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Extracorporeal membrane oxygenation within CPR (ECPR) may improve survival for refractory out-of-hospital cardiac arrest (OHCA). We developed a prehospital, emergency department (ED), and hospital-based clinical and educational protocol to improve the key variable of time-to-ECPR (TTE).
In a single urban health region we involved key prehospital, clinical, and administrative stakeholders over a 2-year period, to develop a regional ECPR program with destination to a single urban tertiary care hospital. We developed clear and reproducible inclusion criteria and processes, including measures of program efficiency. We conducted seminars and teaching modules to paramedics and hospital-based clinicians including monthly simulator sessions, and performed detailed reviews of each treated case in the form of report cards. In this before-and-after study we compared patients with ECPR attempted prior to, and after, protocol implementation. The primary outcome was TTE, defined as the time of initial professional CPR to establishment of extracorporeal circulation. We compared the median TTE for patients in the two groups using the Wilcoxon signed rank test.
Four patients were identified prior to the protocol and managed in an ad hoc basis; for nine patients the protocol was utilized. Overall favourable neurological outcomes among ECPR-treated patients were 27%. The median TTE was 136 minutes (IQR 98 - 196) in the pre-protocol group, and 60 minutes (IQR 49 - 81) minutes in the protocol group (p=0.0165).
An organized clinical and educational protocol to initiate ECPR for patients with OHCA is feasible and significantly reduces the key benchmark of time-to-ECPR flows.
Comorbidity of internalizing and externalizing problems and its risk and protective factors have not been well incorporated into developmental research, especially among racial minority youth from high-poverty neighborhoods. The present study identified a latent comorbid factor as well as specific factors underlying internalizing and externalizing problems among 592 African American adolescents living in economically disadvantaged neighborhoods (291 male; M age = 15.9 years, SD = 1.43 years). Stressful life events and racial discrimination were associated with higher comorbid problems, whereas stressful life events and exposure to violence were associated with higher specific externalizing problems. Collective efficacy was associated with both lower specific externalizing problems and lower comorbid problems. Moreover, high collective efficacy buffered the risk effects of stressful life events and racial discrimination on comorbid problems. Our results demonstrated the advantages of latent variable modeling to understanding comorbidity by articulating impacts of risk factors on comorbid and specific components underlying internalizing and externalizing problems. They also highlighted the protective effect of collective efficacy in mitigating risks for these problems. Broadly, these findings call for more studies on comorbidities in developmental psychopathology among youth from diverse sociocultural backgrounds.
Comorbidity of internalizing and externalizing problems and its risk and protective factors have not been well incorporated into developmental research, especially among racial minority youth from high-poverty neighborhoods. The present study identified a latent comorbid factor as well as specific factors underlying internalizing and externalizing problems among 592 African American adolescents living in economically disadvantaged neighborhoods (291 male; M age = 15.9 years, SD = 1.43 years). Stressful life events and racial discrimination were associated with higher comorbid problems, whereas stressful life events and exposure to violence were associated with higher specific externalizing problems. Collective efficacy was associated with both lower specific externalizing problems and lower comorbid problems. Moreover, high collective efficacy buffered the risk effects of stressful life events and racial discrimination on comorbid problems. Our results demonstrated the advantages of latent variable modeling to understanding comorbidity by articulating impacts of risk factors on comorbid and specific components underlying internalizing and externalizing problems. They also highlighted the protective effect of collective efficacy in mitigating risks for these problems. These findings broadly call for more studies on comorbidities in developmental psychopathology among youth from diverse sociocultural backgrounds.
The prevalence of serious infections caused by multidrug-resistant pathogens transmitted in the hospital setting has reached alarming levels, despite intensified interventions. In the context of mandates that hospitals ensure compliance with disinfection procedures of surfaces in the environment surrounding the patient, we implemented a multihospital project to both evaluate and improve current cleaning practices.
Thirty-six acute care hospitals in the United States ranging in size from 25 to 721 beds.
We used a fluorescent targeting method to objectively evaluate the thoroughness of terminal room disinfection cleaning before and after structured educational and procedural interventions.
Of 20,646 standardized environmental surfaces (14 types of objects), only 9,910 (48%) were cleaned at baseline (95% confidence interval, 43.4-51.8). Thoroughness of cleaning at baseline correlated only with hospital expenditures for environmental services personnel (P = .02). After implementation of interventions and provision of objective performance feedback to the environmental services staff, it was determined that 7,287 (77%) of 9,464 standardized environmental surfaces were cleaned (P < .001). Improvement was unrelated to any demographic, fiscal, or staffing parameter but was related to the degree to which cleaning was suboptimal at baseline (P < .001).
Significant improvements in disinfection cleaning can be achieved in most hospitals, without a substantial added fiscal commitment, by the use of a structured approach that incorporates a simple, highly objective surface targeting method, repeated performance feedback to environmental services personnel, and administrative interventions. However, administrative leadership and institutional flexibility are necessary to achieve success, and sustainability requires an ongoing programmatic commitment from each institution.
On Tuesday 22 August 2006 approximately 40 people attended the Commission 41 History of Astronomy Business Meeting at the IAU XXVI General Assembly in Prague. Commission president Alex Gurshtein opened the meeting, welcoming the commission members and calling for a moment of silence for those members who passed away in the last triennium. David DeVorkin was appointed recording secretary for the meeting, with Steven Dick as the scruitineer of the ballot. A moment of silence was then observed in the memory of members departed over the last triennium, including: Jerzy Dobrzycki (Poland), Robert Duncan (Australia), Mohammad Edalati (Iran), Philip Morrison (USA), John Perdix (Australia), Neil Porter (Ireland), Gibson Reaves (USA), Brian Robinson (Australia), and Raymond E. White (USA).
Puberty is a major biological and psychosocial milestone. It is a stage of intense physical development accompanied by substantial increases in circulating hormone levels leading to reproductive capability. Not all adolescents experience the transition to puberty at the same age, and differential pubertal timing among adolescents appears to have important implications for psychological and behavioral outcomes, making this an important area of study for integrative biopsychosocial models of development. There is also evidence that variation in pubertal timing may have different effects in boys and girls. In girls, early maturation relative to same-age peers appears to be a risk factor for many negative outcomes (Stattin & Magnusson, 1990). It is associated with increased family conflict that persists beyond the temporary perturbation in familial relations also experienced by on-time and late maturing girls.
Early developing girls are more likely to engage in a variety of problem behaviors, including precocious sexual behavior, alcohol use, and smoking, among others. They are more likely to report multiple emotional problems, including higher levels of distress, psychosomatic symptoms, adjustment problems, and greater dissatisfaction with weight and body image. Accordingly, early developers may be at increased risk for psychopathology, including depression, anxiety, and eating disorders. Finally, there is some evidence that early maturing girls are less likely to achieve academic success in adolescence or to pursue education and professional careers.
The effect of pubertal development on behavioral outcome in males has not been studied nearly as extensively as in females. The reasons are likely twofold.
Following the Sydney General Assembly, the membership of C41 stood at 352, of whom, at the time of writing, three are known to have deceased. Since the formation of the Inter-Union Commission for the History of Astronomy (ICHA) prior to the Sydney General Assembly, C41/ICHA has subsequently acted, in effect, as an integrated Commission with a single OC. In this triennium the C41/ICHA OC made strong efforts to clarify and simplify the controversial issue of admitting non-IAU members to the ICHA. After prolonged and active consultation, the OC approved the document “Procedures for Admitting non-IAU members to the ICHA” and the OC Secretary Prof. Clive Ruggles officially presented this document to the history of astronomy community in C41/ICHA Newsletter no. 6. It is subject to ratification by the C41/ICHA Business Meeting in Prague in 2006.
The Conservation Reserve Program (CRP) takes cropland out of production for 10 years, reducing grain supplies available to elevators. Results suggest that the program has negatively impacted elevator merchandising margins, but that elevators adjusted rather quickly to CRP changes, making most of the adjustment within 1 year. The reduction in margins reflects an element of pressure on agribusinesses that has not been measured in previous studies.
The existence of glass or amorphous component in Portland cement clinker has been questioned for a long time. However, besides the crystalline phases, there are reports in the literature of noncrystalline material in cement clinker, which is considered to be the residue of the melt that has failed to crystallize. Absolute phase abundances were determined in this study by Rietveld refinements with laboratory X-ray data, using both internal and external phase composition standards. The results clearly demonstrate the existence of an amorphous component in Portland cement clinker. The presence of an amorphous component was also apparent from diffraction data for clinker from which the silicate phases had been chemically removed, using both laboratory X-ray and synchrotron radiation patterns.
Porous thin films with helical microstructures were fabricated with the Glancing Angle Deposition technique. These films consisted of arrays of “microsprings” whose geometries could be engineered with nanometer scale control. Some of the mechanical properties of these helically structured films were studied with a nanoindentation technique. Several microscopic “springbed” films were tested over a range of forces using a spherical indenter tip. The geometries of the microsprings were varied, and a number of different materials were used to fabricate these films, which were typically a few micrometers thick. Slanted post arrays, resembling micro-cantilevers, were also subjected to nanoindentation tests. Results of initial experiments, theory, and simulations show that these microstructures behave in a manner analogous to macroscopic springs and cantilevers, and may offer some insight into how materials behave at the microscale.
Adenosine, when given as an intravenous bolus, has been shown to produce atrioventricular nodal block in humans. To examine the effect of adenosine on conduction across both accessory pathways and the atrioventricular node in children, we reviewed our experience with adenosine administered during both atrial and ventricular pacing in 42 patients with atrioventricular resting tachycardia and in eight patients with atrioventricular nodal reentry tachycardia. Adenosine was administered as a mean bolus of 195 μg/kg/dose during both atrial and ventricular pacing, examining antegrade and retrograde conduction before and after radiofrequency ablation. In those patients with persistent or intermittent pre-excitation, anomalous ventricular activation was either unchanged (n=8) or increased (n=11). Retrograde conduction (either through the accessory pathway alone in three, or across both the accessory pathway and the atrioventricular node in 19) persisted in 92% of the 24 patients studied. Adenosine produced either first or third degree antegrade heart block in all patients studied without pre-excitation (those with either dual atrioventricular nodal pathways or concealed accessory pathways). Adenosine produced retrograde block in all of the eight patients with dual atrioventricular nodal pathways. In contrast, retrograde conduction persisted in 82% (14/17) of patients with concealed accessory pathways (p=0.001). When used to examine retrograde conduction, adenosine was a sensitive (82%) and highly specific (producing retrograde atrioventricular block in all patients with dual atrioventricular nodal pathways) predictor of tachycardia supported by a concealed accessory pathway. Adenosine yielded a sensitivity and specificity of 96% and a positive predictive value of 99.5% for the success of ablation of accessory pathways. These data indicate that the pattern of adenosine-induced changes in either antegrade or retrograde atrioventricular conduction, or conduction in both directions, in young patients with supraventricular tachycardia is related to the mechanism of the tachycardia. Adenosine, therefore, is a useful adjunct in the electrophysiologic evaluation of supraventricular tachycardia in children.
The Conservation Reserve Program reduced available cropland in the United States by 34 million acres under the first nine signup periods (1986–1990). Among these are ten million acres with wheat base and four million acres with corn base, which could potentially produce 288 million bushels of wheat and 340 million bushels of corn per year upon contract expiration. The impacts of expiring CRP contacts on the production and prices of wheat and corn in the United States are estimated. Based on past production practices and post-CRP land-use intentions of contract holders, 48.2% of base acres enrolled in CRP will return to production. Under this scenario, wheat prices will decline by more than 7% and corn prices by more than 2% by 2000, unless ARP levels, normal flex acres percent, or target prices are changed.
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