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The concept of compressions only cardiopulmonary resuscitation (CO-CPR) evolved from a perception that lay rescuers may be less likely to perform mouth-to-mouth ventilations during an emergency. This study hopes to describe the efficacy of bystander compressions and ventilations cardiopulmonary resuscitation (CV-CPR) in cardiac arrest following drowning.
The aim of this investigation is to test the hypothesis that bystander cardiopulmonary resuscitation (CPR) utilizing compressions and ventilations results in improved survival for cases of cardiac arrest following drowning compared to CPR involving compressions only.
The Cardiac Arrest Registry for Enhanced Survival (CARES) was queried for patients who suffered cardiac arrest following drowning from January 1, 2013 through December 31, 2017, and in whom data were available on type of bystander CPR delivered (ie, CV-CPR CO-CPR). The primary outcome of interest was neurologically favorable survival, as defined by cerebral performance category (CPC).
Neurologically favorable survival was statistically significantly associated with CV-CPR in pediatric patients aged five to 15 years (aOR = 2.68; 95% CI, 1.10–6.77; P = .03), as well as all age group survival to hospital discharge (aOR = 1.54; 95% CI, 1.01–2.36; P = .046). There was a trend with CV-CPR toward neurologically favorable survival in all age groups (aOR = 1.35; 95% CI, 0.86–2.10; P = .19) and all age group survival to hospital admission (aOR = 1.29; 95% CI, 0.91–1.84; P = .157).
In cases of cardiac arrest following drowning, bystander CV-CPR was statistically significantly associated with neurologically favorable survival in children aged five to 15 years and survival to hospital discharge.
Mental illness poses a large and growing disease burden worldwide. Its management is increasingly provided by primary care. The prescribing of psychotropic drugs in general practice has risen in recent decades, and variation in prescribing rates has been identified by a number of studies. It is unclear which factors lead to this variation.
To describe the variables that cause variation in prescribing rates for psychotropic drugs between general practices.
A narrative review was conducted in January 2018 by searching electronic databases using the PRISMA statement. Studies investigating causal factors for variation in psychotropic prescribing between at least two general practice sites were eligible for inclusion.
Ten studies met the inclusion criteria. Prescribing rates varied considerably between practices. Positive associations were found for many variables, including social deprivation, ethnicity, patient age and gender, urban location, co-morbidities, chronic diseases and GP demographics. However studies show conflicting findings, and no single regression model explained more than 57% of the variation in prescribing rates.
There is no consensus on the factors that most predict prescribing rates. Most research was conducted in countries with central electronic databases, such as the United Kingdom; it is unclear whether these findings apply in other healthcare systems. More research is needed to determine the variables that explain prescribing rates for psychotropic medications.
Drawing from our interdisciplinary qualitative study of LGBTI conservative Christians and their allies, we name an especially toxic form of shame—what we call sacramental shame—that affects the lives of LGBTI and other conservative Christians. Sacramental shame results from conservative Christianity's allegiance to the doctrine of gender complementarity, which elevates heteronormativity to the level of the sacred and renders those who violate it as not persons, but monsters. In dispensing shame as a sacrament, nonaffirming Christians require constant displays of shame as proof that LGBTI church members love God and belong in the community. Part of what makes this shame so harmful is that parents and pastors often dispense it with sincere expressions of care and affection, compounding the sense that one's capacity to give and receive love is damaged. We foreground LGBTI Christian movements to overcome sacramental shame by cultivating nonhubristic pride, and conclude by discussing briefly their new understandings of love and justice that could have far‐reaching benefits.
OBJECTIVES/SPECIFIC AIMS: Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) skin and soft tissue infections (SSTIs) recurrence ranges from 16% to 43% and presents significant challenges to clinicians, patients, and families. This comparative effectiveness research study aims to disseminate, implement and evaluate whether an existing intervention, consisting of decolonization and decontamination procedures, which has been determined to be effective in hospital intensive care unit settings, can be implemented by Community Health Workers (CHWs) or “promotoras” conducting home visits prevent recurrence of CA-MRSA and transmission within their households for patients presenting to primary care with SSTIs. METHODS/STUDY POPULATION: In partnership with 3 Community Health Centers and 4 community hospitals in NYC, this study will recruit patients (n=278) with confirmed MRSA SSTIs and their household members. Participants are randomized to receive either a CHW/Promotora-delivered decolonization-decontamination intervention or usual care, which includes hygiene education. The highly engaged stakeholder team meets monthly to review interim results, identify areas for refinement and new research questions, and develop and implement strategies to improve participant engagement and retention. RESULTS/ANTICIPATED RESULTS: MRSA and MSSA were found in 19% and 21.1% of wound cultures, respectively. 59.5% with MRSA+ wound culture had one or more MRSA+ surveillance culture; 67.8% with MSSA+ wound culture had one or more MSSA+ surveillance culture. The “warm handoff” approach, developed and implemented by the stakeholder team to engage patients from their initial consent to return of lab results and scheduling of the home visits, helped improve completion of baseline home visits by 14%, from 45% to 59% of eligible participants. Home visits have demonstrated that 60% of households had at least one surface contaminated with S. aureus. Of the surfaces that tested positive in the households, nearly 20% were MRSA and 81% were MSSA; 32.5% of household members had at least one surveillance culture positive for S. aureus (MRSA: 7.7%, MSSA: 92.3%). DISCUSSION/SIGNIFICANCE OF IMPACT: This study aims to understand the systems-level, patient-level, and environmental-level factors associated with SSTI recurrence and household transmission, and to examine the interactions between bacterial genotypic and clinical/phenotypic factors on decontamination, decolonization, SSTI recurrence and household transmission. This study will evaluate the barriers and facilitators of implementation of home visits by CHWs in underserved populations, and aims to strengthen the weak evidence base for implementation of strategies to reduce SSTI recurrence and household transmission.
Early life exposures affect health and disease across the life course and potentially across multiple generations. The Clinical and Translational Research Institutes (CTSIs) offer an opportunity to utilize and link existing databases to conduct lifespan research.
A survey with Lifespan Domain Taskforce expert input was created and distributed to lead lifespan researchers at each of the 64 CTSIs. The survey requested information regarding institutional databases related to early life exposure, child-maternal health, or lifespan research.
Of 64 CTSI, 88% provided information on a total of 130 databases. Approximately 59% (n=76/130) had an associated biorepository. Longitudinal data were available for 72% (n=93/130) of reported databases. Many of the biorepositories (n=44/76; 68%) have standard operating procedures that can be shared with other researchers.
The majority of CTSI databases and biorepositories focusing on child-maternal health and lifespan research could be leveraged for lifespan research, increased generalizability and enhanced multi-institutional research in the United States.
Recent years have seen great interest in the importance of species richness for the functioning and stability of ecological communities (Ives and Carpenter 2007). Empirical examinations of richness effects typically vary the number of species in experimental treatments and measure resulting ecosystem functions such as biomass accumulation or resource uptake (Naeem et al. 2009). Across trophic levels and communities of many types, a clear pattern has emerged from these experiments: community processes (biomass accumulation, resource uptake, etc.) generally become more efficient when more species are present (Hooper et al. 2005; Cardinale et al. 2006). This pattern is generally attributed to resource partitioning among species, where species differ in ecologically significant ways such that they complement one another (Hooper et al. 2005). For example, in English meadow communities multiple plant species coexist, because different plant species exploit different hydrological conditions (Silvertown et al. 1999). The plants that dominate drought-prone areas are different from those that thrive in flood-prone areas and, presumably, total plant biomass is greatest when both plant groups (drought tolerant and flood tolerant) are present.
A remaining challenge is to effectively predict, a priori, the particular species (or groups of species) that will complement one another. One simplifying scheme that has received considerable attention is the lumping of species into ‘functional groups’. In this functional-group approach, species within a group are relatively similar to one another, and considered ecologically redundant, whereas species in different groups are distinct and complementary (Hillebrand and Matthiessen 2009). This approach gained support from studies suggesting that plant species can be classified into such functional groups (grasses, forbs, legumes and woody plants), and that the number of functional groups is a more effective predictor of ecosystem function than species richness (Diaz and Cabido 2001). For example, in savannah grasslands, plant communities that included C3 grasses, C4 grasses, forbs, legumes and woody plants had greater biomass and plant nitrogen accumulation, and reduced light penetration, than those communities lacking one or more of these groups (Tilman et al. 1997). These authors suggested that competition was greater within than between functional groups, consistent with niche similarity within, but niche differentiation among, groups.
A strong resonance in the inverse photoelectron spectroscopy (IPES) of cerium oxide was reported recently. Here, it is shown that dominance of the indirect channel of the resonant inverse photoelectron spectroscopy (RIPES) is so complete that the photon energy dependence can be explained in terms of emission associated with a single photon energy.
Extinction maps at 8μm from the Spitzer Space Telescope show that many Class 0 protostars exhibit complex, irregular, and non-axisymmetric structure within the densest regions of their dusty envelopes. Many of the systems have highly irregular and non-axisymmetric morphologies on scales ~1000 AU, with a quarter of the sample exhibiting filamentary or flattened dense structures. Complex envelope structure is observed in regions spatially distinct from outflow cavities, and the densest structures often show no systematic alignment perpendicular to the cavities. We suggest that the observed envelope complexity is the result of collapse from protostellar cores with initially non-equilibrium structures. The striking non-axisymmetry in many envelopes could provide favorable conditions for the formation of binary systems. We then show that the kinematics around L1165 as probed with N2H+ are indicative of asymmetric infall; the velocity gradient is not perpendicular to the outflow.
X-ray photoelectron spectroscopy has been used to characterize a sample of UO2 grown on an underlying substrate of Uranium. Both AlKα (1487 eV) and MgKα (1254 eV) emission were utilized as the excitation.
A panel of 10 monoclonal antibodies was used to subgroup 326 strains of Legionella pneumophila serogroup 1. All but two strains could be classified into three major subgroups named after their representative strains Pontiac 1, Olda and Bellingham 1. Of the 50 isolates from patients, 44 representing 32 separate incidents were of the Pontiac subgroup. This subgroup was also found in 16 of 18 buildings epidomiologically associated with Legionnaires' Disease. In contrast, strains of the Olda subgroup predominated in buildings where no infections had occurred. In 9 of the 11 incidents where isolates were available from at least one patient as well as from the suspected environmental source, the monoclonal antibody reaction patterns of strains from patients were identical to those of one or more of their environmental counterparts.
Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) has rapidly emerged in the USA as a cause of severe infections in previously healthy persons without traditional risk factors. We describe the epidemiology of severe CA-MRSA disease in the state of Georgia, USA and analyse the risk of death associated with three different clinical syndromes of CA-MRSA disease – pneumonia, invasive disease, and skin and soft-tissue infections (SSTIs). A total of 1670 cases of severe CA-MRSA disease were reported during 2005–2007. The case-fatality rate was 3·4%; sex and race of fatal and non-fatal cases did not differ significantly. While CA-MRSA pneumonia and invasive disease were less common than SSTIs, they were about 15 times more likely to result in death [risk ratio 16·69, 95% confidence interval (CI) 10·28–27·07 and 13·98, 95% CI 7·74–25·27, respectively]. When controlling for age and the presence of other clinical syndromes the odds of death in patients manifesting specific severe CA-MRSA syndromes was highest in those with pneumonia (odds ratio 11·34). Possible risk factors for severe CA-MRSA SSTI and pneumonia included the draining of lesions without medical assistance and an antecedent influenza-like illness.
We are developing the technique of spin-polarized photoelectron spectroscopy as a probe of electron correlation with the ultimate goal of resolving the Pu electronic structure controversy. Over the last several years, we have demonstrated the utility of spin polarized photoelectron spectroscopy for determining the fine details of the electronic structure in complex systems such as those shown below.
Pentacene is one of the most studied semiconductor for organic thin-film transistors (OTFTs), and enhanced understanding of pentacene-based TFTs has significantly advanced the organic electronics. We report here the crucial effect of the polymer gate dielectric glass transition temperature (Tg) on pentacene film growth mode, microstructure, and the resulting TFT performance. Nanoscopically-confined thin polymer films are known to exhibit reduced glass-transition temperatures versus the corresponding bulk values, and we demonstrate here that pentacene films grown on polymer gate dielectrics at temperatures well below their bulk Tg exhibit morphological/microstructural transitions and OTFT performance discontinuities at well-defined growth temperatures [defined as the surface Tg, or Tg(s)] characteristic of the underlying polymer structure and independent of the film thickness. The results argue that realistic OTFT response must take into account this fundamental polymer property, and that TFT measurements represent a new probe of polymer surface thermal properties.