The education direction of the ACLS training program

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/30978/1/0000651.pd

Assessing uncertainty in outsourcing clinical services at tertiary health centers

When tertiary health centers face capacity constraint, one feasible strategy to meet service demand is outsourcing clinical services to qualified community providers. Clinical outsourcing enables tertiary health centers to meet the expectations of service timeliness and provides good opportunities to collaborate with other health care providers. However, outsourcing may result in dependence and loss of control for the tertiary health centers. Other parties involved in clinical outsourcing such as local partners, patients, and payers may also encounter potential risks as well as enjoy benefits in an outsourcing arrangement. Recommendations on selecting potential outsourcing partners are given to minimize the risks associated with an outsourcing contract. Copyright © 2006 John Wiley & Sons, Ltd.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/56139/1/858_ftp.pd

Education in adult advanced cardiac life support training programs: Changing the paradigm

To develop a consensus for change in the educational aspects of the Advanced Cardiac Life Support (ACLS) Training Program, the American Heart Association appointed panel members to engage in a consensus process. At a preconference meeting held in the fall of 1991, panel members received broad input from experts in adult education, experienced ACLS educators, and resuscitation scientists. The panel then developed a statement based on the preconference discussions and presented it at the National Conference on CPR and Emergency Cardiac Care held in February 1992. The conference's recommendations and the process that led to them are described in this paper.The key conclusions of the consensus process are as follows. The purpose of ACLS programs is the education of health professionals whose jobs include the management of patients in arrest or near-arrest. The goal of each ACLS course is to have each participant succeed in acquiring the skills and knowledge required for resuscitation. Aspects of the course which threaten failure or raise anxiety should be minimized or eliminated. ACLS course directors are strongly encouraged to design courses whose content and presentation are best suited to the training, experience, and needs of the course participants. Flexibility is strongly encouraged. Evaluation (testing) should be used primarily for its educational value, to help both learners and instructors identify areas needing improvement. The problem learner should be identified as early as possible and should receive intensive remediation to achieve the goal of every participant acquiring the targeted skills and knowledge. Because skill retention is variable, rescuers should practice skills frequently in regular refresher sessions. At a minimum, retraining every two years is strongly recommended.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/30977/1/0000650.pd

Comparison of adrenergic agonists for the treatment of ventricular fibrillation and pulseless electrical activity

The primary role of epinephrine for the treatment of ventricular fibrillation (VF) and pulseless electrical activity (PEA) is to increase blood flow to the myocardium and central nervous system and ultimately improve survival. However, despite the administration of epinephrine, survival following VF or PEA is low. In an attempt to improve outcome from VF and PEA, alternative adrenergic agonists (methoxamine, phenylephrine, norepinephrine) which have different pharmacological properties than epinephrine have been evaluated. In order to determine the role of alternative adrenergic agonists for the treatment of VF and PEA this paper will compare the pharmacological properties and pharmacodynamic effects of these drugs to epinephrine. Specifically, receptor physiology along with the effects of adrenergic agonists on coronary perfusion pressure, survival, myocardial oxygen demand, and cerebral blood flow will be discussed.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/31146/1/0000043.pd

Beliefs about control of smoking and smoking behavior: A comparison of different measures in different groups

This study investigated several measures of beliefs about controlling smoking as predictors of cessation and reduction at one and six months after a medically-based control program. Smokers (n = 250 total) attending general medicine clinics at University and Veterans Administration facilities received advice to quit from both physicians and nurses. Beliefs about difficulty resisting urges to smoke in 15 situations, their frequency of occurrence, and general level of difficulty were assessed at baseline. For the University group of patients, significant relationships were found between both general and specific indexes and both cessation and reduction at one month. Although a greater change in smoking was seen at six months, few belief measures remained predictive. At one month, global measures were as useful as specific ones, although difficulty in situations of negative emotion was a consistent and strong predictor. Marked differences between the two sites were found; virtually no measure of difficulty proved predictive for the VA group.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/26910/1/0000476.pd

Education in adult basic life support training programs

The Panel on Educational Issues in Adult Basic Life Support Training Programs reviewed the characteristics of adult learners, aspects of educational theory, issues concerning barriers to learning and performing CPR, and issues concerning testing and evaluation.The panel made the following recommendations: a comprehensive evaluation of the basic life support program with the goal of improving the program design and educational tools must be initiated; adult programs must be designed to motivate laypersons to become trained in CPR, as well as to target relatives and friends of high-risk individuals; and emotional and attitudinal issues, including the student's reluctance to act in an emergency, must be addressed. Programs must incorporate information on the willingness of an individual to perform CPR; CPR programs must be simplified and focus on critical success factors; flexible educational approaches in programs are encouraged; flexible programming that addresses the needs of the allied health professional is encouraged; formal testing should be eliminated for layperson programs; and formal testing for health care providers and instructors should be continued.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/30976/1/0000649.pd

Regional-scale paleofluid system across the Tuscan Nappe–Umbria–Marche Apennine Ridge (northern Apennines) as revealed by mesostructural and isotopic analyses of stylolite–vein networks

We report the results of a multiproxy study that combines structural analysis of a fracture–stylolite network and isotopic characterization of calcite vein cements and/or fault coating. Together with new paleopiezometric and radiometric constraints on burial evolution and deformation timing, these results provide a first-order picture of the regional fluid systems and pathways that were present during the main stages of contraction in the Tuscan Nappe and Umbria–Marche Apennine Ridge (northern Apennines). We reconstruct four steps of deformation at the scale of the belt: burial-related stylolitization, Apenninic-related layer-parallel shortening with a contraction trending NE–SW, local extension related to folding, and late-stage fold tightening under a contraction still striking NE–SW. We combine the paleopiezometric inversion of the roughness of sedimentary stylolites – that constrains the range of burial depth of strata prior to layer-parallel shortening – with burial models and U–Pb absolute dating of fault coatings in order to determine the timing of development of mesostructures. In the western part of the ridge, layer-parallel shortening started in Langhian time (∼15 Ma), and then folding started at Tortonian time (∼8 Ma); late-stage fold tightening started by the early Pliocene (∼5 Ma) and likely lasted until recent/modern extension occurred (∼3 Ma onward). The textural and geochemical (δ18O, δ13C, Δ47CO2 and 87Sr∕86Sr) study of calcite vein cements and fault coatings reveals that most of the fluids involved in the belt during deformation either are local or flowed laterally from the same reservoir. However, the western edge of the ridge recorded pulses of eastward migration of hydrothermal fluids (>140 ∘C), driven by the tectonic contraction and by the difference in structural style of the subsurface between the eastern Tuscan Nappe and the Umbria–Marche Apennine Ridge

A Mouse Model of Post-Arthroplasty Staphylococcus aureus Joint Infection to Evaluate In Vivo the Efficacy of Antimicrobial Implant Coatings

Post-arthroplasty infections represent a devastating complication of total joint replacement surgery, resulting in multiple reoperations, prolonged antibiotic use, extended disability and worse clinical outcomes. As the number of arthroplasties in the U.S. will exceed 3.8 million surgeries per year by 2030, the number of post-arthroplasty infections is projected to increase to over 266,000 infections annually. The treatment of these infections will exhaust healthcare resources and dramatically increase medical costs.To evaluate novel preventative therapeutic strategies against post-arthroplasty infections, a mouse model was developed in which a bioluminescent Staphylococcus aureus strain was inoculated into a knee joint containing an orthopaedic implant and advanced in vivo imaging was used to measure the bacterial burden in real-time. Mice inoculated with 5x10(3) and 5x10(4) CFUs developed increased bacterial counts with marked swelling of the affected leg, consistent with an acute joint infection. In contrast, mice inoculated with 5x10(2) CFUs developed a low-grade infection, resembling a more chronic infection. Ex vivo bacterial counts highly correlated with in vivo bioluminescence signals and EGFP-neutrophil fluorescence of LysEGFP mice was used to measure the infection-induced inflammation. Furthermore, biofilm formation on the implants was visualized at 7 and 14 postoperative days by variable-pressure scanning electron microscopy (VP-SEM). Using this model, a minocycline/rifampin-impregnated bioresorbable polymer implant coating was effective in reducing the infection, decreasing inflammation and preventing biofilm formation.Taken together, this mouse model may represent an alternative pre-clinical screening tool to evaluate novel in vivo therapeutic strategies before studies in larger animals and in human subjects. Furthermore, the antibiotic-polymer implant coating evaluated in this study was clinically effective, suggesting the potential for this strategy as a therapeutic intervention to combat post-arthroplasty infections

The Caenorhabditis elegans HEN1 Ortholog, HENN-1, Methylates and Stabilizes Select Subclasses of Germline Small RNAs

Small RNAs regulate diverse biological processes by directing effector proteins called Argonautes to silence complementary mRNAs. Maturation of some classes of small RNAs involves terminal 2′-O-methylation to prevent degradation. This modification is catalyzed by members of the conserved HEN1 RNA methyltransferase family. In animals, Piwi-interacting RNAs (piRNAs) and some endogenous and exogenous small interfering RNAs (siRNAs) are methylated, whereas microRNAs are not. However, the mechanisms that determine animal HEN1 substrate specificity have yet to be fully resolved. In Caenorhabditis elegans, a HEN1 ortholog has not been studied, but there is evidence for methylation of piRNAs and some endogenous siRNAs. Here, we report that the worm HEN1 ortholog, HENN-1 (HEN of Nematode), is required for methylation of C. elegans small RNAs. Our results indicate that piRNAs are universally methylated by HENN-1. In contrast, 26G RNAs, a class of primary endogenous siRNAs, are methylated in female germline and embryo, but not in male germline. Intriguingly, the methylation pattern of 26G RNAs correlates with the expression of distinct male and female germline Argonautes. Moreover, loss of the female germline Argonaute results in loss of 26G RNA methylation altogether. These findings support a model wherein methylation status of a metazoan small RNA is dictated by the Argonaute to which it binds. Loss of henn-1 results in phenotypes that reflect destabilization of substrate small RNAs: dysregulation of target mRNAs, impaired fertility, and enhanced somatic RNAi. Additionally, the henn-1 mutant shows a weakened response to RNAi knockdown of germline genes, suggesting that HENN-1 may also function in canonical RNAi. Together, our results indicate a broad role for HENN-1 in both endogenous and exogenous gene silencing pathways and provide further insight into the mechanisms of HEN1 substrate discrimination and the diversity within the Argonaute family

Contribution of plasma cells and B cells to hidradenitis suppurativa pathogenesis

Hidradenitis suppurativa (HS) is a debilitating chronic inflammatory skin disease characterized by chronic abscess formation and development of multiple draining sinus tracts in the groin, axillae, and perineum. Using proteomic and transcriptomic approaches, we characterized the inflammatory responses in HS in depth, revealing immune responses centered on IFN-γ, IL-36, and TNF, with lesser contribution from IL-17A. We further identified B cells and plasma cells, with associated increases in immunoglobulin production and complement activation, as pivotal players in HS pathogenesis, with Bruton’s tyrosine kinase (BTK) and spleen tyrosine kinase (SYK) pathway activation as a central signal transduction network in HS. These data provide preclinical evidence to accelerate the path toward clinical trials targeting BTK and SYK signaling in moderate-to-severe HS