Since development of the Utstein style recommendations for the uniform reporting of cardiac arrest, increasing numbers of national and regional out-of-hospital cardiac arrest (OHCA) registries have ...been established worldwide. The International Liaison Committee on Resuscitation (ILCOR) created the Research and Registries Working Group and aimed to systematically report data collected from these registries.
We conducted two surveys of voluntarily participating national and regional registries. The first survey aimed to identify which core elements of the current Utstein style for OHCA were collected by each registry. The second survey collected descriptive summary data from each registry. We chose the data collected for the second survey based on the availability of core elements identified by the first survey.
Seven national and four regional registries were included in the first survey and nine national and seven regional registries in the second survey. The estimated annual incidence of emergency medical services (EMS)-treated OHCA was 30.0–97.1 individuals per 100,000 population. The combined data showed the median age varied from 64 to 79 years and more than half were male in all 16 registries. The provision of bystander cardiopulmonary resuscitation (CPR) and bystander automated external defibrillator (AED) use was 19.1–79.0% in all registries and 2.0–37.4% among 11 registries, respectively. Survival to hospital discharge or 30-day survival after EMS-treated OHCA was 3.1–20.4% across all registries. Favorable neurological outcome at hospital discharge or 30 days after EMS-treated OHCA was 2.8–18.2%. Survival to hospital discharge or 30-day survival after bystander-witnessed shockable OHCA ranged from 11.7% to 47.4% and favorable neurological outcome from 9.9% to 33.3%.
This report from ILCOR describes data on systems of care and outcomes following OHCA from nine national and seven regional registries across the world. We found variation in reported survival outcomes and other core elements of the current Utstein style recommendations for OHCA across nations and regions.
After a violent earthquake, the supply of medical services may fall short of the rising demand, leading to overcrowding in hospitals, and, consequently, a collapse in the healthcare system. This ...paper takes the emergency care system in Taiwan as the research context, where first-aid hospitals are ranked to three levels, advanced, intermediate, and general, and, currently, emphasizes on a general emergency responsibility hospital. Having limited capacity and capability, a general emergency responsibility hospital treats minor and moderate injuries, from which the majority of earthquake-induced casualties suffer. The purpose of this study is to analyze the impact of this group of earthquake-induced non-urgent patients on the performance of a hospital. A patient flow model was built to represent patients' paths throughout emergency care. Based on the model, discrete event simulation was applied to simulate patients' trajectories and states of a hospital under four seismic scenarios, where patient visits are 1.4, 1.6, 1.9, and 2.3 times the normal number. A healthcare performance index, Crowdedness Index (CI), is proposed to measure crowdedness on a daily basis, which is defined as the ratio of the average waiting time for treatment to the recommended maximal waiting time. Results of simulations rendered the establishment of empirical equations, describing the relation between the maximum CIs and the patient growth ratios. In the most severe case in this study, the maximum CI exceeds 92 and it takes 10 days to recover from the quality drop. This highlights the problem a general emergency responsibility hospital may encounter if no emergency response measure is implemented. Findings are provided pertaining to the predication of a recovery curve and the alarming level of patient increase, which are supportive information for preparedness planning as well as response measure formulation to improve resilience.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Timely assessment to accurately prioritize patients is crucial for emergency department (ED) management. Urgent (i.e., level-3, on a 5-level emergency severity index system) patients have become a ...challenge since under-triage and over-triage often occur. This study was aimed to develop a computational model by artificial intelligence (AI) methodologies to accurately predict urgent patient outcomes using data that are readily available in most ED triage systems. We retrospectively collected data from the ED of a tertiary teaching hospital between January 1, 2015 and December 31, 2019. Eleven variables were used for data analysis and prediction model building, including 1 response, 2 demographic, and 8 clinical variables. A model to predict hospital admission was developed using neural networks and machine learning methodologies. A total of 282,971 samples of urgent (level-3) visits were included in the analysis. Our model achieved a validation area under the curve (AUC) of 0.8004 (95% CI 0.7963-0.8045). The optimal cutoff value identified by Youden's index for determining hospital admission was 0.5517. Using this cutoff value, the sensitivity was 0.6721 (95% CI 0.6624-0.6818), and the specificity was 0.7814 (95% CI 0.7777-0.7851), with a positive predictive value of 0.3660 (95% CI 0.3586-0.3733) and a negative predictive value of 0.9270 (95% CI 0.9244-0.9295). Subgroup analysis revealed that this model performed better in the nontraumatic adult subgroup and achieved a validation AUC of 0.8166 (95% CI 0.8199-0.8212). Our AI model accurately assessed the need for hospitalization for urgent patients, which constituted nearly 70% of ED visits. This model demonstrates the potential for streamlining ED operations using a very limited number of variables that are readily available in most ED triage systems. Subgroup analysis is an important topic for future investigation.
Public access to automated external defibrillators (AEDs) plays a key role in increasing survival outcomes for patients with out-of-hospital cardiac arrest. Based on the concept of maximizing "rescue ...benefit" of AEDs, we aimed to propose a systematic methodology for optimizing the deployment of AEDs, and develop such strategies for long and narrow spaces.
We classified the effective coverage of an AED in hot, warm, and cold zones. The AEDs were categorized, according to their accessibility, as fixed, summonable, or patrolling types. The overall rescue benefit of the AEDs were evaluated by the weighted size of their collective hot zones. The optimal strategies for the deployment of AEDs were derived mathematically and numerically verified by computer programs.
To maximize the overall rescue benefit of the AEDs, the AEDs should avoid overlapping with each other's coverage as much as possible. Specific rules for optimally deploying one, two, or multiple AEDs, and various types of AEDs are summarized and presented.
A methodology for assessing the rescue benefit of deployed AEDs was proposed, and deployment strategies for maximizing the rescue benefit of AEDs along a long, narrow, corridor-like, finite space were derived. The strategies are simple and readily implementable. Our methodology can be easily generalized to search for optimal deployment of AEDs in planar areas or three-dimensional spaces.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
With the rapid development of the COVID-19 pandemic, countries are trying to cope with increasing medical demands, and, at the same time, to reduce the increase of infected numbers by implementing a ...number of public health measures, namely non-pharmaceutical interventions (NPIs). These public health measures can include social distancing, frequent handwashing, and personal protective equipment (PPE) at the personal level; at the community and the government level, these measures can range from canceling activities, avoiding mass gatherings, closing facilities, and, at the extreme, enacting national or provincial lockdowns. Rather than completely stopping the infectious disease, the major purpose of these NPIs in facing an emerging infectious disease is to reduce the contact rate within the population, and reduce the spread of the virus until the time a vaccine or reliable medications become available. The idea is to avoid a surge of patients with severe symptoms beyond the capacity of the hospitals' medical resources, which would lead to more mortality and morbidity. While many countries have experienced steep curves in new cases, some, including Hong Kong, Vietnam, South Korea, New Zealand, and Taiwan, seem to have controlled or even eliminated the infection locally. From its first case of COVID-19 on the 21 January until the 12 May, Taiwan had 440 cases, including just 55 local infections, and seven deaths in total, representing 1.85 cases per 100,000 population and a 1.5% death rate (based on the Worldometer 2020 statistics of Taiwan's population of 23.8 million). This paper presents evidence that spread prevention involving mass masking and universal hygiene at the early stage of the COVID-19 pandemic resulted in a 50% decline of infectious respiratory diseases, based on historical data during the influenza season in Taiwan. These outcomes provide potential support for the effectiveness of widely implementing public health precaution measures in controlling COVID-19 without a lockdown policy.
Color gamut is of the paramount importance in the display. Light-current-voltage (<inline-formula> <tex-math notation="LaTeX">L-I-V </tex-math></inline-formula>) characteristics of red, green, and ...blue flip-chip mini-light-emitting diodes (LEDs) (<inline-formula> <tex-math notation="LaTeX">100\,\,\mu \text{m}\,\,\times 200\,\,\mu \text{m} </tex-math></inline-formula>) are investigated at temperatures similar to the operational temperatures. Both the ideality factor and the temperature dependence of external quantum efficiency (EQE) suggest that the nonradiative loss in red mini-LED is higher. We also illustrate the intensive lateral luminous intensity fluctuation for red mini-LED under the over-driving current by capturing the spatial emission mapping. The influence of temperature and driving current on the chromaticity coordinates of mini-LEDs is determined. Furthermore, we propose a drive-current algorithm to maximize the color gamut of the trichromatic mixed light at different temperatures. The results indicate that, for the application of self-emitting mini-LED displays, the maximum color gamut is more sensitive to green emission, whereas enhancing the radiative recombination in red mini-LED could contribute a lot to the improvement on net performance.
A simple printed multiband antenna with parasitic-element design for multi-standard handheld terminals in mobile communications is presented. The proposed antenna performs three resonance modes ...covering six bands of wireless standards, including GSM, GPS, DCS, PCS, UMTS, and LTE 2300/2500. In geometry, the antenna simply consists of two metal stubs. One is an L-shaped driven stub working as a feeder and an embedded transmission line. The other is a U-shaped parasitic stub working as a radiator. With fully printed and simple configuration, the proposed antenna design is cost effective in manufacturing and easy to optimize for different frequency bands. Parametric studies and the design rule are included. The antenna occupies an area of 18 × 37 mm 2 on top of a system board. This communication covers the details of the antenna design, working principle, and the performances of simulation and measurement.
Emergency department (ED) overcrowding is a public health crisis that affects patient care quality. Space management in the ED can affect patient flow dynamics and clinical practice. We proposed a ...novel design of the "emergency procedure zone" (EPZ). The purpose of the EPZ was to provide an isolated area for clinical practice and procedure teaching, to ensure a secure area with adequate equipment and monitors, and safeguard patient privacy and safety. This study aimed to analyze the impact of the EPZ on procedural practice and patient flow dynamics.
This study was conducted at the ED of a tertiary teaching hospital in Taiwan. Data were collected from 1 March 2019 to 31 August 2020 (pre-EPZ period) and from 1 November 2020 to 30 April 2022 (post-EPZ period). Statistical analyses were performed using IBM SPSS Statistics software. This study focused on the number of procedures and length of stay in the emergency department (LOS-ED). Variables were analyzed using the chi-square test and Mann-Whitney U test. Statistical significance was defined as
< 0.05.
There were 137,141 (pre-EPZ period) and 118,386 (post-EPZ period) ED visits recorded during this period. The post-EPZ period showed a significant increase in central venous catheter insertion, chest tube or pigtail placement, arthrocentesis, lumbar puncture, and incision and drainage procedures (
< 0.001). For patients who were directly discharged from the ED, the post-EPZ period also had a higher percentage of ultrasound studies performed in the ED and a shorter LOS-ED for patients who were directly discharged from the ED (
< 0.001).
The establishment of an EPZ in the ED has a positive impact on procedural efficiency. The EPZ improved diagnosis and disposition efficiency, shortened the length of stay, and provided benefits such as improved management, patient privacy, and teaching opportunities.
Perovskite quantum dots (PQDs) are a competitive candidate for next‐generation display technologies as a result of their superior photoluminescence, narrow emission, high quantum yield, and color ...tunability. However, due to poor thermal resistance and instability under high energy radiation, most PQD‐based white light‐emitting diodes (LEDs) show only modest luminous efficiency of ≈50 lm W−1 and a short lifetime of <100 h. In this study, by incorporating cellulose nanocrystals, a new type of QD film is fabricated: CH3NH3PbBr3 PQD paper that features 91% optical absorption, intense green light emission (518 nm), and excellent stability attributed to the complexation effect between the nanocellulose and PQDs. The PQD paper is combined with red K2SiF6:Mn4+ phosphor and blue GaN LED chips to fabricate a high‐performance white LED demonstrating ultrahigh luminous efficiency (124 lm W−1), wide color gamut (123% of National Television System Committee), and long operation lifetime (240 h), which paves the way for advanced lighting technology.
Perovskite quantum dot paper, a new type of perovskite quantum dot film, is demonstrated. Using a simple, fast, scalable, and inexpensive paper fabrication process, the resulting perovskite quantum dot paper is uniform, of high quality, and very stable; it is able to bear high energy radiation and greatly improve the efficiency of perovskite quantum dot–based white light‐emitting diodes.
Adenosine -5'-triphosphate (ATP) plays a valuable role in metabolic activity to produce adequate energy in a biosystem. A high ATP/AMP ratio has a correlation with diabetes that induces suppression ...of AMP-activated protein kinase (AMPK). Matrix-assisted laser desorption/ionization (MALDI)-mass spectrometry (MS) has outstanding potential in determining the ratio of several types of adenosine phosphates in a sample to rapidly understand the primary energy transfer in metabolism. Although MALDI is viewed as a soft ionization technique for MS analysis, excess photon energy might crack the phosphate bonds leading to misinterpretation of the ATP level. In this work, ionic liquid matrices (ILMs) were employed to reduce fragmentation and increase the detection efficiency during the MALDI process. This study demonstrated for the first time that 2,5-dihydroxybenzoic acid pyridine (DHBP) is one of the most effective matrices for further quantitative analysis of adenosine nucleotides. This systematic screening of ILMs also enhances the fundamental understanding of MALDI.
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