Perception of inappropriate cardiopulmonary resuscitation by clinicians working in emergency departments and ambulance services : The REAPPROPRIATE international, multi-centre, cross sectional survey

Introduction: Cardiopulmonary resuscitation (CPR) is often started irrespective of comorbidity or cause of arrest. We aimed to determine the prevalence of perception of inappropriate CPR of the last cardiac arrest encountered by clinicians working in emergency departments and out-of-hospital, factors associated with perception, and its relation to patient outcome. Methods: A cross-sectional survey was conducted in 288 centres in 24 countries. Factors associated with perception of CPR and outcome were analyzed by Cochran-Mantel-Haenszel tests and conditional logistic models. Results: Of the 4018 participating clinicians, 3150 (78.4%) perceived their last CPR attempt as appropriate, 548 (13.6%) were uncertain about its appropriateness and 320 (8.0%) perceived inappropriateness; survival to hospital discharge was 370/2412 (15.3%), 8/481 (1.7%) and 8/294 (2.7%) respectively. After adjusting for country, team and clinician's characteristics, the prevalence of perception of inappropriate CPR was higher for a non-shockable initial rhythm (OR 3.76 [2.13-6.64]; P 79 years) and in case of a "poor" first physical impression of the patient (3.45 [2.36-5.05]; P 79 years) and a "poor" first physical impression (0.26 [0.19-0.35]; P <0.0001). Conclusions: The perception of inappropriate CPR increased when objective indicators of poor prognosis were present and was associated with a low survival to hospital discharge. Factoring clinical judgment into the decision to (not) attempt CPR may reduce harm inflicted by excessive resuscitation attempts.Peer reviewe

Search for microscopic evidence for molecular level negative thermal expansion in fullerenes

We report the high-resolution far infrared vibrational properties of C60 and endohedral Kr@C60 fullerene as a function of temperature. Anomalous softening of the F1u(1) mode (526 cm-1) is observed throughout the temperature range of investigation (300 - 10 K) suggesting that the fullerene cage may expand at low temperature in these molecular solids. To test this idea, we combine these results with temperature and pressure dependent Raman, infrared, and Kr extended x-ray absorption fine structure data from the literature to provide a comprehensive view of local cage size effects. The results are consistent with a recent molecular dynamics study [Kwon et al., Phys. Rev. Lett. 92, 15901 (2004)] that predicts negative thermal expansion in carbon fullerenes.Comment: 6 pages, 2 figures, accepted in Physical Review

Pulsed laser deposition of rare-​earth-​doped gallium lanthanum sulphide chalcogenide glass thin films

International audienceAmorphous chalcogenide thin films are of high current interest for technol. applications as optical storage media or waveguides for photonic integrated circuits. As part of a larger project including fs, ps and ns pulsed laser deposition regimes, Er- and Pr-​doped GLS thin films were deposited by ns PLD, and their structural, chem. and optical properties were analyzed by optical and electronic microscopy, stylus profilometry, X-​ray diffraction, Raman spectroscopy, time-​of-​flight secondary ion mass spectrometry (TOF-​SIMS)​, energy-​dispersive X-​ray spectroscopy, variable-​angle spectroscopic ellipsometry and optical transmission. Films deposited at moderate fluence (∼4 J​/cm2) in UV (266 nm) presented a good surface quality, while exhibiting acceptable compn. uniformity and deviations from stoichiometry in line with the literature. Compn. and optical properties dependences on the deposition conditions were investigated and discussed with respect to previous studies on similar systems