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Atrial fibrillation (AFIB) with rapid ventricular response (RVR) is a common tachydysrhythmia encountered by Emergency Medical Services (EMS). Current guidelines suggest rate control in stable, symptomatic patients.
Little is known about the safety or efficacy of rate-controlling medications given by prehospital providers. This study assessed a protocol for prehospital administration of diltiazem in the setting of AFIB with RVR for provider protocol compliance, patient clinical improvement, and associated adverse events.
This was a retrospective, cohort study of patients who were administered diltiazem by providers in the Orange County EMS System (Florida USA) over a two-year period. The protocol directed a 0.25mg/kg dose of diltiazem (maximum of 20mg) for stable, symptomatic patients in AFIB with RVR at a rate of >150 beats per minute (bpm) with a narrow complex. Data collected included patient characteristics, vital signs, electrocardiogram (ECG) rhythm before and after diltiazem, and need for rescue or additional medications. Adverse events were defined as systolic blood pressure <90mmHg or administration of intravenous fluid after diltiazem administration. Clinical improvement was defined as a heart rate decreased by 20% or less than 100bmp. Original prehospital ECG rhythm interpretations were compared to physician interpretations performed retrospectively.
Over the study period, 197 patients received diltiazem, with 131 adhering to the protocol. The initial rhythm was AFIB with RVR in 93% of the patients (five percent atrial flutter, two percent supraventricular tachycardia, and one percent sinus tachycardia). The agreement between prehospital and physician rhythm interpretation was 92%, with a Kappa value of 0.454 (P <.001). Overall, there were 22 (11%) adverse events, and 112 (57%) patients showed clinical improvement. When diltiazem was given outside of the existing protocol, the patients had higher rates of adverse events (18% versus eight percent; P = .033). Patients who received diltiazem in adherence with protocols were more likely to show clinical improvement (63% versus 46%; P = .031).
This study suggests that prehospital diltiazem administration for AFIB with RVR is safe and effective when strict protocols are followed.
Rodriguez A, Hunter CL, Premuroso C, Silvestri S, Stone A, Miller S, Zuver C, Papa L. Safety and efficacy of prehospital diltiazem for atrial fibrillation with rapid ventricular response. Prehosp Disaster Med. 2019;34(3):297–302.
The human animal type melanoma (ATM) is a rare subtype of melanoma characterised by the proliferation of pigmented dermal epithelioid and spindled melanocytes. However, this variant of melanoma is still lacking a precise nosography definition and classification for the difficulty to be distinguished from other more common melanocytic lesions, as well as for its peculiar biological behaviour. On the other hand, the contribution of scientific literature to this issue is fragmented and limited to the description of very few cases. Starting from the presentation of a case with abnormally aggressive clinical features, here we revisit the current knowledge on ATM from its dermatologic patterns, epidemiology, demography and histopathology to the clinical management. Peculiar accuracy has also been reserved to several histopathologic criteria, which are critical for the differential diagnosis from other melanocytic diseases in junction with molecular data deriving from recent cytogenetic and mutational characterisation of this tumour.
This paper presents a technique to increase the bandwidth in substrate integrated waveguide (SIW) cavity-backed antennas, inspired by the design of cavity filters. The proposed structure consists of a slot antenna backed by two cavities, located one on top of the other and coupled through a slot. To demonstrate the bandwidth increase, a standard cavity-backed SIW antenna, with a rectangular slot etched in the top metal plane, has been designed, manufactured, and measured. Subsequently, a similar antenna was developed, by doubling the substrate thickness with the aim to improve the bandwidth. Finally, the new topology of two-cavity SIW antenna has been implemented and compared with the two previous ones. Simulation and experimental results show that the proposed two-cavity antenna exhibits a bandwidth twice as large as the standard SIW cavity-backed antenna.
The present work consists of an investigation of the turbulence radiation interaction (TRI) in a radiative turbulent channel flow of grey gas bounded by isothermal hot and cold walls. The optical thickness
of the channel is varied from 0.1 to 10 to observe different regimes of TRI. A high-resolution finite volume method for radiative heat transfer is employed and coupled with the direct numerical simulation (DNS) of the flow. The resulting effects of TRI on temperature statistics are strongly dependent on the considered optical depth. In particular, the contrasting role of emission and absorption is highlighted. For a low optical thickness the effect of radiative fluctuations on temperature statistics is low and causes the reduction of temperature variance through the dissipating action of emission. On the other hand, while increasing optical thickness to relatively high levels, the dissipation of temperature variance is balanced, at low wavenumbers in the turbulence spectrum, through the preferential action of absorption, which increases the large-scale temperature fluctuations. A significant rise in the effect of radiation on the temperature variance can be observed as a consequence of the reduction of radiative heat transfer length scales.
Microstructural and morphological features of the layers forming integrated PTB7/PC71BM organic solar cells with Ca/Al cathode are studied. The effects of vacuum treatment on properties and durability were addressed using complementary approaches: time-resolved experiments revealing the structural evolution of the active layers under illumination were conducted combining the in situ energy dispersive X-ray diffraction (EDXD) technique with atomic force microscopy (AFM); space-resolved characterization of the integrated devices was possible via high resolution X-ray diffraction, using a nano-focused synchrotron radiation X-ray beam to discriminate the device components. Active layers surface morphology is stable under illumination and PC71BM structural properties remain unaltered. PTB7 undergoes crystallinity depletion, mainly at the active layer/cathode interface. This effect is actually inhibited in the device submitted to vacuum treatment, proving that this procedure induces stabilization at the cathode’s buried interface, as verified by fourier transform infrared (FTIR) spectroscopy. Importantly, the protective role of the vacuum treatment results in a significant photovoltaic durability enhancement.
This paper briefly describes the principle of operation and science goals of the AMANDA high energy neutrino telescope located at the South Pole, Antarctica. Results from an earlier phase of the telescope, called AMANDA-BIO, demonstrate both reliable operation and the broad astrophysical reach of this device, which includes searches for a variety of sources of ultrahigh energy neutrinos: generic point sources, Gamma-Ray Bursts and diffuse sources. The predicted sensitivity and angular resolution of the telescope were confirmed by studies of atmospheric muon and neutrino backgrounds. We also report on the status of the analysis from AMANDA-II, a larger version with far greater capabilities. At this stage of analysis, details of the ice properties and other systematic uncertainties of the AMANDA-II telescope are under study, but we have made progress toward critical science objectives. In particular, we present the first preliminary flux limits from AMANDA-II on the search for continuous emission from astrophysical point sources, and report on the search for correlated neutrino emission from Gamma Ray Bursts detected by BATSE before decommissioning in May 2000. During the next two years, we expect to exploit the full potential of AMANDA-II with the installation of a new data acquisition system that records full waveforms from the in-ice optical sensors.
This paper presents a new class of quasi-elliptic pass-band filters in substrate-integrated waveguide technology, which exhibits compact size and modular geometry. These filters are based on mushroom-shaped metallic resonators, and they can be easily implemented using a standard dual-layer printed circuit board manufacturing process. The presented filters exploit non-resonating modes to obtain coupling between non-adjacent nodes in the case of in-line geometry. The resulting structure is very compact and capable of transmission zeros. In this work, the singlet configuration is preliminarily investigated, and a parametric study is performed. The design of three-pole, four-pole, and higher-order filters is illustrated with examples and thoroughly discussed. A four-pole filter operating at the frequency of 4 GHz has been manufactured and experimentally verified, to validate the proposed technique.
FUNDAMENTAL AND OTHER PRINCIPLES OF EVIDENCE IN CIVIL LITIGATION
E. Silvestri, Associate Professor of Civil Procedure and Comparative Civil Procedure; Scientific Director of the postgraduate program on Mediation and ADR, Department of Law, University of Pavia (Italy)
The idea of addressing the topic of the impact of language differences on litigation was prompted by the reading of the essays collected in a special issue of Erasmus Law Review under the heading ‘Law and Language: Implication for Harmonization and Cross-Border Litigation’. These essays helped me frame some thoughts on the problems that may arise when the dramatis personae of a judicial proceeding do not share the same native language.
Language differences can affect litigation in many ways, and most of all in transnational cases or, to use the preferred expression in the EU context, in crossborder cases. Cross-border litigation implies that at least one party to a case will have to litigate in a foreign language, since the rule is that the court language is the official language of the forum state. Whenever international rules on jurisdiction allow the plaintiff to do some forum shopping, they also allow him to engage in language shopping. Therefore, often the defendant is the one who is faced with language obstacles. It is clear that these obstacles must not harm his right to a fair trial, nor must they contribute to delaying the proceedings.
Language differences may arise at the very beginning of a case (just think of the problems brought about by service of process), but in this contribution I would like to make some remarks on the impact of language differences at the evidencetaking level, that is, with reference to the documents that are produced as evidence, and to oral evidence, namely, witness testimony or the interrogation of the party himself, as regards the legal systems – such as the Italian system – in which the parties cannot be heard as witnesses, but are subject to a particular form of examination that in Italy is qualified as ‘formal interrogatory’.
The Protection of Language Rights
The problem of language differences and their impact on litigation and on the rights of the parties can be dealt with from different angles. One is to see the problem within the framework of so-called language rights. Scholars have emphasized that ‘the concept of language rights is in an embryonic stage only’, and, as a matter of fact, it is difficult to offer a clear definition of what is meant exactly by ‘language rights’, if one steps back from the perspective in which they are often analysed, namely, the protection of minority languages.
Although addictive syndromes have been traditionally related to substance-use disorders, during the last few decades a novel addictive group, including the so-called “behavioral or no-drug addictions,” has been recognized and has attracted increasing attention for its relevant social impact. This group includes pathological gambling, compulsive shopping, TV/Internet/social network/videogame addictions, workaholism, sex and relationship addictions, orthorexia, and overtraining syndrome. Substance and behavioral addictions show similar phenomenological features, such as craving, dependence, tolerance, and abstinence, and perhaps they share a common possible pathophysiology. It is, however, controversial whether all or at least some of them should be considered real disorders or just normal, albeit extreme, behaviors. The aim of this article is to review current data on pharmacological treatment of behavioral addictions. As no specific and validated treatment algorithms are currently available, only an improved knowledge on their psychopathological, clinical, and neurobiological features may have relevant implications for more focused preventive and therapeutic strategies.
Mobility data are inherently uncertain due to several contributing factors related to different phases of their life cycle, from acquisition to interpretation. When data are processed, uncertainty propagates to intermediate and final results. Thus, it is important to be aware of uncertainty in trajectory data and explicitly account for it in their modeling and managing. For example, consider a simple scenario where people move around a city and disclose their positions twice an hour; to avoid stalking, the disclosed position is randomly selected from inside a circle with a radius of one kilometer, which contains the position of the user. Not being aware of uncertainty could lead to inconsistent conclusions. For instance, we could erroneously assume that a group of people have met or that someone has visited a privacy-sensitive place. On the contrary, taking uncertainty into account, we can avoid such erroneous conclusions; for example, if someone was farther than one kilometer from the place of an accident, we can certainly assume that this person was not involved in that accident.
We next introduce a well-known taxonomy of uncertainty (see Bibliographic Notes section), aimed at clearly defining terms that are often given multiple meanings in the literature.
A Taxonomy of Uncertainty
The taxonomy we present here considers, at the highest abstraction level, that uncertainty in mobility and geographic information is caused by the complexity of the system conformed by three kinds of entities: human being, earth (i.e., geographic/moving), and computing machinery.
Livestock play a significant role in rural livelihoods and the economies of developing countries. They are providers of income and employment for producers and others working in, sometimes complex, value chains. They are a crucial asset and safety net for the poor, especially for women and pastoralist groups, and they provide an important source of nourishment for billions of rural and urban households. These socio-economic roles and others are increasing in importance as the sector grows because of increasing human populations, incomes and urbanisation rates. To provide these benefits, the sector uses a significant amount of land, water, biomass and other resources and emits a considerable quantity of greenhouse gases. There is concern on how to manage the sector's growth, so that these benefits can be attained at a lower environmental cost. Livestock and environment interactions in developing countries can be both positive and negative. On the one hand, manures from ruminant systems can be a valuable source of nutrients for smallholder crops, whereas in more industrial systems, or where there are large concentrations of animals, they can pollute water sources. On the other hand, ruminant systems in developing countries can be considered relatively resource-use inefficient. Because of the high yield gaps in most of these production systems, increasing the efficiency of the livestock sector through sustainable intensification practices presents a real opportunity where research and development can contribute to provide more sustainable solutions. In order to achieve this, it is necessary that production systems become market-orientated, better regulated in cases, and socially acceptable so that the right mix of incentives exists for the systems to intensify. Managing the required intensification and the shifts to new value chains is also essential to avoid a potential increase in zoonotic, food-borne and other diseases. New diversification options and improved safety nets will also be essential when intensification is not the primary avenue for developing the livestock sector. These processes will need to be supported by agile and effective public and private institutions.
The recent collection of four specimens of the royal spiny lobster Panulirus regius in the eastern part of the Ligurian Sea (Italy) is reported. Earlier records of this eastern Atlantic species along the coasts of the western Mediterranean Sea are revised and the possible ways of introduction are discussed.
The rise in the frequency of detecting prednisolone in bovine urine from northern Italy has come into focus of attention in recent years. The possibility that neo-formation of prednisolone or that prednisone may occur in urine after collection of samples was therefore investigated. Cow urine collected for official routine controls in Lombardy containing more than 80 ng/ml cortisol, and prednisolone and prednisone below the decision limit (CCα) of the method (0.4 and 0.5 ng/ml, respectively) was used. The C1–2 dehydrogenation of naturally present cortisol and cortisone was checked by incubating urine, both contaminated and uncontaminated with faeces, at 37°C and by collecting samples at 0, 1, 2, 4, 6 and 24 h. The influence of Helix pomatia juice was also investigated in order to determine whether deconjugation could influence the reliability of the results. All samples were analysed by HPLC-MS3 for the presence of cortisol, cortisone, prednisolone and prednisone in negative electrospray ionisation mode, utilising the consecutive reaction monitoring of product ions derived from the formate molecular adduct ([M+HCOO]–). The observed neo-formation of prednisolone shows that inappropriate temperatures in sample storage and processing can result in an incorrect accusation of non-compliance. The faecal contamination of urine, performed with the aim to mimic a collection conducted without the necessary care, moreover, evoked a high increase in prednisolone concentration in two out of seven animals. Moreover, H. pomatia juice had no significant effect on the prednisolone concentration, indicating that this corticosteroid is present in its free form in cow urine.
APPLICATION OF PROTEOMICS AND NANOTECHNOLOGY TO CANCER BIOMARKER DISCOVERY: CLINICAL NEED VERSUS PHYSIOLOGIC ROADBLOCKS
Proteomics Has Potential to Address Need for Specific Cancer Biomarkers
Cancer is too often diagnosed and treated too late, when the tumor cells have already invaded and metastasized. At this stage, therapeutic modalities are limited in their success. Detecting cancers at their earliest stages, even in the premalignant state, means that current or future treatment modalities might have a higher likelihood of a true cure. For example, ovarian cancer is usually treated at an advanced stage. The resulting five-year survival rate is 35 percent to 40 percent for patients with late-stage disease who receive the best possible surgical and chemotherapeutic intervention. In contrast, if ovarian cancer is detected at an early stage, conventional therapy produces a high rate of five-year survival (95%) . Thus, early detection, by itself, could have a profound effect on the successful treatment of this disease. A clinically useful biomarker for early cancer detection should be measurable in a readily accessible body fluid, such as serum , urine , or saliva . Clinical proteomic methods are especially well suited to discovering such biomarkers . Serum or plasma has been the preferred medium for discovery, because this fluid is a protein-rich information reservoir that contains the traces of what has been encountered by the blood during its constant perfusion and percolation throughout the tissues .
The intramolecular photoinduced energy and electron transfer within a fullereneoligothiophene-fullerene triad with nine thiophene units (C60-9T-C60) and an oligo(p-phenylene vinylene)-fullerene dyad with four phenyl groups (OPV4-C60) is investigated with femtosecond pump-probe spectroscopy with sub-10 fs and 200 fs time resolution in solvents of different polarity. Photoexcitation of the π-conjugated oligomer moiety in the triad and dyad results in an ultrafast singlet-energy transfer reaction to create the fullerene singlet-excited state with a time constant of 150-190 fs, irrespective of the polarity of the medium. In a polar solvent, intramolecular electron transfer occurs from the oligomer moiety to the C60 moiety with a time constant of 10-13 ps as a secondary reaction, subsequent to the ultrafast singlet-energy transfer. The charge-separated state has a lifetime of 50-80 ps and recombines to the ground state.
We present experimental results of impurity and self-diffusion in an isotopically controlled silicon heterostructure extrinsically doped with phosphorus. As a consequence of extrinsic doping, the concentration of singly negatively charged native defects is enhanced and the role of these native defect charge states in the simultaneous phosphorus and Si self-diffusion can be determined. Multilayers of isotopically controlled 28Si and natural silicon enable simultaneous analysis of 30Si self-diffusion into the 28Si enriched layers and phosphorus diffusion throughout the multilayer structure. An amorphous 260 nm thick Si cap layer was deposited on top of the Si isotope heterostructure. The phosphorus ions were implanted to a depth such that all the radiation damage resided inside this amorphous cap layer, preventing the generation of excess native defects and enabling the determination of the Si self-diffusion coefficient and the phosphorus diffusivity under equilibrium conditions. These samples were annealed at temperatures between 950 and 1100°C to study the diffusion. Detailed analysis of the diffusion process was performed on the basis of a P diffusion model which involves neutral and positively charged mobile P species and neutral and singly negatively charged self-interstitial.