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Ventilation with a bag valve mask (BVM) is a challenging but critical skill for airway management in the prehospital setting.
Tidal volumes received during single rescuer ventilation with a modified BVM with supplemental external handle will be higher than those delivered using a standard BVM among health care volunteers in a manikin model.
This study was a randomized crossover trial of adult health care providers performing ventilation on a manikin. Investigators randomized participants to perform single rescuer ventilation, first using either a BVM modified by addition of a supplemental external handle or a standard unmodified BVM (Spur II BVM device; Ambu; Ballerup, Denmark). Participants performed mask placement and delivery of 10 breaths per minute for three minutes, as guided by a metronome. After a three-minute rest period, they performed ventilation using the alternative device. The primary outcome measure was mean received tidal volume as measured by the manikin (IngMar RespiTrainer model; IngMar Medical; Pittsburgh, Pennsylvania USA). Secondary outcomes included subject device preference.
Of 70 recruited participants, all completed the study. The difference in mean received tidal volume between ventilations performed using the modified BVM with external handle versus standard BVM was 20 ml (95% CI, -16 to 56 ml; P=.28). There were no significant differences in mean received tidal volume based on the order of study arm allocation. The proportion of participants preferring the modified BVM over the standard BVM was 47.1% (95% CI, 35.7 to 58.6%).
The modified BVM with added external handle did not result in greater mean received tidal volume compared to standard BVM during single rescuer ventilation in a manikin model.
ReedP, ZobristB, CasmaerM, SchauerSG, KesterN, AprilMD. Single Rescuer Ventilation Using a Bag Valve Mask with Removable External Handle: A Randomized Crossover Trial. Prehosp Disaster Med. 2017;32(6):625–630.
Chemotherapy is often administered in openly designed hospital wards, where the possibility of patient–patient social influence on health exists. Previous research found that social relationships influence cancer patient's health; however, we have yet to understand social influence among patients receiving chemotherapy in the hospital. We investigate the influence of co-presence in a chemotherapy ward. We use data on 4,691 cancer patients undergoing chemotherapy in Oxfordshire, United Kingdom who average 59.8 years of age, and 44% are Male. We construct a network of patients where edges exist when patients are co-present in the ward, weighted by both patients' time in the ward. Social influence is based on total weighted co-presence with focal patients' immediate neighbors, considering neighbors' 5-year mortality. Generalized estimating equations evaluated the effect of neighbors' 5-year mortality on focal patient's 5-year mortality. Each 1,000-unit increase in weighted co-presence with a patient who dies within 5 years increases a patient's mortality odds by 42% (β = 0.357, CI:0.204,0.510). Each 1,000-unit increase in co-presence with a patient surviving 5 years reduces a patient's odds of dying by 30% (β =−0.344, CI:−0.538,0.149). Our results suggest that social influence occurs in chemotherapy wards, and thus may need to be considered in chemotherapy delivery.
Behavioural aspects of taxation and trust
Rebbecca Reed-Arthurs, Associate Director, Berkeley Research Group LLC; PhD in Economics, University of California, Davis,
Steven M. Sheffrin, Executive Director of the Murphy Institute, Tulane University; Professor of Economics and Affiliated Professor of Law
Redistributive taxation is the transfer of resources by the government apart from the simple exchange of goods and services or provision of public goods. To sustain a programme of redistribution requires both the trust of the public and a sense of legitimacy for these transfers. One factor that influences the legitimacy of transfers is the public's desired preferences for redistribution. This chapter explores the public ‘ s expressed attitudes towards redistribution, addressing two important gaps in our understanding. First, studies of support for redistribution have focused on desires for transfers from the rich to the poor or to the poor in general, but redistributive polices may also benefit the middle class and differ in character. Second, there is fundamental uncertainty as to what the public actually means when it suggests preferred distributions of the tax burden – are they expressing ideal preferences, or combining these with their own views of the disincentive effects of higher tax rates? We address this issue using data from the US in a nationally representative survey on taxation and fairness as well as an experiment. We find that Americans have some interest in redistribution to both the middle class and the poor. While the desire for redistribution to the poor is influenced by many factors (including measures of altruism, political ideology and values) demand for redistribution to the middle class appears to be driven by self-interest and knowledge of the tax system. The experimental results suggest that not only does the public not include incentive effects into their expressions for desired progressivity; but that they do not believe they should be included – in other words, the public separates judgements of progressivity from judgements of economic efficiency.
Redistributive taxation is the transfer of resources by the government apart from the simple exchange of goods and services or provision of public goods. To sustain a programme of redistribution requires both the trust of the public and a sense of legitimacy for these transfers. One factor that influences the legitimacy of transfers is the public ‘ s desired preferences for redistribution. These preferences are the focus of this chapter.
Introductions of biocontrol beetles (tamarisk beetles) are causing dieback of exotic tamarisk in riparian zones across the western United States, yet factors that determine plant communities that follow tamarisk dieback are poorly understood. Tamarisk-dominated soils are generally higher in nutrients, organic matter, and salts than nearby soils, and these soil attributes might influence the trajectory of community change. To assess physical and chemical drivers of plant colonization after beetle-induced tamarisk dieback, we conducted separate germination and growth experiments using soil and litter collected beneath defoliated tamarisk trees. Focal species were two common native (red threeawn, sand dropseed) and two common invasive exotic plants (Russian knapweed, downy brome), planted alone and in combination. Nutrient, salinity, wood chip, and litter manipulations examined how tamarisk litter affects the growth of other species in a context of riparian zone management. Tamarisk litter, tamarisk litter leachate, and fertilization with inorganic nutrients increased growth in all species, but the effect was larger on the exotic plants. Salinity of 4 dS m−1 benefitted Russian knapweed, which also showed the largest positive responses to added nutrients. Litter and wood chips generally delayed and decreased germination; however, a thinner layer of wood chips increased growth slightly. Time to germination was lengthened by most treatments for natives, was not affected in exotic Russian knapweed, and was sometimes decreased in downy brome. Because natives showed only small positive responses to litter and fertilization and large negative responses to competition, Russian knapweed and downy brome are likely to perform better than these two native species following tamarisk dieback.
Radio-glaciological parameters from the Moore’s Bay region of the Ross Ice Shelf, Antarctica, have been measured. The thickness of the ice shelf in Moore’s Bay was measured from reflection times of radio-frequency pulses propagating vertically through the shelf and reflecting from the ocean, and is found to be 576 ± 8 m. Introducing a baseline of 543 ± 7m between radio transmitter and receiver allowed the computation of the basal reflection coefficient, R, separately from englacial loss. The depth-averaged attenuation length of the ice column, 〈L〉 is shown to depend linearly on frequency. The best fit (95% confidence level) is 〈L(ν)〉= (460±20) − (180±40)ν m (20 dB km−1), for the frequencies ν = [0.100–0.850] GHz, assuming no reflection loss. The mean electric-field reflection coefficient is (1.7 dB reflection loss) across [0.100–0.850] GHz, and is used to correct the attenuation length. Finally, the reflected power rotated into the orthogonal antenna polarization is <5% below 0.400 GHz, compatible with air propagation. The results imply that Moore’s Bay serves as an appropriate medium for the ARIANNA high-energy neutrino detector.
The focus of our chapter is on current research-based understandings of professional engineering work. We argue for the relevance of these understandings to engineering education. We will also argue, as others have as well (Barley, 2004; Trevelyan, 2007, 2010; Vinck, 2003), that research on professional engineering work is too sparse. Therefore a good part of this chapter is oriented in a programmatic, agenda setting direction.
From the perspective of engineering education, the sparseness of research on professional engineering work is puzzling for a number of reasons. First, engineering education is often reorganized against the backdrop of claims about what professional engineering work is now or will be in the future. Without trustworthy and specific representations of engineering work practice and of the dispositions, skills, and identity orientations of professional engineers, how are engineering educators to know whether engineering education is preparing engineering students to be successful, creative, or impactful engineers? A prominent consensus report from the National Academy of Engineering highlights a “disconnect between engineers in practice and engineers in academe” (National Academy of Engineering [NAE], 2005, pp. 20–21). The report stated that “the great majority of engineering faculty, for example, have no industry experience. Industry representatives point to this disconnect as the reason that engineering students are not adequately prepared, in their view, to enter today's workforce” (National Academy of Engineering [NAE], 2005, pp. 20–21). It is important that a focus on “preparation” of future engineers not be tied to an agenda that solely emphasizes what professional engineering “needs” and economic competitiveness. It also is possible to organize an engineering educational system to prepare recent graduates to be change agents and participants in new social movements within engineering work practice. However, in either case, concrete images of engineering work are critical resources for rethinking engineering education and making empirically based assessments of progress.
Using the 2005 and 2006 AsiaBarometer surveys I analyze religiosity and secularization in Asia. I find that, in South Asia, identification with a particular religion is the norm and most people pray every day but, in East Asia, religious identification and religious practice are both much less common. Even in secular East Asia, however, the demand for religious services is high and belief in a spiritual world is common. I conclude that secularization does not necessarily produce uniformly secular societies. Turning to the causes and consequences of religiosity, I find surprisingly few significant relationships, results that echo similar analyses in Western Europe. I then discuss the implications of these non-findings.
The theory of argumentation is a rich, interdisciplinary area of research straddling the fields of artificial intelligence, philosophy, communication studies, linguistics and psychology. In the last few years, significant progress has been made in understanding the theoretical properties of different argumentation logics. However, one major barrier to the development and practical deployment of argumentation systems is the lack of a shared, agreed notation or ‘interchange format’ for argumentation and arguments. In this paper, we describe a draft specification for an argument interchange format (AIF) intended for representation and exchange of data between various argumentation tools and agent-based applications. It represents a consensus ‘abstract model’ established by researchers across fields of argumentation, artificial intelligence and multi-agent systems. In its current form, this specification is intended as a starting point for further discussion and elaboration by the community, rather than an attempt at a definitive, all-encompassing model. However, to demonstrate proof of concept, a use case scenario is briefly described. Moreover, three concrete realizations or ‘reifications’ of the abstract model are illustrated.
In this chapter, we argue that the learning sciences are poised for a “decade of synergy.” We focus on several key traditions of theory and research with the potential for mutually influencing one another in ways that can transform how we think about the science of learning, as well as how future educators and scientists are trained.
The three major strands of research that we focus on are: (1) implicit learning and the brain, (2) informal learning, and (3) designs for formal learning and beyond. As Figure 2.1A illustrates, these three areas have mainly operated independently, with researchers attempting to apply their thinking and findings directly to education, and with the links between theory and well-grounded implications for practice often proving tenuous at best.
The goal of integrating insights from these strands in order to create a transformative theory of learning is illustrated in Figure 2.1B. Successful efforts to understand and advance human learning require a simultaneous emphasis on informal and formal learning environments, and on the implicit ways in which people learn in whatever situations they find themselves.
We explore examples of research from each of these three strands. We then suggest ways that the learning sciences might draw on these traditions for creating a more robust understanding of learning, which can inform the design of learning environments that allow all students to succeed in the fast changing world of the twenty-first century (e.g., Darling-Hammond & Bransford, 2005; Vaill, 1996).
Elections to Japan's upper house, the House of Councillors, are ‘secondary’ elections, that is, elections that do not choose the government. Among the implications of this secondary status is that the party system is primarily determined elsewhere, by the system used in the general elections that do choose the government. From 1947 through 1993 the system used in general elections fostered a multiparty system that did not sit easily with the many single-member districts of the House of Councillors. Since 1996 general elections use a system based primarily on single-member districts, which is fostering a two-party system. As a two-party system emerges, we should expect the single-member districts of the upper house to become more and the multi-member districts to become less congruent with the party system. The 2004 House of Councillors election presented us with our first example of what two-party elections might look like in future upper house elections. The overall results do indeed indicate the advent of the two-party system with the major parties winning 96% of the seats in the district tier and 71% in the PR tier.
The LDP predominant party system ended in 1993. The big question now is whether an effective opposition party can be created or whether the LDP will find a way to re-establish predominance. One key will be gubernatorial elections. Governors sit at the pivot between national and local politics. All parties except the Communists strive to be part of the gubernatorial coalition because only then can they influence distributive political decisions. Most gubernatorial elections are thus noncompetitive. Recent gubernatorial elections, however, have given some hope to those who would create an alternative to the LDP. Even if an anti-LDP candidate wins, he will be tempted to return to the LDP fold, or at least remain neutral in national politics. Recent gubernatorial elections in Aomori illustrate these pressures and complexities. Aomori was one of three prefectures where the New Frontier Party won gubernatorial elections. The NFP represented the first failed attempt to create a credible alternative to the LDP and we can learn much from its failure.
Examining the 1993 split of the Liberal Democratic Party (LDP) in Japan offers an opportunity to gain greater insight into the impact of the various incentives that influence the behaviour of politicians. Surprisingly, previous analyses of the LDP split have been able to demonstrate only weak evidence of any electoral connection driving politicians' decisions. However, by also examining the role of policy preferences (support for reform) and utilizing interaction terms, our analysis takes into account the fact that politicians at different stages in their careers and facing different sorts of electorates respond to electoral factors in very different ways. Our findings thus confirm the importance of the electoral connection. We are also able to add that a variety of other incentives also shape political behaviour and that politicians do not necessarily all respond to similar stimuli in the same way.
The M + 1 Rule, that at equilibrium there should be only one more candidate running than seats available, extended Duverger's Law to the cases of more than one seat per district. Both the M + 1 rule and Duverger's Law have been confirmed repeatedly, albeit always with qualification. Yet we have reached no consensus on the mechanism that produces these two empirical regularities. In this paper I use a simple simulation to test the hypothesis that the mechanism is that candidates retire after some fixed number of consecutive losses. I test the results of the simulation against several different empirical results and find a reasonably good fit. I also add a mechanism for increasing the number of candidates. These results suggest that the M + 1 rule and Duverger's law may be the result not of rational calculation but of some simple set of decision rules. The analysis also illustrates the usefulness of a simulation approach to hypothesis testing.
In the 1993 general election the Liberal Democratic Party lost power for the first time since it was founded in 1955. The coalition government that followed enacted the most far-reaching political reforms Japan has experienced since the American Occupation. The country has now experienced two elections since these reforms so we can begin to analyze trends and dynamics. It is now possible to make a preliminary evaluation of the effects of these reforms. I evaluate the reforms under three headings: (1) reducing the cost of elections and levels of corruption; (2) replacing candidate-centered with party-centered campaigns; and (3) moving toward a two-party system which would produce alternation in power between the parties of the government and the parties of the opposition. In conclude that, with some notable exceptions, the reforms are working well, about as well as should have been expected.
One year ago I entitled my review of Japanese elections ‘Time for a Change?’. Candidates running against the establishment were defeating candidates who had until recently appeared unbeatable. Most notably, outsider candidates were defeating ainori (supported by all major parties) candidates in gubernatorial elections. A prime example of an outsider candidate defeating the establishment was Prime Minister Koizumi, who defeated the LDP establishment to win the leadership of the LDP. Koizumi's election and subsequent popularity appears to have dampened the trend. Most notably, a well-qualified challenger failed to unseat the incumbent in the Shizuoka gubernatorial election. Once Koizumi's popularity faded, however, the trend in favour of outsiders reappeared. Given an attractive alternative, establishment candidates continue to find themselves in trouble. The clearest recent example comes from the Yokohama mayoral election.
The most important election held in 2001 was that to the House of Councillors. Here, however, I will report on several surprising gubernatorial elections and the shocking LDP party presidential election. Each of these elections sent a similar message from the voters: ‘it is time for a change’. Powerful political machines using tried and true campaign techniques were repeatedly defeated by novices whose primary attraction was that they were not part of the political establishment.