Sample records for provisions limited arrest

  1. 10 CFR 1047.4 - Arrest authority. (United States)


    ... OF ENERGY (GENERAL PROVISIONS) LIMITED ARREST AUTHORITY AND USE OF FORCE BY PROTECTIVE FORCE OFFICERS General Provisions § 1047.4 Arrest authority. (a) Under the Act, the authority of a DOE protective force... badges, identification cards, other insignia—18 U.S.C. 701—(pertains to the manufacture, sale, and...

  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 infections

  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. 76 FR 5272 - Removal of Limitation of Approval of Prevention of Significant Deterioration Provisions... (United States)


    ... language which narrowed its previous approval of Alabama's New Source Review (NSR) Prevention of... AGENCY 40 CFR Part 52 Removal of Limitation of Approval of Prevention of Significant Deterioration Provisions Concerning Greenhouse Gas Emitting-Sources in State Implementation Plans; Alabama AGENCY...

  5. 76 FR 5274 - Removal of Limitation of Approval of Prevention of Significant Deterioration Provisions... (United States)


    ... language which narrowed its previous approval of Mississippi's New Source Review (NSR) Prevention of... AGENCY 40 CFR Part 52 Removal of Limitation of Approval of Prevention of Significant Deterioration Provisions Concerning Greenhouse Gas Emitting-Sources in State Implementation Plans; Mississippi AGENCY...

  6. 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.

  7. 75 FR 73972 - Medicaid Program; Cost Limit for Providers Operated by Units of Government and Provisions To... (United States)


    ... Integrity of Federal-State Financial Partnership AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS... Units of Government and Provisions To Ensure the Integrity of Federal-State Financial Partnership'' (72... Program; Cost Limit for Providers Operated by Units of Government and Provisions To Ensure the Integrity...

  8. Continuity and Change from Adolescence to Emerging Adulthood: Adolescence-Limited vs. Life-Course-Persistent Profound Ego Development Arrests (United States)

    Billings, Rebecca L.; Hauser, Stuart T.; Allen, Joseph P.


    Participants (n = 36) with consistent Pre-conformist ego development levels during multiple adolescent assessments were studied to determine whether and how their ego levels had changed at age 25. Those (n = 12) whose ego levels remained at the Pre-conformist level were assigned to a "life-course-persistent profound ego development arrest"…

  9. 76 FR 45181 - Enhancing Airline Passenger Protections: Limited Delay of Effective Date for Certain Provisions (United States)


    ... provisions and their importance to consumers. After carefully considering all the requests and comments... for the April 2011 final rule) is fast approaching, the Department finds good cause that this action...

  10. Importance of Both Early Reperfusion and Therapeutic Hypothermia in Limiting Myocardial Infarct Size Post-Cardiac Arrest in a Porcine Model. (United States)

    Kern, Karl B; Hanna, Joseph M; Young, Hayley N; Ellingson, Carl J; White, Joshua J; Heller, Brian; Illindala, Uday; Hsu, Chiu-Hsieh; Zuercher, Mathias


    The aim of this study was to test the hypothesis that hypothermia and early reperfusion are synergistic for limiting infarct size when an acutely occluded coronary is associated with cardiac arrest. Cohort studies have shown that 1 in 4 post-cardiac arrest patients without ST-segment elevation has an acutely occluded coronary artery. However, many interventional cardiologists remain unconvinced that immediate coronary angiography is needed in these patients. Thirty-two swine (mean weight 35 ± 5 kg) were randomly assigned to 1 of the following 4 treatment groups: group A, hypothermia and reperfusion; group B, hypothermia and no reperfusion; group C, no hypothermia and reperfusion; and group D, no hypothermia and no reperfusion. The left anterior descending coronary artery was occluded with an intracoronary balloon, and ventricular fibrillation was electrically induced. Cardiopulmonary resuscitation was begun after 4 min of cardiac arrest. Defibrillation was attempted after 2 min of cardiopulmonary resuscitation. Resuscitated animals randomized to hypothermia were rapidly cooled to 34°C, whereas those randomized to reperfusion had such after 45 min of left anterior descending coronary artery occlusion. At 4 h, myocardial infarct size was calculated. Group A had the smallest infarct size at 16.1 ± 19.6% (p cardiac arrest, so treatment of resuscitated patients should include early coronary angiography for potential emergent reperfusion, while providing hypothermia for both brain and myocardial protection. Providing only early hypothermia, while delaying coronary angiography, is not optimal. Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  11. Out-of-hospital cardiac arrest-review of demographics in South Australia to inform decisions about the provision of automatic external defibrillators within the community. (United States)

    Zeitz, Kathryn; Grantham, Hugh; Elliot, Robert; Zeitz, Chris


    Sudden, out-of-hospital cardiac arrest (OHCA) has an annual incidence of approximately 50 per 100,000 population. Public access defibrillation is seen as one of the key strategies in the chain-of-survival for OHCA. Positioning of these devices is important for the maximization of public health outcomes. The literature strongly advocates widespread public access to automated external defibrillatiors (AEDs). The most efficient placement of AEDs within individual communities remains unclear. A retrospective case review of OHCAs attended by the South Australia Ambulance Service in metropolitan and rural South Australia over a 30-month period was performed. Data were analyzed using Utstein-type indicators. Detailed demographics, summative data, and clinical data were recorded. A total of 1,305 cases of cardiac arrest were reviewed. The annual rate of OHCA was 35 per 100,000 population. Of the cases, the mean value for the ages was 66.3 years, 517 (39.6%) were transported to hospital, 761 (58.3%) were judged by the paramedic to be cardiac, and 838 (64.2%) were witnessed. Bystander cardiopulmonary resuscitation (CPR) was performed in 495 (37.9%) of cases. The rhythm on arrival was ventricular fibrillation (VF) or ventricular tachycardia (VT) in 419 (32.1%) cases, and 315 (24.1%) of all arrests had return of spontaneous circulation (ROSC) before or on arrival at the hospital. For cardiac arrest cases that were witnessed by the ambulance service (n=121), the incidence of ROSC was 47.1%. During the 30-month period, there only was one location that recorded more than one cardiac arrest. No other location recorded recurrent episodes. This study did not identify any specific location that would justify defibrillator placement over any other location without an existing defibrillator. The impact of bystander CPR and the relatively low rate of bystander CPR in this study points to an area of need. The relative potential impact of increasing bystander CPR rates versus investing in

  12. Brief psychosexual therapy: reflections on the provision of a time-limited therapy service in a sexual health clinic


    Irwin, R.; Pullen, C.


    Time-limited psychological therapy is increasingly the norm in publically funded healthcare systems. Although brevity of treatment is a characteristic of modern sex therapy, many practitioners would nevertheless consider the provision of effective psychosexual therapy in six or fewer sessions to be a daunting prospect. In this paper we reflect on the challenges, opportunities, and changes to practice associated with the development and delivery of a brief psychosexual therapy service within a...

  13. Rescuer-limited cardiopulmonary resuscitation as an alternative to 2-min switched CPR in the setting of inhospital cardiac arrest: a randomised cross-over study. (United States)

    Jo, Choong Hyun; Cho, Gyu Chong; Ahn, Jung Hwan; Park, Yoo Seok; Lee, Chang Hee


    The 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation (CPR) recommend that chest compression be rotated every 2 min to prevent rescuer fatigue. However, the quality of chest compression using 2-min switched CPR tends to decrease rapidly due to rescuer fatigue. We aimed to compare the effectiveness of use of 2-min switched CPR and rescuer-limited CPR (the person performing compressions is allowed to switch with another rescuer prior to 2 min if feeling fatigued) in the setting of inhospital cardiac arrest. Using a randomised cross-over trial design, 90 medical students were grouped into pairs to perform four cycles of 2-min switched CPR and rescuer-limited CPR (495 s per technique). During each trial, the total number of compressions performed, mean depth of compression and proportion of effective compressions performed (compression depth >5 mm) were recorded for identification of significant differences and changes in pulse rate and RR were measured to determine the extent of exhaustion. Compared with 2-min switched CPR, the mean compression was deeper (51 vs 47 mm, pCPR. Subgroup analysis by 30-s unit showed more consistent compression quality during rescuer-limited CPR. No significant differences in change in pulse rate and RR were found between the two techniques. Rescuer-limited CPR yields a greater number of effective compressions and more consistent quality of CPR than 2-min switched CPR. Rescuer-limited CPR might be a suitable alternative for treating inhospital cardiac arrest. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to

  14. 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...

  15. Cardiac arrest (United States)

    ... also run other tests, depending on your health history and the results of these tests. Treatment Cardiac arrest needs emergency treatment right away to get the heart started again. Cardiopulmonary resuscitation (CPR) . This is often the first type of ...

  16. Criminal process and limitation period’s provisions in the EU jurisprudence framework. Dialogue between systems or identity conflict?

    Directory of Open Access Journals (Sweden)

    Michele Caianiello


    Full Text Available The interaction between European sources and national provisions have increased the level of uncertainty with regard to the nature of time limitation in criminal law in the Italian system. With decision no. 24/2017 the Italian Constitutional Court showed the intent to start a dialogue with the European Court of Justice, after the well-known 2015 Taricco decision. However, in referring the case to the ECJ for a preliminary ruling, Italian Court threatened to make use of the “counterlimits” doctrine. It emerged therefore how difficult the cohabitation is between EU law and Italian criminal law. With decision no. 24/2017 the problems raised by Taricco saga were just postponed, though they are far from being resolved. It seems difficult at the current time to understand how certain sensitive features of the Italian criminal justice system, representative of its identity, such as the time limitation provisions, could be harmonised with the supranational set of rules coming from the EU law.

  17. Sudden Cardiac Arrest (SCA) (United States)

    ... Arrest (SCA) Back to Heart Diseases & Disorders Sudden Cardiac Arrest (SCA) Sudden Cardiac Arrest ( SCA ) occurs when the heart stops beating, abruptly ... to saving someone who is having a sudden cardiac arrest , it is important to understand the difference. The ...

  18. Provision of harm-reduction services to limit unsafe abortion in Tanzania. (United States)

    Kahabuka, Catherine; Pembe, Andrea; Meglioli, Alejandra


    To investigate the feasibility of providing harm-reduction services to reduce unsafe abortion in Tanzania. A cross-sectional study was conducted among 110 women who received harm-reduction counseling at a public health center in Dar es Salaam between February 10 and October 10, 2014. Background and clinical information was collected for all women; a subgroup (n=50) undertook a semi-structured survey that measured the type of services women received, women's perception of the services, and pregnancy outcome. The main study outcomes were attendance at the follow-up visit, type and quality of information women received on both visits, and misoprostol use for pregnancy termination. Overall, 55 (50.0%) women attended follow-up services. Misoprostol was used for induced abortion among 54 (98.2%); 38 (70.4%) of these women had obtained contraception at the follow-up visit. Likelihood of attendance for follow-up was increased among women who were older than 34 years (odds ratio [OR] 2.2, 95% confidence interval [CI] 0.1-35.8), were married (OR 2.1, 95% CI 0.8-5.7), and had a post-primary education level (OR 2.0, 95% CI 0.8-5.3). On average, 44 (87.0%) women received all required information at the initial counseling session and none reported major complications that required hospitalization. Harm-reduction services for unsafe abortion are feasible and acceptable, and could provide an excellent opportunity to fight abortion-related morbidity and mortality in Tanzania. © 2016 CSK Research Solutions Limited.International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics.

  19. 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,…

  20. Problems of house arrest application

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    Mikhail Vladimirovich Kolesnikov


    Full Text Available Objective to determine the position of house arrest in the system of preventive measures and to identify the main problems of criminal procedural regulation that prevent its broader use during the preliminary investigation and trial. Methods dialectical approach to the analysis of social phenomena allowing to view them in static and dynamic aspect evolutionarysynergetic paradigm providing the opportunity to explore the phenomenon under investigation with respect to the system subordinate and coordinating relationships within the system. Dialectical approach and the evolutionarysynergetic paradigm determined the choice of specific methods of research historical comparative law comparative formallegal statistical. Results the problems arising with application of house arrest are grouped by author depending on the structure of the provisions of Article 107 of the CriminalProcedural Code of the Russian Federation. The first group of problems includes the determination of the location of the accused suspect under house arrest and the scope of the legal restrictions imposed. The second group includes the establishment of terms of house arrest and their subsequent renewal or change of the preventive measure. The third group is the identification of persons to which the house arrest will be the best preventive measure. The results of the study allow to make proposals to change the current wording of Art. 107 of the CriminalProcedural Code of Russia. Scientific novelty a comprehensive study of current state of the normativelegal regulation of house arrest in the context of its practical application. Practical value the main provisions and conclusions of the article can be used in scientific and pedagogical activity when considering questions about the nature of preventive measures related to the restraint of personal liberty of the accused. nbsp

  1. 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.

  2. [Heart arrest]. (United States)

    Chiarella, F; Giovannini, E; Bozzano, A; Caristo, G; Delise, P; Fedele, F; Fera, M S; Lavalle, C; Roghi, A; Valagussa, F


    Cardiac arrest is one of the leading causes of mortality in industrialized countries and is mainly due to ischemic heart disease. According to ISTAT estimates, approximately 45,000 sudden deaths occur annually in Italy whereas according to the World Health Organization, its incidence is 1 per 1000 persons. The most common cause of cardiac arrest is ventricular fibrillation due to an acute ischemic episode. During acute ischemia the onset of a ventricular tachyarrhythmia is sudden, unpredictable and often irreversible and lethal. Each minute that passes, the probability that the patient survives decreases by 10%. For this reason, the first 10 min are considered to be priceless for an efficacious first aid. The possibility of survival depends on the presence of witnesses, on the heart rhythm and on the resolution of the arrhythmia. In the majority of cases, the latter is possible by means of electrical defibrillation followed by the reestablishment of systolic function. An increase in equipment alone does not suffice for efficacious handling of cardiac arrest occurring outside the hospital premises. Above all, an adequate intervention strategy is required. Ambulance personnel must be well trained and capable of intervening rapidly, possibly within the first 5 min. The key to success lies in the diffusion and proper use of defibrillators. The availability of new generation instruments, the external automatic defibrillators, encourages their widespread use. On the territory, these emergencies are the responsibility of the 118 organization based, according to the characteristics specific to each country, on the regulated coordination between the operative command, the crews and the first-aid means. Strategies for the handling of these emergencies within hospitals have been proposed by the Conference of Bethesda and tend to guarantee an efficacious resuscitation with a maximum latency of 2 min between cardiac arrest and the first electric shock. The diffusion of external

  3. About Cardiac Arrest (United States)

    ... Artery Disease Venous Thromboembolism Aortic Aneurysm More About Cardiac Arrest Updated:Mar 10,2017 What is cardiac arrest? ... and procedures related to heart disease and stroke. Cardiac Arrest • Home • About Cardiac Arrest • Understand Your Risk for ...

  4. Carboxylation of multiwalled carbon nanotube attenuated the cytotoxicity by limiting the oxidative stress initiated cell membrane integrity damage, cell cycle arrestment, and death receptor mediated apoptotic pathway. (United States)

    Liu, Zhenbao; Liu, Yanfei; Peng, Dongming


    In this study, the effects of carboxylated multiwalled carbon nanotubes (MWCNTs-COOH) on human normal liver cell line L02 was compared with that of pristine multiwalled carbon nanotubes (p-MWCNTs). It was shown that compared with MWCNTs-COOH, p-MWCNTs induced apoptosis, reduced the level of intracellular antioxidant glutathione more significantly, and caused severer cell membrane damage as demonstrated by lactate dehydrogenase leakage. Cell cycles were arrested by both MWCNTs, while p-MWCNTs induced higher ratio of G0/G1 phase arrestment as compared with MWCNTs-COOH. Caspase-8 was also activated after both MWCNTs exposure, indicating extrinsic apoptotic pathway was involved in the apoptosis induced by MWCNTs exposure, more importantly, MWCNTs-COOH significantly reduced the activation of caspase-8 as compared with p-MWCNTs. All these results suggested that MWCNTs-COOH might be safer for in vivo application as compared with p-MWCNTs. © 2015 Wiley Periodicals, Inc.

  5. Intra-arrest hypothermia during cardiac arrest: a systematic review (United States)


    Introduction Therapeutic hypothermia is largely used to protect the brain following return of spontaneous circulation (ROSC) after cardiac arrest (CA), but it is unclear whether we should start therapeutic hypothermia earlier, that is, before ROSC. Methods We performed a systematic search of PubMed, EMBASE, CINAHL, the Cochrane Library and Ovid/Medline databases using "arrest" OR "cardiac arrest" OR "heart arrest" AND "hypothermia" OR "therapeutic hypothermia" OR "cooling" as keywords. Only studies using intra-arrest therapeutic hypothermia (IATH) were selected for this review. Three authors independently assessed the validity of included studies and extracted data regarding characteristics of the studied cohort (animal or human) and the main outcomes related to the use of IATH: Mortality, neurological status and cardiac function (particularly, rate of ROSC). Results A total of 23 animal studies (level of evidence (LOE) 5) and five human studies, including one randomized controlled trial (LOE 1), one retrospective and one prospective controlled study (LOE 3), and two prospective studies without a control group (LOE 4), were identified. IATH improved survival and neurological outcomes when compared to normothermia and/or hypothermia after ROSC. IATH was also associated with improved ROSC rates and with improved cardiac function, including better left ventricular function, and reduced myocardial infarct size, when compared to normothermia. Conclusions IATH improves survival and neurological outcome when compared to normothermia and/or conventional hypothermia in experimental models of CA. Clinical data on the efficacy of IATH remain limited. PMID:22397519

  6. Medicaid program; cost limit for providers operated by units of government and provisions to ensure the integrity of federal-state financial partnership. Final rule with comment period. (United States)


    This regulation clarifies that entities involved in the financing of the non-Federal share of Medicaid payments must be a unit of government; clarifies the documentation required to support a Medicaid certified public expenditure; limits Medicaid reimbursement for health care providers that are operated by units of government to an amount that does not exceed the health care provider's cost of providing services to Medicaid individuals; requires all health care providers to receive and retain the full amount of total computable payments for services furnished under the approved Medicaid State plan; and makes conforming changes to provisions governing the State Child Health Insurance Program (SCHIP) to make the same requirements applicable, with the exception of the cost limit on reimbursement. The Medicaid cost limit provision of this regulation does not apply to: Stand-alone SCHIP program payments made to governmentally-operated health care providers; Indian Health Service (IHS) facilities and tribal 638 facilities that are paid at the all-inclusive IHS rate; Medicaid Managed Care Organizations (MCOs), Prepaid Inpatient Health Plans (PIHPs), and Prepaid Ambulatory Health Plans (PAHPs); Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs). Moreover, disproportionate share hospital (DSH) payments and payments authorized under Section 701(d) and Section 705 of the Benefits Improvement Protection Act of 2000 are not subject to the newly established Medicaid cost limit for governmentally-operated health care providers. Except as noted above, all Medicaid payments and SCHIP payments made under the authority of the State plan and under waiver and demonstration authorities, as well as associated State Medicaid and SCHIP financing arrangements, are subject to all provisions of this regulation. Finally, this regulation solicits comments from the public on issues related to the definition of the Unit of Government.

  7. What Causes Sudden Cardiac Arrest? (United States)

    ... Back To Health Topics / Sudden Cardiac Arrest Sudden Cardiac Arrest Also known as Cardiac Arrest , Sudden Cardiac Death ... the condition For People Who Have Survived Sudden Cardiac Arrest If you've already had SCA, you're ...

  8. What Is Sudden Cardiac Arrest? (United States)

    ... Back To Health Topics / Sudden Cardiac Arrest Sudden Cardiac Arrest Also known as Cardiac Arrest , Sudden Cardiac Death ... the condition For People Who Have Survived Sudden Cardiac Arrest If you've already had SCA, you're ...

  9. 40 CFR 63.500 - Back-end process provisions-carbon disulfide limitations for styrene butadiene rubber by emulsion... (United States)


    ... disulfide limitations for styrene butadiene rubber by emulsion processes. 63.500 Section 63.500 Protection... limitations for styrene butadiene rubber by emulsion processes. (a) Owners or operators of sources subject to this subpart producing styrene butadiene rubber using an emulsion process shall operate the process...

  10. Socioeconomic inequalities in activities of daily living limitations and in the provision of informal and formal care for noninstitutionalized older Brazilians: National Health Survey, 2013. (United States)

    Lima-Costa, Ma Fernanda; Mambrini, Juliana V M; Peixoto, Sérgio V; Malta, Deborah C; Macinko, James


    This study assesses the association between socioeconomic factors and living arrangements with activity of daily living limitations (ADL) and the receipt of informal and formal care among non-institutionalized Brazilians aged ≥ 60 years. Data come from a nationally representative survey (the Brazilian National Health Survey), conducted in 2013. Outcomes examined include the number of ADL tasks performed with limitations and number of tasks for which the individual received informal care (provided by unpaid relatives or friends), formal care, or no care. Key exposure variables were years of education and household assets. Functioning limitations were reported by 7,233 (30.1 %) of 23,815 survey participants. Of these, 5,978 reported needing help to perform at least one ADL task. There was a strong inverse gradient between physical functioning and both education and household assets that was independent of confounders. The provision of care showed an opposite trend, with the wealthiest being more likely to receive help for performing ADL tasks. The receipt of formal care was strongly correlated with highest education (Fully adjusted prevalence ratio [PR] = 1.64; 95 % CI 1.05, 2.58) and with the highest assets level (PR = 2.24; 95 % CI 1.38, 3.64). Living with someone else was associated with provision of care (formal or informal) for those at the lowest and intermediate educational and assets levels, but not for the wealthiest. Despite worse physical functioning, older Brazilians in worse socioeconomic conditions are much less likely to receive needed help in performing ADL tasks.

  11. Training to Care for Limited English Proficient Patients and Provision of Interpreter Services at U.S. Dental School Clinics. (United States)

    Simon, Lisa; Hum, Lauren; Nalliah, Romesh


    Legal protections in the United States mandate that individuals with limited English proficiency (LEP) have equal access to health care. However, LEP populations are at higher risk of poor health. Dental school clinics offer lower cost care by supervised dental students and often provide care for LEP patients. The aims of this study were to survey dental students about their clinical experience with LEP patients, the interpreter resources available at their dental school clinics, and the extent of instruction on these topics. Academic deans at 19 dental schools (30.6% of 62 invited schools) distributed the survey to their students, and the survey was completed by 325 students (4.2% of students at the 19 participating schools). Among the responding students, 44% reported their dental school clinic lacked formal interpreter services, and most of the respondents reported receiving minimal instruction on caring for LEP patients. Only 54% of the responding students reported feeling adequately prepared to manage LEP patients following graduation. These results suggest there is limited access to interpreter services for students while in dental school. A large proportion of these dental students thus reported feeling unprepared to treat LEP patients after graduation.

  12. Chromosomal Aneuploidies and Early Embryonic Developmental Arrest

    Directory of Open Access Journals (Sweden)

    Maria Maurer


    Full Text Available Background: Selecting the best embryo for transfer, with the highest chance of achieving a vital pregnancy, is a major goal in current in vitro fertilization (IVF technology. The high rate of embryonic developmental arrest during IVF treatment is one of the limitations in achieving this goal. Chromosomal abnormalities are possibly linked with chromosomal arrest and selection against abnormal fertilization products. The objective of this study was to evaluate the frequency and type of chromosomal abnormalities in preimplantation embryos with developmental arrest. Materials and Methods: This cohort study included blastomeres of embryos with early developmental arrest that were biopsied and analyzed by fluorescence in-situ hybridization (FISH with probes for chromosomes 13, 16, 18, 21 and 22. Forty-five couples undergoing IVF treatment were included, and 119 arrested embryos were biopsied. All probes were obtained from the Kinderwunsch Zentrum, Linz, Austria, between August 2009 and August 2011. Results: Of these embryos, 31.6% were normal for all chromosomes tested, and 68.4% were abnormal. Eleven embryos were uniformly aneuploid, 20 were polyploid, 3 were haploid, 11 displayed mosaicism and 22 embryos exhibited chaotic chromosomal complement. Conclusion: Nearly 70% of arrested embryos exhibit chromosomal errors, making chromosomal abnormalities a major cause of embryonic arrest and may be a further explanation for the high developmental failure rates during culture of the embryos in the IVF setting.

  13. 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...

  14. 10 CFR 1047.6 - Use of physical force when making an arrest. (United States)


    ... physical force by the offender. It should be noted that verbal abuse alone by the offender cannot be the... 10 Energy 4 2010-01-01 2010-01-01 false Use of physical force when making an arrest. 1047.6... BY PROTECTIVE FORCE OFFICERS General Provisions § 1047.6 Use of physical force when making an arrest...

  15. Cardiac arrest leadership: in need of resuscitation? (United States)

    Robinson, Philip S; Shall, Emma; Rakhit, Roby


    Leadership skills directly correlate with the quality of technical performance of cardiopulmonary resuscitation (CPR) and clinical outcomes. Despite an improved focus on non-technical skills in CPR training, the leadership of cardiac arrests is often variable. To assess the perceptions of leadership and team working among members of a cardiac arrest team and to evaluate future training needs. Cross-sectional survey of 102 members of a cardiac arrest team at an Acute Hospital Trust in the UK with 892 inpatient beds. Responses sought from doctors, nurses and healthcare assistants to 12 rated statements and 4 dichotomous questions. Of 102 responses, 81 (79%) were from doctors and 21 (21%) from nurses. Among specialist registrars 90% agreed or strongly agreed that there was clear leadership at all arrests compared with between 28% and 49% of nurses and junior doctors respectively. Routine omission of key leadership tasks was reported by as many as 80% of junior doctors and 50% of nurses. Almost half of respondents reported non-adherence with Advanced Life Support (ALS) guidelines. Among junior members of the team, 36% felt confident to lead an arrest and 75% would welcome further dedicated cardiac arrest leadership training. Leadership training is integrated into the ALS (Resus Council, UK) qualification. However, this paper found that in spite of this training; standards of leadership are variable. The findings suggest a pressing need for further dedicated cardiac arrest leadership training with a focus on improving key leadership tasks such as role assignment, team briefing and debriefing. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to

  16. 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...

  17. Arrested coalescence of viscoelastic droplets: polydisperse doublets. (United States)

    Dahiya, Prerna; Caggioni, Marco; Spicer, Patrick T


    Arrested droplet coalescence produces stable anisotropic shapes and is a key mechanism for microstructure development in foods, petroleum and pharmaceutical formulations. Past work has examined the dynamic elastic arrest of coalescing monodisperse droplet doublets and developed a simple model of doublet strain as a function of physical variables. Although the work describes experimental data well, it is limited to describing same-size droplets. A new model incorporating a generalized description of doublet shape is developed to describe polydisperse doublet formation in more realistic emulsion systems. Polydisperse doublets are shown to arrest at lower strains than monodisperse doublets as a result of the smaller contribution of surface area in a given pair. Larger droplet size ratios have lower relative degrees of strain because coalescence is arrested at an earlier stage than in more monodisperse cases. Experimental observations of polydisperse doublet formation indicate that the model under-predicts arrest strains at low solid levels and small droplet sizes. The discrepancy is hypothesized to be the result of nonlinear elastic deformation at high strains.This article is part of the themed issue 'Soft interfacial materials: from fundamentals to formulation'. © 2016 The Author(s).

  18. How Is Sudden Cardiac Arrest Treated? (United States)

    ... Back To Health Topics / Sudden Cardiac Arrest Sudden Cardiac Arrest Also known as Cardiac Arrest , Sudden Cardiac Death ... the condition For People Who Have Survived Sudden Cardiac Arrest If you've already had SCA, you're ...

  19. How Is Sudden Cardiac Arrest Diagnosed? (United States)

    ... Back To Health Topics / Sudden Cardiac Arrest Sudden Cardiac Arrest Also known as Cardiac Arrest , Sudden Cardiac Death ... the condition For People Who Have Survived Sudden Cardiac Arrest If you've already had SCA, you're ...

  20. 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

  1. Alterations in Cerebral Blood Flow after Resuscitation from Cardiac Arrest

    Directory of Open Access Journals (Sweden)

    Bistra Iordanova


    Full Text Available Greater than 50% of patients successfully resuscitated from cardiac arrest have evidence of neurological disability. Numerous studies in children and adults, as well as in animal models have demonstrated that cerebral blood flow (CBF is impaired after cardiac arrest. Stages of cerebral perfusion post-resuscitation include early hyperemia, followed by hypoperfusion, and finally either resolution of normal blood flow or protracted hyperemia. At the level of the microcirculation the blood flow is heterogeneous, with areas of no flow, low flow, and increased flow. CBF directed therapies in animal models of cardiac arrest improved neurological outcome, and therefore, the alterations in CBF after cardiac arrest likely contribute to the development of hypoxic ischemic encephalopathy. Current intensive care after cardiac arrest is centered upon maintaining systemic oxygenation, normal blood pressure values for age, maintaining general homeostasis, and avoiding hyperthermia. Assessment of CBF and oxygenation is not routinely performed after cardiac arrest. Currently available and underutilized techniques to assess cerebral perfusion include transcranial doppler, near-infrared spectroscopy, and arterial spin labeling magnetic resonance imaging. Limited clinical studies established the role of CBF and oxygenation monitoring in prognostication after cardiac arrest and few studies suggest that guiding critical care post-resuscitation to mean arterial pressures above the minimal autoregulatory range might improve outcome. Important knowledge gaps thus remain in cerebral monitoring and CBF and oxygen goal-directed therapies post-resuscitation from cardiac arrest.

  2. Automated External Defibrillators Inaccessible to More Than Half of Nearby Cardiac Arrests in Public Locations During Evening, Nighttime, and Weekends

    DEFF Research Database (Denmark)

    Hansen, Carolina Malta; Wissenberg, Mads; Weeke, Peter


    BACKGROUND: Despite wide dissemination, use of automated external defibrillators (AEDs) in community settings is limited. We assessed how AED accessibility affected coverage of cardiac arrests in public locations. METHODS AND RESULTS: We identified cardiac arrests in public locations (1994...

  3. Registry of Unexplained Cardiac Arrest (United States)


    Cardiac Arrest; Long QT Syndrome; Brugada Syndrome; Catecholaminergi Polymorphic Ventricular Tachycardia; Idiopathic VentricularFibrillation; Early Repolarization Syndrome; Arrhythmogenic Right Ventricular Cardiomyopathy

  4. Understand Your Risk for Cardiac Arrest (United States)

    ... Thromboembolism Aortic Aneurysm More Understand Your Risk for Cardiac Arrest Updated:Mar 10,2017 Cardiac arrest may be ... arrest. This content was last reviewed March 2017. Cardiac Arrest • Home • About Cardiac Arrest • Understand Your Risk for ...

  5. ECPR for Refractory Out-Of-Hospital Cardiac Arrest (United States)


    Cardiac Arrest; Heart Arrest; Sudden Cardiac Arrest; Cardiopulmonary Arrest; Death, Sudden, Cardiac; Cardiopulmonary Resuscitation; CPR; Extracorporeal Cardiopulmonary Resuscitation; Extracorporeal Membrane Oxygenation

  6. 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 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 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

  7. Code Blue on Orbit: Treating Cardiac Arrest on the ISS (United States)

    Bacal, Kira; Redmond, Melissa


    As a result of the Columbia tragedy on February 1,2003, the International Space Station (ISS) crew size has been temporarily reduced from three to two. This change forces adaptations in many operational procedures used by the crew, including medical protocols which were designed for scenarios involving one casualty and two caregivers. The Office of Space Medicine directed that the procedure for the resuscitation of a crewmember in cardiac arrest be rewritten for use by a single care provider. Methods: Adaptation of this procedure made use of current American Heart Association Advanced Cardiac Life Support (ACLS) procedures and reflects necessary compromises between the realities of the operational environment and prompt provision of medical care. Results: Numerous changes were incorporated due to the diminution in available personnel, including substitution of endotracheal rather than intravenous delivery of drugs, more rapid defibrillation, addition of a precordial thump, removal of transcutaneous pacing, streamlining of procedural steps, and clarification of termination criteria. Discussion: The on-orbit care available to the ISS crewmembers is constrained by numerous factors, including crew medical training, minimal medical assets, limited air/ground communication , and a single caregiver for the foreseeable future. All of these combine to make a successful resuscitation unlikely, however, this procedure must ultimately deal with not only the patient's welfare, but also that of the caregiver, the mission, and the program.

  8. 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.

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

    ... and Blood Institute Start Here About Cardiac Arrest (American Heart Association) Sudden Cardiac Arrest (Texas Heart Institute) Also in ... Blood Institute) Understand Your Risk for Cardiac Arrest (American Heart Association) Warning Signs of Heart Attack, Stroke and Cardiac ...

  10. 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

  11. An airline cardiac arrest program

    National Research Council Canada - National Science Library

    O'Rourke, M F; Donaldson, E; Geddes, J S


    ...) available for use on airline passengers with cardiac arrest. AEDs were installed on international Qantas aircraft and at major terminals, selected crew were trained in their use, and all crew members were trained in cardiopulmonary resuscitation...

  12. 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.

  13. 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

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

    ... Specialist Share Twitter Facebook SCA Risk Assessment Sudden Cardiac Arrest (SCA) occurs abruptly and without warning, and two- ... and health conditions. Start Risk Assessment The Sudden Cardiac Arrest (SCA) Risk Assessment Tool is supported in part ...

  15. A descriptive study of feelings of arrested escape (entrapment and arrested anger in people presenting to an Emergency Department following an episode of self-harm

    Directory of Open Access Journals (Sweden)

    Martin Clarke


    Full Text Available Background and objectives: To explore the role of elevated feelings of anger and desires to escape (fight or flight which are experienced as inhibited, blocked and arrested (i.e. arrested anger and arrested flight escape leading to feelings of entrapment. This descriptive study developed measures of arrested anger and arrested flight and explored these in the context of a recent self-harm event in people presenting to a Hospital’s Emergency Department (ED.Methods: Fifty-eight individuals presenting to an ED following an act of self-harm were recruited. Participants completed newly developed measures of arrested flight, arrested anger and anger with self in regard to self-harm and suicide intent and depression. Results: 93% participants presented after self-poisoning. The majority (95% reported having experienced high escape motivation that felt blocked (arrested flight with 69% reporting feeling angry with someone but unable to express it (arrested anger. For many participants (53.7%, strong desires to escape from current situations and/or to express anger did not diminish immediately after the act. Limitations: As with many studies, a select group of participants agreed to take part and we did not keep records of how many refused.There are no other validated measures of arrested escape and arrested anger and so for this study, our short item-focused measures rely on face validity. Conclusions: Arrested defences of fight and flight, and self-criticism are common in those who have self-harmed and may continue after acts of self-harm. Many participants revealed that talking about their experiences of escape motivation and blocked anger (using our measures was helpful to them.   Practice points: •Feelings of entrapment and arrested anger are common in people who self-harm •Clinicians could benefit from increased awareness and measures of arrested flight and arrested anger•Discussing these concepts and experiences appears to be useful to

  16. DUI Arrests and Academic Attrition (United States)

    Thompson, Kevin M.; Richardson, Katie


    A sobering 2002 study reported that over 2 million college students drove under the influence of alcohol (DUI) in 1999. Among those driving while intoxicated, approximately 1.7% or roughly 34,000 students reported being arrested on DUI charges. Regrettably, a significant proportion of the 1,400 college student deaths and 500,000 injuries are…

  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. Remineralisation and arresting caries in children with topical fluorides. (United States)

    Gugnani, Neeraj; Gugnani, Shalini


    Data sourcesThe Cochrane Library, PubMed, Embase and the ISI Web of Science.Study selectionEnglish language clinical trials in children with outcome measures including the remineralisation or arresting effect of caries by professional fluoride treatment were considered.Data extraction and synthesisTwo reviewers screened the studies and assessed risk of bias. Random effects meta-analysis was conducted.ResultsSeventeen studies were included, ten focused on remineralisation, seven on arresting carious lesions. Meta-analysis of four studies using 5% fluoride varnish found a 63.6% (95% CI; 36.0% - 91.2%) remineralisation of early enamel caries. For five studies using 38% silver diamine fluoride solution meta-analysis found 65.9% (95% CI; 41.2% - 90.7%) of caries arrested.ConclusionsProfessionally applied 5% sodium fluoride varnish shows the capability to remineralise early enamel caries in children. Silver diamine fluoride solution at 38% is effective in arresting active dentine caries. Because the number of clinical trials that studied the arresting effect of dental caries is limited, more clinical trials should be performed.

  19. Effect of donor cardiac arrest and arrest duration on outcomes of lung transplantation. (United States)

    Mohite, Prashant N; Zych, Bartlomiej; Sabashnikov, Anton; Popov, Aron-Frederik; Garcia-Saez, Diana; Patil, Nikhil P; Koch, Achim; Zeriouh, Mohamed; Rahmanian, Parwis B; Dhar, Dhruva; Amrani, Mohamed; Bahrami, Toufan; DeRobertis, Fabio; Carby, Martin; Reed, Anna; Simon, Andre R


    Limited data are available about lung transplantation (LTx) from donors suffering cardiac arrest (CA) prior to actual donation. A retrospective analysis of LTx performed between January 2007 and September 2012 was done with the focus on CA in donors. The recipients were grouped depending on the history of donor CA and CA duration (downtime) as: No cardiac arrest ("NoCA"), CA downtime less than 20 min ("CA 20"). Early and mid-term outcomes after LTx were compared among the three groups. A total of 237 LTx were performed during the study period. One hundred eighty-eight patients received organs from "NoCA" donors, 25 from "CA 20" donors. There was a trend toward better overall cumulative survival in both CA groups (log rank p = 0.076) whereas the survival in the "CA > 20" group was significantly better than in the "NoCA" group in the subgroup analysis (log rank p = 0.045). Freedom from bronchiolitis obliterans syndrome (BOS) also increased with increase in CA duration, although it did not reach statistical significance. Transplantation of lungs from donors with a history of CA is safe and feasible. Longer duration of cardiac arrest may improve the outcomes after the LTx in terms of survival and freedom from BOS. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  20. Enforcement following 0.08% BAC law change: sex-specific consequences of changing arrest practices? (United States)

    Schwartz, Jennifer; Davaran, Ardavan


    This research evaluated effects of stricter 0.08% BAC drunken driving law on changes in sex-specific DUI arrest rates, controlling for increased law enforcement resources and shifts in DUI-related behaviors. Another main purpose, the study assessed female/male differences in arrest increases due to broader enforcement standards and efforts. Panel data was assembled for 24 states over 1990-2007 on DUI arrests, alcohol policy, law enforcement resources, drinking and drunken driving prevalence. Two-way fixed-effects seemingly unrelated regression models predicted female versus male changes in DUI arrests following implementation of lower legal limits of intoxication, net controls. Findings suggest, first, that a broader legal definition of drunken driving intending to officially sanction less serious offenders (0.08% vs. 0.10% BAC) was associated with increased DUI arrests for both sexes. Second, growth in specialized DUI-enforcement units also was related to increased arrests. Whereas male and female arrest trends were equally affected by the direct net-widening effects of 0.08% BAC alcohol-policy, specialized DUI-enforcement efforts to dig deeper into the offender-pool had stronger arrest-producing effects on females, particularly prior to law change. Specifying how changes in law and enforcement resources affect arrest outcomes is an important pre-cursor to alcohol-policy analyses of effectiveness. A potential unintended consequence, effects of law and enforcement may differ across population segments. Copyright © 2013 Elsevier Ltd. All rights reserved.

  1. An airline cardiac arrest program. (United States)

    O'Rourke, M F; Donaldson, E; Geddes, J S


    As many as 1000 lives are lost annually from cardiac arrest in commercial aircraft. Ventricular fibrillation (VF), the most common mechanism, can be treated effectively only with prompt defibrillation, whereas the current policy of most airlines is to continue cardiopulmonary resuscitation pending aircraft diversion. The objective of this study was to assess the impact of making semiautomatic external defibrillators (AEDs) available for use on airline passengers with cardiac arrest. AEDs were installed on international Qantas aircraft and at major terminals, selected crew were trained in their use, and all crew members were trained in cardiopulmonary resuscitation. Supervision was provided by medical volunteers or (remotely) by airline physicians. During a 64-month period, AEDs were used on 109 occasions: 63 times for monitoring an acutely ill passenger and 46 times for cardiac arrest. Twenty-seven episodes of cardiac arrest occurred in aircraft, often (11 of 27 [41%]) unwitnessed, and they were usually (21 of 27 [78%]) associated with asystole or pulseless idioventricular rhythm. All 19 arrests in terminals were witnessed; VF was present in 17 (89%). Overall, defibrillation was initially successful in 21 of 23 cases (91%). Long-term survival from VF was achieved in 26% (2 of 6 in aircraft and 4 of 17 in terminals). The ability to monitor cardiac rhythm aided decisions on diversion, which was avoided in most passengers with asystole or idioventricular rhythm. AEDs in aircraft and terminals, with appropriate crew training, are helpful in the management of cardiac emergencies. Survival from VF is practicable and is comparable with the most effective prehospital ambulance emergency services. Costly aircraft diversions can be avoided in clearly futile situations, enhancing the cost-effectiveness of the program.

  2. Cardiac arrest: resuscitation and reperfusion. (United States)

    Patil, Kaustubha D; Halperin, Henry R; Becker, Lance B


    The modern treatment of cardiac arrest is an increasingly complex medical procedure with a rapidly changing array of therapeutic approaches designed to restore life to victims of sudden death. The 2 primary goals of providing artificial circulation and defibrillation to halt ventricular fibrillation remain of paramount importance for saving lives. They have undergone significant improvements in technology and dissemination into the community subsequent to their establishment 60 years ago. The evolution of artificial circulation includes efforts to optimize manual cardiopulmonary resuscitation, external mechanical cardiopulmonary resuscitation devices designed to augment circulation, and may soon advance further into the rapid deployment of specially designed internal emergency cardiopulmonary bypass devices. The development of defibrillation technologies has progressed from bulky internal defibrillators paddles applied directly to the heart, to manually controlled external defibrillators, to automatic external defibrillators that can now be obtained over-the-counter for widespread use in the community or home. But the modern treatment of cardiac arrest now involves more than merely providing circulation and defibrillation. As suggested by a 3-phase model of treatment, newer approaches targeting patients who have had a more prolonged cardiac arrest include treatment of the metabolic phase of cardiac arrest with therapeutic hypothermia, agents to treat or prevent reperfusion injury, new strategies specifically focused on pulseless electric activity, which is the presenting rhythm in at least one third of cardiac arrests, and aggressive post resuscitation care. There are discoveries at the cellular and molecular level about ischemia and reperfusion pathobiology that may be translated into future new therapies. On the near horizon is the combination of advanced cardiopulmonary bypass plus a cocktail of multiple agents targeted at restoration of normal metabolism and

  3. Who Is at Risk for Sudden Cardiac Arrest? (United States)

    ... Back To Health Topics / Sudden Cardiac Arrest Sudden Cardiac Arrest Also known as Cardiac Arrest , Sudden Cardiac Death ... the condition For People Who Have Survived Sudden Cardiac Arrest If you've already had SCA, you're ...

  4. How Can Death Due to Sudden Cardiac Arrest Be Prevented? (United States)

    ... Back To Health Topics / Sudden Cardiac Arrest Sudden Cardiac Arrest Also known as Cardiac Arrest , Sudden Cardiac Death ... the condition For People Who Have Survived Sudden Cardiac Arrest If you've already had SCA, you're ...

  5. Police Response to Mandatory Arrest Laws. (United States)

    Mignon, Sylvia I.; Holmes, William M.


    Examines how police officers in 24 departments have responded to mandatory arrest statutes in 861 cases of domestic violence. Arrests of offenders, especially those violating restraining orders, increased. Arrest was affected by victim injury, use of a weapon, use of alcohol, and presence of a witness. Police training was crucial to implementation…

  6. 42 CFR 426.557 - Optional provisions of the Board's decision. (United States)


    ... COVERAGE DETERMINATIONS Review of an NCD § 426.557 Optional provisions of the Board's decision. When appropriate, the Board may limit a decision holding invalid a specific provision(s) of an NCD to specific...

  7. Cardiac arrests in schools: assessing use of automated external defibrillators (AED) on school campuses. (United States)

    Swor, Robert; Grace, Heather; McGovern, Heather; Weiner, Michelle; Walton, Edward


    Sudden cardiac arrest in schools are infrequent, but emotionally charged events. The purpose of our study was to: (1) describe characteristics and outcomes of school cardiac arrests; and (2) assess the feasibility of conducting school bystander interviews to describe the events surrounding cardiac arrests, assess AED availability and use, and identify barriers to AED use. We performed a telephone survey of bystanders to cardiac arrests occurring in K-12 schools in communities participating in the Cardiac Arrest Registry to Enhance Survival (CARES) database and a local cardiac arrest database. The study period was from 8/2005 to 8/2011 and continued in one community through 2011. Utstein style descriptive data and outcomes were collected. A structured telephone interview of a bystander or administrative personnel was conducted for each cardiac arrest event. We collected a descriptive event summary, including provision of bystander CPR, presence of an AED and information regarding AED deployment, training, and use and perceived barriers to AED use. Descriptive data are reported. During the study period there were 30,603 cardiac arrests identified at study communities, of which 47 (0.15%) events were at K-12 schools. Of these, 21 (45.7%) were at high schools, a minority (16, 34.0%) were children (a majority (36, 76.6%) received bystander CPR, and 27 (57.4%) were initially in ventricular fibrillation (VF). Most arrests (28/40, 70%) occurred during the school day (7a-5p). From this population, 15 (31.9%) survived to hospital discharge. A telephone interview was completed for 30 of 47 K-12 events. Nineteen schools had an AED on site. Most schools (84.2%) with AEDs reported that they had a training program, and personnel identified for its use. An AED was applied in 11 of 19 patients, of these 8 were in VF and 4 (all VF) survived to hospital discharge. Bystanders identified multiple reasons for non-use of the AED in the other eight patients. Cardiac arrests in schools are

  8. 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.

  9. Evaluation of surge protection in underground distribution systems using zinc oxide (metal oxide) surge arresters

    Energy Technology Data Exchange (ETDEWEB)

    Banda, J.


    Application of zinc oxide arresters represents a significant development in surge protection. One area of distribution system protection where the new arrester technology can be immediately valuable is underground distribution system protection. Increasing system voltage levels and the economic advantages of lower basic insulation level have led to increased interest in improving protection of underground distribution system equipment. Because conventional silicon-carbide surge arresters have not met the challenges imposed by system requirements, costly alternatives such as paralleling arresters have been used in an attempt to limit surges imposed on systems. In this thesis differences between the two types of arresters are reviewed, and an evaluation of surge protection employing zinc oxide arresters in underground distribution systems is carried out. In order to evaluate zinc oxide surge arrester's performance under various conditions, transient phenomena of single- and multi-line underground distribution systems, with and without surge arresters, are studied. The conditions considered include; (i) low and high surge impedance systems, (ii) slow and fast front surges and (iii) different line terminations. Actual data obtained from a typical and operative underground distribution system is used in the study.

  10. Out-of-hospital cardiac arrest

    DEFF Research Database (Denmark)

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


    : We used data from the nationwide Danish Cardiac Arrest Registry and the Danish AED Network to identify out-of-hospital cardiac arrests and route distances to nearest accessible registered AED during 2008-2013. The association between route distance and bystander defibrillation was described using...... restricted cubic spline logistic regression. RESULTS: We included 6,971 out-of-hospital cardiac arrest cases. The proportion of arrests according to distance in meters (≤100, 101-200, >200) to the nearest accessible AED was: 4.6% (n=320), 5.3% (n=370), and 90.1% (n=6,281), respectively. For cardiac arrests......meters route distance from cardiac arrest to nearest accessible AED whereas the probability of bystander defibrillation was low for all distances in residential areas....

  11. Successful heart transplantation after prolonged cardiac arrest and extracorporeal life support in organ donor-a case report. (United States)

    Arroyo, Diego; Gasche, Yvan; Banfi, Carlo; Stiasny, Brian; Bendjelid, Karim; Giraud, Raphaël


    Although heart transplantation is a successful therapy for patients suffering from end-stage heart failure, the therapeutic is limited by the lack of organs. Donor cardiac arrest is a classic hindrance to heart retrieval as it raises issues on post-transplant outcomes. The present case reports a successful heart transplantation after prolonged donor cardiac arrest (total lowflow time of 95 minutes) due to anaphylactic shock necessitating extracorporeal life support. We further provide an overview of the current evidence and outcomes of heart transplantation in cases of donor cardiac arrest. Providing that donor and recipient criteria are respected, donor cardiac arrest does not seem to be an adverse predictor in heart transplantation.

  12. 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

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

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


    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 upregulated during recovery from growth-arrested states. This expression pattern is anticorrelated to nonoperon 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. We provide evidence that 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. Copyright © 2011 Elsevier Inc. All rights reserved.

  14. Post-resuscitation care following out-of-hospital and in-hospital cardiac arrest. (United States)

    Girotra, Saket; Chan, Paul S; Bradley, Steven M


    Cardiac arrest is a leading cause of death in developed countries. Although a majority of cardiac arrest patients die during the acute event, a substantial proportion of cardiac arrest deaths occur in patients following successful resuscitation and can be attributed to the development of post-cardiac arrest syndrome. There is growing recognition that integrated post-resuscitation care, which encompasses targeted temperature management (TTM), early coronary angiography and comprehensive critical care, can improve patient outcomes. TTM has been shown to improve survival and neurological outcome in patients who remain comatose especially following out-of-hospital cardiac arrest due to ventricular arrhythmias. Early coronary angiography and revascularisation if needed may also be beneficial during the post-resuscitation phase, based on data from observational studies. In addition, resuscitated patients usually require intensive care, which includes mechanical ventilator, haemodynamic support and close monitoring of blood gases, glucose, electrolytes, seizures and other disease-specific intervention. Efforts should be taken to avoid premature withdrawal of life-supporting treatment, especially in patients treated with TTM. Given that resources and personnel needed to provide high-quality post-resuscitation care may not exist at all hospitals, professional societies have recommended regionalisation of post-resuscitation care in specialised 'cardiac arrest centres' as a strategy to improve cardiac arrest outcomes. Finally, evidence for post-resuscitation care following in-hospital cardiac arrest is largely extrapolated from studies in patients with out-of-hospital cardiac arrest. Future studies need to examine the effectiveness of different post-resuscitation strategies, such as TTM, in patients with in-hospital cardiac arrest. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to

  15. Prediction of cardiac arrest recurrence using ensemble classifiers

    Indian Academy of Sciences (India)

    Inability of a heart to contract effectually or its failure to contract prevents blood from circulating efficiently, causing circulatory arrest or cardiac arrest or cardiopulmonary arrest. The unexpected cardiac arrest is medically referred to as sudden cardiac arrest (SCA). Poor survival rate of patients with SCA is one of themost ...

  16. Psychopathology in Women Arrested for Domestic Violence (United States)

    Stuart, Gregory L.; Moore, Todd M.; Gordon, Kristina Coop; Ramsey, Susan E.; Kahler, Christopher W.


    This study examined the prevalence of psychopathology among women arrested for violence and whether the experience of intimate partner violence (IPV) was associated with Axis I psychopathology. Women who were arrested for domestic violence perpetration and court referred to violence intervention programs (N=103) completed measures of IPV…

  17. Collapse arresters for deep water pipelines: identification of crossover mechanisms

    Energy Technology Data Exchange (ETDEWEB)

    Toscano, Rita G.; Mantovano, Luciano; Assanelli, Andrea; Amenta, Pablo; Johnson, Daniel; Charreau, Roberto; Dvorkin, Eduardo [Tenaris Center for industrial Research (CINI), Siderca, Campana (Argentina)


    Deep water pipelines, normally subjected to external pressure and bending, fail due to structural collapse when the external loading exceeds the pipes collapse limit surface. For steel pipes, the influence on this limit surface of manufacturing imperfections has been thoroughly studied by CINI using finite element models that have been validated via laboratory full-scale tests. After a steel pipeline collapses, the collapse is restrained to the collapse initiation section or it propagates along the pipeline, being this second alternative the most detrimental one for the pipeline integrity. Therefore, it is necessary to build in the pipeline periodic reinforcements, to act as arresters for the collapse propagation. Using finite element models, we study the crossover of collapse arresters by the propagating collapse. The occurrence of different crossover mechanisms is determined by the geometry of the pipes and of the arresters. Laboratory tests were carried out at CINI in order to obtain experimental results that could be used to validate the numerical models. In this paper, we compare the numerical and experimental results for external pressure lo (author)

  18. Assessment of fall-arrest systems for scissor lift operators: computer modeling and manikin drop testing. (United States)

    Pan, Christopher S; Powers, John R; Hartsell, Jared J; Harris, James R; Wimer, Bryan M; Dong, Renguang G; Wu, John Z


    The current study is intended to evaluate the stability of a scissor lift and the performance of various fall-arrest harnesses/lanyards during drop/fall-arrest conditions and to quantify the dynamic loading to the head/ neck caused by fall-arrest forces. No data exist that establish the efficacy of fall-arrest systems for use on scissor lifts or the injury potential from the fall incidents using a fall-arrest system. The authors developed a multibody dynamic model of the scissor lift and a human lift operator model using ADAMS and LifeMOD Biomechanics Human Modeler. They evaluated lift stability for four fall-arrest system products and quantified biomechanical impacts on operators during drop/fall arrest, using manikin drop tests. Test conditions were constrained to flat surfaces to isolate the effect of manikin-lanyard interaction. The fully extended scissor lift maintained structural and dynamic stability for all manikin drop test conditions. The maximum arrest forces from the harnesses/lanyards were all within the limits of ANSI Z359.1. The dynamic loading in the lower neck during the fall impact reached a level that is typically observed in automobile crash tests, indicating a potential injury risk for vulnerable participants. Fall-arrest systems may function as an effective mechanism for fall injury protection for operators of scissor lifts. However, operators may be subjected to significant biomechanical loadings on the lower neck during fall impact. Results suggest that scissor lifts retain stability under test conditions approximating human falls from predefined distances but injury could occur to vulnerable body structures.

  19. Myocardial Dysfunction and Shock after Cardiac Arrest (United States)

    Jentzer, Jacob C.; Chonde, Meshe D.; Dezfulian, Cameron


    Postarrest myocardial dysfunction includes the development of low cardiac output or ventricular systolic or diastolic dysfunction after cardiac arrest. Impaired left ventricular systolic function is reported in nearly two-thirds of patients resuscitated after cardiac arrest. Hypotension and shock requiring vasopressor support are similarly common after cardiac arrest. Whereas shock requiring vasopressor support is consistently associated with an adverse outcome after cardiac arrest, the association between myocardial dysfunction and outcomes is less clear. Myocardial dysfunction and shock after cardiac arrest develop as the result of preexisting cardiac pathology with multiple superimposed insults from resuscitation. The pathophysiology involves cardiovascular ischemia/reperfusion injury and cardiovascular toxicity from excessive levels of inflammatory cytokine activation and catecholamines, among other contributing factors. Similar mechanisms occur in myocardial dysfunction after cardiopulmonary bypass, in sepsis, and in stress-induced cardiomyopathy. Hemodynamic stabilization after resuscitation from cardiac arrest involves restoration of preload, vasopressors to support arterial pressure, and inotropic support if needed to reverse the effects of myocardial dysfunction and improve systemic perfusion. Further research is needed to define the role of postarrest myocardial dysfunction on cardiac arrest outcomes and identify therapeutic strategies. PMID:26421284

  20. 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.

  1. Coordination of the insulation and the choice of lightning arresters

    Energy Technology Data Exchange (ETDEWEB)

    Goldstein, A.


    The relationship between the operating conditions and the necessary insulation levels is investigated for networks operating at 525 and 750 kV. The use of high-voltage shunt reactors limits the power-frequency overvoltages and allows lightning arresters having a lower voltage rating to be used. Their use to limit switching surges is discussed and related to the withstand strength of the insulation in air and when immersed in oil. A table lists the attainable insulation levels that were calculated. Also stated are the levels employed in completed installations or visualized for projected networks.

  2. Preventing and arresting coronary atherosclerosis. (United States)

    Roberts, W C


    The good news about coronary atherosclerosis is that it takes an awful lot of plaque before symptoms of myocardial ischemia occur. The bad news is that despite the need for large quantities of plaque for symptoms to occur, nevertheless nearly half of us in the United States eventually have the necessary quantity. Atherosclerosis is infrequently hereditary in origin. Most of us get atherosclerosis because we consume too much fat, cholesterol, and calories. The consequence is an elevated ( > 150 mg/dl) serum total cholesterol level, and the higher the number is above 150, the greater is the quantity of plaque deposited in our arteries. If the serum total cholesterol level can be prevented from rising to more than 150 mg/dl, plaques are not laid down; if elevated levels are lowered to 150 mg/dl, further plaque does not form, and parts of those present may vanish. A fruit-vegetarian-starch diet is necessary as a rule to achieve the 150 mg/dl level in most adults. Lipid-lowering drugs are required in the patients with familial hypercholesterolemia and in most patients with atherosclerotic events. The best news about atherosclerosis is that it can be prevented in those without the hereditary form, and it can be arrested by lowering elevated serum total (and LDL) cholesterol to the 150 mg/dl level.

  3. 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…

  4. Women's perspectives on the context of violence and role of police in their intimate partner violence arrest experiences. (United States)

    Li, Simiao; Levick, Ani; Eichman, Adelaide; Chang, Judy C


    Intimate partner violence (IPV) accounts for up to 50% of all calls to police. In an effort to standardize arrest criteria, mandatory arrest laws were established. It is unclear whether subsequent increased rates of female arrest are due to greater recognition of female IPV perpetrators or of women acting in self-defense. This study aims to understand the context and consequences of IPV-related arrest from perspectives of women arrested in a single metropolitan area. Semi-structured qualitative interviews were conducted with women arrested and court-ordered to attend IPV education groups at a women's shelter in the Northeast United States. Interviews addressed circumstances surrounding arrest, experience with past violence, and reasoning regarding use of partner violence. Two researchers independently coded transcripts and met to iteratively refine the code and review transcripts for themes. Eighteen women were interviewed. Major themes that emerged were as follows: (a) Women's use of violence occurred within the context of their own victimization; (b) the arrest included a complex interplay between subject, partner, and police; (c) women perceived police arrest decisions to be based on a limited understanding of context; and (d) women experienced both positive and negative consequences of arrest. Many relationships did not fall under the traditional victim/perpetrator construct. Rather, women's use of violence evolved, influenced by prior experiences with violence. More appropriate methods must be developed for making arrest decisions, guiding justice system responses, and developing interventions for couples experiencing IPV. Recognition that women's use of partner violence often represented either a retaliatory or self-defensive gesture within the context of prior victimization suggests that victims' interventions should not only focus on empowerment but also provide skills and strategies to avoid temptation to adopt aggression as a primary method of self

  5. Medicaid program; cost limit for providers operated by units of government and provisions to ensure the integrity of federal-state financial partnership. Final rule; implementation of court orders. (United States)


    This final rule amends Medicaid regulations to conform with the decision by the United States District Court for the District of Columbia on May 23, 2008 in Alameda County Medical Center, et al. v. Michael O. Leavitt, Secretary, U.S. Department of Health and Human Services, et al., 559 F. Supp. 2d (2008) that vacated a final rule with comment period published in the Federal Register in May 29, 2007. This regulatory action takes ministerial steps to remove the vacated provisions from the Code of Federal Regulations and reinstate the prior regulatory language impacted by the May 29, 2007 final rule with comment period.

  6. Use of Automated External Defibrillators in Cardiac Arrest (United States)


    volunteers whereas the OPALS study investigators did not. Cost-Effectiveness A systematic review of the literature suggests that cost-effectiveness varies from setting to setting. Most of the studies have estimated cost-effectiveness in American settings from a societal perspective; therefore, the results are not applicable to this report. However, results from this review suggest that the incidence of cardiac arrest in out-of-hospital setting in Ontario is 59 per 100,000 people. The mean age of cardiac arrest patients is 69 years. Eighty-five percent of these cardiac arrests occur in homes. Of all the cardiac arrests, 37% have heart rhythm abnormalities (ventricular tachycardia or ventricular fibrillation) that are correctable by delivering shock through an AED. Thus, in an out-of-hospital setting, general use of AEDs by laypersons would not be cost-effective. Special programs are needed in the out-of-hospital setting for cost-effective use of AEDs. One model for the use of AEDs in out-of-hospital settings was examined in the OPALS study. Firefighters and police were trained and provided with AEDs. The total initial cost (in US dollars) of this program was estimated to be $980,000. The survival rate was 3.9% before implementing the AED program and 5.2% after its implementation (OR, 1.33; 95% CI, 1.03–1.7; P = .03). Applying these estimates to cardiac arrest rates in Ontario in 2002, one would expect 54 patients of the total 1,395 cardiac arrests to survive without AEDs compared with 73 patients with AEDs; thus, 19 additional lives might be saved each year with an AED program. It would initially cost $51,579 to save each additional life. In subsequent years, however, total cost would be lower (about $50,000 per year), when it would cost $2,632 to save each additional life per year. One limitation of the OPALS study was that the authors combined emergency medical service response time and application of an AED into a single variable. Thus, it was not possible to tease out

  7. 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).

  8. 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.

  9. 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…

  10. Simultaneous Radial Lengthening and Ulnar Shortening for a Delayed Presentation of Radius Distal Physeal Arrest: A Case Report

    Directory of Open Access Journals (Sweden)

    Erdal Uzun


    Full Text Available Distal radius fractures are common injuries in both children and in the elderly (25%; 18%. Distal radius physeal fractures have a high incidence, but physeal growth arrest occurs at a low rate. As a main deformity, radial shortening occurs with relative ulnar overgrowth leading to significant complaints of pain and functional limitations after distal radial growth arrest. In this paper we aim to report on the restoration of the wrist mechanics attained by performing a surgical technique of simultaneous radial lengthening and ulnar shortening procedures in an adolescent with a significant ulnar overgrowth deformity due to a posttraumatic growth arrest of distal radius.

  11. Miller Fisher syndrome with sinus arrest

    Directory of Open Access Journals (Sweden)

    Nobuko Shiraiwa


    Full Text Available Dysautonomia in Guillain-Barre syndrome (GBS rarely causes serious cardiovascular complications, such as sinus arrest. Miller Fisher syndrome (MFS is recognized as a variant of GBS. There have been few reports regarding the association between MFS and dysautonomia. We describe a case of a 68-year-old man with ophthalmoplegia, bulbar palsy, truncal ataxia, and areflexia. He was diagnosed with MFS because he exhibited the classical clinical triad and had elevated serum anti- GQ1b immunoglobulin G levels. A magnetic resonance imaging scan of his head was normal. His 24-hour Holter recording showed sinus arrest. He was treated with intravenous immunoglobulin, whereupon his symptoms gradually improved. This included the sinus arrest, which was considered a symptom of dysautonomia in MFS. Therefore, clinicians should be mindful of dysautonomia not only in GBS patients, but also in cases of MFS.

  12. Provisions of English Statutory Law on Servitudes

    Directory of Open Access Journals (Sweden)

    Viktoria S. Arhipova


    Full Text Available In the presented article author tried to list and describe in detail the statutory law of England concerning the right of another's property limited use, analyze laws on servitudes, highlight the most basic features of servitudes in English law. Also in the article such provisions of limited use of foreign property law are given, which are characteristic exclusively for English law, shows the relationship of the statutory law of England in this relationship with doctrine and judicial precedent.

  13. 48 CFR 3.808 - Solicitation provision and contract clause. (United States)


    ... GENERAL IMPROPER BUSINESS PRACTICES AND PERSONAL CONFLICTS OF INTEREST Limitations on the Payment of Funds To Influence Federal Transactions 3.808 Solicitation provision and contract clause. (a) Insert the provision at 52.203-11, Certification and Disclosure Regarding Payments to Influence Certain Federal...

  14. 7 CFR 457.113 - Coarse grains crop insurance provisions. (United States)


    ... Grains Crop Provisions If a conflict exists among the policy provisions, the order of priority is as..., including but not limited to protein and oil, will not be considered. Planted acreage—In addition to the... corn, and excluding: (i) High-amylose, high-oil, high-protein, flint, flour, Indian, or blue corn, or a...

  15. Association between a Hospital’s Rate of Cardiac Arrest Incidence and Cardiac Arrest Survival (United States)

    Chen, Lena M.; Nallamothu, Brahmajee K.; Spertus, John A.; Li, Yan; Chan, Paul S.


    Context National efforts to measure hospital performance for cardiac arrest have focused on case survival, with the hope of improving survival after cardiac arrest. However, it is plausible that hospitals with high case-survival rates do a poor job of preventing cardiac arrests in the first place. Objective To describe the association between inpatient cardiac arrest incidence and survival rates. Design, Setting, and Patients Within a large, national registry, we identified hospitals with at least 50 adult in-hospital cardiac arrest cases between January 1, 2000 and November 30, 2009. We used multivariable hierarchical regression to evaluate the correlation between a hospital’s cardiac arrest incidence rate and its case-survival rate after adjusting for patient and hospital characteristics. Main Outcome Measure The correlation between a hospital’s incidence rate and case-survival rate for cardiac arrest. Results Of 102,153 cases at 358 hospitals, the median hospital cardiac arrest incidence rate was 4.02 per 1000 admissions (IQR: 2.95 to 5.65 per 1000 admissions), and the median hospital case-survival rate was 18.8% (IQR: 14.5% to 22.6%). In crude analyses, hospitals with higher case-survival rates also had lower cardiac arrest incidence (correlation of -0.16; P=0.003). This relationship persisted after adjusting for patient characteristics (correlation of -0.15; P=0.004). After adjusting for potential mediators of this relationship (i.e., hospital characteristics), the relationship between incidence and case-survival was attenuated (correlation of -0.07; P=0.18). The one modifiable hospital factor that most attenuated this relationship was a hospital’s nurse-to-bed ratio (correlation of -0.12; P=0.03). Conclusions Hospitals with exceptional rates of survival for in-hospital cardiac arrest are also better at preventing cardiac arrests, even after adjusting for patient case-mix. This relationship is partially mediated by measured hospital attributes

  16. 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; Hammond, Naomi; Willenberg, Lynsey; Miller, Jennene; Inskip, Deborah; Macken, Lewis; Eatough, Noel; Bass, Frances; Yarad, Elizabeth; O'Connor, Anne; Bird, Simon; Jewell, Timothy; Davies, Gareth; Ng, Karl; Coward, Sharon; Parker, Sharyn; Cortado, Dennis; Gould, Ann; Harward, Meg; Thompson, Kelly; Belholavek, Jan; Kreckova, Marketa; Kral, Ales; Horak, Jan; Otahal, Michal; Rulisek, Jan; Malik, Jan; Prettl, Martin; Wascher, Michael; Boesgaard, Soeren; Moller, Jacob E.; Johansen, Ane Loof; Campanile, Vincenzo; Peratoner, Alberto; Verginella, Francesca; Leone, Daniele; Roncarati, Andrea; Franceschino, Eliana; Sanzani, Anna; Martini, Alice; Perlin, Micol; Pelosi, Paolo; Insorsi, Angelo; Pezzato, Stefano; de Luca, Giorgio; Gazzano, Emanuela; Ottonello, Gian Andrea; Furgani, Andrea; Telani, Rosanna; Maiani, Simona; Kieffer, Jaqueline; vd Veen, Annelou L.; Winters, Tineke; Bosch, Frank; Raaijmakers, Monique A. M.; Metz-Hermans, S. W. L.; Endeman, Henrik; Rijkenberg, Saskia; Bianchi, Addy; Norum, Hilde; Espinoza, Andreas; Kerans, Viesturs; Brevik, Helene; Svalebjørg, Morten; Grindheim, Guro; Petersen, Arne Jan; Baratt-Due, Andreas; Laake, Jon Henrik; Spreng, Ulrik; Karlsen, Marte Marie Wallander; Langøren, Jørund; Fanebust, Rune; Holm, Marianne Sætrang; Flinterud, Stine Iren; Wickman, Carsten; Johnsson, Jesper; Ebner, Florian; Gustavsson, Nerida; Petersson, Heléne; Petersson, Jörgen; Nasiri, Faezheh; Stafilidou, Frida; Edqvist, Kristine; Uhlig, Sven; Sköld, Gunilla; Sanner, Johan; Wallskog, Jesper; Wyon, Nicholas; Golster, Martin; Samuelsson, Anders; Hildebrand, Carl; Kadowaki, Taichi; Larsson-Viksten, Jessica; de Geer, Lina; Hansson, Patrik; Appelberg, Henrik; Hellsten, Anders; Lind, Susanne; Kander, Thomas; Persson, Johan; Annborn, Martin; Adolfsson, Anne; Corrigan, Ingrid; Dragancea, Irina; Undén, Johan; Larsson, Marina; Chew, Michelle; Unnerbäck, Mårten; Petersen, Per; Svedung-Rudebou, Anna; Svensson, Robert; Elvenes, Hilde; Bäckman, Carl; Martner, Patrik; Martinell, Louise; Biber, Björn; Ahlqvist, Marita; Jacobson, Caisa; Forsberg, Marie-Louise; Lindgren, Roman Desta; Bergquist, Fatma; Thorén, Anders; Fredholm, Martin; Sellgren, Johan; Segerstad, Lisa Hård af; Löfgren, Mikael; Gustavsson, Ingvor; Henström, Christina; Andersson, Bertil; Thiringer, Karin; Rydholm, Nadja; Persson, Stefan; Jawad, Jawad; Östman, Ingela; Berglind, Ida; Bergström, Eric; Andersson, Annika; Törnqvist, Cathrine; de Mello, Nubia Lafayete Marques; Gardaz, Valérie; Kleger, Gian-Reto; Schrag, Claudia; Fässler, Edith; Zender, Hervé; Wise, Matthew; Palmer, Nicki; Fouweather, Jen; Cole, Jade M.; Cocks, Eve; Frost, Paul J.; Saayman, Anton G.; Holmes, Tom; Scholey, Gareth M.; Watkins, Helen; Fernandez, Stephen; Walden, Andrew; Atkinson, Jane; Jacques, Nicola; Brown, Abby; Cranshaw, Julius; Berridge, Peter; McCormick, Robert; Schuster-Bruce, Martin; Scott, Michelle; White, Nigel; Vickers, Emma; Glover, Guy; Ostermann, Marlies; Holmes, Paul; Koutroumanidis, Michael; Lei, Katie; Sanderson, Barnaby; Smith, John; Moore, Matthew; Randall, Paul; Mellinghoff, Johannes; Buratti, Azul Forti; Ryan, Chris; Ball, Jonathan; Francis, Gaynor


    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

  17. Warning Signs of Heart Attack, Stroke and Cardiac Arrest (United States)


  18. Heart Attack or Sudden Cardiac Arrest: How Are They Different? (United States)

    ... Thromboembolism Aortic Aneurysm More Heart Attack or Sudden Cardiac Arrest: How Are They Different? Updated:Sep 19,2016 ... flow to the heart is blocked, and sudden cardiac arrest is when the heart malfunctions and suddenly stops ...

  19. Respiratory arrest after retrobulbar anaesthesia | Ashaye | West ...

    African Journals Online (AJOL)

    This is a report of a patient who developed respiratory arrest some minutes after retrobulbar block was given for ocular anesthesia before cataract extraction. She was managed by artificial ventilation and haemodynamic support without any cardiac or neurological sequelae. This report highlights this rare but fatal ...

  20. Cerebral dysplastic vascular malformation: a developmental arrest

    Energy Technology Data Exchange (ETDEWEB)

    Wortzman, G.; Sima, A.A.F.; Morley, T.P.


    A cryptic malformation of the brain was found to represent an arrest in vascular development. Microscopy showed plump endothelium of blood vessels, which did not have a normal lumen and consisted of solid cords of cells. The microscopic, angiographic, and computed tomographic appearance of this anomaly are discussed and compared with cavernous angiomas, arteriovenous malformations, and venous angiomas.

  1. Sudden cardiac arrest risk in young athletes

    African Journals Online (AJOL)

    Underlying cardiac abnormalities are the main cause of unexpected death in athletes on field. These abnormalities have been associated with a previous history of syncope, a family history of sudden cardiac arrest (SCA), cardiac murmur, a history of over-exhaustion post exercise and ventricular tachyarrhythmia during ...

  2. 32 CFR 935.122 - Arrests. (United States)


    ..., without a warrant, for any crime (including a petty offense) that is committed in his presence. (b) Any... this part or commits a crime that is not a violation of this part, in his presence, or that he... to enter any building, vehicle, or aircraft to execute a warrant of arrest, force an entry after...

  3. 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.

  4. Fall arrest characteristics of a scissor lift. (United States)

    Harris, James R; Powers, John R; Pan, Christopher S; Boehler, Brad


    Census of Fatal Occupational Injuries (CFOI) data indicate 306 aerial lift fatalities between 1992-2003. Seventy-eight of these fatalities specifically involved scissor lifts. Members of standards committees have requested that NIOSH conduct research to determine the effects of safety-control practices related to using fall-protection systems for scissor lifts. This research examined the structural and dynamic stability of a scissor lift subjected to fall arrest forces. This was accomplished by conducting drop tests from a scissor lift. Anchorage locations evaluated included manufacturer-supplied anchorage points on the scissor lift platform as well as mid-rail and top-rail locations. Preliminary drop tests determined that a 2400 lb maximum arrest force (MAF) could be generated by dropping 169 lb through a fall height of 36" using Nystron rope as a lanyard. The scissor lift maintained structural and dynamic stability for all drop tests when fully extended and on an incline. Anchoring a fall arrest system to either the mid-rail or top-rail is not a recommended practice by the scissor lift manufacturer. Anchor points are provided on the platform floor of the scissor lift for this purpose. However, our results demonstrate that the mid-rail and top-rail absorb substantial energy from an arrested fall and may have potential as appropriate anchorage points. Employers and workers should consider implementing fall arrest systems when using scissor lifts as part of their overall risk mitigation plan for fall injury prevention. (c) 2010 National Safety Council. Published by Elsevier Ltd. All rights reserved.

  5. 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...... (risk ratio, 1.01; 95% CI, 0.89 to 1.14; P=0.87). The results of analyses adjusted for known prognostic factors were similar. Conclusions In unconscious survivors of out-of-hospital cardiac arrest of presumed cardiac cause, hypothermia at a targeted temperature of 33°C did not confer a benefit...

  6. 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 ...

  7. 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...

  8. 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.

  9. Surge arresters - Part 5: Selection and application recommendations

    CERN Document Server

    International Electrotechnical Commission. Geneva


    Provides recommendations for the selection and application of surge arresters to be used in three-phase systems with nominal voltages above 1kV. It applies to non-linear resistor type gapped surge arresters as defined in IEC 60099-1 and to gapless metal-oxide surge arresters as defined in IEC 60099-4.

  10. 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


    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...... 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...... and medication. To investigate the importance of cardiac arrest related factors and chronic disease and medication use we performed adjusted Cox regression analyses during day 0-7 and day 8-365 following cardiac arrest to calculate hazard ratios (HR) for death. RESULTS: Day 0-7: Un-adjusted HR for death day 0...

  11. 7 CFR 457.141 - Rice crop insurance provisions. (United States)


    ... (Appropriate title for insurance provider) Both FCIC and Reinsured Policies Rice Crop Provisions If a conflict... Standards for Rice including, but not limited to, protein and oil content or milling quality will not be...

  12. Arrest History and Intimate Partner Violence Perpetration in a Sample of Men and Women Arrested for Domestic Violence


    Shorey, Ryan C.; Ninnemann, Andrew; Elmquist, Joanna; Labrecque, Lindsay; Zucosky, Heather; Febres, Jeniimarie; Brasfield, Hope; Temple, Jeff R.; Stuart, Gregory L.


    Intimate partner violence (IPV) is a serious and prevalent problem throughout the United States. Currently, individuals arrested for domestic violence are often court mandated to batterer intervention programs (BIPs). However, little is known about the arrest histories of these individuals, especially women. The current study examined the arrest histories of men (n = 303) and women (n = 82) arrested for domestic violence and court-referred to BIPs. Results demonstrated that over 30% of the en...

  13. Reasons for intimate partner violence perpetration among arrested women. (United States)

    Stuart, Gregory L; Moore, Todd M; Gordon, Kristina Coop; Hellmuth, Julianne C; Ramsey, Susan E; Kahler, Christopher W


    There are limited empirical data regarding the reasons or motives for the perpetration of intimate partner violence among women arrested for domestic violence and court referred to violence intervention programs. The present study examined arrested women's self-report reasons for partner violence perpetration and investigated whether women who were victims of severe intimate partner violence were more likely than were women who were victims of minor partner violence to report self-defense as a reason for their behavior. In all, 87 women in violence intervention programs completed a measure of violence perpetration and victimization and a questionnaire assessing 29 reasons for violence perpetration. Self-defense, poor emotion regulation, provocation by the partner, and retaliation for past abuse were the most common reasons for violence perpetration. Victims of severe partner violence were significantly more likely than were victims of minor partner violence to report self-defense as a reason for their violence perpetration. The clinical implications of these findings are discussed.

  14. 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.

  15. Computation Molecular Kinetics Model of HZE Induced Cell Cycle Arrest (United States)

    Cucinotta, Francis A.; Ren, Lei


    Cell culture models play an important role in understanding the biological effectiveness of space radiation. High energy and charge (HZE) ions produce prolonged cell cycle arrests at the G1/S and G2/M transition points in the cell cycle. A detailed description of these phenomena is needed to integrate knowledge of the expression of DNA damage in surviving cells, including the determination of relative effectiveness factors between different types of radiation that produce differential types of DNA damage and arrest durations. We have developed a hierarchical kinetics model that tracks the distribution of cells in various cell phase compartments (early G1, late G1, S, G2, and M), however with transition rates that are controlled by rate-limiting steps in the kinetics of cyclin-cdk's interactions with their families of transcription factors and inhibitor molecules. The coupling of damaged DNA molecules to the downstream cyclin-cdk inhibitors is achieved through a description of the DNA-PK and ATM signaling pathways. For HZE irradiations we describe preliminary results, which introduce simulation of the stochastic nature of the number of direct particle traversals per cell in the modulation of cyclin-cdk and cell cycle population kinetics. Comparison of the model to data for fibroblast cells irradiated photons or HZE ions are described.

  16. An association between snowfall and ED presentation of cardiac arrest. (United States)

    Spitalnic, S J; Jagminas, L; Cox, J


    Studies from several cities have reported increased cardiovascular mortality associated with snowfall; whether this weather also results in increased emergency department (ED) presentation of cardiac arrests is not known. A retrospective review was conducted of cardiac arrest patients presenting to a New England ED during the months of October through May, from 1991 to 1994. Comparing daily frequency of cardiac arrest patients with climactic data, a 27% increase was observed in the frequency of cardiac arrest presentation to the ED on days with snowfall (P = .0004). ED physicians and staff should anticipate an increased frequency of cardiac arrest patients on days with snowfall.

  17. Factors Affecting the Occurrence of Out-of-Hospital Sudden Cardiac Arrest

    Directory of Open Access Journals (Sweden)

    Izabella Uchmanowicz


    Full Text Available Objective. This paper aims to discover the risk factors for sudden cardiac arrest (out-of-hospital sudden cardiac arrest (OHSCA which significantly affect the decision about prioritizing emergency interventions before dispatching medical emergency teams, risk of deterioration of the patient’s condition at the scene, and emergency procedures. Methods. A retrospective study taking into account the international classification of diseases ICD-10 based on an analysis of medical records of Emergency Medical Service in Wroclaw (Poland. Results. The main risk factor of OHSCA is coexistence of external cause leading to illness or death (ICD Group V-10 as well as the occurrence of diseases from the group of endocrine disorders (group E, in particular diabetes. The increase in the risk of OHSCA incidence is affected by nervous system diseases (group G, especially epilepsy of various etiologies, respiratory diseases (group J, mainly COPD, and bronchial asthma or mental and behavioral disorders (group F, with particular emphasis on the drugs issue. The procedure for receiving calls for Emergency Notification Centre does not take into account clinical risk factors for sudden cardiac arrest (SCA. Conclusion. Having knowledge of OHSCA risk factors can increase the efficiency of rescue operations from rapid assessment and provision of appropriate medical team, through effective performance of medical emergency treatment and prevention of SCA or finally reducing the costs.

  18. A survey of pre-arrest drug use in sentenced prisoners. (United States)

    Maden, A; Swinton, M; Gunn, J


    The paper presents the results of a retrospective, self-report survey of pre-arrest drug use in a representative sample of 1751 men serving a prison sentence. Reported drugs used were cannabis (34%), opiates (9%), amphetamine (9%) and cocaine (5%), including 1% 'crack' users. Pre-arrest injecting was reported by 11% of inmates, including 68% of all opiate users and 57% of amphetamine users. Drug dependence was reported by 11%, including 7% dependent on opiates, 2% on amphetamines and 1% on cocaine. Relative to other drugs, the figure for cocaine is higher than is suggested by a previous clinic survey. Pre-arrest cannabis use was reported by 54% of black prisoners and 34% of white. White prisoners are more likely to report use of 'hard' drugs, drug dependence and injecting, but this masks a higher rate of cocaine use by black prisoners. Opiate use varied between health regions, from 3% of prisoners in the West Midlands to 25% of those from the Mersey region. These findings have implications for service provision and for an understanding of cultural influences on illicit drug use.

  19. Out-of-Hospital Cardiac Arrest in Denmark

    DEFF Research Database (Denmark)

    Wissenberg Jørgensen, Mads

    BACK COVER TEXT Cardiac arrest is an emergency medical condition characterized by the cessation of cardiac mechanical activity; without immediate and decisive treatment, a victim’s chances of survival are minimal. Out-of-hospital cardiac arrest is a particular arrest subgroup that poses additional...... 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...... in patient survival following out-of hospital cardiac arrest; utilizing the Danish nationwide registries, we sought to answer these questions. Moreover, in order to further improve understanding and target future national strategies for cardiac arrest management, we examined whether there were sex- and age...

  20. A case report: arresting dental caries. (United States)

    Milgrom, P; Rothen, M; Spadafora, A; Skaret, E


    To arrest dental caries in the dentin in a patient that had been refractory to other attempts at caries control. Repeated applications of fluoride varnish (5%, Duraflor, Pharmascience Laboratories, Montreal) in the clinic every three months along with two daily two-minute rinses with sodium fluoride at home. Results over five years are presented. None of the lesions identified five years earlier had been restored. The teeth were monitored with frequent bitewing radiographs and clinical exams; the interproximal decay appears inactive clinically. This present case report shows that fluoride varnish may be a good addition to preventive therapy for arresting caries in adult patients in general practice. Surgical intervention may be avoided in patients whose risk has shifted to a lower level.

  1. 75 FR 8671 - Magnuson-Stevens Act Provisions; General Provisions for Domestic Fisheries; Application for... (United States)


    ... minimum fish size. Possession limits Sec. 648.86(b) Atlantic cod. Sec. 648.86(c) Atlantic halibut. Sec... Provisions for Domestic Fisheries; Application for Exempted Fishing Permit AGENCY: National Marine Fisheries... for comments. SUMMARY: The Assistant Regional Administrator for Sustainable Fisheries, Northeast...

  2. [Cardiorespiratory arrest at the age of 30]. (United States)

    Porlier, Magali; Porlier, Ludovic; Lefort, Hugues

    The cardiovascular risk of women is specific and polymorphous. Delays in treatment in women are evident and caused by multiple social and anthropological factors as well as changes to lifestyle habits which are becoming similar to those of men. Young women thereby have a higher risk of sudden death than the rest of the female and general population. A nurse who experienced cardiorespiratory arrest at the age of 30 shares her story. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  3. 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.

  4. 7 CFR 457.161 - Canola and rapeseed crop insurance provisions. (United States)


    ...: Canola and Rapeseed Crop Provisions If a conflict exists among the policy provisions, the order of... that contains at least 30 percent of an industrial type of oil as shown on the Special Provisions and... Official United States Standards for Grain including, but not limited to protein and oil, will not be...

  5. Arrest History and Intimate Partner Violence Perpetration in a Sample of Men and Women Arrested for Domestic Violence. (United States)

    Shorey, Ryan C; Ninnemann, Andrew; Elmquist, Joanna; Labrecque, Lindsay; Zucosky, Heather; Febres, Jeniimarie; Brasfield, Hope; Temple, Jeff R; Stuart, Gregory L


    Intimate partner violence (IPV) is a serious and prevalent problem throughout the United States. Currently, individuals arrested for domestic violence are often court mandated to batterer intervention programs (BIPs). However, little is known about the arrest histories of these individuals, especially women. The current study examined the arrest histories of men ( n = 303) and women ( n = 82) arrested for domestic violence and court-referred to BIPs. Results demonstrated that over 30% of the entire sample had been previously arrested for a non-violent offense, and over 25% of the participants had been previously arrested for a violent offense other than domestic violence. Moreover, men were arrested significantly more frequently for violence-related and non-violent offenses than their female counterparts. In addition, men were more likely than women to have consumed binge-levels of alcohol prior to the offense that led to their most recent arrest and court-referral to a BIP. Lastly, arrest history was positively associated with physical and psychological aggression perpetration against an intimate partner for men only, such that more previous arrests were associated with more frequent aggression. These results provide evidence that many men and women arrested for domestic violence have engaged in a number of diverse criminal acts during their lifetimes, suggesting that BIPs may need to address general criminal behavior.

  6. 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.

  7. The physiology of growth arrest: uniting molecular and environmental microbiology. (United States)

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


    Most bacteria spend the majority of their time in prolonged states of very low metabolic activity and little or no growth, in which electron donors, electron acceptors and/or nutrients are limited, but cells are poised to undergo rapid division cycles when resources become available. These non-growing states are far less studied than other growth states, which leaves many questions regarding basic bacterial physiology unanswered. In this Review, we discuss findings from a small but diverse set of systems that have been used to investigate how growth-arrested bacteria adjust metabolism, regulate transcription and translation, and maintain their chromosomes. We highlight major questions that remain to be addressed, and suggest that progress in answering them will be aided by recent methodological advances and by dialectic between environmental and molecular microbiology perspectives.

  8. Which drugs are associated with highest risk for being arrested for driving under the influence? A case-control study. (United States)

    Bogstrand, Stig Tore; Gjerde, Hallvard


    The aim of this study was to determine the association between drug type and arrest for driving under the influence of drugs (DUID) by calculating odds ratios (ORs) using a case-control design. A DUID arrest is in most cases related to aberrant or risky driving and might therefore be regarded as a proxy for a drug related traffic crash. The 'cases' were 2738 drivers arrested on suspicion of drugged driving from April 2008 to March 2009 with blood alcohol concentrations below the legal limit of 0.2g/L; 794 were arrested due to involvement in road traffic crashes, whereas 1944 were arrested for other reasons, mainly dangerous driving, suspected impairment when stopped in traffic controls, or because of phone calls to the police from other road users or observers. The 'controls' were 9375 random drivers in normal traffic, also with alcohol concentrations below this limit. Blood samples from 'cases' and oral fluid samples from 'controls' were analyzed for 15 drugs that have legislative concentration limits in Norway, in addition to two other commonly detected psychoactive drugs. The most prevalent illicit drug in the control group was tetrahydrocannabinol (THC; 0.58%), which was also commonly found in samples from drivers arrested due to road crash (15.6%) or arrested for other reasons (21.8%). Amphetamine/methamphetamine was most prevalent among arrested drivers involved in crashes (30.6%) and drivers arrested for other reasons (56.9%), whereas only 0.18% of the control group was positive for amphetamine/methamphetamine. The single-use substances which gave highest OR for police arrest were amphetamine/methamphetamine, alprazolam, clonazepam and oxazepam. The majority of the alprazolam and clonazepam findings were probably due to non-therapeutic use of medicinal drugs purchased on the illegal market. Combinations of two or more drugs yielded higher ORs than the use of single substances; combinations of amphetamine/methamphetamine and benzodiazepines gave the highest

  9. Measuring survival rates from sudden cardiac arrest: the elusive definition. (United States)

    Sayre, Michael R; Travers, Andrew H; Daya, Mohamud; Greene, H Leon; Salive, Marcel E; Vijayaraghavan, Krishnaswami; Craven, Richard A; Groh, William J; Hallstrom, Alfred P


    Measuring survival from sudden out-of-hospital cardiac arrest (OOH-CA) is often used as a benchmark of the quality of a community's emergency medical service (EMS) system. The definition of OOH-CA survival rates depends both upon the numerator (surviving cases) and the denominator (all cases). The purpose of the public access defibrillation (PAD) trial was to measure the impact on survival of adding an automated external defibrillator (AED) to a volunteer response system trained in CPR. This paper reports the definition of OOH-CA developed by the PAD trial investigators, and it evaluates alternative statistical methods used to assess differences in reported "survival." Case surveillance was limited to the prospectively determined geographic boundaries of the participating trial units. The numerator in calculating a survival rate should include only those patients who survived an event but who otherwise would have died except for the application of some facet of emergency medical care-in this trial a defibrillatory shock. Among denominators considered were: total population of the study unit, all deaths within the study unit, and documented ventricular fibrillation cardiac arrests. The PAD classification focused upon cases that might have benefited from the early use of an AED, in addition to the likely benefit from early recognition of OOH-CA, early access of EMS, and early cardiopulmonary resuscitation (CPR). Results of this classification system were used to evaluate the impact of the PAD definition on the distribution of cardiac arrest case types between CPR only and CPR + AED units. Potential OOH-CA episodes were classified into one of four groups: definite, probable, uncertain, or not an OOH-CA. About half of cardiac arrests in the PAD units were judged to be definite OOH-CA events and therefore potentially treatable with an AED. However, events that occurred in CPR-only units were less likely to be classified as definite or probable OOH-CA events than those

  10. 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

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

    DEFF Research Database (Denmark)

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


    of cardiac arrest patients included in the Target Temperature Management trial. The main objective was to evaluate if malignant EEG-patterns could reliably be identified. METHODS: Full-length EEGs from 103 comatose cardiac arrest patients were interpreted by four EEG-specialists with different nationalities...... in an international context with high reliability. SIGNIFICANCE: The establishment of strict criteria with high transferability between interpreters will increase the usefulness of routine EEG to assess neurological prognosis after cardiac arrest....

  12. Predictors for outcome among cardiac arrest patients

    DEFF Research Database (Denmark)

    Wibrandt-Johansen, Ida Maria; Norsted, Kristine; Schmidt, Henrik


    BackgroundIn the past decade, early treatment of cardiac arrest (CA) victims has been improved in several ways, leading to more optimistic over all prognoses. However, the global survival rate after out-of-hospital CA (OHCA) is still not more than 5-10%. With a better knowledge of the predictors...... circulation (ROSC).ResultsThe overall mortality was 44% and a favorable neurological outcome was seen among 52%. Strong predictors for survival and favorable neurological outcome were ventricular tachycardia/ventricular fibrillation (VT/VF) as initial rhythm, cardiac etiology and time to ROSC¿... rhythm of VT/VF and a cardiac etiology were the strongest....

  13. Growth arrest specific protein (GAS) 6

    DEFF Research Database (Denmark)

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


    Aims/hypothesis Maternal low-protein (LP) diet during gestation results in a reduced beta cell mass in the offspring at birth and this may hamper the ability to adapt to high-energy food and sedentary lifestyle later in life. To investigate the biology behind the LP-offspring phenotype, this study...... 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...

  14. Sublingual Microcirculation is Impaired in Post-cardiac Arrest Patients

    DEFF Research Database (Denmark)

    G. Omar, Yasser; Massey, Michael; Wiuff Andersen, Lars


    the microcirculation flow index (MFI) at 6 and 24h in the cardiac arrest patients, and within 6h of emergency department admission in the sepsis and control patients. RESULTS: We evaluated 30 post-cardiac arrest patients, 16 severe sepsis/septic shock patients, and 9 healthy control patients. Sublingual...... markers in the post-cardiac arrest state. METHODS: We prospectively evaluated the sublingual microcirculation in post-cardiac arrest patients, severe sepsis/septic shock patients, and healthy control patients using Sidestream Darkfield microscopy. Microcirculatory flow was assessed using...

  15. Automated External Defibrillators and Emergency Planning for Sudden Cardiac Arrest in Vermont High Schools


    Wasilko, Scott M.; Lisle, David K.


    Background: Sudden cardiac death (SCD) events are tragic. Secondary prevention of SCD depends on availability of automated external defibrillators (AEDs). High school athletes represent a high-risk group for SCD, and current efforts aim to place AEDs in all high schools. Hypothesis: The prevalence of AEDs and emergency planning for sudden cardiac arrest (SCA) in Vermont high schools is similar to other states. Understanding specific needs and limitations in rural states may prevent SCD in rur...

  16. Variability in the determination of death after cardiac arrest: a review of guidelines and statements. (United States)

    Dhanani, Sonny; Hornby, Laura; Ward, Roxanne; Shemie, Sam


    The reemergence of organ donation after circulatory determination of death (DCDD) in Canada demands the establishment of clear, evidence-based guidelines for the determination of death. The primary purpose of this study was to investigate the variability in specific criteria, diagnostic tests, and recommended wait periods for the determination of death after cardiac arrest. We used PubMed and Web of Science to perform a structured search of the medical literature for articles published up to January 1, 2010. We also performed an unstructured search of the internet for unrestricted, readily available, nonjournal sources. We limited the search to countries that are most active in DCDD. A total of 26 documents were retrieved; 21 medical professional society/institution statements and 5 national/international guidelines. Specific criteria for the determination of death after cardiac arrest were cited in 24 documents: 14 recommend cardiocirculatory criteria alone; 6 oblige the requirement of a prolonged waiting period after declaration to ensure neurological death; 3 recommend following "accepted medical practice" without specific details; and 1 leaves the definition up to "national authorities." Only 16 of the documents require specific diagnostic procedures with unresponsiveness, absent arterial pulse and apnea cited the most consistently. Specific wait periods after declaration are required for the determination of death after cardiac arrest in 24 documents, cited times range from 2 to 10 minutes, with a 5-minute period the most frequent. This review is the first to document the variability of guidelines and statements for the determination of death after cardiac arrest, in countries where the practice of DCDD is becoming increasingly common. The scarcity of peer-reviewed published guidelines in the medical literature exemplifies the need for further investigation. We believe these results will inform the ethical discussions surrounding the determination of death

  17. 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.

  18. Consent: statutory Provisions in Eritrea

    African Journals Online (AJOL)

    appreciate the legal significance of consent. "Every human being ... {2} Nothing in this article shall affect the provisions of laws ... (1 A court may, at any stage of a case, order that the accused .... undue influence, incapacitated person is invalid.

  19. 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...

  20. 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.

  1. Thiamine as a neuroprotective agent after cardiac arrest. (United States)

    Ikeda, Kohei; Liu, Xiaowen; Kida, Kotaro; Marutani, Eizo; Hirai, Shuichi; Sakaguchi, Masahiro; Andersen, Lars W; Bagchi, Aranya; Cocchi, Michael N; Berg, Katherine M; Ichinose, Fumito; Donnino, Michael W


    Reduction of pyruvate dehydrogenase (PDH) activity in the brain is associated with neurological deficits in animals resuscitated from cardiac arrest. Thiamine is an essential co-factor of PDH. The objective of this study was to examine whether administration of thiamine improves outcomes after cardiac arrest in mice. Secondarily, we aimed to characterize the impact of cardiac arrest on PDH activity in mice and humans. Animal study: Adult mice were subjected to cardiac arrest whereupon cardiopulmonary resuscitation was performed. Thiamine or vehicle was administered 2min before resuscitation and daily thereafter. Mortality, neurological outcome, and metabolic markers were evaluated. Human study: In a convenience sample of post-cardiac arrest patients, we measured serial PDH activity from peripheral blood mononuclear cells and compared them to healthy controls. Animal study: Mice treated with thiamine had increased 10-day survival (48% versus 17%, Pcardiac arrest patients had lower PDH activity in mononuclear cells than did healthy volunteers (estimated difference: -5.8O.D./min/mg protein, Pcardiac arrest improved neurological outcome and 10-day survival in mice. PDH activity was markedly depressed in post-cardiac arrest patients suggesting that this pathway may represent a therapeutic target. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  2. 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

  3. 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.

  4. Resuscitation, prolonged cardiac arrest, and an automated chest compression device

    DEFF Research Database (Denmark)

    Risom, Martin; Jørgensen, Henrik; Rasmussen, Lars S


    The European Resuscitation Council's 2005 guidelines for cardiopulmonary resuscitation (CPR) emphasize the delivery of uninterrupted chest compressions of adequate depth during cardiac arrest.......The European Resuscitation Council's 2005 guidelines for cardiopulmonary resuscitation (CPR) emphasize the delivery of uninterrupted chest compressions of adequate depth during cardiac arrest....

  5. Exercise-related cardiac cardiac rehabilitation arrest In

    African Journals Online (AJOL)

    most important being myocardial infarction and cardiac arrest. (CA).1,2. 'Normal' ... myocardial infarction and CA in cardiac rehabilitation pro- ..... The acute risk of. Strenuous exercise.JAMA 1980; 244: 1799-1801. 5. Siscovick DS, Weiss NS, Fletcber RH et al. The incidence of primary cardiac arrest during vigorous exercise.

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

    African Journals Online (AJOL)


    Mar 7, 2013 ... 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 ...

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

    NARCIS (Netherlands)

    Yee, R.; 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;

  8. Location of cardiac arrest and impact of pre-arrest chronic disease and medication use on survival. (United States)

    Granfeldt, Asger; Wissenberg, Mads; Hansen, Steen Møller; Lippert, Freddy K; Torp-Pedersen, Christian; Christensen, Erika Frischknecht; Christiansen, Christian Fynbo


    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. To investigate whether the association between cardiac arrest in a private location and a higher mortality can be explained by differences in chronic diseases and medication. 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 and medication. To investigate the importance of cardiac arrest related factors and chronic disease and medication use we performed adjusted Cox regression analyses during day 0-7 and day 8-365 following cardiac arrest to calculate hazard ratios (HR) for death. Day 0-7: Un-adjusted HR for death day 0-7 was 1.21 (95%CI:1.18-1.25) in private compared to public location. When including cardiac arrest related factors HR for death was 1.09 (95%CI:1.06-1.12). Adding chronic disease and medication to the analysis changed HR for death to 1.08 (95%CI:1.05-1.12). 8-365 day: The un-adjusted HR for death day 8-365 was 1.70 (95% CI: 1.43-2.02) in private compared to public location. When including cardiac arrest related factors the HR decreased to 1.39 (95% CI: 1.14-1.68). Adding chronic disease and medication to the analysis changed HR for death to 1.27 (95% CI:1.04-1.54). The higher mortality following cardiac arrest in a private location is partly explained by a higher prevalence of chronic disease and medication use in patients surviving until day 8. Copyright © 2017 Elsevier B.V. All rights reserved.

  9. 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

  10. The effect of time to defibrillation and targeted temperature management on functional survival after out-of-hospital cardiac arrest. (United States)

    Drennan, Ian R; Lin, Steve; Thorpe, Kevin E; Morrison, Laurie J


    Cardiac arrest physiology has been proposed to occur in three distinct phases: electrical, circulatory and metabolic. There is limited research evaluating the relationship of the 3-phase model of cardiac arrest to functional survival at hospital discharge. Furthermore, the effect of post-cardiac arrest targeted temperature management (TTM) on functional survival during each phase is unknown. To determine the effect of TTM on the relationship between the time of initial defibrillation during each phase of cardiac arrest and functional survival at hospital discharge. This was a retrospective observational study of consecutive adult (≥18 years) out-of-hospital cardiac arrest (OHCA) patients with initial shockable rhythms. Included patients obtained a return of spontaneous circulation (ROSC) and were eligible for TTM. Multivariable logistic regression was used to determine predictors of functional survival at hospital discharge. There were 20,165 OHCA treated by EMS and 871 patients were eligible for TTM. Of these patients, 622 (71.4%) survived to hospital discharge and 487 (55.9%) had good functional survival. Good functional survival was associated with younger age (OR 0.94; 95% CI 0.93-0.95), shorter times from collapse to initial defibrillation (OR 0.73; 95% CI 0.65-0.82), and use of post-cardiac arrest TTM (OR 1.49; 95% CI 1.07-2.30). Functional survival decreased during each phase of the model (65.3% vs. 61.7% vs. 50.2%, Pdefibrillation and was decreased during each successive phase of the 3-phase model. Post-cardiac arrest TTM was associated with improved functional survival. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  11. 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 h 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 Category 3-5 at 6 months. RESULTS: Increased tau was associated with poor outcome at 6 months after cardiac arrest (median 38.5 [IQR 5.7-245] ng/L in poor versus 1.5 [0.7-2.4] ng/L in good outcome, for tau at 72 h, p... 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 than serum NSE, which is recommended in guidelines and currently used in clinical practice...

  12. 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], pcardiac 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.

  13. Hypothermia after cardiac arrest as a novel approach to increase survival in cardiopulmonary cerebral resuscitation: a review. (United States)

    Soleimanpour, Hassan; Rahmani, Farzad; Safari, Saeid; Golzari, Samad Ej


    The aim of this review study was to evaluate therapeutic mild hypothermia, its complications and various methods for induced mild hypothermia in patients following resuscitation after out-of-hospital cardiac arrest. Studies conducted on post-cardiac arrest cares, history of induced hypothermia, and therapeutic hypothermia for patients with cardiac arrest were included in this study. We used the valid databases (PubMed and Cochrane library) to collect relevant articles. According to the studies reviewed, induction of mild hypothermia in patients after cardiopulmonary resuscitation would lead to increased survival and better neurological outcome; however, studies on the complications of hypothermia or different methods of inducing hypothermia were limited and needed to be studied further. This study provides strategic issues concerning the induction of mild hypothermia, its complications, and different ways of performing it on patients; using this method helps to increase patients' neurological survival rate.

  14. 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 arrest of the crack. Digital image correlation is used through the duration of the fatigue experiment to track the strain evolution as the crack tip advances. The measured strains are related to crack tip propagation, arrest, and re-initiation of the crack. A finite element model is used to calculate...... the energy release rate, mode mixity and to simulate crack propagation and arrest of the crack. Finally, the effectiveness of the crack arresting device is demonstrated on composite sandwich beams subjected to fatigue loading conditions....

  15. 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

  16. Development of a theoretical guide for nursing care in cardiac arrest

    Directory of Open Access Journals (Sweden)

    Aliandra Bittencourt da Silva


    Full Text Available This study aimed to identify the knowledge on cardiorespiratory arrest among nurses in a hospital of Vale do Paraíba, São Paulo, Brazil, and develop a theoretical guide for care of this emergency. We prepared an instrument of data collection based on relevant literature and the 2010 AHA Guidelines for CPR, from August to October 2012. The sample consisted of 41 nurses who deliver care activities in various units of the hospital. The study showed that professional participants said they were able to act in cardiopulmonary resuscitation, however, there were limitations of knowledge about the theme. Given the above, we developed a theoretical guide for cardiac arrest care based on scientific literature and covering questions submitted by nurses.

  17. Thermodynamic coarsening arrested by viscous fingering in partially miscible binary mixtures (United States)

    Fu, Xiaojing; Cueto-Felgueroso, Luis; Juanes, Ruben


    We study the evolution of binary mixtures far from equilibrium, and show that the interplay between phase separation and hydrodynamic instability can arrest the Ostwald ripening process characteristic of nonflowing mixtures. We describe a model binary system in a Hele-Shaw cell using a phase-field approach with explicit dependence of both phase fraction and mass concentration. When the viscosity contrast between phases is large (as is the case for gas and liquid phases), an imposed background flow leads to viscous fingering, phase branching, and pinch off. This dynamic flow disorder limits phase growth and arrests thermodynamic coarsening. As a result, the system reaches a regime of statistical steady state in which the binary mixture is permanently driven away from equilibrium.

  18. 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...

  19. Epidemiology and management of cardiac arrest: what registries are revealing. (United States)

    Gräsner, Jan-Thorsten; Bossaert, Leo


    Major European institutions report cardiovascular disease (CVD) as the first cause of death in adults, with cardiac arrest and sudden death due to coronary ischaemia as the primary single cause. Global incidence of CVD is decreasing in most European countries, due to prevention, lifestyle and treatment. Mortality of acute coronary events inside the hospital decreases more rapidly than outside the hospital. To improve the mortality of cardiac arrest outside the hospital, reliable epidemiological and process figures are essential: "we can only manage what we can measure". Europe is a patchwork of 47 countries (total population of 830 million), with a 10-fold difference in incidence of coronary heart disease between North and South, East and West, and a 5-fold difference in number of EMS-treated cardiac arrest (range 17-53/1000,000/year). Epidemiology of cardiac arrest should not be calculated as a European average, but it is appropriate to describe the incidence of cardiac arrest, the resuscitation process, and the outcome in each of the European regions, for benchmarking and quality management. Epidemiological reports of cardiac arrest should specify definitions, nominator (number of cases) and denominator (study population). Recently some regional registries in North America, Japan and Europe fulfilled these conditions. The European Registry of Cardiac Arrest (EuReCa) has the potential to achieve these objectives on a pan-European scale. For operational applications, the Utstein definition of "Cardiac arrest" is used which includes the potential of survival. For application in community health, the WHO definition of "sudden death" is frequently used, describing the mode of death. There is considerable overlap between both definitions. But this explains that no single method can provide all information. Integrating data from multiple sources (local, national, multinational registries and surveys, death certificates, post-mortem reports, community statistics, medical

  20. 26 CFR 1.856-2 - Limitations. (United States)


    ... Investment Trust R has made no acquisition of stock or other property during such second quarter it will not... TAXES Real Estate Investment Trusts § 1.856-2 Limitations. (a) Effective date. The provisions of part II... estate investment trust beginning after December 31, 1960. (b) Election. Under the provisions of section...

  1. Post-resuscitation care for survivors of cardiac arrest (United States)

    Mangla, Ashvarya; Daya, Mohamud R.; Gupta, Saurabh


    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. PMID:24568821

  2. Social Housing Provision in Copenhagen

    DEFF Research Database (Denmark)

    Tsenkova, Sasha; Vestergaard, Hedvig

    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......-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...... 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...

  3. Crack propagation and arrest of structural steels and pipelines

    Energy Technology Data Exchange (ETDEWEB)

    Inoue, Takehiro


    Crack arrest of fast running cracks is an important issue for the safety of steel structures. Crack arrest design can prevent fatal damage of large structures by restricting the influence of the incidents. Therefore crack arrest design is important especially for very large structure, where accidents may cause huge economical and social losses. Propagating shear fracture, long running ductile crack propagation in pipelines and brittle crack propagation in heavy thick shipbuilding steels have been investigated. For the propagating shear fracture issue, a new HLP simulation model, applicable to various backfill conditions, including underwater backfill, was developed. The proposed backfill model can be applied to the prediction of the crack arrest of propagating shear fracture under various backfill conditions. The new HLP simulation was successful in estimating full-scale burst tests with various backfill depths. The new HLP simulation for underwater pipelines indicated that propagating shear cracks are easily arrested in offshore pipelines compared to onshore pipeline. The toughness requirement of the line pipe for preventing propagating shear fracture can be significantly smaller in underwater pipelines compared to onshore pipelines. The margin of the underwater pipeline for propagating shear fracture was clarified by the new model developed in this thesis. For brittle crack arrest, an empirical approach for long crack propagation has been conducted. Several large-scale crack arrest tests were carried out in order to investigate the long crack arrestability of heavy-thick shipbuilding steel plates. All plates and their welded joints used in this study satisfied the Charpy toughness requirement for EH-grade shipbuilding steels and welded joints. A brittle crack ran along a welded joint and penetrated through the test plate under a stress exceeding 200MPa, despite the presence of longitudinal stiffeners across the test weld. A brittle crack in a base plate model

  4. 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 any separability 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...

  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. 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.

  7. [Heart arrest during dextran infusion despite hapten blockade]. (United States)

    Schöning, B; Sommer, K; Koch, H


    In a running clinical prospective study on the incidence of adverse reactions to colloidal polysaccharides (randomised, single blind, n = 300) a bronchospasm followed by cardiac arrest occurred during dextran infusion although the necessary hapten blockage with monovalent dextran-1 had been effected. Resuscitation was successful. Directly after this, surgery was carried out as planned under general anaesthesia. The 69-year-old patient was discharged without noticeable sequelae. For the first time in the literature on dextran the studied sample allows a generalisation: The event occurred with an incidence of about 0.9% (of 116 patients who had received dextran infusion). This incidence corresponds to a confidence interval ranging from 0.02 to 4.96%. If the study would be continued as planned, the upper limit of this interval signals the probability of another case of severe intolerance. The diagnosis "dextran adverse reaction" can be made in this case by clinical symptoms. Since no previous or concomitant medication had been administered as provided in the protocol to confirm the diagnosis as an adverse reaction to dextran by determination of the titer of dextran antibodies prior to infusion is not required and it may be concluded that dextran was the causative agent.

  8. 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.

  9. Drinking and driving and perceptions of arrest risk among California drivers: Relationships with DUI arrests in their city of residence. (United States)

    MacLeod, Kara E; Karriker-Jaffe, Katherine J; Satariano, William A; Kelley-Baker, Tara; Lacey, John H; Ragland, David R


    Addressing drinking and driving remains a challenge in the United States. The present study aims to provide feedback on driving under the influence (DUI) in California by assessing whether drinking and driving behavior is associated with the DUI arrest rates in the city in which the driver lives; whether this is due to perceptions that one can get arrested for this behavior; and whether this differed by those drivers who would be most affected by deterrence efforts (those most likely to drink outside the home). This study consisted of a 2012 roadside survey of 1,147 weekend nighttime drivers in California. City DUI arrest rates for 2009-2011 were used as an indicator of local enforcement efforts. Population average logistic modeling was conducted modeling the odds of perceived high arrest likelihood for DUI and drinking and driving behavior within the past year. As the DUI arrest rates for the city in which the driver lives increased, perceived high risk of DUI arrest increased. There was no significant relationship between either city DUI arrest rates or perceived high risk of DUI arrest with self-reported drinking and driving behavior in the full sample. Among a much smaller sample of those most likely to drink outside the home, self-reported drinking and driving behavior was negatively associated with DUI arrests rates in their city of residence but this was not mediated by perceptions. The results of the present study suggest that perceptions are correlated with one aspect of DUI efforts in one's community. Those who were more likely to drink outside the home could be behaviorally influenced by these efforts.

  10. Cardiac Arrest in Pediatric Patients Receiving Azithromycin. (United States)

    Valdés, Santiago O; Kim, Jeffrey J; Niu, Mary C; de la Uz, Caridad M; Miyake, Christina Y; Moffett, Brady S


    To compare outcomes of pediatric patients treated with azithromycin compared with penicillin or cephalosporin. We hypothesized that azithromycin use would not be associated with increased cardiac mortality in the pediatric population. Retrospective cohort study from the Pediatric Health Information System database between 2008 and 2012. Patients Azithromycin was used in 5039 (6.1%); penicillin or cephalosporin was used in 77 943 (93.9%). Overall prevalence of antibiotic-associated CPR was 0.14%. Patients receiving a macrolide antibiotic had a lower prevalence of CPR compared with patients receiving a penicillin or cephalosporin (0.04% vs 0.14%, P = .04), and there was no difference in mortality. Multivariable analysis did not find an association between macrolide use and CPR. In contrast to recent adult studies, among children hospitalized for community-acquired pneumonia, azithromycin use was not associated with a greater prevalence of cardiac arrest compared with penicillin or cephalosporin use. Copyright © 2016 Elsevier Inc. All rights reserved.

  11. Arresting dissolution by interfacial rheology design (United States)

    Beltramo, Peter J.; Gupta, Manish; Alicke, Alexandra; Liascukiene, Irma; Gunes, Deniz Z.; Baroud, Charles N.; Vermant, Jan


    A strategy to halt dissolution of particle-coated air bubbles in water based on interfacial rheology design is presented. Whereas previously a dense monolayer was believed to be required for such an “armored bubble” to resist dissolution, in fact engineering a 2D yield stress interface suffices to achieve such performance at submonolayer particle coverages. We use a suite of interfacial rheology techniques to characterize spherical and ellipsoidal particles at an air-water interface as a function of surface coverage. Bubbles with varying particle coverages are made and their resistance to dissolution evaluated using a microfluidic technique. Whereas a bare bubble only has a single pressure at which a given radius is stable, we find a range of pressures over which bubble dissolution is arrested for armored bubbles. The link between interfacial rheology and macroscopic dissolution of ˜ 100 μm bubbles coated with ˜ 1 μm particles is presented and discussed. The generic design rationale is confirmed by using nonspherical particles, which develop significant yield stress at even lower surface coverages. Hence, it can be applied to successfully inhibit Ostwald ripening in a multitude of foam and emulsion applications.

  12. Evaluation of emergency medical dispatch in out-of-hospital cardiac arrest in Taipei. (United States)

    Ma, Matthew Huei-Ming; Lu, Tsung-Chien; Ng, Josh Chian-Shuin; Lin, Chih-Hao; Chiang, Wen-Chu; Ko, Patrick Chow-In; Shih, Fuh-Yuan; Huang, Chien-Hua; Hsiung, Kuang-Hua; Chen, Shyr-Chyr; Chen, Wen-Jone


    Emergency medical dispatchers are the entry points to the emergency medical services (EMS). The overall performances of the dispatchers are imperative determinants of the emergency medical services dispatching system. There is little data on the cultural and language impacts on emergency medical dispatch. This study examined the emotional content and cooperation score (ECCS) among Mandarin Chinese speaking callers for cardiac arrests, and evaluated the performances of emergency medical services dispatching system in Taipei. This retrospective, observational study examined dispatching audio recordings obtained from the Taipei City Fire Department Dispatching Center between January 2004 to April 2004. The tapes of call relating to adult (age >or=18 years), non-traumatic cases with a presumed or field diagnosis of out-of-hospital cardiac arrest (OHCA) underwent systemic review. The caller's ECCS and the dispatcher's performances, including interview skills, provision of telephone-assisted cardiopulmonary resuscitation (T-CPR), and dispatcher's ability to identify OHCA were examined. Interrater reliability for determining ECCS and interview skills were assessed using kappa statistic. A total of 199 audio recordings were reviewed. A mean ECCS of 1.42+/-0.64 (95% CI: 1.33-1.51) demonstrated that most callers were emotionally stable and cooperative when calling for help, even when facing cardiac arrest patients. There was a good association between ECCS and the sex of the callers (male 1.32 versus female 1.49; pskills of the dispatchers was high (4 or 5 points); while in one fifth the interview skills were suboptimal. About one third of the cases were provided with T-CPR by the dispatchers. The sensitivity and positive predictive value (PPV) for predicting OHCA by dispatchers were 96.9% and 97.9%, respectively. A kappa value of 0.65 and 0.68 were obtained for the interrater reliability of ECCS and interview skills. Most callers were found to be emotional stable and

  13. Cardiac Arrest? Someday, Drones May Come to Your Rescue (United States)

    ... gov/news/fullstory_166543.html Cardiac Arrest? Someday, Drones May Come to Your Rescue Like something from ... 13, 2017 TUESDAY, June 13, 2017 (HealthDay News) -- Drones have been proposed for some pretty mundane uses, ...

  14. 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.

  15. Fewer Heart Failure Patients Dying of Cardiac Arrest (United States)

    ... Fewer Heart Failure Patients Dying of Cardiac Arrest Researchers chock it ... 6, 2017 THURSDAY, July 6, 2017 (HealthDay News) -- Heart failure patients are much less likely now to die ...

  16. 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.

  17. Consent: statutory Provisions in Eritrea

    African Journals Online (AJOL)


    CONSENT IN THE ERITREAN CIVIL CODE. Consent is a requirement or prerequisite for many ... Notwithstanding the provisions of ArtfZl] Civil Code where an investigating police officer considers it necessary, having .... Liability Article 2028 — General Principle. Whosoever causes damage to another by an offence.

  18. 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...


    African Journals Online (AJOL)



    Nov 1, 2012 ... a high level of community participation in the provision of such infrastructure as schools, electricity, ... Department of Geography & Environmental Management, ... “secondary towns”. The range of cites or towns that constitute the level of urban hierarchy vary among countries, depending on the pattern of.

  20. Al-Qaeda arrest casts shadow over the LHC

    CERN Document Server

    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)

  1. Impact of donor cardiac arrest on heart transplantation. (United States)

    Southerland, Kevin W; Castleberry, Anthony W; Williams, Judson B; Daneshmand, Mani A; Ali, Ayyaz A; Milano, Carmelo A


    Cardiac transplantation is an effective therapy for patients with end-stage heart failure, but it is still hindered by the lack of donor organs. A history of donor cardiac arrest raises trepidation regarding the possibility of poor post-transplant outcomes. The impact of donor cardiac arrest following successful cardiopulmonary resuscitation on heart transplant outcomes is unknown. Therefore, we sought to evaluate the impact of donor cardiac arrest on orthotropic heart transplantation using the United Network for Organ Sharing database. We performed a secondary longitudinal analysis of all cardiac transplants performed between April 1994 and December 2011 through the United Network for Organ Sharing registry. Multiorgan transplants, repeat transplants, and pediatric recipients were excluded. Survival analyses were performed using Kaplan-Meier methods as well as multivariate adjusted logistic regression and Cox proportional hazard models. A total of 19,980 patients were analyzed. In 856 cases, the donors had histories of cardiac arrest, and in the remaining 19,124 cases, there was no history of donor cardiac arrest. The unadjusted 1-, 5-, and 10-year actuarial survival rates between the arrest and the nonarrest groups were not significantly different. Multivariate logistic regression demonstrated no difference in survival in the donor arrest group at 30 days, 1 year, or 3 years. Furthermore, the adjusted Cox proportional hazard model for cumulative survival also showed no survival difference between the 2 groups. If standard recipient and donor transplantation criteria are met, a history of donor cardiac arrest should not prohibit the potential consideration of an organ for transplantation. Copyright © 2013 Mosby, Inc. All rights reserved.

  2. Structural integrity and damage assessment of high performance arresting cable systems using an embedded distributed fiber optic sensor (EDIFOS) system (United States)

    Mendoza, Edgar A.; Kempen, Cornelia; Sun, Sunjian; Esterkin, Yan; Prohaska, John; Bentley, Doug; Glasgow, Andy; Campbell, Richard


    Redondo Optics in collaboration with the Cortland Cable Company, TMT Laboratories, and Applied Fiber under a US Navy SBIR project is developing an embedded distributed fiber optic sensor (EDIFOSTM) system for the real-time, structural health monitoring, damage assessment, and lifetime prediction of next generation synthetic material arresting gear cables. The EDIFOSTM system represents a new, highly robust and reliable, technology that can be use for the structural damage assessment of critical cable infrastructures. The Navy is currently investigating the use of new, all-synthetic- material arresting cables. The arresting cable is one of the most stressed components in the entire arresting gear landing system. Synthetic rope materials offer higher performance in terms of the strength-to-weight characteristics, which improves the arresting gear engine's performance resulting in reduced wind-over-deck requirements, higher aircraft bring-back-weight capability, simplified operation, maintenance, supportability, and reduced life cycle costs. While employing synthetic cables offers many advantages for the Navy's future needs, the unknown failure modes of these cables remains a high technical risk. For these reasons, Redondo Optics is investigating the use of embedded fiber optic sensors within the synthetic arresting cables to provide real-time structural assessment of the cable state, and to inform the operator when a particular cable has suffered impact damage, is near failure, or is approaching the limit of its service lifetime. To date, ROI and its collaborators have developed a technique for embedding multiple sensor fibers within the strands of high performance synthetic material cables and use the embedded fiber sensors to monitor the structural integrity of the cable structures during tensile and compressive loads exceeding over 175,000-lbsf without any damage to the cable structure or the embedded fiber sensors.

  3. Heritability of Risk for Sudden Cardiac Arrest in ESRD. (United States)

    Chan, Kevin E; Newton-Cheh, Christopher; Gusella, James F; Maddux, Franklin W


    Patients on dialysis are 20 times more likely to have a cardiac arrest compared with the general population. We considered whether inherited factors associate with cardiac arrest among patients on dialysis. From a sample of 647,457 patients on chronic dialysis, we identified 5117 pairs of patients who came from the same family. These patients were each matched to a control subject from the same population. McNemar's tests were used to compare the risk of cardiac arrest between the familial related and unrelated pairs. Genetically related family members who did not cohabitate had an odds ratio of 1.88 (95% confidence interval [95% CI], 1.25 to 2.84) for cardiac arrest compared with their phenotypically matched unrelated controls. Genetically related family members who lived together in the same environment had an odds ratio of 1.66 (95% CI, 1.20 to 2.28). Spouses, who are genetically unrelated but live together in the same environment, had an odds ratio of 0.95 (95% CI, 0.60 to 1.59) for cardiac arrest. The risk of cardiac arrest in patients on dialysis may be attributable to inherited factors. Additional studies are needed to identify such candidate genes that modify cardiovascular risk in ESRD. Copyright © 2015 by the American Society of Nephrology.

  4. Arrested coalescence of viscoelastic droplets with internal microstructure. (United States)

    Pawar, Amar B; Caggioni, Marco; Hartel, Richard W; Spicer, Patrick T


    There are many new approaches to designing complex anisotropic colloids, often using droplets as templates. However, droplets themselves can be designed to form anisotropic shapes without any external templates. One approach is to arrest binary droplet coalescence at an intermediate stage before a spherical shape is formed. Further shape relaxation of such anisotropic, arrested structures is retarded by droplet elasticity, either interfacial or internal. In this article we study coalescence of structured droplets, containing a network of anisotropic colloids, whose internal elasticity provides a resistance to full shape relaxation and interfacial energy minimization during coalescence. Precise tuning of droplet elasticity arrests coalescence at different stages and leads to various anisotropic shapes, ranging from doublets to ellipsoids. A simple model balancing interfacial and elastic energy is used to explain experimentally observed coalescence arrest in viscoelastic droplets. During coalescence of structured droplets the interfacial energy is continuously reduced while the elastic energy is increased by compression of the internal structure and, when the two processes balance one another, coalescence is arrested. Experimentally we observe that if either interfacial energy or elasticity dominates, total coalescence or total stability of droplets results. The stabilization mechanism is directly analogous to that in a Pickering emulsion, though here the resistance to coalescence is provided via an internal volume-based, rather than surface, structure. This study provides guidelines for designing anisotropic droplets by arrested coalescence but also explains some observations of "partial" coalescence observed in commercial foods like ice cream and whipped cream.

  5. 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.

  6. 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.

  7. Respiratory Arrest in an Obese Pregnant Woman with Hyperemesis Gravidarum

    Directory of Open Access Journals (Sweden)

    Ayumi Iwashita


    Full Text Available A pregnant, non-Japanese-speaking Peruvian, and, thus, with communication difficulty, suffered hyperemesis gravidarum and had respiratory arrest, requiring cardiopulmonary resuscitation. The obese pregnant woman (prepregnancy weight: 107 kg had vomited and lost 15 kg in bodyweight over appropriately 2 weeks prior to the arrest but had not complained due to communication difficulty, which, together with her obesity, prevented a Japanese obstetrician from noticing her severe condition. 1,000 mL of low potassium fluid plus thiamine was administered. She became unable to stand, suggesting lower-extremity-proximal-muscle weakness, and then respiratory arrest occurred. Hypopotassemia (2.3 mEq/L, pulseless electrical activity, and muscle weakness suggested the presence of severe potassium deficiency, which may have caused respiratory muscle paralysis, leading to the respiratory arrest. Hypercapnea was severer than expected for compensatory hypoventilation, indicating the presence of concomitant severe hypoventilation, which may also have contributed to respiratory arrest. She recovered with electrolyte and volume replacement. Respiratory arrest can occur with hyperemesis gravidarum, and obesity and communication difficulties can prevent the early detection of severe conditions.

  8. 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.

  9. Equitable provision of social facilities for a range of settlements: guidelines and tools for integrated provision

    CSIR Research Space (South Africa)

    Green, Cheri A


    Full Text Available looks at equitable provision of social facilities for a range of settlements and offers guidelines and tools for integrated provision that incorporates the 1) development of fully provisioned quality living environments, 2) improvement of access...

  10. Acute kidney injury after cardiac arrest. (United States)

    Tujjar, Omar; Mineo, Giulia; Dell'Anna, Antonio; Poyatos-Robles, Belen; Donadello, Katia; Scolletta, Sabino; Vincent, Jean-Louis; Taccone, Fabio Silvio


    The aim of this study was to evaluate the incidence and determinants of AKI in a large cohort of cardiac arrest patients. We reviewed all patients admitted, for at least 48 hours, to our Dept. of Intensive Care after CA between January 2008 and October 2012. AKI was defined as oligo-anuria (daily urine output <0.5 ml/kg/h) and/or an increase in serum creatinine (≥0.3 mg/dl from admission value within 48 hours or a 1.5 time from baseline level). Demographics, comorbidities, CA details, and ICU interventions were recorded. Neurological outcome was assessed at 3 months using the Cerebral Performance Category scale (CPC 1-2 = favorable outcome; 3-5 = poor outcome). A total of 199 patients were included, 85 (43%) of whom developed AKI during the ICU stay. Independent predictors of AKI development were older age, chronic renal disease, higher dose of epinephrine, in-hospital CA, presence of shock during the ICU stay, a low creatinine clearance (CrCl) on admission and a high cumulative fluid balance at 48 hours. Patients with AKI had higher hospital mortality (55/85 vs. 57/114, p = 0.04), but AKI was not an independent predictor of poor 3-month neurological outcome. AKI occurred in more than 40% of patients after CA. These patients had more severe hemodynamic impairment and needed more aggressive ICU therapy; however the development of AKI did not influence neurological recovery.

  11. Characterizing cardiopulmonary arrest during interventional radiology procedures. (United States)

    Rueb, George Richard; Brady, William J; Gilliland, Charles A; Patrie, James T; Saad, Wael E; Sabri, Saher S; Park, Auh W; Stone, James R; Angle, John F


    Careful case selection and preparation can prevent most cardiopulmonary arrest (CPA) in the interventional radiology (IR) suite. A series of CPAs was analyzed to provide insight into risk factors for these events. A single-institution CPA database was used to identify all code team activations from January 1, 2005, to May 30, 2011, in the IR department. Medical records were searched for medical history, American Society of Anesthesiologists (ASA) classification, moderate sedation, and outcomes. Procedural data and procedure classification was acquired from the HI-IQ database. There were 36,489 procedures and 23 CPAs during the study period. Of the 23 patients with CPAs, 12 (52%) were male and 11 (48%) female, and average age was 57 years ± 19 (standard deviation). Risk factors included a 56% incidence of diabetes mellitus, 48% incidence of hypertension, and 78% incidence of renal failure. Of the patients with kidney disease, 56% were chronically dialysis-dependent, and an additional 9% were undergoing central venous catheter placement for new hemodialysis. Seventy-eight percent had ASA status of III or greater, and 57% underwent moderate sedation during the procedure. Relative risk of a CPA during dialysis shunt interventions versus arterial interventions was 3.6 (95% confidence interval, 1.0-11.3; P = .045). Eight of 23 (35%) died: one (12%) during resuscitation and seven (88%) after resuscitation (P = .070). The most common comorbidity of patients with CPA in IR was kidney disease, and the most patients who had CPA underwent dialysis access-related procedures. Copyright © 2013 SIR. Published by Elsevier Inc. All rights reserved.

  12. Perioperative cardiac arrest: an evolutionary analysis of the intra-operative cardiac arrest incidence in tertiary centers in Brazil. (United States)

    Vane, Matheus Fachini; do Prado Nuzzi, Rafael Ximenes; Aranha, Gustavo Fabio; da Luz, Vinicius Fernando; Sá Malbouisson, Luiz Marcelo; Gonzalez, Maria Margarita Castro; Auler, José Otávio Costa; Carmona, Maria José Carvalho


    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. 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. 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. 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. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

  13. [Perioperative cardiac arrest: an evolutionary analysis of the intra-operative cardiac arrest incidence in tertiary centers in Brazil]. (United States)

    Vane, Matheus Fachini; do Prado Nuzzi, Rafael Ximenes; Aranha, Gustavo Fabio; da Luz, Vinicius Fernando; Sá Malbouisson, Luiz Marcelo; Gonzalez, Maria Margarita Castro; Auler, José Otávio Costa; Carmona, Maria José Carvalho


    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. 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. 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. 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. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  14. Not Nearly Enough Geography! University Provision for England's Pre-Service Primary Teachers (United States)

    Catling, Simon


    Research into geography provision in primary initial teacher education [ITE] courses in the United Kingdom and worldwide is very limited. England educates pre-service primary teachers of 5-11 year olds to be "generalists" who teach the full range of curriculum subjects, including geography. This article identifies that the provision of…

  15. 42 CFR 426.555 - Prohibited provisions of the Board's decision. (United States)


    ... COVERAGE DETERMINATIONS Review of an NCD § 426.555 Prohibited provisions of the Board's decision. The Board... provisions of an NCD. (b) Order CMS or its contractors to pay a specific claim. (c) Set a time limit for CMS to establish a new or revised NCD. (d) Review or evaluate an NCD other than the NCD under review. (e...

  16. Incidence and outcome from adult cardiac arrest occurring in the intensive care unit: a systematic review of the literature. (United States)

    Efendijev, Ilmar; Nurmi, Jouni; Castrén, Maaret; Skrifvars, Markus B


    -term survival rates of 45-69%. At present data on intensive care unit cardiac arrest is quite limited and originates mostly from retrospective single center studies. The quality of data overall seems to be poor and thus focused prospective multi-center studies are needed. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  17. Use of automated external defibrillators in cardiac arrest: an evidence-based analysis. (United States)


    suggests that cost-effectiveness varies from setting to setting. Most of the studies have estimated cost-effectiveness in American settings from a societal perspective; therefore, the results are not applicable to this report. However, results from this review suggest that the incidence of cardiac arrest in out-of-hospital setting in Ontario is 59 per 100,000 people. The mean age of cardiac arrest patients is 69 years. Eighty-five percent of these cardiac arrests occur in homes. Of all the cardiac arrests, 37% have heart rhythm abnormalities (ventricular tachycardia or ventricular fibrillation) that are correctable by delivering shock through an AED. Thus, in an out-of-hospital setting, general use of AEDs by laypersons would not be cost-effective. Special programs are needed in the out-of-hospital setting for cost-effective use of AEDs. One model for the use of AEDs in out-of-hospital settings was examined in the OPALS study. Firefighters and police were trained and provided with AEDs. The total initial cost (in US dollars) of this program was estimated to be $980,000. The survival rate was 3.9% before implementing the AED program and 5.2% after its implementation (OR, 1.33; 95% CI, 1.03-1.7; P = .03). Applying these estimates to cardiac arrest rates in Ontario in 2002, one would expect 54 patients of the total 1,395 cardiac arrests to survive without AEDs compared with 73 patients with AEDs; thus, 19 additional lives might be saved each year with an AED program. It would initially cost $51,579 to save each additional life. In subsequent years, however, total cost would be lower (about $50,000 per year), when it would cost $2,632 to save each additional life per year. One limitation of the OPALS study was that the authors combined emergency medical service response time and application of an AED into a single variable. Thus, it was not possible to tease out the independent effects of reduction in response time and application of an AED on the small improvement in survival

  18. 77 FR 76841 - Lending Limits (United States)


    ... surplus if the loan is fully secured. Section 5(u)(1) of the Home Owners' Loan Act (HOLA), 12 U.S.C. 1464...) of HOLA, 12 U.S.C. 1464(u)(2), includes exceptions to the lending limits for certain loans made by savings associations. These HOLA provisions apply to both Federal and state-chartered savings associations...

  19. 78 FR 37930 - Lending Limits (United States)


    ...' Loan Act (HOLA), 12 U.S.C. 1464(u)(1), provides that section 5200 of the Revised Statutes ``shall apply....'' In addition, section 5(u)(2) of HOLA, 12 U.S.C. 1464(u)(2), includes exceptions to the lending limits for certain loans made by savings associations. These HOLA provisions apply to both Federal and state...

  20. 77 FR 37265 - Lending Limits (United States)


    ...)(1) of the Home Owners' Loan Act (HOLA), 12 U.S.C. 1464(u)(1), provides that section 5200 of the... applies to ] national banks.'' In addition, section 5(u)(2) of HOLA, 12 U.S.C. 1464(u)(2), includes exceptions to the lending limits for certain loans made by savings associations. These HOLA provisions apply...

  1. Interprofessionalism, personalization and care provision. (United States)

    Laurenson, Mary; Brocklehurst, Hilary


    This UK-based empirical research investigates interprofessionalism and personalization to assess their potential to achieve quality care provision for people with long-term conditions. Governmental policies extol the virtues of interprofessionalism and personalization to drive modernization forward, however, change requires the commitment of health and social care professionals. Therefore the complexity of turning policy into practice requires continual review to ensure policy ideals become practice realities rather than speculative rhetoric. This paper examines interprofessional working (IPW) and interprofessional education (IPE) by analysing the experiences and working relationships of professionals from different professions and their potential impact upon personalization initiatives. The conclusion argues that educational providers and professional awarding bodies need to enshrine interprofessionalism into curricula and qualification accreditation thereby instilling collaboration intrinsically into care provision.

  2. Contemporary animal models of cardiac arrest: A systematic review. (United States)

    Vognsen, Mikael; Fabian-Jessing, Bjørn K; Secher, Niels; Løfgren, Bo; Dezfulian, Cameron; Andersen, Lars W; Granfeldt, Asger


    Animal models are widely used in cardiac arrest research. This systematic review aimed to provide an overview of contemporary animal models of cardiac arrest. Using a comprehensive research strategy, we searched PubMed and EMBASE from March 8, 2011 to March 8, 2016 for cardiac arrest animal models. Two investigators reviewed titles and abstracts for full text inclusion from which data were extracted according to pre-defined definitions. Search criteria yielded 1741 unique titles and abstracts of which 490 full articles were included. The most common animals used were pigs (52%) followed by rats (35%) and mice (6%). Studies favored males (52%) over females (16%); 17% of studies included both sexes, while 14% omitted to report on sex. The most common methods for induction of cardiac arrest were either electrically-induced ventricular fibrillation (54%), asphyxia (25%), or potassium (8%). The median no-flow time was 8min (quartiles: 5, 8, range: 0-37min). The majority of studies used adrenaline during resuscitation (64%), while bicarbonate (17%), vasopressin (8%) and other drugs were used less prevalently. In 53% of the studies, the post-cardiac arrest observation time was ≥24h. Neurological function was an outcome in 48% of studies while 43% included assessment of a cardiac outcome. Multiple animal models of cardiac arrest exist. The great heterogeneity of these models along with great variability in definitions and reporting make comparisons between studies difficult. There is a need for standardization of animal cardiac arrest research and reporting. Copyright © 2017 Elsevier B.V. All rights reserved.

  3. The impact of emotional disturbances on the arrest trajectories of youth as they transition into young adulthood. (United States)

    Constantine, Robert J; Andel, Ross; Robst, John; Givens, Eugenia M


    This article identifies the arrest trajectories of youth from ages 12 through 24 years old and tests hypotheses derived from Moffitt's developmental taxonomic theory of crime concerning the impact of various emotional disturbances on the specific trajectories of the youth involved. The study uses exclusively administrative data sets and includes a gender and racially diverse sample of 10,360 youth (30.7% females) who were arrested at least once between ages 12 and 24 in the early 2000s. Latent class growth analysis was employed in order to identify distinct arrest trajectories of youth in the sample. Multinomial logistic regression was used to identify diagnostic and other characteristics associated with membership in the specific trajectories predicted by Moffitt's theory. Five trajectory classes were identified, 3 of which were consistent with taxonomic theory including high and classic adolescence limited trajectory classes and a "snared adolescence limited class" described more recently by Moffitt. The distribution of youth among the 5 classes was very different for those with and without emotional disturbances. Youth with emotional disturbances in their late adolescent years were more likely to fall into the high arrest trajectory class and much less likely to fall into the low arrest trajectory class. Compared to youth without an emotional disturbance, youth with psychotic disorders were more than twice as likely to fall into the high as into the low arrest trajectory class. Youth with disruptive behavior disorders were more than twice as likely to fall into the high and intermediate classes as into the low trajectory class. Anxiety and depressive disorders were not associated with significantly greater likelihood of falling into any one of the trajectory classes. Youth in the snared adolescence limited class were more likely than those in the classic adolescence limited class to be male, black versus white and in the foster care enrollment category lending

  4. 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

  5. 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.

  6. 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.

  7. 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...

  8. Provision of deep procedural sedation by a pediatric sedation team at a freestanding imaging center. (United States)

    Emrath, Elizabeth T; Stockwell, Jana A; McCracken, Courtney E; Simon, Harold K; Kamat, Pradip P


    Freestanding imaging centers are popular options for health care systems to offer services accessible to local communities. The provision of deep sedation at these centers could allow for flexibility in scheduling imaging for pediatric patients. Our Children's Sedation Services group, comprised of pediatric critical care medicine and pediatric emergency medicine physicians, has supplied such a service for 5 years. However, limited description of such off-site services exists. The site has resuscitation equipment and medications, yet limited staffing and no proximity to hospital support. To describe the experience of a cohort of pediatric patients undergoing sedation at a freestanding imaging center. A retrospective chart review of all sedations from January 2012 to December 2012. Study variables include general demographics, length of sedation, type of imaging, medications used, completion of imaging, adverse events based on those defined by the Pediatric Sedation Research Consortium database and need for transfer to a hospital for additional care. Six hundred fifty-four consecutive sedations were analyzed. Most patients were low acuity American Society of Anesthesiologists physical class ≤ 2 (91.8%). Mean sedation time was 55 min (SD ± 24). The overwhelming majority of patients (95.7%) were sedated for MRI, 3.8% for CT and patients) for both modalities. Propofol was used in 98% of cases. Overall, 267 events requiring intervention occurred in 164 patient encounters (25.1%). However, after adjustment for changes from expected physiological response to the sedative, the rate of events was 10.2%. Seventy-five (11.5%) patients had desaturation requiring supplemental oxygen, nasopharyngeal tube or oral airway placement, continuous positive airway pressure or brief bag valve mask ventilation. Eleven (1.7%) had apnea requiring continuous positive airway pressure or bag valve mask ventilation briefly. One patient had bradycardia that resolved with nasopharyngeal tube

  9. 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.

  10. The use of amiodarone for in-hospital cardiac arrest at two tertiary care centres. (United States)

    Pollak, P Timothy; Wee, Vinnie; Al-Hazmi, Ahmed; Martin, Janet; Zarnke, Kelly B


    Although amiodarone significantly increases survival to hospital admission when used in resuscitation of out-of-hospital pulseless ventricular tachycardia and fibrillation, there are limited data on its utility for in-hospital arrests. To determine whether the use of amiodarone, as recommended by the year 2000 American Heart Association Advanced Cardiac Life Support guidelines, improved survival following its introduction to the resuscitation algorithm at two tertiary care institutions. Charts of 374 cardiac resuscitations were retrospectively studied at the two institutions. Basic survival outcomes and demographic data were recorded for cardiac arrests with ventricular tachyarrhythmias qualifying for administration of antiarrhythmic agents. Qualifying rhythms were present in 95 patients. Clinical uptake of amiodarone was limited. In the 36 patients who received amiodarone, survival of resuscitation was 67% versus 83% (P=0.07) in the 59 patients receiving only other antiarrhythmic agents (chiefly lidocaine [94%]), while survival to discharge was 36.1% and 55.9% (P=0.06) in these two groups, respectively. Following two years' experience with the introduction of intravenous amiodarone for resuscitation in the institutions, use was less than 50% and no clinically observable survival benefit could be documented. Possible explanations for the difference between this experience and that found in out-of-hospital resuscitation trials include differing patient populations and operator bias during resuscitation. These results should provoke other institutions to question whether amiodarone has improved survival of cardiac arrest under the conditions prevailing in their hospitals. A patient registry or prospective, randomized trial will be required to assess what parameters affect the success of intravenous amiodarone for resuscitation in-hospital.

  11. Numerical study of fracture arrest on snow cover

    Directory of Open Access Journals (Sweden)

    B. Frigo


    Full Text Available Under the hypothesis of a perfectly brittle phenomenon, avalanche triggering can be investigated numerically by means of Linear Elastic Fracture Mechanics (LEFM. Since, however, the real phenomenon is intrinsically dynamical, another aspect to investigate is represented by dynamic fracture propagation. In this paper, we model dynamic crack propagation into a dry snow slab and we investigate the possibility to arrest the crack propagation through the presence of weak zones distributed along the extension of the snow slope. Assuming that the weak layer is almost collapsed, we simulate the efficiency of artificial voids in the slab to arrest fracture propagation, into the framework of Dynamical Fracture Mechanics. We put forward here a new philosophy for the use of artificial discontinuities (void into the snowpack able to perform as crack arresters distributed along the snow slope area: the target is to split a large avalanche slab into smaller slabs, causing small avalanches to propagate with less catastrophic effects.

  12. Transcranial optical vascular imaging (TOVI) during cardiac arrest (Conference Presentation) (United States)

    Kalchenko, Vyacheslav; Kuznetsov, Yuri; Meglinski, Igor; Harmelin, Alon


    Based on the recent studies the prognosis of patients after cardiac arrest (CA) remains poor. Thus it is extremely important to understand fine mechanisms related to the influence of CA on the brain and Cerebral Blood Flow (CBF) during and after cardiac arrest. Recently our group introduced Transcranial Optical Vascular Imaging (TOVI) approach that combines laser speckle and dynamic fluorescent imaging. TOVI proved to be useful during various preclinical brain research applications. For example it allows imaging of brain blood vessels of a mouse in vivo through the intact cranium. Herein for the first time we present the use of TOVI during cardiac arrest. TOVI possibly could be a useful tool for preclinical studies of CBF during and after CA.

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

    DEFF Research Database (Denmark)

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


    Introduction: The reported incidences of out-of-hospital cardiac arrests (OHCA) in western countries vary considerably. According to the latest report from Danish Cardiac Arrest Database (DCAD) the incidence rate in Denmark in 2004 was 51/100,000/year. The report states however that this number...... 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...... 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...

  14. Automated external defibrillators and simulated in-hospital cardiac arrests. (United States)

    Rossano, Joseph W; Jefferson, Larry S; Smith, E O'Brian; Ward, Mark A; Mott, Antonio R


    To test the hypothesis that pediatric residents would have shorter time to attempted defibrillation using automated external defibrillators (AEDs) compared with manual defibrillators (MDs). A prospective, randomized, controlled trial of AEDs versus MDs was performed. Pediatric residents responded to a simulated in-hospital ventricular fibrillation cardiac arrest and were randomized to using either an AED or MD. The primary end point was time to attempted defibrillation. Sixty residents, 21 (35%) interns, were randomized to 2 groups (AED = 30, MD = 30). Residents randomized to the AED group had a significantly shorter time to attempted defibrillation [median, 60 seconds (interquartile range, 53 to 71 seconds)] compared with those randomized to the MD group [median, 103 seconds (interquartile range, 68 to 288 seconds)] (P attempted defibrillation at attempted defibrillation by pediatric residents in simulated cardiac arrests. Further studies are needed to help determine the role of AEDs in pediatric in-hospital cardiac arrests.

  15. [Cardiac arrest in France: Why a national register?]. (United States)

    Gueugniaud, Pierre-Yves; Bertrand, C; Savary, Dominique; Hubert, H


    Cardiac arrest is a public health issue for which international guidelines are updated every five years (last bringing up to date on 2010 october). The lake of epidemiologic data on cardiac arrest justifies the building of a national register. French SAMU experienced registers especially in the field of acute coronary syndrom. Our national register "RéAC"is planned to deploy the present year for out-of-hospital cardiac arrest with the help of our scientific societies and the Department of Health. It is integrated in a program of evaluation and improvement of professional practices for physicians and prehospital teams who will be involved in its exhaustive use. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

  16. Fatigue crack arrest in a self-healing polymer composite

    Energy Technology Data Exchange (ETDEWEB)

    Brown, E. N. (Eric N.); White, S. R. (Scott R.); Sottos, Nancy R.


    A comprehensive experimental program is performed to assess the in situ fatigue behavior of a self-healing polymer. A fatigue-life-extension protocol is established for characterizing healing efficiency of the self-healing epoxy under cyclic loading. At moderate {Delta}K{sub I} and at high {Delta}K{sub I}, when a rest period is employed, in situ healing extends fatigue life though temporary crack arrest and retardation. In situ self-healing permanently arrests crack growth at low {delta}K{sub I} and at moderate {Delta}K{sub I}, when a rest period is employed. Fatigue crack retardation and arrest result from two primary crack-tip shielding mechanisms: hydrodynamic pressure in the viscous healing agent and artificial crack closure. Application of self-healing functionality to fatigue slows the crack growth rate and increases the fatigue threshold.

  17. 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...

  18. 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....... METHODS: A community-based case-control study was performed, with 1310 cases of SCA of the ARREST study and 5793 age, sex and SCA-date matched non-SCA controls from the PHARMO database. Only incident SCA cases, age older than 40 years, that resulted from unequivocal cardiac causes...

  19. Delamination Arrestment in Bonded-Bolted Composite Structures by Fasteners (United States)

    Cheung, Chi Ho Eric

    Laminated composites have exceptional in-plane strengths and fatigue properties. However, they are susceptible to the interlaminar mode of failure, namely disbond and delamination. This failure mode challenges the edges of structural interface, such as the skin-stringer flange and run-out, where interlaminar tension, shear, and opening moment are concentrated. The fasteners provide a substantiation path for the FAA damage tolerance requirement for composite bonded joints (FAR 23.573). A comprehensive understanding of delamination arrestment by fasteners was developed. The fastener provides crack arrest capability by three main mechanisms: 1) mode I suppression, 2) crack-face friction, and 3) fastener joint shear stiffness. The fastener mechanically closes the crack tip, suppressing mode I fracture and forcing the crack to propagate in pure mode II with higher fracture toughness. Fastener preload generates significant friction force on the cracked surfaces which reduces crack-tip forces and moments. The fastener shear joint provides an alternate load path around the crack tip that becomes more effective as crack length increases. The three mechanisms work in concert to provide various degrees of crack arrestment and retardation capability. A novel test technique was developed to quantify the delamination arrestment capability by fasteners under in-plane dominated loading, i.e. mode II propagation. The test results show that the fastener is highly capable of delamination arrestment and retardation. The test also demonstrates that fastener installation preload, which is directly related to crack-face friction, is an important factor in delamination arrestment. A computationally efficient analytical method was developed to capture the behavior and efficacy of delamination arrestment by fasteners. The solution method is based on the principle of minimum potential energy and beam-column modeling of the delaminating structure. The fastener flexibility approach is used to

  20. Temporal patterns of change in vital signs and Cardiac Arrest Risk Triage scores over the 48 hours preceding fatal in-hospital cardiac arrest. (United States)

    Oh, HyunSoo; Lee, KangIm; Seo, WhaSook


    To determine temporal patterns of vital sign and Cardiac Arrest Risk Triage score changes over the 48-hour period preceding cardiac arrest in an ICU setting. Vital sign instability usually occurs prior to cardiac arrest. However, few studies have been conducted on the temporal patterns of individual vital signs preceding cardiac arrest. A retrospective case-control study. The study subjects were 140 ICU patients (1 June 2011-31 December 2012): 46 died of cardiac arrest (case group), 45 died of other illnesses (control I group) and 49 were discharged after recovering (control II group). Initial detectable changes in blood pressure appeared 18-20 hours and became dramatic at 5-10 hours before cardiac arrest. Noticeable changes in heart rates began at 4 hours and became more prominent at 2 hours pre-arrest. No apparent patterns in respiratory rate changes were observed. Body temperatures usually indicated a hypothermic state pre-arrest. Cardiac Arrest Risk Triage scores were 16-18 at 48 hours pre-arrest and then continuously increased to 20. Only mean values of systolic blood pressures were significantly different between the three study groups. Mean diastolic blood pressures, heart rates, respiratory rates and Cardiac Arrest Risk Triage scores differed between the case and control II groups and between the control I and II groups. The study demonstrates vital sign instability preceded cardiac arrest and that the temporal patterns of changes in individual vital signs and Cardiac Arrest Risk Triage scores differed between groups. The findings of this study may aid the development of management strategies for cardiac arrest. © 2016 John Wiley & Sons Ltd.

  1. Pre-arrest predictors of failure to survive after in-hospital cardiopulmonary resuscitation: a meta-analysis. (United States)

    Ebell, Mark H; Afonso, Anna M


    Our objective was to perform a systematic review of pre-arrest predictors of the outcome of in-hospital cardiopulmonary resuscitation (CPR) in adults. We searched PubMed for studies published since 1985 and bibliographies of previous meta-analyses. We included studies with predominantly adult patients, limited to in-hospital arrest, using an explicit definition of cardiopulmonary arrest and CPR and reporting survival to discharge by at least one pre-arrest variable. A total of 35 studies were included in the final analysis. Inclusion criteria, design elements and results were abstracted in parallel by both investigators. Discrepancies were resolved by consensus. The rate of survival to discharge was 17.5%; we found a trend towards increasing survival in more recent studies. Metastatic malignancy [odds ratio (OR) 3.9] or haematologic malignancy (OR 3.9), age over 70, 75 or 80 years (OR 1.5, 2.8 and 2.7, respectively), black race (OR 2.1), altered mental status (OR 2.2), dependency for activities of daily living (range OR 3.2-7.0 depending on specific activity), impaired renal function (OR 1.9), hypotension on admission (OR 1.8) and admission for pneumonia (OR 1.7), trauma (OR 1.7) or medical non-cardiac diagnosis (OR 2.2) were significantly associated with failure to survive to discharge; cardiovascular diagnoses and co-morbidities were associated with improved survival (range OR 0.23-0.53). Elevated CPR risk scores predicted failure to survive but have not been validated consistently in different populations. We identified several pre-arrest variables associated with failure to survive to discharge. This information should be shared with patients as part of a shared decision-making process regarding the use of do not resuscitate orders.

  2. 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


    fatigue test study. Based on a linear elastic fracture mechanics approach, the developed FE model is utilised to simulate crack propagation and arrest in foam-cored sandwich beam specimens subjected to fatigue loading conditions. The effect of the crack arresters on the fatigue life is analysed......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 experimental......, and the predictive results are subsequently compared with the observations from the previously conducted fatigue tests. The FE model predicts the energy release rate and the mode mixity based on the derived crack surface displacements, utilising algorithms for the prediction of accelerated fatigue crack growth...

  3. Clinical characteristics and reproductive outcomes in infertile men with testicular early and late maturation arrest. (United States)

    Tsai, Ming-Chun; Cheng, Yu-Sheng; Lin, Tsung-Yen; Yang, Wen-Horng; Lin, Yung-Ming


    To compare the clinical characteristics and reproductive outcomes of nonobstructive azoospermic men with uniform early and late maturation arrest. Patients with biopsy-documented uniform maturation arrest undergoing testicular sperm retrieval and complete medical records were enrolled in the present study. Their medical history, physical examination findings, testicular volume, serum hormone parameters, genetic anomalies, sperm retrieval, and reproductive outcomes were retrospectively analyzed. In a cohort of 223 nonobstructive azoospermic men, 34 men with uniform maturation arrest (21 early maturation arrest and 13 late maturation arrest) were identified. No significant differences were seen in the age distribution, testicular volume, or hormone parameters between patients with early and late maturation arrest. Only 13 patients (38.2%) had a normal serum follicle-stimulating hormone level and normal testicular volume. Patients with early maturation arrest had a greater frequency of overall genetic anomalies, and patients with late maturation arrest had a greater frequency of previous testicular insults. The sperm retrieval and impregnation rate were nonsignificantly greater in patients with late maturation arrest. Maturation arrest has a variety of causes and presents with diverse phenotypes. Not all patients with uniform maturation arrest have a normal follicle-stimulating hormone level or testicular volume. Patients with early maturation arrest have a greater incidence of genetic anomalies and are more likely to have worse reproductive outcomes than are patients with late maturation arrest. Copyright © 2012 Elsevier Inc. All rights reserved.

  4. Genetic Testing in the Evaluation of Unexplained Cardiac Arrest: From the CASPER (Cardiac Arrest Survivors With Preserved Ejection Fraction Registry). (United States)

    Mellor, Greg; Laksman, Zachary W M; Tadros, Rafik; Roberts, Jason D; Gerull, Brenda; Simpson, Christopher S; Klein, George J; Champagne, Jean; Talajic, Mario; Gardner, Martin; Steinberg, Christian; Arbour, Laura; Birnie, David H; Angaran, Paul; Leather, Richard; Sanatani, Shubhayan; Chauhan, Vijay S; Seifer, Colette; Healey, Jeffrey S; Krahn, Andrew D


    Unexplained cardiac arrest may be because of an inherited arrhythmia syndrome. The role of genetic testing in cardiac arrest survivors without a definite clinical phenotype is unclear. The CASPER (Cardiac Arrest Survivors with Preserved Ejection Fraction Registry) is a large registry of cardiac arrest survivors where initial assessment reveals normal coronary arteries, left ventricular function, and resting ECG. Of 375 cardiac arrest survivors in CASPER from 2006 to 2015, 174 underwent genetic testing. Patients were classified as phenotype-positive (n=72) or phenotype-negative (n=102). Genetic testing was performed at treating physicians' discretion in line with contemporary guidelines and availability. All genetic variants identified from original laboratory reports were reassessed by the investigators in line with modern criteria. Pathogenic variants were identified in 29 (17%) patients (60% channelopathy-associated and 40% cardiomyopathy-associated genes) and 70 variants of unknown significance were identified in 32 (18%) patients. Prior syncope (odds ratio, 4.0; 95% confidence interval, 1.6-9.7) and a family history of sudden death (odds ratio, 3.2; 95% confidence interval, 1.1-9.4) were independently associated with the presence of a pathogenic variant. In phenotype-negative patients, broad multiphenotype genetic testing led to higher yields (21% versus 8%; P=0.04) but was associated with more variants of unknown significance (55% versus 5%; Pcardiac arrest survivors. Prior syncope and family history of sudden death are predictors of a positive genetic test. Both arrhythmia and cardiomyopathy genes are implicated. Broad, multiphenotype testing revealed the highest frequency of pathogenic variants in phenotype-negative patients. Unique Identifier: NCT00292032. © 2017 American Heart Association, Inc.

  5. A randomized trial of the effects of the noble gases helium and argon on neuroprotection in a rodent cardiac arrest model. (United States)

    Zuercher, Patrick; Springe, Dirk; Grandgirard, Denis; Leib, Stephen L; Grossholz, Marius; Jakob, Stephan; Takala, Jukka; Haenggi, Matthias


    The noble gas xenon is considered as a neuroprotective agent, but availability of the gas is limited. Studies on neuroprotection with the abundant noble gases helium and argon demonstrated mixed results, and data regarding neuroprotection after cardiac arrest are scant. We tested the hypothesis that administration of 50% helium or 50% argon for 24 h after resuscitation from cardiac arrest improves clinical and histological outcome in our 8 min rat cardiac arrest model. Forty animals had cardiac arrest induced with intravenous potassium/esmolol and were randomized to post-resuscitation ventilation with either helium/oxygen, argon/oxygen or air/oxygen for 24 h. Eight additional animals without cardiac arrest served as reference, these animals were not randomized and not included into the statistical analysis. Primary outcome was assessment of neuronal damage in histology of the region I of hippocampus proper (CA1) from those animals surviving until day 5. Secondary outcome was evaluation of neurobehavior by daily testing of a Neurodeficit Score (NDS), the Tape Removal Test (TRT), a simple vertical pole test (VPT) and the Open Field Test (OFT). Because of the non-parametric distribution of the data, the histological assessments were compared with the Kruskal-Wallis test. Treatment effect in repeated measured assessments was estimated with a linear regression with clustered robust standard errors (SE), where normality is less important. Twenty-nine out of 40 rats survived until day 5 with significant initial deficits in neurobehavioral, but rapid improvement within all groups randomized to cardiac arrest. There were no statistical significant differences between groups neither in the histological nor in neurobehavioral assessment. The replacement of air with either helium or argon in a 50:50 air/oxygen mixture for 24 h did not improve histological or clinical outcome in rats subjected to 8 min of cardiac arrest.

  6. Equilibrium gels of limited valence colloids


    Sciortino, Francesco; Zaccarelli, Emanuela


    Gels are low-packing arrested states of matter which are able to support stress. On cooling, limited valence colloidal particles form open networks stabilized by the progressive increase of the interparticle bond lifetime. These gels, named equilibrium gels, are the focus of this review article. Differently from other types of colloidal gels, equilibrium gels do not require an underlying phase separation to form. Oppositely, they form in a region of densities deprived of thermodynamic instabi...

  7. 10 CFR 1047.5 - Exercise of arrest authority-general guidelines. (United States)


    .... (c) After the arrest is effected, the arrested person shall be advised of his or her constitutional right against self-incrimination (Miranda warnings). If the circumstances are such that making such...

  8. 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.

  9. Prognostic Value of A Qualitative Brain MRI Scoring System After Cardiac Arrest

    NARCIS (Netherlands)

    Hirsch, Karen G.; Mlynash, Michael; Jansen, Sofie; Persoon, Suzanne; Eyngorn, Irina; Krasnokutsky, Michael V.; Wijman, Christine A. C.; Fischbein, Nancy J.


    BACKGROUND AND PURPOSETo develop a qualitative brain magnetic resonance imaging (MRI) scoring system for comatose cardiac arrest patients that can be used in clinical practice. METHODSConsecutive comatose postcardiac arrest patients were prospectively enrolled. Routine MR brain sequences were scored

  10. 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...

  11. Exercise-related cardiac arrest in cardiac rehabilitation - The ...

    African Journals Online (AJOL)

    ... to establish the safety of cardiac rehabilitation as a medical intervention at the Johannesburg Cardiac Rehabilitation Centre from its inception in September 1982 to July 1988, and analyses the medical status of patients who suffered a cardiac arrest (CA) in order to determine possible factors predictive of sudden death.

  12. Haemodynamic consequences of mild therapeutic hypothermia after cardiac arrest.

    NARCIS (Netherlands)

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


    BACKGROUND AND OBJECTIVE: Mild therapeutic hypothermia (MTH) is used after out-of-hospital cardiac arrest (OHCA) to minimize cerebral damage. Induced hypothermia may further interfere with cardiac function and influence haemodynamics after OHCA. METHODS: This was a prospective study of haemodynamic

  13. An evaluation of the narrowing gender gap in DUI arrests. (United States)

    Robertson, Angela A; Liew, Hui; Gardner, Sheena


    Although males account for the vast majority of those convicted of driving under the influence of alcohol and/or other drugs (DUI), female DUI convictions have increased over the past two decades. In this study, we examined the ratio of males-to-females who were court-mandated between the years 1992 and 2008 to attend the Mississippi Alcohol Safety Education Program (MASEP), a DUI intervention program in Mississippi. The data for this study came from MASEP records; the Behavioral Risk Factor Surveillance System (BRFSS); the Uniform Crime Reports (UCR); the Treatment Episode Data Set (TEDS); the National Household Travel Survey (NHTS); and National Highway Traffic Safety Administration (NHTSA), an agency within the US Department of Transportation. Augmented Dickey-Fuller (ADF) tests were used to assess the nature (i.e., convergence, divergence, or stability) of this trend and to identify predictors. The results showed that, over the 17-year period, the gender gap in DUI convictions, self-reported history of prior arrest, official drug arrests, and substance abuse treatment admissions has narrowed considerably. Results from the autoregressive integrated moving average (ARIMA) models show that three factors account for increases in the proportion of women mandated to attend MASEP: self-reported arrest prior to the DUI conviction, female admissions to substance abuse treatment, and annual miles driven. Changes in both women's behavior and law enforcement practices have increased female exposure to DUI arrests and narrowed the gender gap in DUI convictions. Copyright © 2011 Elsevier Ltd. All rights reserved.

  14. 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...

  15. 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.

  16. [Cardio respiratory arrest out of the hospital at the eldest]. (United States)

    Karma, Sonia; Zouari, Abdelaziz; Frikha, Mokhtar; Dridi, Sana; Ghanem, Chedli; Jedidi, Slim; Belakhdar, Hajer; Abdelmoumen, Samir; Daghfous, Mounir


    The management of the older constituted a problematic that will be more attractive in the future because of the population's advanced age. To evaluate the management of the older more than 75 years that presented an arrest chest. Retrospective study during 12 months (from the first January 2004 to 31 December 2004) and interested 15 regulation's documents; we studied demographic parameters, the cause and the time of called the evolution after cardio-respiratory resuscitation. We had 9276 called cases: 320 concerned patients more than 75 years (3, 45%) among 15 (4, 68%) had a chest arrest, the ratio sex was 0, 5 and the middle age: 78, 4 years. In the most cases; the called arrived by night (40%). The principal symptomatology was respiratory troubles (33, 33%); the outcome was fatal in all cases. The older over than 75 years had many pathologies that is why the prognostic of the chest arrest was very bad (mortality 100%), the gravity of the chest arrest was seen on this study so we must take seriously all the pathology presented by the older, multiplied the medical consultations to detect the complications earlier and to improve the life's quality.

  17. [Refractory cardiac arrest patients in prehospital care, potential organ donors]. (United States)

    Le Jan, Arnaud; Dupin, Aurélie; Garrigue, Bruno; Sapir, David


    Under the authority of the French Biomedicine Agency, a new care pathway integrates refractory cardiac arrest patients into a process of organ donation. It is a medical, logistical and ethical challenge for the staff of the mobile emergency services. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  18. A novel parameter estimation method for metal oxide surge arrester ...

    Indian Academy of Sciences (India)

    In this paper, a new technique, which is the combination of Adaptive Particle Swarm Optimization (APSO) and Ant Colony Optimization (ACO) algorithms and linking the MATLAB and EMTP, is proposed to estimate the parameters of MO surge arrester models. The proposed algorithm is named Modified Adaptive Particle ...

  19. Sudden cardiac arrest in sports - need for uniform registration

    DEFF Research Database (Denmark)

    Solberg, E E; Borjesson, M; Sharma, S


    There are large variations in the incidence, registration methods and reported causes of sudden cardiac arrest/sudden cardiac death (SCA/SCD) in competitive and recreational athletes. A crucial question is to which degree these variations are genuine or partly due to methodological incongruities....

  20. Sudden cardiac arrest risk in young athletes | Gradidge | South ...

    African Journals Online (AJOL)

    Underlying cardiac abnormalities are the main cause of unexpected death in athletes on field. These abnormalities have been associated with a previous history of syncope, a family history of sudden cardiac arrest (SCA), cardiac murmur, a history of over-exhaustion post exercise and ventricular tachyarrhythmia during ...

  1. 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...

  2. Public Cardiac Arrest Characteristics in Enclosed Pedestrian Networks

    NARCIS (Netherlands)

    Lee, Minha; Demirtas, Derya; Buick, Jason E.; Ng, Amy; Feldman, Michael J.; Cheskes, Sheldon; Morrison, Laurie J.; Chan, Timothy C.Y.


    Background: Cities around the world have underground or above-ground enclosed networks for pedestrian travel, representing unique environments for studying out-of-hospital cardiac arrest (OHCA) and resuscitation. The characteristics of OHCAs that occur in such networks are unknown. Objective: To

  3. 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.

  4. 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; Kreckova, Marketa; Kral, Ales; Horak, Jan; Otahal, Michal; Rulisek, Jan; Malik, Jan; Prettl, Martin; Wascher, Michael; Boesgaard, Soeren; Moller, Jacob E.; Bro-Jeppesen, John; Johansen, Ane Loof; Campanile, Vincenzo; Peratoner, Alberto; Verginella, Francesca; Leone, Daniele; Pellis, Thomas; Roncarati, Andrea; Franceschino, Eliana; Sanzani, Anna; Martini, Alice; Perlin, Micol; Pelosi, Paolo; Brunetti, Iole; Insorsi, Angelo; Pezzato, Stefano; de Luca, Giorgio; Gazzano, Emanuela; Ottonello, Gian Andrea; Furgani, Andrea; Telani, Rosanna; Maiani, Simona; Werer, Christophe; Kieffer, Jaqueline; van der Veen, Annelou L.; Winters, Tineke; Juffermans, Nicole P.; Egbers, Ph; Boerma, EC; Gerritsen, R. T.; Buter, H.; de Jager, C.; de Lange, F.; Loos, M.; Koetsier, P. M.; Kingma, W. P.; Bruins, N.; de Kock, L.; Koopmans, M.; Bosch, Frank; Raaijmakers, Monique A. M.; Metz-Hermans, S. W. L.; Endeman, Henrik; Rijkenberg, Saskia; Bianchi, Addy; Bugge, Jan Frederik; Norum, Hilde; Espinoza, Andreas; Kerans, Viesturs; Brevik, Helene; Svalebjørg, Morten; Grindheim, Guro; Petersen, Arne Jan; Baratt-Due, Andreas; Laake, Jon Henrik; Spreng, Ulrik; Wallander Karlsen, Marte Marie; Langøren, Jørund; Fanebust, Rune; Holm, Marianne Sætrang; Flinterud, Stine Iren; Wickman, Carsten; Johnsson, Jesper; Ebner, Florian; Gustavsson, Nerida; Petersson, Heléne; Petersson, Jörgen; Nasiri, Faezheh; Stafilidou, Frida; Edqvist, Kristine; Uhlig, Sven; Sköld, Gunilla; Sanner, Johan; Wallskog, Jesper; Wyon, Nicholas; Golster, Martin; Samuelsson, Anders; Hildebrand, Carl; Kadowaki, Taichi; Larsson-Viksten, Jessica; de Geer, Lina; Hansson, Patrik; Appelberg, Henrik; Hellsten, Anders; Lind, Susanne; Rundgren, Malin; Kander, Thomas; Persson, Johan; Annborn, Martin; Adolfsson, Anne; Corrigan, Ingrid; Dragancea, Irina; Undén, Johan; Larsson, Marina; Chew, Michelle; Unnerbäck, Mårten; Petersen, Per; Svedung-Rudebou, Anna; Svensson, Robert; Elvenes, Hilde; Bäckman, Carl; Rylander, Christian; Martner, Patrik; Martinell, Louise; Biber, Björn; Ahlqvist, Marita; Jacobson, Caisa; Forsberg, Marie-Louise; Lindgren, Roman Desta; Bergquist, Fatma; Thorén, Anders; Fredholm, Martin; Sellgren, Johan; Hård Af Segerstad, Lisa; Löfgren, Mikael; Gustavsson, Ingvor; Henström, Christina; Andersson, Bertil; Thiringer, Karin; Rydholm, Nadja; Persson, Stefan; Jawad, Jawad; Östman, Ingela; Berglind, Ida; Bergström, Eric; Andersson, Annika; Törnqvist, Cathrine; Marques de Mello, Nubia Lafayete; Gardaz, Valérie; Kleger, Gian-Reto; Schrag, Claudia; Fässler, Edith; Zender, Hervé; Wise, Matthew; Palmer, Nicki; Fouweather, Jen; Cole, Jade M.; Cocks, Eve; Frost, Paul J.; Saayman, Anton G.; Holmes, Tom; Hingston, Christopher D.; Scholey, Gareth M.; Watkins, Helen; Fernandez, Stephen; Walden, Andrew; Atkinson, Jane; Jacques, Nicola; Brown, Abby; Cranshaw, Julius; Berridge, Peter; McCormick, Robert; Schuster-Bruce, Martin; Scott, Michelle; White, Nigel; Vickers, Emma; Glover, Guy; Ostermann, Marlies; Holmes, Paul; Koutroumanidis, Michael; Lei, Katie; Sanderson, Barnaby; Smith, John; al-Subaie, Nawaf; Moore, Matthew; Randall, Paul; Mellinghoff, Johannes; Buratti, Azul Forti; Ryan, Chris; Ball, Jonathan; Francis, Gaynor


    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,

  5. 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...

  6. The arresting phase determines the total healing time of

    Directory of Open Access Journals (Sweden)

    LI Ping


    Full Text Available 【Abstract】Objective: Radiation is an important cause of delayed wound healing, and there still exist many questions regarding the patterns and mechanisms of wound healing. This study investigated the characteristics of wound healing after varying doses of local radiation and explored possible causes of the delay in healing caused by radiation. Methods: A full-thickness dorsal longitudinal skin tissue, 2 cm in diameter, was excised after local irradiation on one side of the back of swine, and the other side was wounded as a control. The size of the wound area was re-corded every two days after injury. Pathological changes, proliferating cell nuclear antigen (PCNA, immunohisto-chemistry and apoptosis levels (TUNEL assay were mea-sured at different time points after wounding. Results: The course of wound healing can be divided into four phases, namely: the arresting phase, the healing priming phase, the fast healing phase, and the healed phase. Although the total wound healing time was closely corre-lated to the dose of irradiation (R 2 = 0.9758, it was more dependent on the length of the arresting phase (R 2 =0.9903 because once the arresting phase ended, the wound healed at a similar speed regardless of radiation doses. Pathologi-cal analysis showed that compared with the control side there were more necrotic tissues, slower epithelial crawling, as well as fewer blood vessels and cellular components in the irradiated side at the arresting phase, while other phases revealed no significant difference concerning these measurements. Immunohistochemistry showed that the ir-radiated wounds had significantly less PCNA-positive and more TUNEL-positive labeling of cells in the arresting phase than in other phases. Moreover, the changes were posi-tively related to the radiation doses, but there was no obvi-ous difference in cell proliferation or apoptosis among the healing priming phase, fast healing phase or healed phase, whether on the control side

  7. Synchrotron 3D characterization of arrested fatigue cracks initiated from small tilted notches in steel

    Directory of Open Access Journals (Sweden)

    P. Lorenzino


    Full Text Available High resolution synchrotron X-ray tomography has been used to obtain 3D images of arrested cracks initiated at small artificial defects located on the surface of cylindrical steel specimens subjected to mode I fatigue loading. These defects consist in small semi-circular slits tilted at 0°, 30° or 60° with respect to the plane normal to the loading axis; all of them had the same defect size, area = 188 μm, where the area denotes the area of the domain defined by projecting the defect on a plane normal to the loading axis. Arrested cracks initiated from the notch were observed for all tilt angles at the surface of samples cycled at the fatigue limit (stress amplitude at which the specimen does not fail after 1×107 cycles. High resolution synchrotron X-ray tomography has been used to obtain 3D images of those small defects and non-propagating cracks (NPC. Despite the fact that steel is a highly attenuating material for X rays, high resolution 3D images of the cracks and of the initiating defects were obtained (0.65 m voxel size. The values of surface crack length measured by tomography are the same as those obtained by optical microscope measurements. The area values present the same tendency as the surface length of NPC, i.e. larger non-propagating cracks areas were observed in the softer steel. In the extreme case of 60º tilted defect, the crack fronts appear much more discontinuous with several cracks propagating in mode I until arrest.

  8. Exercise-related sudden cardiac arrest in London: incidence, survival and bystander response


    Edwards, Melanie J; Fothergill, Rachael T


    Objective The study aimed to (1) establish the incidence of exercise-related sudden cardiac arrest (SCA) in London, (2) investigate survival from exercise-related SCA and (3) examine factors related to survival. Method This retrospective observational study examined 2 years’ data from the London Ambulance Service (LAS) cardiac arrest registry for patients in whom resuscitation was attempted following an out-of-hospital cardiac arrest (OHCA), a cardiac cause was presumed and the arrest occurre...

  9. Cardiopulmonary arrest in pregnancy with schizophrenia: a case report. (United States)

    Kudo, Takako; Kaga, Akimune; Akagi, Kozo; Iwahashi, Hideki; Makino, Hiromitsu; Watanabe, Yoko; Kawamura, Takae; Sato, Taiju; Shinozaki, Tsuyoshi; Miwa, Shinya; Okazaki, Nobuo; Kure, Shigeo; Nakae, Shingi


    Cardiopulmonary arrest in pregnancy has a very high maternal and fetal mortality rate. We report a case of successful maternal and neonatal survival in association with emergency cesarean section of a schizophrenic pregnant patient. To our knowledge, this is the first reported case of cardiopulmonary arrest in a pregnant woman with schizophrenia. The parents were Japanese. The mother was 39 years old and had no history of prior pregnancy. Her admission to our hospital at 36 weeks and 4 days of pregnancy was due to deterioration of schizophrenia. On the first day of hospitalization, she collapsed after a seizure and vomiting, and an emergency resuscitation team was called immediately. The team identified apparent aspiration and successfully resuscitated the patient after 11 minutes of cardiopulmonary arrest. An emergency cesarean section was performed in the operating room. The newborn male infant received bag and mask ventilation at birth, and his Apgar scores were 5 at 1 minute and 8 at 5 minutes. He had a myoclonic seizure on the 2nd day of life: however, he experienced no further seizures on anticonvulsant medication after that episode. On the 18th day of life, magnetic resonance imaging of his brain revealed bilateral small hyperintensities on T1-weighted images in the basal ganglia. The mother and her newborn were discharged from our hospital without neurological disorders. We speculate that the cause of cardiopulmonary arrest was aspiration due to seizure, and it is possible that a neurological response was evoked by administration of antipsychotic drugs and/or by eclampsia. Medical staff must be aware of the possibility of cardiopulmonary arrest in pregnant women with schizophrenia.

  10. Incidence and survival outcome according to heart rhythm during resuscitation attempt in out-of-hospital cardiac arrest patients with presumed cardiac etiology

    DEFF Research Database (Denmark)

    Rajan, Shahzleen; Folke, Fredrik; Hansen, Steen Møller


    BACKGROUND: Knowledge about heart rhythm conversion from non-shockable to shockable rhythm during resuscitation attempt after out-of-hospital cardiac arrest (OHCA) and following chance of survival is limited and inconsistent. METHODS: We studied 13,860 patients with presumed cardiac-caused OHCA...... not witnessed by the emergency medical services from the Danish Cardiac Arrest Register (2005-2012). Patients were stratified according to rhythm: shockable, converted shockable (based on receipt of subsequent defibrillation) and sustained non-shockable rhythm. Multiple logistic regression was used to identify...... predictors of rhythm conversion and to compute 30-day survival chances. RESULTS: Twenty-five percent of patients who received pre-hospital defibrillation by ambulance personnel were initially found in non-shockable rhythms. Younger age, males, witnessed arrest, shorter response time, and heart disease were...

  11. Multiple recruitment limitation causes arrested succession in Mediterranean Cork Oak systems

    NARCIS (Netherlands)

    Acácio, V.C.; Holmgren, M.; Jansen, P.A.; Schrotter, O.


    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

  12. 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

  13. 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.

  14. 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…

  15. Mechanical cardiopulmonary resuscitation in in-hospital cardiac arrest : a systematic review

    NARCIS (Netherlands)

    Lameijer, Heleen; Immink, Rosa S.; Broekema, Josien J.; Ter Maaten, Jan C.


    With increasing rates of in-hospital cardiac arrest, improving resuscitation outcomes is essential. Mechanical chest compressors seem to be related to improved outcome in out-of hospital cardiac arrest; however, the literature on its use in in-hospital cardiac arrest is scarce. We used the Medline

  16. Comparison of use and role of adrenaline and amiodarone in cardiac arrest: Case of emergency center in Kosovo

    Directory of Open Access Journals (Sweden)

    Basri Lenjani


    Conclusions: Anti-arrhythmic drugs as with vasopressors, the evidence that anti-arrhythmic drugs are of benefit in cardiac is limited. No anti-arrhythmic drug given during human cardiac arrest has been shown to increase survival to hospital discharge, although amiodarone has been shown to increase survival to hospital admission after shock-refractory VF/VT. There are no data on the use of amiodarone for shock-refractory VF/VT when single shocks are used. Despite the lack of human long-term outcome data, the balance of evidence is in favour of the use of some anti-arrhythmic drugs for the management of arrhythmias in cardiac arrest.

  17. Girls with Emotional Disturbance and a History of Arrest: Characteristics and School-Based Predictors of Arrest (United States)

    Gage, Nicholas A.; Josephs, Nikki L.; Lunde, Kimberly


    Research suggests that girls receiving special education services for Emotional Disturbance (ED) may have unique characteristics and needs. Similarly, juvenile justice research has identified unique characteristics of court-involved girls. This study examined characteristics of girls with ED and a history of arrest. Additionally, classroom-based…

  18. 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


    IMPORTANCE Out-of-hospital cardiac arrest is a major health problem associated with poor outcomes. Early recognition and intervention are critical for patient survival. Bystander cardiopulmonary resuscitation (CPR) is one factor among many associated with improved survival. OBJECTIVE To examine...... temporal changes in bystander resuscitation attempts and survival during a 10-year period in which several national initiatives were taken to increase rates of bystander resuscitation and improve advanced care. DESIGN, SETTING, AND PARTICIPANTS Patients with out-of-hospital cardiac arrest for which...... 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...

  19. Exploring spatial patterns of sudden cardiac arrests in the city of Toronto using Poisson kriging and Hot Spot analyses.

    Directory of Open Access Journals (Sweden)

    Raymond Przybysz

    Full Text Available 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.

  20. Local Immigration Enforcement and Arrests of the Hispanic Population

    Directory of Open Access Journals (Sweden)

    Michael Coon


    Full Text Available Section 287(g of the Immigration and Nationality Act (INA, which was added to the INA by the Illegal Immigration Reform and Immigrant Responsibility Act of 1996 (IIRIRA, allows the federal government to enter into voluntary partnerships with state and local law enforcement agencies to enforce immigration law. Upon entering these agreements, law enforcement officers are trained by Immigration and Customs Enforcement (ICE and receive delegated authority to enquire about an individual’s immigration status and, if found to be removable, to detain the individual while ICE makes a determination of whether to initiate deportation proceedings. In some instances, this inquiry about immigration status takes place as part of the intake process when a criminal defendant is arrested and placed into a criminal jail. In other instances, task force officers are trained to inquire in the field about immigration status and enforce immigration law against people who have not committed any criminal offense.  The key difference between the two models is that task force agents can arrest for immigration violations undocumented individuals who have not committed any criminal offense, whereas in the jail model individuals must be arrested on some other criminal charge before immigration status can be determined. The 287(g program has raised several concerns regarding its implementation and results. First, the program could lead to racial and ethnic profiling. In particular, given that the majority of undocumented immigrants hail from Latin American countries, it is highly plausible that Hispanics, regardless of immigrant status, might be disproportionally affected by this program. That is, in a jurisdiction that participates in the jail model, an officer might arrest a Hispanic individual for a very minor offence in order to process them through the jail and determine their immigration status, when perhaps without the program they may have only issued a citation

  1. [Involvement of psychologists in the organ procurement procedure after 'controlled' cardiac arrest]. (United States)

    Vernay, Catherine


    A protocol for the provision of psychological support for family members has been put in place by a hospital coordination team, in the framework of organ donation after the limitation or cessation of treatment. The support takes into account the needs of the families in terms of information, listening and follow-up. The unit psychologist plays an important role in this approach. Copyright © 2016. Published by Elsevier Masson SAS.

  2. 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.

  3. Code Blue: methodology for a qualitative study of teamwork during simulated cardiac arrest. (United States)

    Clarke, Samuel; Carolina Apesoa-Varano, Ester; Barton, Joseph


    In-hospital cardiac arrest (IHCA) is a particularly vexing entity from the perspective of preparedness, as it is neither common nor truly rare. Survival from IHCA requires the coordinated efforts of multiple providers with different skill sets who may have little prior experience working together. Survival rates have remained low despite advances in therapy, suggesting that human factors may be at play. This qualitative study uses a quasiethnographic data collection approach combining focus group interviews with providers involved in IHCA resuscitation as well as analysis of video recordings from in situ-simulated cardiac arrest events. Using grounded theory-based analysis, we intend to understand the organisational, interpersonal, cognitive and behavioural dimensions of IHCA resuscitation, and to build a descriptive model of code team functioning. This ongoing study has been approved by the IRB at UC Davis Medical Center. The results will be disseminated in a subsequent manuscript. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to

  4. 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.

  5. Drug use and sexually transmitted diseases among female and male arrested youths. (United States)

    Dembo, Richard; Belenko, Steven; Childs, Kristina; Wareham, Jennifer


    Knowledge of the rates and correlates of juvenile offenders' sexually transmitted diseases (STD) has been limited to samples of incarcerated youths comprised mostly of males. Data collected on 442 female and 506 male youths processed at a centralized intake facility enabled us to study this important public health problem among a sample of juvenile offenders at the front end of the justice system. Female-male, multi-group latent class analyses identified two subgroups, High Risk and Lower Risk, of youths described by a latent construct of risk based on drug test results, STD test results, and a classification for the seriousness of arrest charge. The results found: (1) a similar classification distinguished High Risk and Lower Risk male and female youths, and (2) important gender group differences in sexual risk related factors (e.g., substance use during sexual encounters). Among the youths in this sample who tested positive for an STD, 66% of the girls and 57% of the boys were released back into the community after arrest. Overall, our findings raise serious public health and social welfare concerns, for both the youths and the community. Prevention and intervention implications of these findings are also discussed.

  6. Child Welfare and the Transition to Adulthood: Investigating Placement Status and Subsequent Arrests. (United States)

    Ryan, Joseph P; Perron, Brian E; Huang, Hui


    Studies of the transition to adulthood in child welfare focus almost exclusively on youth in foster care. Yet, research indicates that maltreated children who remain in the home may display similar risks as compared with their peers in formal foster care settings. Utilizing administrative data from child welfare, juvenile justice and adult corrections, the current study fills a gap in the literature by analyzing justice outcomes for older adolescents involved with the child welfare system regardless of their placement status. We focus on both intact family cases and formal foster care placements. The diverse sample (11% Hispanic, 8% African American, 6% Native American, 9% multi-racial, 56% female) included open child welfare cases involving 17 year olds (n = 9874). Twenty-nine percent of adolescents were associated with a long term out of home placement and 62% were associated with an intact family case. Event history models were developed to estimate the risk of subsequent offending. Adolescents associated with long term foster care placement were significantly less likely to experience a subsequent arrest as compared with adolescents associated with a long term intact family case. Males, African Americans and adolescents associated with neglect were also more likely to experience a subsequent arrest. Limited focus on the intact family population in child welfare represents a lost opportunity to support critical developmental gains and facilitate a smooth transition to adulthood.

  7. 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

  8. Limiting Skepticism

    DEFF Research Database (Denmark)

    Hendricks, Vincent Fella; Symons, John


    Skeptics argue that the acquisition of knowledge is impossible given the standing possibility of error. We present the limiting convergence strategy for responding to skepticism and discuss the relationship between conceivable error and an agent’s knowledge in the limit. We argue that the skeptic...

  9. 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... status within 3 years from the time of award. Grantee B then provides services to homeless veterans for a... 38 Pensions, Bonuses, and Veterans' Relief 2 2010-07-01 2010-07-01 false Recovery provisions. 61...

  10. 24 CFR 206.27 - Mortgage provisions. (United States)


    ... 24 Housing and Urban Development 2 2010-04-01 2010-04-01 false Mortgage provisions. 206.27 Section... DEVELOPMENT MORTGAGE AND LOAN INSURANCE PROGRAMS UNDER NATIONAL HOUSING ACT AND OTHER AUTHORITIES HOME EQUITY CONVERSION MORTGAGE INSURANCE Eligibility; Endorsement Eligible Mortgages § 206.27 Mortgage provisions. (a...

  11. 40 CFR 63.647 - Wastewater provisions. (United States)


    ... 40 Protection of Environment 10 2010-07-01 2010-07-01 false Wastewater provisions. 63.647 Section... Emission Standards for Hazardous Air Pollutants From Petroleum Refineries § 63.647 Wastewater provisions... wastewater stream shall comply with the requirements of §§ 61.340 through 61.355 of 40 CFR part 61, subpart...

  12. 40 CFR 63.1330 - Wastewater provisions. (United States)


    ... 40 Protection of Environment 11 2010-07-01 2010-07-01 true Wastewater provisions. 63.1330 Section... for Hazardous Air Pollutant Emissions: Group IV Polymers and Resins § 63.1330 Wastewater provisions... subpart. (10) Whenever §§ 63.132 through 63.149 refer to a Group 1 wastewater stream or a Group 2...

  13. 40 CFR 63.1433 - Wastewater provisions. (United States)


    ... 40 Protection of Environment 11 2010-07-01 2010-07-01 true Wastewater provisions. 63.1433 Section... for Hazardous Air Pollutant Emissions for Polyether Polyols Production § 63.1433 Wastewater provisions. (a) Process wastewater. Except as specified in paragraph (c) of this section, the owner or operator...

  14. 40 CFR 63.1106 - Wastewater provisions. (United States)


    ... 40 Protection of Environment 10 2010-07-01 2010-07-01 false Wastewater provisions. 63.1106 Section... Technology Standards § 63.1106 Wastewater provisions. (a) Process wastewater. Except as specified in... source shall comply with the HON process wastewater requirements in §§ 63.132 through 63.148. (1) When...

  15. 40 CFR 63.501 - Wastewater provisions. (United States)


    ... 40 Protection of Environment 9 2010-07-01 2010-07-01 false Wastewater provisions. 63.501 Section... for Hazardous Air Pollutant Emissions: Group I Polymers and Resins § 63.501 Wastewater provisions. (a... comply with the requirements of §§ 63.132 through 63.147 for each process wastewater stream originating...

  16. 28 CFR 512.21 - Copyright provisions. (United States)


    ... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Copyright provisions. 512.21 Section 512... ADMINISTRATION RESEARCH Research § 512.21 Copyright provisions. (a) An employee of the Bureau may not copyright... non-employee may copyright original materials developed as a result of research conducted under this...

  17. 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.

  18. 40 CFR 192.42 - Substitute provisions. (United States)


    ... 40 Protection of Environment 24 2010-07-01 2010-07-01 false Substitute provisions. 192.42 Section 192.42 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) RADIATION PROTECTION... § 192.42 Substitute provisions. The regulatory agency may, with the concurrence of EPA, substitute for...

  19. 38 CFR 8.29 - Policy provisions. (United States)


    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Policy provisions. 8.29 Section 8.29 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS NATIONAL SERVICE LIFE INSURANCE National Service Life Insurance Policy § 8.29 Policy provisions. Contracts of insurance authorized to be made in accordance with the...

  20. 24 CFR 5.321 - Lease provisions. (United States)


    ... GENERAL HUD PROGRAM REQUIREMENTS; WAIVERS Pet Ownership for the Elderly or Persons With Disabilities General Requirements § 5.321 Lease provisions. (a) Lease provisions. (1) PHAs which have established pet... persons with disabilities: (i) State that tenants are permitted to keep common household pets in their...

  1. 50 CFR 71.12 - General provisions. (United States)


    ...) MANAGEMENT OF FISHERIES CONSERVATION AREAS HUNTING AND FISHING ON NATIONAL FISH HATCHERY AREAS Fishing § 71.12 General provisions. The following provisions shall apply to public sport fishing on a national... may be amended as needed to meet management responsibilities for the area. ...

  2. 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...

  3. 9 CFR 93.916 - Special provisions. (United States)


    ... CONVEYANCE AND SHIPPING CONTAINERS Aquatic Animal Species General Provisions for Vhs-Regulated Fish Species... 9 Animals and Animal Products 1 2010-01-01 2010-01-01 false Special provisions. 93.916 Section 93.916 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE...

  4. 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.

  5. Nascent SecM chain outside the ribosome reinforces translation arrest.

    Directory of Open Access Journals (Sweden)

    Zhuohao Yang

    Full Text Available SecM, a bacterial secretion monitor protein, contains a specific amino acid sequence at its C-terminus, called arrest sequence, which interacts with the ribosomal tunnel and arrests its own translation. The arrest sequence is sufficient and necessary for stable translation arrest. However, some previous studies have suggested that the nascent chain outside the ribosome affects the stability of translation arrest. To clarify this issue, we performed in vitro translation assays with HaloTag proteins fused to the C-terminal fragment of E. coli SecM containing the arrest sequence or the full-length SecM. We showed that the translation of HaloTag proteins, which are fused to the fragment, is not effectively arrested, whereas the translation of HaloTag protein fused to full-length SecM is arrested efficiently. In addition, we observed that the nascent SecM chain outside the ribosome markedly stabilizes the translation arrest. These results indicate that changes in the nascent polypeptide chain outside the ribosome can affect the stability of translation arrest; the nascent SecM chain outside the ribosome stabilizes the translation arrest.

  6. Nascent SecM chain outside the ribosome reinforces translation arrest. (United States)

    Yang, Zhuohao; Iizuka, Ryo; Funatsu, Takashi


    SecM, a bacterial secretion monitor protein, contains a specific amino acid sequence at its C-terminus, called arrest sequence, which interacts with the ribosomal tunnel and arrests its own translation. The arrest sequence is sufficient and necessary for stable translation arrest. However, some previous studies have suggested that the nascent chain outside the ribosome affects the stability of translation arrest. To clarify this issue, we performed in vitro translation assays with HaloTag proteins fused to the C-terminal fragment of E. coli SecM containing the arrest sequence or the full-length SecM. We showed that the translation of HaloTag proteins, which are fused to the fragment, is not effectively arrested, whereas the translation of HaloTag protein fused to full-length SecM is arrested efficiently. In addition, we observed that the nascent SecM chain outside the ribosome markedly stabilizes the translation arrest. These results indicate that changes in the nascent polypeptide chain outside the ribosome can affect the stability of translation arrest; the nascent SecM chain outside the ribosome stabilizes the translation arrest.

  7. A large specific deterrent effect of arrest for patronizing a prostitute.

    Directory of Open Access Journals (Sweden)

    Devon D Brewer


    Full Text Available Prior research suggests that arrest, compared with no police detection, of some types of offenders does not decrease the chances they will reoffend.We assessed the specific deterrent effect of arrest for patronizing a street prostitute in Colorado Springs by comparing the incidence of arrest for clients of prostitutes first detected through public health surveillance with the incidence of rearrest for clients first detected by police arrest. Although these sets of clients were demographically and behaviorally similar, arrest reduced the likelihood of a subsequent arrest by approximately 70%. In other areas of the United States, arrest did not appear to displace a client's patronizing.Our results suggest that apprehending clients decreases their patronizing behavior substantially.

  8. A Large Specific Deterrent Effect of Arrest for Patronizing a Prostitute (United States)

    Brewer, Devon D.; Potterat, John J.; Muth, Stephen Q.; Roberts, John M.


    Background Prior research suggests that arrest, compared with no police detection, of some types of offenders does not decrease the chances they will reoffend. Methodology/Principal Findings We assessed the specific deterrent effect of arrest for patronizing a street prostitute in Colorado Springs by comparing the incidence of arrest for clients of prostitutes first detected through public health surveillance with the incidence of rearrest for clients first detected by police arrest. Although these sets of clients were demographically and behaviorally similar, arrest reduced the likelihood of a subsequent arrest by approximately 70%. In other areas of the United States, arrest did not appear to displace a client's patronizing. Conclusions/Significance Our results suggest that apprehending clients decreases their patronizing behavior substantially. PMID:17183691

  9. Cardiac Arrest in a Pregnant Patient Diagnosed with Bochdalek Hernia

    Directory of Open Access Journals (Sweden)

    Pinar Karabacak


    Full Text Available Bochdalek hernia is thought to be the result of a defect of the pleuroperitoneal fold and the septum transversum fusion in the 8th week of gestation. The majority of these patients present with respiratory distress after delivery; asymptomatic progress until adulthood is an extremely rare clinical occurrence. The adult form of a Bochdalek hernia accompanying pregnancy is a rare entity. A 39-year-old, 24-week pregnant patient applied to Emergency service with epigastric pain and vomiting. Abdominal ultrasonography was planned due to the abdominal pain; sudden cardiopulmonary arrest occurred during the procedure. In this case report, congenital diaphragmatic hernia in a young pregnant woman who underwent cardiac arrest is presented.

  10. Drugs in cardiac arrest: the rise and fall of antiarrhythmics. (United States)

    Karlis, George; Afantenou, Sevasti


    Since the publication of 2000 guidelines for resuscitation, amiodarone is considered the antiarrhythmic drug of choice for refractory ventricular fibrillation/pulseless ventricular tachycardia. However, to date there is no proven benefit in terms of neurologically intact survival to hospital discharge. A comprehensive search of the recent literature on amiodarone, nifekalant and lidocaine in cardiac arrest was performed. Amiodarone and nifekalant are superior to lidocaine with regards to the return of spontaneous circulation and survival to hospital admission. Nifekalant shows a trend towards quicker termination of ventricular fibrillation compared to amiodarone. There is great uncertainty about the efficacy of antiarrhythmics in cardiac arrest. Failure to show improvements regarding meaningful survival questions their current use and suggests the need for re-evaluating their place in cardiopulmonary resuscitation.

  11. 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.

  12. A Case of Morgagni Hernia Resulting with Respiratory Arrest

    Directory of Open Access Journals (Sweden)

    Cavit Çöl


    Full Text Available Morgagni’s hernia is seen at a rate of 3-4% among all diaphragmatic hernias. It develops from a defect in the pleuroperitoneal membrane. Herniation of the omentum is seen most commonly, that of the colon frequently, and herniation of small bowel and stomach is seen rarely. When being examined due to anemia and dyspnea, a 53-year-old male patient suffered from a respiratory arrest and was hence intubated and placed under treatment at the intensive care unit. On radiological examination, a giant diaphragmatic hernia was observed bilaterally, more marked on the right side. On laparotomy, especially on the right side, the caecum, the ascending colon, the transverse colon, the appendix, the omentum and part of the small bowel was seen to be herniated. Primary diaphragmatic repair + right hemicolectomy + end-to-end ileo-transversostomy was performed. We have reported this case because it was a giant hernia which caused respiratory arrest.

  13. Electrophysiological prognostication and brain injury from cardiac arrest. (United States)

    Kaplan, Peter W


    Anoxic coma after cardiorespiratory arrest warrants precocious investigation to establish probable outcome. Electroencephalogram (EEG) may uncover subclinical seizures; EEG grades have provided accurate prognosis of poor and favorable outcomes, but are weakest in those patients in between. Somatosensory evoked potentials now have proven benefit in accurately establishing a poor outcome (death or persistent vegetative state) when cortical responses (N20) are absent. These studies are particularly helpful when clinical examination of coma, early on, might yield uncertain prognosis (i.e., when brain stem reflexes are present). Combining clinical examination with electrophysiology has increasingly yielded multimodality approaches to early prognostication of coma after cardiorespiratory arrest, with more recent studies using event-related and middle-latency potentials showing promise for distinguishing good outcome (to consciousness), from awake but vegetative states. Further studies are warranted for this multimodality approach which, hopefully, may yield more widespread practical use of these testing modalities.

  14. Cardiac arrest related to anaesthesia in Williams-Beuren syndrome. (United States)

    Lucena Delgado, J; Sanabria Carretero, P; Durán la Fuente, P; Gónzalez Rocafort, A; Castro Parga, L; Reinoso Barbero, F


    Williams-Beuren syndrome is the clinical manifestation of a congenital genetic disorder in the elastin gene, among others. There is a history of cardiac arrest refractory to resuscitation manoeuvres in anaesthesia. The incidence of myocardial ischaemia is high during anaesthetic induction, but there are patients who do not have this condition yet also have had very serious cardiac events, and issues that are still to be resolved. Case descriptions will enable the common pathophysiological factors to be defined, and decrease morbidity and mortality. We report the case of a 3-year-old boy with cardiac arrest at induction, rescued with circulatory assistance with extracorporeal membrane oxygenation and hypothermia induced for cerebral protection. Copyright © 2017 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  15. Thermal Arrest Memory Effect in Ni-Mn-Ga Alloys

    Directory of Open Access Journals (Sweden)

    A. Rudajevova


    Full Text Available Dilatation characteristics were measured to investigate the thermal arrest memory effect in Ni53.6Mn27.1Ga19.3 and Ni54.2Mn29.4Ga16.4 alloys. Interruption of the martensite-austenite phase transformation is connected with the reduction of the sample length after thermal cycle. If a total phase transformation took place in the complete thermal cycle following the interruption, then the sample length would return to its original length. Analysis of these results has shown that the thermal arrest memory effect is a consequence of a stress-focusing effect and shape memory effect. The stress-focusing effect occurs when the phase transformation propagates radially in a cylindrical sample from the surface, inward to the center. Evolution and release of the thermoelastic deformations in both alloys during heating and cooling are analyzed.

  16. 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

  17. Luminescence from Tube-Arrest Bubbles in Pure Glycerin (United States)

    Chen, Qi-Dai; Wang, Long


    Single transient cavitation bubble with luminescence has been generated in pure glycerin by using the `tube arrest' method. The analyses of high-speed photograph and light emission data suggest that the light emission would be a single bubble sonoluminescence. The luminescence pulse width is observed to vary from sub-nanosecond to about 30 ns. The width and intensity of luminescence pulses increases with the height of the liquid column height and decreases with the liquid temperature.

  18. 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.

  19. Cardiac arrest in schools: Nationwide incidence, risk, and outcome. (United States)

    Hwang, Soyun; Shin, Sang Do; Lee, Kyungwon; Song, Kyoung Jun; Ahn, Ki Ok; Kim, Yu Jin; Hong, Ki Jeong; Ro, Young Sun; Lee, Eui Jung


    Schools are an important location for improving OHCA outcome. But there are few data on out of hospital cardiac arrest (OHCA) in schools. This study aimed to show incidence and outcome of OHCA in schools, specifying location and activities. We used the Korean nationwide OHCA registry from 2008 to 2014. OHCA victims were categorized regarding level of school. The average annual incidence of OHCA was calculated based on per 1000 schools. The epidemiological characteristics are analysed and location and activity at the time of arrest is further described. The outcome of OHCA victims were analysed. 511 OHCA occurred in school while 374 cases were cardiac origin, 125 cases were non-cardiac, and 12 cases were missing in information. Annual incidence was 5.72 per 1000 school while highest incidence was shown in university (11.02 per 1000 school). The majority of victims were male (84.1%), aged 19-64 (62.2%, median 44.75), either students (35.0%) or visitors (35.2%). Most victims had none shockable rhythms, did not received EMS defibrillation and were not witnessed arrests, while most received bystander CPR. A large proportion of arrests occurred at an outdoor campus (29.7%) or sports facility (28.8%), and the most frequent activity was exercise (30.7%). 100 patients (19.6%) survived to discharge, and 66 patients (12.9%) were discharged with good neurological outcome. Incidence of OHCA in school is low. Most of victims were adult visitors. About one third of OHCA occurred during sports activity or at the sports facility. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  20. 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.

  1. Family Burden After Out-of-Hospital Cardiac Arrest in Children. (United States)

    Meert, Kathleen L; Slomine, Beth S; Christensen, James R; Telford, Russell; Holubkov, Richard; Dean, J Michael; Moler, Frank W


    To describe family burden among caregivers of children who survived out-of-hospital cardiac arrest and who were at high risk for neurologic disability and examine relationships between family burden, child functioning, and other factors during the first year post arrest. Secondary analysis of data from the Therapeutic Hypothermia after Pediatric Cardiac Arrest Out-of-Hospital trial. Thirty-six PICUs in the United States and Canada. Seventy-seven children recruited to the Therapeutic Hypothermia after Pediatric Cardiac Arrest Out-of-Hospital trial who had normal prearrest neurologic functioning and were alive 1 year post arrest. Family burden was assessed using the Infant Toddler Quality of Life Questionnaire for children less than 5 years old and the Child Health Questionnaire for children 5 years old or older at baseline (reflecting prearrest status), 3 months, and 12 months post arrest. Child functioning was assessed using the Vineland Adaptive Behavior Scale II, the Pediatric Overall Performance Category, and Pediatric Cerebral Performance Category scales and caregiver perception of global functioning. Fifty-six children (72.7%) were boys, 48 (62.3%) were whites, and 50 (64.9%) were less than 5 years old prior to out-of-hospital cardiac arrest. Family burden at baseline was not significantly different from reference values. Family burden was increased at 3 and 12 months post arrest compared with reference values (p family burden all measured 3 months post arrest were associated with higher family burden 12 months post arrest (p family burden 12 months post arrest. Families of children who survive out-of-hospital cardiac arrest and have high risk for neurologic disability often experience substantial burden during the first year post arrest. The extent of child dysfunction 3 months post arrest is associated with family burden at 12 months.

  2. Mitotic arrest in teratoma susceptible fetal male germ cells.

    Directory of Open Access Journals (Sweden)

    Patrick S Western

    Full Text Available Formation of germ cell derived teratomas occurs in mice of the 129/SvJ strain, but not in C57Bl/6 inbred or CD1 outbred mice. Despite this, there have been few comparative studies aimed at determining the similarities and differences between teratoma susceptible and non-susceptible mouse strains. This study examines the entry of fetal germ cells into the male pathway and mitotic arrest in 129T2/SvJ mice. We find that although the entry of fetal germ cells into mitotic arrest is similar between 129T2/SvJ, C57Bl/6 and CD1 mice, there were significant differences in the size and germ cell content of the testis cords in these strains. In 129T2/SvJ mice germ cell mitotic arrest involves upregulation of p27(KIP1, p15(INK4B, activation of RB, the expression of male germ cell differentiation markers NANOS2, DNMT3L and MILI and repression of the pluripotency network. The germ-line markers DPPA2 and DPPA4 show reciprocal repression and upregulation, respectively, while FGFR3 is substantially enriched in the nucleus of differentiating male germ cells. Further understanding of fetal male germ cell differentiation promises to provide insight into disorders of the testis and germ cell lineage, such as testis tumour formation and infertility.

  3. Sildenafil after cardiac arrest and infarction; an experimental rat model. (United States)

    Mennander, Ari A; Vuohelainen, Vilma; Aanismaa, Riikka S; Narkilahti, Susanna; Paavonen, Timo; Tarkka, Matti


    Resuscitation after cardiac arrest may lead to ischemia-reperfusion injury and infarction. We evaluated whether sildenafil, a phosphodiesterase-5 inhibitor, has an impact on recovery after cardiac arrest in a rat cardiac transplantation model. Sixty-one Fischer344 rats underwent syngeneic heterotopic cardiac transplantation after ischemia and ligation of the left anterior coronary artery of the heart to yield myocardial infarction (IRI + MI). Of these, 22 rats received subcutaneously injected sildenafil (1 mg/kg/day) (IRI +MI + S). Twenty-three additional grafted animals with transplantation only served as controls with ischemia reperfusion injury (IRI). After 2 days, immunohistochemistry for eNOS, and RT-PCR for iNOS and Aquaporin-7 were performed after graft harvesting and histology. Two days after transplantation, remote intramyocardial arteries were more preserved in IRI + MI + S as compared with IRI +MI and IRI (0.74 ± 0.14, 0.56 ± 0.23 and 0.55 ± 0.22, PSU, p cardiac arrest and ischemia.

  4. Brain injury following cardiac arrest: pathophysiology for neurocritical care. (United States)

    Uchino, Hiroyuki; Ogihara, Yukihiko; Fukui, Hidekimi; Chijiiwa, Miyuki; Sekine, Shusuke; Hara, Naomi; Elmér, Eskil


    Cardiac arrest induces the cessation of cerebral blood flow, which can result in brain damage. The primary intervention to salvage the brain under such a pathological condition is to restore the cerebral blood flow to the ischemic region. Ischemia is defined as a reduction in blood flow to a level that is sufficient to alter normal cellular function. Brain tissue is highly sensitive to ischemia, such that even brief ischemic periods in neurons can initiate a complex sequence of events that may ultimately culminate in cell death. However, paradoxically, restoration of blood flow can cause additional damage and exacerbate the neurocognitive deficits in patients who suffered a brain ischemic event, which is a phenomenon referred to as "reperfusion injury." Transient brain ischemia following cardiac arrest results from the complex interplay of multiple pathways including excitotoxicity, acidotoxicity, ionic imbalance, peri-infarct depolarization, oxidative and nitrative stress, inflammation, and apoptosis. The pathophysiology of post-cardiac arrest brain injury involves a complex cascade of molecular events, most of which remain unknown. Many lines of evidence have shown that mitochondria suffer severe damage in response to ischemic injury. Mitochondrial dysfunction based on the mitochondrial permeability transition after reperfusion, particularly involving the calcineurin/immunophilin signal transduction pathway, appears to play a pivotal role in the induction of neuronal cell death. The aim of this article is to discuss the underlying pathophysiology of brain damage, which is a devastating pathological condition, and highlight the central signal transduction pathway involved in brain damage, which reveals potential targets for therapeutic intervention.

  5. 7 CFR 457.117 - Forage production crop insurance provisions. (United States)


    ... 7 Agriculture 6 2010-01-01 2010-01-01 false Forage production crop insurance provisions. 457.117... production crop insurance provisions. The Forage Production Crop Insurance Provisions for the 2001 and... Forage Production Crop Insurance Provisions If a conflict exists among the policy provisions, the order...

  6. Impact of Dispatcher‐Assisted Bystander Cardiopulmonary Resuscitation on Neurological Outcomes in Children With Out‐of‐Hospital Cardiac Arrests: A Prospective, Nationwide, Population‐Based Cohort Study (United States)

    Goto, Yoshikazu; Maeda, Tetsuo; Goto, Yumiko


    Background The impact of dispatcher‐assisted bystander cardiopulmonary resuscitation (CPR) on neurological outcomes in children is unclear. We investigated whether dispatcher‐assisted bystander CPR shows favorable neurological outcomes (Cerebral Performance Category scale 1 or 2) in children with out‐of‐hospital cardiac arrest (OHCA). Methods and Results Children (n=5009, ageCPR (n=2287); bystander CPR with dispatcher instruction (n=2019); and bystander CPR without dispatcher instruction (n=703) groups. The primary endpoint was favorable neurological outcome at 1 month post‐OHCA. Dispatcher CPR instruction was offered to 53.9% of patients, significantly increasing bystander CPR provision rate (adjusted odds ratio [aOR], 7.51; 95% confidence interval [CI], 6.60 to 8.57). Bystander CPR with and without dispatcher instruction were significantly associated with improved 1‐month favorable neurological outcomes (aOR, 1.81 and 1.68; 95% CI, 1.24 to 2.67 and 1.07 to 2.62, respectively), compared to no bystander CPR. Conventional CPR was associated with increased odds of 1‐month favorable neurological outcomes irrespective of etiology of cardiac arrest (aOR, 2.30; 95% CI, 1.56 to 3.41). However, chest‐compression‐only CPR was not associated with 1‐month meaningful outcomes (aOR, 1.05; 95% CI, 0.67 to 1.64). Conclusions In children with OHCA, dispatcher‐assisted bystander CPR increased bystander CPR provision rate and was associated with improved 1‐month favorable neurological outcomes, compared to no bystander CPR. Conventional bystander CPR was associated with greater likelihood of neurologically intact survival, compared to chest‐compression‐only CPR, irrespective of cardiac arrest etiology. PMID:24785780

  7. [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

  8. Development of a data dictionary for the Strategies for Post Arrest Resuscitation Care (SPARC) network for post cardiac arrest research. (United States)

    Lin, Steve; Morrison, Laurie J; Brooks, Steven C


    The widely accepted Utstein style has standardized data collection and analysis in resuscitation and post resuscitation research. However, collection of many of these variables poses significant practical challenges. In addition, several important variables in post resuscitation research are missing. Our aim was to develop a comprehensive data dictionary and web-based data collection tool as part of the Strategies for Post Arrest Resuscitation Care (SPARC) Network project, which implemented a knowledge translation program for post cardiac arrest therapeutic hypothermia in 37 Ontario hospitals. A list of data variables was generated based on the current Utstein style, previous studies and expert opinion within our group of investigators. We developed a data dictionary by creating clear definitions and establishing abstraction instructions for each variable. The data dictionary was integrated into a web-based collection form allowing for interactive data entry. Two blinded investigators piloted the data collection tool, by performing a retrospective chart review. A total of 454 variables were included of which 400 were Utstein, 2 were adapted from existing studies and 52 were added to address missing elements. Kappa statistics for two outcome variables, survival to discharge and induction of therapeutic hypothermia were 0.86 and 0.64, respectively. This is the first attempt in the literature to develop a data dictionary as part of a standardized, pragmatic data collection tool for post cardiac arrest research patients. In addition, our dataset defined important variables that were previously missing. This data collection tool can serve as a reference for future trials in post cardiac arrest care. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

  9. Older peoples' personal care needs: an analysis of care provision: care provision and the roles of key healthcare personnel. (United States)

    Hooks, Rachel; Roberts, Julia


    Aims and Objectives.  The study aimed to investigate and evaluate the provision of personal care for older patients within the acute care setting. Specific objectives included: (i) exploration of older peoples' perceptions of personal care provision; (ii) evaluation of nursing documentation related to personal cleansing and dressing care; (iii) identification of personnel responsible for personal cleansing and dressing care; (iv) identification of personal cleansing and dressing ward facilities; (v) development of a tool for use in the assessment and planning of personal hygiene and dressing care. Background.  The maintenance of individual hygiene and dressing needs are key activities of living and constitute important aspects of personal care. This is an area of care which to date has attracted limited empirical enquiry. This paper reports on the findings from an evaluation study which sought to examine key aspects of personal care provision. Design.  A quantitative multi-method research design was adopted. Methods.  The methods used included patient interviews (n = 20), documentary analysis (n = 100) and a review of ward facilities (n = 5). Data were analysed using descriptive and non-parametric statistics. Results.  Data suggest little patient involvement in decision-making regarding the provision of personal care. Documentary analysis highlighted limited assessment and care planning related to this key aspect of care. The key role of healthcare assistants in meeting personal care needs was highlighted and results indicated diversity in the availability of ward facilities. Conclusion.  Inadequacies in the provision of personal care for older patients in the acute care setting are highlighted. While state-of-the-art ward facilities are desirable, they are not the determining factor in quality personal care. The key role of healthcare assistants in personal care provision is emphasized. A more structured approach to the assessment and

  10. 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.

  11. Hospital Variation in Mortality From Cardiac Arrest After Cardiac Surgery: An Opportunity for Improvement? (United States)

    LaPar, Damien J.; Ghanta, Ravi K.; Kern, John A.; Crosby, Ivan K.; Rich, Jeffrey B.; Speir, Alan M.; Kron, Irving L.; Ailawadi, Gorav


    Background Among all postoperative complications, cardiac arrest after cardiac surgical operations has the greatest association with mortality. However, hospital variation in the ability to rescue after cardiac arrest is unknown. The purpose of this study was to characterize the impact of cardiac arrest on mortality and determine the relative impact of patient, operative, and hospital factors on failure to rescue (FTR) rates and surgical mortality after cardiac arrest. Methods A total of 79,582 patients underwent operations at 17 different hospitals (2001 through 2011), including 5.2% (n = 4,138) with postoperative cardiac arrest. Failure to rescue was defined as mortality after cardiac arrest. Patient risk, operative features, and outcomes were compared among hospitals. Results Overall FTR rate was 60% with significant variation among hospitals (range, 50% to 83%; p cardiac arrest, and FTR rates varied across hospitals and did not correlate. High-performing hospitals with lowest FTR rates accrued longer postoperative and intensive care unit stays after the index operation (2 to 3 days; p cardiac surgical mortality and FTR rates after cardiac arrest. Institutional factors appear to confer the strongest influence on the likelihood for mortality after cardiac arrest compared with patient and operative factors. Identifying best practice patterns at the highest performing centers may serve to improve surgical outcomes after cardiac arrest and improve patient quality. PMID:24820394

  12. Good quality of life before cardiac arrest predicts good quality of life after resuscitation. (United States)

    Hellevuo, H; Sainio, M; Huhtala, H; Olkkola, K T; Tenhunen, J; Hoppu, S


    The survival rate of cardiac arrest patients is increasing. Our aim was to compare the quality of life before and after cardiac arrest and analyse the factors associated with outcome. All adult cardiac arrest patients admitted to the Tampere University Hospital intensive care unit between 2009 and 2011 were included in a retrospective follow-up study if surviving to discharge and were asked to return a questionnaire after 6 months. Data on patient demographics and pre-arrest quality of life were retrieved from medical records. Data are given as means (SD) or medians [Q 1 , Q 3 ]. We used logistic regression to identify factors associated with better quality of life after cardiac arrest. Six months after cardiac arrest, 36% (79/222) were alive and 70% (55/79) of those patients completed the follow-up EuroQoL (EQ-5D) quality of life questionnaire. Median values for the EQ-5D before and after cardiac arrest were 0.89 [0.63, 1] and 0.89 [0.62, 1], respectively (P = 0.75). Only the EQ-5D prior to cardiac arrest was associated with better quality of life afterwards (OR 1.2; 95% CI 1.0-1.3; P = 0.02). Quality of life remained good after cardiac arrest especially in those patients who had good quality of life before cardiac arrest. © 2018 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

  13. Biological Evidence in Adult and Adolescent Sexual Assault Cases: Timing and Relationship to Arrest. (United States)

    Cross, Theodore P; Alderden, Megan; Wagner, Alex; Sampson, Lisa; Peters, Brittany; Lounsbury, Kaitlin


    This study examined the timing of the crime laboratory report relative to arrests in sexual assault cases and explored the relationship between biological evidence and arrest in those cases in which the crime laboratory report came first and thus could have influenced the arrest decision. A random sample ( N = 528) of cases that occurred between 2008 and 2010 and included a report to police was drawn from a Massachusetts statewide database of medical reports on sexual assault cases. Data from medical providers were merged with data abstracted from crime laboratory reports and with data requested from police departments. The vast majority (91.5%) of arrests took place before crime laboratory analysis could be conducted. The crime laboratory report was available before or near in time to the arrest in 11 cases. These cases were significantly more likely than other cases to have DNA profiles of the assailant, DNA matches to the suspect, and a match to another investigation in the FBI's CODIS DNA database. Given that the probable cause needed to make an arrest in these cases was presumably established only after crime laboratory analysis was available, DNA may have helped lead to the arrest in these cases. However, these results should be interpreted very cautiously, because statistically significant results in early, small studies can have inflated effect sizes and often do not replicate in future studies. Because most arrests occur well before biological evidence is available, improvements in recovering biological evidence may have modest effects on arrest rates, though they may impact arrest rates by identifying more serial offenders. Future research on the relationship of biological evidence to arrest should use methods to increase sample size of relevant cases, such as oversampling cases with later arrests and using case control study designs. Future studies should also use case abstraction and interview methods to explore how police use biological evidence to

  14. The role of bystanders, first responders, and emergency medical service providers in timely defibrillation and related outcomes after out-of-hospital cardiac arrest: Results from a statewide registry. (United States)

    Hansen, Carolina Malta; Kragholm, Kristian; Granger, Christopher B; Pearson, David A; Tyson, Clark; Monk, Lisa; Corbett, Claire; Nelson, R Darrell; Dupre, Matthew E; Fosbøl, Emil L; Strauss, Benjamin; Fordyce, Christopher B; McNally, Bryan; Jollis, James G


    Defibrillation by bystanders and first responders has been associated with increased survival, but limited data are available from non-metropolitan areas. We examined time from 911-call to defibrillation (according to who defibrillated patients) and survival in North Carolina. Through the Cardiac Arrest Registry to Enhance Survival, we identified 1732 defibrillated out-of-hospital cardiac arrests from counties with complete case capture (population 2.7 million) from 2010 to 2013. Most patients (60.9%) were defibrillated in > 10 min. A minority (8.0%) was defibrillated defibrillated by first responders (51.8%) and bystanders (33.1%), independent of location of arrest (residential or public). Bystanders initiated cardiopulmonary resuscitation (CPR) in 49.0% of cases and defibrillated 13.4% of those. Survival decreased with increasing time to defibrillation ( 10 min: 13.2%). Odds of survival with favorable neurologic outcome adjusted for age, sex, and bystander CPR improved with faster defibrillation ( 10 min: reference). Bystanders and first responders were mainly responsible for defibrillation within 5 min, independent of location of arrest. Bystanders initiated CPR in half of the cardiac arrest cases but only defibrillated a minority of those. Timely defibrillation and defibrillation by bystanders and/or first responders were strongly associated with increased survival. Strategic efforts to increase bystander and first-responder defibrillation are warranted to increase survival after out-of-hospital cardiac arrest. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  15. 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

  16. 7 CFR 1493.530 - Miscellaneous provisions. (United States)


    ... Agriculture Regulations of the Department of Agriculture (Continued) COMMODITY CREDIT CORPORATION, DEPARTMENT OF AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS CCC EXPORT CREDIT GUARANTEE PROGRAMS CCC Supplier Credit Guarantee Program Operations § 1493.530 Miscellaneous provisions. (a) Assignment. (1) The...

  17. 19 CFR 171.55 - Notice provisions. (United States)


    ... section 6079 of the Anti-Drug Abuse Act of 1988 and implementing regulations. (b) Notice provision. The... property and shall include a statement of the applicable law under which the property is seized and a...

  18. 48 CFR 4.607 - Solicitation Provisions. (United States)


    ... United States or its outlying areas. ..., Data Universal Numbering System (DUNS) Number, in solicitations that— (1) Are expected to result in a..., Central Contractor Registration. (b) Insert the provision at 52.204-5, Women-Owned Business (Other Than...

  19. 24 CFR 266.410 - Mortgage provisions. (United States)


    ... HOUSING FINANCE AGENCY RISK-SHARING PROGRAM FOR INSURED AFFORDABLE MULTIFAMILY PROJECT LOANS Mortgage and... accordance with HUD guidelines. (i) Regulatory Agreement. The mortgage must contain a provision incorporating the Regulatory Agreement by reference. ...

  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. Banks' Procyclical Behavior: Does Provisioning Matter?


    Vincent Bouvatier; Laetitia Lepetit


    International audience; A panel of 186 European banks is used for the period 1992-2004 to determine if banking behaviors, induced by the capital adequacy constraint and the provisioning system, amplify credit fluctuations. Our nding is consistent with the bank capital channel hypothesis, which means that poorly capitalized banks constrained to expand credit. We also find that loan loss provisions (LLP) made in order to cover identified credit losses (non discretionary LLP) amplify credit fluc...

  2. Determinants of occupational pension provision in Germany


    Dummann, Kathrin


    Demographic change causes an undersupply of financial old age benefits within the statutory pay-as-you-go pension system in Germany. Therefore, the provision of occupational as well as private pensions has to be enhanced. However, there seems to be an undersupply of occupational pension provision particularly in small and medium sized enterprises (SMEs). Using survey data of the German Socio-Economic Panel (GSOEP) and the German SAVE survey, the present paper studies econometrically the deter...

  3. In vivo Post-Cardiac Arrest Myocardial Dysfunction is Supported by CaMKII-Mediated Calcium Long-Term Potentiation and Mitigated by Alda-1, an Agonist of Aldehyde Dehydrogenase Type 2 (United States)

    Downey, Peter; Zalewski, Adrian; Rubio, Gabriel R.; Liu, Jing; Homburger, Julian R.; Grunwald, Zachary; Qi, Wei; Bollensdorff, Christian; Thanaporn, Porama; Ali, Ayyaz; Riemer, Kirk; Kohl, Peter; Mochly-Rosen, Daria; Gerstenfeld, Edward; Large, Stephen; Ali, Ziad; Ashley, Euan


    Background Survival after sudden cardiac arrest is limited by post-arrest myocardial dysfunction but understanding of this phenomenon is constrained by lack of data from a physiological model of disease. In this study, we established an in vivo model of cardiac arrest and resuscitation, characterized the biology of the associated myocardial dysfunction, and tested novel therapeutic strategies. Methods We developed rodent models of in vivo post-arrest myocardial dysfunction using extra-corporeal membrane oxygenation (ECMO) resuscitation followed by invasive hemodynamics measurement. In post-arrest isolated cardiomyocytes, we assessed mechanical load and Ca2+ induced Ca2+ release (CICR) simultaneously using the micro-carbon-fiber technique and observed reduced function and myofilament calcium sensitivity. We used a novel-designed fiber optic catheter imaging system, and a genetically encoded calcium sensor GCaMP6f, to image CICR in vivo. Results We found potentiation of CICR in isolated cells from this ECMO model and also in cells isolated from an ischemia-reperfusion Langendorff model perfused with oxygenated blood from an arrested animal, but not when reperfused in saline. We established that CICR potentiation begins in vivo. The augmented CICR observed post-arrest was mediated by the activation of Ca2+/calmodulin kinase II (CaMKII). Increased phosphorylation of CaMKII, phospholamban and ryanodine receptor 2 (RyR2) was detected in the post-arrest period. Exogenous adrenergic activation in vivo recapitulated Ca2+ potentiation but was associated with lesser CaMKII activation. Since oxidative stress and aldehydic adduct formation were high post arrest, we tested a small molecule activator of aldehyde dehydrogenase type 2, Alda-1, which reduced oxidative stress, restored calcium and CaMKII homeostasis, and improved cardiac function and post-arrest outcome in vivo. Conclusions Cardiac arrest and reperfusion lead to CaMKII activation and calcium long-term potentiation

  4. 45 CFR 63.18 - Limitations on costs. (United States)


    ... OFFICE OF THE ASSISTANT SECRETARY FOR PLANNING AND EVALUATION Financial Provisions § 63.18 Limitations on... amount shall thereupon constitute the maximum cost to the Government for the performance of the grant. ...

  5. 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.

  6. Cardiac arrest without physical cardiac injury during Nuss repair of pectus excavatum. (United States)

    Zou, Jianyong; Luo, Canqiao; Liu, Zhenguo; Cheng, Chao


    Cardiac arrest is a lethal complication of Nuss repair of pectus excavatum which is strongly related to heart or big vessels injury. A rare case developed cardiac arrest without direct cardiac injury during Nuss procedure is presented in this article. In July 2015, a previously healthy 18-year-old man undergoing Nuss repair for pectus excavatum developed cardiac arrest while the Nuss bar was being inserted into the chest. After successful resuscitation and exclusion of direct cardiac injury, the Nuss procedure was continued. The patient suffered a second cardiac arrest during rotation of the Nuss bar. This time, the patient had poor initial response to resuscitation and defibrillation until the retrosternal bar was removed. He ultimately recovered well from the episodes of cardiac arrest, but was unable to receive surgical correction of his pectus excavatum deformity. The possible mechanisms of cardiac arrest and lessons we can learn from this complication are discussed.

  7. Arrest types and co-occurring disorders in persons with schizophrenia or related psychoses. (United States)

    McCabe, Patrick J; Christopher, Paul P; Druhn, Nicholas; Roy-Bujnowski, Kristen M; Grudzinskas, Albert J; Fisher, William H


    This study examined the patterns of criminal arrest and co-occurring psychiatric disorders among individuals with schizophrenia or related psychosis that were receiving public mental health services and had an arrest history. Within a 10-year period, 65% of subjects were arrested for crimes against public order, 50% for serious violent crimes, and 45% for property crimes. The presence of any co-occurring disorder increased the risk of arrest for all offense categories. For nearly all offense types, antisocial personality disorder and substance use disorders conferred the greatest increase in risk for arrest. Among anxiety disorders, post-traumatic stress disorder was associated with a greater risk of arrest for serious violent crimes but not other offense types. Criminal risk assessments and clinical management in this population should focus on co-occurring antisocial personality disorder and substance use disorders in addition to other clinical and non-clinical factors.

  8. 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.

  9. 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.

  10. Emergency Preservation and Resuscitation for Cardiac Arrest from Trauma (EPR-CAT) (United States)


    Award Number: W81XWH-07-1-0682 TITLE: Emergency Preservation and Resuscitation for Cardiac Arrest from Trauma (EPR-CAT) PRINCIPAL INVESTIGATOR...COVERED (From - To) 26 SEP 2014 – 25 SEP 2015 4. TITLE AND SUBTITLE Emergency Preservation and Resuscitation for Cardiac Arrest 5a. CONTRACT NUMBER It was felt that patients who arrive at the hospital with a pulse, but then develop cardiac arrest in the operating room, rather than in the

  11. Cardiac Arrest in Acute Ischemic Stroke: Incidence, Predisposing Factors, and Clinical Outcomes. (United States)

    Joundi, Raed A; Rabinstein, Alejandro A; Nikneshan, Davar; Tu, Jack V; Fang, Jiming; Holloway, Robert; Saposnik, Gustavo


    Cardiac arrest is a devastating complication of acute ischemic stroke, but little is known about its incidence and characteristics. We studied a large ischemic stroke inpatient population and compared patients with and without cardiac arrest. We studied consecutive patients from the Ontario Stroke Registry who had an ischemic stroke between July 2003 and June 2008 at 11 tertiary care stroke centers in Ontario. Multivariable analyses were used to determine independent predictors of cardiac arrest and associated outcomes. Adjusted survival curves were computed, and hazard ratios for mortality at 30 days and 1 year were determined for cardiac arrest and other major outcomes. Among the 9019 patients with acute ischemic stroke, 352 had cardiac arrest, for an overall incidence of 3.9%. In a sensitivity analysis with palliative patients removed, the incidence of cardiac arrest was 2.5%. Independent predictors of cardiac arrest were as follows: older age, greater stroke severity, preadmission dependence, and a history of diabetes, myocardial infarction, congestive heart failure, and atrial fibrillation. Systemic complications associated with cardiac arrest were as follows: myocardial infarction, pulmonary embolism, sepsis, gastrointestinal hemorrhage, and pneumonia. Patients with cardiac arrest had higher disability at discharge, and a markedly increased 30-day mortality of 82.1% compared with 9.3% without cardiac arrest. Cardiac arrest had a high incidence and was associated with poor outcomes after ischemic stroke, including multiple medical complications and very high mortality. Predictors of cardiac arrest identified in this study could help risk stratify ischemic stroke patients for cardiac investigations and prolonged cardiac monitoring. Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  12. Applications of elastic-viscoplastic constitutive models in dynamic analyses of crack run-arrest events (United States)

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


    Applications of nonlinear techniques to the first series of six HSST wide-plate crack-arrest tests that were performed are described. The experiments include crack initiations at low temperatures and relatively long (20 cm) cleavage propagation phases which are terminated by arrest in high temperature regions. Crack arrest are then followed by ductile tearing events. Consequently, the crack front regions are exposed to wide ranges of strain rates and temperatures.

  13. Testing and checking of zinc oxide overvoltage arresters. Beproeven en keuren van zinkoxide overspanningsafleiders

    Energy Technology Data Exchange (ETDEWEB)

    Baron van Boetzelaer, A.W. (NV KEMA, Arnhem (Netherlands))


    Surge arresters are relatively inexpensive, but because they protect components with multiple costs against overvoltages they take an important place in the high voltage grid. Therefore it is of great importance to check whether these arresters perform properly. KEMA's laboratories are able to carry out all the necessary tests according to the relevant IEC standards on surge arresters. 6 figs., 2 tabs.

  14. Causes of sudden cardiac arrest in young athletes. (United States)

    Westrol, Michael S; Kapitanyan, Raffi; Marques-Baptista, Andreia; Merlin, Mark A


    Knowledge of sudden cardiac death in young athletes is imperative for all physicians and allied health professionals. The complete differential diagnosis of a young patient with sudden cardiac arrest will result in proper work-up and treatment. In this article, we review several etiologies of sudden cardiac death, including hypertrophic cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy, Wolff-Parkinson-White syndrome, long QT syndrome, Brugada syndrome, and commotio cordis. Clinical findings, work-up, treatment, long-term management, and athlete preparticipation screening guidelines are discussed.

  15. 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.

  16. The inflammatory marker suPAR after cardiac arrest

    DEFF Research Database (Denmark)

    Rundgren, Malin; Lyngbaek, Stig; Fisker, Helle


    BACKGROUND: Soluble urokinase plasminogen activator receptor (suPAR) is released in response to inflammatory stimuli, and plasma levels are associated with long-term outcomes. The ischemia/reperfusion injury caused by cardiac arrest (CA) and resuscitation triggers an inflammatory response...... analysis shoved an AUC of 0.76 at 6 hours. In the subgroup of CA of cardiac cause, the AUC was 0.84. CONCLUSION: suPAR levels at 6 and 36 hours after CA were significantly higher in nonsurviving patients compared with survivors; however, the overlap in suPAR levels between the outcome groups...

  17. Cardiac Arrest Caused by Multiple Recurrent Pulmonary Embolism

    Directory of Open Access Journals (Sweden)

    Kjartan Eskjaer Hannig


    Full Text Available Pulmonary embolism is a common condition with a high mortality. We describe a previously healthy 68-year-old male who suffered three pulmonary embolisms during a short period of time, including two embolisms while on anticoagulant treatment. This paper illustrates three important points. (1 The importance of optimal anticoagulant treatment in the prevention of pulmonary embolism reoccurrence. (2 The benefit of immediate accessibility to echocardiography in the handling of haemodynamically unstable patients with an unknown underlying cause. (3 Thrombolytic treatment should always be considered and may be life-saving in patients with cardiac arrest suspected to be caused by pulmonary embolism.

  18. [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.

  19. [Cardiac arrest in newborn of mother treated with labetalol]. (United States)

    Sala, X; Monsalve, C; Comas, C; Botet, F; Nalda, M A


    The use of beta-adrenergic antagonists for the control of high blood pressure associated to pregnancy is frequent. Their use is related with the appearance of undesirable effects of the fetus. The case of neonatal cardiac arrest attributed, to the administration of labetalol to the mother is presented. The high transplacentary passage, the different pharmacokinetics of the drug in the newborn and the clinical evolution of the patient suggests its involvement. It is concluded that labetalol may cause severe undesirable effects in newborns and fetal heart rate of the mother and neonate should be monitored upon use of this drug.

  20. Advanced life support for cardiac arrest beyond the algorithm

    DEFF Research Database (Denmark)

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


    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......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......, but are not supported by firm scientific evidence....

  1. A review of epidermal maturation arrest: a unique entity or another description of persistent granulation tissue? (United States)

    Kessides, Maria C; Khachemoune, Amor


    To conduct a review of reported cases of epidermal maturation arrest and to compare their clinical and histological descriptions with that of persistent granulation tissue with a focus on diagnostic methods and response to treatment. The authors performed a literature search within Pubmed, Embase, Google Scholar, and Web of Science for all reported cases of epidermal maturation arrest under the terms "epidermal maturation arrest," "epidermal arrest," "epidermal maturation," and "re-epithelialization maturation arrest." They reviewed the clinical and histological presentation of hypergranulation tissue as well as the evidence for the most widely used treatments. There is only one case series and one case report of epidermal maturation arrest, and the former gives the most detailed clinical and histological description including response to treatment. The clinical description, histological findings, and response to treatment of all cases are comparable to that of persistent granulation tissue and there is no histological or cytological data provided to support that epidermal maturation arrest exists as a distinct entity. Among the cases of epidermal maturation arrest reported in the literature, there is insufficient evidence that keratinocytes acquired a state of arrest in their migration. Rather, the described cases appear to have been complicated by persistent granulation tissue, a well-known aberration in wound healing.

  2. Clinical and ultramicroscopic myocardial randomized study of beating versus arrested heart for mitral surgery

    National Research Council Canada - National Science Library

    Clotario Neptali Carrasco Cueva; Maiara dosSantos Rocha; Carlos Mauricio Cardeal Mendes; Luiz Antonio Rodrigues deFreitas; Jose Augusto Baucia; Roberto Badaro


    ...: This study compared clinical and transmission electron microscopic aspects of myocardial protection during mitral valve replacement using warm retrograde perfusion in empty beating versus arrested...

  3. Cardiac Arrest during Hospitalization for Delivery in the United States, 1998–2011 (United States)

    Mhyre, Jill M.; Tsen, Lawrence C.; Einav, Sharon; Kuklina, Elena V.; Leffert, Lisa R.; Bateman, Brian T.


    Background The objective of this analysis was to evaluate the frequency, distribution of potential etiologies, and survival rates of maternal cardiopulmonary arrest during the hospitalization for delivery in the United States. Methods By using data from the Nationwide Inpatient Sample during the years 1998 through 2011, the authors obtained weighted estimates of the number of U.S. hospitalizations for delivery complicated by maternal cardiac arrest. Clinical and demographic risk factors, potential etiologies, and outcomes were identified and compared in women with and without cardiac arrest. The authors tested for temporal trends in the occurrence and survival associated with maternal arrest. Results Cardiac arrest complicated 1 in 12,000 or 8.5 per 100,000 hospitalizations for delivery (99% CI, 7.7 to 9.3 per 100,000). The most common potential etiologies of arrest included hemorrhage, heart failure, amniotic fluid embolism, and sepsis. Among patients with cardiac arrest, 58.9% of patients (99% CI, 54.8 to 63.0%) survived to hospital discharge. Conclusions Approximately 1 in 12,000 hospitalizations for delivery is complicated by cardiac arrest, most frequently due to hemorrhage, heart failure, amniotic fluid embolism, or sepsis. Survival depends on the underlying etiology of arrest. PMID:24694844

  4. Sudden cardiac arrest and coexisting mitral valve prolapse: a case report and literature review

    Directory of Open Access Journals (Sweden)

    Mohamed Ahmed


    Full Text Available The aetiology of sudden cardiac arrest can often be identified to underlying cardiac pathology. Mitral valve prolapse is a relatively common valvular pathology with symptoms manifesting with increasing severity of mitral regurgitation (MR. It is unusual for severe MR to be present without symptoms, and there is growing evidence that this subset of patients may be at increased risk of sudden cardiac arrest or death. The difficulty lies in identifying those patients at risk and applying measures that are appropriate to halting progression to cardiac arrest. This article examines the association of mitral valve prolapse with cardiac arrests, the underlying pathophysiological process and the strategies for identifying those at risk.

  5. Limits on $\

    CERN Document Server

    Perego, D L


    A limit on the tau neutrino mass is obtained using all the $Z^{0} \\to \\tau^{+} \\tau^{-}$ data collected at LEP by the DELPHI detector between 1992 and 1995. In this analysis events in which one of the taus decays into one charged particle, while the second $\\tau$ decays into f{}ive charged pions (1-5 topology) have been used. The neutrino mass is determined from a bidimensional \\fit ~on the invariant mass $m^{*}_{5 \\pi}$ and on the energy $E_{5 \\pi}$ of the f{}ive $\\pi^{\\pm}$ system. The result found is $m_{\

  6. 26 CFR 1.851-2 - Limitations. (United States)


    ... TAXES Regulated Investment Companies and Real Estate Investment Trusts § 1.851-2 Limitations. (a) Election to be a regulated investment company. Under the provisions of section 851(b)(1), a corporation... taxable year, will not be considered a regulated investment company for such year, within the meaning of...

  7. Urban and rural differences in out-of-hospital cardiac arrest in Ireland. (United States)

    Masterson, S; Wright, P; O'Donnell, C; Vellinga, A; Murphy, A W; Hennelly, D; Sinnott, B; Egan, J; O'Reilly, M; Keaney, J; Bury, G; Deasy, C


    More than a third of Ireland's population lives in a rural area, defined as the population residing in all areas outside clusters of 1500 or more inhabitants. This presents a challenge for the provision of effective pre-hospital resuscitation services. In 2012, Ireland became one of three European countries with nationwide Out-of-Hospital Cardiac Arrest (OHCA) register coverage. An OHCA register provides an ability to monitor quality and equity of access to life-saving services in Irish communities. To use the first year of national OHCAR data to assess differences in the occurrence, incidence and outcomes of OHCA where resuscitation is attempted and the incident is attended by statutory Emergency Medical Services between rural and urban settings. The geographical coordinates of incident locations were identified and co-ordinates were then classified as 'urban' or 'rural' according to the Irish Central Statistics Office (CSO) definition. 1798 OHCA incidents were recorded which were attended by statutory Emergency Medical Services (EMS) and where resuscitation was attempted. There was a higher percentage of male patients in rural settings (71% vs. 65%; p = 0.009) but the incidence of male patients did not differ significantly between urban and rural settings (26 vs. 25 males/100,000 population/year p = 0.353). A higher proportion of rural patients received bystander cardiopulmonary resuscitation (B-CPR) 70% vs. 55% (p ≤ 0.001), and had defibrillation attempted before statutory EMS arrival (7% vs. 4% (p = 0.019), respectively). Urban patients were more likely to receive a statutory EMS response in 8 min or less (33% vs. 9%; p ≤ 0.001). Urban patients were also more likely to be discharged alive from hospital (6% vs. 3%; p = 0.006) (incidence 2.5 vs. 1.1/100,000 population/year; p ≤ 0.001). Multivariable analysis of survival showed that the main variable of interest i.e. urban vs. rural setting was also independently associated with discharge from hospital alive

  8. Rates of organ donation in a UK tertiary cardiac arrest centre following out-of-hospital cardiac arrest. (United States)

    Cheetham, Olivia V; Thomas, Matthew J C; Hadfield, John; O'Higgins, Fran; Mitchell, Claire; Rooney, Kieron D


    To ascertain the rate of successful organ donation (OD) within patients who sustained an out of hospital cardiac arrest (OHCA) with initial return of spontaneous circulation (ROSC) and survival to hospital admission, but whom subsequently do not survive to hospital discharge. A retrospective audit of ambulance service and hospital databases from January 2010 to January 2015 was undertaken in a United Kingdom tertiary-referral regional cardiac arrest centre. Crude denominator data for cardiac arrests was obtained from the regional ambulance service; the ICU database was interrogated for OHCA patient admissions and outcomes. Patients who died were cross-referenced against the local Organ Donation service database. Five hundred and fourteen {514} patients were admitted to ICU following OHCA over this five year period. Two hundred and forty-one {241} patients (47%) survived to hospital discharge and 273 (53%) died of whom 106 (39%) were referred to a Specialist Nurse for Organ Donation (SNOD). The conversion rate after the family was approached was 64%. Twenty-eight {28} patients proceeded to donation and 25 patients (24%) successfully donated at least one organ. On average, a patient proceeding to donation provided 1.9 organs. A proactive, systematic approach to OD in OHCA patients can provide a good conversion rate and substantial number of donors. Most donations occur after death from circulatory criteria. There is a positive socio-economic benefit with nearly £4m in savings to the health service within the next 5 years potentially being realised during this period by liberating patients from dialysis. Copyright © 2016. Published by Elsevier Ireland Ltd.

  9. Cardiac arrest risk standardization using administrative data compared to registry data. (United States)

    Grossestreuer, Anne V; Gaieski, David F; Donnino, Michael W; Nelson, Joshua I M; Mutter, Eric L; Carr, Brendan G; Abella, Benjamin S; Wiebe, Douglas J


    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.

  10. Systematic review of the effectiveness of prehospital critical care following out-of-hospital cardiac arrest. (United States)

    von Vopelius-Feldt, Johannes; Brandling, Janet; Benger, Jonathan


    Improving survival after out-of-hospital cardiac arrest (OHCA) is a priority for modern emergency medical services (EMS) and prehospital research. Advanced life support (ALS) is now the standard of care in most EMS. In some EMS, prehospital critical care providers are also dispatched to attend OHCA. This systematic review presents the evidence for prehospital critical care for OHCA, when compared to standard ALS care. We searched the following electronic databases: PubMed, EmBASE, CINAHL Plus and AMED (via EBSCO), Cochrane Database of Systematic Reviews, DARE, Cochrane Central Register of Controlled Trials, NHS Economic Evaluation Database, NIHR Health Technology Assessment Database, Google Scholar and Search terms related to cardiac arrest and prehospital critical care. All studies that compared patient-centred outcomes between prehospital critical care and ALS for OHCA were included. The review identified six full text publications that matched the inclusion criteria, all of which are observational studies. Three studies showed no benefit from prehospital critical care but were underpowered with sample sizes of 1028-1851. The other three publications showed benefit from prehospital critical care delivered by physicians. However, an imbalance of prognostic factors and hospital treatment in these studies systematically favoured the prehospital critical care group. Current evidence to support prehospital critical care for OHCA is limited by the logistic difficulties of undertaking high quality research in this area. Further research needs an appropriate sample size with adjustments for confounding factors in observational research design. Copyright © 2017 Elsevier B.V. All rights reserved.

  11. 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.

  12. [Adult cardio-respiratory arrest: guidelines 2005-2010]. (United States)

    Mols, P; Claessens, B


    At the end of 2005 the new guidelines for the treatment of cardiac arrest were published. The diagnostic criteria of cardiac arrest were simplified and priority is given to thoracic compressions. The ratio of thoracic compressions to insufflations is 30/2. The frequency of thoracic compression is 100/min. In ventricular tachycardia (VT) without pulse or in ventricle fibrillation (VF), defibrillation is attempted with a single external electric shock per cycle. The reanimation cycles are divided in periods of 2 minutes. The two drugs, used to treat VF and VT without pulse, are amiodarone and adrenaline. Adrenaline is not given before the fourth minute into the reanimation and it is administered before the third electrical external shock. In case of asystole or pulse less electrical activity adrenaline is administered as early as possible. Atropine is used in case of pulse less electrical activity with a ventricular response lower than 60/min. In advanced life support a priority is given to whether or not there are treatable secondary causes (4H, 4T), furthermore controlled hypothermia is installed when systemic circulation is restored and optimal support to all vital functions is given.

  13. Cariporide for pharmacologic defibrillation after prolonged cardiac arrest. (United States)

    Wann, Shue-ren; Weil, Max Harry; Sun, Shijie; Tang, Wanchun; Yu, Ting


    We hypothesized that cariporide, a sodium-hydrogen exchange inhibitor, would be as cardioprotective during the global myocardial ischemia of prolonged cardiac arrest as it is in settings of coronary occlusion. Fifteen Sprague-Dawley rats were randomized to receive bolus injections of cariporide or placebo in a dose of 3 mgxkg(-1) into the right atrium either 5 minutes before, or at 8 minutes after, onset of ventricular fibrillation. Ventricular fibrillation was electrically induced and untreated for 8 minutes. Precordial compression, together with mechanical ventilation, was then started and continued for an interval of 8 minutes prior to attempted resuscitation. All but one placebo-treated animal were successfully resuscitated. Spontaneous defibrillation with restoration of circulation was observed in both cariporide-pretreatment and post-treatment groups but in none of the placebo-treated animals. Postresuscitation cardiac index, end-tidal CO(2), mean aortic pressure, left ventricular systolic pressure, left ventricular end-diastolic pressure, and left ventricular contractile and lusitropic functions (dP/dt(40), and -dP/dt) were significantly less impaired after cariporide, especially in the pretreated group, compared to electrically defibrillated controls. Postresuscitation ventricular premature beats were significantly reduced after cariporide. The duration of post-resuscitation survival was significantly increased in animals pretreated with cariporide. Cariporide, when administered prior to and during cardiac arrest, improved both the success of resuscitation and postresuscitation myocardial function.

  14. Arrested coalescence of viscoelastic droplets: triplet shape and restructuring (United States)

    Dahiya, Prerna; DeBenedictis, Andrew; Atherton, Timothy J.; Caggioni, Marco; Prescott, Stuart W.; Hartel, Richard W.; Spicer, Patrick T.

    The stability of shapes formed by three viscoelastic droplets during their arrested coalescence has been investigated using micromanipulation experiments. Addition of a third droplet to arrested droplet doublets is shown to be controlled by the balance between interfacial pressures driving coalescence and internal elasticity that resists total consolidation. The free fluid available within the droplets controls the transmission of stress during droplet combination and allows connections to occur via formation of a neck between the droplets. The anisotropy of three-droplet systems adds complexity to the symmetric case of two-droplet aggregates because of the multiplicity of orientations possible for the third droplet. When elasticity dominates, the initial orientation of the third droplet is preserved in the triplet's final shape. When elasticity is dominated by the interfacial driving force, the final shape can deviate strongly from the initial positioning of droplets. Movement of the third droplet to a more compact packing occurs, driven by liquid meniscus expansion that minimizes the surface energy of the triplet. A range of compositions and orientations are examined and the resulting domains of restructuring and stability are mapped based on the final triplet structure. A geometric and a physical model are used to explain the mechanism driving meniscus-induced restructuring and are related to the impact of these phenomena on multiple droplet emulsions.

  15. Salivary mutans streptococci and lactobacilli after self arresting caries treatment. (United States)

    Thaweboon, Sroisiri; Thaweboon, Boonyanit; Soo-Ampon, Surin; Soo-Ampon, Malinee


    Previous studies have shown that Self Arresting Caries Treatment (SACT) may be a useful technique to arrest active caries in Thai preschool children in remote areas. The objective of this study was to examine the effect of SACT on the levels of salivary mutans streptococci and lactobacilli in Thai children. Eighty-two subjects aged 4-6 years from primary school in a remote area of Thailand were recruited for this study. Each subject has at least two pairs of interproximal carious cavities between the first and second deciduous molars, and no history of severe pain. The subjects were divided into the control and SACT groups. The SACT technique was performed by removing food remnants and the surrounding overhang enamel of the carious cavity walls to enlarge the space between the carious cavities. The levels of mutans streptococci and lactobacilli in paraffin-stimulated whole saliva were determined at baseline, 2 and 4 months after treatment compared to those of the control group by the spatula method. The bacterial growth score was divided into three categories: 1 = 0-20 CFU, 2 = 21-100 CFU, and 3 > or = 100 CFU. At baseline, no differences in the mutans streptococci and lactobacilli scores were found between the SACT and control groups (p>0.05). Lower salivary lactobacilli levels were found in the SACT group on follow-up at 2 and 4 months (pinterproximal lesions and can reduce the retentive sites in the oral cavity due to a reduction in salivary lactobacilli.

  16. Theophylline improves lipopolysaccharide-induced alveolarization arrest through inflammatory regulation. (United States)

    He, Hua; Chen, Fei; Ni, Wensi; Li, Jianhui; Zhang, Yongjun


    Bronchopulmonary dysplasia (BPD) is characterized by alveolar simplification with decreased numbers of alveoli and increased airspace. BPD, frequently suffered by very low birth weight infants, has been closely associated with intrauterine infection. However, the underlying mechanisms of BPD remain unclear. In the present study, it was identified that administration of intra-amniotic lipopolysaccharide (LPS) to pregnant rats on embryonal day 16.5 (E16.5) induced significant alveolarization arrest similar to that of BPD in neonatal pups, and theophylline injected subcutaneously into the newborns improved the pathological changes. To further investigate the underlying mechanism of the morphogenesis amelioration of theophylline, cytokine antibody arrays were performed with the lung lysates of neonatal rats. The results indicated that LPS upregulated a series of pro-inflammatory cytokines and theophylline significantly attenuated the expression levels of pro-inflammatory cytokines tumor necrosis factor‑α, macrophage inflammatory protein (MIP)-1α and MIP-2, and markedly elevated the production of tumor growth factor (TGF)-β family members TGF-β1, TGF-β2 and TGF-β3, which are anti‑inflammatory cytokines. Accordingly, it was hypothesized that theophylline may protect against BPD and improve chorioamnionitis‑induced alveolar arrest by regulating the balance between pro‑and anti-inflammatory cytokine expression.

  17. Variation in Out-of-Hospital Cardiac Arrest Management

    Directory of Open Access Journals (Sweden)

    Jason M. Jones


    Full Text Available Objective. To evaluate variation in airway management strategies in one suburban emergency medical services system treating patients experiencing out-of-hospital cardiac arrest (OHCA. Method. Retrospective chart review of all adult OHCA resuscitation during a 13-month period, specifically comparing airway management decisions. Results. Paramedics demonstrated considerable variation in their approaches to airway management. Approximately half of all OHCA patients received more than one airway management attempt (38/77 [49%], and one-quarter underwent three or more attempts (25/77 [25%]. One-third of patients arrived at the emergency department with a different airway device than initially selected (25/77 [32%]. Conclusion. This study confirmed our hypothesis that paramedics’ selection of ventilation strategies in cardiac arrest varies considerably. This observation raises concern because airway management diverts time and energy from interventions known to improve outcomes in OHCA management, such as cardiopulmonary resuscitation and defibrillation. More research is needed to identify more focused airway management strategies for prehospital care providers.

  18. The Use of Force in Affecting Arrest in South Africa and the 2010 Bill: A Step in the Right Direction?

    Directory of Open Access Journals (Sweden)

    T van der Walt


    Full Text Available In South Africa the use of force in effecting arrest is statutorily governed by section 49 of the Criminal Procedure Act 51 of 1977. The inception of the Constitution brought about a dramatic change in South African law in this regard. During 2001 and 2002 the two highest courts in the country had to decide on the constitutionality of sections 49(1 and 49(2 respectively. The Supreme Court of Appeal in Govender v Minister of Safety and Security 2001 2 SACR 197(SCA did not declare section 49(1 unconstitutional but found it had to be interpreted restrictively ("read down" to survive constitutional scrutiny. The Constitutional Court on the other hand confirmed the unconstitutionality of section 49(2 in S v Walters 2002 2 SACR 105 (CC and the section was declared invalid. By the(as early as 1998 the legislature had alreadypromulgated an amendment to section 49, but the amendment came into op eration only in 2003 after section 49 had undergone intensive constitutional scrutiny. Legal scholars and others raised serious objections against the amendment – some were even of the opinion that it created a "right to flee" and that the rights of perpetratorswere protected to the detriment of law-abiding citizens. The Department of Justice and Constitutional Development in 2010 drafted an Amendment Bill which was subsequently approved in Parliament. This paper discusses and concludes on: the developments over the last years in the South African law with regard to the use offorce in effecting arrest by the South African Police Service(SAPS; international policies and guidelines of the police in this regard; and the application of the provisions of the Amendment Bill in practice and the possible pitfalls in the application of the latter.

  19. Does location matter? A proposed methodology to evaluate neighbourhood effects on cardiac arrest survival and bystander CPR. (United States)

    Buick, Jason E; Allan, Katherine S; Ray, Joel G; Kiss, Alexander; Dorian, Paul; Gozdyra, Peter; Morrison, Laurie J


    Traditional variables used to explain survival following out-of-hospital cardiac arrest (OHCA) account for only 72% of survival, suggesting that other unknown factors may influence outcomes. Research on other diseases suggests that neighbourhood factors may partly determine health outcomes. Yet, this approach has rarely been used for OHCA. This work outlines a methodology to investigate multiple neighbourhood factors as determinants of OHCA outcomes. A retrospective, observational cohort study design will be used. All adult non-emergency medical service witnessed OHCAs of cardiac etiology within the city of Toronto between 2006 and 2010 will be included. Event details will be extracted from the Toronto site of the Resuscitation Outcomes Consortium Epistry-Cardiac Arrest, an existing population-based dataset of consecutive OHCA patients. Geographic information systems technology will be used to assign patients to census tracts. Neighbourhood variables to be explored include the Ontario Marginalization Index (deprivation, dependency, ethnicity, and instability), crime rate, and density of family physicians. Hierarchical logistic regression analysis will be used to explore the association between neighbourhood characteristics and 1) survival-to-hospital discharge, 2) return-of-spontaneous circulation at hospital arrival, and 3) provision of bystander cardiopulmonary resuscitation (CPR). Receiver operating characteristics curves will evaluate each model's ability to discriminate between those with and without each outcome. Discussion This study will determine the role of neighbourhood characteristics in OHCA and their association with clinical outcomes. The results can be used as the basis to focus on specific neighbourhoods for facilitating educational interventions, CPR awareness programs, and higher utilization of automatic defibrillation devices.

  20. 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.

  1. 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.

  2. 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; ...

  3. 40 CFR 63.1194 - Which general provisions apply? (United States)


    ... 40 Protection of Environment 10 2010-07-01 2010-07-01 false Which general provisions apply? 63... Information § 63.1194 Which general provisions apply? The general provisions in subpart A of this part define... for general provisions that apply (or don't apply) to you as an owner or operator subject to the...

  4. 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.

  5. Epidemiology of Cardiac Arrest During Hospitalization for Delivery in Canada: A Nationwide Study. (United States)

    Balki, Mrinalini; Liu, Shiliang; León, Juan Andrés; Baghirzada, Leyla


    Cardiac arrest in pregnancy is a rare and devastating condition with high mortality and morbidity. The objective of this study was to generate information about maternal cardiac arrest in Canada by examining the frequency, temporal incidence, associated conditions, potential etiologies, and survival rates. This retrospective population-based study used hospitalization data from the discharge abstract database of the Canadian Institute for Health Information relating to obstetric deliveries in Canada from April 1, 2002, to March 31, 2015. The data were accessed through the Public Health Agency of Canada's (PHAC) Canadian Perinatal Surveillance System. Cases of cardiac arrest were identified using the diagnostic and intervention codes from the International Statistical Classification of Diseases and the Canadian Classification of Health Interventions, respectively. Data on patient demographics, medical and obstetrical conditions, and potential etiologies of cardiac arrest were collected. Multivariable logistic regression analysis was used to identify conditions associated with cardiac arrest. There were 286 cases of maternal cardiac arrest among 3,568,597 hospitalizations for delivery during the 13-year period. A total of 204 (71.3%) women survived to hospital discharge (95% confidence interval, 65.7%-76.5%). There was no significant variation in the incidence of cardiac arrest or survival from arrest over time or across provinces. Among the pre-existing conditions, hypertensive disorders of pregnancy, gestational diabetes, malignancy, and diseases of the respiratory and nervous system were found to be significantly associated with cardiac arrest. Among the obstetrical conditions, placental abnormalities and polyhydramnios were associated with cardiac arrest. The common potential etiologies included postpartum hemorrhage, heart failure, amniotic fluid embolism, and complications of anesthesia. In this first Canadian study, the incidence of cardiac arrest during

  6. Hospital Variation in Survival After Pediatric In-Hospital Cardiac Arrest (United States)

    Jayaram, Natalie; Spertus, John A.; Nadkarni, Vinay; Berg, Robert A.; Tang, Fengming; Raymond, Tia; Guerguerian, Anne-Marie; Chan, Paul S.


    Background Although survival after in-hospital cardiac arrest is likely to vary among hospitals caring for children, validated methods to risk-standardize pediatric survival rates across sites do not currently exist. Methods and Results Within the American Heart Association’s Get With the Guidelines-Resuscitation registry for in-hospital cardiac arrest, we identified 1,551 cardiac arrests in children (cardiac arrest survival for hospitals with a minimum of 10 pediatric cardiac arrest cases. A total of 13 patient-level predictors were identified: age, sex, cardiac arrest rhythm, location of arrest, mechanical ventilation, acute non-stroke neurologic event, major trauma, hypotension, metabolic or electrolyte abnormalities, renal insufficiency, sepsis, illness category, and need for intravenous vasoactive agents prior to the arrest. The model had good discrimination (C-statistic of 0.71), confirmed by bootstrap validation (validation C-statistic of 0.69). Among 30 hospitals with at least 10 cardiac arrests, unadjusted hospital survival rates varied considerably (median, 37%; inter-quartile range [IQR]: 24%–42%; range: 0%–61%). After risk-standardization, the range of hospital survival rates narrowed (median, 37%; IQR: 33%–38%; range: 29%– 48%), but variation in survival persisted. Conclusion Using a national registry, we developed and validated a model to predict survival after in-hospital cardiac arrest in children. After risk-standardization, significant variation in survival rates across hospitals remained. Leveraging these models, future studies can identify best practices at high-performing hospitals to improve survival outcomes for pediatric cardiac arrest. PMID:24939940

  7. Organisation of in-hospital cardiac arrest teams - a nationwide study. (United States)

    Lauridsen, Kasper Glerup; Schmidt, Anders Sjørslev; Adelborg, Kasper; Løfgren, Bo


    In-hospital cardiac arrests are treated by a team of health care providers. Improving team performance may increase survival. Currently, no international standards for cardiac arrest teams exist in terms of member composition and allocation of tasks. To describe the composition of in-hospital cardiac arrest teams and review pre-arrest allocation of tasks. A nationwide cross-sectional study was performed. Data on cardiac arrest teams and pre-arrest allocation of tasks were collected from protocols on resuscitation required for hospital accreditation in Denmark. Additional data were collected through telephone interviews and email correspondence. Psychiatric hospitals and hospitals serving outpatients only were excluded. Data on the cardiac arrest team were available from 44 of 47 hospitals. The median team size was 5 (25th percentile; 75th percentile: 4; 6) members. Teams included a nurse anaesthetist (100%), a medical house officer (82%), an orderly (73%), an anaesthesiology house officer (64%) and a medical assistant (20%). Less likely to participate was a cardiology house officer (23%) or a cardiology specialist registrar (5%). Overall, a specialist registrar was represented on 20% of teams and 20% of cardiac arrest teams had a different team composition during nights and weekends. In total, 41% of teams did not define a team leader pre-arrest, and the majority of the teams did not define the tasks of the remaining team members. In Denmark, there are major differences among cardiac arrest teams. This includes team size, profession of team members, medical specialty and seniority of the physicians. Nearly half of the hospitals do not define a cardiac arrest team leader and the majority do not define the tasks of the remaining team members. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  8. Induced hypothermia after cardiac arrest in trauma patients: a case series. (United States)

    Tuma, Mazin A; Stansbury, Lynn G; Stein, Deborah M; McQuillan, Karen A; Scalea, Thomas M


    Induced hypothermia after cardiac arrest is an accepted neuroprotective strategy. However, its role in cardiac arrest during acute trauma care is not yet defined. To characterize recent experience with this technique at our center, we undertook a detailed chart review of acute trauma patients managed with induced hypothermia after cardiac arrest. From Trauma Registry records, we identified all adult patients (older than 17 years) admitted to our Level I trauma center from July 1, 2008, through June 30, 2010, who experienced cardiac arrest during acute trauma care and were managed via our induced hypothermia protocol. This requires maintenance of core body temperature between 32°C and 34°C for 24 hours after arrest. Patient clinical records were then reviewed for selected factors. Six acute trauma patients (3 male and 3 female; median age, 53 years) with cardiac arrest managed per protocol were identified. All injuries were due to blunt impact, and five of six injuries were motor-vehicle-associated. Median Injury Severity Score was 27; median prearrest Glasgow Coma Scale (GCS) score was 15. One patient arrested prehospital and the other 5 in-hospital. Median duration of arrest was 8 minutes. All were comatose after arrest. One death occurred, in the patient with a prehospital cardiac arrest. Two patients were discharged to chronic care facilities with GCS11-tracheostomy; three were discharged to active rehabilitation care facilities with GCS score of 14 to 15. There were no obvious complications related to cooling. Mild induced hypothermia can be beneficial in a selected group of trauma patients after cardiac arrest. Prospective trials are needed to explore the effects of targeted temperature management on coagulation in this patient group.

  9. Epidemiology and outcomes of cardiac arrest among children with Down Syndrome: a multicenter analysis. (United States)

    Padiyath, Asif; Rettiganti, Mallikarjuna; Gossett, Jeffrey M; Tadphale, Sachin D; Garcia, Xiomara; Seib, Paul M; Gupta, Punkaj


    With the increasing prevalence of Down Syndrome, it is unknown if children with Down Syndrome are associated with increased incidence of cardiac arrest and poor outcomes after cardiac arrest. The objective of this study was to evaluate the epidemiology of cardiac arrest and mortality after cardiac arrest among critically ill children with and without Down Syndrome. Patients ≤18 years admitted at a Pediatric Health Information Systems (PHIS) participating Intensive Care Unit were included (2004-2014). Multivariable logistic regression models were fitted to evaluate association of Down Syndrome with study outcomes after adjusting for patient and center characteristics. A total of 849,250 patients from 44 centers were included. Of the 25,143 patients with Down Syndrome, cardiac arrest was noted among 568 (2.3%) patients with an associated mortality at hospital discharge of 248 (43.6%) patients. In contrast, of the 824,107 patients without Down Syndrome, cardiac arrest was noted among 15,822 (1.9%) patients with an associated mortality at hospital discharge of 7775 (49.1%) patients. In adjusted models, patients with Down Syndrome had a higher likelihood of having cardiac arrest as compared to patients without Down Syndrome (with vs. without Down, OR: 1.14, 95% CI: 1.03-1.25, P=0.01). Despite having a higher likelihood of cardiac arrest, patients with Down Syndrome were associated with a lower mortality after cardiac arrest (OR: 0.78, 95% CI: 0.63-0.96, P=0.02). Both incidence of cardiac arrest, and mortality at hospital discharge in those with cardiac arrest vary substantially in children with and without Down Syndrome.

  10. Provision of frequency control by wind farms

    Energy Technology Data Exchange (ETDEWEB)

    Speckmann, Markus; Baier, Andre [Fraunhofer Institut fuer Windenergie und Energiesystemtechnik (IWES), Kassel (Germany)


    Nowadays, wind farms do not provide frequency control in Germany. Because of the increasing wind energy generation, wind farms will have to provide this ancillary service in the future. Even though the provision of frequency control by wind farms has become a big field of research, no work has yet been done concerning the proof of the provision. Thus, the scope of this paper is the presentation of a new concept how wind farms can prove the provision of frequency control. Moreover, this paper describes a method for calculating the available amount of frequency control power based on probabilistic forecasts. An economic analysis is conducted for three different wind farms and a virtual power plant consisting of these wind farms participating at the market for negative tertiary control power in Germany. (orig.)

  11. Comparable Outcome of Out-of-Hospital Cardiac Arrest and In-Hospital Cardiac Arrest Treated With Extracorporeal Life Support. (United States)

    Ellouze, Omar; Vuillet, Melitine; Perrot, Justine; Grosjean, Sandrine; Missaoui, Anis; Aho, Serge; Malapert, Ghislain; Bouhemad, Belaid; Bouchot, Oliver; Girard, Claude


    Extracorporeal life support (ECLS) has shown benefits in the management of refractory in-hospital cardiac arrest (IHCA) by improving survival. Nonetheless, the results concerning out-of-hospital refractory cardiac arrests (OHCA) remain uncertain. The aim of our investigation was to compare survival between the two groups. We realized a single-center retrospective, observational study of all patients who presented IHCA or OHCA treated with ECLS between 2011 and 2015. Multivariate analysis was realized to determine independent factors associated with mortality. Over the 4-year period, 65 patients were included, 43 in the IHCA group (66.2%), and 22 (33.8%) in the OHCA group. The duration of low flow was significantly longer in the OHCA group (60 vs. 90 min, P = 0.004). Survival to discharge from the hospital was identical in the two groups (27% in the OHCA group vs. 23% in the IHCA group, P = 0.77). All surviving patients in the OHCA group had a cerebral performance categories score of 1-2. In multivariate analysis, we found that the initial lactate level and baseline blood creatinine were independently associated with mortality. We found comparable survival and neurological score in patients who presented IHCA and OHCA treated with ECLS. We believe that appropriate selection of patients and optimization of organ perfusion during resuscitation can lead to good results in patients with OHCA treated with ECLS. © 2017 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

  12. Early detection of brain death using the Bispectral Index (BIS) in patients treated by extracorporeal cardiopulmonary resuscitation (E-CPR) for refractory cardiac arrest. (United States)

    Jouffroy, Romain; Lamhaut, Lionel; Guyard, Alexandra; Philippe, Pascal; An, Kim; Spaulding, Christian; Baud, Frédéric; Carli, Pierre; Vivien, Benoît


    Despite increasing use of extracorporeal cardiopulmonary resuscitation (E-CPR) for treatment of refractory cardiac arrest patients, prognosis remains dismal, often resulting in brain-death. However, clinical assessment of brain-death occurence is difficult in post-cardiac arrest patients, sedated, paralyzed, under mild therapeutic hypothermia (MTH). Our objective was to assess the usefulness of Bispectral-Index (BIS) monitoring at bedside for an early detection of brain-death occurrence in refractory cardiac arrest patients treated by E-CPR. This prospective study was performed in an intensive care unit of an university hospital. Forty-six patients suffering from refractory cardiac arrest treated by E-CPR were included. BIS was continuously recorded during ICU hospitalization. Clinical brain-death was confirmed when appropriate by EEG and/or cerebral CT angiography. Twenty-nine patients evolved into brain-death and had average BIS values under MTH and after rewarming (temperature ≥35°C) of 4 (0-47) and 0 (0-82), respectively. Among these, 11 (38%) entered into a procedure of organs donation. Among the 17 non-brain-dead patients, the average BIS values at admission and after rewarming were 39 (0-65) and 59 (22-82), respectively. Two patients had on admission a BIS value equal to zero and evolved to a poor prognostic (CPC 4) and died after care limitations. BIS values were significantly different between patients who developed brain death and those who did not. In both groups, no differences were observed between the AUCs of ROC curves for BIS values under MTH and after rewarming (respectively 0.86 vs 0.83, NS). Initial values of BIS could be used as an assessment tool for early detection of brain-death in refractory cardiac arrest patients treated by mild therapeutic hypothermia and E-CPR. Copyright © 2017 Elsevier B.V. All rights reserved.

  13. Neuron-Specific Enolase Predicts Poor Outcome After Cardiac Arrest and Targeted Temperature Management: A Multicenter Study on 1,053 Patients. (United States)

    Streitberger, Kaspar Josche; Leithner, Christoph; Wattenberg, Michael; Tonner, Peter H; Hasslacher, Julia; Joannidis, Michael; Pellis, Tommaso; Di Luca, Elena; Födisch, Markus; Krannich, Alexander; Ploner, Christoph J; Storm, Christian


    Outcome prediction after cardiac arrest is important to decide on continuation or withdrawal of intensive care. Neuron-specific enolase is an easily available, observer-independent prognostic biomarker. Recent studies have yielded conflicting results on its prognostic value after targeted temperature management. We analyzed neuron-specific enolase serum concentrations 3 days after nontraumatic in-hospital cardiac arrest and out-of-hospital cardiac arrest and outcome of patients from five hospitals in Germany, Austria, and Italy. Patients were treated at 33°C for 24 hours. Cerebral Performance Category was evaluated upon ICU discharge. We performed case reviews of good outcome patients with neuron-specific enolase greater than 90 μg/L and poor outcome patients with neuron-specific enolase less than or equal to 17 μg/L (upper limit of normal). A neuron-specific enolase serum concentration greater than 90 μg/L predicted Cerebral Performance Category 4-5 with a positive predictive value of 99%, false positive rate of 0.5%, and a sensitivity of 48%. All three patients with neuron-specific enolase greater than 90 μg/L and Cerebral Performance Category 1-2 had confounders for neuron-specific enolase elevation. An neuron-specific enolase serum concentration less than or equal to 17 μg/L excluded Cerebral Performance Category 4-5 with a negative predictive value of 92%. The majority of 14 patients with neuron-specific enolase less than or equal to 17 μg/L who died had a cause of death other than hypoxic-ischemic encephalopathy. Specificity and sensitivity for prediction of poor outcome were independent of age, sex, and initial rhythm but higher for out-of-hospital cardiac arrest than for in-hospital cardiac arrest patients. High neuron-specific enolase serum concentrations reliably predicted poor outcome at ICU discharge. Prediction accuracy differed and was better for out-of-hospital cardiac arrest than for in-hospital cardiac arrest patients. Our "in

  14. 42 CFR 426.400 - Procedure for filing an acceptable complaint concerning a provision (or provisions) of an LCD. (United States)


    ... concerning a provision (or provisions) of an LCD. 426.400 Section 426.400 Public Health CENTERS FOR MEDICARE... COVERAGE DETERMINATIONS AND LOCAL COVERAGE DETERMINATIONS Review of an LCD § 426.400 Procedure for filing an acceptable complaint concerning a provision (or provisions) of an LCD. (a) The complaint. An...

  15. 42 CFR 426.500 - Procedure for filing an acceptable complaint concerning a provision (or provisions) of an NCD. (United States)


    ... concerning a provision (or provisions) of an NCD. 426.500 Section 426.500 Public Health CENTERS FOR MEDICARE... COVERAGE DETERMINATIONS AND LOCAL COVERAGE DETERMINATIONS Review of an NCD § 426.500 Procedure for filing an acceptable complaint concerning a provision (or provisions) of an NCD. (a) The complaint. An...

  16. Municipal service provision in rural communities

    DEFF Research Database (Denmark)

    Nørgaard, Helle

    EU policies for rural development stress the importance of investments rather than subsidies and aim at integrating different sectoral policies in order to improve the coherence and effectiveness of public expenditure. Policies also emphasize a place-based approach for rural development and thereby...... setting a competitive framework for local development. Rural municipalities are challenged due to demographic changes and population decline and consequently need to adjust municipal services. In this respect it is stressed that service provision need be linked to strategic planning based on urban...... municipalities can plan strategically, manage service provision and support place bound potential in rural communities in light of a competitive framework for local development....

  17. Juvenile and adult offenders arrested for sexual homicide: an analysis of victim-offender relationship and weapon used by race. (United States)

    Chan, Heng Choon Oliver; Heide, Kathleen M; Myers, Wade C


    Limited information is available on racial offending patterns of sexual homicide offenders (SHOs). This study used a 30-year U.S. Supplementary Homicide Reports sample of SHOs arrested in single-victim situations (N = 3745). The analysis strength was used to determine whether the findings yielded meaningful patterns for offender profiling. Several important findings emerged for the juvenile offenders. Juvenile White SHOs were likely to target victims with whom they shared a mutual relationship. In contrast, Black juveniles were equally likely to murder strangers and those with whom they had prior and familial relationships. Notably, no juvenile Black SHOs were arrested for murdering intimate partners. Juvenile White SHOs were twice as likely to use edged weapons as their Black counterparts. Black juveniles, conversely, were more likely than White juveniles to use personal weapons. Beyond these findings, known victim-offender relationships and weapon used may not have significant utility for investigators in identifying the SHO race, even after controlling for offender age. Limitations and future directions are discussed. © 2012 American Academy of Forensic Sciences.

  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. [Cardiocirculatory arrest caused by electric shock: importance of semi-automatic defibrillator]. (United States)

    Siah, S; Fouadi, F E; Ababou, K; Ihrai, I; Drissi, N K


    Accidental electrical burn injuries are serious because they can cause death by cardiocirculatory arrest. Cardiocirculatory arrest induced by low-voltage current is generally due to ventricular fibrillation, and the prognosis is fairly good if the survival chain is efficient. It is necessary to give priority to early defibrillation using an automated external defibrillator. Early defibrillation can immediately restore spontaneous circulation.

  20. 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...

  1. 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…

  2. Cardiac Arrest During Anaesthesia In Enugu Nigeria,1994-96 | Nze ...

    African Journals Online (AJOL)

    Aim: To determine the incidence and outcome of cardiac arrest during general anaesthesia at the University of Nigerian Teaching Hospital Enugu, Nigeria. Patient and Methods: A retrospective study of 6,450 anaesthetic charts from January 1994 to December1996 was undertaken. The cases where cardiac arrest box had ...

  3. Temporal differences in out-of-hospital cardiac arrest incidence and survival

    DEFF Research Database (Denmark)

    Bagai, Akshay; McNally, Bryan F.; Al-Khatib, Sana M.


    Understanding temporal differences in the incidence and outcomes of out-of-hospital cardiac arrest (OHCA) has important implications for developing preventative strategies and optimizing systems for OHCA care.......Understanding temporal differences in the incidence and outcomes of out-of-hospital cardiac arrest (OHCA) has important implications for developing preventative strategies and optimizing systems for OHCA care....

  4. 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...

  5. 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....

  6. Programmed cell cycle arrest is required for infection of corn plants by the fungus Ustilago maydis. (United States)

    Castanheira, Sónia; Mielnichuk, Natalia; Pérez-Martín, José


    Ustilago maydis is a plant pathogen that requires a specific structure called infective filament to penetrate the plant tissue. Although able to grow, this filament is cell cycle arrested on the plant surface. This cell cycle arrest is released once the filament penetrates the plant tissue. The reasons and mechanisms for this cell cycle arrest are unknown. Here, we have tried to address these questions. We reached three conclusions from our studies. First, the observed cell cycle arrest is the result of the cooperation of at least two distinct mechanisms: one involving the activation of the DNA damage response (DDR) cascade; and the other relying on the transcriptional downregulation of Hsl1, a kinase that modulates the G2/M transition. Second, a sustained cell cycle arrest during the infective filament step is necessary for the virulence in U. maydis, as a strain unable to arrest the cell cycle was severely impaired in its ability to infect corn plants. Third, production of the appressorium, a structure required for plant penetration, is incompatible with an active cell cycle. The inability to infect plants by strains defective in cell cycle arrest seems to be caused by their failure to induce the appressorium formation process. In summary, our findings uncover genetic circuits to arrest the cell cycle during the growth of this fungus on the plant surface, thus allowing the penetration into plant tissue. © 2014. Published by The Company of Biologists Ltd.

  7. Out of hospital thoracotomy for cardiac arrest after penetrating thoracic trauma

    NARCIS (Netherlands)

    M.G. van Vledder (Mark); O.J.F. van Waes (Oscar); Kooij, F.O. (Fabian O.); Peters, J.H. (Joost H.); E.M.M. van Lieshout (Esther); M.H.J. Verhofstad (Michiel)


    textabstractIntroduction: Emergency department thoracotomy is an established procedure for cardiac arrest in patients suffering from penetrating thoracic trauma and yields relatively high survival rates (up to 21%) in patients with cardiac tamponade. To minimize the delay between arrest and

  8. Out of hospital thoracotomy for cardiac arrest after penetrating thoracic trauma

    NARCIS (Netherlands)

    van Vledder, Mark G.; van Waes, Oscar J. F.; Kooij, Fabian O.; Peters, Joost H.; van Lieshout, Esther M. M.; Verhofstad, Michael H. J.


    Emergency department thoracotomy is an established procedure for cardiac arrest in patients suffering from penetrating thoracic trauma and yields relatively high survival rates (up to 21%) in patients with cardiac tamponade. To minimize the delay between arrest and thoracotomy, some have advocated

  9. The science of reperfusion injury post cardiac arrest--Implications for emergency nurses. (United States)

    Baker, Edward; Lee, Geraldine


    Survival following cardiac arrest in the developed world remains below 10%. In those who survive the initial cardiac arrest, prognosis remains poor due to the onset of multi-organ failure with both significant cardiac and neurological dysfunction. Nurses have demonstrated good understanding of cardiac arrest/post arrest guidelines and have good technical skills but deficits remain in their understanding of pathophysiological processes involved in post cardiac arrest syndromes. This article aims to provide an overview of these pathophysiological processes involved in the post cardiac arrest phase, potential treatment options and the nursing interventions that may be required within the emergency department setting. This article will focus emergency nurses to become more involved in patient management at this critical phase of treatment and highlight potential early signs of deterioration. Although return of spontaneous circulation (ROSC) is crucial in the process of recovery from cardiac arrest, it is only the first of many complex stages. Given the complexity of post cardiac arrest syndrome and its impact on the patient, healthcare professionals need to understand the cellular changes associated with reperfusion injuries in order to improve outcomes. It is only through effective nursing care and medical management that improved outcomes will become more common in the future. Copyright © 2015 Elsevier Ltd. All rights reserved.

  10. 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) tria...

  11. 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

  12. Limited oxygen availability in utero may constrain the evolution of live birth in reptiles. (United States)

    Rafferty, Anthony R; Evans, Roger G; Scheelings, T Franciscus; Reina, Richard D


    Although viviparity (live birth) has evolved from oviparity (egg laying) at least 140 times in vertebrates, nearly 120 of these independent events occurred within a single reptile taxon. Surprisingly, only squamate reptiles (lizards and snakes) are capable of facilitating embryonic development to increasingly advanced stages inside the mother during extended periods of oviducal egg retention. Viviparity has never evolved in turtle lineages, presumably because embryos enter and remain in an arrested state until after eggs are laid, regardless of the duration of egg retention. Until now, the limiting factor that initiates and maintains developmental arrest has remained elusive. Here, we show that oviducal hypoxia arrests embryonic development. We demonstrate that hypoxia can maintain developmental arrest after oviposition and that subsequent exposure of arrested embryos to normoxia triggers resumption of their development. We discovered remarkably low oxygen partial pressure in the oviducts of gravid turtles and found that secretions produced by the oviduct retard oxygen diffusion. Our results suggest that an extremely hypoxic environment in the oviduct arrests embryonic development and may constrain the evolution of viviparity in turtles, with the reduced diffusive capacity of oviducal secretions possibly creating or contributing to this hypoxia. We anticipate that these findings will allow us to better understand the mechanisms underlying the evolutionary transition between reproductive modes.

  13. Wheelchair service provision education and training in low and lower middle income countries: a scoping review. (United States)

    McSweeney, Elizabeth; Gowran, Rosemary Joan


    Improving access to education and training for those providing wheelchair and seating assistive technology to meet personal posture and mobility requirements, as a basic human right, is a priority. This review considers education and training available to personnel within low and lower middle income countries (LLMIC), to ascertain where gaps in knowledge exist and identify human resource education priorities. A scoping review, mapping out existing scientific and grey literature within the field between 1993 and 2017 was conducted. The search strategy included use of online databases, manual analogue searches and key stakeholder informant advice. A content analysis process was applied to organize the literature retrieved and extract key themes. Education and training in LLMIC appears ad hoc and limited, however, there is growing recognition as to its importance, notably by the World Health Organization and nongovernmental organizations, delivering education initiatives to a number of countries, along with the development of a credentialing test. Inconsistency exists regarding personnel responsible for wheelchair provision, with no specific professional clearly recognized to oversee the system within many LLMIC. Education and training is required for all stakeholders involved in wheelchair provision. Advocating for programme development to enhance personnel skills, build capacity and ensure best practice is a priority. Pilot sites, delivering and credentialing appropriate wheelchair provision education and training within context should be considered. Measuring outcomes and transferable skills should be part of education programme delivery structures. Considering a new discipline responsible for oversight of wheelchair provision should be investigated. Implications for rehabilitation Education and training is an essential step in the wheelchair provision process in the bid to obtain an appropriate wheelchair via appropriate provision services. However, it is more

  14. RNA Pol II accumulates at promoters of growth genes during developmental arrest. (United States)

    Baugh, L Ryan; Demodena, John; Sternberg, Paul W


    When Caenorhabditis elegans larvae hatch from the egg case in the absence of food, their development is arrested (L1 arrest), and they show increased stress resistance until food becomes available. To study nutritional control of larval development, we analyzed growth and gene expression profiles during L1 arrest and recovery. Larvae that were fed responded relatively slowly to starvation compared with the rapid response of arrested larvae to feeding. Chromatin immunoprecipitation of RNA polymerase II (Pol II) followed by deep sequencing showed that during L1 arrest, Pol II continued transcribing starvation-response genes, but the enzyme accumulated on the promoters of growth and development genes. In response to feeding, promoter accumulation decreased, and elongation and messenger RNA levels increased. Therefore, accumulation of Pol II at promoters anticipates nutritionally controlled gene expression during C. elegans development.

  15. Reversible cryo-arrest for imaging molecules in living cells at high spatial resolution (United States)

    Sabet, Ola; Wehner, Frank; Konitsiotis, Antonios; Fuhr, Günther R.; Bastiaens, Philippe I. H.


    The dynamics of molecules in living cells hamper precise imaging of molecular patterns by functional and super resolution microscopy. Circumventing lethal chemical fixation, an on-stage cryo-arrest was developed for consecutive imaging of molecular patterns within the same living, but arrested cells. The reversibility of consecutive cryo-arrests was demonstrated by the high survival rate of different cell lines and intact growth factor signaling that was not perturbed by stress response. Reversible cryo-arrest was applied to study the evolution of ligand-induced receptor tyrosine kinase activation at different scales. The nanoscale clustering of epidermal growth factor receptor (EGFR) in the plasma membrane was assessed by single molecule localization microscopy and endosomal microscale activity patterns of ephrin receptor type-A (EphA2) by fluorescence lifetime imaging microscopy. We thereby demonstrate that reversible cryo-arrest allows the precise determination of molecular patterns while conserving the dynamic capabilities of living cells. PMID:27400419

  16. Outdoor air pollution and out-of-hospital cardiac arrest in Okayama, Japan. (United States)

    Yorifuji, Takashi; Suzuki, Etsuji; Kashima, Saori


    We evaluated the association between short-term exposure to outdoor air pollution and out-of-hospital cardiac arrest in Japan. We studied 558 residents of Okayama, Japan, who visited hospital emergency departments between January 2006 and December 2010 for out-of-hospital cardiac arrest using a time-stratified case-crossover design. We calculated city-representative average concentrations of different air pollutants and examined the association between air pollution and cardiac arrest. Exposure to air pollution was associated with an elevated risk of cardiac arrest; for example, odds ratios was 1.17 (95% confidence interval, 1.02 to 1.33) per interquartile-range increase in suspended particulate matter concentrations in the previous 48 to 72 hours. We also observed different susceptibilities to suspended particulate matter and ozone exposures by age category. Short-term exposure to outdoor air pollution was associated with increased risk of cardiac arrest.

  17. 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)

  18. 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.

  19. Partners in Crime in the Setting of Recurring Cardiac Arrest

    Directory of Open Access Journals (Sweden)

    Lida P. Papavasileiou


    Full Text Available No previous reports are available about the potential dramatic effects resulting from the combination of acquired long QT interval not associated to bradycardia and myocardial ischemia. We report the case of a man that during acute necrotic pancreatitis presented QT interval prolongation without bradycardia, TdP, and two episodes of cardiac arrest. A coronary angiogram revealed a subocclusive stenosis of left anterior descending coronary artery, treated with a percutaneous coronary intervention. After myocardial revascularization, even in presence of long QT interval, no arrhythmic events occurred suggesting the key role of myocardial ischemia in triggering TdP in acquired long QT even without bradycardia. ECG performed six months later, after complete recovery from pancreatitis, showed a normal QT interval.

  20. Partners in crime in the setting of recurring cardiac arrest. (United States)

    Papavasileiou, Lida P; Forleo, Giovanni B; Santini, Luca; Martuscelli, Eugenio; Romeo, Francesco


    No previous reports are available about the potential dramatic effects resulting from the combination of acquired long QT interval not associated to bradycardia and myocardial ischemia. We report the case of a man that during acute necrotic pancreatitis presented QT interval prolongation without bradycardia, TdP, and two episodes of cardiac arrest. A coronary angiogram revealed a subocclusive stenosis of left anterior descending coronary artery, treated with a percutaneous coronary intervention. After myocardial revascularization, even in presence of long QT interval, no arrhythmic events occurred suggesting the key role of myocardial ischemia in triggering TdP in acquired long QT even without bradycardia. ECG performed six months later, after complete recovery from pancreatitis, showed a normal QT interval.

  1. 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 (children (1-5 years); school children (6-15 years); and high school adolescents/young adults (16-21 years). Multivariate logistic regression...... analyses were used to investigate associations between pre-hospital factors and study endpoints: return of spontaneous circulation and survival. RESULTS: A total of 459 individuals were included. Overall incidence of OHCA was 3.3 per 100,000 inhabitants per year. The incidence rates for infants, pre...

  2. 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.

  3. 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.

  4. 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.

  5. The Involvement of Danger-Associated Molecular Patterns in the Development of Immunoparalysis in Cardiac Arrest Patients

    NARCIS (Netherlands)

    Timmermans, K.; Kox, M.; Gerretsen, J.; Peters, E.; Scheffer, G.J.; Hoeven, J.G. van der; Pickkers, P.; Hoedemaekers, C.W.E.


    OBJECTIVES: After cardiac arrest, patients are highly vulnerable toward infections, possibly due to a suppressed state of the immune system called "immunoparalysis." We investigated if immunoparalysis develops following cardiac arrest and whether the release of danger-associated molecular patterns

  6. Lithium Causes G2 Arrest of Renal Principal Cells (United States)

    de Groot, Theun; Alsady, Mohammad; Jaklofsky, Marcel; Otte-Höller, Irene; Baumgarten, Ruben; Giles, Rachel H.


    Vasopressin-regulated expression and insertion of aquaporin-2 channels in the luminal membrane of renal principal cells is essential for urine concentration. Lithium affects urine concentrating ability, and approximately 20% of patients treated with lithium develop nephrogenic diabetes insipidus (NDI), a disorder characterized by polyuria and polydipsia. Lithium-induced NDI is caused by aquaporin-2 downregulation and a reduced ratio of principal/intercalated cells, yet lithium induces principal cell proliferation. Here, we studied how lithium-induced principal cell proliferation can lead to a reduced ratio of principal/intercalated cells using two-dimensional and three-dimensional polarized cultures of mouse renal collecting duct cells and mice treated with clinically relevant lithium concentrations. DNA image cytometry and immunoblotting revealed that lithium initiated proliferation of mouse renal collecting duct cells but also increased the G2/S ratio, indicating G2/M phase arrest. In mice, treatment with lithium for 4, 7, 10, or 13 days led to features of NDI and an increase in the number of principal cells expressing PCNA in the papilla. Remarkably, 30%–40% of the PCNA-positive principal cells also expressed pHistone-H3, a late G2/M phase marker detected in approximately 20% of cells during undisturbed proliferation. Our data reveal that lithium treatment initiates proliferation of renal principal cells but that a significant percentage of these cells are arrested in the late G2 phase, which explains the reduced principal/intercalated cell ratio and may identify the molecular pathway underlying the development of lithium-induced renal fibrosis. PMID:24408872

  7. 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.

  8. Generation of a Spindle Checkpoint Arrest from Synthetic Signaling Assemblies. (United States)

    Yuan, Ivan; Leontiou, Ioanna; Amin, Priya; May, Karen M; Soper Ní Chafraidh, Sadhbh; Zlámalová, Eliška; Hardwick, Kevin G


    The spindle checkpoint acts as a mitotic surveillance system, monitoring interactions between kinetochores and spindle microtubules and ensuring high-fidelity chromosome segregation [1-3]. The checkpoint is activated by unattached kinetochores, and Mps1 kinase phosphorylates KNL1 on conserved MELT motifs to generate a binding site for the Bub3-Bub1 complex [4-7]. This leads to dynamic kinetochore recruitment of Mad proteins [8, 9], a conformational change in Mad2 [10-12], and formation of the mitotic checkpoint complex (MCC: Cdc20-Mad3-Mad2 [13-15]). MCC formation inhibits the anaphase-promoting complex/cyclosome (Cdc20-APC/C), thereby preventing the proteolytic destruction of securin and cyclin and delaying anaphase onset. What happens at kinetochores after Mps1-dependent Bub3-Bub1 recruitment remains mechanistically unclear, and it is not known whether kinetochore proteins other than KNL1 have significant roles to play in checkpoint signaling and MCC generation. Here, we take a reductionist approach, avoiding the complexities of kinetochores, and demonstrate that co-recruitment of KNL1(Spc7) and Mps1(Mph1) is sufficient to generate a robust checkpoint signal and prolonged mitotic arrest. We demonstrate that a Mad1-Bub1 complex is formed during synthetic checkpoint signaling. Analysis of bub3Δ mutants demonstrates that Bub3 acts to suppress premature checkpoint signaling. This synthetic system will enable detailed, mechanistic dissection of MCC generation and checkpoint silencing. After analyzing several mutants that affect localization of checkpoint complexes, we conclude that spindle checkpoint arrest can be independent of their kinetochore, spindle pole, and nuclear envelope localization. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

  9. Ethical dilemmas during cardiac arrest incidents in the patient's home. (United States)

    Karlsson, Mattias; Karlsson, Niclas; Hilli, Yvonne


    The majority (70%) of cardiac arrests in Sweden are experienced in the patient's home. In these situations, the ambulance nurses may encounter several ethical dilemmas. The aim was to investigate Swedish specialist ambulance nurses' experiences of ethical dilemmas associated with cardiac arrest situations in adult patients' homes. Nine interviews were conducted with specialist ambulance nurses at four different ambulance stations in the southeast region of Sweden. Data were analysed using content analysis. Ethical considerations: Ethical principles mandated by the Swedish Research Council were carefully followed during the whole process. Two main themes with six sub-themes were identified: The scene - creating a sheltered space for caring and Ethical decision-making. The results showed that ethical dilemmas might occur when trying to create a sheltered space to preserve the patients' integrity and dignity. A dilemma could be whether or not to invite significant others to be present during the medical treatment. Ethical decision-making was dependent on good communication and ethical reasoning among all parties. In certain situations, decisions were made not to commence or to terminate care despite guidelines. The decision was guided by combining the medical/nursing perspectives and ethical competence with respect to the human being's dignity and a will to do good for the patient. The nurses followed the voice of their heart and had the courage to be truly human. The ambulance nurses were guided by their ethos, including the basic motive to care for the patient, to alleviate suffering, to confirm the patient's dignity and to serve life and health.

  10. Rationale, development and implementation of the Resuscitation Outcomes Consortium Epistry-Cardiac Arrest. (United States)

    Morrison, Laurie J; Nichol, Graham; Rea, Thomas D; Christenson, Jim; Callaway, Clifton W; Stephens, Shannon; Pirrallo, Ronald G; Atkins, Dianne L; Davis, Daniel P; Idris, Ahamed H; Newgard, Craig


    To describe the development, design and consequent scientific implications of the Resuscitation Outcomes Consortium (ROC) population-based registry; ROC Epistry-Cardiac Arrest. The ROC Epistry--Cardiac Arrest is designed as a prospective population-based registry of all Emergency Medical Services (EMSs)-attended 9-1-1 calls for patients with out-of-hospital cardiac arrest occurring in the geographical area described by the eight US and three Canadian regions. The dataset was derived by an North American interdisciplinary steering committee. Enrolled cases include individuals of all ages who experience cardiac arrest outside the hospital, with evaluation by organized EMS personnel and: (a) attempts at external defibrillation (by lay responders or emergency personnel), or chest compressions by organized EMS personnel; (b) were pulseless but did not receive attempts to defibrillate or CPR by EMS personnel. Selected data items are categorized as mandatory or optional and undergo revisions approximately every 12 months. Where possible all definitions are referenced to existing literature. Where a common definition did not exist one was developed. Optional items include standardized CPR process data elements. It is anticipated the ROC Epistry--Cardiac Arrest will enroll between approximately 9000 and 13,500 treated all rhythm arrests and 4000 and 5000 ventricular fibrillation arrests annually and approximately 8000 EMS-attended but untreated arrests. We describe the rationale, development, design and future implications of the ROC Epistry--Cardiac Arrest. This paper will serve as the reference for subsequent ROC manuscripts and for the common data elements captured in both ROC Epistry--Cardiac Arrest and the ROC trials.

  11. Differential arrest and adhesion of tumor cells and microbeads in the microvasculature. (United States)

    Guo, Peng; Cai, Bin; Lei, Ming; Liu, Yang; Fu, Bingmei M


    To investigate the mechanical mechanisms behind tumor cell arrest in the microvasculature, we injected fluorescently labeled human breast carcinoma cells or similarly sized rigid beads into the systemic circulation of a rat. Their arrest patterns in the microvasculature of mesentery were recorded and quantified. We found that 93% of rigid beads were arrested either at arteriole-capillary intersections or in capillaries. Only 3% were at the capillary-postcapillary venule intersections and in postcapillary venules. In contrast, most of the flexible tumor cells were either entrapped in capillaries or arrested at capillary or postcapillary venule-postcapillary venule intersections and in postcapillary venules. Only 12% of tumor cells were arrested at the arteriole-capillary intersections. The differential arrest and adhesion of tumor cells and microbeads in the microvasculature was confirmed by a χ(2) test (p < 0.001). These results demonstrate that mechanical trapping was responsible for almost all the arrest of beads and half the arrest of tumor cells. Based on the measured geometry and blood flow velocities at the intersections, we also performed a numerical simulation using commercial software (ANSYS CFX 12.01) to depict the detailed distribution profiles of the velocity, shear rate, and vorticity at the intersections where tumor cells preferred to arrest and adhere. Simulation results reveal the presence of localized vorticity and shear rate regions at the turning points of the microvessel intersections, implying that hemodynamic factors play an important role in tumor cell arrest in the microcirculation. Our study helps elucidate long-debated issues related to the dominant factors in early-stage tumor hematogenous metastasis.

  12. Arrest functions of the MIF ligand/receptor axes in atherogenesis

    Directory of Open Access Journals (Sweden)

    Sabine eTillmann


    Full Text Available Macrophage migration inhibitory factor (MIF has been defined as an important chemokine-like function (CLF chemokine with an essential role in monocyte recruitment and arrest. Adhesion of monocytes to the vessel wall and their transendothelial migration are critical in atherogenesis and many other inflammatory diseases. Chemokines carefully control all steps of the monocyte recruitment process. Those chemokines specialized in controlling arrest are typically immobilized on the endothelial surface, mediating the arrest of rolling monocytes by chemokine receptor-triggered pathways. The chemokine receptor CXCR2 functions as an important arrest receptor on monocytes. An arrest function has been revealed for the bona fide CXCR2 ligands CXCL1 and CXCL8, but genetic studies also suggested that additional arrest chemokines are likely to be involved in atherogenic leukocyte recruitment. While CXCR2 is known to interact with numerous CXC chemokine ligands, the CLF-chemokine MIF, which structurally does not belong to the CXC chemokine sub-family, was surprisingly identified as a non-cognate ligand of CXCR2, responsible for critical arrest functions during the atherogenic process. MIF was originally identified as macrophage migration inhibitory factor, but is now known as a potent inflammatory cytokine with chemokine-like functions including chemotaxis and leukocyte arrest. This review will cover the mechanisms underlying these functions, including MIF’s effects on LFA1 integrin activity and signal transduction, and will discuss the structural similarities between MIF and the bona fide CXCR2 ligand CXCL8 while emphasizing the structural differences. As MIF also interacts with CXCR4, a chemokine receptor implicated in CXCL12-elicited lymphocyte arrest, the arrest potential of the MIF/CXCR4 axis will also be scrutinized as well as the recently identified role of pericyte MIF in attracting leukocytes exiting through venules as part of the pericyte 'motility

  13. 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.

  14. 48 CFR 5215.407 - Solicitation provisions. (United States)


    ... that adequate price competition will exist. If it is anticipated that an award will be based on adequate price competition, the solicitation shall include the provision at 5252.215-9000. If the... minimum delay in the event that adequate price competition does not materialize and it is necessary to...

  15. Housing Data Base for Sustainable Housing Provision

    African Journals Online (AJOL)


    that the housing provision as currently practised is not socially sustainable as it does not rely on data from the .... Design Base. One of the first issues the architect always tries to address before embarking on a design is to obtain the design brief and analyse the data provided. ..... of Housing. Nigeria: Jos Universal. Press.

  16. 24 CFR 203.17 - Mortgage provisions. (United States)


    ... 24 Housing and Urban Development 2 2010-04-01 2010-04-01 false Mortgage provisions. 203.17 Section... DEVELOPMENT MORTGAGE AND LOAN INSURANCE PROGRAMS UNDER NATIONAL HOUSING ACT AND OTHER AUTHORITIES SINGLE FAMILY MORTGAGE INSURANCE Eligibility Requirements and Underwriting Procedures Eligible Mortgages § 203...

  17. 12 CFR 931.9 - Transition provision. (United States)


    ... November 12, 1999, and whose investment in Bank stock as of the effective date of the capital plan will be... FEDERAL HOME LOAN BANK CAPITAL STOCK § 931.9 Transition provision. (a) In general. Each Bank shall comply... chapter, respectively, and each member shall comply with the minimum investment established in the capital...

  18. 9 CFR 93.318 - Special provisions. (United States)


    ... recognized expositions in Canada, including racing, horse shows, rodeo, circus, or stage exhibitions in... CONVEYANCE AND SHIPPING CONTAINERS Horses Canada 16 § 93.318 Special provisions. (a) In-bond shipments from Canada. (1) Horses from Canada transported in-bond through the United States for immediate export shall...

  19. 40 CFR 1042.301 - General provisions. (United States)


    ... Production-line Engines § 1042.301 General provisions. (a) If you produce engines that are subject to the... engine manufacturers may omit testing under this subpart. (2) We may exempt Category 1 engine families... certain engine families if your production-line engines do not meet the requirements of this part or you...

  20. 10 CFR 26.711 - General provisions. (United States)


    ... 10 Energy 1 2010-01-01 2010-01-01 false General provisions. 26.711 Section 26.711 Energy NUCLEAR... information about individuals is retained and shared with other licensees and entities. If, for any reason, the shared information used for determining an individual's eligibility for authorization under this...

  1. 15 CFR 301.1 - General provisions. (United States)


    ... FOR EDUCATIONAL AND SCIENTIFIC INSTITUTIONS § 301.1 General provisions. (a) Purpose. This part sets... duty-free importation of scientific instruments and apparatus by public or private nonprofit institutions. (b) Background. (1) The Agreement on the importation of Educational, Scientific and Cultural...

  2. 32 CFR 518.15 - General provisions. (United States)


    ... information under the FOIA can have an adverse impact on OPSEC. The Army implementing directive for OPSEC is... provisions of the FOIA are reserved for persons with private interests as opposed to U.S. Federal Agencies... release of names and duty information of personnel who, by the nature of their position and duties...

  3. 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...

  4. 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 tri...

  5. 45 CFR 612.1 - General provisions. (United States)


    .... science, news releases) may be provided to the public without reliance on this Part. As a matter of policy... 45 Public Welfare 3 2010-10-01 2010-10-01 false General provisions. 612.1 Section 612.1 Public Welfare Regulations Relating to Public Welfare (Continued) NATIONAL SCIENCE FOUNDATION AVAILABILITY OF...

  6. 45 CFR 74.48 - Contract provisions. (United States)



  7. 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...

  8. 5 CFR 831.1905 - Additional provisions. (United States)


    ... necessary to properly process a request for State income tax withholding. (d) If the State is paid... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false Additional provisions. 831.1905 Section 831.1905 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS...

  9. 76 FR 32316 - Gap in Termination Provisions (United States)


    ... example, the Software and Information Industry Association (SIIA) stated that the better practice would be... Copyright Office 37 CFR Part 201 Gap in Termination Provisions AGENCY: Copyright Office, Library of Congress. ACTION: Final rule. SUMMARY: The Copyright Office is amending its regulations governing notices of...

  10. Housing Data Base for Sustainable Housing Provision

    African Journals Online (AJOL)


    ATBU Journal of Environmental Technology 10, 1, June 20 I 7. 53 ... impact on the type and nature of houses provided within the city .... architects. The common data usually obtained when it comes to mass housing estates provision has been that of income capability of the house owners as shown in researches by Igbinosa.

  11. 28 CFR 105.27 - Miscellaneous provisions. (United States)


    ... Private Security Officer Employment § 105.27 Miscellaneous provisions. (a) Alternate State availability... national fingerprint-based criminal history checks of prospective and current private security officers and... history checks of prospective and current private security officers. (b) FBI fees for national check. The...

  12. 20 CFR 301.1 - Statutory provisions. (United States)


    ... 20 Employees' Benefits 1 2010-04-01 2010-04-01 false Statutory provisions. 301.1 Section 301.1 Employees' Benefits RAILROAD RETIREMENT BOARD REGULATIONS UNDER THE RAILROAD UNEMPLOYMENT INSURANCE ACT... therefor, or in any of such activities. * * * (b) The term “carrier” means an express company, sleeping-car...

  13. 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... regulations within the framework of this circular will be issued by the Fiscal Assistant Secretary of the...

  14. 40 CFR 35.6595 - Contract provisions. (United States)


    ... must comply with 40 CFR 31.36(i)(3) through (6). (4) Conflict of interest. The recipient must include provisions pertaining to conflict of interest as described in § 35.6550(b)(2)(ii). ... regulations pertaining to reporting and patent rights under any contract involving research, developmental...

  15. 40 CFR 1042.701 - General provisions. (United States)


    ..., Banking, and Trading for Certification § 1042.701 General provisions. This subpart describes how you may... family with a higher FEL that applies only to future production. (f) Engine families that use emission...) Emission credits may be used in the model year they are generated or in future model years. Emission...

  16. 7 CFR 249.25 - Other provisions. (United States)


    ... Regulations of the Department of Agriculture (Continued) FOOD AND NUTRITION SERVICE, DEPARTMENT OF AGRICULTURE CHILD NUTRITION PROGRAMS SENIOR FARMERS' MARKET NUTRITION PROGRAM (SFMNP) Miscellaneous Provisions § 249... (7 U.S.C. 2011, et seq.) and to any other Federal or State food or nutrition assistance program. (b...

  17. 5 CFR 9701.527 - Savings provision. (United States)



  18. 78 FR 48048 - Student Assistance General Provisions (United States)


    ...] [Pages 48048-48051] [FR Doc No: 2013-19071] DEPARTMENT OF EDUCATION 34 CFR Part 668 RIN 1880-AA87 Student... Education. ACTION: Final regulations. SUMMARY: The Secretary amends the Student Assistance General Provisions regulations governing participation in the student financial assistance programs authorized under...

  19. Constitutional Provisions And Administrative Disciplinary Powers ...

    African Journals Online (AJOL)

    The Medical and Dental Practitioners Disciplinary Tribunal is empowered to deal with all cases of professional discipline under the Medical and Dental Practitioners Act. This process of administrative adjudication is examined against the background of constitutional provision that affects the exercise of the powers of the ...

  20. Girls and Gender in Alternative Education Provision (United States)

    Russell, Lisa; Thomson, Pat


    UK Government policy states that all young people aged 14-19 are entitled to a broad and balanced curriculum, with access to "personalised" education and training pathways. With boys currently leading the statistics on exclusion, girls' educational and social needs are often sidelined in alternative education provision, as the majority…

  1. 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...

  2. 29 CFR 1902.36 - General provisions. (United States)


    ... 29 Labor 5 2010-07-01 2010-07-01 false General provisions. 1902.36 Section 1902.36 Labor Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR STATE PLANS FOR THE DEVELOPMENT AND ENFORCEMENT OF STATE STANDARDS Procedures for Determinations Under...

  3. 22 CFR 96.49 - Provision of medical and social information in incoming cases. (United States)


    ... individual who observed the child; (2) The date of the examination or observation; how the report's..., including, but not limited to any social work or court reports on the child and any information on who... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Provision of medical and social information in...

  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. 78 FR 35217 - Atlantic Coastal Fisheries Cooperative Management Act Provisions; American Lobster Fishery (United States)


    ... National Oceanic and Atmospheric Administration 50 CFR Part 697 RIN 0648-AT31 Atlantic Coastal Fisheries Cooperative Management Act Provisions; American Lobster Fishery AGENCY: National Marine Fisheries Service... lobster trap fishing effort by limiting access into the lobster trap fishery in Lobster Conservation...

  6. Serum procalcitonin, C-reactive protein and white blood cell levels following hypothermia after cardiac arrest: a retrospective cohort study. (United States)

    Schuetz, Philipp; Affolter, Barbara; Hunziker, Sabina; Winterhalder, Clemens; Fischer, Michael; Balestra, Gianmarco M; Hunziker, Patrick; Marsch, Stephan


    The aim of this study was to investigate time course of procalcitonin (PCT), C-reactive protein (CRP) and white blood cell (WBC) levels in patients with therapeutic hypothermia after cardiac arrest. We retrospectively assessed laboratory and clinical data in a consecutive cohort of patients admitted to the medical intensive-care-unit of the University Hospital in Basel, Switzerland, in whom therapeutic hypothermia was induced because of cardiac arrest between December 2007 and January 2009. Infection was considered based on microbiological evidence (restricted definition) and/or clinical evidence of infection with prescription of antibiotics (extended definition). From 34 included patients, 25 had respiratory tract infection based on the clinical judgment and in 18 microbiological cultures turned positive (restricted definition). PCT concentrations were highest on the first day after hypothermia and showed a steady decrease until day 7 without differences in patients with and without presumed infection. CRP concentrations increased to a peak level at days 3-4 followed by a steady decrease; CRP concentrations were higher in patients with clinical diagnosis of infection on day 4 (P = 0.02); and in patients with evidence of bacterial growth in cultures on days 4 and 5 (P = 0.01 and P = 0.006). WBC remained unchanged after hypothermia without differences between patients with and without infection. High initial values of PCT and high peak levels after 3-4 days of CRP were found in patients with induction of hypothermia after cardiac arrest. This increase was unspecific and mirrors rather an inflammatory reaction than true underlying infection, limiting the diagnostic potential for early antibiotic stewardship in these patients.

  7. 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.

  8. Prehospital traumatic cardiac arrest: Management and outcomes from the resuscitation outcomes consortium epistry-trauma and PROPHET registries. (United States)

    Evans, Christopher C D; Petersen, Ashley; Meier, Eric N; Buick, Jason E; Schreiber, Martin; Kannas, Delores; Austin, Michael A


    Traumatic arrests have historically had poor survival rates. Identifying salvageable patients and ideal management is challenging. We aimed to (1) describe the management and outcomes of prehospital traumatic arrests; (2) determine regional variation in survival; and (3) identify Advanced Life Support (ALS) procedures associated with survival. This was a secondary analysis of cases from the Resuscitation Outcomes Consortium Epistry-Trauma and Prospective Observational Prehospital and Hospital Registry for Trauma (PROPHET) registries. Patients were included if they had a blunt or penetrating injury and received cardiopulmonary resuscitation. Logistic regression analyses were used to determine the association between ALS procedures and survival. We included 2,300 patients who were predominately young (Epistry mean [SD], 39 [20] years; PROPHET mean [SD], 40 [19] years), males (79%), injured by blunt trauma (Epistry, 68%; PROPHET, 67%), and treated by ALS paramedics (Epistry, 93%; PROPHET, 98%). A total of 145 patients (6.3%) survived to hospital discharge. More patients with blunt (Epistry, 8.3%; PROPHET, 6.5%) vs. penetrating injuries (Epistry, 4.6%; PROPHET, 2.7%) survived. Most survivors (81%) had vitals on emergency medical services arrival. Rates of survival varied significantly between the 12 study sites (p = 0.048) in the Epistry but not PROPHET (p = 0.14) registries.Patients in the PROPHET registry who received a supraglottic airway insertion or intubation experienced decreased odds of survival (adjusted OR, 0.27; 95% confidence interval, 0.08-0.93; and 0.37; 95% confidence interval, 0.17-0.78, respectively) compared to those receiving bag-mask ventilation. No other procedures were associated with survival. Survival from traumatic arrest may be higher than expected, particularly in blunt trauma and patients with vitals on emergency medical services arrival. Although limited by confounding and statistical power, no ALS procedures were associated with increased

  9. Intra-arrest selective brain cooling improves success of resuscitation in a porcine model of prolonged cardiac arrest. (United States)

    Wang, Hao; Barbut, Denise; Tsai, Min-Shan; Sun, Shijie; Weil, Max Harry; Tang, Wanchun


    We have previously demonstrated that early intra-nasal cooling improved post-resuscitation neurological outcomes. The present study utilizing a porcine model of prolonged cardiac arrest investigated the effects of intra-nasal cooling initiated at the start of cardiopulmonary resuscitation (CPR) on resuscitation success. Our hypothesis was that rapid nasal cooling initiated during "low-flow" improves return of spontaneous resuscitation (ROSC). In 16 domestic male pigs weighing 40+/-3 kg, VF was electrically induced and untreated for 15 min. Animals were randomized to either head cooling or control. CPR was initiated and continued for 5 min before defibrillation was attempted. Coincident with starting CPR, the hypothermic group was cooled with a RhinoChill device which produces evaporative cooling in the nasal cavity of pigs. No cooling was administrated to control animals. If ROSC was not achieved after defibrillation, CPR was resumed for 1 min prior to the next defibrillation attempt until either successful resuscitation or for a total of 15 min. Seven of eight animals in the hypothermic group (87.5%) and two of eight animals in control group (25%) (p=0.04) were successfully resuscitated. At ROSC, brain temperature was increased from baseline by 0.3 degrees C in the control group, and decreased by 0.1 degrees C in the hypothermic animals. Pulmonary artery temperature was above baseline in both groups. Intra-nasal cooling initiated at the start of CPR significantly improves the success of resuscitation in a porcine model of prolonged cardiac arrest. This may have occurred by preventing brain hyperthermia. Copyright 2010 Elsevier Ireland Ltd. All rights reserved.

  10. Crack arrestability of ship hull steel plate in accidental conditions: Application of high arrestability endowed ultra fine-grain surface layer steel

    Energy Technology Data Exchange (ETDEWEB)

    Ishikawa, Tadashi; Hagiwara, Yukito [Oita R and D Lab. (Japan); Oshita, Shigeru [Nippon Steel Corp., Oita (Japan). Oita Works; Inoue, Takehiro [Nippon Steel Corp., Futsu, Chiba (Japan). Steel Research Labs.; Hashimoto, Kunifumi; Kuroiwa, Takashi; Tada, Masuo [Mitsubishi Heavy Industries, Ltd., Nagasaki (Japan); Yajima, Hiroshi [Univ. of Hiroshima (Japan)


    A new type steel plate with ultra fine-grained surface layers (SUF steel) has been developed to improve crack arrestability. The application of this new type steel makes it possible to prevent catastrophic brittle fracture accidents of ship hull structures in emergency conditions, such as in serious collisions or groundings. It will reduce further the risk of casualties and environmental pollutions, caused by accidents of large crude oil carriers (VLCCs). The authors have investigated the validity for the application of the new type steel with ultra-high crack arrestability. Both computer simulations for collision of two VLCCs and large-scale fracture testings for crack arrestability have been carried out to study the accidental cases. The simulation results suggest that a collision generates a significant amount of plastic strain damage for the hull plate around a struck part. For example, the sheer strake plate near the struck part suffers 5 to 10% of plastic strain, before an inner-hull ruptures. Therefore, the effect of plastic strain (10% level) on crack arrestability of steel plates (the SUF plate and a conventional TMCP plate) was examined by standard ESSO tests, ultra wide-plate duplex ESSO tests, and sheer strake model tests. The test results are as follows: (1) Plastic strain deteriorates crack arrestability of steel plates. (2) Sufficient crack arrestability at 0 deg. C cannot be expected in the conventional TMCP steel plate plastically strained by about 10%. (3) The SUF plate maintains high crack arrestability even after introducing 10% plastic strain, at design temperature of 0 deg. C.

  11. A standardized Code Blue Team eliminates variable survival from in-hospital cardiac arrest. (United States)

    Qureshi, Sultana A; Ahern, Terence; O'Shea, Ryan; Hatch, Lorien; Henderson, Sean O


    Recent studies suggest that time of day affects survival from in-hospital cardiac arrest. Lower survival rates are observed during nights and on weekends, except in areas with consistent physician care, such as the Emergency Department. Since 1997, our hospital has utilized a standard, hospital-wide "Code Blue Team" (CBT) to respond to cardiac arrests at any time. This team is always led by an emergency physician, and includes specially trained nurses. To assess if time of day or week affects survival from in-hospital cardiac arrest when a trained, consistent, emergency physician-led CBT is implemented. This is an analysis of prospectively collected data on initial survival rates (return of spontaneous circulation >20 min) of all cardiac arrests that were managed by the CBT from 2000 to 2008. Cardiac arrests were also subcategorized based on initial cardiac rhythm. Survival rates were compared according to time of day or week. A total of 1692 cardiac arrests were included. There was no significant difference in the overall rate of initial survival between day/evening vs. night hours (odds ratio [OR] 1.04, 95% confidence interval [CI] 0.83-1.29), or between weekday vs. weekend hours (OR 1.10, 95% CI 0.85-1.38). This held true for all cardiac rhythms. At our institution, there is no significant difference in survival from cardiac arrest when a standardized "Code Blue Team" is utilized, regardless of the time of day or week. Copyright © 2012. Published by Elsevier Inc.

  12. 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.

  13. Acute-phase reactants after paediatric cardiac arrest. Procalcitonin as marker of immediate outcome

    Directory of Open Access Journals (Sweden)

    Medina Alberto


    Full Text Available Abstract Objective Procalcitonin (PCT and C reactive protein (CRP have been used as infection parameters. PCT increase correlates with the infection's severity, course, and mortality. Post-cardiocirculatory arrest syndrome may be related to an early systemic inflammatory response, and may possibly be associated with an endotoxin tolerance. Our objective was to report the time profile of PCT and CRP levels after paediatric cardiac arrest and to assess if they could be use as markers of immediate survival. Materials and methods A retrospective observational study set in an eight-bed PICU of a university hospital was performed during a period of two years. Eleven children younger than 14 years were admitted in the PICU after a cardiac arrest. PCT and CRP plasma concentrations were measured within the first 12 and 24 hours of admission. Results In survivors, PCT values increased 12 hours after cardiac arrest without further increase between 12 and 24 hours. In non survivors, PCT values increased 12 hours after cardiac arrest with further increase between 12 and 24 hours. Median PCT values (range at 24 hours after cardiac arrest were 22.7 ng/mL (0.2 – 41.0 in survivors vs. 205.5 ng/mL (116.6 – 600.0 in non survivors (p Conclusion Measurement of PCT during the first 24 hours after paediatric cardiac arrest could serve as marker of mortality.

  14. 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.

  15. Reduced right ventricular diameter during cardiac arrest caused by tension pneumothorax - a porcine ultrasound study. (United States)

    Caap, P; Aagaard, R; Sloth, E; Løfgren, B; Granfeldt, A


    Advanced life support (ALS) guidelines recommend ultrasound to identify reversible causes of cardiac arrest. Right ventricular (RV) dilatation during cardiac arrest is commonly interpreted as a sign of pulmonary embolism. The RV is thus a focus of clinical ultrasound examination. Importantly, in animal studies ventricular fibrillation and hypoxia results in RV dilatation. Tension pneumothorax (tPTX) is another reversible cause of cardiac arrest, however, the impact on RV diameter remains unknown. To investigate RV diameter evaluated by ultrasound in cardiac arrest caused by tPTX or hypoxia. Pigs were randomized to cardiac arrest by either tPTX (n = 9) or hypoxia (n = 9) and subsequently resuscitated. Tension pneumothorax was induced by injection of air into the pleural cavity. Hypoxia was induced by reducing tidal volume. Ultrasound images of the RV were obtained throughout the study. Tension pneumothorax was decompressed after the seventh rhythm analysis. The primary endpoint was RV diameter after the third rhythm analysis. At cardiac arrest the RV diameter was 17 mm (95% CI: 13; 21) in the tPTX group and 36 mm (95% CI: 33; 40) in the hypoxia group (P cardiac arrest caused by tPTX when compared with hypoxia. The difference disappears after tPTX decompression. © 2017 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

  16. The Association Between Arterial Oxygen Tension and Neurological Outcome After Cardiac Arrest. (United States)

    Johnson, Nicholas J; Dodampahala, Kalani; Rosselot, Babette; Perman, Sarah M; Mikkelsen, Mark E; Goyal, Munish; Gaieski, David F; Grossestreuer, Anne V


    A number of observational studies have evaluated the association between arterial oxygen tensions and outcome after cardiac arrest with variable results. The objective of this study is to determine the association between arterial oxygen tension and neurological outcome after cardiac arrest. A retrospective cohort analysis was performed using the Penn Alliance for Therapeutic Hypothermia registry. Adult patients who experienced return of spontaneous circulation after in-hospital or out-of-hospital cardiac arrest (OHCA) and had a partial pressure of arterial oxygen (PaO2) recorded within 48 hours were included. Our primary exposure of interest was PaO2. Hyperoxemia was defined as PaO2 > 300 mmHg, hypoxemia as PaO2 arrests were witnessed, and pulseless electrical activity was the most common initial rhythm (40%). More than 72% of the patients had cardiac etiology for their arrests, and 55% underwent targeted temperature management. A total of 38% of patients survived to hospital discharge. There was no significant association between PaO2 at any time interval and neurological outcome at hospital discharge. Hyperoxemia at 12 hours after cardiac arrest was associated with decreased odds of survival (OR 0.17 [0.03-0.89], p = 0.032). There was no significant association between arterial oxygen tension measured within the first 48 hours after cardiac arrest and neurological outcome.

  17. Detection of Pulmonary Embolism During Cardiac Arrest-Ultrasonographic Findings Should Be Interpreted With Caution. (United States)

    Aagaard, Rasmus; Caap, Philip; Hansson, Nicolaj C; Bøtker, Morten T; Granfeldt, Asger; Løfgren, Bo


    The aim of this study was to test the hypothesis that the right ventricle is more dilated during resuscitation from cardiac arrest caused by pulmonary embolism, compared with hypoxia and primary arrhythmia. Twenty-four pigs were anesthetized and cardiac arrest was induced using three different methods. Pigs were resuscitated after 7 minutes of untreated cardiac arrest. Ultrasonographic images were obtained and the right ventricular diameter was measured. University hospital animal laboratory. Female crossbred Landrace/Yorkshire/Duroc pigs (27-32 kg). Pigs were randomly assigned to cardiac arrest induced by pulmonary embolism, hypoxia, or primary arrhythmia. There was no difference at baseline. During induction of cardiac arrest, the right ventricle dilated in all groups (p cardiac ultrasonography were able to detect a difference in right ventricle diameter of approximately 10 mm with a sensitivity of 79% (95% CI, 64-94) and a specificity of 68% (95% CI, 56-80). The right ventricle was more dilated during resuscitation when cardiac arrest was caused by pulmonary embolism compared with hypoxia and primary arrhythmia. However, the right ventricle was dilated, irrespective of the cause of arrest, and diagnostic accuracy by physicians with basic training in focused cardiac ultrasonography was modest. These findings challenge the paradigm that right ventricular dilatation on ultrasound during cardiopulmonary resuscitation is particularly associated with pulmonary embolism.

  18. 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.

  19. The impact of hidden liquidity in limit order books


    Frey, Stefan; Sandås, Patrik


    We report evidence that the presence of hidden liquidity is associated with greater liquidity in the order books, greater trading volume, and smaller price impact. Limit and market order submission behavior changes when hidden liquidity is present consistent with at least some traders being able to detect hidden liquidity. We estimate a model of liquidity provision that allows us to measure variations in the marginal and total payoffs from liquidity provision in states with and without hidden...

  20. The oxidative costs of territory quality and offspring provisioning. (United States)

    Guindre-Parker, S; Baldo, S; Gilchrist, H G; Macdonald, C A; Harris, C M; Love, O P


    The costs of reproduction are an important constraint that shapes the evolution of life histories, yet our understanding of the proximate mechanism(s) leading to such life-history trade-offs is not well understood. Oxidative stress is a strong candidate measure thought to mediate the costs of reproduction, yet empirical evidence supporting that increased reproductive investment leads to oxidative stress is equivocal. We investigated whether territory quality and offspring provisioning increase oxidative stress in male snow buntings (Plectrophenax nivalis) using a repeated sampling design. We show that arrival oxidative stress is not a constraint on territory quality or the number of offspring fledged. Nevertheless, owners of higher-quality territories experienced an oxidative cost, with this cost increasing more rapidly in younger males. Males that provisioned offspring at a high rate also experienced increased oxidative stress. Together, these findings support the potential role of oxidative stress in mediating life-history trade-offs. Future work should consider that reproductive workload is not limited to offspring care, and other activities - including territory defence - may contribute significantly to the costs of reproduction. © 2013 The Authors. Journal of Evolutionary Biology © 2013 European Society For Evolutionary Biology.

  1. Inhibition of the Mitochondrial Fission Protein Drp1 Improves Survival in a Murine Cardiac Arrest Model (United States)

    Sharp, Willard W.; Beiser, David G.; Fang, Yong Hu; Han, Mei; Piao, Lin; Varughese, Justin; Archer, Stephen L.


    Objectives Survival following sudden cardiac arrest is poor despite advances in cardiopulmonary resuscitation (CPR) and the use of therapeutic hypothermia. Dynamin related protein 1 (Drp1), a regulator of mitochondrial fission, is an important determinant of reactive oxygen species generation, myocardial necrosis, and left ventricular function following ischemia/reperfusion injury, but its role in cardiac arrest is unknown. We hypothesized that Drp1 inhibition would improve survival, cardiac hemodynamics, and mitochondrial function in an in vivo model of cardiac arrest. Design Laboratory investigation. Setting University laboratory Interventions Anesthetized and ventilated adult female C57BL/6 wild-type mice underwent an 8-min KCl induced cardiac arrest followed by 90 seconds of CPR. Mice were then blindly randomized to a single intravenous injection of Mdivi-1 (0.24 mg/kg), a small molecule Drp1 inhibitor or vehicle (DMSO). Measurements and Main Results Following resuscitation from cardiac arrest, mitochondrial fission was evidenced by Drp1 translocation to the mitochondrial membrane and a decrease in mitochondrial size. Mitochondrial fission was associated with increased lactate and evidence of oxidative damage. Mdivi-1 administration during CPR inhibited Drp1 activation, preserved mitochondrial morphology, and decreased oxidative damage. Mdivi-1 also reduced the time to return of spontaneous circulation (ROSC) 116±4 vs. 143±7 sec (pcardiac arrest. Conclusions Post cardiac arrest inhibition of Drp1 improves time to ROSC and myocardial hemodynamics resulting in improved survival and neurological outcomes in a murine model of cardiac arrest. Pharmacological targeting of mitochondrial fission may be a promising therapy for cardiac arrest. PMID:25599491

  2. Performance analysis of surge arrester on high voltage systems using ATP

    Energy Technology Data Exchange (ETDEWEB)

    Nallagownden, P.; Magumane, A.H. [Univ. Teknologi Petronas, Perak (Malaysia); Kanth, K.S.R. [Tenaga National Berhad (Malaysia)


    Lightning strikes are among the major factors that cause failures in electrical power systems. Phase to ground arresters are commonly installed at power transformer terminals to offer some lightning protection. However, it is important to understand the performance of metal oxide arresters under very fast transient overvoltages in order to determine the protection zone of the arrester and to achieve economical benefits. This study investigated lightning overvoltage protection in a complete three-phase scheme of a 500 KV substation. Overvoltages originated from direct lightning stroke on a phase of a real overhead line (OHL) model. The effect of the separation distance of the arrester from the transformer connected at the open end of the substations was investigated as well as the performance of the arrester for different substation configurations. In the first scenario, the connection of the arrester and transformer was done with a direct connection of an overhead line. In the second scenario, the connection of these devices was done through a cable. Both the overhead line and cable lengths were varied and the maximum overvoltages coming to the transformer were recorded. The results showed that there is a direct proportionality between overvoltages and length of the overhead line or cable. As long the length of the line or cable between the arrester and the transformer was increased, the vulnerability of the transformer to receive high overvoltages also increased. Surge overvoltages were found to be very sensitive to impedance of the line or cable. The direct connections of overhead lines between the arrester and transformer make it necessary to add some protective device. It was suggested that surge arresters should be installed every 200 meters along the overhead lines in order to ensure the safety of equipment. 12 refs., 4 tabs., 8 figs.

  3. Localization of out-of-hospital cardiac arrest in Goteborg 1994-2002 and implications for public access defibrillation. (United States)

    Engdahl, Johan; Herlitz, Johan


    The purpose of this study was to report the locality of out-of-hospital cardiac arrest (OHCA) in the city of Goteborg and to identify implications for public access defibrillation (PAD). Ambulance run reports for the years 1994-2002 were studied retrospectively and manually to establish the location of the cardiac arrest. The location could be identified in 2194 of 2197 patients (99.9%). One thousand four hundred and twenty-nine (65%) of the arrests took place in the victims' homes. Two hundred eighty-five (13%) were outdoors and 57 (3%) in cars. Fifty-one (2%) took place en route in ambulances. These arrests were regarded not to be generally suitable for PAD. One hundred thirty-five (6%) of the arrests happened in a public building. Eighteen of these 135 were in 15 different general practitioners' offices. A ferry terminal had 11 cardiac arrests. One hundred fifty (7%) of the arrests took place in different care facilities. Twenty-one (1%) patients had their cardiac arrest in public transport locations. Twenty-two (1%) patients arrested at work in 20 different sites. In total, 17% of the cardiac arrests were regarded as generally suitable for PAD. Several sites with more than one cardiac arrest in five years could be identified and 54 patients (2.5%) had their cardiac arrest in these high-incidence sites. Among patients suffering from out-of-hospital cardiac arrest in Goteborg in whom resuscitation efforts were attempted 17% of all cardiac arrests were regarded as generally suitable for PAD. According to previous suggestions, the indication for public access defibrillation is in a place with a reasonable probability of use of one AED in 5 years. Several high-incidence sites that probably would benefit from defibrillator availability could be identified, and 54 patients (2.5%) arrested in these sites.

  4. 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 to...... 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......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...... to a privatization agency and electoral delegation from voters to a government. We identify two powerfull effects of delegation when contracts are incomplete: The incentive effect increases the incentive part of service providers' remuneration and we show that strategic delegation may substitute formal incentive...

  5. When is a Cardiac Arrest Non-Cardiac? (United States)

    Carter, Ryan M; Cone, David C


    Introduction While the overall survival rate for out-of-hospital cardiac arrest (OHCA) is low, ranging from 5%-10%, several characteristics have been shown to decrease mortality, such as presence of bystander cardiopulmonary resuscitation (CPR), witnessed vs unwitnessed events, and favorable initial rhythm (VF/VT). More recently, studies have shown that modified CPR algorithms, such as chest-compression only or cardio-cerebral resuscitation, can further increase survival rates in OHCA. Most of these studies have included only OHCA patients with "presumed cardiac etiology," on the assumption that airway management is of lesser impact than chest compressions in these patients. However, prehospital personnel often lack objective and consistent criteria to assess whether an OHCA is of cardiac or non-cardiac etiology. Hypothesis/Problem The relative proportions of cardiac vs non-cardiac etiology in published data sets of OHCA in the peer-reviewed literature were examined in order to assess the variability of prehospital clinical etiology assessment. A Medline (US National Library of Medicine, National Institutes of Health; Bethesda, Maryland USA) search was performed using the subject headings "OHCA" and "Emergency Medical Services" (EMS). Studies were included if they reported prevalence of cardiac etiology among OHCA in the entire patient sample, or in all arms of a comparison study. Studies that either did not report etiology of OHCA, or that excluded all cardiac or non-cardiac etiologies prior to reporting clinical data, were excluded. Twenty-four studies were identified, containing 27 datasets of OHCA which reported the prevalence of presumed cardiac vs non-cardiac etiology. These 27 datasets were drawn from 15 different countries. The prevalence of cardiac etiology among OHCA ranged from 50% to 91%. No obvious patterns were found regarding database size, year of publication, or global region (continent) of origin. There exists significant variation in published

  6. Sex differences in cardiac arrest survivors who receive therapeutic hypothermia. (United States)

    Greenberg, Marna Rayl; Ahnert, Amy M; Patel, Nainesh C; Bennett, Courtney E; Elliott, Nicole; Lundquist, Mark; Miller, Andrew; Feiner, Ellina C; Kurt, Anita; Glenn-Porter, Bernadette; Scott, Mercedes; Burmeister, David B


    Sex differences have not been well defined for patients undergoing therapeutic hypothermia (TH). We aimed to determine sex differences in mortality and Cerebral Performance Category (CPC) scores at discharge among those receiving TH. This retrospective cohort study used data abstracted from an "ICE alert" database, an institutional protocol expediting mild TH for postarrest patients. Quality assurance variables (such as age, time to TH, CPC scores, and mortality) were reviewed and compared by sex. χ2 Test and Wilcoxon rank sum test were used. Stepwise logistic regression was used to assess the association between mortality and sex, while controlling for patient characteristics and clinical presentation of cardiac arrest. Three hundred thirty subjects were analyzed, 198 males and 132 females. Subjects' mean age (SD) was 61.7 years (15.0); there was no significant sex difference in age. There were no statistically significant sex differences in history of coronary artery disease, congestive heart failure, arrhythmia, hypertension, chronic obstructive pulmonary disease, renal disease, type 1 and/or type 2 diabetes mellitus, or those previously healthy. Obesity (body mass index>35 kg/m2) was more likely in females (37, 28.0%) than males (35, 17.7%); P=.03. Females (64, 49.6%) were more likely than males (71, 36.8%) to have shock; P=.02. There was no difference in arrest to initiating hypothermia, but there was a significant difference in time to target temperature (in median minutes, interquartile range): male (440, 270) vs female (310, 270), P=.003. There was no statistical difference in CPC at discharge. Crude mortality was not different between sexes: male, 67.7%; female, 70.5%; P=.594. However, after controlling for differences in age, obesity, shock, and other variables, females were less likely to die (odds ratio, 0.46; 95% confidence interval, 0.23-0.92; P=.03) than males. There is no statistically significant difference in CPC or crude mortality outcomes


    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.

  8. 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

  9. 49 CFR 172.507 - Special placarding provisions: Highway. (United States)



  10. 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.

  11. 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.

  12. Arresting Tailhook: The Prosecution of Sexual Harassment in the Military (United States)


    against female sexual assault victims so pervasive that Air Force investigators use a "rape allegation checklist " as a way to minimize or discredit...prohibition against the dse of "indecent language.",230 The expansive applicability of this provision can be seen in the analysis of several recent child...See e.g. Air Force Suspends Use of Sex-Assault Checklist , Wash. Times, Sept. 23, 1992, at A2; Why Women Need Power, Atl. Journ. & Const., Sept. 26, 1992

  13. 30 CFR 229.3 - Limitation on applicability. (United States)


    ... 30 Mineral Resources 2 2010-07-01 2010-07-01 false Limitation on applicability. 229.3 Section 229.3 Mineral Resources MINERALS MANAGEMENT SERVICE, DEPARTMENT OF THE INTERIOR MINERALS REVENUE MANAGEMENT DELEGATION TO STATES General Provisions § 229.3 Limitation on applicability. As of the effective...

  14. 30 CFR 228.3 - Limitation on applicability. (United States)


    ... 30 Mineral Resources 2 2010-07-01 2010-07-01 false Limitation on applicability. 228.3 Section 228.3 Mineral Resources MINERALS MANAGEMENT SERVICE, DEPARTMENT OF THE INTERIOR MINERALS REVENUE MANAGEMENT COOPERATIVE ACTIVITIES WITH STATES AND INDIAN TRIBES General Provisions § 228.3 Limitation on...

  15. 33 CFR 52.22 - Time limit for filing application. (United States)


    ... PERSONNEL BOARD FOR CORRECTION OF MILITARY RECORDS OF THE COAST GUARD General Provisions Regarding Applications § 52.22 Time limit for filing application. An application for correction of a record must be filed... 33 Navigation and Navigable Waters 1 2010-07-01 2010-07-01 false Time limit for filing application...

  16. 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...

  17. 40 CFR 1400.10 - Limitation on public dissemination. (United States)


    ... 40 Protection of Environment 32 2010-07-01 2010-07-01 false Limitation on public dissemination. 1400.10 Section 1400.10 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY AND DEPARTMENT OF... CONSEQUENCE ANALYSIS INFORMATION Other Provisions § 1400.10 Limitation on public dissemination. Except as...

  18. Identification and characterization of CCAAT/Enhancer Binding proteindelta (C/EBPdelta target genes in G0 growth arrested mammary epithelial cells

    Directory of Open Access Journals (Sweden)

    Huang Tim


    Full Text Available Abstract Background CCAAT/Enhancer Binding Proteinδ (C/EBPδ is a member of the highly conserved C/EBP family of leucine zipper (bZIP proteins. C/EBPδ is highly expressed in G0 growth arrested mammary epithelial cells (MECs and "loss of function" alterations in C/EBPδ have been associated with impaired contact inhibition, increased genomic instability and increased cell migration. Reduced C/EBPδ expression has also been reported in breast cancer and acute myeloid leukemia (AML. C/EBPδ functions as a transcriptional activator, however, only a limited number of C/EBPδ target genes have been reported. As a result, the role of C/EBPδ in growth control and the potential mechanisms by which "loss of function" alterations in C/EBPδ contribute to tumorigenesis are poorly understood. The goals of the present study were to identify C/EBPδ target genes using Chromatin Immunoprecipitation coupled with a CpG Island (HCG12K Array gene chip ("ChIP-chip" assay and to assess the expression and potential functional roles of C/EBPδ target genes in growth control. Results ChIP-chip assays identified ~100 C/EBPδ target gene loci which were classified by gene ontology (GO into cell adhesion, cell cycle regulation, apoptosis, signal transduction, intermediary metabolism, gene transcription, DNA repair and solute transport categories. Conventional ChIP assays validated the ChIP-chip results and demonstrated that 14/14 C/EBPδ target loci were bound by C/EBPδ in G0 growth arrested MCF-12A MECs. Gene-specific RT-PCR analysis also demonstrated C/EBPδ-inducible expression of 14/14 C/EBPδ target genes in G0 growth arrested MCF-12A MECs. Finally, expression of endogenous C/EBPδ and selected C/EBPδ target genes was also demonstrated in contact-inhibited G0 growth arrested nontransformed human MCF-10A MECs and in mouse HC11 MECs. The results demonstrate consistent activation and downstream function of C/EBPδ in growth arrested human and murine MECs. Conclusion

  19. Identification and characterization of CCAAT/Enhancer Binding proteindelta (C/EBPdelta) target genes in G0 growth arrested mammary epithelial cells. (United States)

    Zhang, Yingjie; Liu, Tong; Yan, Pearlly; Huang, Tim; Dewille, Jim


    CCAAT/Enhancer Binding Proteindelta (C/EBPdelta) is a member of the highly conserved C/EBP family of leucine zipper (bZIP) proteins. C/EBPdelta is highly expressed in G0 growth arrested mammary epithelial cells (MECs) and "loss of function" alterations in C/EBPdelta have been associated with impaired contact inhibition, increased genomic instability and increased cell migration. Reduced C/EBPdelta expression has also been reported in breast cancer and acute myeloid leukemia (AML). C/EBPdelta functions as a transcriptional activator, however, only a limited number of C/EBPdelta target genes have been reported. As a result, the role of C/EBPdelta in growth control and the potential mechanisms by which "loss of function" alterations in C/EBPdelta contribute to tumorigenesis are poorly understood. The goals of the present study were to identify C/EBPdelta target genes using Chromatin Immunoprecipitation coupled with a CpG Island (HCG12K) Array gene chip ("ChIP-chip") assay and to assess the expression and potential functional roles of C/EBPdelta target genes in growth control. ChIP-chip assays identified approximately 100 C/EBPdelta target gene loci which were classified by gene ontology (GO) into cell adhesion, cell cycle regulation, apoptosis, signal transduction, intermediary metabolism, gene transcription, DNA repair and solute transport categories. Conventional ChIP assays validated the ChIP-chip results and demonstrated that 14/14 C/EBPdelta target loci were bound by C/EBPdelta in G0 growth arrested MCF-12A MECs. Gene-specific RT-PCR analysis also demonstrated C/EBPdelta-inducible expression of 14/14 C/EBPdelta target genes in G0 growth arrested MCF-12A MECs. Finally, expression of endogenous C/EBPdelta and selected C/EBPdelta target genes was also demonstrated in contact-inhibited G0 growth arrested nontransformed human MCF-10A MECs and in mouse HC11 MECs. The results demonstrate consistent activation and downstream function of C/EBPdelta in growth arrested

  20. Appressorium formation in the corn smut fungus Ustilago maydis requires a G2 cell cycle arrest. (United States)

    Castanheira, Sónia; Pérez-Martín, José


    Many of the most important plant diseases are caused by fungal pathogens that form specialized cell structures to breach the leaf surface as well as to proliferate inside the plant. To initiate pathogenic development, the fungus responds to a set of inductive cues. Some of them are of extracellular nature (environmental signals) while others respond to intracellular conditions (developmental signals). These signals have to be integrated into a single response that has as a major outcome changes in the morphogenesis of the fungus. The cell cycle regulation is pivotal during these cellular differentiations, and we hypothesized that cell cycle regulation would be likely to provide control points for infection development by fungal pathogens. Although efforts have been done in various fungal systems, there is still limited information available regarding the relationship of these processes with the induction of the virulence programs. Hence, the role of fungal cell cycle regulators -which are wide conserved elements- as true virulence factors, has yet to be defined. Here we discuss the recent finding that the formation of the appressorium, a structure required for plant penetration, in the corn smut fungus Ustilago maydis seems to be incompatible with an active cell cycle and, therefore genetic circuits evolved in this fungus to arrest the cell cycle during the growth of this fungus on plant surface, before the appressorium-mediated penetration into the plant tissue.

  1. 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 (MAD) 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.

  2. 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)

  3. A comparative study of educational provision for children with neurogenetic syndromes: parent and teacher survey. (United States)

    Reilly, C; Senior, J; Murtagh, L


    A number of neurogenetic syndromes have a high association with special educational needs including fragile X syndrome (FXS), Prader-Willi syndrome (PWS), Williams syndrome (WS) and Velo-Cardio-Facial syndrome (VCFS). There is a paucity of research on educational provision for children affected by these syndromes. Parents (n = 381) and teachers (n = 204) of school-aged children with one of the four syndromes in the UK and Ireland were surveyed in a range of areas concerning the child's educational provision. Areas surveyed included school placement, views on the needs of children with the syndromes, desired changes to current provision and perceived teacher knowledge. School placement in mainstream settings decreased with age in all of the syndromes. Males with the syndromes were more likely to be in specialised educational settings with the exception of WS. Teachers reported limited input on initial or subsequent training for all of the syndromes. The majority of teachers did not view the needs of children with syndromes as different from other children with intellectual disability (ID) although there were significant differences between the syndromes. Changes deemed necessary to provision by parents and teachers differed between the syndromes indicating the existence of perceptions of syndrome specific needs. The lowest perceived level of teacher knowledge was in the VCFS group. The majority of teachers of children with neurogenetic syndromes report limited knowledge of the syndromes, but also a lack of belief that the children's needs are different from the majority of children with ID. Differences between the syndromes in some areas of provision suggest that a child's syndrome does impact on educational provision in some areas. © 2015 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons Ltd.

  4. Assessment of utilization of maternal health care provisions in ...

    African Journals Online (AJOL)

    Health services provisions are crucial aspects of everyone's well-being especially pregnant women who are most often, denied access to maternal health care provisions. Previous studies on maternal health care focused mainly on economic factors as the main reason for poor utilization of maternal health care provisions ...

  5. 7 CFR 457.151 - Forage seeding crop insurance provisions. (United States)


    ... 7 Agriculture 6 2010-01-01 2010-01-01 false Forage seeding crop insurance provisions. 457.151... INSURANCE CORPORATION, DEPARTMENT OF AGRICULTURE COMMON CROP INSURANCE REGULATIONS § 457.151 Forage seeding crop insurance provisions. The Forage Seeding Crop Insurance Provisions for 2003 and succeeding crop...

  6. 28 CFR 9.8 - Provisions applicable to victims. (United States)


    ... 28 Judicial Administration 1 2010-07-01 2010-07-01 false Provisions applicable to victims. 9.8... MITIGATION OF CIVIL AND CRIMINAL FORFEITURES § 9.8 Provisions applicable to victims. The provisions of this section apply to victims of an offense underlying the forfeiture of property, or of a related offense, who...

  7. 29 CFR 452.8 - Trusteeship provisions, title III. (United States)


    ... 29 Labor 2 2010-07-01 2010-07-01 false Trusteeship provisions, title III. 452.8 Section 452.8... AND DISCLOSURE ACT OF 1959 Other Provisions of the Act Affecting Title IV § 452.8 Trusteeship provisions, title III. Placing a labor organization under trusteeship consistent with title III, may have the...

  8. 24 CFR 107.25 - Provisions in legal instruments. (United States)


    ... 24 Housing and Urban Development 1 2010-04-01 2010-04-01 false Provisions in legal instruments. 107.25 Section 107.25 Housing and Urban Development Regulations Relating to Housing and Urban... Provisions in legal instruments. (a) The following documents shall contain provisions or statements requiring...

  9. 26 CFR 1.818-2 - Accounting provisions. (United States)


    ... 26 Internal Revenue 8 2010-04-01 2010-04-01 false Accounting provisions. 1.818-2 Section 1.818-2...) INCOME TAXES Miscellaneous Provisions § 1.818-2 Accounting provisions. (a) Method of accounting. (1... accounting. Thus, the over-all method of accounting for life insurance companies shall be the accrual method...

  10. 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…

  11. Arrested Development of Audiovisual Speech Perception in Autism Spectrum Disorders (United States)

    Stevenson, Ryan A.; Siemann, Justin K.; Woynaroski, Tiffany G.; Schneider, Brittany C.; Eberly, Haley E.; Camarata, Stephen M.; Wallace, Mark T.


    Atypical communicative abilities are a core marker of Autism Spectrum Disorders (ASD). A number of studies have shown that, in addition to auditory comprehension differences, individuals with autism frequently show atypical responses to audiovisual speech, suggesting a multisensory contribution to these communicative differences from their typically developing peers. To shed light on possible differences in the maturation of audiovisual speech integration, we tested younger (ages 6-12) and older (ages 13-18) children with and without ASD on a task indexing such multisensory integration. To do this, we used the McGurk effect, in which the pairing of incongruent auditory and visual speech tokens typically results in the perception of a fused percept distinct from the auditory and visual signals, indicative of active integration of the two channels conveying speech information. Whereas little difference was seen in audiovisual speech processing (i.e., reports of McGurk fusion) between the younger ASD and TD groups, there was a significant difference at the older ages. While TD controls exhibited an increased rate of fusion (i.e., integration) with age, children with ASD failed to show this increase. These data suggest arrested development of audiovisual speech integration in ASD. The results are discussed in light of the extant literature and necessary next steps in research. PMID:24218241

  12. Bispectral index monitoring is useless during cardiac arrest patients' resuscitation. (United States)

    Chollet-Xémard, Charlotte; Combes, Xavier; Soupizet, François; Jabre, Patricia; Penet, Candice; Bertrand, Catherine; Margenet, Alain; Marty, Jean


    It has been suggested that out-of-hospital bispectral (BIS) index monitoring during advanced cardiac life support (ACLS) might provide an indication of cerebral resuscitation. The aims of our study were to establish whether BIS values during ACLS might predict return to spontaneous circulation, and whether BIS values on hospital admission might predict survival. This was a prospective observational study in 92 patients with cardiac arrest who received basic life support from a fire-fighter squad and ACLS on arrival of an emergency medical team on the scene. BIS values, electromyographic activity, and signal quality index were recorded throughout resuscitation and out-of-hospital management. Seven patients had recovered spontaneous cardiac activity by the time the medical team arrived on scene. Of the 92 patients, 62 patients died on scene and 30 patients returned to spontaneous cardiac activity and were admitted to hospital. The correlation between BIS values and end-tidal CO(2) during the first minutes of ACLS was poor (r(2)=0.02, P=0.19). Of the 30 admitted patients, 27 died. Three were discharged with no disabilities. There was no significant difference in BIS values on admission between the group of patients who died and the group who survived (P=0.78). Although BIS monitoring during resuscitation was not difficult, it did not predict return to spontaneous cardiac activity, nor survival after admission to intensive care. Its use to monitor cerebral function during ACLS is therefore pointless.

  13. Amiodarone and cardiac arrest: Systematic review and meta-analysis. (United States)

    Laina, Ageliki; Karlis, George; Liakos, Aris; Georgiopoulos, Georgios; Oikonomou, Dimitrios; Kouskouni, Evangelia; Chalkias, Athanasios; Xanthos, Theodoros


    The 2015 Guidelines for Resuscitation recommend amiodarone as the antiarrhythmic drug of choice in the treatment of resistant ventricular fibrillation or pulseless ventricular tachycardia. We reviewed the effects of amiodarone on survival and neurological outcome after cardiac arrest. We systematically searched MEDLINE and Cochrane Library from 1940 to March 2016 without language restrictions. Randomized control trials (RCTs) and observational studies were selected. Our search initially identified 1663 studies, 1458 from MEDLINE and 205 from Cochrane Library. Of them, 4 randomized controlled studies and 6 observational studies met the inclusion criteria and were selected for further review. Three randomized studies were included in the meta-analysis. Amiodarone significantly improves survival to hospital admission (OR=1.402, 95% CI: 1.068-1.840, Z=2.43, P=0.015), but neither survival to hospital discharge (RR=0.850, 95% CI: 0.631-1.144, Z=1.07, P=0.284) nor neurological outcome compared to placebo or nifekalant (OR=1.114, 95% CI: 0.923-1.345, Z=1.12, P=0.475). Amiodarone significantly improves survival to hospital admission. However there is no benefit of amiodarone in survival to discharge or neurological outcomes compared to placebo or other antiarrhythmics. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  14. Dexmedetomidine Related Bradycardia Leading to Cardiac Arrest in a Dog

    Directory of Open Access Journals (Sweden)

    C. Y. Chen2, K-S. Chen1,2, K. M. Chang2, W. M. Lee1,2, S. C. Chang1,2 and H. C. Wang1,2


    Full Text Available A 2-year-old, mixed breed female dog (16 kg underwent an exploratory laparotomy following ultrasonographic diagnosis of foreign body and a segment of small intestine intussusceptions. The patient was classified as an ASA II. Ketamine (1mg/kg, IV, and dexmedetomidine (2.5 µg/kg, IV, and morphine (0.6 mg/kg, SC were given as anesthetic premedication. Propofol (0.1 mg/kg, IV titrated to a total amount of 4 ml (2.5 mg/ kg was given for intubation. Asystole was occurred. Cardiac resuscitation was then conducted immediately. Atipamezole (0.1 ml was injected, but showed no response on ECG. Atropine (0.02 mg/kg was then injected, and a second dosage was given. Two-three mins later, the heart rate at 84 beats/min. The NIBP showed 203/132 with MAP 153 mmHg, and the SpO2 showed 95% after the cardiac function was regained. Dexmedetomidine related bradycardia leading to cardiac arrest has been suggested in this case.

  15. Horizontal fall arrest systems: rigid systems vs. flexible line systems. (United States)

    Lough, David


    There are many types of flexible and rigid systems on the market, both permanent and temporary. This article does not mean to encompass all possible systems or hazards and only intends to give an outline of what at a minimum should be examined to make an educated purchasing decision. In many instances, the buyer will use the same type of horizontal system for all situations. This is a good idea in some cases because it will reduce the need for training on a number of different systems, reduce system compatibility issues, and may reduce costs for installation, supply, and maintenance. This may not be the best idea if the hazard areas differ a great deal; as we have illustrated, one system may not function for all areas and tasks. The rigid system is typically the best solution simply based on the fact the worker won't fall as far as when he is connected to a flexible system, because of the elimination of any dynamic sag and horizontal energy absorber deployment. In any case, where you stop the worker from falling farther, you decrease the chance there may be an incident where the worker is injured. From a cost standpoint, flexible fall arrest systems typically are cheapest. In the end, safety professionals must balance the cost and effectiveness of the system to prevent an injury.

  16. The best timing for defibrillation in shockable cardiac arrest. (United States)

    Scapigliati, A; Ristagno, G; Cavaliere, F


    High quality cardiopulmonary resuscitation (CPR, i.e. chest compressions and ventilations) and prompt defibrillation when appropriate (i.e. in ventricular fibrillation and pulseless ventricular tachycardia, VF/VT) are currently the best early treatment for cardiac arrest (CA). In cases of prolonged CA due to shockable rhythms, it is reasonable to presume that a period of CPR before defibrillation could partially revert the metabolic and hemodynamic deteriorations imposed to the heart by the no flow state, thus increasing the chances of successful defibrillation. Despite supporting early evidences in CA cases in which Emergency Medical System response time was longer than 5 minutes, recent studies have failed to confirm a survival benefit of routine CPR before defibrillation. These data have imposed a change in guidelines from 2005 to 2010. To take in account all the variables encountered when treating CA (heart condition before CA, time elapsed, metabolic and hemodynamic changes, efficacy of CPR, responsiveness to defibrillation attempt), it would be very helpful to have a real-time and non invasive tool able to predict the chances of defibrillation success. Recent evidences have suggested that ECG waveform analysis of VF, such as the derived Amplitude Spectrum Area, can fit the purpose of monitoring the CPR effectiveness and predicting the responsiveness to defibrillation. While awaiting clinical studies confirming this promising approach, CPR performed according to high quality standard and with minimal interruptions together with early defibrillation are the best immediate way to achieve resuscitation in CA due to shochable rhythms..

  17. Variability of Post-Cardiac Arrest Care Practices Among Cardiac Arrest Centers: United States and South Korean Dual Network Survey of Emergency Physician Research Principal Investigators. (United States)

    Coppler, Patrick J; Sawyer, Kelly N; Youn, Chun Song; Choi, Seung Pill; Park, Kyu Nam; Kim, Young-Min; Reynolds, Joshua C; Gaieski, David F; Lee, Byung Kook; Oh, Joo Suk; Kim, Won Young; Moon, Hyung Jun; Abella, Benjamin S; Elmer, Jonathan; Callaway, Clifton W; Rittenberger, Jon C


    There is little consensus regarding many post-cardiac arrest care parameters. Variability in such practices could confound the results and generalizability of post-arrest care research. We sought to characterize the variability in post-cardiac arrest care practice in Korea and the United States. A 54-question survey was sent to investigators participating in one of two research groups in South Korea (Korean Hypothermia Network [KORHN]) and the United States (National Post-Arrest Research Consortium [NPARC]). Single investigators from each site were surveyed (N = 40). Participants answered questions based on local institutional protocols and practice. We calculated descriptive statistics for all variables. Forty surveys were completed during the study period with 30 having greater than 50% of questions completed (75% response rate; 24 KORHN and 6 NPARC). Most centers target either 33°C (N = 16) or vary the target based on patient characteristics (N = 13). Both bolus and continuous infusion dosing of sedation are employed. No single indication was unanimous for cardiac catheterization. Only six investigators reported having an institutional protocol for withdrawal of life-sustaining therapy (WLST). US patients with poor neurological prognosis tended to have WLST with subsequent expiration (N = 5), whereas Korean patients are transferred to a secondary care facility (N = 19). Both electroencephalography modality and duration vary between institutions. Serum biomarkers are commonly employed by Korean, but not US centers. We found significant variability in post-cardiac arrest care practices among US and Korean medical centers. These practice variations must be taken into account in future studies of post-arrest care.

  18. Survival and Neurologic Outcome After Out-of-hospital Cardiac Arrest. Results of the Andalusian Out-of-hospital Cardiopulmonary Arrest Registry. (United States)

    Rosell Ortiz, Fernando; Mellado Vergel, Francisco; López Messa, Juan Bautista; Fernández Valle, Patricia; Ruiz Montero, María M; Martínez Lara, Manuela; Vergara Pérez, Santiago; Vivar Díaz, Itziar; Caballero García, Auxiliadora; García Alcántara, Ángel; García Del Águila, Javier


    There is a paucity of data on prehospital cardiac arrest in Spain. Our aim was to describe the incidence, patient characteristics, and outcomes of out-of-hospital emergency care for this event. We conducted a retrospective analysis of a prospective registry of cardiopulmonary arrest handled by an out-of-hospital emergency service between January 2008 and December 2012. The registry included all patients considered to have a cardiac etiology as the cause of arrest, with a descriptive analysis performed of general patient characteristics and factors associated with good neurologic outcome at hospital discharge. A total of 4072 patients were included, with an estimated incidence of 14.6 events per 100000 inhabitants and year; 72.6% were men. The mean age was 62.0 ± 15.8 years, 58.6% of cases occurred in the home, 25% of patients had initial defibrillable rhythm, 28.8% of patients arrived with a pulse at the hospital (58.3% of the group with defibrillable rhythm), and 10.2% were discharged with good neurologic outcome. The variables associated with this recovery were: witnessed arrest (P=.04), arrest witnessed by emergency team (P=.005), previous life support (P=.04), initial defibrillable rhythm (P=.0001), and performance of a coronary interventional procedure (P=.0001). More than half the cases of sudden cardiac arrest occur at home, and the population was found to be relatively young. Although recovery was satisfactory in 1 out of every 10 patients, there is a need for improvement in the phase prior to emergency team arrival. Coronary interventional procedures had an impact on patient prognosis. Copyright © 2015 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

  19. 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

  20. Effect of a pharmacologically induced decrease in core temperature in rats resuscitated from cardiac arrest (United States)

    Targeted temperature management is recommended to reduce brain damage after resuscitation from cardiac arrest in humans although the optimal target temperature remains controversial. 1 4 The American Heart Association (AHA) and the International Liaison Committee on Resuscitation...