonin induced a G1 phase cell cycle arrest in HCT116 cells in a concentration- and time-dependent manner. Meanwhile, the cell cycle-related proteins, such as cyclin A, E, D1, and CDK2, 4 were down-regulated in wogonin-induced G1 cell cycle arrest. Furthermore, we showed that the anti-proliferation and G1 arrest effect of wogonin on HCT116 cells was associated with deregulation of Wnt/β-catenin signaling pathway. Wogonin-treated cells showed decreased intracellular levels of Wnt proteins, and activated degradation complex to phosphorylated and targeted β-catenin for proteasomal degradation. Wogonin inhibited β-catenin-mediated transcription by interfering in the transcriptional activity of TCF/Lef, and repressing the kinase activity of CDK8 which has been considered as an oncogene involving in the development of colorectal cancers. Moreover, CDK8 siRNA-transfected HCT116 cells showed similar results to wogonin treated cells. Thus, our data suggested that wogonin induced anti-proliferation and G1 arrest via Wnt/β-catenin signaling pathway and it can be developed as a therapeutic agent against human colorectal cancer

  4. Proteomic analysis of the response to cell cycle arrests in human myeloid leukemia cells. (United States)

    Ly, Tony; Endo, Aki; Lamond, Angus I


    Previously, we analyzed protein abundance changes across a 'minimally perturbed' cell cycle by using centrifugal elutriation to differentially enrich distinct cell cycle phases in human NB4 cells (Ly et al., 2014). In this study, we compare data from elutriated cells with NB4 cells arrested at comparable phases using serum starvation, hydroxyurea, or RO-3306. While elutriated and arrested cells have similar patterns of DNA content and cyclin expression, a large fraction of the proteome changes detected in arrested cells are found to reflect arrest-specific responses (i.e., starvation, DNA damage, CDK1 inhibition), rather than physiological cell cycle regulation. For example, we show most cells arrested in G2 by CDK1 inhibition express abnormally high levels of replication and origin licensing factors and are likely poised for genome re-replication. The protein data are available in the Encyclopedia of Proteome Dynamics (

  5. Application of Powell's optimization method to surge arrester circuit models' parameters

    Energy Technology Data Exchange (ETDEWEB)

    Christodoulou, C.A.; Stathopulos, I.A. [National Technical University of Athens, School of Electrical and Computer Engineering, 9 Iroon Politechniou St., Zografou Campus, 157 80 Athens (Greece); Vita, V.; Ekonomou, L.; Chatzarakis, G.E. [A.S.PE.T.E. - School of Pedagogical and Technological Education, Department of Electrical Engineering Educators, N. Heraklion, 141 21 Athens (Greece)


    Powell's optimization method has been used for the evaluation of the surge arrester models parameters. The proper modelling of metal-oxide surge arresters and the right selection of equivalent circuit parameters are very significant issues, since quality and reliability of lightning performance studies can be improved with the more efficient representation of the arresters' dynamic behavior. The proposed approach selects optimum arrester model equivalent circuit parameter values, minimizing the error between the simulated peak residual voltage value and this given by the manufacturer. Application of the method in performed on a 120 kV metal oxide arrester. The use of the obtained optimum parameter values reduces significantly the relative error between the simulated and manufacturer's peak residual voltage value, presenting the effectiveness of the method. (author)

  6. Condition Assessment of Metal Oxide Surge Arrester Based on Multi-Layer SVM Classifier

    Directory of Open Access Journals (Sweden)

    M Khodsuz


    Full Text Available This paper introduces the indicators for surge arrester condition assessment based on the leakage current analysis. Maximum amplitude of fundamental harmonic of the resistive leakage current, maximum amplitude of third harmonic of the resistive leakage current and maximum amplitude of fundamental harmonic of the capacitive leakage current were used as indicators for surge arrester condition monitoring. Also, the effects of operating voltage fluctuation, third harmonic of voltage, overvoltage and surge arrester aging on these indicators were studied. Then, obtained data are applied to the multi-layer support vector machine for recognizing of surge arrester conditions. Obtained results show that introduced indicators have the high ability for evaluation of surge arrester conditions.

  7. Electronic registration of out-of-hospital cardiac arrests

    DEFF Research Database (Denmark)

    Nielsen, Niels Dalsgaard; Dahl, Michael; Gade, John


    of cardiac arrest. 83 of those (28 %) received first aid. The first aid was provided by layman (68 %), physicians (11 %), nurses (11 %) and first-aiders (4 %). In 6 % the identity of the first aid provider was unknown. The majority of the patients (n = 177 (58 %)) had asystole upon ambulance arrival. 37 (12...... patients according to whether they received first aid, the identity of the first aid provider and the initial cardiac rhythm as diagnosed by the patient monitor.   Results: 18,666 patients where in contact with an emergency ambulance in the study period. Of those 296 (89/100,000/year) met the definition...... a considerably higher incidence rate for OHCA, than documented by the analogue nationwide registry. Further we discovered a high rate of first aid to OHCA-patients. Finally our data showed a high occurence of asystolia in patients who met the official criteria for OHCA....

  8. Out-of-hospital cardiac arrests in children and adolescents

    DEFF Research Database (Denmark)

    Rajan, Shahzleen; Wissenberg, Mads; Folke, Fredrik


    BACKGROUND: There is insufficient knowledge of out-of-hospital cardiac arrest (OHCA) in the very young. OBJECTIVES: This nationwide study sought to examine age-stratified OHCA characteristics and the role of parental socioeconomic differences and its contribution to mortality in the young...... population. METHODS: All OHCA patients in Denmark, ≤21 years of age, were identified from 2001 to 2010. The population was divided into infants (adolescents/young adults (16-21 years). Multivariate logistic regression......-school children, school children and high school adolescents were 11.5, 3.5, 1.3 and 5.3 per 100,000 inhabitants. Overall bystander CPR rate was 48.8%, and for age groups: 55.4%, 41.2%, 44.9% and 63.0%, respectively. Overall 30-day survival rate was 8.1%, and for age groups: 1.4%, 4.5%, 16.1% and 9...

  9. Increased risk of sudden cardiac arrest in obstructive pulmonary disease

    DEFF Research Database (Denmark)

    Warnier, Miriam Jacoba; Blom, Marieke Tabo; Bardai, Abdennasser


    BACKGROUND: We aimed to determine whether (1) patients with obstructive pulmonary disease (OPD) have an increased risk of sudden cardiac arrest (SCA) due to ventricular tachycardia or fibrillation (VT/VF), and (2) the SCA risk is mediated by cardiovascular risk-profile and/or respiratory drug use...... with electrocardiographic documentation of VT/VF were included. Conditional logistic regression analysis was used to assess the association between SCA and OPD. Pre-specified subgroup analyses were performed regarding age, sex, cardiovascular risk-profile, disease severity, and current use of respiratory drugs. RESULTS...... is associated with an increased observed risk of SCA. The most increased risk was observed in patients with a high cardiovascular risk-profile, and in those who received SABA and, possibly, those who received AC at the time of SCA....

  10. Current practice in out-of-hospital cardiac arrest management

    DEFF Research Database (Denmark)

    Proclemer, Alessandro; Dobreanu, Dan; Pison, Laurent


    AIMS: The purpose of this EP wire is to examine clinical practice in the field of out-of-hospital cardiac arrest (OHCA) management, with special focus on in-hospital diagnostic and therapeutic strategies. METHODS AND RESULTS: Fifty-three European centres, all members of the EHRA-EP Research network......, completed the questions of the survey. A dedicated strategy for OHCA management is active in 85% of the centres. Shockable tachyarrhythmias such as initial OHCA rhythm are reported in >70% of the patients in 64% of the centres. In-hospital therapeutic hypothermia was applied in >50% of the patients in 53...... management strategy, including coronary angiography/PCI and implantable cardioverter defibrillator therapy, while therapeutic hypothermia appears to be underused....

  11. A Unique Case of Cardiac Arrest following K2 Abuse

    Directory of Open Access Journals (Sweden)

    Saif Ibrahim


    Full Text Available Sudden cardiac death (SCD accounts for up to 450,000 deaths every year in the United States (Zipes et al. (2006. Most cases of sudden cardiac death occur in subjects with no prior history of heart disease (Myerburg et al. (1998. The incidence of sudden death in a general population has been shown to increase contemporaneously with substance abuse (Phillips et al. (1999. The causative association of sudden death with cocaine, methadone, and volatile agents is well established (Adgey et al. (1995 and Isner et al. (1986. We describe a case of out-of-hospital cardiac arrest temporally related to abuse of the synthetic cannabinoid street drug known as K2. To our knowledge, there are no previously documented cases of sudden cardiac death associated with synthetic cannabinoids although they have been linked to myocardial infarction in teenagers despite normal coronary angiography (Mir et al. (2011.

  12. Central diabetes insipidus following cardiopulmonary arrest in a dog. (United States)

    Bellis, Tara; Daly, Meredith; Davidson, Benjamin


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

  13. Opiate Withdrawal Complicated by Tetany and Cardiac Arrest

    Directory of Open Access Journals (Sweden)

    Irfanali R. Kugasia


    Full Text Available Patients with symptoms of opiate withdrawal, after the administration of opiate antagonist by paramedics, are a common presentation in the emergency department of hospitals. Though most of opiate withdrawal symptoms are benign, rarely they can become life threatening. This case highlights how a benign opiate withdrawal symptom of hyperventilation led to severe respiratory alkalosis that degenerated into tetany and cardiac arrest. Though this patient was successfully resuscitated, it is imperative that severe withdrawal symptoms are timely identified and immediate steps are taken to prevent catastrophes. An easier way to reverse the severe opiate withdrawal symptom would be with either low dose methadone or partial opiate agonists like buprenorphine. However, if severe acid-base disorder is identified, it would be safer to electively intubate these patients for better control of their respiratory and acid-base status.

  14. Lobaplatin arrests cell cycle progression in human hepatocellular carcinoma cells

    Directory of Open Access Journals (Sweden)

    Chen Chang-Jie


    Full Text Available Abstract Background Hepatocellular carcinoma (HCC still is a big burden for China. In recent years, the third-generation platinum compounds have been proposed as potential active agents for HCC. However, more experimental and clinical data are warranted to support the proposal. In the present study, the effect of lobaplatin was assessed in five HCC cell lines and the underlying molecular mechanisms in terms of cell cycle kinetics were explored. Methods Cytotoxicity of lobaplatin to human HCC cell lines was examined using MTT cell proliferation assay. Cell cycle distribution was determined by flow cytometry. Expression of cell cycle-regulated genes was examined at both the mRNA (RT-PCR and protein (Western blot levels. The phosphorylation status of cyclin-dependent kinases (CDKs and retinoblastoma (Rb protein was also examined using Western blot analysis. Results Lobaplatin inhibited proliferation of human HCC cells in a dose-dependent manner. For the most sensitive SMMC-7721 cells, lobaplatin arrested cell cycle progression in G1 and G2/M phases time-dependently which might be associated with the down-regulation of cyclin B, CDK1, CDC25C, phosphorylated CDK1 (pCDK1, pCDK4, Rb, E2F, and pRb, and the up-regulation of p53, p21, and p27. Conclusion Cytotoxicity of lobaplatin in human HCC cells might be due to its ability to arrest cell cycle progression which would contribute to the potential use of lobaplatin for the management of HCC.

  15. 28 CFR 16.1 - General provisions. (United States)


    ... 28 Judicial Administration 1 2010-07-01 2010-07-01 false General provisions. 16.1 Section 16.1 Judicial Administration DEPARTMENT OF JUSTICE PRODUCTION OR DISCLOSURE OF MATERIAL OR INFORMATION... administration of the Department of Justice. ...

  16. Constitutional Provisions And Administrative Disciplinary Powers ...

    African Journals Online (AJOL)

    Constitutional Provisions And Administrative Disciplinary Powers: The Medical ... and Dental Practitioners Act. This process of administrative adjudication is ... the rights guaranteed to the professionals when they appear before the Tribunal.

  17. 48 CFR 225.7605 - Solicitation provision. (United States)


    ... SYSTEM, DEPARTMENT OF DEFENSE SOCIOECONOMIC PROGRAMS FOREIGN ACQUISITION Secondary Arab Boycott of Israel... accordance with 225.7604, use the provision at 252.225-7031, Secondary Arab Boycott of Israel, in all...

  18. Cardiac arrest during gamete release in chum salmon regulated by the parasympathetic nerve system.

    Directory of Open Access Journals (Sweden)

    Yuya Makiguchi

    Full Text Available Cardiac arrest caused by startling stimuli, such as visual and vibration stimuli, has been reported in some animals and could be considered as an extraordinary case of bradycardia and defined as reversible missed heart beats. Variability of the heart rate is established as a balance between an autonomic system, namely cholinergic vagus inhibition, and excitatory adrenergic stimulation of neural and hormonal action in teleost. However, the cardiac arrest and its regulating nervous mechanism remain poorly understood. We show, by using electrocardiogram (ECG data loggers, that cardiac arrest occurs in chum salmon (Oncorhynchus keta at the moment of gamete release for 7.39+/-1.61 s in females and for 5.20+/-0.97 s in males. The increase in heart rate during spawning behavior relative to the background rate during the resting period suggests that cardiac arrest is a characteristic physiological phenomenon of the extraordinarily high heart rate during spawning behavior. The ECG morphological analysis showed a peaked and tall T-wave adjacent to the cardiac arrest, indicating an increase in potassium permeability in cardiac muscle cells, which would function to retard the cardiac action potential. Pharmacological studies showed that the cardiac arrest was abolished by injection of atropine, a muscarinic receptor antagonist, revealing that the cardiac arrest is a reflex response of the parasympathetic nerve system, although injection of sotalol, a beta-adrenergic antagonist, did not affect the cardiac arrest. We conclude that cardiac arrest during gamete release in spawning release in spawning chum salmon is a physiological reflex response controlled by the parasympathetic nervous system. This cardiac arrest represents a response to the gaping behavior that occurs at the moment of gamete release.

  19. Outsourcing, public Input provision and policy cooperation


    Aronsson, Thomas; Koskela, Erkki


    This paper concerns public input provision as an instrument for redistribution under international outsourcing by using a model-economy comprising two countries, North and South, where firms in the North may outsource part of their low-skilled labor intensive production to the South. We consider two interrelated issues: (i) the incentives for each country to modify the provision of public input goods in response to international outsourcing, and (ii) whether international outsourcing justifie...

  20. Obligatory provisions for nuclear power plants

    International Nuclear Information System (INIS)

    Cloosters, W.


    To cover the expenses associated with decommissioning and disposal of their nuclear power plants, German nuclear power plant operators set aside a total of more than EUR 30 billion and entered the respective provisions into their balance sheets. One point of eminent importance in this regard is the question whether these provisions are adequate in amount and permitted under accounting and tax laws. The other point to be considered is whether the funds will be available reliably if and when needed. Against the backdrop of these issues, the practice and importance of making these provisions are described. This is followed by an outline of the basic accounting and taxation aspects. It is seen that obligations under public law can be the basis of financial provisions only if there is a obligation sufficiently concrete in terms of time and object. The following examination of applicable obligations under the Atomic Energy Act incumbent upon nuclear power plant operators with regard to decommissioning and disposal results in the finding that such obligations are only partly regulated in the Atomic Energy Act, and that specifications in terms of time and purpose are insufficient. If the national practice of making financial provisions is to be put on a reliable basis, it is recommended to express the law on decommissioning and its mode of financing in more concrete terms in the Atomic Energy Act. In addition to unequivocal decommissioning and disposal obligations, the Atomic Energy Act should also incorporate regulations about financial provisions for decomissioning which are in need of more precise language. The present practice of making provisions is characterized by the risk that the funds necessary for planned decommissioning and disposal may not be available when needed. It is against this background that possible solutions reducing that risk are discussed. A recommendation is expressed to establish a public fund for decommissioning and disposal to which the

  1. Economic Loan Loss Provision and Expected Loss

    Directory of Open Access Journals (Sweden)

    Stefan Hlawatsch


    Full Text Available The intention of a loan loss provision is the anticipation of the loan's expected losses by adjusting the book value of the loan. Furthermore, this loan loss provision has to be compared to the expected loss according to Basel II and, in the case of a difference, liable equity has to be adjusted. This however assumes that the loan loss provision and the expected loss are based on a similar economic rationale, which is only valid conditionally in current loan loss provisioning methods according to IFRS. Therefore, differences between loan loss provisions and expected losses should only result from different approaches regarding the parameter estimation within each model and not due to different assumptions regarding the outcome of the model. The provisioning and accounting model developed in this paper overcomes the before-mentioned shortcomings and is consistent with an economic rationale of expected losses. Additionally, this model is based on a close-to-market valuation of the loan that is in favor of the basic idea of IFRS. Suggestions for changes in current accounting and capital requirement rules are provided.

  2. Ionic and Wigner Glasses, Superionic Conductors, and Spinodal Electrostatic Gels: Dynamically Arrested Phases of the Primitive Model

    International Nuclear Information System (INIS)

    Sanchez-Diaz, L. E.; Juarez-Maldonado, R.; Vizcarra-Rendon, A.


    Based on the recently proposed self-consistent generalized Langevin equation theory of dynamic arrest, in this letter we show that the ergodic-nonergodic phase diagram of a classical mixture of charged hard spheres (the so-called 'primitive model' of ionic solutions and molten salts) includes arrested phases corresponding to nonconducting ionic glasses, partially arrested states that represent solid electrolytes (or 'superionic' conductors), low-density colloidal Wigner glasses, and low-density electrostatic gels associated with arrested spinodal decomposition.

  3. Cross-country Differences in Reporting Practices – the Case of Provisions for Liabilities

    Directory of Open Access Journals (Sweden)

    Katarzyna Klimczak


    Full Text Available Purpose: The aim of the study was to explore and compare reporting practices on provisions for liabilities in different countries. Methodology: The research was limited to the types of provisions that are addressed in the International Accounting Standard 37 - Provisions, Contingent Liabilities and Contingent Assets. For the purpose of the study, financial statements of the biggest public companies in Great Britain, Germany and Poland have been chosen to be taken into consideration. The following detailed issues have been explored: - Presentation of the types of provisions in a statement of financial position and additional notes to a financial statement, - Presentation of the amounts of provisions made, used, and reversed during a given period and the effects of changes in the discount rate, - Scope and quality of descriptions of the nature of obligations presented by entities. The results of the analysis have been viewed from two perspectives - the areas of compliance and non-compliance of reporting on provisions with IFRS have been identified and a comparison of the extent of compliance with particular requirements between companies from different countries has been developed. Findings: The results of the analysis have revealed that companies from selected countries demonstrate different levels of compliance with International Financial Reporting Standards (IFRS. Substantial differences in the scope and the quality of descriptive disclosures on provisions have been also identified. Originality/value: The study contributes to the research on cross-country differences in reporting practices and indicates the need for a further analysis of the underlying determinants

  4. Serial plasma choline measurements after cardiac arrest in patients undergoing mild therapeutic hypothermia: a prospective observational pilot trial.

    Directory of Open Access Journals (Sweden)

    Christian Storm

    Full Text Available OBJECTIVE: Choline is related to phospholipid metabolism and is a marker for global ischaemia with a small reference range in healthy volunteers. The aim of our study was to characterize the early kinetics of plasma free choline in patients after cardiac arrest. Additionally, we investigated the potential of plasma free choline to predict neurological outcome. METHODS: Twenty patients admitted to our medical intensive care unit were included in this prospective, observational trial. All patients were enrolled between May 2010 and May 2011. They received post cardiac arrest treatment including mild therapeutic hypothermia which was initiated with a combination of cold fluid and a feedback surface cooling device according to current guidelines. Sixteen blood samples per patient were analysed for plasma free choline levels within the first week after resuscitation. Choline was detected by liquid chromatography-tandem mass spectrometry. RESULTS: Most patients showed elevated choline levels on admission (median 14.8 µmol/L; interquartile range; IQR 9.9-20.1 which subsequently decreased. 48 hours after cardiac arrest choline levels in all patients reached subnormal levels at a median of 4.0 µmol/L (IQR 3-4.9; p = 0.001. Subsequently, choline levels normalized within seven days. There was no significant difference in choline levels when groups were analyzed in relation to neurological outcome. CONCLUSIONS: Our data indicate a choline deficiency in the early postresucitation phase. This could potentially result in impaired cell membrane recovery. The detailed characterization of the early choline time course may aid in planning of choline supplementation trials. In a limited number of patients, choline was not promising as a biomarker for outcome prediction.

  5. Communication between members of the cardiac arrest team--a postal survey. (United States)

    Pittman, J; Turner, B; Gabbott, D A


    Effective communication enhances team building and is perceived to improve the quality of team performance. A recent publication from the Resuscitation Council (UK) has highlighted this fact and recommended that cardiac arrest team members make contact daily. We wished to identify how often members of this team communicate prior to a cardiopulmonary arrest. A questionnaire on cardiac arrest team composition, leadership, communication and debriefing was distributed nationally to Resuscitation Training Officers (RTOs) and their responses analysed. One hundred and thirty (55%) RTOs replied. Physicians and anaesthetists were the most prominent members of the team. The Medical Senior House Officer is usually nominated as the team leader. Eighty-seven centres (67%) have no communication between team members prior to attending a cardiopulmonary arrest. In 33%, communication occurs but is either informal or fortuitous. The RTOs felt that communication is important to enhance team dynamics and optimise task allocation. Only 7% achieve a formal debrief following a cardiac arrest. Communication between members of the cardiac arrest team before and after a cardiac arrest is poor. Training and development of these skills may improve performance and should be prioritised. Team leadership does not necessarily reflect experience or training.

  6. Discrimination, arrest history, and major depressive disorder in the U.S. Black population. (United States)

    Anglin, Deidre M; Lighty, Quenesha; Yang, Lawrence H; Greenspoon, Michelle; Miles, Rashun J; Slonim, Tzachi; Isaac, Kathleen; Brown, Monique J


    Everyday discrimination contributes negatively to depressive symptomatology among Blacks in the US and being arrested could add to this depression. Using data from the National Survey on American Life, the present study determined the association between an arrest history and major depressive disorder (MDD), while accounting for discrimination among African Americans, US-born Afro-Caribbeans and first-generation Black immigrants. Findings from logistic regression analyses adjusted for discrimination suggested an arrest history is associated with 12-month MDD (Adjusted OR=1.47; 95% CI=1.02-2.10) and lifetime MDD (Adjusted OR=1.56 CI=1.17-2.09). Accounting for drug and alcohol dependence attenuated the association between arrest history and 12-month MDD, but not lifetime MDD. The associations between arrest history and both 12-month and lifetime MDD, and discrimination and lifetime MDD varied by ethnic/immigrant group. Specifically, while the association between arrest history and MDD (both 12-month and lifetime) was strongest among US-born Afro-Caribbeans, evidence consistent with the immigrant paradox, the association between discrimination and lifetime MDD was particularly relevant for first-generation Black immigrants, suggesting discrimination may hinder the protection of first-generation status. Mental health prevention and treatment programs should target the stress associated with being arrested and experiencing discrimination among US Blacks. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  7. Early Recognition of Foreign Body Aspiration as the Cause of Cardiac Arrest

    Directory of Open Access Journals (Sweden)

    Muhammad Kashif


    Full Text Available Foreign body aspiration (FBA is uncommon in the adult population but can be a life-threatening condition. Clinical manifestations vary according to the degree of airway obstruction, and, in some cases, making the correct diagnosis requires a high level of clinical suspicion combined with a detailed history and exam. Sudden cardiac arrest after FBA may occur secondary to asphyxiation. We present a 48-year-old male with no history of cardiac disease brought to the emergency department after an out-of-hospital cardiac arrest (OHCA. The patient was resuscitated after 15 minutes of cardiac arrest. He was initially managed with therapeutic hypothermia (TH. Subsequent history suggested FBA as a possible etiology of the cardiac arrest, and fiberoptic bronchoscopy demonstrated a piece of meat and bone lodged in the left main stem bronchus. The foreign body was removed with the bronchoscope and the patient clinically improved with full neurological recovery. Therapeutic hypothermia following cardiac arrest due to asphyxia has been reported to have high mortality and poor neurological outcomes. This case highlights the importance of early identification of FBA causing cardiac arrest, and we report a positive neurological outcome for postresuscitation therapeutic hypothermia following cardiac arrest due to asphyxia.

  8. Cardiopulmonary resuscitation duration and survival in out-of-hospital cardiac arrest patients. (United States)

    Adnet, Frederic; Triba, Mohamed N; Borron, Stephen W; Lapostolle, Frederic; Hubert, Hervé; Gueugniaud, Pierre-Yves; Escutnaire, Josephine; Guenin, Aurelien; Hoogvorst, Astrid; Marbeuf-Gueye, Carol; Reuter, Paul-Georges; Javaud, Nicolas; Vicaut, Eric; Chevret, Sylvie


    Relationship between cardiopulmonary arrest and resuscitation (CPR) durations and survival after out-of-hospital cardiac arrest (OHCA) remain unclear. Our primary aim was to determine the association between survival without neurologic sequelae and cardiac arrest intervals in the setting of witnessed OHCA. We analyzed 27,301 non-traumatic, witnessed OHCA patients in France included in the national registry from June 1, 2011 through December 1, 2015. We analyzed cardiac arrest intervals, designated as no-flow (NF; from collapse to start of CPR) and low-flow (LF; from start of CPR to cessation of resuscitation) in relation to 30-day survival without sequelae. We determined the influence of recognized prognostic factors (age, gender, initial rhythm, location of cardiac arrest) on this relation. For the entire cohort, the area delimited by a value of NF greater than 12min (95% confidence interval: 11-13min) and LF greater than 33min (95% confidence interval: 29-45min), yielded a probability of 30-day survival of less than 1%. These sets of values were greatly influenced by initial cardiac arrest rhythm, age, sex and location of cardiac arrest. Extended CPR duration (greater than 40min) in the setting of initial shockable cardiac rhythm is associated with greater than 1% survival with NF less than 18min. The NF interval was highly influential on the LF interval regardless of outcome, whether return of spontaneous circulation (padvanced techniques. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  9. Use of forces from instrumented Charpy V-notch testing to determine crack-arrest toughness

    International Nuclear Information System (INIS)

    Iskander, S.K.; Nanstad, R.K.; Sokolov, M.A.; McCabe, D.E.; Hutton, J.T.


    The objective of this investigation is an estimation of the crack-arrest toughness, particularly of irradiated materials, from voltage versus time output of an instrumented setup during a test on a Charpy V-notch (CVN) specimen. This voltage versus time trace (which can be converted to force versus displacement) displays events during fracture of the specimen. Various stages of the fracture process can be identified on the trace, including an arrest point indicating arrest of brittle fracture. The force at arrest, F a , versus test temperature, T, relationship is examined to explore possible relationships to other experimental measures of crack-arrest toughness such as the drop-weight nil-ductility temperature (NDT), or crack-arrest toughness, K a . For a wide range of weld and plate materials, the temperature at which F a = 2.45 kN correlates with NDT with a standard deviation, sigma, of about 11 K. Excluding the so-called low upper-shelf energy (USE) welds from the analysis resulted in F a = 4.12 kN and σ = 6.6 K. The estimates of the correlation of the temperature for F a = 7.4 kN with the temperature at 100-MPa√m level for a mean American Society of Mechanical Engineers (ASME) type K Ia curve through crack-arrest toughness values show that prediction of conservative values of K a are possible

  10. The role of ductile ligaments and warm prestress on the re-initiation of fracture from a crack arrested during thermal shock

    International Nuclear Information System (INIS)

    Smith, E.


    The protection offered by warm prestress can be important for preserving a nuclear pressure vessel's integrity during a postulated emergency condition involving a loss of coolant, when the emergency core cooling water subjects the pressure vessel to a thermal shock. There are two aspects to the problem: (a) the initial extension of a defect into the vessel wall, and (b) the subsequent re-initiation of fracture at an arrested crack tip. This note considers the effect of warm prestress on the re-initiation of fracture from an arrested crack, and emphasizes the role of ductile ligaments. It is argued that the warm prestress concept is applicable, thus complementing the limited experimental results provided by the HSST Thermal Shock experimental programme. (orig.)

  11. Oocyte transport: Developmental competence of bovine oocytes arrested at germinal vesicle stage by cycloheximide under air. (United States)

    Hashimoto, Shu; Kimura, Kouji; Iwata, Hisataka; Takakura, Ryo


    The effects of the medium (TCM 199 or SOFaa) and temperature (20 or 39 C) during meiotic arrest by cycloheximide (CHX) under air on the developmental competence of bovine oocytes after in vitro maturation (IVM) and fertilization (IVF) were investigated. Oocytes were maintained in meiotic arrest by 10 microg/ml CHX in a 50-microl droplet of 25-mM HEPES-buffered TCM 199 (H199) at 39 C or synthetic oviduct fluid (HSOFaa) at 20 or 39 C in air for 24 h. After release from the arrest, the oocytes was matured and fertilized in vitro and their developmental competence was examined. The developmental rate of oocytes arrested in HSOFaa at 20 C to the blastocyst stage was similar to that of non-arrested oocytes but was significantly higher (Ptransport conditions, we also investigated the meiotic arrest of oocytes maintained in a 0.25-ml straw by CHX individually with 10 microl HSOFaa or as a group (40-50 oocytes) with 170-200 microl HSOFaa at 20 C in air for 24 h. After release from meiotic arrest, the developmental competence of these oocytes was assessed similarly. The developmental rate of oocytes treated with CHX individually was similar to that of those treated with CHX in 50-microl droplet of HSOFaa at 20 C. However, the developmental rate of oocytes treated with CHX as a group was lower than that of oocytes treated with CHX in a 50-microl droplet. Five blastocysts developed from oocytes maintained in meiotic arrest in a plastic straw were transferred to five recipient heifers. Consequently, three recipients became pregnant and 2 calves were delivered. The results of the present study indicate that bovine oocytes treated with CHX in HSOFaa at 20 C under air retain the same developmental competence as non-arrested oocytes.

  12. Mechanical versus manual chest compressions for cardiac arrest. (United States)

    Brooks, Steven C; Hassan, Nizar; Bigham, Blair L; Morrison, Laurie J


    This is the first update of the Cochrane review on mechanical chest compression devices published in 2011 (Brooks 2011). Mechanical chest compression devices have been proposed to improve the effectiveness of cardiopulmonary resuscitation (CPR). To assess the effectiveness of mechanical chest compressions versus standard manual chest compressions with respect to neurologically intact survival in patients who suffer cardiac arrest. We searched the Cochrane Central Register of Controlled Studies (CENTRAL; 2013, Issue 12), MEDLINE Ovid (1946 to 2013 January Week 1), EMBASE (1980 to 2013 January Week 2), Science Citation abstracts (1960 to 18 November 2009), Science Citation Index-Expanded (SCI-EXPANDED) (1970 to 11 January 2013) on Thomson Reuters Web of Science, biotechnology and bioengineering abstracts (1982 to 18 November 2009), conference proceedings Citation Index-Science (CPCI-S) (1990 to 11 January 2013) and (2 August 2013). We applied no language restrictions. Experts in the field of mechanical chest compression devices and manufacturers were contacted. We included randomised controlled trials (RCTs), cluster RCTs and quasi-randomised studies comparing mechanical chest compressions versus manual chest compressions during CPR for patients with atraumatic cardiac arrest. Two review authors abstracted data independently; disagreement between review authors was resolved by consensus and by a third review author if consensus could not be reached. The methodologies of selected studies were evaluated by a single author for risk of bias. The primary outcome was survival to hospital discharge with good neurological outcome. We planned to use RevMan 5 (Version 5.2. The Nordic Cochrane Centre) and the DerSimonian & Laird method (random-effects model) to provide a pooled estimate for risk ratio (RR) with 95% confidence intervals (95% CIs), if data allowed. Two new studies were included in this update. Six trials in total, including data from 1166

  13. Bank loan loss provisions research: A review

    Directory of Open Access Journals (Sweden)

    Peterson K. Ozili


    Full Text Available We review the recent academic and policy literature on bank loan loss provisioning. Among other things, we observe that there exist some interaction between LLPs and existing prudential, accounting, institutional, cultural, religious, tax and fiscal frameworks which differ across countries; and we find that managerial discretion in provisioning is strongly linked to income smoothing, capital management, signalling, tax management and other objectives. We also address several issues including the ethical dimensions of income smoothing, factors influencing income smoothing, methodological issues in LLP modelling and the dynamic loan loss provisioning experiment; which opens up several avenues for further research such as: finding a balance between sufficient LLPs which regulators want versus transparent LLPs which standard setters want; the sensitivity of abnormal LLPs to changes in equity; the persistence of abnormal LLPs following CEO exit; country-specific interventions that induce LLP procyclicality in emerging countries; the impact of Basel III on banks' provisioning discretion; LLP behaviour among systemic and non-systemic financial institutions; etc. We conclude that regulators need to pay attention to how much discretion lending institutions should have in determining reported provision estimates, and this has been a long standing issue.

  14. Methods of Services Provision in Slovak Towns

    Directory of Open Access Journals (Sweden)

    Emília Sičáková-Beblavá


    Full Text Available This article deals with the methods of services provision in Slovak towns.  It addresses decision-making concerning selected services provision, based on a transaction cost economic model. The article looks at five types of services from that point of view. These are core services, i.e., services that are provided in most Slovak towns, thereby allowing outcomes of decision-making to be compared, and services which can be outsourced according to transaction cost theory. Findings partially confirm the hypothesis: Slovak towns do outsource, though “insourcing” moderately prevails. However, a comparison of several research studies in the area indicates a trend towards higher outsourcing of such local services provision.  The findings show that public bodies do not always select the most suitable methods of services provision, as suggested by the transaction costs theory (the Brown-Potoski model. This indicates that it is not only economic models that influence decision-making concerning the organization of services provision in the Slovak towns.

  15. Income inequality, drug-related arrests, and the health of people who inject drugs: Reflections on seventeen years of research. (United States)

    Friedman, Samuel R; Tempalski, Barbara; Brady, Joanne E; West, Brooke S; Pouget, Enrique R; Williams, Leslie D; Des Jarlais, Don C; Cooper, Hannah L F


    This paper reviews and then discusses selected findings from a seventeen year study about the population prevalence of people who inject drugs (PWID) and of HIV prevalence and mortality among PWID in 96 large US metropolitan areas. Unlike most research, this study was conducted with the metropolitan area as the level of analysis. It found that metropolitan area measures of income inequality and of structural racism predicted all of these outcomes, and that rates of arrest for heroin and/or cocaine predicted HIV prevalence and mortality but did not predict changes in PWID population prevalence. Income inequality and measures of structural racism were associated with hard drug arrests or other properties of policing. These findings, whose limitations and implications for further research are discussed, suggest that efforts to respond to HIV and to drug injection should include supra-individual efforts to reduce both income inequality and racism. At a time when major social movements in many countries are trying to reduce inequality, racism and oppression (including reforming drug laws), these macro-social issues in public health should be both addressable and a priority in both research and action. Copyright © 2016 Elsevier B.V. All rights reserved.

  16. Extracorporeal Cardiopulmonary Resuscitation for Refractory Out-of-Hospital Cardiac Arrest: The State of the Evidence and Framework for Application. (United States)

    Grunau, Brian; Hornby, Laura; Singal, Rohit K; Christenson, Jim; Ortega-Deballon, Ivan; Shemie, Sam D; Bashir, Jamil; Brooks, Steve C; Callaway, Clifton W; Guadagno, Elena; Nagpal, Dave


    Out-of-hospital cardiac arrest (OHCA) affects 134 per 100,000 citizens annually. Extracorporeal cardiopulmonary resuscitation (ECPR), providing mechanical circulatory support, may improve the likelihood of survival among those with refractory OHCA. Compared with in-hospital ECPR candidates, those in the out-of-hospital setting tend to be sudden unexpected arrests in younger and healthier patients. The aims of this review were to summarize, and identify the limitations of, the evidence evaluating ECPR for OHCA, and to provide an approach for ECPR program application. Although there are many descriptions of ECPR-treated cohorts, we identified a paucity of robust data showing ECPR effectiveness compared with conventional resuscitation. However, it is highly likely that ECPR, provided after a prolonged attempt with conventional resuscitation, does benefit select patient populations compared with conventional resuscitation alone. Although reliable data showing the optimal patient selection criteria for ECPR are lacking, most implementations sought young previously healthy patients with rapid high-quality cardiopulmonary resuscitation. Carefully planned development of ECPR programs, in high-performing emergency medical systems at experienced extracorporeal membrane oxygenation centres, may be reasonable as part of systematic efforts to determine ECPR effectiveness and globally improve care. Protocol evaluation requires regional-level assessment, examining the incremental benefit of survival compared with standard care, while accounting for resource utilization. Copyright © 2017 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

  17. Novel approach for independent control of brain hypothermia and systemic normothermia: cerebral selective deep hypothermia for refractory cardiac arrest. (United States)

    Wang, Chih-Hsien; Lin, Yu-Ting; Chou, Heng-Wen; Wang, Yi-Chih; Hwang, Joey-Jen; Gilbert, John R; Chen, Yih-Sharng


    A 38-year-old man was found unconscious, alone in the driver's seat of his car. The emergency medical team identified his condition as pulseless ventricular tachycardia. Defibrillation was attempted but failed. Extracorporeal membrane oxygenation (ECMO) was started in the emergency room 52 min after the estimated arrest following the extracorporeal cardiopulmonary resuscitation (ECPR) protocol in our center. The initial prognosis under the standard protocol was <25% chance of survival. A novel adjunctive to our ECPR protocol, cerebral selective deep (<30°C) hypothermia (CSDH), was applied. CSDH adds a second independent femoral access extracorporeal circuit, perfusing cold blood into the patient's common carotid artery. The ECMO and CSDH circuits demonstrated independent control of cerebral and core temperatures. Nasal temperature was lowered to below 30°C for 12 hours while core was maintained at normothermia. The patient was discharged without significant neurological deficit 32 days after the initial arrest. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to

  18. 5 CFR 551.702 - Time limits. (United States)


    ... at any time file a complaint under the child labor provisions of the Act or an FLSA claim challenging... claim concerning his or her entitlement to minimum wage or overtime pay for work performed under the Act... limitations is 3 years. In deciding a claim, a determination must be made as to whether the cause or basis of...

  19. 40 CFR 1042.640 - Special provisions for branded engines. (United States)


    ... 40 Protection of Environment 32 2010-07-01 2010-07-01 false Special provisions for branded engines. 1042.640 Section 1042.640 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR... Special Compliance Provisions § 1042.640 Special provisions for branded engines. The following provisions...

  20. The perception of children of elementary education about cardiorespiratory arrest

    Directory of Open Access Journals (Sweden)

    Mariélli Terassi


    Full Text Available Cardiorespiratory arrest (CRA is a serious situation that occurs frequently in public environments, which makes assistance training of the general population of great importance. The objective was to understand the perception of children on CRA. Qualitative research conducted with children 8-10 years old enrolled in a private elementary school with a constructive proposal. Data collection occurred between the months of October and November 2013 in a recorded collective interview. As a criterion for inclusion students should be enrolled in the institution and accept to participate in the research with the consent of a guardian. Thirty children participated in the study. The students were divided into four groups: 5th year, 4th year, 3rd year A and 3rd year B, with an average of 08 students per group. The interviews were analyzed using the Bardin content analysis methodology. From the speeches, two categories emerged: Child's prior knowledge on CRA and how to act on the event of a CRA. Children associate the event of sudden CRA to a condition in which the heart and/or lungs suddenly stop acting. Seeking emergency assistance was reported as one of the main actions to be taken if a person is unconscious. It was observed that the 5th graders had best prior knowledge about the topic CRA when compared to students in the 3rd year. The thematic approach of CRA in schools contributes to the exchange of experiences, awareness of children and building new knowledge-oriented health education.

  1. Patterns of premature physeal arrest: MR imaging of 111 children. (United States)

    Ecklund, Kirsten; Jaramillo, Diego


    The purpose of this study was to use MR imaging, especially fat-suppressed three-dimensional (3D) spoiled gradient-recalled echo sequences, to identify patterns of growth arrest after physeal insult in children. We evaluated 111 children with physeal bone bridges (median age, 11.4 years) using MR imaging to analyze bridge size, location in physis, signal intensity, growth recovery lines, avascular necrosis, and metaphyseal cartilage tongues. Fifty-eight patients underwent fat-suppressed 3D spoiled gradient-recalled echo imaging with physeal mapping. The cause, bone involved, radiographic appearance, and surgical interventions (60/111) were also correlated. Data were analyzed with the two-tailed Fisher's exact test. Posttraumatic bridges, accounting for 70% (78/111) of patients, were most often distal, especially of the tibia (n = 43) and femur (n = 14), whereas those due to the other miscellaneous causes were more frequently proximal (p children is most often posttraumatic and disproportionately involves the distal tibia and femur where bridges tend to develop at the sites of earliest physiologic closure, namely anteromedially and centrally, respectively. MR imaging, especially with the use of fat-suppressed 3D spoiled gradient-recalled echo imaging, exquisitely shows the growth disturbance and associated abnormalities that may follow physeal injury and guides surgical management.

  2. Cardiac Arrest After Status Epilepticus: Bupropion and Ecstasy Intoxication

    Directory of Open Access Journals (Sweden)

    Zübeyde Tuba Duran


    Full Text Available Bupropion is a monocyclic antidepressant that has been known to cause seizures in high therapeutic doses or acute high doses. Bupropion is a selective norepinephrine, dopamine and minimally serotonin reuptake inhibitor. Overdose of bupropion may lead to recurrent seizures, hypoxia and death. It is important to be aware in terms of bradycardia-asystole as a significant consequence of seizure and hypoxia. Patients using high dose of bupropion should be closely monitored in terms of cardiological and neurological. In this study, we presented a 19 year-old female patient who did not have previous history of epilepsy but who used oral bupropion to reduce nicotine addiction. A status epilepticus and cardiac arrest developed in a case receiving 1,8 g bupropion for suicide. 3.4-methylenedioxy-N-methylamphetamine (MDMA and benzodiazepine were detected in urine sample. We did not find any cases in the literature related to MDMA and bupropion overdose. Therefore, we presented this rare case.

  3. Prehospital traumatic cardiac arrest: the cost of futility. (United States)

    Rosemurgy, A S; Norris, P A; Olson, S M; Hurst, J M; Albrink, M H


    Of 12,462 trauma patients cared for by prehospital services from October 1, 1989 to March 31, 1991, 138 patients underwent CPR at the scene or during transport because of the absence of blood pressure, pulse, and respiration. Ninety-six (70%) suffered blunt trauma, 42 (30%) suffered penetrating trauma. Sixty (43%) were transported by air utilizing county-wide transport protocols. None of the patients survived. Aggregate care cost $871,186.00. In 11 cases (8%), tissue for transplantation was procured (only corneas). Trauma patients who require CPR at the scene or in transport die. Infrequent organ procurement does not seem to justify the cost (primarily borne by hospitals), consumption of resources, and exposure of health care providers to occupational health hazards. The wisdom of transporting trauma victims suffering cardiopulmonary arrest at the scene or during transport must be questioned. Allocation of resources to these patients is not an insular medical issue, but a broad concern for our society, and society should decide if the "cost of futility" is excessive.

  4. DNA damage mediated transcription arrest: Step back to go forward. (United States)

    Mullenders, Leon


    The disturbance of DNA helix conformation by bulky DNA damage poses hindrance to transcription elongating due to stalling of RNA polymerase at transcription blocking lesions. Stalling of RNA polymerase provokes the formation of R-loops, i.e. the formation of a DNA-RNA hybrid and a displaced single stranded DNA strand as well as displacement of spliceosomes. R-loops are processed into DNA single and double strand breaks by NER factors depending on TC-NER factors leading to genome instability. Moreover, stalling of RNA polymerase induces a strong signal for cell cycle arrest and apoptosis. These toxic and mutagenic effects are counteracted by a rapid recruitment of DNA repair proteins to perform transcription coupled nucleotide excision repair (TC-NER) to remove the blocking DNA lesions and to restore transcription. Recent studies have highlighted the role of backtracking of RNA polymerase to facilitate TC-NER and identified novel factors that play key roles in TC-NER and in restoration of transcription. On the molecular level these factors facilitate stability of the repair complex by promotion and regulation of various post-translational modifications of NER factors and chromatin substrate. In addition, the continuous flow of new factors that emerge from screening assays hints to several regulatory levels to safeguard the integrity of transcription elongation after disturbance by DNA damage that have yet to be explored. Copyright © 2015 Elsevier B.V. All rights reserved.

  5. Risk for Arrest: The Role of Social Bonds in Protecting Foster Youth Making the Transition to Adulthood (United States)

    Cusick, Gretchen Ruth; Havlicek, Judy R.; Courtney, Mark E.


    This study examines a sample of foster youth at the onset of the transition to adulthood and explores how social bonds are related to the risk of arrest during adulthood. Drawing from official arrest records, event history models are used to examine the time to arrest. Because individuals may be at risk for different types of crime, competing risk regression models are used to distinguish among arrests for drug-related, nonviolent, or violent crimes. Between the ages of 17–18 and 24, 46% of former foster youth experience an arrest. Arrests were evenly distributed across drug, nonviolent, and violent crimes columns. Although findings fail to support the significance of social bonds to interpersonal domains, bonds to employment and education are associated with a lower risk for arrest. Child welfare policy and practice implications for building connections and protections around foster youth are discussed. PMID:22239390

  6. Risk-adjusted survival for adults following in-hospital cardiac arrest by day of week and time of day: observational cohort study. (United States)

    Robinson, Emily J; Smith, Gary B; Power, Geraldine S; Harrison, David A; Nolan, Jerry; Soar, Jasmeet; Spearpoint, Ken; Gwinnutt, Carl; Rowan, Kathryn M


    Internationally, hospital survival is lower for patients admitted at weekends and at night. Data from the UK National Cardiac Arrest Audit (NCAA) indicate that crude hospital survival was worse after in-hospital cardiac arrest (IHCA) at night versus day, and at weekends versus weekdays, despite similar frequency of events. To describe IHCA demographics during three day/time periods-weekday daytime (Monday to Friday, 08:00 to 19:59), weekend daytime (Saturday and Sunday, 08:00 to 19:59) and night-time (Monday to Sunday, 20:00 to 07:59)-and to compare the associated rates of return of spontaneous circulation (ROSC) for >20 min (ROSC>20 min) and survival to hospital discharge, adjusted for risk using previously developed NCAA risk models. To consider whether any observed difference could be attributed to differences in the case mix of patients resident in hospital and/or the administered care. We performed a prospectively defined analysis of NCAA data from 27 700 patients aged ≥16 years receiving chest compressions and/or defibrillation and attended by a hospital-based resuscitation team in response to a resuscitation (2222) call in 146 UK acute hospitals. Risk-adjusted outcomes (OR (95% CI)) were worse (p20 min 0.88 (0.81 to 0.95); hospital survival 0.72 (0.64 to 0.80)), and night-time (ROSC>20 min 0.72 (0.68 to 0.76); hospital survival 0.58 (0.54 to 0.63)) compared with weekday daytime. The effects were stronger for non-shockable than shockable rhythms, but there was no significant interaction between day/time of arrest and age, or day/time of arrest and arrest location. While many daytime IHCAs involved procedures, restricting the analyses to IHCAs in medical admissions with an arrest location of ward produced results that are broadly in line with the primary analyses. IHCAs attended by the hospital-based resuscitation team during nights and weekends have substantially worse outcomes than during weekday daytimes. Organisational or care differences at

  7. A conservation vent is not a safe substitute for a flame arrester

    Energy Technology Data Exchange (ETDEWEB)

    Siestrup, Francisco Hubertus Grosse [Protego Leser do Brasil Ltda., Rio de Janeiro, RJ (Brazil)


    For several decades state organizations and engineering societies have published strict engineering guidelines for the design and safe management of storage tanks. Storage tanks in refineries and chemical plants can contain flammable and hazardous chemicals. Accidents in these systems resulting from explosions can cause million dollar property loss and production interruption. In severe cases lawsuits may result and companies can even be driven into bankruptcy. This article focuses on tests which have been conducted by the PROTEGO Research and Development Group in Braunschweig, Germany. Latest research, in which conservation vents have been tested in accordance to the new ISO 16852 test method, have proven that conservation vents cannot be used to substitute a flame arrester if potentially explosive atmospheres are present in storage tanks. This research was conducted during the development of ISO 28300 and the test results are considered in this standard. This paper will prove that the use of conservation vents to protect tanks from atmospheric explosion is not a reliable protection method when the vapor/air mixtures in the tank have a concentration between the Upper and Lower Explosive Limits (UEL and LEL). This is very common for Ethanol storage which is globally in evidence. (author)

  8. [Prognostic factors after cardiac arrest. Usefulness of early video-electroencephalogram]. (United States)

    Arméstar, Fernando; Becerra Cuñat, Juan Luis; León Chan, Yariela; Mesalles Sanjuan, Eduard; Moreno, José Antonio; Jiménez González, Marta; Roca, Josep


    Predictors of unfavorable outcome in patients after cardiopulmonary arrest (CPA) are important to make decisions about the limitation of therapeutic efforts. The aim was to analyze the clinical variables in the prognosis of patients recovered after CPA. Retrospective study on comatose patients with recovered CPA. The variables were: age, sex, Glasgow Coma Score (GCS), pupillary light reflex, other variables related to CPA (cause, duration, witnessed or not witnessed), myoclonic status and electroencephalographic (EEG) patterns. Fifty patients were studied. The variables associated with mortality were the absence of pupillary light reflex (hazard ratio [HR] 0.277, 95% confidence interval [95% CI] 0.103-0.741, P=.01), a low GCS (HR 0.701, 95% CI 0.542-0.908, P=.007) and myoclonic state (HR 0.38, 95% CI 0.176-0.854, P=.01). We evaluated the EEG patterns in 22 patients. No statistical significance was observed. The absence of pupillary light reflex, a low GCS and myoclonic state are prognostic factors in patients recovered after a CPA. The EEG patterns showed a nonsignificant association with prognosis. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

  9. Magnetized advective accretion flows: formation of magnetic barriers in magnetically arrested discs (United States)

    Mondal, Tushar; Mukhopadhyay, Banibrata


    We discuss the importance of large-scale strong magnetic field in the removal of angular momentum outward, as well as the possible origin of different kinds of magnetic barrier in advective, geometrically thick, sub-Keplerian accretion flows around black holes. The origin of this large-scale strong magnetic field near the event horizon is due to the advection of the magnetic flux by the accreting gas from the environment, say, the interstellar medium or a companion star, because of flux freezing. In this simplest vertically averaged, 1.5-dimensional disc model, we choose the maximum upper limit of the magnetic field, which the disc around a black hole can sustain. In this so called magnetically arrested disc model, the accreting gas either decelerates or faces the magnetic barrier near the event horizon by the accumulated magnetic field depending on the geometry. The magnetic barrier may knock the matter to infinity. We suggest that these types of flow are the building block to produce jets and outflows in the accreting system. We also find that in some cases, when matter is trying to go back to infinity after knocking the barrier, matter is prevented being escaped by the cumulative action of strong gravity and the magnetic tension, hence by another barrier. In this way, magnetic field can lock the matter in between these two barriers and it might be a possible explanation for the formation of episodic jet.

  10. Content provision and multi-homing


    Pires, Armando J. Garcia


    We analyze the effects of multi-homing consumers on content provision by media firms. We develop a model where media firms compete on content provision and advertising revenues, and consumers enjoy network effects from consuming content that other consumers also consume. Media firms have to choose if they are single-content or multi-content, and in the latter case how much content to offer. Competition for advertising revenues gives a two-sided market nature to our model, since advertisers pr...

  11. Dividends Provisions in Croatian Double Taxation Agreements

    Directory of Open Access Journals (Sweden)

    Marjeta Tomulić Vehovec


    Full Text Available This paper analyzes the provisions concerning dividends in the double taxation avoidance agreements concluded by the Republic of Croatia. Since the base for taxation is necessarily laid down in domestic law, Croatian legislation is examined as well. The author primarily discusses dividends provisions in four agreements signed with Germany, Austria, Switzerland and Slovenia, in addition to analyzing the differences from and similarities with the OECD Model Convention. Second, the paper briefly explains the methods for eliminating double taxation on income from dividends. Finally, it addresses the changes necessary for accession to the European Union.

  12. Importance of the first link: description and recognition of an out-of-hospital cardiac arrest in an emergency call. (United States)

    Berdowski, Jocelyn; Beekhuis, Freerk; Zwinderman, Aeilko H; Tijssen, Jan G P; Koster, Rudolph W


    The content of emergency calls for suspected cardiac arrest is rarely analyzed. This study investigated the recognition of a cardiac arrest by dispatchers and its influence on survival rates. During 8 months, voice recordings of 14,800 consecutive emergency calls were collected to audit content and cardiac arrest recognition. The presence of cardiac arrest during the call was assessed from the ambulance crew report. Included calls were placed by laypersons on site and did not involve trauma. Prevalence of cardiac arrest was 3.0%. Of the 285 cardiac arrests, 82 (29%) were not recognized during the call, and 64 of 267 suspected calls (24%) were not cardiac arrest. We analyzed a random sample (n=506) of 9230 control calls. Three-month survival was 5% when a cardiac arrest was not recognized versus 14% when it was recognized (P=0.04). If the dispatcher did not recognize the cardiac arrest, the ambulance was dispatched a mean of 0.94 minute later (P<0.001) and arrived 1.40 minutes later on scene (P=0.01) compared with recognized calls. The main reason for not recognizing the cardiac arrest was not asking if the patient was breathing (42 of 82) and not asking to describe the type of breathing (16 of 82). Normal breathing was never mentioned in true cardiac arrest calls. A logistic regression model identified spontaneous trigger words like facial color that could contribute to cardiac arrest recognition (odds ratio, 7.8 to 9.7). Not recognizing a cardiac arrest during emergency calls decreases survival. Spontaneous words that the caller uses to describe the patient may aid in faster and better recognition of a cardiac arrest.

  13. Optimizing Neurologically Intact Survival from Sudden Cardiac Arrest: A Call to Action

    Directory of Open Access Journals (Sweden)

    Jeffrey M. Goodloe


    Full Text Available The U.S. national out-of-hospital and in-hospital cardiac arrest survival rates, although improving recently, have remained suboptimal despite the collective efforts of individuals, communities, and professional societies. Only until very recently, and still with inconsistency, has focus been placed specifically on survival with pre-arrest neurologic function. The reality of current approaches to sudden cardiac arrest is that they are often lacking an integrative, multi-disciplinary approach, and without deserved funding and outcome analysis. In this manuscript, a multidisciplinary group of authors propose practice, process, technology, and policy initiatives to improve cardiac arrest survival with a focus on neurologic function. [West J Emerg Med. 2014;15(7:-0.

  14. Biofilm Community Dynamics in Bench-Scale Annular Reactors Simulating Arrestment of Chloraminated Drinking Water Nitrification (United States)

    Annular reactors (ARs) were used to study biofilm community succession and provide an ecological insight during nitrification arrestment through simultaneously increasing monochloramine (NH2Cl) and chlorine to nitrogen mass ratios, resulting in four operational periods (I to IV)....

  15. Excessive chest compression rate is associated with insufficient compression depth in prehospital cardiac arrest

    NARCIS (Netherlands)

    Monsieurs, Koenraad G.; De Regge, Melissa; Vansteelandt, Kristof; De Smet, Jeroen; Annaert, Emmanuel; Lemoyne, Sabine; Kalmar, Alain F.; Calle, Paul A.


    Background and goal of study: The relationship between chest compression rate and compression depth is unknown. In order to characterise this relationship, we performed an observational study in prehospital cardiac arrest patients. We hypothesised that faster compressions are associated with

  16. Recurrent respiratory distress and cardiopulmonary arrest caused by megaoesophagus secondary to achalasia

    Directory of Open Access Journals (Sweden)

    Nigel Tapiwa Mabvuure


    CONCLUSION: Oesophagectomy should be considered for patients with end-stage achalasia and mega-oesophagus causing respiratory compromise to avoid potential fatal complications such as tracheal compression and subsequent respiratory arrest.

  17. Investigation of a Water-Pond Arresting of a Dynamic Model of a Jet Transport (United States)

    Thompson, William C.


    Brief dynamic-model tests have been made at the request of the Federal Aviation Agency to investigate the use of a shallow pond of water at the end of a runway as a means of arresting jet-transport aircraft when they are forced to abort on take-off or overrun on landing. Such a scheme is of particular interest for civil aircraft because it requires no modifications or attachments to the airplane and no mechanical devices in the arresting system. A modification of this scheme that uses a flexible plastic cover over the water surface has also been tested. The purpose of this paper is to present the results of a dynamic model investigation which would aid in determining whether the water-pond arresting system could be used as a means of arresting airplane overrun.

  18. [After your heart arrest, would you like to test a medicinal elixir?]. (United States)

    Carron, P-N; Hugli, O; Liaudet, L; Yersin, B


    So far, cardiac arrest is still associated with high mortality or severe neurological disability in survivors. At the tissue level, cardiac arrest results into an acute condition of generalized hypoxia. A better understanding of the pathophysiology of ischemia-reperfusion and of the inflammatory response that develops after cardiac arrest could help to design novel therapeutic strategies in the future. It seems unlikely that a single drug, acting as a , might be able to improve survival or neurological prognosis. Lessons learned from pathophysiological mechanisms rather indicate that combined therapies, involving thrombolysis, neuroprotective agents, antioxidants and anti-inflammatory molecules, together with temperature cooling, might represent helpful strategies to improve patient's outcome after cardiac arrest.

  19. 10 CFR 1047.6 - Use of physical force when making an arrest. (United States)


    .... (a) When a protective force officer has the right to make an arrest as discussed above, the... physical force by the offender. It should be noted that verbal abuse alone by the offender cannot be the...

  20. GLP-1 analogues for neuroprotection after out-of-hospital cardiac arrest

    DEFF Research Database (Denmark)

    Wiberg, Sebastian; Hassager, Christian; Thomsen, Jakob Hartvig


    one-to-one fashion to a 6-hour and 15-minute infusion of either Exenatide or placebo. Patients are eligible for inclusion if resuscitated from cardiac arrest with randomization from 20 minutes to 240 minutes after return of spontaneous circulation. The co-primary endpoint is feasibility, defined......Background: Attenuating the neurological damage occurring after out-of-hospital cardiac arrest is an ongoing research effort. This dual-centre study investigates the neuroprotective effects of the glucagon-like-peptide-1 analogue Exenatide administered within 4 hours from the return of spontaneous...... circulation to comatose patients resuscitated from out-of-hospital cardiac arrest. Methods/design: This pilot study will randomize a total of 120 unconscious patients with sustained return of spontaneous circulation after out-of-hospital cardiac arrest undergoing targeted temperature management in a blinded...

  1. Influence of mild therapeutic hypothermia after cardiac arrest on hospital mortality

    NARCIS (Netherlands)

    van der Wal, Greetje; Brinkman, Sylvia; Bisschops, Laurens L. A.; Hoedemaekers, Cornelia W.; van der Hoeven, Johannes G.; de Lange, Dylan W.; de Keizer, Nicolette F.; Pickkers, Peter


    Objective: Following two randomized controlled trials that demonstrated reduced mortality and better neurological outcome in cardiac arrest patients, mild therapeutic hypothermia was implemented in many intensive care units. Up to now, no large observational studies have confirmed the beneficial

  2. Transfusion Associated Hyperkalemia and Cardiac Arrest in an Infant after Extracorporeal Membrane Oxygenation

    Directory of Open Access Journals (Sweden)

    Do Wan Kim


    Full Text Available Cardiac arrest associated with hyperkalemia during red blood cell transfusion is a rare but fatal complication. Herein, we report a case of transfusion-associated cardiac arrest following the initiation of extracorporeal membrane oxygenation support in a 9-month old infant. Her serum potassium level was increased to 9.0 mEq/L, soon after the newly primed circuit with pre-stored red blood cell (RBC was started and followed by sudden cardiac arrest. Eventually, circulation was restored and the potassium level decreased to 5.1 mEq/L after 5 min. Extracorporeal membrane oxygenation (ECMO priming is a relatively massive transfusion into a pediatric patient. Thus, to prevent cardiac arrest during blood-primed ECMO in neonates and infants, freshly irradiated and washed RBCs should be used when priming the ECMO circuit, to minimize the potassium concentration. Also, physicians should be aware of all possible complications associated with transfusions during ECMO.

  3. Cloning and Expression Analysis of Zygote Arrest 1 (Zar1) in New ...

    Indian Academy of Sciences (India)


    healthy, sexually mature female rabbits of similar weight were assigned to each group. Tissues, .... brain and liver (Michailidis et al. 2010). .... arrest 1 gene in pig, cattle and human: evidence of different transcript variants in male and female.

  4. Modeling of vibrations isolation and arrest by shape memory parts and permanent magnets (United States)

    Belyaev, Fedor S.; Volkov, Aleksandr E.; Evard, Margarita E.; Vikulenkov, Andrey V.; Uspenskiy, Evgeniy S.


    A vibration protection system under consideration consists of a payload connected to a vibrating housing by shape memory alloy (SMA) slotted springs. To provide an arrest function two permanent magnets are inserted into the system. The slotted SMA elements are preliminary deformed in the martensitic state. Activation of one element by heating initiates force and displacement generation, which provide an arrest of the payload by magnets. The magnets also secure the arrest mode after cooling of the SMA element. Activation of the other element results in uncaging of the payload and switching to the vibration isolation mode. Computer simulations of arrest and uncaging when the housing is quiescent or producing sine-wave displacements were carried out. Functional-mechanical behavior of SMA parts was described by means of a microstructural model.

  5. Parameter identification of ZnO surge arrester models based on genetic algorithms

    Energy Technology Data Exchange (ETDEWEB)

    Bayadi, Abdelhafid [Laboratoire d' Automatique de Setif, Departement d' Electrotechnique, Faculte des Sciences de l' Ingenieur, Universite Ferhat ABBAS de Setif, Route de Bejaia Setif 19000 (Algeria)


    The correct and adequate modelling of ZnO surge arresters characteristics is very important for insulation coordination studies and systems reliability. In this context many researchers addressed considerable efforts to the development of surge arresters models to reproduce the dynamic characteristics observed in their behaviour when subjected to fast front impulse currents. The difficulties with these models reside essentially in the calculation and the adjustment of their parameters. This paper proposes a new technique based on genetic algorithm to obtain the best possible series of parameter values of ZnO surge arresters models. The validity of the predicted parameters is then checked by comparing the predicted results with the experimental results available in the literature. Using the ATP-EMTP package, an application of the arrester model on network system studies is presented and discussed. (author)

  6. Arrest of metamorphosis induced by x rays in flesh fly, Sarcophaga peregrina

    International Nuclear Information System (INIS)

    Sasaki, S.; Sakka, M.


    Arrest of metamorphosis induced by x irradiation at prepupal stage was studied histologically, and age dependency of radiosensitivity with regard to this effect was examined. Prepupae did not cease their development soon after irradiation, but continued to develop and evaginated the head and the thorax. At this point, development came to a stop. In these animals, not only the histogenesis of imaginal tissues but also the histolysis of larval tissues was arrested. Since the arrest of development was not observed after irradiation at the pupal stage, the effect was considered to result from inhibition of initiation of postpupation development. A possible mechanism of the arrest of postpupation development in the irradiated animals was discussed in connection with the neuroendocrine control of insect development

  7. Management of cardiac arrest caused by coronary artery spasm: epinephrine/adrenaline versus nitrates. (United States)

    Kiss, Gabor; Corre, Olivier; Gueret, Gildas; Nguyen Ba, Vinh; Gilard, Martine; Boschat, Jaques; Arvieux, Charles Chistian


    Cardiopulmonary resuscitation guidelines imply the use of epinephrine/adrenaline during cardiopulmonary arrest. However, in cardiac arrest situations resulting from coronary artery spasm (CAS), the use of epinephrine/adrenaline could be deleterious. A 49-year-old patient underwent an emergency coronarography with an attempt to stent the coronary arteries. Radiologic imaging revealed a positive methylergonovine maleate (Methergine, Novartis Pharmaceuticals, East Hanover, NJ) test, with subocclusive CAS in several coronary vessels leading to electromechanical dissociation. Cardiopulmonary resuscitation was performed, and intracoronary boluses of isosorbide dinitrate were given to treat CAS. Epinephrine/adrenaline was not administered during resuscitation. Spontaneous circulation was obtained after cardioversion for ventricular fibrillation, and the patient progressively regained consciousness. Resuscitation guidelines do not specify the use of trinitrate derivatives in cardiac arrest situations caused by CAS. The pros and cons of the use of nitrates and epinephrine/adrenaline during cardiac arrest caused by CAS are analyzed in this case report.

  8. 12 CFR 714.8 - Are the early payment provisions, or interest rate provisions, applicable in leasing arrangements? (United States)


    ... provisions, or interest rate provisions, applicable in leasing arrangements? You are not subject to the early... 12 Banks and Banking 6 2010-01-01 2010-01-01 false Are the early payment provisions, or interest rate provisions, applicable in leasing arrangements? 714.8 Section 714.8 Banks and Banking NATIONAL...

  9. Provisional thoughts on limitations to the right to procreate ...

    African Journals Online (AJOL)

    ... also had a severe non-intended impact on the social and economic situation in China. It is suggested, therefore, that positive measures (eg proper education and social provision) be considered to limit population growth. KEYWORDS: Limitation of rights; right to procreate; overpopulation; limitation of the right to procreate; ...

  10. Characteristics of psychiatric patients for whom financial considerations affect optimal treatment provision. (United States)

    West, Joyce C; Pingitore, David; Zarin, Deborah A


    This study assessed characteristics of psychiatric patients for whom financial considerations affected the provision of "optimal" treatment. Psychiatrists reported that for 33.8 percent of 1,228 patients from a national sample, financial considerations such as managed care limitations, the patient's personal finances, and limitations inherent in the public care system adversely affected the provision of optimal treatment. Patients were more likely to have their treatment adversely affected by financial considerations if they were more severely ill, had more than one behavioral health disorder or a psychosocial problem, or were receiving treatment under managed care arrangements. Patients for whom financial considerations affect the provision of optimal treatment represent a population for whom access to treatment may be particularly important.

  11. Crime and Young Men: The Role of Arrest, Criminal Experience, and Heterogeneity


    Susumu Imai; Hajime Katayama; Kala Krishna


    Using National Youth Survey (NYS) data, we examine the relationship of current criminal activity and past arrests using an ordered probit model with unobserved heterogeneity. Past arrests raise current criminal activity only for the non-criminal type, while past criminal experience raises current criminal activity for both types. Also, the age crime profile peaks at age 18 for non-criminal type individuals, but for criminal type individuals, it continues to rise with age. Past research indica...

  12. TGEV nucleocapsid protein induces cell cycle arrest and apoptosis through activation of p53 signaling

    International Nuclear Information System (INIS)

    Ding, Li; Huang, Yong; Du, Qian; Dong, Feng; Zhao, Xiaomin; Zhang, Wenlong; Xu, Xingang; Tong, Dewen


    Highlights: • TGEV N protein reduces cell viability by inducing cell cycle arrest and apoptosis. • TGEV N protein induces cell cycle arrest and apoptosis by regulating p53 signaling. • TGEV N protein plays important roles in TGEV-induced cell cycle arrest and apoptosis. - Abstract: Our previous studies showed that TGEV infection could induce cell cycle arrest and apoptosis via activation of p53 signaling in cultured host cells. However, it is unclear which viral gene causes these effects. In this study, we investigated the effects of TGEV nucleocapsid (N) protein on PK-15 cells. We found that TGEV N protein suppressed cell proliferation by causing cell cycle arrest at the S and G2/M phases and apoptosis. Characterization of various cellular proteins that are involved in regulating cell cycle progression demonstrated that the expression of N gene resulted in an accumulation of p53 and p21, which suppressed cyclin B1, cdc2 and cdk2 expression. Moreover, the expression of TGEV N gene promoted translocation of Bax to mitochondria, which in turn caused the release of cytochrome c, followed by activation of caspase-3, resulting in cell apoptosis in the transfected PK-15 cells following cell cycle arrest. Further studies showed that p53 inhibitor attenuated TGEV N protein induced cell cycle arrest at S and G2/M phases and apoptosis through reversing the expression changes of cdc2, cdk2 and cyclin B1 and the translocation changes of Bax and cytochrome c induced by TGEV N protein. Taken together, these results demonstrated that TGEV N protein might play an important role in TGEV infection-induced p53 activation and cell cycle arrest at the S and G2/M phases and apoptosis occurrence

  13. Radiological analyses of France Telecom surge arresters. Study performed for the CGT FAPT Cantal

    International Nuclear Information System (INIS)


    This document reports the radiological characterization of various versions of surge arresters used in the past to protect telephone lines against over-voltages. These equipment, which use various radioactive materials, were assessed by gamma radiation flow measurements, alpha-beta-gamma count rate measurements, dose rate measurements, gamma spectrometry analyses, tritium emanation test, radon 222 emanation test, smearing. Recommendations are formulated to manage radioactive surge arresters which are still being operated

  14. Crack arrest within teeth at the dentinoenamel junction caused by elastic modulus mismatch


    Bechtle, Sabine


    Enamel and dentin compose the crowns of human teeth. They are joined at the dentinoenamel junction (DEJ) which is a very strong and well-bonded interface unlikely to fail within healthy teeth despite the formation of multiple cracks within enamel during a lifetime of exposure to masticatory forces. These cracks commonly are arrested when reaching the DEJ. The phenomenon of crack arrest at the DEJ is described in many publications but there is little consensus on the underlying cause and mecha...

  15. Cardiac Arrest in Patients Managed for Convulsive Status Epilepticus: Characteristics, Predictors, and Outcome. (United States)

    Legriel, Stephane; Bresson, Edouard; Deye, Nicolas; Grimaldi, David; Sauneuf, Bertrand; Lesieur, Olivier; Lascarrou, Jean-Baptiste; Argaud, Laurent; Chelly, Jonathan; Beuret, Pascal; Schnell, David; Chateauneuf, Anne-Laure; Holleville, Mathilde; Perier, François; Lemiale, Virginie; Bruel, Cedric; Cronier, Pierrick; Pichon, Nicolas; Mongardon, Nicolas; de-Prost, Nicolas; Dumas, Florence; Cariou, Alain


    Cardiac arrest is a catastrophic event that may arise during the management of convulsive status epilepticus. We aimed to report the clinical characteristics, outcomes, and early predictors of convulsive status epilepticus-related cardiac arrest. Retrospective multicenter study. Seventeen university or university affiliated participating ICUs in France and Belgium. Consecutive patients admitted to the participating ICUs for management of successfully resuscitated out-of-hospital cardiac arrest complicating the initial management of convulsive status epilepticus between 2000 and 2015. Patients were compared with controls without cardiac arrest identified in a single-center registry of convulsive status epilepticus patients, regarding characteristics, management, and outcome. None. We included 49 cases with convulsive status epilepticus-cardiac arrest and 235 controls. In the cases, median time from medical team arrival to cardiac arrest was 25 minutes (interquartile range, 5-85 min). First recorded rhythm was asystole in 25 patients (51%) and pulseless electrical activity in 13 patients (27%). A significantly larger proportion of patients had a favorable 1-year outcome (Glasgow Outcome Scale score of 5) among controls (90/235; 38%) than among cases (10/49; 21%; p = 0.02). By multivariate analysis, independent predictors of cardiac arrest were pulse oximetry less than 97% on scene (odds ratio, 2.66; 95% CI, 1.03-7.26; p = 0.04), drug poisoning as the cause of convulsive status epilepticus (odds ratio, 4.13; 95% CI, 1.27-13.53; p = 0.02), and complications during early management (odds ratio, 11.98; 95% CI, 4.67-34.69; p status epilepticus, relative hypoxemia, on-scene management complications, and drug poisoning as the cause of convulsive status epilepticus were strong early predictors of cardiac arrest, suggesting areas for improvement.

  16. Local stresses, dyke arrest and surface deformation in volcanic edificesand rift zones

    Directory of Open Access Journals (Sweden)

    L. S. Brenner


    Full Text Available Field studies indicate that nearly all eruptions in volcanic edifices and rift zones are supplied with magma through fractures (dykes that are opened by magmatic overpressure. While (inferred dyke injections are frequent during unrest periods, volcanic eruptions are, in comparison, infrequent, suggesting that most dykes become arrested at certain depths in the crust, in agreement with field studies. The frequency of dyke arrest can be partly explained by the numerical models presented here which indicate that volcanic edifices and rift zones consisting of rocks of contrasting mechanical properties, such as soft pyroclastic layers and stiff lava flows, commonly develop local stress fields that encourage dyke arrest. During unrest, surface deformation studies are routinely used to infer the geometries of arrested dykes, and some models (using homogeneous, isotropic half-spaces infer large grabens to be induced by such dykes. Our results, however, show that the dyke-tip tensile stresses are normally much greater than the induced surface stresses, making it difficult to explain how a dyke can induce surface stresses in excess of the tensile (or shear strength while the same strength is not exceeded at the (arrested dyke tip. Also, arrested dyke tips in eroded or active rift zones are normally not associated with dyke-induced grabens or normal faults, and some dykes arrested within a few metres of the surface do not generate faults or grabens. The numerical models show that abrupt changes in Young's moduli(stiffnesses, layers with relatively high dyke-normal compressive stresses (stress barriers, and weak horizontal contacts may make the dyke-induced surface tensile stresses too small for significant fault or graben formation to occur in rift zones or volcanic edifices. Also, these small surface stresses may have no simple relation to the dyke geometry or the depth to its tip. Thus, for a layered crust with weak contacts, straightforward

  17. Parameters Calculation of ZnO Surge Arrester Models by Genetic Algorithms

    Directory of Open Access Journals (Sweden)

    A. Bayadi


    Full Text Available This paper proposes to provide a new technique based on the genetic algorithm to obtain the best possible series of values of the parameters of the ZnO surge arresters models. The validity of the predicted parameters is then checked by comparing the results predicted with the experimental results available in the literature. Using the ATP-EMTP package an application of the arrester model on network system studies is presented and discussed.

  18. The relationship of sport participation to provision of sports facilities and socioeconomic status: a geographical analysis. (United States)

    Eime, Rochelle M; Harvey, Jack; Charity, Melanie J; Casey, Meghan; Westerbeek, Hans; Payne, Warren R


    Ecological models have been applied to investigate multiple domains influencing physical activity behaviour, including individual, social, organisational, community, environmental and policy factors. With regard to the built environment, research to date has been limited to small geographical areas and/or small samples of participants. This study examined the geographical association between provision of sport facilities and participation in sport across an entire Australian state, using objective total enumerations of both, for a group of sports, with adjustment for the effect of socioeconomic status (SES). De-identified membership registration data were obtained from state sport governing bodies of four popular team sports. Associations between participation rate, facility provision rate and SES were investigated using correlation and regression methods. Participation rate was positively associated with provision of facilities, although this was complicated by SES and region effects. The non-metropolitan region generally had higher participation rates and better provision of facilities than the metropolitan region. Better provision of sports facilities is generally associated with increased sport participation, but SES and region are also contributing factors. Implications for public health: Community-level analysis of the population, sport participation and provision of facilities should be used to inform decisions of investments in sports facilities. © 2017 The Authors.

  19. Trade Facilitation Provisions in Regional Trade Agreements: Discriminatory or Non-discriminatory?

    Directory of Open Access Journals (Sweden)

    Innwon Park


    Full Text Available The RTAs with trade facilitation provisions have been expected to generate a larger net trade-creating effect and complement the discriminatory feature of RTAs but have yet to be empirically proven. Recognizing the limitations of existing studies, we conducted a quantitative analysis on the effects of RTAs with and without trade facilitation provisions on both intra- and extra-bloc trade by using a modified gravity equation. We applied the Poisson Pseudo-Maximum Likelihood (PPML estimation with time varying exporter and importer fixed effect method to panel data consisting of 45,770 country pairs covering 170 countries for 2000-2010. We found that the trade facilitation provisions in existing RTAs are non-discriminatory by generating more intra- and extra-bloc trade in general. In particular, we found that the trade effects of RTAs in the APEC region are much stronger than the general case covering all RTAs in the world. In addition, as we control the trade effect of a country's trade facilitation, which is ranked by the World Bank's logistic performance index, RTAs consisting of trade facilitation provisions are discriminatory for trade in final goods and non-discriminatory for trade in intermediate goods. Overall, we endeavor to "explain," instead of "hypothesizing," why most of the recent RTAs contain trade facilitation provisions, especially in light of the deepening regional interdependence through trade in parts and components under global value chains and support the necessity of multilateralizing RTAs by implementing non-discriminatory trade facilitation provisions.

  20. 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


    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...

  1. 26 CFR 1.904(i)-1 - Limitation on use of deconsolidation to avoid foreign tax credit limitations. (United States)


    ... foreign tax credit limitations. 1.904(i)-1 Section 1.904(i)-1 Internal Revenue INTERNAL REVENUE SERVICE... United States § 1.904(i)-1 Limitation on use of deconsolidation to avoid foreign tax credit limitations... applying the foreign tax credit provisions of section 59(a), sections 901 through 908, and section 960, the...

  2. Synchronization and Arrest of the Budding Yeast Cell Cycle Using Chemical and Genetic Methods. (United States)

    Rosebrock, Adam P


    The cell cycle of budding yeast can be arrested at specific positions by different genetic and chemical methods. These arrests enable study of cell cycle phase-specific phenotypes that would be missed during examination of asynchronous cultures. Some methods for arrest are reversible, with kinetics that enable release of cells back into a synchronous cycling state. Benefits of chemical and genetic methods include scalability across a large range of culture sizes from a few milliliters to many liters, ease of execution, the absence of specific equipment requirements, and synchronization and release of the entire culture. Of note, cell growth and division are decoupled during arrest and block-release experiments. Cells will continue transcription, translation, and accumulation of protein while arrested. If allowed to reenter the cell cycle, cells will do so as a population of mixed, larger-than-normal cells. Despite this important caveat, many aspects of budding yeast physiology are accessible using these simple chemical and genetic tools. Described here are methods for the block and release of cells in G 1 phase and at the M/G 1 transition using α-factor mating pheromone and the temperature-sensitive cdc15-2 allele, respectively, in addition to methods for arresting the cell cycle in early S phase and at G 2 /M by using hydroxyurea and nocodazole, respectively. © 2017 Cold Spring Harbor Laboratory Press.

  3. Assessment of surge arrester failure rate and application studies in Hellenic high voltage transmission lines

    Energy Technology Data Exchange (ETDEWEB)

    Christodoulou, C.A.; Fotis, G.P.; Gonos, I.F.; Stathopulos, I.A. [National Technical University of Athens, School of Electrical and Computer Engineering, High Voltage Laboratory, 9 Iroon Politechniou St., Zografou Campus, 157 80 Athens (Greece); Ekonomou, L. [A.S.PE.T.E. - School of Pedagogical and Technological Education, Department of Electrical Engineering Educators, N. Heraklion, 141 21 Athens (Greece)


    The use of transmission line surge arresters to improve the lightning performance of transmission lines is becoming more common. Especially in areas with high soil resistivity and ground flash density, surge arresters constitute the most effective protection mean. In this paper a methodology for assessing the surge arrester failure rate based on the electrogeometrical model is presented. Critical currents that exceed arresters rated energy stress were estimated by the use of a simulation tool. The methodology is applied on operating Hellenic transmission lines of 150 kV. Several case studies are analyzed by installing surge arresters on different intervals, in relation to the region's tower footing resistance and the ground flash density. The obtained results are compared with real records of outage rate showing the effectiveness of the surge arresters in the reduction of the recorded failure rate. The presented methodology can be proved valuable to the studies of electric power systems designers intending in a more effective lightning protection, reducing the operational costs and providing continuity of service. (author)

  4. Protein synthetic requirements for caffeine amelioration of radiation-induced G/sub 2/-arrest

    International Nuclear Information System (INIS)

    Rowley, R.; Colkitt, D.


    Irradiated cells are arrested in G/sub 2/ (transition point [TP] = 32 min before cell selection in mitosis). Irradiated cells do not recover from G/sub 2/ arrest in the presence of cycloheximide (CHM) indicating dependence of recovery on protein synthesis. Irradiated cells in the presence of caffeine progress to mitosis without arrest. The authors investigate whether irradiated cells in the presence of caffeine require protein synthesis to progress to mitosis. Mitotic cell selection was used to monitor the progression of irradiated CHO cells (150 rad) during exposure to 5 mM caffeine and/or 50 μg/ml CHM. Protein synthesis inhibition was confirmed using /sup 3/H-leucine incorporation. Cells exposed to CHM alone are arrested in G/sub 2/ (TP=49 min), thus cells beyond this point have synthesized all proteins necessary for entry into mitosis. In the presence of caffeine, unirradiated cells exposed to CHM are not arrested at all in G/sub 2/, instead arrest occurs near the S/G/sub 2/ boundary (TP=95 min) indicating that caffeine alleviates the dependence of G/sub 2/ cell progression on protein synthesis. However, irradiated cells exposed to both caffeine and CHM are only able to progress to mitosis if beyond the CHM-TP. Irradiated cells in the presence of caffeine thus behave as untreated cells and require protein synthesis for progression to mitosis when prior to the CHM-TP

  5. SMC1-Mediated Intra-S-Phase Arrest Facilitates Bocavirus DNA Replication (United States)

    Luo, Yong; Deng, Xuefeng; Cheng, Fang; Li, Yi


    Activation of a host DNA damage response (DDR) is essential for DNA replication of minute virus of canines (MVC), a member of the genus Bocavirus of the Parvoviridae family; however, the mechanism by which DDR contributes to viral DNA replication is unknown. In the current study, we demonstrate that MVC infection triggers the intra-S-phase arrest to slow down host cellular DNA replication and to recruit cellular DNA replication factors for viral DNA replication. The intra-S-phase arrest is regulated by ATM (ataxia telangiectasia-mutated kinase) signaling in a p53-independent manner. Moreover, we demonstrate that SMC1 (structural maintenance of chromosomes 1) is the key regulator of the intra-S-phase arrest induced during infection. Either knockdown of SMC1 or complementation with a dominant negative SMC1 mutant blocks both the intra-S-phase arrest and viral DNA replication. Finally, we show that the intra-S-phase arrest induced during MVC infection was caused neither by damaged host cellular DNA nor by viral proteins but by replicating viral genomes physically associated with the DNA damage sensor, the Mre11-Rad50-Nbs1 (MRN) complex. In conclusion, the feedback loop between MVC DNA replication and the intra-S-phase arrest is mediated by ATM-SMC1 signaling and plays a critical role in MVC DNA replication. Thus, our findings unravel the mechanism underlying DDR signaling-facilitated MVC DNA replication and demonstrate a novel strategy of DNA virus-host interaction. PMID:23365434

  6. Arrested embryonic development: a review of strategies to delay hatching in egg-laying reptiles (United States)

    Rafferty, Anthony R.; Reina, Richard D.


    Arrested embryonic development involves the downregulation or cessation of active cell division and metabolic activity, and the capability of an animal to arrest embryonic development results in temporal plasticity of the duration of embryonic period. Arrested embryonic development is an important reproductive strategy for egg-laying animals that provide no parental care after oviposition. In this review, we discuss each type of embryonic developmental arrest used by oviparous reptiles. Environmental pressures that might have directed the evolution of arrest are addressed and we present previously undiscussed environmentally dependent physiological processes that may occur in the egg to bring about arrest. Areas for future research are proposed to clarify how ecology affects the phenotype of developing embryos. We hypothesize that oviparous reptilian mothers are capable of providing their embryos with a level of phenotypic adaptation to local environmental conditions by incorporating maternal factors into the internal environment of the egg that result in different levels of developmental sensitivity to environmental conditions after they are laid. PMID:22438503

  7. An Analysis of Alternatives to New York City's Current Marijuana Arrest and Detention Policy. (United States)

    Johnson, Bruce D; Golub, Andrew; Dunlap, Eloise; Sifaneck, Stephen J


    During the 1990s, the New York Police Department (NYPD) instituted a policy of arresting and detaining people for minor offenses that occur in public as part of their quality-of-life (hereafter QOL) policing initiative. The number of NYPD arrests for smoking marijuana in public view (MPV) increased from 3,000 in 1994 to over 50,000 in 2000, and have been about 30,000 in the mid 2000s. Most of these arrestees (84%) have been minority; blacks have been 2.7 more likely and Hispanics 1.8 times more likely to be detained than whites for an MPV arrest. Minorities have been most likely to receive more severe dispositions, even controlling for demographics and prior arrest histories.This paper examines the pros and cons of the current policy; this is compared with possible alternatives including the following: arrest and issue a desk appearance ticket (DAT); issue a non-criminal citation (violation); street warnings; and tolerate public marijuana smoking. The authors recommend that the NYPD change to issuing DATs on a routine basis. Drug policy reformers might wish to further pursue changing statutes regarding smoking marijuana in public view into a violation (noncriminal) or encourage the wider use of street warnings. Any of these policy changes would help reduce the disproportionate burden on minorities associated with the current arrest and detention policy. These policies could help maintain civic norms against smoking marijuana in public.

  8. A new on-line leakage current monitoring system of ZnO surge arresters

    International Nuclear Information System (INIS)

    Lee, Bok-Hee; Kang, Sung-Man


    This paper presents a new on-line leakage current monitoring system of zinc oxide (ZnO) surge arresters. To effectively diagnose the deterioration of ZnO surge arresters, a new algorithm and on-line leakage current detection device, which uses the time-delay addition method, for discriminating the resistive and capacitive currents was developed to use in the aging test and durability evaluation for ZnO arrester blocks. A computer-based measurement system of the resistive leakage current, the on-line monitoring device can detect accurately the leakage currents flowing through ZnO surge arresters for power frequency ac applied voltages. The proposed on-line leakage current monitoring device of ZnO surge arresters is more highly sensitive and gives more linear response than the existing devices using the detection method of the third harmonic leakage currents. Therefore, the proposed leakage current monitoring device can be useful for predicting the defects and performance deterioration of ZnO surge arresters in power system applications

  9. Juvenile Arrest and Collateral Educational Damage in the Transition to Adulthood (United States)

    Kirk, David S.; Sampson, Robert J.


    Official sanctioning of students by the criminal justice system is a long-hypothesized source of educational disadvantage, but its explanatory status remains unresolved. Few studies of the educational consequences of a criminal record account for alternative explanations such as low self-control, lack of parental supervision, deviant peers, and neighborhood disadvantage. Moreover, virtually no research on the effect of a criminal record has examined the “black box” of mediating mechanisms or the consequence of arrest for postsecondary educational attainment. Analyzing longitudinal data with multiple and independent assessments of theoretically relevant domains, this paper estimates the direct effect of arrest on later high school dropout and college enrollment for adolescents with otherwise equivalent neighborhood, school, family, peer, and individual characteristics as well as similar frequency of criminal offending. We present evidence that arrest has a substantively large and robust impact on dropping out of high school among Chicago public school students. We also find a significant gap in four-year college enrollment between arrested and otherwise similar youth without a criminal record. We assess intervening mechanisms hypothesized to explain the process by which arrest disrupts the schooling process, and, in turn, produces collateral educational damage. The results imply that institutional responses and disruptions in students’ educational trajectories, rather than social psychological factors, are responsible for the arrest-education link. PMID:25309003

  10. Master curve based correlation between static initiation toughness KIC and crack arrest toughness KIa

    International Nuclear Information System (INIS)

    Wallin, K.; Rintamaa, R.


    Historically the ASME reference curve concept assumes a constant relation between static fracture toughness initiation toughness and crack arrest toughness. In reality, this is not the case. Experimental results show that the difference between K IC and K Ia is material specific. For some materials there is a big difference while for others they nearly coincide. So far, however, no systematic study regarding a possible correlation between the two parameters has been performed. The recent Master curve method, developed for brittle fracture initiation estimation, has enabled a consistent analysis of fracture initiation toughness data. The Master curve method has been modified to be able to describe also crack arrest toughness. Here, this modified 'crack arrest master curve' is further validated and used to develop a simple, but yet (for safety assessment purpose) adequately accurate correlation between the two fracture toughness parameters. The correlation enables the estimation of crack arrest toughness from small Charpy-sized static fracture toughness tests. The correlation is valid for low Nickel steels ≤ (1.2% Ni). If a more accurate description of the crack arrest toughness is required, it can either be measured experimentally or estimated from instrumented Charpy-V crack arrest load information. (orig.)

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

    Directory of Open Access Journals (Sweden)

    Pil Kwon


    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.

  12. Information provision by regulated public transport companies

    DEFF Research Database (Denmark)

    Deborger, Bruno; Fosgerau, Mogens


    We study the interaction between pricing, frequency of service and information provision by public transport firms offering scheduled services, and we do so under various regulatory regimes. The model assumes that users can come to the bus stop or rail station at random or they can plan their trips...

  13. 15 CFR 748.1 - General provisions. (United States)


    ... approval of the Secretary of Commerce or of the Under Secretary for Industry and Security. (d) Electronic... 15 Commerce and Foreign Trade 2 2010-01-01 2010-01-01 false General provisions. 748.1 Section 748.1 Commerce and Foreign Trade Regulations Relating to Commerce and Foreign Trade (Continued) BUREAU...

  14. Cloud-based Collaborative Business Services Provision

    NARCIS (Netherlands)

    Camarinha-Matos, L.M.; Afsarmanesh, H.; Oliveira, A.I.; Ferrada, F.; Hammoudi, S.; Cordeiro, J.; Maciaszek, L.A.; Filipe, J.


    The notion of service-enhanced product, representing the association of services to manufactured products, offers an important mechanism for value creation and product differentiation. This is particularly relevant in the case of complex, highly customized and long-life products. Provision of

  15. 28 CFR 105.27 - Miscellaneous provisions. (United States)


    ... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Miscellaneous provisions. 105.27 Section 105.27 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) CRIMINAL HISTORY BACKGROUND CHECKS... has elected to opt out; or (ii) A participating State that has not yet established a process for...

  16. 5 CFR 534.506 - Conversion provisions. (United States)


    ... conversion, other than to the minimum rate under 5 U.S.C. 5376, the increase must be approved by the head of... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Conversion provisions. 534.506 Section... OTHER SYSTEMS Pay for Senior-Level and Scientific and Professional Positions § 534.506 Conversion...

  17. 10 CFR 1706.6 - Solicitation provisions. (United States)


    ... organizational conflicts of interest certificate from any marketing consultants engaged by an offeror in support... 10 Energy 4 2010-01-01 2010-01-01 false Solicitation provisions. 1706.6 Section 1706.6 Energy DEFENSE NUCLEAR FACILITIES SAFETY BOARD ORGANIZATIONAL AND CONSULTANT CONFLICTS OF INTERESTS § 1706.6...

  18. 7 CFR 1956.57 - General provisions. (United States)


    ... 7 Agriculture 14 2010-01-01 2009-01-01 true General provisions. 1956.57 Section 1956.57 Agriculture Regulations of the Department of Agriculture (Continued) RURAL HOUSING SERVICE, RURAL BUSINESS... and surviving spouse, allowable funeral expenses, and dower and courtesy rights, and specific...

  19. 20 CFR 718.1 - Statutory provisions. (United States)


    ... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false Statutory provisions. 718.1 Section 718.1 Employees' Benefits EMPLOYMENT STANDARDS ADMINISTRATION, DEPARTMENT OF LABOR FEDERAL COAL MINE HEALTH AND... establish criteria for the techniques to be used to take chest roentgenograms (X-rays) in connection with a...

  20. 15 CFR 301.1 - General provisions. (United States)


    ... 15 Commerce and Foreign Trade 2 2010-01-01 2010-01-01 false General provisions. 301.1 Section 301.1 Commerce and Foreign Trade Regulations Relating to Commerce and Foreign Trade (Continued) INTERNATIONAL TRADE ADMINISTRATION, DEPARTMENT OF COMMERCE MISCELLANEOUS REGULATIONS INSTRUMENTS AND APPARATUS...

  1. 7 CFR 226.15 - Institution provisions. (United States)


    ... personnel supported by funds provided under this part to support a nonprofit nutrition program for the... Agriculture Regulations of the Department of Agriculture (Continued) FOOD AND NUTRITION SERVICE, DEPARTMENT OF AGRICULTURE CHILD NUTRITION PROGRAMS CHILD AND ADULT CARE FOOD PROGRAM Operational Provisions § 226.15...

  2. Mitigating Provider Uncertainty in Service Provision Contracts (United States)

    Smith, Chris; van Moorsel, Aad

    Uncertainty is an inherent property of open, distributed and multiparty systems. The viability of the mutually beneficial relationships which motivate these systems relies on rational decision-making by each constituent party under uncertainty. Service provision in distributed systems is one such relationship. Uncertainty is experienced by the service provider in his ability to deliver a service with selected quality level guarantees due to inherent non-determinism, such as load fluctuations and hardware failures. Statistical estimators utilized to model this non-determinism introduce additional uncertainty through sampling error. Inability of the provider to accurately model and analyze uncertainty in the quality level guarantees can result in the formation of sub-optimal service provision contracts. Emblematic consequences include loss of revenue, inefficient resource utilization and erosion of reputation and consumer trust. We propose a utility model for contract-based service provision to provide a systematic approach to optimal service provision contract formation under uncertainty. Performance prediction methods to enable the derivation of statistical estimators for quality level are introduced, with analysis of their resultant accuracy and cost.

  3. 40 CFR 79.58 - Special provisions. (United States)


    ... Non-baseline Products. A manufacturer with total annual sales less than $50 million is not required to... section. (3) Provisions Applicable to Atypical Products. A manufacturer with total annual sales less than... required for aerosol products. EPA will review the submitted information and, at EPA's discretion, may...

  4. 7 CFR 249.25 - Other provisions. (United States)


    ... 7 Agriculture 4 2010-01-01 2010-01-01 false Other provisions. 249.25 Section 249.25 Agriculture Regulations of the Department of Agriculture (Continued) FOOD AND NUTRITION SERVICE, DEPARTMENT OF AGRICULTURE... (7 U.S.C. 2011, et seq.) and to any other Federal or State food or nutrition assistance program. (b...

  5. National Interference in Local Public Good Provision

    NARCIS (Netherlands)

    A.J. Dur (Robert); K. Staal (Klaas)


    textabstractWe analyze a simple model of local public good provision in a country consisting of a large number of heterogeneous regions, each comprising two districts, a city and a village. When districts remain autonomous and local public goods have positive spillover effects on the neighbouring

  6. 36 CFR 62.9 - General provisions. (United States)


    ... 36 Parks, Forests, and Public Property 1 2010-07-01 2010-07-01 false General provisions. 62.9 Section 62.9 Parks, Forests, and Public Property NATIONAL PARK SERVICE, DEPARTMENT OF THE INTERIOR... governments, or other interested individuals or groups to assist in administering the National Natural...

  7. Music Provision in UK Public Libraries (United States)

    Dorney, Carl; McKnight, Cliff


    Public library music provision, as a less traditional role for public libraries, has always caused contention: a vital source of cultural materials within the community though never confirmed to be a core part of library services by the Government. This article concerns itself with a detailed consideration of the decline of music services over the…

  8. Incomplete Contracting Theory and EU Treaty Provisions

    DEFF Research Database (Denmark)

    Citi, Manuele; Jensen, Mads Dagnis

    , the paper utilises an automated text analysis approach to measure the ambiguity of Treaty provisions on a number of indicators. Empirically, the analysis demonstrates a significant association between the indicators of article ambiguity and the number of laws and court rulings. It thus provides support...

  9. 10 CFR 905.34 - Adjustment provisions. (United States)


    ... continue to take place based on existing contract/marketing criteria principles. ... 10 Energy 4 2010-01-01 2010-01-01 false Adjustment provisions. 905.34 Section 905.34 Energy DEPARTMENT OF ENERGY ENERGY PLANNING AND MANAGEMENT PROGRAM Power Marketing Initiative § 905.34 Adjustment...

  10. 13 CFR 102.41 - Other provisions. (United States)


    ... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false Other provisions. 102.41 Section 102.41 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION RECORD DISCLOSURE AND PRIVACY... the preservation of the constitutional principles of federalism and separation of powers. (d) Medical...

  11. Remote Health Care Provision in Care Homes. (United States)

    Newbould, Louise; Mountain, Gail; Hawley, Mark; Ariss, Steve


    A survey was developed to map provision, knowledge, attitudes and views towards videoconferencing in care homes in Yorkshire and The Humber. The survey was sent to 859 care homes, with a 14% response rate. Twelve homes reported using videoconferencing. Non-users appeared skeptical, managers using the system reported improvements in outcomes.

  12. Wheelchair service provision education in academia

    Directory of Open Access Journals (Sweden)

    Karen H. Fung


    Conclusion: The majority of the educational institutions teach wheelchair education; however, there is great variability in what and how it is taught and evaluated. The results demonstrate the need for more in-depth investigation regarding the integration process of wheelchair education in educational institutions, with the ultimate goal of improving wheelchair service provision worldwide.

  13. 7 CFR 250.53 - Contract provisions. (United States)


    ... the food service management company will ensure that its system of inventory management will not... recipient agency's fixed-price contract with a food service management company. Such provisions must also be... management company must credit the recipient agency for the value of all donated foods received for use in...

  14. 38 CFR 61.67 - Recovery provisions. (United States)


    ...) VA HOMELESS PROVIDERS GRANT AND PER DIEM PROGRAM § 61.67 Recovery provisions. (a) If after 3 years from the date of award of a capital grant, the grant recipient has withdrawn from the VA Homeless Providers Grant and Per Diem Program (Program); does not establish the project for which the grant was made...

  15. 20 CFR 332.1 - Statutory provisions. (United States)


    ..., or, with respect to a female employee, a calendar day on which, because of pregnancy, miscarriage, or... 20 Employees' Benefits 1 2010-04-01 2010-04-01 false Statutory provisions. 332.1 Section 332.1 Employees' Benefits RAILROAD RETIREMENT BOARD REGULATIONS UNDER THE RAILROAD UNEMPLOYMENT INSURANCE ACT...

  16. Constitutional provisions regarding juristic persons | Pienaar ...

    African Journals Online (AJOL)

    The interim Constitution of 1993 and the final Constitution of 1996 contain specific provisions applicable to juristic persons. Juristic persons are also entitled to the fundamental rights contained in the Bill of Rights to the extent that these rights are applicable to them. It must be kept in mind that juristic persons have peculiar ...

  17. 44 CFR 17.625 - Exception provision. (United States)


    ... 44 Emergency Management and Assistance 1 2010-10-01 2010-10-01 false Exception provision. 17.625 Section 17.625 Emergency Management and Assistance FEDERAL EMERGENCY MANAGEMENT AGENCY, DEPARTMENT OF HOMELAND SECURITY GENERAL GOVERNMENTWIDE REQUIREMENTS FOR DRUG-FREE WORKPLACE (GRANTS) § 17.625 Exception...

  18. 42 CFR 412.200 - General provisions. (United States)


    ... PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment System for Inpatient Operating... the prospective payment system for inpatient operating costs. Except as provided in this subpart, the... for § 412.60, which deals with DRG classification and weighting factors, the provisions of subparts D...

  19. 15 CFR 700.70 - General provisions. (United States)


    ... 15 Commerce and Foreign Trade 2 2010-01-01 2010-01-01 false General provisions. 700.70 Section 700.70 Commerce and Foreign Trade Regulations Relating to Commerce and Foreign Trade (Continued) BUREAU OF INDUSTRY AND SECURITY, DEPARTMENT OF COMMERCE NATIONAL SECURITY INDUSTRIAL BASE REGULATIONS...

  20. 15 CFR 700.60 - General provisions. (United States)


    ... 15 Commerce and Foreign Trade 2 2010-01-01 2010-01-01 false General provisions. 700.60 Section 700.60 Commerce and Foreign Trade Regulations Relating to Commerce and Foreign Trade (Continued) BUREAU OF INDUSTRY AND SECURITY, DEPARTMENT OF COMMERCE NATIONAL SECURITY INDUSTRIAL BASE REGULATIONS...

  1. 15 CFR 700.50 - General provisions. (United States)


    ... 15 Commerce and Foreign Trade 2 2010-01-01 2010-01-01 false General provisions. 700.50 Section 700.50 Commerce and Foreign Trade Regulations Relating to Commerce and Foreign Trade (Continued) BUREAU OF INDUSTRY AND SECURITY, DEPARTMENT OF COMMERCE NATIONAL SECURITY INDUSTRIAL BASE REGULATIONS...

  2. 28 CFR 16.40 - General provisions. (United States)


    ... 28 Judicial Administration 1 2010-07-01 2010-07-01 false General provisions. 16.40 Section 16.40 Judicial Administration DEPARTMENT OF JUSTICE PRODUCTION OR DISCLOSURE OF MATERIAL OR INFORMATION..., commission, service, or administration of the Department of Justice. (2) Request for access to a record means...

  3. 7 CFR 760.808 - General provisions. (United States)


    ... harvested production does not exist; (2) The loss is due to an ineligible cause of loss or practices, soil... provisions. (a) For calculations of loss, the participant's existing unit structure will be used as the basis... (2) For NAP covered crops, part 1437 of this title. (b) County average yield for loss calculations...

  4. 31 CFR 25.400 - Loan provisions. (United States)



  5. 33 CFR 135.405 - Appeal provisions. (United States)


    ... 33 Navigation and Navigable Waters 2 2010-07-01 2010-07-01 false Appeal provisions. 135.405 Section 135.405 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) MARINE POLLUTION FINANCIAL RESPONSIBILITY AND COMPENSATION OFFSHORE OIL POLLUTION COMPENSATION FUND...

  6. 5 CFR 9901.361 - General provisions. (United States)


    ...) Introduction. As provided in § 9901.303(a)(2), the provisions of 5 U.S.C. chapter 55, subchapter V, and related... market supplements are treated the same as locality pay under 5 U.S.C. 5304 and are included in computing...

  7. 42 CFR 421.5 - General provisions. (United States)


    ... U.S. Revised Statutes or any other provision of law that requires competitive bidding. (b.... (a) Competitive bidding not required for carriers. CMS may enter into contracts with carriers, or... certain administrative responsibilities that the law imposes. Accordingly, their agreements and contracts...

  8. 31 CFR 281.9 - General provisions. (United States)


    ... 31 Money and Finance: Treasury 2 2010-07-01 2010-07-01 false General provisions. 281.9 Section 281.9 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) FISCAL SERVICE, DEPARTMENT OF THE TREASURY FINANCIAL MANAGEMENT SERVICE FOREIGN EXCHANGE OPERATIONS § 281.9 General...

  9. 40 CFR 63.1433 - Wastewater provisions. (United States)


    ... for Hazardous Air Pollutant Emissions for Polyether Polyols Production § 63.1433 Wastewater provisions... operation of the treatment process or control technique, the owner or operator shall instead comply with the... calibration gas for Method 25A, 40 CFR part 60, appendix A shall be the single organic HAP representing the...

  10. Strong and nonlinear effects of fragmentation on ecosystem service provision at multiple scales (United States)

    Mitchell, Matthew G. E.; Bennett, Elena M.; Gonzalez, Andrew


    Human actions, such as converting natural land cover to agricultural or urban land, result in the loss and fragmentation of natural habitat, with important consequences for the provision of ecosystem services. Such habitat loss is especially important for services that are supplied by fragments of natural land cover and that depend on flows of organisms, matter, or people across the landscape to produce benefits, such as pollination, pest regulation, recreation and cultural services. However, our quantitative knowledge about precisely how different patterns of landscape fragmentation might affect the provision of these types of services is limited. We used a simple, spatially explicit model to evaluate the potential impact of natural land cover loss and fragmentation on the provision of hypothetical ecosystem services. Based on current literature, we assumed that fragments of natural land cover provide ecosystem services to the area surrounding them in a distance-dependent manner such that ecosystem service flow depended on proximity to fragments. We modeled seven different patterns of natural land cover loss across landscapes that varied in the overall level of landscape fragmentation. Our model predicts that natural land cover loss will have strong and unimodal effects on ecosystem service provision, with clear thresholds indicating rapid loss of service provision beyond critical levels of natural land cover loss. It also predicts the presence of a tradeoff between maximizing ecosystem service provision and conserving natural land cover, and a mismatch between ecosystem service provision at landscape versus finer spatial scales. Importantly, the pattern of landscape fragmentation mitigated or intensified these tradeoffs and mismatches. Our model suggests that managing patterns of natural land cover loss and fragmentation could help influence the provision of multiple ecosystem services and manage tradeoffs and synergies between services across different human

  11. Mitral valve prolapse and sudden cardiac arrest in the community. (United States)

    Narayanan, Kumar; Uy-Evanado, Audrey; Teodorescu, Carmen; Reinier, Kyndaron; Nichols, Gregory A; Gunson, Karen; Jui, Jonathan; Chugh, Sumeet S


    Mitral valve prolapse (MVP) is relatively common in the general population with recently reported prevalence of 1% and familial clustering (Framingham Heart Study). However, its association with ventricular arrhythmias and sudden cardiac arrest (SCA) remains controversial. The purpose of this study was to characterize the frequency and clinical profile of patients with MVP who suffer SCA in the community. Patients with SCA cases were prospectively identified in the population-based Oregon Sudden Unexpected Death Study (population ~1 million). The presence of MVP was identified from echocardiograms recorded prior but unrelated to the SCA event. The detailed clinical profile of patients with SCA and MVP was compared with that of SCA patients without MVP to identify potential differences. A total of 729 SCA patients were evaluated over a 12-year period (mean age 69.5 ± 14.8 years; 64.6% men). MVP was observed in 17 (2.3%) prior to the SCA event (95% confidence interval 1.2%-3.4%). Mitral regurgitation was present in 14 SCA patients with MVP (82.3%) and was moderate or severe in 10 (58.8%). Compared with SCA patients without MVP, SCA patients with MVP were younger (mean age 60.9 ± 16.4 years vs 69.7 ± 14.7 years; P = .02), with fewer risk factors (diabetes 5.9% vs 46.4%; P = .001; hypertension 41.2% vs 78.9%; P = .001) or known coronary disease (29.4% vs 65.6%; P MVP was observed in a small proportion (2.3%) of SCA patients in the general population, suggesting a low risk overall. Since SCA patients with MVP were characterized by younger age and relatively low cardiovascular comorbidity, a focus on imaging for valve structure/insufficiency as well as genetics could aid future risk stratification approaches. Copyright © 2016 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

  12. Mechanisms involved in alternariol-induced cell cycle arrest

    Energy Technology Data Exchange (ETDEWEB)

    Solhaug, A., E-mail: [Norwegian Veterinary Institute, Oslo (Norway); Vines, L.L. [Michigan State University, Department of Food Science and Human Nutrition, East Lansing, MI (United States); Ivanova, L.; Spilsberg, B. [Norwegian Veterinary Institute, Oslo (Norway); Holme, J.A. [Norwegian Institute of Public Health, Division of Environmental Medicine, Oslo (Norway); Pestka, J. [Michigan State University, Department of Food Science and Human Nutrition, East Lansing, MI (United States); Collins, A. [University of Oslo, Department of Nutrition, Faculty of Medicine, Oslo (Norway); Eriksen, G.S. [Norwegian Veterinary Institute, Oslo (Norway)


    Alternariol (AOH), a mycotoxin produced by Alternaria sp, is often found as a contaminant in fruit and cereal products. Here we employed the murine macrophage cell line RAW 264.7 to test the hypothesis that AOH causes toxicity as a response to DNA damage. AOH at concentrations of 15-30 {mu}M almost completely blocked cell proliferation. Within 30 min treatment, AOH (30 {mu}M) significantly increased the level of reactive oxygen species (ROS). Furthermore, DNA base oxidations as well as DNA strand breaks and/or alkaline labile sites were detected by the comet assay after 2 h exposure of AOH. Cell death (mostly necrosis) was observed after prolonged exposure to the highest concentration of AOH (60 {mu}M for 24 and 48 h) in our study. The DNA damage response involved phosphorylation (activation) of histone H2AX and check point kinase-1- and 2 (Chk-1/2). Moreover, AOH activated p53 and increased the expression of p21, Cyclin B, MDM2, and Sestrin 2; likewise the level of several miRNA was affected. AOH-induced Sestrin 2 expression was regulated by p53 and could at least partly be inhibited by antioxidants, suggesting a role of ROS in the response. Interestingly, the addition of antioxidants did not inhibit cell cycle arrest. Although the formation of ROS by itself was not directly linked cell proliferation, AOH-induced DNA damage and resulting transcriptional changes in p21, MDM2, and Cyclin B likely contribute to the reduced cell proliferation; while Sestrin 2 would contribute to the oxidant defense.

  13. Contemporary approach to neurologic prognostication of coma after cardiac arrest. (United States)

    Ben-Hamouda, Nawfel; Taccone, Fabio S; Rossetti, Andrea O; Oddo, Mauro


    Coma after cardiac arrest (CA) is an important cause of admission to the ICU. Prognosis of post-CA coma has significantly improved over the past decade, particularly because of aggressive postresuscitation care and the use of therapeutic targeted temperature management (TTM). TTM and sedatives used to maintain controlled cooling might delay neurologic reflexes and reduce the accuracy of clinical examination. In the early ICU phase, patients' good recovery may often be indistinguishable (based on neurologic examination alone) from patients who eventually will have a poor prognosis. Prognostication of post-CA coma, therefore, has evolved toward a multimodal approach that combines neurologic examination with EEG and evoked potentials. Blood biomarkers (eg, neuron-specific enolase [NSE] and soluble 100-β protein) are useful complements for coma prognostication; however, results vary among commercial laboratory assays, and applying one single cutoff level (eg, > 33 μg/L for NSE) for poor prognostication is not recommended. Neuroimaging, mainly diffusion MRI, is emerging as a promising tool for prognostication, but its precise role needs further study before it can be widely used. This multimodal approach might reduce false-positive rates of poor prognosis, thereby providing optimal prognostication of comatose CA survivors. The aim of this review is to summarize studies and the principal tools presently available for outcome prediction and to describe a practical approach to the multimodal prognostication of coma after CA, with a particular focus on neuromonitoring tools. We also propose an algorithm for the optimal use of such multimodal tools during the early ICU phase of post-CA coma.

  14. Outcome among patients suffering from in-hospital cardiac arrest

    Directory of Open Access Journals (Sweden)

    Trpković Sladjana


    Full Text Available Introduction. In relation to pre-hospital treatment of patients with cardiac arrest (CA in the field where resuscitation is often started by nonprofessionals, resuscitation in hospital is most commonly performed by well-trained personnel. Objective. The aim was to define the factors associated with an improved outcome among patients suffering from the inhospital CA (IHCA. Methods. The prospective study included a total of 100 patients in the Emergency Center over two-year period. The patterns by the Utstein-Style guidelines recorded the following: age, sex, reason for hospital admission, comorbidity, cause and origin of CA, continuous monitoring, time of arrival of the medical emergency team and time of delivery of the first defibrillation shock (DC. Results. Most patients (61% had cardiac etiology. Return of spontaneous circulation (ROSC was achieved in 58% of patients. ROSC was more frequently achieved in younger patients (57.69±11.37, (p<0.05, non-surgical patients (76.1%, (p<0.01 and in patients who were in continuous monitoring (66.7% (p<0.05. The outcome of CPR was significantly better in patients who received advanced life support (ALS (76.6% (p<0.01. Time until the delivery of the first DC shock was significantly shorter in patients who achieved ROSC (1.67±1.13 min, (p<0.01. A total of 5% of IHCA patients survived to hospital discharge. Conclusion. In our study, the outcome of CPR was better in patients who were younger and with non-surgical diseases, which are prognostic factors that we cannot control. Factors associated with better outcome of IHCA patients were: continuous monitoring, shorter time until the delivery of the first DC and ALS. This means that better education of medical staff, better organization and up-to-dated technical equipment are needed.

  15. Sudden cardiac arrest in people with epilepsy in the community (United States)

    Lamberts, Robert J.; Blom, Marieke T.; Wassenaar, Merel; Bardai, Abdennasser; Leijten, Frans S.; de Haan, Gerrit-Jan; Sander, Josemir W.; Thijs, Roland D.


    Objective: To ascertain whether characteristics of ventricular tachycardia/fibrillation (VT/VF) differed between people with epilepsy and those without and which individuals with epilepsy were at highest risk. Methods: We ascertained 18 people with active epilepsy identified in a community-based registry of sudden cardiac arrest (SCA) with ECG-confirmed VT/VF (cases). We compared them with 470 individuals with VT/VF without epilepsy (VT/VF controls) and 54 individuals with epilepsy without VT/VF (epilepsy controls). Data on comorbidity, epilepsy severity, and medication use were collected and entered into (conditional) logistic regression models to identify determinants of VT/VF in epilepsy. Results: In most cases, there was an obvious (10/18) or presumed cardiovascular cause (5/18) in view of preexisting heart disease. In 2 of the 3 remaining events, near–sudden unexpected death in epilepsy (SUDEP) was established after successful resuscitation. Cases had a higher prevalence of congenital/inherited heart disease (17% vs 1%, p = 0.002), and experienced VT/VF at younger age (57 vs 64 years, p = 0.023) than VT/VF controls. VT/VF in cases occurred more frequently at/near home (89% vs 58%, p = 0.009), and was less frequently witnessed (72% vs 89%, p = 0.048) than in VT/VF controls. Cases more frequently had clinically relevant heart disease (50% vs 15%, p = 0.005) and intellectual disability (28% vs 1%, p epilepsy controls. Conclusion: Cardiovascular disease rather than epilepsy characteristics is the main determinant of VT/VF in people with epilepsy in the community. SCA and SUDEP are partially overlapping disease entities. PMID:26092917

  16. Mechanisms involved in alternariol-induced cell cycle arrest

    International Nuclear Information System (INIS)

    Solhaug, A.; Vines, L.L.; Ivanova, L.; Spilsberg, B.; Holme, J.A.; Pestka, J.; Collins, A.; Eriksen, G.S.


    Alternariol (AOH), a mycotoxin produced by Alternaria sp, is often found as a contaminant in fruit and cereal products. Here we employed the murine macrophage cell line RAW 264.7 to test the hypothesis that AOH causes toxicity as a response to DNA damage. AOH at concentrations of 15–30 μM almost completely blocked cell proliferation. Within 30 min treatment, AOH (30 μM) significantly increased the level of reactive oxygen species (ROS). Furthermore, DNA base oxidations as well as DNA strand breaks and/or alkaline labile sites were detected by the comet assay after 2 h exposure of AOH. Cell death (mostly necrosis) was observed after prolonged exposure to the highest concentration of AOH (60 μM for 24 and 48 h) in our study. The DNA damage response involved phosphorylation (activation) of histone H2AX and check point kinase-1- and 2 (Chk-1/2). Moreover, AOH activated p53 and increased the expression of p21, Cyclin B, MDM2, and Sestrin 2; likewise the level of several miRNA was affected. AOH-induced Sestrin 2 expression was regulated by p53 and could at least partly be inhibited by antioxidants, suggesting a role of ROS in the response. Interestingly, the addition of antioxidants did not inhibit cell cycle arrest. Although the formation of ROS by itself was not directly linked cell proliferation, AOH-induced DNA damage and resulting transcriptional changes in p21, MDM2, and Cyclin B likely contribute to the reduced cell proliferation; while Sestrin 2 would contribute to the oxidant defense.

  17. Young man presenting with out-of-hospital cardiac arrest. (United States)

    Huang, Hans David; Lombardi, William L; Steinberg, Zachary Louis


    A man in his early 30s with remote history of a febrile rash as a toddler presented to the emergency room following an out-of-hospital cardiac arrest while riding his bicycle. He received bystander cardiopulmonary resuscitation and one shock from an automatic external defibrillator, successfully restoring sinus rhythm. On arrival, he was haemodynamically stable without ECG evidence of ST segment changes to suggest active ischaemia, and an initial troponin I was mildly elevated at 0.10 ng/mL (normal <0.04 ng/mL). A CT angiogram (CTA) was obtained showing a normal-appearing aorta and no abnormal extracardiac findings. Urgent coronary angiography was performed; images are shown in figure 1A-C. Echocardiogram revealed a mildly reduced left ventricular ejection fraction (45%) with a hypokinetic inferior wall.heartjnl;heartjnl-2018-312966v1/F1F1F1Figure 1(A) Right coronary artery angiogram in the left anterior oblique cranial projection. (B) Left coronary artery angiogram in the right anterior oblique caudal projection. (C) Left coronary artery angiogram in the right anterior oblique cranial projection. CAUD, caudal; CRAN, cranial; LAO, left anterior oblique; RAO, right anterior oblique. What is the next best step in the management of this patient at this time?Complete revascularisation via percutaneous coronary intervention (PCI).Referral for coronary artery bypass surgery (CABG).Initiation of high-dose steroids.Initiation of dual-antiplatelet therapy without planned revascularisation. © 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.

  18. Sexual homicide in the USA committed by juveniles and adults, 1976-2007: Age of arrest and incidence trends over 32 years. (United States)

    Myers, Wade C; Chan, Heng Choon Oliver; Mariano, Timothy Y


    Reliable epidemiological data on sexual homicide are sparse, especially on trends in its incidence over time and age at arrest. Our main aims were to study age at arrest and incidence trends for sexual homicide in the USA over about three decades (1976-2007). We conducted longitudinal analyses of data from the largest USA homicide database available for the years 1976-2007. The mean age at arrest for a sexual homicide was 26.3 years (range 7-76; modal 21 years). Three quarters of these offenders were young adults aged 18-35. Age at probable first arrest for a sexual homicide rose significantly from a mean of 25 to a mean of 29 years over the study period. The last decade of the three studied accounted for just one quarter of the homicides as charged in the whole period, but the proportion of sexual homicides specifically fell with each decade, so that the first period accounted for 56% of those in the whole period, the second for 33% and the final decade for just 11%. This was reflected in a reduction in the proportion of all homicides that were sexual, from 1.4% in the first decade to 0.8% in the second and 0.4% in the third, declining by a factor of five for adults and seven for juveniles. Use of official national criminal statistics has limitations in studying the epidemiology of any particular behaviour. Nonetheless, our findings of falling sexual homicide rates and of changes in at least one important demographic of these killers indicate a need for a considered reappraisal of such crimes. Establishment of accurate epidemiology and a study of associated factors may assist in the improvement of investigative and preventive strategies. Copyright © 2014 John Wiley & Sons, Ltd.

  19. The SecA2 pathway of Mycobacterium tuberculosis exports effectors that work in concert to arrest phagosome and autophagosome maturation. (United States)

    Zulauf, Katelyn E; Sullivan, Jonathan Tabb; Braunstein, Miriam


    To subvert host defenses, Mycobacterium tuberculosis (Mtb) avoids being delivered to degradative phagolysosomes in macrophages by arresting the normal host process of phagosome maturation. Phagosome maturation arrest by Mtb involves multiple effectors and much remains unknown about this important aspect of Mtb pathogenesis. The SecA2 dependent protein export system is required for phagosome maturation arrest and consequently growth of Mtb in macrophages. To better understand the role of the SecA2 pathway in phagosome maturation arrest, we identified two effectors exported by SecA2 that contribute to this process: the phosphatase SapM and the kinase PknG. Then, utilizing the secA2 mutant of Mtb as a platform to study effector functions, we identified specific steps in phagosome maturation inhibited by SapM and/or PknG. By identifying a histidine residue that is essential for SapM phosphatase activity, we confirmed for the first time that the phosphatase activity of SapM is required for its effects on phagosome maturation in macrophages. We further demonstrated that SecA2 export of SapM and PknG contributes to the ability of Mtb to replicate in macrophages. Finally, we extended our understanding of the SecA2 pathway, SapM, and PknG by revealing that their contribution goes beyond preventing Mtb delivery to mature phagolysosomes and includes inhibiting Mtb delivery to autophagolysosomes. Together, our results revealed SapM and PknG to be two effectors exported by the SecA2 pathway of Mtb with distinct as well as cumulative effects on phagosome and autophagosome maturation. Our results further reveal that Mtb must have additional mechanisms of limiting acidification of the phagosome, beyond inhibiting recruitment of the V-ATPase proton pump to the phagosome, and they indicate differences between effects of Mtb on phagosome and autophagosome maturation.

  20. Nursing Unit Environment Associated with Provision of Language Services in Pediatric Hospices. (United States)

    Lindley, Lisa C; Held, Mary L; Henley, Kristen M; Miller, Kathryn A; Pedziwol, Katherine E; Rumley, Laurie E


    Provision of language services in pediatric hospice enables nurses to communicate effectively with patients who have limited English proficiency. Language barriers contribute to ethnic disparities in health care. While language service use corresponds with improved patient comprehension of illness and care options, we lack an understanding of how the nurse work environment affects the provision of these services. Data were obtained from the 2007 National Home and Hospice Care Survey and included a study sample of 1251 pediatric hospice agencies. Variable selection was guided by structural contingency theory, which posits that organizational effectiveness is dependent upon how well an organization's structure relates to its context. Using multivariate logistic regression, we analyzed the extent to which nursing unit environment predicted provision of translation services and interpreter services. The majority of hospices provided translation services (74.9 %) and interpreter services (87.1 %). Four variables predicted translation services: registered nurse (RN) unit size, RN leadership, RN medical expertise, and for-profit status. RN medical expertise and having a safety climate within the hospice corresponded with provision of interpreter services. Findings indicate that nursing unit environment predicts provision of language services. Hospices with more specialized RNs and a stronger safety climate might include staffs who are dedicated to best care provision, including language services. This study provides valuable data on the nurse work environment as a predictor of language services provision, which can better serve patients with limited English proficiency and ultimately reduce ethnic disparities in end-of-life care for children and their families.

  1. The Arrested Black Men in Europe: Criminal or Victim?

    Directory of Open Access Journals (Sweden)

    Michael Platzer


    Full Text Available The Africans detained in Austria have been targeted by police by their skin color, often are arrested with violence, are poorly defended by assigned defense lawyers, given longer sentences than Austrian citizens and have less access to alternatives or bail.A modified form of the United Nations Crime Victim questionnaire was administered to all the African prisoners at the Vienna’s Central Detention Facility. It revealed that the Africans were not only victims of violence (sometimes even torture and crimes (assault-58%, burglary-32%, fraud-27%, bribery-33% in their home countries, but also 24 percent had experienced assault, 16% theft, and 13% had been defrauded in Austria-much higher rates than the EU citizen. On the other hand, the Africans are rarely charged with burglary, robbery, or violent crimes. They are primarily arrested for the possession or sale of narcotic drugs (83% and an additional four percent for resisting arrest. This is primarily the result of insufficient financial support provided to asylum seekers and the prohibition to work pending their determination of immigrant status. Because of the long appeal processes and the practical impossibility of deporting certain nationalities, a type of underground community is taking root where simple survival is the determining factor whether to commit a non-violent offence. Les Africains détenus en Autriche sont visés par la police à cause de la couleur de leur peau; ils sont souvent arrêtés avec violence, sont mal défendus par leurs avocats de défense, doivent passer de plus longues périodes en prison que des citoyens autrichiens ayant commis un crime pareil, et ils ont moins d'accès aux mesures extrajudiciaires et au système de liberté sous caution. Une forme modifiée du questionnaire de victimes de crime des Nations Unies fut administrée à tous les prisonniers africains au Service Central de la Détention de Vienne. Les résultats indiquèrent que les Africains furent

  2. Capnography in the Emergency Department: A Review of Uses, Waveforms, and Limitations. (United States)

    Long, Brit; Koyfman, Alex; Vivirito, Michael A


    Capnography has many uses in the emergency department (ED) and critical care setting, most commonly cardiac arrest and procedural sedation. This review evaluates several indications concerning capnography beyond cardiac arrest and procedural sedation in the ED, as well as limitations and specific waveforms. Capnography includes the noninvasive measurement of CO 2 , providing information on ventilation, perfusion, and metabolism in intubated and spontaneously breathing patients. Since the 1990s, capnography has been utilized extensively for cardiac arrest and procedural sedation. Qualitative capnography includes a colorimetric device, changing color on the amount of CO 2 present. Quantitative capnography provides a numeric value (end-tidal CO 2 ), and capnography most commonly includes a waveform as a function of time. Conditions in which capnography is informative include cardiac arrest, procedural sedation, mechanically ventilated patients, and patients with metabolic acidemia. Patients with seizure, trauma, and respiratory conditions, such as pulmonary embolism and obstructive airway disease, can benefit from capnography, but further study is needed. Limitations include use of capnography in conditions with mixed pathophysiology, patients with low tidal volumes, and equipment malfunction. Capnography should be used in conjunction with clinical assessment. Capnography demonstrates benefit in cardiac arrest, procedural sedation, mechanically ventilated patients, and patients with metabolic acidemia. Further study is required in patients with seizure, trauma, and respiratory conditions. It should only be used in conjunction with other patient factors and clinical assessment. Published by Elsevier Inc.

  3. The role of doctors in provision of support for primary health care ...

    African Journals Online (AJOL)


    Nov 13, 2008 ... meaningful relationships between the visiting doctor and clinic staff. The current ... Doctors felt that a lack of essential equipment and drugs at the clinic limited the value of the ... by registered nurses working in PHC clinics, so provision of quality .... up, because most clinics are nearby their homes. So they ...

  4. Student Perceptions of the Importance of Employability Skill Provision in Business Undergraduate Programs (United States)

    Jackson, Denise


    Studies examining student perceptions of employability skill development in business undergraduate programs are limited. Assurance of student buy-in is important to ensure learners engage with skill provision; to enable them to articulate their capabilities to potential employers; and to facilitate the transfer of acquired skills. The author…

  5. The LOB Provision in the New Japan-Netherlands Tax Treaty

    NARCIS (Netherlands)

    Potgens, F.P.G.; Hofland, D.A.


    In this article, the authors review the comptability of the limitation on benefits provision of the Japan-Netherlands tax treaty with the OECD Model Tax Convention and the fundamental freedoms of the Treaty on the Functioning of the European Union, and conclude that it is clearly in conflict with a

  6. 76 FR 42577 - Magnuson-Stevens Act Provisions; Fisheries of the Northeastern United States; Northeast... (United States)


    ... for FYs 2010 and 2011. 7. Multispecies Minimum Fish Sizes and Fillet Provisions The current... (ACE) for the sector in which that vessel participates. Currently, fillets and parts of fish as... limits. That is, the regulations require the weight of fillets or parts of fish to be multiplied by 3 and...

  7. 18 CFR 367.1110 - Account 111, Accumulated provision for amortization of service company property. (United States)



  8. Chromosome Mis-segregation Generates Cell-Cycle-Arrested Cells with Complex Karyotypes that Are Eliminated by the Immune System. (United States)

    Santaguida, Stefano; Richardson, Amelia; Iyer, Divya Ramalingam; M'Saad, Ons; Zasadil, Lauren; Knouse, Kristin A; Wong, Yao Liang; Rhind, Nicholas; Desai, Arshad; Amon, Angelika


    Aneuploidy, a state of karyotype imbalance, is a hallmark of cancer. Changes in chromosome copy number have been proposed to drive disease by modulating the dosage of cancer driver genes and by promoting cancer genome evolution. Given the potential of cells with abnormal karyotypes to become cancerous, do pathways that limit the prevalence of such cells exist? By investigating the immediate consequences of aneuploidy on cell physiology, we identified mechanisms that eliminate aneuploid cells. We find that chromosome mis-segregation leads to further genomic instability that ultimately causes cell-cycle arrest. We further show that cells with complex karyotypes exhibit features of senescence and produce pro-inflammatory signals that promote their clearance by the immune system. We propose that cells with abnormal karyotypes generate a signal for their own elimination that may serve as a means for cancer cell immunosurveillance. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. Genetic, clinical and pharmacological determinants of out-of-hospital cardiac arrest: rationale and outline of the AmsteRdam Resuscitation Studies (ARREST) registry (United States)

    Blom, M T; van Hoeijen, D A; Bardai, A; Berdowski, J; Souverein, P C; De Bruin, M L; Koster, R W; de Boer, A; Tan, H L


    Introduction Out-of-hospital cardiac arrest (OHCA) is a major public health problem. Recognising the complexity of the underlying causes of OHCA in the community, we aimed to establish the clinical, pharmacological, environmental and genetic factors and their interactions that may cause OHCA. Methods and analysis We set up a large-scale prospective community-based registry (AmsteRdam Resuscitation Studies, ARREST) in which we prospectively include all resuscitation attempts from OHCA in a large study region in the Netherlands in collaboration with Emergency Medical Services. Of all OHCA victims since June 2005, we prospectively collect medical history (through hospital and general practitioner), and current and previous medication use (through community pharmacy). In addition, we include DNA samples from OHCA victims with documented ventricular tachycardia/fibrillation during the resuscitation attempt since July 2007. Various study designs are employed to analyse the data of the ARREST registry, including case–control, cohort, case only and case-cross over designs. Ethics and dissemination We describe the rationale, outline and potential results of the ARREST registry. The design allows for a stable and reliable collection of multiple determinants of OHCA, while assuring that the patient, lay-caregiver or medical professional is not hindered in any way. Such comprehensive data collection is required to unravel the complex basis of OHCA. Results will be published in peer-reviewed journals and presented at relevant scientific symposia. PMID:25332818

  10. Genetic, clinical and pharmacological determinants of out-of-hospital cardiac arrest : rationale and outline of the AmsteRdam Resuscitation Studies (ARREST) registry

    NARCIS (Netherlands)

    Blom, M T; van Hoeijen, D A; Bardai, A; Berdowski, J; Souverein, P C; De Bruin, M L; Koster, R W; de Boer, A; Tan, H L


    INTRODUCTION: Out-of-hospital cardiac arrest (OHCA) is a major public health problem. Recognising the complexity of the underlying causes of OHCA in the community, we aimed to establish the clinical, pharmacological, environmental and genetic factors and their interactions that may cause OHCA.

  11. 40 CFR 401.12 - Law authorizing establishment of effluent limitations guidelines for existing sources, standards... (United States)


    ... effluent limitations guidelines for existing sources, standards of performance for new sources and... ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) EFFLUENT GUIDELINES AND STANDARDS GENERAL PROVISIONS § 401.12 Law authorizing establishment of effluent limitations guidelines for existing sources, standards of performance...

  12. Socioeconomic factors associated with outcome after cardiac arrest in patients under the age of 65. (United States)

    Uray, Thomas; Mayr, Florian B; Fitzgibbon, James; Rittenberger, Jon C; Callaway, Clifton W; Drabek, Tomas; Fabio, Anthony; Angus, Derek C; Kochanek, Patrick M; Dezfulian, Cameron


    In a prior study of seven North American cities Pittsburgh had the highest crude rate of cardiac arrest deaths in patients 18 to 64 years of age, particularly in neighborhoods with lower socioeconomic status (SES). We hypothesized that lower SES, associated poor health behaviors (e.g., illicit drug use) and pre-existing comorbid conditions (grouped as socioeconomic factors [SE factors]) could affect the type and severity of cardiac arrest, thus outcomes. We retrospectively identified patients aged 18 to 64 years treated for in-hospital (IHCA) and out-of hospital arrest (OHCA) at two Pittsburgh hospitals between January 2010 and July 2012. We abstracted data on baseline demographics and arrest characteristics like place of residence, insurance and employment status. Favorable cerebral performance category [CPC] (1 or 2) was our primary outcome. We examined the associations between SE factors, cardiac arrest variables and outcome as well as post-resuscitation care. Among 415 subjects who met inclusion criteria, unfavorable CPC were more common in patients who were unemployed, had a history of drug abuse or hypertension. In OHCA, favorable CPC was more often associated with presentation with ventricular fibrillation/tachycardia (OR 3.53, 95% CI 1.43-8.74, p = 0.006) and less often associated with non-cardiovascular arrest etiology (OR 0.22, 95% CI 0.08-0.62, p = 0.004). We found strong associations between specific SE factors and arrest factors associated with outcome in OHCA patients only. Significant differences in post-resuscitation care existed based on injury severity, not on SES. SE factors strongly influence type and severity of OHCA but not IHCA resulting in an association with outcomes. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  13. Critical experiments, measurements, and analyses to establish a crack arrest methodology for nuclear pressure vessel steels

    International Nuclear Information System (INIS)

    Hahn, G.T.


    Substantial progress was made in three important areas: crack propagation and arrest theory, two-dimensional dynamic crack propagation analyses, and a laboratory test method for the material property data base. The major findings were as follows: Measurements of run-arrest events lent support to the dynamic, energy conservation theory of crack arrest. A two-dimensional, dynamic, finite-difference analysis, including inertia forces and thermal gradients, was developed. The analysis was successfully applied to run-arrest events in DCB (double-cantilever-beam) and SEN (single-edge notched) test pieces. A simplified procedure for measuring K/sub D/ and K/sub Im/ values with ordinary and duplex DCB specimens was demonstrated. The procedure employs a dynamic analysis of the crack length at arrest and requires no special instrumentation. The new method was applied to ''duplex'' specimens to measure the large K/sub D/ values displayed by A533B steel above the nil-ductility temperature. K/sub D/ crack velocity curves and K/sub Im/ values of two heats of A533B steel and the corresponding values for the plane strain fracture toughness associated with static initiation (K/sub Ic/), dynamic initiation (K/sub Id/), and the static stress intensity at crack arrest (K/sub Ia/) were measured. Possible relations among these toughness indices are identified. During the past year the principal investigators of the participating groups reached agreement on a crack arrest theory appropriate for the pressure vessel problem. 7 figures

  14. Cell cycle arrest and cell survival induce reverse trends of cardiolipin remodeling.

    Directory of Open Access Journals (Sweden)

    Yu-Jen Chao

    Full Text Available Cell survival from the arrested state can be a cause of the cancer recurrence. Transition from the arrest state to the growth state is highly regulated by mitochondrial activity, which is related to the lipid compositions of the mitochondrial membrane. Cardiolipin is a critical phospholipid for the mitochondrial integrity and functions. We examined the changes of cardiolipin species by LC-MS in the transition between cell cycle arrest and cell reviving in HT1080 fibrosarcoma cells. We have identified 41 cardiolipin species by MS/MS and semi-quantitated them to analyze the detailed changes of cardiolipin species. The mass spectra of cardiolipin with the same carbon number form an envelope, and the C64, C66, C68, C70 C72 and C74 envelopes in HT1080 cells show a normal distribution in the full scan mass spectrum. The cardiolipin quantity in a cell decreases while entering the cell cycle arrest, but maintains at a similar level through cell survival. While cells awakening from the arrested state and preparing itself for replication, the groups with short acyl chains, such as C64, C66 and C68 show a decrease of cardiolipin percentage, but the groups with long acyl chains, such as C70 and C72 display an increase of cardiolipin percentage. Interestingly, the trends of the cardiolipin species changes during the arresting state are completely opposite to cell growing state. Our results indicate that the cardiolipin species shift from the short chain to long chain cardiolipin during the transition from cell cycle arrest to cell progression.

  15. Protective head-cooling during cardiac arrest and cardiopulmonary resuscitation: the original animal studies

    Directory of Open Access Journals (Sweden)

    Eric W. Brader


    Full Text Available Prolonged standard cardiopulmonary resuscitation (CPR does not reliably sustain brain viability during cardiac arrest. Pre-hospital adjuncts to standard CPR are needed in order to improve outcomes. A preliminary dog study demonstrated that surface cooling of the head during arrest and CPR can achieve protective levels of brain hypothermia (30°C within 10 minutes. We hypothesized that protective head-cooling during cardiac arrest and CPR improves neurological outcomes. Twelve dogs under light ketamine-halothane-nitrous oxide anesthesia were arrested by transthoracic fibrillation. The treated group consisted of six dogs whose shaven heads were moistened with saline and packed in ice immediately after confirmation of ventricular fibrillation. Six control dogs remained at room temperature. All 12 dogs were subjected to four minutes of ventricular fibrillation and 20 minutes of standard CPR. Spontaneous circulation was restored with drugs and countershocks. Intensive care was provided for five hours post-arrest and the animals were observed for 24 hours. In both groups, five of the six dogs had spontaneous circulation restored. After three hours, mean neurological deficit was significantly lower in the treated group (P=0.016, with head-cooled dogs averaging 37% and the normothermic dogs 62%. Two of the six head-cooled dogs survived 24 hours with neurological deficits of 9% and 0%, respectively. None of the control group dogs survived 24 hours. We concluded that head-cooling attenuates brain injury during cardiac arrest with prolonged CPR. We review the literature related to the use of hypothermia following cardiac arrest and discuss some promising approaches for the pre-hospital setting.

  16. Association of Ambient Fine Particles With Out-of-Hospital Cardiac Arrests in New York City (United States)

    Silverman, Robert A.; Ito, Kazuhiko; Freese, John; Kaufman, Brad J.; De Claro, Danilynn; Braun, James; Prezant, David J.


    Cardiovascular morbidity has been associated with particulate matter (PM) air pollution, although the relation between pollutants and sudden death from cardiac arrest has not been established. This study examined associations between out-of-hospital cardiac arrests and fine PM (of aerodynamic diameter ≤2.5 μm, or PM2.5), ozone, nitrogen dioxide, sulfur dioxide, and carbon monoxide in New York City. The authors analyzed 8,216 out-of-hospital cardiac arrests of primary cardiac etiology during the years 2002–2006. Time-series and case-crossover analyses were conducted, controlling for season, day-of-week, same-day, and delayed/apparent temperature. An increased risk of cardiac arrest in time-series (relative risk (RR) = 1.06, 95% confidence interval (CI): 1.02, 1.10) and case-crossover (RR = 1.04, 95% CI: 0.99, 1.08) analysis for a PM2.5 increase of 10 μg/m3 in the average of 0- and 1-day lags was found. The association was significant in the warm season (RR = 1.09, 95% CI: 1.03, 1.15) but not the cold season (RR = 1.01, 95% CI: 0.95, 1.07). Associations of cardiac arrest with other pollutants were weaker. These findings, consistent with studies implicating acute cardiovascular effects of PM, support a link between PM2.5 and out-of-hospital cardiac arrests. Since few individuals survive an arrest, air pollution control may help prevent future cardiovascular mortality. PMID:20729350

  17. Aortic arch reconstruction: deep and moderate hypothermic circulatory arrest with selective antegrade cerebral perfusion. (United States)

    Wu, YanWen; Xiao, LiQiong; Yang, Ting; Wang, Lei; Chen, Xin


    To compare the effects of moderate and deep hypothermic circulatory arrest (DHCA) with selective antegrade cerebral perfusion (SACP) during aortic arch surgery in adult patients and to offer the evidence for the detection of the temperature which provides best brain protection in the subjects who accept aortic arch reconstruction surgery. A total of 109 patients undergoing surgery of the aortic arch were divided into the moderate hypothermic circulatory arrest group (Group I) and the deep hypothermic circulatory arrest group (Group II). We recorded the data of the patients and their cardiopulmonary bypass (CPB) time, aortic clamping time, SACP time and postoperative anesthetized recovery time, tracheal intubation time, time in the intensive care unit (ICU) and postoperative neurologic dysfunction. Patient characteristics were similar in the two groups. There were four patients who died in Group II and 1 patient in Group I. There were no significant differences in aortic clamping time of each group (111.4±58.4 vs. 115.9±16.2) min; SACP time (27.4±5.9 vs. 23.5±6.1) min of the moderate hypothermic circulatory arrest group and the deep hypothermic circulatory arrest group; there were significant differences in cardiopulmonary bypass time (207.4±20.9 vs. 263.8±22.6) min, postoperative anesthetized recovery time (19.0±11.1 vs. 36.8±25.3) hours, extubation time (46.4±15.1 vs. 64.4±6.0) hours; length of stay in the intensive care unit (ICU) (4.7±1.7 vs. 8±2.3) days and postoperative neurologic dysfunction in the two groups. Compared to deep hypothermic circulatory arrest, moderate hypothermic circulatory arrest can provide better brain protection and achieve good clinical results.

  18. Public health capacity in the provision of health care services. (United States)

    Valdmanis, Vivian; DeNicola, Arianna; Bernet, Patrick


    In this paper, we assess the capacity of Florida's public health departments. We achieve this by using bootstrapped data envelopment analysis (DEA) applied to Johansen's definition of capacity utilization. Our purpose in this paper is to measure if there is, theoretically, enough excess capacity available to handle a possible surge in the demand for primary care services especially after the implementation of the Affordable Care Act that includes provisions for expanded public health services. We measure subunit service availability using a comprehensive data source available for all 67 county health departments in the provision of diagnostic care and primary health care. In this research we aim to address two related research questions. First, we structure our analysis so as to fix budgets. This is based on the assumption that State spending on social and health services could be limited, but patient needs are not. Our second research question is that, given the dearth of primary care providers in Florida if budgets are allowed to vary is there enough medical labor to provide care to clients. Using a non-parametric approach, we also apply bootstrapping to the concept of plant capacity which adds to the productivity research. To preview our findings, we report that there exists excess plant capacity for patient treatment and care, but question whether resources may be better suited for more traditional types of public health services.

  19. Strategic provisioning of replacement parts for CANDU power plants

    International Nuclear Information System (INIS)

    Mizuno, G.; Tume, P.; Prentice, J.


    Provisioning of replacement parts and management of critical spares are key factors in optimizing maintenance programs for CANDU power plants. With a view to supply assurance, Atomic Energy Canada Limited (AECL) has created a Spare Parts Branch (SPB) to provide a clear pipeline from the client to the delivered replacement part(s). SPB provides the client with assured access to a qualified supplier database, computer aided design, engineering and manufacturing services and material upgrades and design registration through the authorized inspection agency. The AECL spare parts strategic provisioning service plan that has four thrusts: 1) the efficient delivery of cost-effective replacement parts; 2) obsolete parts resolution; 3) a website that will provide our clients with real-time access to replacement part data; and 4) inventory recovery opportunities. Thrusts one and two are actively ensuring plant maintenance for on-shore and off-shore CANDU clients. Thrusts three and four are longer-term commitments. This paper will explore these thrusts in the context of our CANDU business practices. (author)

  20. Development of a virtual learning environment for cardiorespiratory arrest training. (United States)

    Silva, Anazilda Carvalho da; Bernardes, Andrea; Évora, Yolanda Dora Martinez; Dalri, Maria Célia Barcellos; Silva, Alexandre Ribeiro da; Sampaio, Camila Santana Justo Cintra


    To develop a Virtual Learning Environment (VLE) aiming at the training of nursing team workers and emergency vehicle drivers in Basic Life Support (BLS) to attend Cardiorespiratory arrest, and to evaluate the quality of its contents among specialists in the area of Emergency and Urgent care. Applied research of technological development. The methodology used was based on the Instructional Design Model (ADDIE), which structures the teaching-learning planning in different stages (analysis, design, development, implementation and evaluation). The VLE was composed of texts elaborated from bibliographic research, links, edited video from a simulation scenario in the laboratory and questions to evaluate the fixation of the content, organized in modules. After its development, it was evaluated as adequate to satisfy the needs of the target public, by eight expert judges, which was made available for electronic access. The VLE has potential as a tool for training and qualification in BLS, as it can be easily integrated with other pedagogical approaches and strategies with active methodologies. Desenvolver um Ambiente Virtual de Aprendizagem (AVA) visando à capacitação de trabalhadores da equipe de enfermagem e condutores de veículo de emergência em Suporte Básico de Vida (SBV) no atendimento à Parada Cardiorrespiratória, e avaliar a qualidade do seu conteúdo junto a especialistas na área de Urgência e Emergência. Pesquisa aplicada, de produção tecnológica. A metodologia utilizada foi baseada no Modelo de Design Instrucional (ADDIE), que estrutura o planejamento de ensino-aprendizagem em estágios distintos (analysis, design, development, implementation and evaluation). O AVA foi composto por textos elaborados a partir de pesquisa bibliográfica, links, vídeo construído a partir de um cenário de simulação em laboratório e questões para avaliar a fixação do conteúdo, organizados em módulos. Após a sua construção, foi avaliado como adequado para

  1. Mutuality in the provision of Scottish healthcare. (United States)

    Howieson, Brian


    The backdrop to this article is provided by the Better Health, Better Care Action Plan (Scottish Government, 2007), Section 1 of which is entitled 'Towards a Mutual NHS'. According to Better Health, Better Care (Scottish Government, 2007: 5): 'Mutual organisations are designed to serve their members. They are designed to gather people around a common sense of purpose. They are designed to bring the organisation together in what people often call "co-production."' The aim of this article is to précis the current knowledge of mutuality in the provision of Scottish healthcare. In detail, it will: introduce the 'mutual' organisation; offer a historical perspective of mutuality; suggest why healthcare mutuality is important; and briefly, detail the differences in mutual health-care policy in England and Scotland. It is hoped that this analysis will help researchers and practitioners alike appreciate further the philosophy of mutuality in the provision of Scottish healthcare. © The Author(s) 2015.

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

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


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

  3. The spares provisioning problem with parts inventory


    Abboud, Nadim E.


    In this research, we consider the spares provisioning problem, where a finite population of homogeneous machines are being deployed to meet a constant demand. While a machine is operating, it could become inoperable due to the failure of a critical built-in part in the machine. Before repairs on the machine can be initiated, however, a replacement part must be obtained. If a replacement part is available from stock, the machine is immediately transferred to the repair subsystem...

  4. Fringe Benefits Provision by Rural Small Businesses


    Jayachandran N. Variyam; David S. Kraybill


    We examine the relationship between employer size and the provision of fringe benefits in a large sample of rural businesses. A clear employer size-benefits relationship exists only in the case of health insurance, while other benefits are not strongly linked to employer size. The negative relationship between employer size and health insurance is weaker, though still existent, in businesses whose employees have relatively high skill levels. Single, independent establishments and sole proprie...

  5. Arm's Length Provision of Public Services

    DEFF Research Database (Denmark)

    Bennedsen, Morten; Schultz, Christian

    We analyze the economic consequences of strategic delegation of the right to decide between public or private provision of governmental service and/or the authority to negotiate and renegotiate with the chosen service provider. Our model encompass both bureaucratic delegation from a government...... contracts. The bargaining effect improves the bargaining position vis a vis a private firm with market power and leads to a lower price for the service...


    Directory of Open Access Journals (Sweden)

    Ekaterina P. Bochkareva


    Full Text Available In the paper is given an approach to themanagement of components provision formachine building manufacturer based uponinternational standards and best practicesof leading international companies. Thecomplex expertise methods are used forthe development of the proposed machinebuilding manufacturer suppliers’ operational management method. At a strategic level is proposed a tool for planning the suppliers’portfolio and a machine building manufacturer supplier development methodology.

  7. Collateral in Loan Classification and Provisioning


    In W Song


    Adequate loan classification practices are an essential part of a sound and effective credit risk-management process in a bank. Failure to identify deterioration in credit quality in a timely manner can aggravate and prolong the problem. Two key issues arise with regard to the use of collateral in the context of loan classification and provisioning. In particular, the questions arise whether collateral should be taken into account in classifying a collateralized loan, and whether it should be...

  8. The Full Costs of Electricity Provision

    International Nuclear Information System (INIS)

    Horst Keppler, Jan; Rothwell, Geoffrey; Cometto, Marco; Deffrennes, Marc; Iracane, Daniel; Ha, Jaejoo; Paillere, Henri; ); Aspelund, Karl; Aydil, Ismail; ); Berthelemy, Michel; Devezeaux De Lavergne, Jean-Guy; Burtin, Alain; Crozat, Matthew P.; D'Haeseleer, William; Friedrich, Reiner; Gonzalez Jimenez, Antonio; Hirschberg, Stefan; Kiso, Jan-Ole; ); Lee, Manki; Le Masne, Dominique; ); Lundmark, Roger J.; Neumann, Doris; ); Politis, Savvas; ); Prin, Coralie; Skonieczny, Olgierd; Voss, Alfred


    Electricity provision touches upon every facet of life in OECD and non-OECD countries alike, and choosing how this electricity is generated - whether from fossil fuels, nuclear energy or renewables - affects not only economic outcomes but individual and social well-being in the broader sense. Research on the overall costs of electricity is an ongoing effort, as only certain costs of electricity provision are perceived directly by producers and consumers. Other costs, such as the health impacts of air pollution, damage from climate change or the effects on the electricity system of small-scale variable production are not reflected in market prices and thus diminish well-being in unaccounted for ways. Accounting for these social costs in order to establish the full costs of electricity provision is difficult, yet such costs are too important to be disregarded in the context of the energy transitions currently under way in OECD and NEA countries. This report draws on evidence from a large number of studies concerning the social costs of electricity and identifies proven instruments for internalising them so as to improve overall welfare. The results outlined in the report should lead to new and more comprehensive research on the full costs of electricity, which in turn would allow policy makers and the public to make better informed decisions along the path towards fully sustainable electricity systems


    Directory of Open Access Journals (Sweden)

    S.Yu. Shevchenko


    Full Text Available Purpose.The aim of this study is to obtain a method for determining the capacity surge arrester nonlinear absorb energy without breaking the heat balance in modes of long-term application of operating voltage, which allows for analysis of their work in terms of violations as electricity. Methodology. For values of the energy passing through the arrester must be able to determine the current value for the voltage value in the area of leakage current-voltage characteristics. We have carried out calculations of the energy passing everywhere arrester for certain periods of time based on the current-voltage characteristics obtained experimentally. Analysis of the experimental current-voltage characteristics of resistors and literature led to the important conclusion that the dielectric properties of the ceramic varistor affect the value of active power losses in the arrester only when the active component of the leakage current is very small. This is confirmed by the characteristics of different classes of varistor voltage. This property of varistors and surge arresters shows the need to consider how the dielectric and conductive properties of the varistor ceramics in the analysis of work in the area of the arrester leakage current-voltage characteristic. These results demonstrate the need to clarify the mathematical model and the method for determining the energy dissipates in the area of the arrester leakage current CVC with their account. Results. The study, an improved mathematical model for calculating energy affects surge arrester during its working life. The study obtained the method, of evaluation capacity surge arrester, maintains heat balance throughout working life. Based on experimentally obtained current-voltage characteristic of the varistors is defined voltage at which surge arrester starts conducting active current. This allowed to receive specified mathematical model for calculating energy affects surge arrester and develop a method

  10. Security infrastructure for dynamically provisioned cloud infrastructure services

    NARCIS (Netherlands)

    Demchenko, Y.; Ngo, C.; de Laat, C.; Lopez, D.R.; Morales, A.; García-Espín, J.A.; Pearson, S.; Yee, G.


    This chapter discusses conceptual issues, basic requirements and practical suggestions for designing dynamically configured security infrastructure provisioned on demand as part of the cloud-based infrastructure. This chapter describes general use cases for provisioning cloud infrastructure services

  11. Time series analysis as input for clinical predictive modeling: modeling cardiac arrest in a pediatric ICU. (United States)

    Kennedy, Curtis E; Turley, James P


    Thousands of children experience cardiac arrest events every year in pediatric intensive care units. Most of these children die. Cardiac arrest prediction tools are used as part of medical emergency team evaluations to identify patients in standard hospital beds that are at high risk for cardiac arrest. There are no models to predict cardiac arrest in pediatric intensive care units though, where the risk of an arrest is 10 times higher than for standard hospital beds. Current tools are based on a multivariable approach that does not characterize deterioration, which often precedes cardiac arrests. Characterizing deterioration requires a time series approach. The purpose of this study is to propose a method that will allow for time series data to be used in clinical prediction models. Successful implementation of these methods has the potential to bring arrest prediction to the pediatric intensive care environment, possibly allowing for interventions that can save lives and prevent disabilities. We reviewed prediction models from nonclinical domains that employ time series data, and identified the steps that are necessary for building predictive models using time series clinical data. We illustrate the method by applying it to the specific case of building a predictive model for cardiac arrest in a pediatric intensive care unit. Time course analysis studies from genomic analysis provided a modeling template that was compatible with the steps required to develop a model from clinical time series data. The steps include: 1) selecting candidate variables; 2) specifying measurement parameters; 3) defining data format; 4) defining time window duration and resolution; 5) calculating latent variables for candidate variables not directly measured; 6) calculating time series features as latent variables; 7) creating data subsets to measure model performance effects attributable to various classes of candidate variables; 8) reducing the number of candidate features; 9

  12. The Use of Extracorporeal Membrane Oxygenation-Cardiopulmonary Resuscitation in Prolonged Cardiac Arrest in Pediatric Patients: Is it Time to Expand It? (United States)

    Absi, Mohammed; Kumar, Susheel Tk; Sandhu, Hitesh


    Extracorporeal membrane oxygenation was instituted as an aid to in-hospital cardiopulmonary resuscitation (E-CPR) nearly 23 years ago, this led to remarkable improvement in survival considering the mortality rate associated with conventional cardiopulmonary resuscitation (CPR). Given this success, one begins to wonder whether the time has come for expanding the use of E-CPR to outside hospital cardiac arrests especially in the light of development of newer extracorporeal life support devices that are small, mobile, and easy to assemble. This editorial will review recent studies on this subject and address some key guidelines and limitations of this evolving and promising technology.

  13. Main Complications of Mild Induced Hypothermia after Cardiac Arrest: A Review Article

    Directory of Open Access Journals (Sweden)

    Hassan Soleimanpour


    Full Text Available The aim of the present study is to assess the complications of mild induced hypothermia (MIH in patients with cardiac arrest. Presently, based on the guidelines of the American heart Association, MIH following successful cardiopulmonary resuscitation (CPR in unconscious adult patients due to ventricular fibrillation (VF with out-of-hospital cardiac arrest (OOHCA is essential and required. However, MIH could be associated with complications in Patients with cardiac arrest. Studies conducted on the precautions and care following cardiac arrest and MIH were included. Valid scientific data bases were used for data collection. The obtained results from different studies revealed that mild MIH could be associated with numerous complications and the knowledge and awareness of the medical staff from the complications is required to guarantee successful therapeutic approaches in MIH following cardiac arrest which is a novel medical facility with different styles and complications. Overall, further future studies are required to improve the quality of MIH, to increase survival and to decrease complications rates.

  14. Conservatism of ASME KIR-reference curve with respect to crack arrest

    International Nuclear Information System (INIS)

    Wallin, K.; Rintamaa, R.; Nagel, G.


    The conservatism of the RT NDT temperature indexing parameter and the ASME K IR -reference curve with respect to crack arrest toughness, has been evaluated. Based on an analysis of the original ASME K Ia data, it was established that inherently, the ASME K IR -reference curve corresponds to an overall 5% lower bound curve with respect to crack arrest. It was shown that the scatter of crack arrest toughness is essentially material independent and has a standard deviation of 18% and the temperature dependence of K Ia has the same form as predicted by the master curve for crack initiation toughness. The 'built in' offset between the mean 100 MPa√(m) crack arrest temperature, TK Ia , and RT NDT is 38 C (TK Ia =RT NDT +38 C) and the experimental relation between TK Ia and NDT is, TK Ia =NDT+28 C. The K IR -reference curve using NDT as reference temperature will be conservative with respect to the general 5% lower bound K Ia(5%) -curve, with a 75% confidence. The use of RT NDT , instead of NDT, will generally increase the degree of conservatism, both for non-irradiated as well as irradiated materials, close to a 95% confidence level. This trend is pronounced for materials with Charpy-V upper shelf energies below 100 J. It is shown that the K IR -curve effectively constitutes a deterministic lower bound curve for crack arrest. The findings are valid both for nuclear pressure vessel plates, forgings and welds. (orig.)

  15. Temporal variation of out-of-hospital cardiac arrests in an equatorial climate. (United States)

    Ong, Marcus Eh; Ng, Faith Sp; Yap, Susan; Yong, Kok Leong; Peberdy, Mary A; Ornato, Joseph P


    We aimed to determine whether there is a seasonal variation of out-of-hospital cardiac arrests (OHCA) in an equatorial climate, which does not experience seasonal environmental change. We conducted an observational prospective study looking at the occurrence of OHCA in Singapore. Included were all patients with OHCA presented to Emergency Departments across the country. We examined the monthly, daily, and hourly number of cases over a three-year period. Data was analyzed using analysis of variance (ANOVA). From October, 1st 2001 to October, 14th 2004, 2428 patients were enrolled in the study. Mean age for cardiac arrests was 60.6 years with 68.0% male. Ethnic distribution was 69.5% Chinese, 15.0% Malay, 11.0% Indian, and 4.4% Others. There was no significant seasonal variation (spring/summer/fall/winter) of events (ANOVA P = 0.71), monthly variation (P = 0.88) or yearly variation (P = 0.26). We did find weekly peaks on Mondays and a circadian pattern with daily peaks from 9-10 am. We did not find any discernable seasonal pattern of cardiac arrests. This contrasts with findings from temperate countries and suggests a climatic influence on cardiac arrest occurrence. We also found that sudden cardiac arrests follow a circadian pattern.

  16. Dynamical principles of cell-cycle arrest: Reversible, irreversible, and mixed strategies (United States)

    Pfeuty, Benjamin


    Living cells often alternate between proliferating and nonproliferating states as part of individual or collective strategies to adapt to complex and changing environments. To this aim, they have evolved a biochemical regulatory network enabling them to switch between cell-division cycles (i.e., oscillatory state) and cell-cycle arrests (i.e., steady state) in response to extracellular cues. This can be achieved by means of a variety of bifurcation mechanisms that potentially give rise to qualitatively distinct cell-cycle arrest properties. In this paper, we study the dynamics of a minimal biochemical network model in which a cell-division oscillator and a differentiation switch mutually antagonize. We identify the existence of three biologically plausible bifurcation scenarios organized around a codimension-four swallowtail-homoclinic singularity. As a result, the model exhibits a broad repertoire of cell-cycle arrest properties in terms of reversibility of these arrests, tunability of interdivision time, and ability to track time-varying signals. This dynamic versatility would explain the diversity of cell-cycle arrest strategies developed in different living species and functional contexts.

  17. Surgical management of arrested hydrocephalus: Case report, literature review, and 18-month follow-up. (United States)

    Hong, Jennifer; Barrena, Benjamin G; Lollis, S Scott; Bauer, David F


    Arrested hydrocephalus is stable ventriculomegaly without evidence of neurologic deterioration or symptoms. Management of arrested hydrocephalus in asymptomatic adults is controversial, with little clinical data. This case highlights the potential for decompensation in adults with arrested hydrocephalus and reviews the literature regarding pathophysiology and management of this clinical entity. A 39 year-old gentleman with arrested hydrocephalus incidentally found during work-up for new-onset seizure and managed conservatively for ten years presented with increasing headache, memory loss, gait instability and urinary and fecal incontinence. Stable massive triventriculomegaly was documented on serial brain imaging, and ophthalmologic exam revealed no papilledema. The patient underwent endoscopic third ventriculostomy with immediate post-operative improvement of headache, resolution of incontinence, and cessation of seizures. At 15 months after surgery, neuropsychiatric testing demonstrated improvement in visuomotor skills, problem solving, verbal fluency and cognitive flexibility compared to his pre-operative baseline. At 18 months after surgery he remained seizure free with full continence and significant improvement in headaches. Early recognition of arrested hydrocephalus and its potential for decompensation may prompt surgical treatment and prevent neurologic deterioration. Copyright © 2016 Elsevier B.V. All rights reserved.

  18. Therapeutic Hypothermia Reduces Oxidative Damage and Alters Antioxidant Defenses after Cardiac Arrest (United States)

    Hackenhaar, Fernanda S.; Medeiros, Tássia M.; Heemann, Fernanda M.; Behling, Camile S.; Putti, Jordana S.; Mahl, Camila D.; Verona, Cleber; da Silva, Ana Carolina A.; Guerra, Maria C.; Gonçalves, Carlos A. S.; Oliveira, Vanessa M.; Riveiro, Diego F. M.; Vieira, Silvia R. R.


    After cardiac arrest, organ damage consequent to ischemia-reperfusion has been attributed to oxidative stress. Mild therapeutic hypothermia has been applied to reduce this damage, and it may reduce oxidative damage as well. This study aimed to compare oxidative damage and antioxidant defenses in patients treated with controlled normothermia versus mild therapeutic hypothermia during postcardiac arrest syndrome. The sample consisted of 31 patients under controlled normothermia (36°C) and 11 patients treated with 24 h mild therapeutic hypothermia (33°C), victims of in- or out-of-hospital cardiac arrest. Parameters were assessed at 6, 12, 36, and 72 h after cardiac arrest in the central venous blood samples. Hypothermic and normothermic patients had similar S100B levels, a biomarker of brain injury. Xanthine oxidase activity is similar between hypothermic and normothermic patients; however, it decreases posthypothermia treatment. Xanthine oxidase activity is positively correlated with lactate and S100B and inversely correlated with pH, calcium, and sodium levels. Hypothermia reduces malondialdehyde and protein carbonyl levels, markers of oxidative damage. Concomitantly, hypothermia increases the activity of erythrocyte antioxidant enzymes superoxide dismutase, glutathione peroxidase, and glutathione S-transferase while decreasing the activity of serum paraoxonase-1. These findings suggest that mild therapeutic hypothermia reduces oxidative damage and alters antioxidant defenses in postcardiac arrest patients. PMID:28553435

  19. [Ability of typical greenery shrubs of Beijing to adsorb and arrest PM2.5 ]. (United States)

    Liang, Dan; Wang, Bin; Wang, Yun-qi; Zhang, Hui-lan; Yang, Song-nan; Li, Ang


    Four typical types of green shrubs of Beijing (Euonymus japonicus, Buxus microphylla, Berberis thunbergii cv. atropurpurea, Taxus cuspidate cv. nana) were selected to study their capacities in adsorbing and arresting PM2.5 using both field observations and air chamber simulations. Concurrently, in order to analyze the pollution characteristics of Beijing in winter and spring, the PM2.5 concentrations of December 2012 to May 2013 were collected. Experimental results showed that: From the gas chamber experiments, the ability to adsorb and arrest PM2.5 was in the order of Berberis thunbergii cv. atropurpurea > Buxus microphylla > Taxus cuspidate cv. nana > Euonymus japonicus, mainly due to the differences in leaf characteristics; Outside measurement results showed that the ability to adsorb and arrest PM2.5 was ranked as Buxus microphylla > Berberis thunbergii cv. atropurpurea > Taxus cuspidate cv. nana > Euonymus japonicus. Chamber simulation and outdoor observation showed that Buxus microphylla and Berberis thunbergii cv. atropurpurea had strong ability to adsorb and arrest PM2.5; Meanwhile, the slight differences between the chamber simulation and outdoor observation results might be related to plant structure. Compared to tree species, the planting condition of shrub species was loose, and it greened quickly; By analyzing the Beijing PM2.5 concentration values in winter and spring, it was found that the PM2.5 concentration was particularly high in the winter of Beijing, and evergreen shrubs maintained the ability to adsorb and arrest PM2.5.

  20. Crack arrest within teeth at the dentinoenamel junction caused by elastic modulus mismatch. (United States)

    Bechtle, Sabine; Fett, Theo; Rizzi, Gabriele; Habelitz, Stefan; Klocke, Arndt; Schneider, Gerold A


    Enamel and dentin compose the crowns of human teeth. They are joined at the dentinoenamel junction (DEJ) which is a very strong and well-bonded interface unlikely to fail within healthy teeth despite the formation of multiple cracks within enamel during a lifetime of exposure to masticatory forces. These cracks commonly are arrested when reaching the DEJ. The phenomenon of crack arrest at the DEJ is described in many publications but there is little consensus on the underlying cause and mechanism. Explanations range from the DEJ having a larger toughness than both enamel and dentin up to the assumption that not the DEJ itself causes crack arrest but the so-called mantle dentin, a thin material layer close to the DEJ that is somewhat softer than the bulk dentin. In this study we conducted 3-point bending experiments with bending bars consisting of the DEJ and surrounding enamel and dentin to investigate crack propagation and arrest within the DEJ region. Calculated stress intensities around crack tips were found to be highly influenced by the elastic modulus mismatch between enamel and dentin and hence, the phenomenon of crack arrest at the DEJ could be explained accordingly via this elastic modulus mismatch. Copyright 2010 Elsevier Ltd. All rights reserved.

  1. Specific Consideration on Superior Performance and Evaluation Methods of Polymer-housed Surge Arresters (United States)

    Ishizaki, Yoshihiro; Kobayashi, Misao; Suzuki, Hironori; Futagami, Koichi

    It is very suitable to select the polymer materials for the housings of surge arresters (SAs), because the polymer materials are generally soft and light weight. Therefore, many kinds of polymer-housed SAs using various polymer materials have been developed, and expanding into many countries. Considering these backgrounds, the JEC technical report (JEC-TR) 23002-2008; polymer-housed surge arrester(1) has been established based on the existent relevant standards of arresters, such as JEC-2371-2003; Insulator-housed surge arresters(2) and IEC 60099-4 Edition 2.2, Metal-oxide surge arresters (MOSAs) without gaps for a.c. systems(3) in order to introduce the technology and provide a common guide for testing of polymer-housed SAs. According as the JEC-TR, the various new applications of the polymer-housed SAs, which are caused by superior advantages such as compact, light weight, safe failure mode, anti-seismic performance, anti-pollution performance and cost efficiency design, have been realized recently in Japan. Therefore, this paper gives specific consideration on the superior performance of the polymer-housed SAs and the evaluation methods of the polymer-housed SAs, because there are some issues in the existent standards to be solved.

  2. Rotavirus replication is correlated with S/G2 interphase arrest of the host cell cycle.

    Directory of Open Access Journals (Sweden)

    Selene Glück

    Full Text Available In infected cells rotavirus (RV replicates in viroplasms, cytosolic structures that require a stabilized microtubule (MT network for their assembly, maintenance of the structure and perinuclear localization. Therefore, we hypothesized that RV could interfere with the MT-breakdown that takes place in mitosis during cell division. Using synchronized RV-permissive cells, we show that RV infection arrests the cell cycle in S/G2 phase, thus favoring replication by improving viroplasms formation, viral protein translation, and viral assembly. The arrest in S/G2 phase is independent of the host or viral strain and relies on active RV replication. RV infection causes cyclin B1 down-regulation, consistent with blocking entry into mitosis. With the aid of chemical inhibitors, the cytoskeleton network was linked to specific signaling pathways of the RV-induced cell cycle arrest. We found that upon RV infection Eg5 kinesin was delocalized from the pericentriolar region to the viroplasms. We used a MA104-Fucci system to identify three RV proteins (NSP3, NSP5, and VP2 involved in cell cycle arrest in the S-phase. Our data indicate that there is a strong correlation between the cell cycle arrest and RV replication.

  3. Predicting Arrest in a Sample of Youth Perinatally Exposed to HIV: The Intersection of HIV and Key Contextual Factors. (United States)

    Elkington, Katherine S; Peters, Zachary; Choi, C Jean; Bucek, Amelia; Leu, Cheng-Shiun; Abrams, Elaine J; Mellins, Claude A


    We examined the role of youth HIV status and other key factors on past-year arrest in perinatally HIV-exposed but uninfected (PHIV-) and perinatally HIV-infected (PHIV+) youth using data from a multi-site study of psychosocial behaviors in PHIV-exposed urban youth (N = 340; 61% PHIV+; 51% female; ages 9-16 at baseline). Youth and caregivers were administered 5 interviews, spanning approximately 7.5 years. Using longitudinal logistic mixed-effect models, we explored the association between past year arrest, internal [e.g., substance use disorder (SUD)] and external (e.g., neighborhood arrest rates) contextual factors, and social-regulation processes (e.g., in-school/work). Arrest rates increased from 2.6 to 19.7% across follow-ups; there were no differences in arrest over time by HIV status. In the final model, odds of arrest were greater for youth who were male, with SUD, ≥ 18 years old, with high levels of city stress, and neither in school nor employed. PHIV-exposed, urban youth have much higher rates of arrest than national samples. Lack of differences in arrest by HIV status suggests key contextual factors are more important in promoting arrest.

  4. Bank Loan Loss Provisions, Investor Protection and the Macroeconomy


    Ozili, Peterson K


    This study investigates the non-discretionary determinants of bank loan loss provisions in Africa after controlling for macroeconomic fluctuation, financial development and investor protection. We find that non-performing loans, loan-to-asset ratio and loan growth are significant non-discretionary drivers of bank provisions in the African region. We observe that bank provision is a positive function of non-performing loans up to a threshold beyond which bank provisions will no longer increase...

  5. An Approach to Measuring Provisions for Collateralised Lending


    Cho-hoi Hui; Tom Fong


    Under the framework of Basel II, banks which adopt the internal ratings-based approach will be required to compare their actual provisions with expected losses. Any shortfall (i.e., the expected loss exceeds the provision) should be deducted from capital of the bank. It is therefore important to ensure banks make adequate provisions against expected losses. In addition, both sound policy and the Banking Ordinance require banks to take a forward-looking view of provisions. These requirements r...

  6. Care provision to prevent chronic disease by community mental health clinicians. (United States)

    Bartlem, Kate M; Bowman, Jennifer A; Freund, Megan; Wye, Paula M; McElwaine, Kathleen M; Wolfenden, Luke; Campbell, Elizabeth M; Gillham, Karen E; Wiggers, John H


    People with a mental illness have higher prevalence of behavioral risks for chronic disease than the general population. Despite recommendations regarding the provision of preventive care by mental health services, limited research has examined the extent to which such care is provided. To examine mental health clinician provision of care for preventable chronic disease risks, and whether such care was associated with the availability of practice support strategies. A cross-sectional survey was undertaken of 151 community mental health clinicians in New South Wales, Australia regarding the provision of three elements of preventive care (i.e., assessment, brief advice, and referral/follow-up) for four health risk behaviors (i.e., tobacco smoking, inadequate fruit and vegetable consumption, harmful alcohol consumption, and inadequate physical activity). Clinicians reported the availability of 16 strategies to support such care delivery. Data were collected in 2010 and analyzed in 2012-2013. Preventive care provision varied by both care element and risk behavior. Optimal care (each care element provided to at least 80% of clients for all health behaviors) was provided by few clinicians: assessment (8.6%), brief advice (24.5%), and referral/follow-up (9.9%). Less than half of clinicians reported more than four support strategies were available (44.4%). The availability of five or more strategies was associated with increased optimal preventive care. The provision of preventive care focused on chronic disease prevention in community mental health services is suboptimal. Interventions to increase the routine provision of such care should involve increasing the availability of evidence-based strategies to support care provision. Copyright © 2014 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

  7. Consideration of Cosmetic Surgery As Part of Women's Benefit-Provisioning Mate Retention Strategy. (United States)

    Atari, Mohammad; Barbaro, Nicole; Sela, Yael; Shackelford, Todd K; Chegeni, Razieh


    Individuals perform mate retention behaviors to minimize the risk of partner infidelity and relationship dissolution. The current study investigates whether consideration of cosmetic surgery can be conceptualized as part of a broader strategy of mate retention for women, but not men. We hypothesized that women's consideration of cosmetic surgery would be positively associated with performance frequencies of Benefit-Provisioning and Cost-Inflicting mate retention behaviors. We recruited 203 individuals (54% women) in committed heterosexual relationships from Tehran, Iran. Results indicate a positive association between consideration of cosmetic surgery and Benefit-Provisioning mate retention behaviors for women, but not men. There was no association between consideration of cosmetic surgery and Cost-Inflicting mate retention behaviors. Women therefore may consider cosmetic surgery to improve their physical attractiveness as part of a Benefit-Provisioning strategy to retain a long-term mate. We discuss limitations of the study and highlight future directions for research from an evolutionary perspective.

  8. Early administration of epinephrine (adrenaline) in patients with cardiac arrest with initial shockable rhythm in hospital: propensity score matched analysis. (United States)

    Andersen, Lars W; Kurth, Tobias; Chase, Maureen; Berg, Katherine M; Cocchi, Michael N; Callaway, Clifton; Donnino, Michael W


    To evaluate whether patients who experience cardiac arrest in hospital receive epinephrine (adrenaline) within the two minutes after the first defibrillation (contrary to American Heart Association guidelines) and to evaluate the association between early administration of epinephrine and outcomes in this population. Prospective observational cohort study. Analysis of data from the Get With The Guidelines-Resuscitation registry, which includes data from more than 300 hospitals in the United States. Adults in hospital who experienced cardiac arrest with an initial shockable rhythm, including patients who had a first defibrillation within two minutes of the cardiac arrest and who remained in a shockable rhythm after defibrillation. Epinephrine given within two minutes after the first defibrillation. Survival to hospital discharge. Secondary outcomes included return of spontaneous circulation and survival to hospital discharge with a good functional outcome. A propensity score was calculated for the receipt of epinephrine within two minutes after the first defibrillation, based on multiple characteristics of patients, events, and hospitals. Patients who received epinephrine at either zero, one, or two minutes after the first defibrillation were then matched on the propensity score with patients who were "at risk" of receiving epinephrine within the same minute but who did not receive it. 2978 patients were matched on the propensity score, and the groups were well balanced. 1510 (51%) patients received epinephrine within two minutes after the first defibrillation, which is contrary to current American Heart Association guidelines. Epinephrine given within the first two minutes after the first defibrillation was associated with decreased odds of survival in the propensity score matched analysis (odds ratio 0.70, 95% confidence interval 0.59 to 0.82; P<0.001). Early epinephrine administration was also associated with a decreased odds of return of spontaneous circulation

  9. Valproic Acid Arrests Proliferation but Promotes Neuronal Differentiation of Adult Spinal NSPCs from SCI Rats. (United States)

    Chu, Weihua; Yuan, Jichao; Huang, Lei; Xiang, Xin; Zhu, Haitao; Chen, Fei; Chen, Yanyan; Lin, Jiangkai; Feng, Hua


    Although the adult spinal cord contains a population of multipotent neural stem/precursor cells (NSPCs) exhibiting the potential to replace neurons, endogenous neurogenesis is very limited after spinal cord injury (SCI) because the activated NSPCs primarily differentiate into astrocytes rather than neurons. Valproic acid (VPA), a histone deacetylase inhibitor, exerts multiple pharmacological effects including fate regulation of stem cells. In this study, we cultured adult spinal NSPCs from chronic compressive SCI rats and treated with VPA. In spite of inhibiting the proliferation and arresting in the G0/G1 phase of NSPCs, VPA markedly promoted neuronal differentiation (β-tubulin III(+) cells) as well as decreased astrocytic differentiation (GFAP(+) cells). Cell cycle regulator p21(Cip/WAF1) and proneural genes Ngn2 and NeuroD1 were increased in the two processes respectively. In vivo, to minimize the possible inhibitory effects of VPA to the proliferation of NSPCs as well as avoid other neuroprotections of VPA in acute phase of SCI, we carried out a delayed intraperitoneal injection of VPA (150 mg/kg/12 h) to SCI rats from day 15 to day 22 after injury. Both of the newborn neuron marker doublecortin and the mature neuron marker neuron-specific nuclear protein were significantly enhanced after VPA treatment in the epicenter and adjacent segments of the injured spinal cord. Although the impaired corticospinal tracks had not significantly improved, Basso-Beattie-Bresnahan scores in VPA treatment group were better than control. Our study provide the first evidence that administration of VPA enhances the neurogenic potential of NSPCs after SCI and reveal the therapeutic value of delayed treatment of VPA to SCI.

  10. Early prediction of coma recovery after cardiac arrest with blinded pupillometry. (United States)

    Solari, Daria; Rossetti, Andrea O; Carteron, Laurent; Miroz, John-Paul; Novy, Jan; Eckert, Philippe; Oddo, Mauro


    Prognostication studies on comatose cardiac arrest (CA) patients are limited by lack of blinding, potentially causing overestimation of outcome predictors and self-fulfilling prophecy. Using a blinded approach, we analyzed the value of quantitative automated pupillometry to predict neurological recovery after CA. We examined a prospective cohort of 103 comatose adult patients who were unconscious 48 hours after CA and underwent repeated measurements of quantitative pupillary light reflex (PLR) using the Neurolight-Algiscan device. Clinical examination, electroencephalography (EEG), somatosensory evoked potentials (SSEP), and serum neuron-specific enolase were performed in parallel, as part of standard multimodal assessment. Automated pupillometry results were blinded to clinicians involved in patient care. Cerebral Performance Categories (CPC) at 1 year was the outcome endpoint. Survivors (n = 50 patients; 32 CPC 1, 16 CPC 2, 2 CPC 3) had higher quantitative PLR (median = 20 [range = 13-41] vs 11 [0-55] %, p < 0.0001) and constriction velocity (1.46 [0.85-4.63] vs 0.94 [0.16-4.97] mm/s, p < 0.0001) than nonsurvivors. At 48 hours, a quantitative PLR < 13% had 100% specificity and positive predictive value to predict poor recovery (0% false-positive rate), and provided equal performance to that of EEG and SSEP. Reduced quantitative PLR correlated with higher serum neuron-specific enolase (Spearman r = -0.52, p < 0.0001). Reduced quantitative PLR correlates with postanoxic brain injury and, when compared to standard multimodal assessment, is highly accurate in predicting long-term prognosis after CA. This is the first prognostication study to show the value of automated pupillometry using a blinded approach to minimize self-fulfilling prophecy. Ann Neurol 2017;81:804-810. © 2017 American Neurological Association.

  11. Digitization of Electrocardiogram From Telemetry Prior to In-hospital Cardiac Arrest: A Pilot Study. (United States)

    Attin, Mina; Wang, Lu; Soroushmehr, S M Reza; Lin, Chii-Dean; Lemus, Hector; Spadafore, Maxwell; Najarian, Kayvan


    Analyzing telemetry electrocardiogram (ECG) data over an extended period is often time-consuming because digital records are not widely available at hospitals. Investigating trends and patterns in the ECG data could lead to establishing predictors that would shorten response time to in-hospital cardiac arrest (I-HCA). This study was conducted to validate a novel method of digitizing paper ECG tracings from telemetry systems in order to facilitate the use of heart rate as a diagnostic feature prior to I-HCA. This multicenter study used telemetry to investigate full-disclosure ECG papers of 44 cardiovascular patients obtained within 1 hr of I-HCA with initial rhythms of pulseless electrical activity and asystole. Digital ECGs were available for seven of these patients. An algorithm to digitize the full-disclosure ECG papers was developed using the shortest path method. The heart rate was measured manually (averaging R-R intervals) for ECG papers and automatically for digitized and digital ECGs. Significant correlations were found between manual and automated measurements of digitized ECGs (p < .001) and between digitized and digital ECGs (p < .001). Bland-Altman methods showed bias = .001 s, SD = .0276 s, lower and upper 95% limits of agreement for digitized and digital ECGs = .055 and -.053 s, and percentage error = 0.22%. Root mean square (rms), percentage rms difference, and signal to noise ratio values were in acceptable ranges. The digitization method was validated. Digitized ECG provides an efficient and accurate way of measuring heart rate over an extended period of time. © The Author(s) 2015.

  12. Current and Future Status of Extracorporeal Cardiopulmonary Resuscitation for In-Hospital Cardiac Arrest. (United States)

    Singal, Rohit K; Singal, Deepa; Bednarczyk, Joseph; Lamarche, Yoan; Singh, Gurmeet; Rao, Vivek; Kanji, Hussein D; Arora, Rakesh C; Manji, Rizwan A; Fan, Eddy; Nagpal, A Dave


    Numerous series, propensity-matched trials, and meta-analyses suggest that appropriate use of extracorporeal cardiopulmonary resuscitation (E-CPR) for in-hospital cardiac arrest (IHCA) can be lifesaving. Even with an antecedent cardiopulmonary resuscitation (CPR) duration in excess of 45 minutes, 30-day survival with favourable neurologic outcome using E-CPR is approximately 35%-45%. Survival may be related to age, duration of CPR, or etiology. Associated complications include sepsis, renal failure, limb and neurologic complications, hemorrhage, and thrombosis. However, methodological biases-including small sample size, selection bias, publication bias, and inability to control for confounders-in these series prevent definitive conclusions. As such, the 2015 American Heart Association Advanced Cardiac Life Support guidelines update recommended E-CPR as a Level of Evidence IIb recommendation in appropriate cases. The absence of high-quality evidence presents an opportunity for clinician/scientists to generate practice-defining data through collaborative investigation and prospective trials. A multidisciplinary dialogue is required to standardize the field and promote multicentre investigation of E-CPR with data sharing and the development of a foundation for high-quality trials. The objectives of this review are to (1) provide an overview of the strengths and limitations of currently available studies investigating the use of E-CPR in patients with IHCA and highlight knowledge gaps; (2) create a framework for the standardization of terminology, clinical practice, data collection, and investigation of E-CPR for patients with IHCA that will help ensure congruence in future work in this area; and (3) propose suggestions to guide future research by the cardiovascular community to advance this important field. Copyright © 2016 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

  13. Reductions in access to HIV prevention and care services are associated with arrest and convictions in a global survey of men who have sex with men. (United States)

    Santos, Glenn-Milo; Makofane, Keletso; Arreola, Sonya; Do, Tri; Ayala, George


    Men who have sex with men (MSM) are disproportionately impacted by HIV. Criminalisation of homosexuality may impede access to HIV services. We evaluated the effect of the enforcement of laws criminalising homosexuality on access to services. Using data from a 2012 global online survey that was published in a prior paper, we conducted a secondary analysis evaluating differences in perceived accessibility to health services (ie, 'how accessible are ____' services) between MSM who responded 'yes'/'no' to: 'have you ever been arrested or convicted for being gay/MSM?' Of the 4020 participants who completed the study and were included in the analysis, 8% reported ever being arrested or convicted under laws relevant to being MSM. Arrests and convictions were most common in sub-Saharan Africa (23.6% (58/246)), Eastern Europe/Central Asia (18.1% (123/680)), the Caribbean (15% (15/100)), Middle East/North Africa (13.2% (10/76)) and Latin America (9.7% (58/599)). Those arrested or convicted had significantly lower access to sexually transmitted infection treatment (adjusted OR (aOR)=0.81; 95% CI 0.67 to 0.97), condoms (aOR=0.77; 95% CI 0.61 to 0.99) and medical care (aOR=0.70; 95% CI 0.54 to 0.90), compared with other MSM, while accounting for clustering by country and adjusting for age, HIV status, education and country-level income. Arrests and convictions under laws relevant to being MSM have a strong negative association with access to HIV prevention and care services. Creating an enabling legal and policy environment, and increasing efforts to mitigate antihomosexuality stigma to ensure equitable access to HIV services are needed, along with decriminalisation of homosexuality, to effectively address the public health needs of this population. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to

  14. 7 CFR 457.166 - Blueberry crop insurance provisions. (United States)


    ... 7 Agriculture 6 2010-01-01 2010-01-01 false Blueberry crop insurance provisions. 457.166 Section... CORPORATION, DEPARTMENT OF AGRICULTURE COMMON CROP INSURANCE REGULATIONS § 457.166 Blueberry crop insurance provisions. The Blueberry Crop Insurance Provisions for the 2005 and succeeding crop years are as follows...

  15. Children's Rights, School Exclusion and Alternative Educational Provision (United States)

    McCluskey, Gillean; Riddell, Sheila; Weedon, Elisabet


    This paper examines findings from a recent study in Wales of school exclusion and alternative educational provision. Many, but not all, children in alternative provision have been excluded from school. The most recent statistics reveal that nearly 90% of pupils in alternative provision have special educational needs, nearly 70% are entitled to…

  16. 7 CFR 457.142 - Northern potato crop insurance provisions. (United States)


    ... 7 Agriculture 6 2010-01-01 2010-01-01 false Northern potato crop insurance provisions. 457.142... INSURANCE CORPORATION, DEPARTMENT OF AGRICULTURE COMMON CROP INSURANCE REGULATIONS § 457.142 Northern potato crop insurance provisions. The Northern Potato Crop Insurance Provisions for the 2008 and succeeding...

  17. 7 CFR 457.123 - Almond crop insurance provisions. (United States)


    ... 7 Agriculture 6 2010-01-01 2010-01-01 false Almond crop insurance provisions. 457.123 Section 457... CORPORATION, DEPARTMENT OF AGRICULTURE COMMON CROP INSURANCE REGULATIONS § 457.123 Almond crop insurance provisions. The Almond Crop Insurance Provisions for the 2008 and succeeding crop years are as follows: FCIC...

  18. 7 CFR 457.162 - Nursery crop insurance provisions. (United States)


    ... 7 Agriculture 6 2010-01-01 2010-01-01 false Nursery crop insurance provisions. 457.162 Section 457... CORPORATION, DEPARTMENT OF AGRICULTURE COMMON CROP INSURANCE REGULATIONS § 457.162 Nursery crop insurance provisions. The Nursery Crop Insurance Provisions for the 2006 and succeeding crop years are as follows: FCIC...

  19. 10 CFR 625.3 - Standard sales provisions. (United States)


    ... 10 Energy 4 2010-01-01 2010-01-01 false Standard sales provisions. 625.3 Section 625.3 Energy DEPARTMENT OF ENERGY (CONTINUED) SALES REGULATION PRICE COMPETITIVE SALE OF STRATEGIC PETROLEUM RESERVE PETROLEUM § 625.3 Standard sales provisions. (a) Contents. The Standards Sales Provisions shall contain...

  20. Long-term deconditioning of gas-filled surge arresters (United States)

    Stanković, Koviljka; Brajović, Dragan; Alimpijević, Mališa; Lončar, Boris


    The aim of this paper is to identify parameters that influence the long-term deconditioning effect of gas-filled surge arrester (GFSA) and to provide practical recommendations for mitigating this effect. Namely, after some period of time, on order of hours or days, during which there is no activation due to overvoltage, the deconditioning of GFSA occurs. This effect was observed experimentally within the paper. The observed parameters that could influence the long-term deconditioning effect were the following: shape of voltage load, gas type, gas pressure, interelectrode distance, electrode material, electrode surface topography as well as GFSA design such as two- or three-electrode configuration. According to the results obtained, it has been shown that the occurrence of long-term deconditioning in an insulating system, insulated by a noble gas at a subpressure and with small interelectrode distances, is a phenomenon that always occurs when the insulating system is at rest for about an hour. It has been found that the type of noble gas does not influence the long-term deconditioning. Analysis of such insulating systems' parameters, with a prospect of being used as GFSAs, has demonstrated that this phenomenon is less pronounced at higher pressures (for the same value of the pressure (p) and interelectrode distance (d) product) and for electrodes with microscopically embossed surfaces. According to the results that were obtained by noble gases and their mixtures, as well as the results that were obtained by mixtures of SF6 gas with noble gasses, it can be claimed with confidence that the effect of the long-term deconditioning is an electrode effect. It has also been established that the deconditioning effect does not depend on the electrode material except in the case of electrodes made out of noble metals, which reduce the effect. Based on these results, it can be recommended that the working point of GFSAs be set (according to the DC breakdown voltage value) at a

  1. Effect of caffeine on radiation-induced mitotic delay: delayed expression of G2 arrest

    International Nuclear Information System (INIS)

    Rowley, R.; Zorch, M.; Leeper, D.B.


    In the presence of 5 mM caffeine, irradiated (1.5 Gy) S and G 2 cells progressed to mitosis in register and without arrest in G 2 . Caffeine (5 mM) markedly reduced mitotic delay even after radiation doses up to 20 Gy. When caffeine was removed from irradiated (1.5 Gy) and caffeine-treated cells, a period of G 2 arrest followed, similar in length to that produced by radiation alone. The arrest expressed was independent of the duration of the caffeine treatment for exposures up to 3 hr. The similarity of the response to the cited effects of caffeine on S-phase delay suggests a common basis for delay induction in S and G 2 phases

  2. Arrested pneumatization of the sphenoid sinus mimicking intraosseous lesions of the skull base

    Energy Technology Data Exchange (ETDEWEB)

    Jalali, Elnaz; Tadinada, Aditya [Dept. of Oral and Maxillofacial Radiology, University of Connecticut School of Dental Medicine, Farmington (United States)


    Arrested pneumatization of the sphenoid sinus is a developmental variant that is not always well recognized and is often confused with other pathologies associated with the skull base. This report describes the case of a patient referred for cone-beam computed tomography (CBCT) imaging for dental implant therapy. CBCT demonstrated a well-defined incidental lesion in the left sphenoid sinus with soft tissue-like density and sclerotic borders with internal curvilinear opacifications. The differential diagnoses included intraosseous lipoma, arrested pneumatization of the sphenoid sinus, chondrosarcoma, chondroid chordoma, and ossifying fibroma. The radiographic diagnosis of arrested pneumatization was based on the location of the lesion, its well-defined nature, the presence of internal opacifications, and lack of expansion. Gray-scale CBCT imaging of the area demonstrated values similar to fatty tissue. This case highlighted the fact that benign developmental variants associated with the skull base share similar radiographic features with more serious pathological entities.

  3. Cardiac Arrest Secondary to Lightning Strike: Case Report and Review of the Literature. (United States)

    Rotariu, Elena L; Manole, Mioara D


    Lightning strike injuries, although less common than electrical injuries, have a higher morbidity rate because of critical alterations of the circulatory system, respiratory system, and central nervous system. Most lightning-related deaths occur immediately after injury because of arrhythmia or respiratory failure. We describe the case of a pediatric patient who experienced cardiorespiratory arrest secondary to a lightning strike, where the Advanced Cardiac Life Support and Basic Life Support chain of survival was well executed, leading to return of spontaneous circulation and intact neurological survival. We review the pathophysiology of lightning injuries, prognostic factors of favorable outcome after cardiac arrest, including bystander cardiopulmonary resuscitation, shockable rhythm, and automatic external defibrillator use, and the importance of temperature management after cardiac arrest.

  4. Hyperkalemia masked by pseudo-stemi infarct pattern and cardiac arrest. (United States)

    Peerbhai, Shareez; Masha, Luke; DaSilva-DeAbreu, Adrian; Dhoble, Abhijeet


    Hyperkalemia is a common electrolyte abnormality and has well-recognized early electrocardiographic manifestations including PR prolongation and symmetric T wave peaking. With severe increase in serum potassium, dysrhythmias and atrioventricular and bundle branch blocks can be seen on electrocardiogram. Although cardiac arrest is a worrisome consequence of untreated hyperkalemia, rarely does hyperkalemia electrocardiographically manifest as acute ischemia. We present a case of acute renal failure complicated by malignant hyperkalemia and eventual ventricular fibrillation cardiac arrest. Recognition of this disorder was delayed secondary to an initial ECG pattern suggesting an acute ST segment elevation myocardial infarction (STEMI). Emergent coronary angiography performed showed no evidence of coronary artery disease. Pseudo-STEMI patterns are rarely seen in association with acute hyperkalemia and are most commonly described with patient without acute cardiac symptomatology. This is the first such case presenting concurrently with cardiac arrest. A brief review of this rare pseudo-infarct pattern is also given.

  5. Sudden Cardiac Arrest due to Brugada Syndrome: a Case Report and Literature Review

    Directory of Open Access Journals (Sweden)

    R Soleimanirad


    Full Text Available Brugada Syndrome is a rare cause of sudden cardiac arrest and has a unique ECG pattern. In fact, with ST-segment elevation down sloping in the right precordial leads (v1-v3, RBBB pattern in lateral leads and J-point elevation is revealed. We must notice and avoid trigger factors of this syndrome during general anesthesia. Patient is a 39 old man who attended to emergency department with sudden cardiac arrest and resuscitate. He was transferred to ICU for management of hypoxic ischemic encephalopathy. Complementary studies concluded the diagnosis of Brugada syndrome. We must consider Brugada syndrome within patients with family history of sudden cardiac arrest. Moreover, we must avoid trigger factors of this syndrome such as fever, bradicardia and electrolyte abnormality (specialy Na, Ca abnormalities during general anesthesia and if they appear, we should treat them.

  6. [Consideration of early rehabilitation in the treatment of post-cardiac arrest syndrome]. (United States)

    Kurihara, Masaki; Ogasawara, Sadanobu; Kadowaki, Aya; Onizuka, Shouzaburou; Samejima, Mituhiro


    Resumption of spontaneous circulation (ROSC) after cardiac arrest is an unnatural pathophysiological state. In 2008, ILCOR has proposed "post-cardiac arrest syndrome (PCAS)". Clinicians must focus on treating to reverse the pathophysiological manifestations of PCAS in bed. Immobility, deconditioning, and weakness are common problems in patients with critical illness. Therapeutic strategies have to be identified to give patients after ROSC the best chance for survival with good neurological function. Concerning the beneficial effects of early mobilization after stroke, and the efficacy of a strategy for whole-body rehabilitation in the earliest days of critical illness on functional outcomes, the intervention of early rehabilitation care by an interdisciplinary team seems to contribute to good long-time outcome of post-cardiac arrest patients.

  7. Assessment of risks for employees of France Telecom regarding overvoltage arresters containing radio-elements

    International Nuclear Information System (INIS)

    Thomassin, A.; Metz, C.; Rannou, A.


    As a great number of overvoltage arresters used by France Telecom to protect its telecommunication network against disturbing voltages (notably lightning) contain radio-elements, this report aims at assessing dose levels and associated risks for employees exposed to radioactive overvoltage arrester when setting them up, exploiting installations containing such arresters, or when removing them. After a presentation of these devices, a modelling of activities and geometries is proposed, as well as computation tools. Different scenarios and exposure situations are considered. As far as risks are concerned, after a recall on cancers and ionizing radiation, and on the exposure of France Telecom employees, the report comments the knowledge on radio-induced cancers; notably breast cancer, skin cancer, and mouth and pharynx cancers

  8. Care to patient in heart arrest at the intensive care unit

    Directory of Open Access Journals (Sweden)

    Luiza Taciana Rodrigues de Moura


    Full Text Available Care to heart arrest patient should be performed in a systematic way, based on basic protocol as well as advanced life support. The objective of this study is to assess the knowledge of the nursing staff of an intensive care unit in relation to the recognition of heart arrest and the establishment of resuscitation according to the protocols above. It is a descriptive and quantitative study which was conducted from April to June 2011. Of the 33 professionals who participated in the study, 54.5% had not undergone previous training on the theme, 93.9% partially agreed the rates of heart arrest, and only 15.2 % got all the maneuvers in ventilating intubated patient. The low hit total demonstrates the need to update the nursing staff, with periodical theoretical-practical training, and systematic assessments of the performance of the team.

  9. Infectious complications after out-of-hospital cardiac arrest-A comparison between two target temperatures

    DEFF Research Database (Denmark)

    Dankiewicz, Josef; Nielsen, Niklas; Linder, Adam


    -to-treat population. Five-hundred patients (53%) developed pneumonia, severe sepsis or septic shock which was associated with mortality in multivariate analysis (Hazard ratio [HR] 1.39; 95%CI 1.13-1.70; p=0.001). There was no statistically significant difference in the incidence of infectious complications between......BACKGROUND: It has been suggested that target temperature management (TTM) increases the probability of infectious complications after cardiac arrest. We aimed to compare the incidence of pneumonia, severe sepsis and septic shock after out-of-hospital cardiac arrest (OHCA) in patients with two...... complications were recorded daily during the ICU-stay. Pneumonia, severe sepsis and septic shock were considered infectious complications. Procalcitonin (PCT) and C-reactive-protein (CRP) levels were measured at 24h, 48h and 72h after cardiac arrest. RESULTS: There were 939 patients in the modified intention...

  10. Utilization of polymer enclosed intermediate class arresters to improve the performance of modern power systems

    International Nuclear Information System (INIS)

    Sakich, J.D.; Lenk, D.W.; Koepfinger, J.L.


    This paper introduces the first commercially available polymer enclosed intermediate class metal oxide surge arrester. It describes the unique construction of the design, including reduced size, increased flexibility, a collared seal on the polymer housing and an open webbed fiberglass-epoxy module which houses the metal oxide disc elements. Performance advantages are discussed. These include improved short term contamination performance of the insulator-like polymer design when compared to multi-unit porcelain housed designs. Data will show that polymer housed open-webbed fiberglass module construction extends the pressure relief capability beyond that of typical porcelain enclosed designs. The capability of the polymer enclosed design to withstand repeated pressure relief tests, simulating system reclose on a failed arrester, is also discussed. This paper discusses the circumstances at one utility which has considered utilizing polymer enclosed intermediate class arresters to effectively upgrade their system protection capabilities

  11. Survival in patients without acute ST elevation after cardiac arrest and association with early coronary angiography

    DEFF Research Database (Denmark)

    Dankiewicz, J; Nielsen, N; Annborn, M


    PURPOSE: To investigate whether early coronary angiography (CAG) after out-of-hospital cardiac arrest of a presumed cardiac cause is associated with improved outcomes in patients without acute ST elevation. METHODS: The target temperature management after out-of-hospital cardiac arrest (TTM) trial...... showed no difference in all-cause mortality or neurological outcome between an intervention of 33 and 36 °C. In this post hoc analysis, 544 patients where the admission electrocardiogram did not show acute ST elevation were included. Early CAG was defined as being performed on admission or within...... early CAG was not significantly associated with survival. CONCLUSIONS: In this post hoc observational study of a large randomized trial, early coronary angiography for patients without acute ST elevation after out-of-hospital cardiac arrest of a presumed cardiac cause was not associated with improved...

  12. Evaluation of silver diamine fluoride application in children and factors associated with arrested caries survival (United States)

    Chandra, L.; Rahardjo, A.; Adiatman, M.; Darwita, R.; Maharani, D. A.; Callea, M.


    Dental caries is one of the most prevalent infectious diseases in children in Indonesia. Therefore, a solution to overcome caries is needed. Evaluate Silver diamine fluoride (SDF) application for overcoming caries in children and determine factors related to the percentage of arrested caries after SDF application. Cohort study for evaluation and a cross-sectional study; 115 children aged 3-5 years who had active dentin caries were the subjects. Caries risk factors were measured by questionnaires filled out by subjects’ parents. Active caries treated with SDF had odds ratios of 9.9 and 6.8 of being arrested after 3 and 10 months, respectively, when compared with those not treated. Conclusion: SDF is effective in arresting caries and decreasing toothaches suffered by children, thus potentially increasing children’s quality of life.

  13. 40 CFR 434.63 - Effluent limitations for precipitation events. (United States)


    ... 40 Protection of Environment 29 2010-07-01 2010-07-01 false Effluent limitations for precipitation... SOURCE PERFORMANCE STANDARDS Miscellaneous Provisions § 434.63 Effluent limitations for precipitation... discharge or increase in the volume of a discharge caused by precipitation within any 24 hour period less...

  14. Implementation of mild therapeutic hypothermia for post-resuscitation care of sudden cardiac arrest survivors in cardiology units in Poland. (United States)

    Kołtowski, Łukasz; Malesa, Karolina; Tomaniak, Mariusz; Stępińska, Janina; Średniawa, Beata; Karolczyk, Paulina; Puchta, Dominika; Kowalik, Robert; Kremis, Elżbieta; Filipiak, Krzysztof J; Banaszewski, Marek; Opolski, Grzegorz; Bagińska, Marta


    The post-cardiac arrest (CA) period is often associated with secondary damage of the brain that leads to severe neurological deficits. The current practice guidelines recommend the use of therapeutic hypothermia (TH) to prevent neurological deficit and improve survival. The aim of the study was to investigate the implementation of medical guidelines in clinical practice and to evaluate the barriers for implementation of TH in cardiology units in Poland. A telephone survey, fax and online inquiry form were used to assess the implementation of TH in cardiology units in the management of unconscious patients after cardiac arrest (CA). The questions addressed the local practice, TH protocol, reasons for not using TH and outcomes of CA patients. We obtained information from 79 units out of 150 asked (53%). At the time of the survey, 24 units (30.8%) were using TH as part of their post-CA management. Of all CA patients, 45% underwent TH in cardiac intensive care units (CICU), 37.5% in the coronary care unit (CCU) and 12.5% in the intensive care unit (ICU). The major barrier for the implementation of TH declared by the non-cooling centers was lack of sufficient knowledge regarding the technique and protocol, as well as experience (37%); access to dedicated equipment was not perceived as an obstacle. The number of cardiology units that provide TH for comatose CA patients is low. The main limiting factor for wider use of TH is lack of knowledge and experience. There is a clear need for urgent educational activities for cardiology units. The benefits of TH still have not reached their potential in cardiology units.

  15. Randomised trial comparing the recording ability of a novel, electronic emergency documentation system with the AHA paper cardiac arrest record. (United States)

    Grigg, Eliot; Palmer, Andrew; Grigg, Jeffrey; Oppenheimer, Peter; Wu, Tim; Roesler, Axel; Nair, Bala; Ross, Brian


    To evaluate the ability of an electronic system created at the University of Washington to accurately document prerecorded VF and pulseless electrical activity (PEA) cardiac arrest scenarios compared with the American Heart Association paper cardiac arrest record. 16 anaesthesiology residents were randomly assigned to view one of two prerecorded, simulated VF and PEA scenarios and asked to document the event with either the paper or electronic system. Each subject then repeated the process with the other video and documentation method. Five types of documentation errors were defined: (1) omission, (2) specification, (3) timing, (4) commission and (5) noise. The mean difference in errors between the paper and electronic methods was analysed using a single factor repeated measures ANOVA model. Compared with paper records, the electronic system omitted 6.3 fewer events (95% CI -10.1 to -2.5, p=0.003), which represents a 28% reduction in omission errors. Users recorded 2.9 fewer noise items (95% CI -5.3 to -0.6, p=0.003) when compared with paper, representing a 36% decrease in redundant or irrelevant information. The rate of timing (Δ=-3.2, 95% CI -9.3 to 3.0, p=0.286) and commission (Δ=-4.4, 95% CI -9.4 to 0.5, p=0.075) errors were similar between the electronic system and paper, while the rate of specification errors were about a third lower for the electronic system when compared with the paper record (Δ=-3.2, 95% CI -6.3 to -0.2, p=0.037). Compared with paper documentation, documentation with the electronic system captured 24% more critical information during a simulated medical emergency without loss in data quality. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to

  16. Effects of advanced life support on patients who suffered cardiac arrest outside of hospital and were defibrillated. (United States)

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


    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.

  17. EIF2A-dependent translational arrest protects leukemia cells from the energetic stress induced by NAMPT inhibition

    International Nuclear Information System (INIS)

    Zucal, Chiara; D’Agostino, Vito G.; Casini, Antonio; Mantelli, Barbara; Thongon, Natthakan; Soncini, Debora; Caffa, Irene; Cea, Michele; Ballestrero, Alberto; Quattrone, Alessandro; Indraccolo, Stefano; Nencioni, Alessio; Provenzani, Alessandro


    Nicotinamide phosphoribosyltransferase (NAMPT), the rate-limiting enzyme in NAD + biosynthesis from nicotinamide, is one of the major factors regulating cancer cells metabolism and is considered a promising target for treating cancer. The prototypical NAMPT inhibitor FK866 effectively lowers NAD + levels in cancer cells, reducing the activity of NAD + -dependent enzymes, lowering intracellular ATP, and promoting cell death. We show that FK866 induces a translational arrest in leukemia cells through inhibition of MTOR/4EBP1 signaling and of the initiation factors EIF4E and EIF2A. Specifically, treatment with FK866 is shown to induce 5′AMP-activated protein kinase (AMPK) activation, which, together with EIF2A phosphorylation, is responsible for the inhibition of protein synthesis. Notably, such an effect was also observed in patients’ derived primary leukemia cells including T-cell Acute Lymphoblastic Leukemia. Jurkat cells in which AMPK or LKB1 expression was silenced or in which a non-phosphorylatable EIF2A mutant was ectopically expressed showed enhanced sensitivity to the NAMPT inhibitor, confirming a key role for the LKB1-AMPK-EIF2A axis in cell fate determination in response to energetic stress via NAD + depletion. We identified EIF2A phosphorylation as a novel early molecular event occurring in response to NAMPT inhibition and mediating protein synthesis arrest. In addition, our data suggest that tumors exhibiting an impaired LBK1- AMPK- EIF2A response may be especially susceptible to NAMPT inhibitors and thus become an elective indication for this type of agents. The online version of this article (doi:10.1186/s12885-015-1845-1) contains supplementary material, which is available to authorized users

  18. The experiences of male sudden cardiac arrest survivors and their partners: a gender analysis. (United States)

    Uren, Alan; Galdas, Paul


    To explore how masculinities shape the experiences of men and their partners after survival from out-of-hospital cardiac arrest. Survivors of out-of-hospital cardiac arrest report depression, dependence on others for daily functioning, decreased participation in society and significant decreases in quality of life. There is growing evidence that masculine gender identities play a central role in the recovery experiences of men and their families following other major cardiac events. However, to date, there has been no examination of how masculinities shape men's experiences of recovery following out-of-hospital cardiac arrest. Interview study guided by an interpretive description approach. Data were subjected to thematic analysis. A purposive sample of seven male sudden cardiac arrest survivors and 6 female partners was recruited in 2010 from a secondary care centre in British Columbia, Canada. Three themes were prominent in the experiences of the participants: (1) Support and self-reliance; (2) Dealing with emotional (in) vulnerability; and (3) No longer a 'He-man'. Masculinities played a role in men's experiences of recovery and adaptation following out-of-hospital cardiac arrest. Hegemonic masculinity partly explained men's experiences, notably their reluctance to seek professional support and reactions to changes in lifestyle. However, the study also suggests that the popular stereotype of men being 'strong and silent' in the face of ill-health may only be a part of a more complex story. Nurses would benefit from taking into consideration the potential influence of male gender identities on men's recovery postcardiac arrest. © 2014 John Wiley & Sons Ltd.

  19. Caries arrest by topical fluorides in preschool children: 30-month results. (United States)

    Duangthip, D; Wong, M C M; Chu, C H; Lo, E C M


    To compare the effectiveness of three applications of silver diammine fluoride (SDF) solution at yearly interval and three applications of SDF solution or sodium fluoride (NaF) varnish at weekly interval at baseline in arresting active caries in the primary teeth of preschool children. Children aged 3-4 years (n = 371) who had at least one active caries lesion (ICDAS codes 3-6) in their primary teeth were randomly allocated into three groups: Group 1 - annual application of 30% SDF solution; Group 2 - three applications of 30% SDF at weekly intervals; and Group 3 - three applications of 5% NaF varnish at weekly intervals. Follow-up examinations were performed every 6 mo nths by the same masked examiner. After 30 months, 309 (83%) children with 1877 caries lesions remained in the study. For cavitated lesions (ICDAS code 5 or 6), the caries arrest rate of Group 1 (48%) was significantly higher than those of Group 2 (33%) and Group 3 (34%), (p  0.05). Presence of plaque on caries lesion, tooth type and tooth surface type had an influence on caries arrest. Over a 30-month period, annual applications of SDF solution is more effective than three weekly applications of NaF varnish or SDF solution at baseline in arresting active cavitated dentine caries lesions in primary teeth. As annual application of SDF solution was found to be more effective than 3 weekly applications of NaF varnish or SDF solution at baseline in arresting active cavitated dentine caries lesions, the former application protocol is preferred for young children who are available for regular caries arrest treatment. Copyright © 2017 Elsevier Ltd. All rights reserved.

  20. Survivors of cardiac arrest with good neurological outcome show considerable impairments of memory functioning. (United States)

    Sulzgruber, Patrick; Kliegel, Andreas; Wandaller, Cosima; Uray, Thomas; Losert, Heidrun; Laggner, Anton N; Sterz, Fritz; Kliegel, Matthias


    Deficits in cognitive function are a well-known dysfunction in survivors of cardiac arrest. However, data concerning memory function in this neurological vulnerable patient collective remain scarce and inconclusive. Therefore, we aimed to assess multiple aspects of retrospective and prospective memory performance in patients after cardiac arrest. We prospectively enrolled 33 survivors of cardiac arrest, with cerebral performance categories (CPC) 1 and 2 and a control-group (n=33) matched in sex, age and educational-level. To assess retrospective and prospective memory performance we administrated 4 weeks after cardiac arrest the "Rey Adult Learning Test" (RAVLT), the "Digit-Span-Backwards Test", the "Logic-Memory Test" and the "Red-Pencil Test". Results indicate an impairment in immediate and delayed free recall, but not in recognition. However, the overall impairment in immediate recall was qualified by analyzing RAVLT performance, showing that patients were only impaired in trials 4 and 5 of the learning sequence. Moreover, working and prospective memory as well as prose recall were worse in cardiac arrest survivors. Cranial computed tomography was available in 61% of all patients (n=20) but there was no specific neurological damage detectable that could be linked to this cognitive impairment. Episodic long-term memory functioning appears to be particularly impaired after cardiac arrest. In contrast, short-term memory storage, even tested via free-call, seems not to be affected. Based on cranial computed tomography we suggest that global brain ischemia rather than focal brain lesions appear to underlie these effects. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.