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Low rates of bystander cardiopulmonary resuscitation (CPR) were identified as a shortcoming in the “chain of survival” for out-of-hospital cardiac arrest (OHCA) care in the Korean city of Ansan. This study sought to evaluate the effect of an initiative to increase bystander CPR and quality of out-of-hospital resuscitation on outcome from OHCA. The post-intervention data were used to determine the next quality improvement (QI) target as part of the “Plan-Do-Study-Act” (PDSA) model for QI.
The study hypothesis was that bystander CPR, return of spontaneous circulation (ROSC), and survival to discharge after OHCA would increase in the post-intervention period.
This was a retrospective pre/post study. The data from the pre-intervention period were abstracted from 2008–2011 and the post-intervention period from 2012–2013. The effect of the intervention on the odds of ROSC and survival to hospital discharge was determined using a generalized estimating equation to account for confounders and the effect of clustering within medical centers. The analysis was then used to identify other factors associated with outcomes to determine the next targets for intervention in the chain of survival for cardiac arrest in this community.
Rates of documented bystander CPR increased from 13% in the pre-intervention period to 37% in the post-intervention period. The overall rate of ROSC decreased from 18.4% to 14.3% (risk difference −4.1%; 95% CI, −7.1%–1.0%), whereas survival to hospital discharge increased from 3.9% to 5.0% (risk difference 1.1%; 95% CI, −1.8%–3.8%), and survival with good neurologic outcome increased from 0.8% to 1.6% (risk difference 0.8%; 95% CI, −0.8%–2.4%). In multivariable analyses, there was no association between the intervention and the rate of ROSC or survival to hospital discharge. The designated level of the treating hospital was a significant predictor of both survival and ROSC.
In this case study, there were no observed improvements in outcomes from OHCA after the targeted intervention to improve out-of-hospital CPR. However, utilizing the PDSA model for QI, the designated level of the treating hospital was found to be a significant predictor of survival in the post-period, identifying the next target for intervention.
Given its diverse disease courses and symptom presentations, multiple phenotype dimensions with different biological underpinnings are expected with bipolar disorders (BPs). In this study, we aimed to identify lifetime BP psychopathology dimensions. We also explored the differing associations with bipolar I (BP-I) and bipolar II (BP-II) disorders.
We included a total of 307 subjects with BPs in the analysis. For the factor analysis, we chose six variables related to clinical courses, 29 indicators covering lifetime symptoms of mood episodes, and 6 specific comorbid conditions. To determine the relationships among the identified phenotypic dimensions and their effects on differentiating BP subtypes, we applied structural equation modeling.
We selected a six-factor solution through scree plot, Velicer's minimum average partial test, and face validity evaluations; the six factors were cyclicity, depression, atypical vegetative symptoms, elation, psychotic/irritable mania, and comorbidity. In the path analysis, five factors excluding atypical vegetative symptoms were associated with one another. Cyclicity, depression, and comorbidity had positive associations, and they correlated negatively with psychotic/irritable mania; elation showed positive correlations with cyclicity and psychotic/irritable mania. Depression, cyclicity, and comorbidity were stronger in BP-II than in BP-I, and they contributed significantly to the distinction between the two disorders.
We identified six phenotype dimensions; in addition to symptom features of manic and depressive episodes, various comorbidities and high cyclicity constructed separate dimensions. Except for atypical vegetative symptoms, all factors showed a complex interdependency and played roles in discriminating BP-II from BP-I.
Bloodstream infection (BSI) occurred in 21 of 121 patients (17%) receiving venovenous extracorporeal membrane oxygenation within the median time of 6 days after initiation (interquartile range, 4–19 days). Longer duration of arterial catheterization and more blood transfusions were independently associated with BSI, which is associated with poor clinical outcomes.
To evaluate the appropriateness of the screening strategy for healthcare personnel (HCP) during a hospital-associated Middle East Respiratory Syndrome (MERS) outbreak, we performed a serologic investigation in 189 rRT-PCR–negative HCP exposed and assigned to MERS patients. Although 20%–25% of HCP experienced MERS-like symptoms, none of them showed seroconversion by plaque reduction neutralization test (PRNT).
Despite recent reports regarding the biology of cytosine methylation in Schistosoma mansoni, the impact of the regulatory machinery remains unclear in diverse platyhelminthes. This ambiguity is reinforced by discoveries of DNA methyltransferase 2 (DNMT2)-only organisms and the substrate specificity of DNMT2 preferential to RNA molecules. Here, we characterized a novel DNA methyltransferase, named CsDNMT2, in a liver fluke Clonorchis sinensis. The protein exhibited structural properties conserved in other members of the DNMT2 family. The native and recombinant CsDNMT2 exhibited considerable enzymatic activity on DNA. The spatiotemporal expression of CsDNMT2 mirrored that of 5-methylcytosine (5 mC), both of which were elevated in the C. sinensis eggs. However, CsDNMT2 and 5 mC were marginally detected in other histological regions of C. sinensis adults including ovaries and seminal receptacle. The methylation site seemed not related to genomic loci occupied by progenies of an active long-terminal-repeat retrotransposon. Taken together, our data strongly suggest that C. sinensis has preserved the functional DNA methylation machinery and that DNMT2 acts as a genuine alternative to DNMT1/DNMT3 to methylate DNA in the DNMT2-only organism. The epigenetic regulation would target functional genes primarily involved in the formation and/or maturation of eggs, rather than retrotransposons.
Si delta-doping in the GaN layer has been successfully demonstrated by low-pressure metalorganic chemical vapor deposition at a growth temperature of 1040 . Si delta-doping concentration increases and then decreases with an increase in delta-doping time. This indicates that delta-doping concentration is limited by the desorption process owing to much higher thermal decomposition efficiency of silane at high growth temperatures of GaN. In addition, it was observed that the use of a post-purge step in the ammonia ambient reduces Si delta-doping concentration. From capacitance-voltage measurement, a sharp carrier concentration profile with a full-width at half maximum of 4.1 nm has been achieved with a high peak concentration of 9.8 1018 cm−3.
The in vitro corrosion mechanism of the biodegradable cast Mg–10% Ca binary alloy in Hanks' solution was evaluated through transmission electron microscopy observations. The corrosion behavior depends strongly on the microstructural peculiarity of Mg2Ca phase surrounding the island-like primary Mg phase and the fast corrosion induced by the interdiffusion of O and Ca via the Mg2Ca phase of lamellar structure. At the corrosion front, we found that a nanosized crack-like pathway was formed along the interface between the Mg2Ca phase and the primary Mg phase. Through the crack-like pathway, O and Ca are atomically exchanged each other and then the corroded Mg2Ca phase was transformed to Mg oxides. The in vitro corrosion by the exchange of Ca and O at the nanosized pathway led to the rapid bulk corrosion in the Mg–Ca alloys.
Learning to read and to write influences not only verbal skills but also global cognitive performance. Our study aimed to compare the visuoconstructional abilities of elderly illiterates with those of elderly literates. A total of 125 healthy subjects over 65 years old were recruited. Korean version of Mini-Mental State Examination (K-MMSE) and the Alzheimer's Disease Assessment Scale-cognitive subscale (ADAS-cog) constructional praxis examination were used. We divided subjects into three groups (educated literate n = 53, uneducated literate n = 36 and uneducated illiterate n = 36). Interlocking pentagons drawing, a part of the K-MMSE, was scored using the 6-point hierarchical scale. The uneducated-illiterate group obtained significantly lower scores than did the other two groups. Scores on the ADAS-cog constructional praxis test were highest in the educated-literate group and those in the uneducated-illiterate group obtained the lowest scores. We demonstrated that illiteracy influences not only language performance but also visuoconstructional functioning. (JINS, 2011, 17, 934–939)
Si delta-doping in the GaN layer has been successfully demonstrated by low-pressure metalorganic chemical vapor deposition at a growth temperature of 1040°C. Si delta-doping concentration increases and then decreases with an increase in delta-doping time. This indicates that delta-doping concentration is limited by the desorption process owing to much higher thermal decomposition efficiency of silane at high growth temperatures of GaN. In addition, it was observed that the use of a post-purge step in the ammonia ambient reduces Si delta-doping concentration. From capacitance-voltage measurement, a sharp carrier concentration profile with a full-width at half maximum of 4.1 nm has been achieved with a high peak concentration of 9.8 x 1018 cm-3
A systematic study on the effect of sputtering deposition parameters on material properties of Al doped ZnO (ZnO:Al) films prepared by an in-line rf magnetron sputtering and on surface morphology of the films after wet etching process was carried out. For application to silicon thin film solar cells as a front electrode, the as-deposited films were surface-textured by a dilute HCl solution to improve the light scattering properties such as haze and angle resolved distribution of scattered light on the film surfaces. The microstructure of as-deposited films is affected significantly by the working pressure and film compactness decreases with increasing working pressure from 1.5 mTorr to 10 mTorr. High quality ZnO:Al films with electrical resistivity of 4.25 × 10-4 Ω cm and optical transmittance of 80% in a visible range are obtained at low working pressure of 1.5 mTorr and substrate temperature of 100℃. Crater-like surface morphologies are observed on the textured ZnO:Al films after wet etching. The size and shape of craters are closely dependent on the microstructure and film compactness of as-deposited films. Haze values of the textured ZnO:Al films are improved in a whole wavelength of 300 – 1100 nm compared to commercial SnO2:F films (Asahi U type) and incident light on the textured films is scattered effectively with 30° angle.
We aimed to investigate the factors associated with a positive intake of folic acid (FA) during the periconceptional period among Korean women.
In a cross-sectional study of demographic, obstetric and socio-economic data, history of periconceptional intake of FA and awareness of the benefits of FA supplementation in pregnancy were obtained and analysed using the χ2 test, followed by multiple logistic regression analysis.
The Maternity School, Cheil General Hospital and Women’s Healthcare Center, Seoul, South Korea, between October 2005 and March 2006.
In total 1313 pregnant women participating in a two-day training course available every month.
After excluding subjects with incomplete or inconsistent data, there were 1277 women included in the analysis. Participants were aged 29·4 (sd 2·9) years and had a mean gestational age of 27·9 (sd 7·1) weeks. Only 131 (10·3 %) women took FA during the periconceptional period. According to multiple logistic regression analyses, the adjusted OR for FA supplementation was 1·79 (95 % CI 1·10, 2·91) in women who had previous spontaneous abortions, 4·10 (95 % CI 2·43, 6·78) in women who planned their pregnancy and 6·63 (95 % CI 2·08, 21·12) in those who were aware of the protective effects of FA.
Periconceptional intake of FA was more likely among Korean women with a history of previous spontaneous abortion, who planned their pregnancy or who were aware of the protective effects of FA during pregnancy. However, the proportion of women who took FA in the periconceptional period was low.
To investigate the epidemiologic characteristics of vancomycin-resistant enterococci (VRE) infection.
An epidemiologic description by means of chromosomal DNA fingerprinting and transposon typing.
A 2,200-bed tertiary care hospital in Korea.
First VRE isolates were obtained from patients hospitalized from April 1997 to December 2001.
The van genotypes of isolates were identified by means of multiplex polymerase chain reaction (PCR). The macro-restriction patterns of chromosomal DNA were determined by pulsed-field gel electrophoresis (PFGE). The transposon Tn1546was typed by means of 2 sets of long PCR restriction fragment-length polymorphism analysis, which were ClaI restriction of a 10.4-kb region from orf1 to vanZ and DdeI restriction of a 4.4-kb region from vanR to vanX.
VRE isolates were recovered from 215 patients. All were vanA genotype. PFGE analysis of the 215 isolates showed 172 types, including 21 clusters composed of 64 isolates and 151 types of as many isolates. Each type was composed of 2-10 isolates; the isolates within each PFGE cluster were detected within a 10-month period and mostly shared a transposon type. Transposon typing classified 169 strains into 15 types and 158 strains belonged to 4 major transposon clusters. Each of these 4 transposon clusters was isolated from patients treated in 5-22 different wards during a 31-52 month period and consisted of 9-80 PFGE types. Each of the other 11 types were found in only one strain.
Our findings suggest that the horizontal transfer of Tn1546 has a major role in the nosocomial spread of vanA VRE. Clonal spread of VRE seemed to contribute to short-term dissemination in limited areas.
Based on a structure model of mixture of phases, the crystal structure analysis of (Ba1−xLax)[Mg(1+x)/3Nb(2−x)/3]O3 (BLMN) (x = 0.9 and 1.0) by Rietveld refinements was carried out. The pure La(Mg2/3Nb1/3)O3 (LMN) and BLMN (x=0.9) actually consist of a two-phase mixture rather a single phase. One is Fm-3m, which is cubic and 1:1 ordered and the other is P21/n, which is monoclinic and has both 1:1 ordering and the antiphase and inphase tilting of oxygen octahedra with a−a−c+. The weight fraction of the Fm-3m phase is 17.5% at x=0.9 and further decreases to 7.5% in pure LMN. Meanwhile, that of the P21/n phase is 82.5% at x =0.9 and further increases to 92.5% in pure LMN. The I4/m phase, which is present as a minor phase from x=0.3 to 0.7, disappeared when x≥0.9. The abrupt change of the x-ray diffraction pattern at x=0.9 is caused by a change of major phase from Fm-3m to P21/n phase in the matrix.
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