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Introduction: Despite significant advances in resuscitation efforts, there are some patients who remain in ventricular fibrillation (VF) after multiple shocks during out-of-hospital cardiac arrest (OHCA). Double sequential external defibrillation (DSED) has been proposed as a treatment option for patients in shock refractory VF. We sought to compare DSED to standard therapy with regards to VF termination and return of spontaneous circulation (ROSC) for patients presenting in shock refractory VF. Methods: We performed a retrospective review of all treated adult OHCA who presented in VF and received a minimum of three successive shocks over a two year period beginning on Jan 1, 2015 in four Canadian EMS agencies. Using ambulance call reports and defibrillator files, we compared VF termination (defined as the absence of VF at the rhythm check following defibrillation and 2 minutes of CPR) and VF termination into a perfusing rhythm with ROSC between patients who received standard therapy (CPR, defibrillation, epinephrine and antiarrhythmics) and those who received DSED (after on-line medical consultation) for shock refractory VF. Cases of traumatic cardiac arrest and those who presented in VF but terminated VF prior to 3 successive shocks were excluded. Results: Among 197 patients who met the study criteria for shock refractory VF, 161 (81.7%) patients received standard therapy and 36 (18.3%) received DSED. For the primary outcome, VF termination was significantly higher for DSED compared to standard therapy (63.9% vs 18.0%; Δ45.9%; 95% CI: 28.3 to 60.5). For the secondary outcome of VF termination into ROSC, DSED was associated with significantly higher ROSC compared to standard care (33.3% vs 13%; Δ20.3%; 95% CI:13.0 to 33.3). The median (IQR) number of failed standard shocks prior to DSED was 8 (6, 10). When DSED terminated VF, it did so with a single DSED shock in 69.6% of cases. Conclusion: Our observational findings suggest improved VF termination and ROSC are associated with DSED compared to standard therapy for shock refractory VF. An appropriately powered randomized controlled trial is required to assess the impact of DSED on patient-important outcomes.
Thin films containing periodic chemical or strain modulation (e.g. artificial superlattices or SL) are often characterized nondestructively by X-ray double-axis diffractometry. The satellite peaks from the modulated structure allow analysis of layer structure, elemental concentration and strain profile. This paper focuses on the effect of layer uniformity on the rocking curves of (001) GaAs/AlxGa1-xAsSL. Double-axis diffractometry for results from MBE samples with 800 Å SL periods and x=0.35 are compared for GaAs/AlGaAs layer thicknesses of 350/450, 400/400 and 450/350 Å. Symmetric (004) and asymmetric (315) diffraction planes are used to measure parallel and perpendicular misfit strains, layer periodicity and aluminum concentration. A modified kinematical scattering model, correcting for absorption and extinction, is used to calculate the satellite peak intensities and spacings. The relative thicknesses of GaAs and AlGaAs and the aluminum elemental concentration are optimized by matching with experimental results. The effect of nonuniform layer thickness on SL peak intensities is also investigated. The experimental results, the modified kinematical scattering calculations and dynamical theory agree closely for the 3-4 /zm thickness layers studied.
Structural and functional properties of exoskeleton in moulting sea slaters Ligia pallasii from the Eastern Pacific coast were investigated with CT scanning and electron microscopy. Ultrastructure of preecdysial and postecdysial cuticular layers was described in premoult, intramoult and postmoult animals. Cuticle is a flexible extracellular matrix connected to the epidermal cells through pore channels. During premoult epicuticle and exocuticle are formed and during intramoult and postmoult endocuticular lamellae are deposited and the cuticle is progressively constructed by thickening and mineralization. Cuticle permeability, flexibility and waterproofing capacity change accordingly. Elaboration of epicuticular scales connected to an extensive network of nanotubules, establish its anti-adhesive and hydrophobic properties. Labelling with gold conjugated WGA lectins on Tokuyashu thawed cryosections exposes differences in chitin content between exocuticle and endocuticle. Histochemical staining of cuticle shows presence of acidic carbohydrates/glycoconjugates and lipoproteins in epicuticular layer. Chitin microfibrils are formed at the microvillar border of epidermal cells with abundant Golgi apparatus and secretory vesicles. Numerous spherules associated with nanotubules were observed in the ecdysial space in intramoult animals. The mineral component of the cuticle as visualized with CT scanning indicates progressive mineral resorption from the posterior to the anterior half of the body in premoult animals, its translocation from the anterior to posterior part during intramoult and its progressive deposition in the posterior and anterior exoskeleton during postmoult. Cuticle of sea slaters is a unique biocomposite and biodynamic material constantly reconstructed during frequent moults, and adapted to specific physical and biotic conditions of the high intertidal rocky zone.
While maternal folate deficiency has been linked to poor pregnancy outcomes such as neural tube defects, anaemia and low birth weight, the relationship between folate and preterm birth (PTB) in the context of the US post-folic acid fortification era is inconclusive. We sought to explore the relationship between maternal folate status and PTB and its subtypes, i.e. spontaneous and medically indicated PTB.
Boston Birth Cohort, a predominantly urban, low-income, race/ethnic minority population at a high risk for PTB.
Mother–infant dyads (n 7675) enrolled in the Boston Birth Cohort. A sub-sample (n 2313) of these dyads had maternal plasma folate samples collected 24–72 h after delivery.
Unadjusted and adjusted logistic regressions revealed an inverse relationship between the frequency of multivitamin supplement intake and PTB. Compared with less frequent use, multivitamin supplement intake 3–5 times/week (adjusted OR (aOR) = 0·78; 95 % CI 0·64, 0·96) or >5 times/week (aOR = 0·77; 95 % CI 0·64, 0·93) throughout pregnancy was associated with reduced risk of PTB. Consistently, higher plasma folate levels (highest v. lowest quartile) were associated with lower risk of PTB (aOR = 0·74; 95 % CI 0·56, 0·97). The above associations were similar among spontaneous and medically indicated PTB.
If confirmed by future studies, our findings raise the possibility that optimizing maternal folate levels across pregnancy may help to reduce the risk of PTB among the most vulnerable US population in the post-folic acid fortification era.
Giant electromagnetic pulses (EMP) generated during the interaction of high-power lasers with solid targets can seriously degrade electrical measurements and equipment. EMP emission is caused by the acceleration of hot electrons inside the target, which produce radiation across a wide band from DC to terahertz frequencies. Improved understanding and control of EMP is vital as we enter a new era of high repetition rate, high intensity lasers (e.g. the Extreme Light Infrastructure). We present recent data from the VULCAN laser facility that demonstrates how EMP can be readily and effectively reduced. Characterization of the EMP was achieved using B-dot and D-dot probes that took measurements for a range of different target and laser parameters. We demonstrate that target stalk geometry, material composition, geodesic path length and foil surface area can all play a significant role in the reduction of EMP. A combination of electromagnetic wave and 3D particle-in-cell simulations is used to inform our conclusions about the effects of stalk geometry on EMP, providing an opportunity for comparison with existing charge separation models.
Background: Previous research suggests that computerized interpretation bias modification (IBM) techniques may be useful for modifying thoughts and behaviours relevant to eating pathology; however, little is known about the utility of IBM for decreasing specific eating disorder (ED) symptoms (e.g. bulimia, drive for thinness). Aims: The current study sought to further examine the utility of IBM for ED symptoms via secondary analyses of an examination of IBM for individuals with elevated body dysmorphic disorder (BDD) symptoms (see Summers and Cougle, 2016), as these disorders are both characterized by threat interpretation biases of ambiguous appearance-related information. Method: We recruited 41 participants for a randomized trial comparing four sessions of IBM aimed at modifying problematic social and appearance-related threat interpretation biases with a placebo control training (PC). Results: At 1-week post-treatment, and relative to the PC, the IBM group reported greater reductions in negative/threat interpretations of ambiguous information in favour of positive/benign biases. Furthermore, among individuals with high pre-treatment bulimia symptoms, IBM yielded greater reductions in bulimia symptoms compared with PC at post-treatment. No treatment effects were observed on drive for thinness symptoms. Conclusions: The current study suggests that cognitive interventions for individuals with primary BDD symptoms may improve co-occurring ED symptoms such as bulimia.
Functional modeling is an effective method of depicting products in the design process. Using this approach, product architecture, concept generation, and physical modeling all contribute to the design process to generate a result full of quality and functionality. The functional basis approach provides taxonomy of uniform vocabulary to produce function structures with consistent functions (verbs) and flows (nouns). Material and energy flows dominate function structures in the mechanical engineering domain with only a small percentage including signal flows. Research suggests that the signal flow gap is due to the requirement of “carrier” flows of either material or energy to transport the signals between functions. This research suggests that incorporating controls engineering methodologies may increase the number of signal flows in function structures. We show correlations between the functional modeling and controls engineering in four facets: schematic similarities, performance matching through flows, mathematical function creation using bond graphs, and isomorphic matching of the aforementioned characteristics allows for analogical solutions. Controls systems use block diagrams to represent the sequential steps of the system. These block diagrams parallel the function structures of engineering design. Performance metrics between the two domains can be complimentary when decomposed down to nondimensional engineering units. Mathematical functions of the actions in controls systems can resemble the functional basis functions with bond graphs by identifying characteristic behavior of the functions on the flows. Isomorphic matching, using the schematic diagrams, produces analogies based upon similar functionality and target performance metrics. These four similarities bridge the mechanical and electrical domains via the controls domain. We provide concepts and contextualization for the methodology using domain-agnostic examples. We conclude with suggestion of pathways forward for this preliminary research.
Benchmarking function modeling and representation approaches requires a direct comparison, including the inferencing support by the different approaches. To this end, this paper explores the value of a representation by comparing the ability of a representation to support reasoning based on varying amounts of information stored in the representational components of a function structure: vocabulary, grammar, and topology. This is done by classifying the previously developed functional pruning rules into vocabulary, grammatical, and topological classes and applying them to function structures available from an external design repository. The original and pruned function structures of electromechanical devices are then evaluated for how accurately market values can be predicted using the graph complexity connectivity method. The accuracy is found to be inversely related to the amount of information and level of detail. Applying the topological rule does not significantly impact the predictive power of the models, while applying the vocabulary rules and the grammar rules reduces the accuracy of the predictions. Finally, the least predictive model set is that which had all rules applied. In this manner, the value of a representation to predict or answer questions is quantified.
Critical chains composed of critical flows and functions have been demonstrated as an effective qualitative analogy retrieval approach based on performance metrics. In prior work, engineers used expert knowledge to transform functional models into critical chain models, which are abstractions of the functional model. Automating this transformation process is highly desirable so as to provide for a robust transformation method. Within this paper, two paradigms for functional modeling abstraction are compared. A series of pruning rules provide an automated transformation approach, and this is compared to the results generated previously through an expert knowledge approach. These two approaches are evaluated against a set of published functional models. The similarity of the resulting transformation of the functional models into critical chain models is evaluated using a functional chain similarity metric, developed in previous work. Once critical chain models are identified, additional model evaluation criteria are used to evaluate the utility of the critical chain models for design analogy identification. Since the functional vocabulary acts as a common language among designers and engineers to abstract and represent critical design artifact information, analogous matching can be made about the functional vocabulary. Thus, the transformation of functional models into critical chain models enables engineers to use functional abstraction as a mechanism to identify design analogies. The critical flow rule is the most effective first step when automatically transforming a functional model to a critical chain model. Further research into more complex critical chain model architectures and the interactions between criteria is merited.
The current pilot study aimed to assess whether reporting quality would decline materially in adolescents completing weekly web-based Automated Self-Administered 24-Hour dietary recalls (ASA24-Kids-2014) and interviewer-administered 24 h dietary recalls for six weeks. We also aimed to assess method preference.
We conducted two studies. Study 1 (n 20) randomized participants to complete either one ASA24-Kids-2014 or one interviewer-administered recall weekly, for six weeks. Energy intake and number of foods reported were described for each method over time. Differences between recall methods for each measure were tested using mixed-effects regression. Study 2 (n 10) employed a randomized crossover design to describe method preference.
Dietary intake was collected either by telephone (interviewer-administered dietary recalls) or via the Internet (ASA24-Kids-2014 dietary recalls).
Adolescents aged 12–17 years with no prior diet recording experience were enrolled.
In Study 1, mean (sd) total energy and number of foods reported decreased by 50 (222) kJ (12 (53) kcal) and 0·05 (0·31) items v. 38 (138) kJ (9 (33) kcal) and 0·17 (0·14) items per recall for participants randomized to the ASA24-Kids-2014 v. interviewer-administered recalls, respectively. There was no difference between groups for either measure (P > 0·57). In Study 2, eight of ten participants preferred the interviewer-administered recall over the ASA24-Kids-2014. Overall, seven of twenty participants experienced technical difficulties with the ASA24-Kids-2014.
No appreciable decay in reporting quality was seen for either method. However, participants reported a preference for the interviewer-administered recall. Our findings can help inform and support larger studies to further characterize the performance of the ASA24 in adolescents.
Background: Disgust is thought to play a prominent role in multiple anxiety disorders and fears, including spider phobia, though little attention has been given to specific treatment strategies that may be effective for multiple disgust-based fears. Aims: In the present study, we evaluated contamination-focused exposure as a potential transdiagnostic treatment strategy for disgust-based fears in a spider fearful sample. Method: Women with significant spider fear were randomized to three 30-minute sessions of exposure therapy involving repeated contact with a dirt mixture (n=17) or a waitlist control condition (n=17). Assessments of spider fear and disgust were administered at baseline and at one-week posttreatment. Results: At high (but not low) levels of pretreatment disgust propensity, exposure led to lower in vivo spider fear and perceived danger than waitlist, though exposure had no effects on spider-related disgust. Similar effects of exposure on spider fear were found at high levels of pretreatment spider-related disgust. Exposure also reduced fear and danger perceptions, but not disgust, related to a separate contamination assessment (touching a toilet). No effects of treatment were found on self-report measures of spider fear or disgust propensity. Conclusions: These findings suggest contamination-focused exposure therapy may be an effective transdiagnostic treatment strategy for individuals with elevated disgust propensity. Limitations and directions for future research are discussed.
Delayed biotic recovery from the end-Permian mass extinction has long been interpreted to result from environmental inhibition. Recently, evidence of more rapid recovery has begun to emerge, suggesting the role of environmental inhibition was previously overestimated. However, there have been few high-resolution taxonomic and ecological studies spanning the full Early and Middle Triassic recovery interval, leaving the precise pattern of recovery and underlying mechanisms poorly constrained. In this study, we document Early and Middle Triassic trends in taxonomic diversity, assemblage evenness, and size distribution of benthic foraminifers on an exceptionally exposed carbonate platform in south China. We observe gradual increases in all metrics through Early Triassic and earliest Middle Triassic time, with stable values reached early in the Anisian. There is little support in our data set for a substantial Early Triassic lag interval during the recovery of foraminifers or for a stepwise recovery pattern. The recovery pattern of foraminifers on the GBG corresponds well with available global data for this taxon and appears to parallel that of many benthic invertebrate clades. Early Triassic diversity increase in foraminifers was more gradual than in ammonoids and conodonts. However, foraminifers continued to increase in diversity, size, and evenness into Middle Triassic time, whereas diversity of ammonoids and conodonts declined. These contrasts suggest decoupling of recovery between benthic and pelagic environments; it is unclear whether these discrepancies reflect inherent contrasts in their evolutionary dynamics or the differential impact of Early Triassic ocean anoxia or associated environmental parameters on benthic ecosystems.
Cognitive reserve (CR) is a protective factor that supports cognition by increasing the resilience of an individual's cognitive function to the deleterious effects of cerebral lesions. A single environmental proxy indicator is often used to estimate CR (e.g. education), possibly resulting in a loss of the accuracy and predictive power of the investigation. Furthermore, while estimates of an individual's prior CR can be made, no operational measure exists to estimate dynamic change in CR resulting from exposure to new life experiences.
We aimed to develop two latent measures of CR through factor analysis: prior and current, in a sample of 467 healthy older adults.
The prior CR measure combined proxy measures traditionally associated with CR, while the current CR measure combined variables that had the potential to reflect dynamic change in CR due to new life experiences. Our main finding was that the analyses uncovered latent variables in hypothesized prior and current models of CR.
The prior CR model supports multivariate estimation of pre-existing CR and may be applied to more accurately estimate CR in the absence of neuropathological data. The current CR model may be applied to evaluate and explore the potential benefits of CR-based interventions prior to dementia onset.
This study is an investigation of tool design and the organization of work. Here we further test Wilmsen’s (1970) conclusion that early Paleoindian tools—specifically, hafted end scrapers—were redesigned to facilitate the processing of a broader range of resources as colonizing populations moved into the forested environments of eastern North America from the west. We use a large sample from the Nobles Pond site, morphometic variables, and high-powered microwear to evaluate the effects of design and reduction as they bear on this generalization. Results do not support Wilmsen’s model, and, more generally, we conclude that an understanding of form and function in reductive technologies comes not only from an appreciation of the planned, stage-like change that is inherent in the design of reliable tools, but also from a consideration of the many contingencies and particular work situations that arise in the lives of mobile foragers.
Coronal Multi-channel Polarimeter (CoMP-S), developed by HAO/NCAR, has been introduced to regular operation at the Lomnicky Peak Observatory (High Tatras in northern Slovakia, 2633 m a.s.l.) of the Astronomical Institute of Slovak Academy of Sciences. We present here the technical parameters of the current version of the instrument and its potential for observations of prominences in the visual and near-IR spectral regions. The first results derived from observations of prominences in the Hα emission line taken during a coordinated observing campaign of several instruments in October 2012 are shown here.
The present study assessed the impact of the 2009 food packages mandated by the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) on dietary intake and home food availability in low-income African-American and Hispanic parent/child dyads.
A natural experiment was conducted to assess if the revised WIC food package altered dietary intake, home food availability, weight and various lifestyle measures immediately (6 months) following policy implementation.
Twelve WIC clinics in Chicago, IL, USA.
Two hundred and seventy-three Hispanic and African-American children aged 2–3 years, enrolled in WIC, and their mothers.
Six months after the WIC food package revisions were implemented, we observed modest changes in dietary intake. Fruit consumption increased among Hispanic mothers (mean = 0·33 servings/d, P = 0·04) and low-fat dairy intake increased among Hispanic mothers (0·21 servings/d, P = 0·02), Hispanic children (0·34 servings/d, P < 0·001) and African-American children (0·24 servings/d, P = 0·02). Home food availability of low-fat dairy and whole grains also increased. Dietary changes, however, varied by racial/ethnic group. Changes in home food availability were not significantly correlated with changes in diet.
The WIC food package revisions are one of the first efforts to modify the nutrition guidelines that govern foods provided in a federal food and nutrition assistance programme. It will be important to examine the longer-term impact of these changes on dietary intake and weight status.
Background: Differences in the level of cognitive compromise between individuals following brain injury are thought to arise from underlying differences in cognitive reserve. The level of cognitive reserve attained by an individual is influenced by both genetic and life experience factors such as educational attainment and occupational history. The Tasmanian Healthy Brain Project (THBP) is a world-first prospective study examining the capacity of university-level education to enhance cognitive reserve in older adults and subsequently reduce age-related cognitive decline and risk for neurodegenerative disease.
Methods: Up to 1,000 adults aged 50–79 years at the time of entry into the study will be recruited to participate in the THBP. All participants will be healthy and free of significant medical, psychological, or psychiatric illness. Of the participant sample, 90% will undertake a minimum of 12 months part-time university-level study as an intervention. The remaining 10% will act as a control reference group. Participants will complete an annual comprehensive assessment of neuropsychological function, medical health, socialization, and personal well-being. Premorbid estimates of past cognitive, education, occupational, and physical function will be used to account for the mediating influence of prior life experience on outcomes. Potential contributing genetic factors will also be explored.
Results: Participant results will be assessed annually. Participants displaying evidence of dementia on the comprehensive neuropsychological assessment will be referred to an independent psycho-geriatrician for screening and diagnosis.
Conclusions: The THBP commenced in 2011 and is expected to run for 10–20 years duration. To date, a total of 383 participants have been recruited into the THBP.
This book has sketched a theory of positive evidentiary rights around the notion of effective defence participation which it has been argued is emerging, not always coherently, from international human rights law and within domestic and international criminal processes. The theory does not require systems to model their evidentiary processes upon any particular legal tradition. It has been argued that the principles of equality of arms and the right to adversarial procedure developed in particular by the ECtHR can be accommodated across the common law and civil law traditions. The development of these principles is better portrayed in terms of realigning and transforming the established procedural traditions of the common law and the civil law than as representing a convergence of the two traditions. So the notion of ‘adversarial procedure’ developed by the ECtHR does not require systems to organise procedural control entirely around the prosecution and defence with a passive judge or jury deciding cases purely upon the facts and arguments adduced by the parties. Indeed, one of the themes that emerges in the human rights jurisprudence is the importance of judicial activism in ensuring the fairness of the proceedings. At the same time, the notion of an active defence which has been increasingly stressed in the jurisprudence as important in the pre-trial process, as well as at trial, rubs against any old ‘inquisitorial’ notion of the court exclusively dominating the procedural action. In this final chapter, we assess the impact that a theory of evidentiary defence rights has on the established common law and civil law traditions and what prospects there are for such a theory taking hold in the future.