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PubMed2004

Witnessed arrest, but not delayed bystander cardiopulmonary resuscitation improves prehospital cardiac arrest survival.

INTRODUCTION: This study correlated the effect of witnessing a cardiac arrest and instituting bystander CPR (ByCPR), as a secondary end point in a study evaluating the effect of bicarbonate on survival. METHODS: This prospective, randomised, double blinded clinical intervention trial enrolled 874 prehospital cardiopulmonary arrest patients encountered in a prehospital urban, suburban, and rural regional emergency medical service (EMS) area. This group underwent conventional advanced cardiac life support intervention followed by empiric early administration of sodium bicarbonate (1 mEq/l), monitoring conventional resuscitation parameters. Survival was measured as presence of vital signs on emergency department (ED) arrival. Data were analysed using chi(2) with Pearson correlation and odds ratio where appropriate. RESULTS: The overall survival rate was 13.9% (110 of 792) of prehospital cardiac arrest patients. The mean (SD) time until provision of bystander cardiopulmonary resuscitation (ByCPR) by laymen was 2.08 (2.77) minutes, and basic life support (BLS) by emergency medical technicians was 6.62 (5.73) minutes. There was improved survival noted with witnessed cardiac arrest-a 2.2-fold increase in survival, 18.9% (76 of 402) versus 8.6% (27 of 315) compared with unwitnessed arrests (p<0.001) with a decreased risk ratio of mortality of 0.4534 (95% CI, 0.0857 to 0.1891). The presence of ByCPR occurred in 32% (228 of 716) of patients, but interestingly did not correlate with survival. The survival rate was 18.2% (33 of 181) if ByCPR was performed within two minutes and 12.8% (6 of 47), if performed >two minutes (p = 0.3752). CONCLUSIONS: Survival after prehospital cardiac arrest is more likely when witnessed, but not necessarily when ByCPR was performed by laymen.

Adult↗
PubMed2002

Occupational injury prevention research: progress and priorities.

The twentieth century witnessed remarkable reductions in the number and rate of occupational fatalities and injuries. However, many preventable injuries and deaths still occur. Barriers to progress in occupational injury prevention are discussed, along with strategies for overcoming them. In mining, the frequency of death has dramatically declined over the century. The latest figures from the BLS indicate that less than 6000 worker deaths from injury occurred in 2000. Catastrophic events have prompted increased attention, resources, and action on workplace hazards and risks, resulting in sweeping changes, including new protective laws. Science based approaches to prevention have contributed to progress. Multidisciplinary collaboration among injury prevention researchers, and collaboration and cooperation among multiple sectors, have improved the relevance and application of injury prevention research and development. Barriers to further progress include lack of evaluation of the effectiveness of prevention strategies and technologies, including cost effectiveness; lack of widespread implementation of known, effective prevention; and lack of efficient transfer and implementation of prevention knowledge and products to the workplace. Evaluation and implementation of prevention efforts are most successfully achieved in partnership between researchers and the industry at risk, which requires outreach efforts on the part of the occupational research community.

Accident Prevention↗
PubMed2003

Frequency dispersion of sound propagation in Rouse polymer melts via generalized dynamic random phase approximation.

An extended generalization of the dynamic random phase approximation (DRPA) for L-component polymer systems is presented. Unlike the original version of the DRPA, which relates the (LxL) matrices of the collective density-density time correlation functions and the corresponding susceptibilities of concentrated polymer systems to those of the tracer macromolecules and so-called broken-links system (BLS), our generalized DRPA solves this problem for the (5xL) x (5xL) matrices of the coupled susceptibilities and time correlation functions of the component number, kinetic energy and flux densities. The presented technique is used to study propagation of sound and dynamic form-factor in disentangled (Rouse) monodisperse homopolymer melt. The calculated ultrasonic velocity and absorption coefficient reveal substantial frequency dispersion. The relaxation time tau is proportional to the degree of polymerization N, which is N times less than the Rouse time and evidences strong dynamic screening because of interchain interaction. We discuss also some peculiarities of the Brillouin scattering in polymer melts. Besides, a new convenient expression for the dynamic structure function of the single Rouse chain in (q,p) representation is found.

Journal Article↗
PubMed1980

Light microscopic, immunohistochemical localization of the pia-glial basal lamina.

The current histologic methods for studying the pia-glial basal lamina (BL) are inappropriate for high contrast, permanent light microscopy preparation. We have developed a staining technique for epithelial BL which is highly specific, extremely sensitive, permanent, relatively inexpensive, and suitable for light or electron microscopy (EM). Central nervous system (CNS) basement membrane zone (BMZ) antigens were isolated by the technique of Meezan (1975) from female albino Wistar rats. Using this CNS BMZ preparation as an antigenic source, a hyperimmune rabbit serum was developed. This serum was exhaustively adsorbed with rat splenic pulp to remove undesirable antibodies to endothelial BL and collagen. The peroxidase-antiperoxidase indirect antibody technique was used to test the staining specificity of this splenic adsorbed serum on different tissues containing BLs of known origin and/or function. The results indicated that this BL staining technique was specific for epithelial BL of the rat and of some other species.

Animals↗
PubMed2005

Immunoglobulin gene analysis reveals 2 distinct cells of origin for EBV-positive and EBV-negative Burkitt lymphomas.

The normal counterpart of the neoplastic B cells in Burkitt lymphoma (BL) is still unclear. Based on immunoglobulin gene rearrangement studies, some authors suggest an origin from germinal center cells and others from memory B cells. However, most of these studies rely on cell lines or on a small series of cases. To help clarify the cell of origin of BL, semi-nested polymerase chain reaction (PCR) was performed to amplify the VDJ rearrangements of the immunoglobulin heavy chain (V(H)) genes, and the resultant amplificates were sequenced for comparison with known germline V(H) segments. The results of this approach revealed that all cases (15 endemic BL [eBL], 10 sporadic BL [sBL], and 6 AIDS-related BL) harbor mutated V(H) genes, with different mutation ranges among the 3 types of BL. The eBL and AIDS-related forms showed considerably higher mutation rates than the sBL form (5.1%, 5.4%, and 1.5%, respectively). The mutations in eBL and AIDS-related BL also showed signs of antigen selection, whereas no signs of antigen selection were found in sBL. Finally, after subcloning the amplificates, sequence analysis revealed no signs of ongoing mutations in any of the cases analyzed. Given that one of the main differences between eBL and AIDS-related BL on the one hand and sBL on the other hand is the association with Epstein-Barr virus (EBV), we compared EBV-positive and EBV-negative BLs independently of their geographic origin and HIV status. The differences in the number of somatic mutations and antigen selection were even more evident when this approach was used. According to our molecular results, it appears that EBV-positive and EBV-negative BL may originate from 2 distinct subsets of B cells, pointing to a particular role for the germinal-center reaction in the pathogenesis of these tumors. The different types of C-MYC translocation reported in BL may also be related to the different stages of B-cell maturation.

Adolescent↗
PubMed2001

Effects of high intensity exercise training on cardiovascular function, oxygen uptake, internal oxygen transport and osmotic balance in chinook salmon (Oncorhynchus tshawytscha) during critical speed swimming.

To examine cardiorespiratory plasticity, cardiovascular function, oxygen consumption, oxygen delivery and osmotic balance were measured at velocities up to critical swimming speed (Ucrit) in seawater-adapted chinook salmon. We used two groups of fish. The control group had swum continuously for 4 months at a low intensity (0.5 BLs(-1)) and the other was given a high-intensity training regimen (a Ucrit swim test on alternate days) over the same period of time. Compared with available data for other salmonid species, the control group had a higher maximum oxygen consumption (MO2max; 244 micromol O2 min(-1) kg(-1)), cardiac output (Qmax; 65 ml min(-1) kg(-1)) and blood oxygen content (CaO2; 15 ml O2 dl(-1)). Exercise training caused a 50% increase in MO2max without changing either Ucrit or CaO2, even though there were small but significant increases in hematocrit, hemoglobin concentration and relative ventricular mass. During swimming, however, exercise-trained fish experienced a smaller decrease in body mass and muscle moisture, a smaller increase in plasma osmolality, and reduced venous oxygen stores compared with control fish. Consequently, exercise training apparently diminished the osmo-respiratory compromise, but improved oxygen extraction at the tissues. We conclude that the training-induced increase in MO2max provided benefits to systems other than the locomotory system, such as osmoregulation, enabling trained fish to better multitask physiological functions while swimming. Furthermore, because a good interspecific correlation exists between MO2max and arterial oxygen supply (TO2max; r2=0.99) among temperate fish species, it is likely that CaO2 and Qmax are principal loci for cardiorespiratory evolutionary adaptation but not for intraspecific cardiorepiratory plasticity as revealed by high intensity exercise training.

Animals↗
PubMed2006

Fatal work-related injuries in the agriculture production sector among youth in the United States, 1992-2002.

Youth working on farms face unique risks that are not present for many other young workers, including machinery, large animals, electrical hazards, chemical hazards and excessive noise. This research identified the number and rate of occupational fatalities for youth working in the agriculture production industry, which is most closely affiliated with farming, for the years 1992-2002. The Census of Fatal Occupational Injuries (CFOI), developed by the Bureau of Labor Statistics (BLS), was the database used for the analysis. There were 310 work-related deaths to youth less than 20 years of age from 1992 through 2002 in the agriculture production sector. This compares to 1,958 total fatalities for all workers less than 20 years of age for the same time period. The number of agricultural production fatalities to youth has shown a general downward trend over this time period. The rates were higher for young workers in agriculture production than for young workers in all industries by a factor of 3.6. Fifteen year olds had the highest fatality rates with the crop production sector having a rate six times that of all 15 year old workers. The objective of this descriptive research was to identify, prioritize and publicize the risks to children and youth who work on farms in order to provide public health and safety professionals relevant information upon which to base decisions for interventions or other prevention activities for this priority population. This research also has direct applications for farm parents and safety and health professionals who work with the priority population of young agricultural workers.

Accidents, Occupational↗
PubMed2002

Clonal heterogeneity assessed by flow cytometry in B-cell lymphomas arising from germinal centers.

Patients with mature follicular B-cell lymphomas develop aggressive non-Hodgkin lymphomas (NHLs) during disease progression. It is controversial whether most diffuse large B-cell lymphomas (DLBCLs) and Burkitt lymphomas (BLs) emerge as de novo lymphomas or from an original follicular lymphoma. To distinguish clonally related populations in aggressive NHL, we studied the immunophenotypic features of 18 consecutive samples from 16 patients. Three flow cytometric patterns were distinguished: (1) a homogeneous neoplastic population of large B cells with phenotypic features of follicular center cells; (2) 2 atypical populations of B cells, small monoclonal B cells, and large B cells with loss of some surface antigens; and (3) 2 clonal populations of small and large B cells sharing the same light-chain isotype. The 3 flow cytometric patterns were observed, respectively, in de novo DLBCL and BL, transformation into BL, and transformation into DLBCL. Flow cytometric data can provide valuable information about the natural history of NHL.

Biomarkers, Tumor↗
PubMed2002

Office emergencies and emergency kits.

Preparedness to recognize and appropriately manage medical emergencies in the dental environment includes the following: current BLS certification for all office staff; didactic and clinical courses in emergency medicine; periodic office emergency drills; telephone numbers of EMS or other appropriately trained health care providers; emergency drug kit and equipment, and the knowledge to properly use all items. This update on office emergencies and emergency kits replaces the previous Association report, prepared in 1980 by the Council on Dental Therapeutics.

Cardiopulmonary Resuscitation↗
PubMed1996

Regulation of class II MHC expression.

The class II genes of the major histocompatibility complex (MHC) encode the alpha/beta heterodimeric glycoproteins that play a critical role in the induction of immune responses through presentation of processed antigen to CD4+ T lymphocytes. The constitutive expression of class II MHC antigens is restricted primarily to B cells, dendritic cells, thymic epithelium, and macrophages, although a wide variety of other cell types can be induced to express class II antigens after exposure to cytokines. The appropriate constitutive and inducible te constitutive and inducible expression of class II MHC antigens is essential for normal immune function; thus it is not surprising that aberrant expression on cell types normally class II MHC negative has been correlated with various autoimmune disorders, and lack of expression results in a severe combined immunodeficiency disorder called bare lymphocyte syndrome (BLS). In this review, we discuss the agents that both induce and inhibit class II MHC expression, the function of class II MHC antigens with an emphasis on the ability of these proteins to act as signal transducing molecules, and the molecular regulation of class II MHC expression.

Animals↗
PubMed1999

Using current on-line carcass evaluation parameters to estimate boneless and bone-in pork carcass yield as influenced by trim level.

The objective of this study was to develop prediction equations for estimating proportional carcass yield to a variety of external trim levels and bone-in and boneless pork primal cuts. Two hundred pork carcasses were selected from six U.S. pork processing plants and represented USDA carcass grades (25% USDA #1, 36% USDA #2, 25% USDA #3, and 14% USDA #4). Carcasses were measured (prerigor and after a 24 h chill) for fat and muscle depth at the last rib (LR) and between the third and fourth from last rib (TH) with a Hennessy optical grading probe (OGP). Carcasses were shipped to Texas A&M University, where one was randomly assigned for fabrication. Selected sides were fabricated to four lean cuts (ham, loin, Boston butt, and picnic shoulder) then fabricated progressively into bone-in (BI) and boneless (BL) four lean cuts (FLC) trimmed to .64, .32, and 0 cm of s.c. fat, and BL 0 cm trim, seam fat removed, four lean cuts (BLS-OFLC). Total dissected carcass lean was used to calculate the percentage of total carcass lean (PLEAN). Lean tissue subsamples were collected for chemical fat-free analysis and percentage carcass fat-free lean (FFLEAN) was determined. Longissimus muscle area and fat depth also were collected at the 10th and 11th rib interface during fabrication. Regression equations were developed from linear carcass and OGP measurements predicting FLC of each fabrication point. Loin muscle and fat depths from the OPG obtained on warm, prerigor carcasses at the TH interface were more accurate predictors of fabrication end points than warm carcass probe depth obtained at the last rib or either of the chilled carcass probe sites (probed at TH or LR). Fat and loin muscle depth obtained via OGP explained 46.7, 52.6, and 57.1% (residual mean square error [RMSE] = 3.30, 3.19, and 3.04%) of the variation in the percentage of BI-FLC trimmed to .64, .32, and 0 cm of s.c. fat, respectively, and 49.0, 53.9, and 60.7% (RMSE = 2.91, 2.81, and 2.69%) of the variation in the percentage of BL-FLC trimmed to .64, .32, and 0 cm of s.c. fat, respectively. Fat and loin muscle depth from warm carcass OGP probes at the TH interface accounted for 62.4 and 63.5% (RMSE = 3.38 and 3.27%) of the variation in PLEAN and FFLEAN, respectively. These equations provide an opportunity to estimate pork carcass yield for a variety of procurement end point equations using existing on-line techniques.

Animals↗
PubMed2004

Dialysis membrane-dependent removal of middle molecules during hemodiafiltration: the beta2-microglobulin/albumin relationship.

AIM: Current hemodialysis therapy modalities such as online hemodiafiltration (HDF) attempt to enhance solute removal over a wide molecular weight range through a combination of diffusion and convection. While the effects of variations of treatment modalities and conditions have been studied reasonably well, few studies have examined the efficacy of HDF to remove middle molecules in relation to the dialyzer and membrane characteristics. In this investigation, diverse high-flux dialyzers, covering a wide range of membrane permeabilities, were compared under identical in vivo conditions to assess their ability to eliminate larger uremic retention solutes (using beta2-microglobulin as a surrogate of middle molecules) without simultaneously causing excessive leakage of useful proteins such as albumin. PATIENTS AND METHODS: In a prospective, crossover study, 3 ESRD patients were treated with 8 different brands of high-flux dialyzers at 4 different ultrafiltration (UF)/substitution flow rates (QS: 0, 30, 60, 90 ml/min) in post-dilution HDF mode. Thus, each patient underwent 32 treatment sessions, with a total of 96 treatment sessions conducted during the entire clinical study. Albumin and beta2-microglobulin levels were measured in both, dialysate and blood. Both, albumin and beta2-microglobulin elimination was dependent upon the permeability of the dialysis membrane as well as on the ultrafiltration/substitution flow rates applied. RESULTS: At the maximum UF rate of 90 ml/min, the total albumin loss (measured in the dialysate) ranged from 300 mg/4 h (for the FLX-15 GWS dialyzers) to 7,000 mg/4 h (for the BS-1.3U dialyzers). Up to 50% reduction of albumin occurred within the first 30 minutes of the dialysis treatment, and the leakage of albumin increased exponentially with increasing UF rates as well as increasing transmembrane pressure (TMP). The various dialyzers could be classified according to their UFR-dependent beta2-m reduction rates (RR), into low (< 50%; FLX-15 GWS, CT 150G), medium (50-70%; Polyflux 14 S, BLS 814SD, H4) and high (> 70%; BS-1.3U, APS 650, FX 60) removers of middle molecules. One dialyzer type (CT 150G) showed extremely low beta2-m RR and relatively high albumin losses. Most membranes, however, showed either low albumin leakage coupled with low beta2-m removal, or high beta2-m RR but at the expense of considerable albumin leakage. Only 2 membrane types approached the desired balance between high to medium beta2-m RR while simultaneously restricting the albumin leakage especially at higher filtration/substitution rates. CONCLUSION: Our investigations demonstrate that not all dialysis membranes classified as "high-flux" are comparable in their ability to specifically and efficiently remove middle molecules, or curtail the unwanted excessive leakage of essential proteins from the patient's blood. Thus, the selection of appropriate high-flux dialyzers for specific patient requirements should be based more upon clinical evaluations and analyses rather than on product specifications alone.

Albumins↗
PubMed1990

Dispatch life support: establishing standards that work.

The consistency of care brought about by the AHA standards created order from the chaos that previously existed in the areas of BLS, CPR, and ACLS. But significant difficulties arise when they are applied directly to pre-arrival instructions given by EMSs.

American Heart Association↗
PubMed1992

Medical care price indexes: theory, construction & empirical analysis of the US series 1927-1990.

The historical development of price indexes as wage adjustment mechanisms is reviewed, as is the theory of aggregation and methods for dealing with quality and technological change. The construction of the U.S. Bureau of Labor Statistics (BLS) Medical Care Price Index (MCPI) is detailed. ARIMA analysis of the MCPI for the period 1927-1990 indicates that; (i) the MCPI is largely a damped and delayed function of the CPI, with an average lag of 8 months; (ii) medical care prices rose 2-4 percent faster than the all-items CPI since 1950, but not for 1927-1950; (iii) health expenditures are affected primarily by the general CPI, with little independent effect of specifically medical prices. The MCPI is a reliable measure of changes in consumer prices with strong construct validity. However, it was not designed for use as a deflator of medical expenditures, and is misleading when erroneously employed in that unintended role. The price/quantity duality and linear expenditure function which form the basis of Laspeyres price indexes are not applicable to nonconcatenable goods such as insurance or medical care. In these complex transactions, quality dominates quantity, fixed prices are replaced by reimbursement and professional judgement, and the assumption of additive separability required to use the price index as a deflator of health expenditures is not valid.

Abstracting and Indexing↗
PubMed1994

The 1992-2005 job outlook in brief.

What's up? Docs, as well as most other occupations, according to BLS's latest economic projections, which are revised every 2 years. Here's the most recent look into the future employment of 250 occupations. Bonus #1: An overview of the outlook for the major occupational groups. Bonus #2: Major trends since 1950 and some uncertainties about the future. Bonus #3: Information on job competition, whenever possible.

Data Collection↗
PubMed1995

Staying on top--9 rules for surviving and excelling on the streets.

When EMS providers at both the BLS and ALS levels leave their training programs, they are armed with newfound knowledge, but they usually lack the appropriate life experiences to excel and survive on the streets. As these new providers enter the real world of EMS, they face the challenge of making life-and-death decisions in uncontrolled environments. This includes making the appropriate decisions while functioning effectively--even in potentially dangerous settings. The high job stress this creates often leads to burnout and, in many systems, high turnover rates. This need not be the situation, however, as field providers can learn to survive and excel in the streets by using the following nine rules.

Accidents, Traffic↗
PubMed1994

Simulated pediatric cardiopulmonary resuscitation: initial events and response times of a hospital arrest team.

BACKGROUND: Cardiopulmonary resuscitation (CPR) training programs exist to enhance knowledge and skills retention. However, they do not ensure that effective CPR will be performed by trainees or resuscitation teams. One aspect of CPR effectiveness is the ability of the team to respond to an emergency call in a timely manner. METHODS: We prospectively evaluated the time required for team members to respond to an emergency call and to initiate definitive treatment in our pediatric facility. The medical staff who responded had no prior knowledge of the simulated cardiac arrest (SCA) events. All events were recorded on audio-cassette tape to determine the sequence of events and response time of arrest team members. SCA scenarios represented examples of cardiac, hematologic, renal, respiratory, and pharmacologic pathophysiology. All participants were instructed to respond as though the SCA were an actual emergency. RESULTS: From December 1991 to January 1993, 37 SCAs were evaluated. Documentation began after a concise arrest scenario had been presented to a designated nursing representative who was to be the first rescuer on the scene. The rescuer first assessed the patient's condition, activated the cardiac arrest system (median elapsed time, MET, 0.50 minutes), and then initiated single-person CPR (MET 0.58 minutes). Administration of oxygen occurred at an MET of 2.25 minutes. The first member of the arrest team to respond was the pediatric resident (MET 3.17 minutes) followed by the respiratory therapist (MET 3.20 minutes), an ICU nurse (MET 3.58 minutes), a pharmacist (MET 3.42 minutes), and anesthesiology personnel (MET 4.70 minutes). DISCUSSION: The use of SCAs (termed "Mega Code") serves as an extension of Basic Life Support and Advanced Cardiac Life Support education and provides a valuable learning experience and quality assurance tool. Limitations that might influence patient outcome during an actual in-hospital arrest have led to refinements in our cardiac arrest procedures. Of particular note was the delay in oxygen administration, which may be linked to its omission from the 1986 and 1992 American Heart Association Basic Life Support Guidelines. CONCLUSION: We believe that BLS education for hospital employees should include and emphasize oxygen delivery for resuscitation.

Cardiopulmonary Resuscitation↗
PubMedDate not supplied

Stress levels in EMS personnel: a national survey.

OBJECTIVE: The purpose of this study was to evaluate stress levels in emergency medical services personnel across the United States. DESIGN: Confidential, 20-question survey tool, Medical Personnel Stress Survey--Abbreviated (MPSS-R). A total score of 50 indicates average stress levels. A score of 12.5 on the subset measurements of somatic distress, job dissatisfaction, organizational stress, and negative attitudes towards patients indicates average levels of stress. Data were analyzed using ANOVA and t-test. INTERVENTIONS: None. RESULTS: A total of 658 of 3,000 emergency medical technicians (EMTs) (22%) completed the survey. The mean value of 69.3 +/- 6.3 for the total stress scores was very high. Mean values for the subset scores were: somatic distress = 19.6 +/- 3.3; organizational stress = 17.3 +/- 2.4; job dissatisfaction = 17.0 +/- 2.6; negative attitudes towards patients = 15.5 +/- 2.3. Characteristics predicting higher stress were EMT-basic (A) licensure, basic life support (BLS) only service provider, volunteer status, new employee working in a small EMS organization, and providing service to a small town. CONCLUSION: Stress levels in EMS personnel were very high, were manifested primarily as somatic distress, secondarily as organizational stress and job dissatisfaction, and lastly as negative patient attitudes. Stress levels and subset manifestations of occupational stress among EMS personnel varied depending on gender, marital status, age, level of training and function, on salaried or volunteer status, length of time as an EMT, and size of the organization, city, and population served. Care should be taken to address stresses peculiar to individual EMS system needs.

Adult↗