Cardiac and Perceptual Responses to Performing Tandem Cardiopulmonary Resuscitation

Introduction: Information regarding the physiological and perceptual response of the human body in the act of performing tandem cardiopulmonary resuscitation (CPR) relative to solo CPR is lacking.  Purpose: The purpose of this investigation is to compare rescuer heart rate (HR), rating of perceived exertion (RPE), and CPR quality during TandemCPR and Solo-CPR.  Methods: Thirteen healthy young adults (aged 26.5±4.3 yrs) were recruited from MSUB campus community.  Participants completed two 6-minute bouts of CPR during a single session. Tandem and solo techniques were counterbalanced, with a 15-minute rest period separating the bouts.  Values for HR and RPE were recorded using a Polar V800 HR monitor and Adult OMNI-RPE scale, respectively.  A Laerdal ResusciAnne CPR manikin was used to record compression score (0-100%), which is a value that incorporates compression rate and depth to illustrate CPR quality.  Mean HR, peak RPE and CPR compression scores were examined with dependent t-tests between CPR techniques.  Statistical significance was accepted at p<0.05.  Results: Sample mean HR per bout was significantly lower in Tandem-CPR than in Solo-CPR (111.2±16.8 vs. 126.1±19.3, p<0.0001).  Peak RPE was significantly lower during Tandem-CPR compared to Solo-CPR (3.2±2.0 vs. 5.0±2.5, p<0.05).  Compression scores were significantly higher for Tandem-CPR when compared to Solo-CPR (96±3% vs. 94±5%, p<0.05). Discussion: Current findings call for a professional recommendation that tandem CPR be used when available, based on perception, performance, and physiological differences. This confirms professional guidelines.  This study does not account for the anecdotally reported stress incited in CPR context; further research should examine this aspect

The Impact of Marketing On The Agribusiness Economic Sales Function

The purpose of this study is to exam the effect of marketing on the agribusiness economic sales functions in the agricultural manufacturing industry using financial metrics. For the purpose of this study the agricultural manufacturing industry will be broken into four separate sectors. These sectors are: agricultural machinery manufacturing, processing and agronomy-based manufacturers, automotive/automotive part manufacturers, and other agricultural manufacturers. The resource-based view is used to target sectors competitive advantage in this research. Applied business knowledge will support the application of the research. The financial metrics used in this study were extracted from Bloomberg Terminal in the College of Business at Southern Illinois University at Carbondale. The Security and Exchange Commission (SEC) rated data compiled consist of numerical values representing expenditure, return on investments, and product segmentation in terms of individual allocation, segment value, and segment count. Ordinary Least Square Method will be used to analyze the data while incorporating dummy variables to differentiate between sector types. From this research it can be deduced that marketing has a large impact on the salesforces functions explained by the operating return on assets and return on investment capital. The predicted outcome for operating return on assets and return on investment capital are rhetorical suggesting operating return on assets and return on investment capital are good indicators of the impact of marketing on the agribusiness economics sales functions. In contrast, it is believed that sales are a vague indictor of performance and cannot be used as a performance metric

The Impact of Heatwaves on Community Morbidity and Healthcare Usage: A Retrospective Observational Study Using Real-Time Syndromic Surveillance.

We investigated the impact of a moderate heatwave on a range of presenting morbidities in England. Asthma, difficulty breathing, cerebrovascular accident, and cardiovascular symptoms were analysed using general practitioner in hours (GPIH), out of hours (GPOOH) and emergency department (ED) syndromic surveillance systems. Data were stratified by age group and compared between a heatwave year (2013) and non-heatwave years (2012, 2014). Incidence rate ratios were calculated to estimate the differential impact of heatwave compared to non-heatwave summers: there were no apparent differences for the morbidities tested between the 2013 heatwave and non-heatwave years. A subset of GPIH data were used to study individuals at higher risk from heatwaves based on their pre-existing disease. Higher risk patients were not more likely to present at GPs or ED than other individuals. Comparing GPIH consultations and ED attendances for myocardial infarction/ischaemia (MI), there was evidence of a fall in the presentation of MI during the heatwave, which was particularly noted in the 65-74 years age group (and over 75 years in ED attendances). These results indicate the difficulty in identifying individuals at risk from non-fatal health effects of heatwaves and hot weather

Maintained physical activity and physiotherapy in the management of distal upper limb pain – a protocol for a randomised controlled trial (the arm pain trial)

<b>Background</b><p></p> Distal upper limb pain (pain affecting the elbow, forearm, wrist, or hand) can be non-specific, or can arise from specific musculoskeletal disorders. It is clinically important and costly, the best approach to clinical management is unclear. Physiotherapy is the standard treatment and, while awaiting treatment, advice is often given to rest and avoid strenuous activities, but there is no evidence base to support these strategies. This paper describes the protocol of a randomised controlled trial to determine, among patients awaiting physiotherapy for distal arm pain, (a) whether advice to remain active and maintain usual activities results in a long-term reduction in arm pain and disability, compared with advice to rest; and (b) whether immediate physiotherapy results in a long-term reduction in arm pain and disability, compared with physiotherapy delivered after a seven week waiting list period.<p></p> <b>Methods/Design</b><p></p> Between January 2012 and January 2014, new referrals to 14 out-patient physiotherapy departments were screened for potential eligibility. Eligible and consenting patients were randomly allocated to one of the following three groups in equal numbers: 1) advice to remain active, 2) advice to rest, 3) immediate physiotherapy. Patients were and followed up at 6, 13, and 26 weeks post-randomisation by self-complete postal questionnaire and, at six weeks, patients who had not received physiotherapy were offered it at this time. The primary outcome is the proportion of patients free of disability at 26 weeks, as determined by the modified DASH (Disabilities of the Arm, Shoulder and Hand) questionnaire.<p></p> We hypothesise (a) that advice to maintain usual activities while awaiting physiotherapy will be superior than advice to rest the arm; and (b) that fast-track physiotherapy will be superior to normal (waiting list) physiotherapy. These hypotheses will be examined using an intention-to-treat analysis.<p></p> <b>Discussion</b><p></p> Results from this trial will contribute to the evidence base underpinning the clinical management of patients with distal upper limb pain, and in particular, will provide guidance on whether they should be advised to rest the arm or remain active within the limits imposed by their symptoms

Arm Pain Trial : Study materials

Publisher PD

Maintained physical activity and physiotherapy in the management of distal arm pain: A randomised controlled trial

Objectives: The epidemiology of distal arm pain and back pain are similar. However, management differs considerably: for back pain, rest is discouraged, whereas patients with distal arm pain are commonly advised to rest and referred to physiotherapy. We hypothesised that remaining active would reduce long-term disability and that fast-track physiotherapy would be superior to physiotherapy after time on a waiting list.Methods: Adults referred to community-based physiotherapy with distal arm pain were randomised to: advice to remain active while awaiting physiotherapy (typically delivered after 6-8 weeks); advice to rest while awaiting physiotherapy, or immediate treatment. Intention-to-treat analysis determined whether the probability of recovery at 26 weeks was greater among the active advice group, compared with those advised to rest and/or among those receiving immediate versus usually timed physiotherapy.Results: 538 of 1663 patients invited between February 2012 and February 2014 were randomised (active=178; rest=182; immediate physiotherapy=178). 81% provided primary outcome data, and complete recovery was reported by 60 (44%), 46 (32%) and 53 (35%). Those advised to rest experienced a lower probability of recovery (OR: 0.54; 95% CI 0.32 to 0.90) versus advice to remain active. However, there was no benefit of immediate physiotherapy (0.64; 95% CI 0.39 to 1.07).Conclusions: Among patients awaiting physiotherapy for distal arm pain, advice to remain active results in better 26-week functional outcome, compared with advice to rest. Also, immediate physiotherapy confers no additional benefit in terms of disability, compared with physiotherapy delivered after 6-8 weeks waiting time. These findings question current guidance for the management of distal arm pain

Evaluación diagnóstica de la agrodiversidad y sustentabilidad de pequeñas fincas que cultivan maíz en el Ecuador

The study was carried out in small Agricultural Production Units (UPA) that grow corn in the Cuatro Vientos and Lomas de Mera villages of the Mocache canton, humid tropics of Ecuador in order to evaluate the composition of agrodiversity and its relationship with its sustainability. The rapid characterization consisted of identifying the perceived problems and the state of agrodiversity on the farms, through direct observation and semi-structured interviews. For the detailed characterization, standardized and weighted sustainability indicators were used according to their importance in the sociocultural, economic and environmental dimensions. Farmers had a limitation on the low costs of the products since there was no price stability. The local hybrid INIAP H-551 continues to be managed under conventional practices. The planned agrodiversity influenced the similarity of the farms between both villages. Likewise, the Cuatro Vientos village maintained the greatest progressive change from the cultivation of corn to the cultivation of cocoa, resulting in the inverse relationship by increasing the loss of agrodiversity and providing the lowest values on the general sustainability index.El trabajo se realizó en pequeñas Unidades de Producción Agropecuarias (UPA) que cultivan maíz en las parroquias Cuatro Vientos y Lomas de Mera del cantón Mocache, trópico húmedo del Ecuador, con el fin de evaluar la composición de la agrodiversidad y su relación con su sustentabilidad. La caracterización rápida consistió en identificar los problemas percibidos y el estado de la agrodiversidad en las fincas, a través de la observación directa y entrevistas semiestructuradas. Para la caracterización detallada se utilizó indicadores de sustentabilidad estandarizados y ponderados de acuerdo con su importancia en la dimensión sociocultural, económica y ambiental. Las fincas tenían una limitación a los bajos costos de los productos al no existir estabilidad en los precios. El híbrido local INIAP H-551 continúa manejándose bajo prácticas convencionales. La agrodiversidad planeada influyó sobre la similitud de las fincas entre ambas parroquias. Asimismo, la parroquia Cuatro Vientos mantuvo el mayor cambio progresivo del cultivo de maíz al cultivo de cacao, dando como resultado la relación inversa al incrementar la pérdida de la agrodiversidad y proporcionar los valores más bajos sobre el índice de sustentabilidad general

Non‐canonical autophagy functions of ATG16L1 in epithelial cells limit lethal infection by influenza A virus

Influenza A virus (IAV) and SARS-CoV-2 (COVID-19) cause pandemic infections where cytokine storm syndrome and lung inflammation lead to high mortality. Given the high social and economic cost of respiratory viruses, there is an urgent need to understand how the airways defend against virus infection. Here we use mice lacking the WD and linker domains of ATG16L1 to demonstrate that ATG16L1-dependent targeting of LC3 to single-membrane, non-autophagosome compartments - referred to as non-canonical autophagy - protects mice from lethal IAV infection. Mice with systemic loss of non-canonical autophagy are exquisitely sensitive to low-pathogenicity IAV where extensive viral replication throughout the lungs, coupled with cytokine amplification mediated by plasmacytoid dendritic cells, leads to fulminant pneumonia, lung inflammation and high mortality. IAV was controlled within epithelial barriers where non-canonical autophagy reduced IAV fusion with endosomes and activation of interferon signalling. Conditional mouse models and ex vivo analysis showed that protection against IAV infection of lung was independent of phagocytes and other leucocytes. This establishes non-canonical autophagy in airway epithelial cells as a novel innate defence that restricts IAV infection and lethal inflammation at respiratory surfaces

Estimating the burden of heat illness in England during the 2013 summer heatwave using syndromic surveillance.

BACKGROUND: The burden of heat illness on health systems is not well described in the UK. Although the UK generally experiences mild summers, the frequency and intensity of hot weather is likely to increase due to climate change, particularly in Southern England. We investigated the impact of the moderate heatwave in 2013 on primary care and emergency department (ED) visits using syndromic surveillance data in England. METHODS: General practitioner in hours (GPIH), GP out of hours (GPOOH) and ED syndromic surveillance systems were used to monitor the health impact of heat/sun stroke symptoms (heat illness). Data were stratified by age group and compared between heatwave and non-heatwave years. Incidence rate ratios were calculated for GPIH heat illness consultations. RESULTS: GP consultations and ED attendances for heat illness increased during the heatwave period; GPIH consultations increased across all age groups, but the highest rates were in school children and those aged ≥75 years, with the latter persisting beyond the end of the heatwave. Extrapolating to the English population, we estimated that the number of GPIH consultations for heat illness during the whole summer (May to September) 2013 was 1166 (95% CI 1064 to 1268). This was double the rate observed during non-heatwave years. CONCLUSIONS: These findings support the monitoring of heat illness (symptoms of heat/sun stroke) as part of the Heatwave Plan for England, but also suggest that specifically monitoring heat illness in children, especially those of school age, would provide additional early warning of, and situation awareness during heatwaves

Type I interferon signaling in hematopoietic cells is required for survival in mouse polymicrobial sepsis by regulating CXCL10

Type I interferon (IFN) α/β is critical for host defense. During endotoxicosis or highly lethal bacterial infections where systemic inflammation predominates, mice deficient in IFN-α/β receptor (IFNAR) display decreased systemic inflammation and improved outcome. However, human sepsis mortality often occurs during a prolonged period of immunosuppression and not from exaggerated inflammation. We used a low lethality cecal ligation and puncture (CLP) model of sepsis to determine the role of type I IFNs in host defense during sepsis. Despite increased endotoxin resistance, IFNAR−/− and chimeric mice lacking IFNAR in hematopoietic cells display increased mortality to CLP. This was not associated with an altered early systemic inflammatory response, except for decreased CXCL10 production. IFNAR−/− mice display persistently elevated peritoneal bacterial counts compared with wild-type mice, reduced peritoneal neutrophil recruitment, and recruitment of neutrophils with poor phagocytic function despite normal to enhanced adaptive immune function during sepsis. Importantly, CXCL10 treatment of IFNAR−/− mice improves survival and decreases peritoneal bacterial loads, and CXCL10 increases mouse and human neutrophil phagocytosis. Using a low lethality sepsis model, we identify a critical role of type I IFN–dependent CXCL10 in host defense during polymicrobial sepsis by increasing neutrophil recruitment and function