Abstract only Background: Deployment of mechanical chest compression devices is suspected to increase hands-off fraction. A potential benefit of mechanical devices is defibrillation during ...compressions, but it is unknown if this is utilized in the field. Our objectives were to compare hands-off fraction between manual CPR (M-CPR) and integrated AutoPulse CPR (iA-CPR), and to determine if providers will defibrillate during mechanical compressions. Methods: An international randomized clinical trial of EMS treated adult cardiac arrests of cardiac origin was conducted at 5 sites from March 2009 to January 2011. All EMS providers received 4 hours of training in providing high quality CPR and AutoPulse deployment. After initial manual compressions, patients were randomized to iA-CPR or M-CPR. ECG and impedance or accelerometer data were analyzed to determine the number of compressions per minute, and hands-off fraction was calculated at 10 and 20 minutes. Descriptive statistics and 95% CI were calculated. Results: A total of 4,232 subjects were enrolled. Electronic data were available for 4,135 (98%) cases (2,055 M-CPR, 2,080 iA-CPR). There were 117 (3%) cases with no compression data (69 M-CPR, 48 iA-CPR). There were more compressions per minute in the M-CPR arm (table). The mean hands-off fraction at 10 minutes was 20.4% M-CPR and 21.5% iA-CPR (difference 1.1%; 95% CI 0.5% to 1.7%) and at 20 minutes was 20.2% M-CPR and 19.6% iA-CPR (difference -0.6%; 95% CI -1.2% to 0.1%). Average time to AutoPulse start after defibrillator on was 172 seconds (±183). In 84% of the iA-CPR cases the device was not stopped during the first cycle of resuscitation. 74% of the defibrillated iA-CPR cases were shocked during compressions. Conclusion: This is the first study to document operational deployment of the AutoPulse. There was no difference in hands-off fraction between M-CPR and iA-CPR. Providers without prior experience using the AutoPulse shocked through compressions in the majority of cases.
It is becoming increasingly apparent that neonates are not immune-compromised, but rather immune-variant. We have described a neonatal model of Yersinia enterocolitica infection in which protective ...inflammation occurs at the level of the mesenteric lymph nodes (MLN). The expression of pro-inflammatory, but not anti-inflammatory, cytokine genes was markedly induced in the neonatal MLN early after infection. Strikingly, the expression levels in neonates greatly exceeded those seen in infected adults. Elevated pro-inflammatory gene expression was quickly followed by enhanced innate phagocyte recruitment to the MLN of neonates, compared to adults. Neither CD4+ nor B cells were required for inflammation in the neonatal MLN; however, CD4+ and CD8+ cells did increase as well as innate cells as early as 24 hours post-infection. Although MyD88 was shown to be critical in eliciting inflammation in neonates, neither TLR4 nor TLR9 were required. Because Y. enterocolitica contains ligands for multiple TLRs, it is possible that compensation by other TLRs is sufficient to elicit inflammation in the absence of TLR4 or TLR9. Bacterial components were also critical in eliciting high level inflammation in the neonatal MLN. The virulence plasmid of Y. enterocolitica was required for selected pro-inflammatory gene expression and neutrophil recruitment to the neonatal MLN. TNF-alpha protein expression and neutrophil recruitment was markedly enhanced in the neonatal MLN after infection with the delta-yopP strain, while only a modest increase occurred in adults. These models suggest that the level of intestinal inflammation in neonates is critical in determining whether protection or pathology occurs following infection with microbial pathogens.
...the traditional checks against officers remain, as claims may still be brought for breach of the fiduciary duty of loyalty or actions taken in bad faith and the board and stockholders (bringing ...suits derivatively on behalf of the corporation subject to demand requirements) may still bring fiduciary claims against officers. Frequently Asked Questions For more than 35 years, Delaware law has permitted Delaware corporations to exculpate directors from personal liability for monetary damages associated with breaches of the duty of care. ...that protection did not extend to a Delaware corporation's officers. ...stockholder plaintiffs have had an incentive to single out officers for duty of care claims, and in recent years, they have deployed that tactic to extract settlement leverage. ...corporations (for their own benefit and, indirectly, the stockholders) that adopt officer exculpation, where already obligated to indemnify or insure those officers, are expected to see benefits in terms of tempered insurance premiums and reduced settlement costs over time as compared to those who do not adopt officer exculpation.
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CEKLJ, IZUM, KILJ, NUK, PILJ, SAZU, UL, UM, UPUK
