The American Heart Association 2005 Emergency Cardiovascular Care Guidelines Impact on Myocardial Infarction Mortality in Nevada Hospitals

This study investigates the impact of the 2005 American Heart Association (AHA) guidelines on first heart attack (AMI) mortality in Nevada. These guidelines are accepted by the healthcare industry in the U.S. and in many other countries to improve AMI outcomes. The 2005 AHA guidelines for cardiopulmonary and emergency cardiovascular care, which are based on the evidence evaluated by the International Consensus on Science and Treatment Recommendations, aim to decrease mortality and morbidity. The guidelines are based on evidence-based practice and science. This study uses hospital discharge data from full service hospitals in Nevada from 1996 – 2007 to measure the impact of the recommend guideline that percutaneous coronary intervention (PCI) be implemented within 90 minutes from emergency room arrival to the PCI (door-to-balloon). The PCI guideline is expected to decrease AMI mortality. AMI mortality is adjusted for comorbidities and other factors that can influence AMI outcome, and does not include transferred AMI patients. While the proportion of patients receiving PCI increased after the guideline was implemented, mortality did not decrease. This suggests that Nevada healthcare providers do not fully comply with the guidelines for PCI, which causes more heart damage that leads to life threatening complications and death in 2005 to 2007. The results likely represent a lag in implementing the guidelines beyond 2007. PCI utilization appears poor with 39% use in 1996 – 2004 that only increased to approximately 47% in 2005 – 2007

Engagement for Life\u27s Sake: Reflections on Partnering and Partnership with Rural Tribal Nations\u3csup\u3e☆\u3c/sup\u3e

In this paper, we reflect on our collective experiences engaging with Anishinaabe Tribal Nations in the Great Lakes region to support Tribal sovereignty in decision-making for food, energy, and water (FEW) systems. In these diverse experiences, we find common lessons. The first set of lessons contributes new empirical knowledge regarding the challenges and opportunities that rural Great Lakes Tribal Nations navigate for enacting sovereignty in decision-making. Our experiences illustrate that while Tribal Nations benefit from a broad and deep commitment to sovereignty and many cultural strengths, they are often challenged by shortages in administrative capacity; technical support; and embeddedness in economic, socio-cultural, and institutional dynamics that must be further negotiated for Tribes to enact the sovereignty to which they are inherently (and legally) entitled. Productive partnerships struggle when university partners fail to acknowledge these realities. The second set of lessons addresses the potential for, and challenges of, effective engagement processes. We find that engagement with university professionals is often mismatched with the priorities and needs of Tribal Nations. Effective engagement with Tribal Nations requires practical knowledge, applied assistance, and grounded, genuine relationships; these requirements often run counter to the institutional structures and priorities imposed by universities, federal funding agencies, and student recruitment. These findings, associated with both empirical knowledge and lessons on process, highlight shared insights on formidable barriers to effective engagement. Based on our firsthand experience working with rural Tribal Nations on FEW decision-making, we share these reflections with particular focus on lessons learned for professionals who engage, or hope to engage, with Tribal Nations in rural settings and offer opportunities to transform engagement processes to better support the immediate, practical needs of rural Tribal Nations

Research on Layer Manufacturing Techniques at Fraunhofer

Within the German Fraunhofer-Gesellschaft, the Fraunhofer Alliance Rapid Prototyping unites the competences of 12 institutes in the field of solid freeform fabrication. Covered competences are virtual and computer-aided product planning methods and techniques, the development and integration of materials and processes for different industrial sectors. This paper presents actual research results on layer manufacturing within the Fraunhofer- Gesellschaft based on examples from Fraunhofer ILT »Laser Melting - Direct manufacturing of metal parts with unique properties«, Fraunhofer IFAM »ecoMold - A novel concept to produce molds for plastic injection molding and pressure die casting« and Fraunhofer IPT »Quick manufacture, repair and modification of steel molds using Controlled Metal Build Up (CMB)«.Mechanical Engineerin

COVID-19 and household energy implications: what are the main impacts on energy use?

This study explores the impacts of COVID-19 on household energy use. Some of these impacts are associated with longer-term energy demand changes and some could just be temporary. The study intends to present the results of a small pilot study conducted in China, by addressing household energy use. The samples are from 352 households and particularly focus on primary energy use in three periods of pre-pandemic (and pre-lockdown), start of COVID-19 outbreak and lockdown, and post lockdown. Each period is identified as a timeframe of 2.5 months, from November 2019 to late June 2020. The samples of this study highlight the primary implications of energy use, some that are understood as interim changes and some that may appear to be more prolonged. The results from the study highlight a variety of impacts on household energy use as well as prolonged impacts on transportation use. The primary household energy use are assessed in six fundamental elements of (1) transportation for commuting and leisure (for both private and public modes), (2) cooking, (3) entertainment, (4) heating and cooling, (5) lighting, and (6) the others. The results are summarized in three sections focused on major impacts on transportation use (comparison between private and public modes), cooking and entertainment, heating/cooling and lighting. The results could provide early suggestions for cities/regions that are experiencing longer lockdown. Furthermore, this study provides insights for larger-scale research in assessing household energy use/demand during times of health emergency and crises, such as the event of a pandemic

Health anxiety and cognitive processes as risks for insomnia in women undergoing chemotherapy for breast cancer

Breast cancer patients have a high incidence of co-morbid chronic insomnia which frequently persists into survivorship. The mechanism behind this insomnia is poorly understood, yet maladaptive responses to the sleep disturbance resulting from an acute stressor are implicated in cognitive models of insomnia. Evidence suggests that health anxiety, pre-sleep cognitive arousal and compensatory sleep effort may predispose and/or perpetuate psychophysiological insomnia. These mechanisms have not been examined in patients with breast cancer, but if present, may be used to identify individuals at risk for developing chronic insomnia as well as inform intervention. Twenty women recently diagnosed with breast cancer and scheduled for adjuvant chemotherapy (age M = 54.6, SD = 7.9, range = 36-64) and 20 healthy age-matched women without history of breast cancer (age M = 53.6, SD = 7.5, range = 38-69) completed self-assessments and 72-hour wrist actigraphy on two occasions:(a) baseline, which for breast cancer patients was prior to start of chemotherapy (BL); and (b) at a subsequent occasion during or yoked to the last week of cycle 4 of chemotherapy (C4). Two-factor ANOVA revealed that at BL and C4 both groups reported similar levels of insomnia in addition to health anxiety, pre-sleep cognitive arousal and compensatory sleep effort. Actigraphic sleep and menopausal symptoms were also similar. Linear regression-based mediation analyses revealed that at BL, both groups demonstrated an association between health anxiety, compensatory sleep effort and insomnia. At C4, both groups demonstrated an association between compensatory sleep effort, pre-sleep cognitive arousal and insomnia. Additionally, compensatory sleep effort mediated links between health anxiety and insomnia, and pre-sleep cognitive arousal and insomnia. The results validate cognitive models of insomnia and provide support for targeting health anxiety, pre-sleep cognitive arousal and compensatory sleep effort as risk factors for insomnia in women with and without breast cance