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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.
The Sewol ferry disaster is one of the most tragic events in Korea’s modern history. Among the 476 people on board, which included Danwon High School students (324) and teachers (14), 304 passengers died in the disaster (295 recovered corpses and 9 missing) and 172 survived. Of the rescued survivors, 72 were attending Danwon High School, located in Ansan City, and residing in a residence nearby. Because the students were young, emotionally susceptible adolescents, both the government and the parents requested the students be grouped together at a single hospital capable of appropriate psychiatric care. Korea University Ansan Hospital was the logical choice, as the only third-tier university-grade hospital with the necessary faculty and facilities within the residential area of the families of the students. We report the experiences and the lessons learned from the processes of preparing for and managing the surviving young students as a community-based hospital. (Disaster Med Public Health Preparedness. 2017;11:389–393)
We present experimental evidence of enhancement of thermoelectric properties in tellurium (Te) nanoparticle-embedded bismuth antimony telluride (BiSbTe) alloys. Bi0.5Sb1.5Te3 films with a high density of Te particles of 10–20 nm size were prepared by growth of alternating multilayers of ultrathin Te and Bi0.5Sb1.5Te3. As the amount of Te nanoinclusions increased up to ∼15%, the Seebeck coefficient and thermoelectric power factor were increased. Based on the concept of band bending at heterointerfaces as a carrier energy filter, the energy relaxation calculation was made to confirm that the Te nanoinclusions result in a carrier energy filtering effect in p-type bismuth antimony telluride. In addition, thermal conductivities were reduced in the Te-embedded samples, permitting possible further enhancement of the thermoelectric figure of merit. The advantages of Te nanoinclusions in p-type Bi0.5Sb1.5Te3alloys on thermoelectric performance are experimentally realized by both electron- and phonon scattering.
Rapid thermal annealing (RTA) processing under N2 and O2 ambient is suggested and characterized in this work for improvement of SiCOH ultra-low-k (k = 2.4) film properties. Low-k film was deposited by plasma-enhanced chemical vapor deposition (PECVD) with decamethylcyclopentasiloxane and cyclohexane precursors. The PECVD films were treated by RTA processing in N2 and O2 environments at 550 °C for 5 min, and k values of 1.85 and 2.15 were achieved in N2 and O2 environments, respectively. Changes in the k value were correlated with the chemical composition of C–Hx and Si–O related groups determined from the Fourier transform infrared (FTIR) analysis. As the treatment temperature was increased from 300 to 550 °C, the signal intensities of both the CHx and Si–CH3 peaks were markedly decreased. The hardness and modulus of the film processed by RTA have been determined as 0.44 and 3.95 GPa, respectively. Hardness and modulus of RTA-treated films were correlated with D-group [O2Si–(CH3)2] and T-group [O3Si–(CH3)] fractions determined from the FTIR Si–CH3 bending peak. The hardness and modulus improvement in this work is attributed to the increase of oxygen content in (O)x–Si–(CH3)y by rearrangement.
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