Abstract Objective To compare integrated automated load distributing band CPR (iA-CPR) with high-quality manual CPR (M-CPR) to determine equivalence, superiority, or inferiority in survival to ...hospital discharge. Methods Between March 5, 2009 and January 11, 2011 a randomized, unblinded, controlled group sequential trial of adult out-of-hospital cardiac arrests of presumed cardiac origin was conducted at three US and two European sites. After EMS providers initiated manual compressions patients were randomized to receive either iA-CPR or M-CPR. Patient follow-up was until all patients were discharged alive or died. The primary outcome, survival to hospital discharge, was analyzed adjusting for covariates, (age, witnessed arrest, initial cardiac rhythm, enrollment site) and interim analyses. CPR quality and protocol adherence were monitored (CPR fraction) electronically throughout the trial. Results Of 4753 randomized patients, 522 (11.0%) met post enrollment exclusion criteria. Therefore, 2099 (49.6%) received iA-CPR and 2132 (50.4%) M-CPR. Sustained ROSC (emergency department admittance), 24 h survival and hospital discharge (unknown for 12 cases) for iA-CPR compared to M-CPR were 600 (28.6%) vs. 689 (32.3%), 456 (21.8%) vs. 532 (25.0%), 196 (9.4%) vs. 233 (11.0%) patients, respectively. The adjusted odds ratio of survival to hospital discharge for iA-CPR compared to M-CPR, was 1.06 (95% CI 0.83–1.37), meeting the criteria for equivalence. The 20 min CPR fraction was 80.4% for iA-CPR and 80.2% for M-CPR. Conclusion Compared to high-quality M-CPR, iA-CPR resulted in statistically equivalent survival to hospital discharge.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Exercise is commonly prescribed as a lifestyle treatment for chronic metabolic diseases as it functions as an insulin sensitizer, cardio-protectant, and essential lifestyle tool for effective weight ...maintenance. Exercise boosts the production of reactive oxygen species (ROS) and subsequent transient oxidative damage, which also upregulates counterbalancing endogenous antioxidants to protect from ROS-induced damage and inflammation. Exercise elevates heme oxygenase-1 (HO-1) and biliverdin reductase A (BVRA) expression as built-in protective mechanisms, which produce the most potent antioxidant, bilirubin. Together, these mitigate inflammation and adiposity. Moderately raising plasma bilirubin protects in two ways: (1) via its antioxidant capacity to reduce ROS and inflammation, and (2) its newly defined function as a hormone that activates the nuclear receptor transcription factor PPARα. It is now understood that increasing plasma bilirubin can also drive metabolic adaptions, which improve deleterious outcomes of weight gain and obesity, such as inflammation, type II diabetes, and cardiovascular diseases. The main objective of this review is to describe the function of bilirubin as an antioxidant and metabolic hormone and how the HO-1-BVRA-bilirubin-PPARα axis influences inflammation, metabolic function and interacts with exercise to improve outcomes of weight management.
Abstract Introduction An 80% chest compression fraction (CCF) during resuscitation is recommended. However, heterogeneous results in CCF studies were found during the 2015 Consensus on Science (CoS), ...which may be because chest compressions are stopped for a wide variety of reasons including providing lifesaving care, provider distraction, fatigue, confusion, and inability to perform lifesaving skills efficiently. Objective The effect of confounding variables on CCF to predict cardiac arrest survival. Methods A secondary analysis of emergency medical services (EMS) treated out-of-hospital cardiac arrest (OHCA) patients who received manual compressions. CCF (percent of time patients received compressions) was determined from electronic defibrillator files. Two Sample Wilcoxon Rank Sum or regression determined a statistical association between CCF and age, gender, bystander CPR, public location, witnessed arrest, shockable rhythm, resuscitation duration, study site, and number of shocks. Univariate and multivariate logistic regressions were used to determine CCF effect on survival. Results Of 2132 patients with manual compressions 1997 had complete data. Shockable rhythm ( p < 0.001), public location ( p < 0.004), treatment duration ( p < 0.001), and number of shocks ( p < 0.001) were associated with lower CCF. Univariate logistic regression found that CCF was inversely associated with survival (OR 0.07; 95% CI 0.01–0.36). Multivariate regression controlling for factors associated with survival and/or CCF found that increasing CCF was associated with survival (OR 6.34; 95% CI 1.02–39.5). Conclusion CCF cannot be looked at in isolation as a predictor of survival, but in the context of other resuscitation activities. When controlling for the effects of other resuscitation activities, a higher CCF is predictive of survival. This may explain the heterogeneity of findings during the CoS review.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
The presence of clouds and their shadows in remotely sensed images limits their potential uses for extracting information. The commonly used methods for replacing clouded pixels by land cover ...reflection estimates usually yield poor results if the images being combined exhibit radical differences in target radiance due, for example, to large date separation and high temporal variability. This study focuses on introducing geostatistical techniques for interpolating the DN values of clouded pixels in multispectral remotely sensed images using traditional ordinary cokriging and standardized ordinary cokriging. Two case studies were conducted in this study. The first case study shows that the methods work well for the small clouds in a heterogeneous landscape even when the images being combined show high temporal variability. Although the basic spatial structure in large size clouds can be captured, image interpolation-related artefacts such as smoothing effects are visually apparent in a heterogeneous landscape. The second case study indicates that the cokriging methods work better in homogenous regions such as the dominantly agricultural areas in United States Midwest. Various statistics including both global statistics and local statistics are employed to confirm the reliability of the methods.
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BFBNIB, GIS, IJS, KISLJ, NUK, PNG, UL, UM, UPUK
Non-combat musculoskeletal injuries (MSKIs) during military training significantly impede the US military's functionality, with an annual cost exceeding $3.7 billion. This study aimed to investigate ...the effectiveness of a markerless motion capture system and full-body biomechanical movement pattern assessments to predict MSKI risk among military trainees.
A total of 156 male United States Air Force (USAF) airmen were screened using a validated markerless biomechanics system. Trainees performed multiple functional movements, and the resultant data underwent Principal Component Analysis and Uniform Manifold And Projection to reduce the dimensionality of the time-dependent data. Two approaches, semi-supervised and supervised, were then used to identify at-risk trainees.
The semi-supervised analysis highlighted two major clusters with trainees in the high-risk cluster having a nearly five times greater risk of MSKI compared to those in the low-risk cluster. In the supervised approach, an AUC of 0.74 was produced when predicting MSKI in a leave-one-out analysis.
The application of markerless motion capture systems to measure an individual's kinematic profile shows potential in identifying MSKI risk. This approach offers a novel way to proactively address one of the largest non-combat burdens on the US military. Further refinement and wider-scale implementation of these techniques could bring about substantial reductions in MSKI occurrence and the associated economic costs.
The American Heart Association Mission: Lifeline program objectives are to improve the quality of care and outcomes for patients with ST-segment-elevation myocardial infarction. Every minute of delay ...in treatment adversely affects 1-year mortality. Transfer of patients safely and timely to hospitals with primary percutaneous coronary intervention capability is needed to improve outcomes. But treatment times continue to show delays, especially during interhospital transfers. A simple 3-step process of an interhospital "Call 9-1-1" protocol may expedite this process. This STAT TRANSFER process uses a systems approach that considers diverse ways in which patients access care, how EMS responds and determines destinations, how referring hospital transfers are performed, urban and rural differences, and how receiving hospitals prepare for an incoming patient with ST-segment-elevation myocardial infarction. This initiative suggests a strategy to reduce variability in interhospital transfer times using a STAT TRANSFER and a Call 9-1-1 process in a system of care that involves all stakeholders.
Abstract Background Shorter manual chest compression pauses prior to defibrillation attempts is reported to improve the defibrillation success rate. Mechanical load-distributing band (LDB-) CPR ...enables shocks without compression pause. We studied pre-shock pause and termination of ventricular fibrillation/pulseless ventricular tachycardia 5 s post-shock (TOF) and return of organized rhythm (ROOR) with LDB and manual (M-) CPR. Methods In a secondary analysis from the Circulation Improving Resuscitation Care trial, patients with initial shockable rhythm and interpretable post-shock rhythms were included. Pre-shock rhythm, pause duration (if any), and post-shock rhythm were obtained for each shock. Associations between TOF/ROOR and pre-shock pause duration, including no pause shocks with LDB-CPR, were analyzed with Chi-square test. A p -value <0.05 was considered statistically significant. Results For TOF and ROOR analyses we included 417 LDB-CPR patients with 1476 and 1438 shocks, and 495 M-CPR patients with 1839 and 1796 shocks, respectively. For first shocks with LDB-CPR, pre-shock pause was associated with TOF ( p = 0.049) with lowest TOF (77%) for shocks given without pre-shock compression pause. This association was not significant when all shocks were included ( p = 0.07) and not for ROOR. With M-CPR there were no significant associations between shock-related chest compression pause duration and TOF or ROOR. Conclusion For first shocks with LDB-CPR, termination of fibrillation was associated with pre-shock pause duration. There was no association for the rate of return of organized rhythm. For M-CPR, where no shocks were given during continuous chest compressions, there were no associations between pre-shock pause duration and TOF or ROOR.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Although geographers are highly visible in research into contemporary climate changes accompanying greenhouse gas increases ("global warming"), a relatively little explored component by them is the ...impact of aviation. This contrasts with the atmospheric science community of cloud physicists, chemists, and numerical modelers, who use geographic tools of trade. Geographers are well positioned to investigate aviation-climate impacts, especially related to contrail clouds, given geographic traditions of environment, spatial variation, regionalization, generalization, and the integrative approach to studying physical and human systems (here, climate, transportation, and energy). We highlight the role played by geographers in contrail-climate studies and advocate for a broader involvement in aviation policy formulation.
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BFBNIB, DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Abstract Introduction Animal studies indicate higher termination of VF/VT (TOF) rates after shocks delivered during the decompression phase of the compression cycle for manual and mechanical CPR. We ...investigated TOF for shocks delivered in different compression cycle phases during load distributing band (LDB) mechanical CPR in the CIRC trial. Methods Shocks were retrospectively categorized as delivered during the compression, decompression, or relaxation phase of LDB compressions using transthoracic impedance data. Shocks delivered when the LDB device was paused, were used as controls. The first shock and the first up-to-three shocks (first shocks plus shocks two and three if given) from patients with initial VF/VT and LDB CPR prior to shock were grouped according to compression cycle phase. TOF rates for these groups versus the control group were analyzed using logistic regression for first shocks and the general estimating equations (GEE) model for the up-to-three shocks. Adjustments were made for bystander CPR, witnessed arrest, defibrillator shock energy and transthoracic impedance. Results Among 244 first shocks and 685 up-to-three shocks TOF success rates were lower ( p < 0.05 and p < 0.02) for shocks given during the compression phase (72% and 71% respectively) than for control shocks given during compression pauses (86% and 82% respectively). Decompression and relaxation phase shocks had TOF rates not different from the controls. Conclusion Shocks delivered in the compression phase of LDB chest compressions had lower TOF rates than shocks delivered while pausing the LDB device. More research is needed to see how defibrillation during chest compressions affect ROSC and survival.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
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