A randomized cross-over study of the quality of cardiopulmonary resuscitation among females performing 30:2 and hands-only cardiopulmonary resuscitation

Abstract Background Hands-Only cardiopulmonary resuscitation (CPR) is recommended for use on adult victims of witnessed out-of-hospital (OOH) sudden cardiac arrest or in instances where rescuers cannot perform ventilations while maintaining minimally interrupted quality compressions. Promotion of Hands-Only CPR should improve the incidence of bystander CPR and, subsequently, survival from OOH cardiac arrest; but, little is known about a rescuer's ability to deliver continuous chest compressions of adequate rate and depth for periods typical of emergency services response time. This study evaluated chest compression rate and depth as subjects performed Hands-Only CPR for 10 minutes. For comparison purposes, each also performed chest compressions with ventilations (30:2) CPR. It also evaluated fatigue and changes in body biomechanics associated with each type of CPR. Methods Twenty healthy female volunteers certified in basic life support performed Hands-Only CPR and 30:2 CPR on a manikin. A mixed model repeated measures cross-over design evaluated chest compression rate and depth, changes in fatigue (chest compression force, perceived exertion, and blood lactate level), and changes in electromyography and joint kinetics and kinematics. Results All subjects completed 10 minutes of 30:2 CPR; but, only 17 completed 10 minutes of Hands-Only CPR. Rate, average depth, percentage at least 38 millimeters deep, and force of compressions were significantly lower in Hands-Only CPR than in 30:2 CPR. Rates were maintained; but, compression depth and force declined significantly from beginning to end CPR with most decrement occurring in the first two minutes. Perceived effort and joint torque changes were significantly greater in Hands-Only CPR. Performance was not influenced by age. Conclusion Hands-Only CPR required greater effort and was harder to sustain than 30:2 CPR. It is not known whether the observed greater decrement in chest compression depth associated with Hands-Only CPR would offset the potential physiological benefit of having fewer interruptions in compressions during an actual resuscitation. The dramatic decrease in compression depth in the first two minutes reinforces current recommendations that rescuers take turns performing compressions, switching every two minutes or less. Further study is recommended to determine the impact of real-time feedback and dispatcher coaching on rescuer performance.http://deepblue.lib.umich.edu/bitstream/2027.42/112830/1/12912_2008_Article_58.pd

Biodiversity of shallow subtidal, under-rock invertebrates in Europe's first marine reserve: effects of physical factors and scientific sampling

At Lough Hyne Marine Reserve in SW Ireland, shallow subtidal, under-rock biodiversity was investigated to assess (i) any deleterious effects of scientific sampling and (ii) quantitative baseline community patterns. Comparisons were made between 10 sites with annual rock-turning disturbance and 10 with multi-decadal (historical) disturbance. At each site, shallow subtidal rocks (N = 1289 total) were lifted, organisms recorded, and rocks replaced in their original position. Biodiversity indices were calculated to evaluate how diversity varied with location within the lough, frequency of sampling disturbance, degree of hypoxia/anoxia, dissolved oxygen (DO) concentration, and number of rocks turned. The richness of solitary invertebrates surveyed in situ averaged 21 taxa per site with significantly more in the South Basin (near the lough's connection to the ocean) than in the North Basin. The Shannon-Wiener Index did not differ significantly with variables investigated. However, evenness was higher at annually disturbed sites than at historical ones where anemones with algal symbionts often dominated. Several sites were hypoxic to anoxic under the shallow subtidal rocks. Cup corals were most abundant in the South Basin; DO was a crucial explanatory variable of these sensitive species. Solitary ascidians were most abundant at South-Basin annual sites with DO levels being a highly significant explanatory variable

No ‘silver bullet’:Multiple factors control population dynamics of european purple sea urchins in Lough Hyne marine reserve, Ireland

Two-decade-long monitoring studies at Europe\u27s first statutory marine reserve—Lough Hyne in SW Ireland—indicate that benthic communities are rapidly changing. Populations of the ecologically important purple urchin (Paracentrotus lividus) have fluctuated widely, most recently with a population boom in the late 1990s, followed by a mass mortality that persists to the present day. Eight general hypotheses have been proposed to account for the urchin decline including cold temperature limiting reproduction, ephemeral algal exudates disrupting urchin fertilization, low larval availability (due to over-harvesting and/or episodic recruitment), high mortality of settlers and juveniles due to hypoxia, hyperoxia, or predation (a trophic cascade hypothesis), and increased mortality due to pathogens (stress hypothesis). The cold-temperature and the trophic cascade hypotheses appear unlikely. The remaining hypotheses, however, all seem to play a role, to some degree, in driving the urchin decline. Ulvoid exudates, for example, significantly reduced urchin fertilization and few larvae were found in plankton tows (2012–2015), indicating low larval availability in summer. Whilst settling urchins regularly recruited under shallow-subtidal rocks until 2011, no settlers were found in these habitats from 2011 to 2014 or in field experiments (2012–2018) using various settlement substrata. Seawater quality was poor in shallow areas of the lough with extreme oxygen fluctuations (diel-cycling hypoxia), and 1-day experimental exposures to DO values < 1 mg L−1 were lethal to most juvenile urchins. Multiple increases of the predatory spiny starfish (Marthasterias glacialis) population in recent decades may also have contributed to the demise of the coexisting juvenile urchins. Finally, urchins of all sizes were seen suffering from dropped spines, tissue necrosis, or white-coloured infection, suggestive of stress-related pathogen mortality. There was a paucity of broken tests, indicating limited predation by large crustaceans; the large number of adult urchins ‘missing’ and few P. lividus tests on the north shore points to possible urchin removal by poachers and/or starfish predation. While these ecological, environmental, and anthropogenic processes occur on open coast rocky shores, many are exacerbated by the semi-enclosed nature of this fully marine sea lough due to its limited flushing. Multiple factors, including low larval availability and rapidly expanding starfish populations, coupled with degraded habitat quality (ephemeral algal mats and extreme oxygen fluctuations), indicate that the purple urchin populations will not recover without an improvement in the water quality of Lough Hyne Marine Reserve, the restocking of urchins, and protection from poaching

Extreme oxygen dynamics in shallow water of a fully marine Irish sea lough

The benthos of Lough Hyne (Europe’s first marine reserve) in SW Ireland has changed dramatically in the past decade with declining invertebrate communities and proliferating ephemeral macroalgae. In summer 2011 and 2012, we measured dissolved oxygen (DO) levels on shallow subtidal rocky shores of the lough and recorded both benthic hypoxia (<2 mg O2 L−1) and hyperoxia (∼10–16 mg O2 L−1). In late summer 2013, we systematically characterized the spatial and temporal patterns of DO in the lough seawater. Daytime DO levels were hyperoxic either at or near the rocky shore, declined with increased distance for the first 5 m offshore, then stabilized at normoxic levels (∼8 mg O2 L−1). DO levels above and below rocks were variable and often showed large differences (max. difference of 15.6 mg O2 L−1), particularly at rocky shore sites with low current flow. At night, the DO in shallow water declined, becoming hypoxic to anoxic during calm weather. These extreme oxygen fluctuations (i) are amongst the first records to report severe conditions within Irish coastal waters and (ii) could contribute to the known recent decline in benthic invertebrate diversity within the marine reserve

A counterbalanced cross-over study of the effects of visual, auditory and no feedback on performance measures in a simulated cardiopulmonary resuscitation

<p>Abstract</p> <p>Background</p> <p>Previous research has demonstrated that trained rescuers have difficulties achieving and maintaining the correct depth and rate of chest compressions during both in and out of hospital cardiopulmonary resuscitation (CPR). Feedback on rate and depth mitigate decline in performance quality but not completely with the residual performance decline attributed to rescuer fatigue. The purpose of this study was to examine the effects of feedback (none, auditory only and visual only) on the quality of CPR and rescuer fatigue.</p> <p>Methods</p> <p>Fifteen female volunteers performed 10 minutes of 30:2 CPR in each of three feedback conditions: none, auditory only, and visual only. Visual feedback was displayed continuously in graphic form. Auditory feedback was error correcting and provided by a voice assisted CPR manikin. CPR quality measures were collected using SkillReporter^®software. Blood lactate (mmol/dl) and perceived exertion served as indices of fatigue. One-way and two way repeated measures analyses of variance were used with alpha set <it>a priori </it>at 0.05.</p> <p>Results</p> <p>Visual feedback yielded a greater percentage of correct compressions (78.1 ± 8.2%) than did auditory (65.4 ± 7.6%) or no feedback (44.5 ± 8.1%). Compression rate with auditory feedback (87.9 ± 0.5 compressions per minute) was less than it was with both visual and no feedback (p < 0.05). CPR performed with no feedback (39.2 ± 0.5 mm) yielded a shallower average depth of compression and a lower percentage (55 ± 8.9%) of compressions within the accepted 38-50 mm range than did auditory or visual feedback (p < 0.05). The duty cycle for auditory feedback (39.4 ± 1.6%) was less than it was with no feedback (p < 0.05). Auditory feedback produced lower lactate concentrations than did visual feedback (p < 0.05) but there were no differences in perceived exertion.</p> <p>Conclusions</p> <p>In this study feedback mitigated the negative effects of fatigue on CPR performance and visual feedback yielded better CPR performance than did no feedback or auditory feedback. The perfect confounding of sensory modality and periodicity of feedback (visual feedback provided continuously and auditory feedback provided to correct error) leaves unanswered the question of optimal form and timing of feedback.</p

Analysis and characterization of heparin impurities

This review discusses recent developments in analytical methods available for the sensitive separation, detection and structural characterization of heparin contaminants. The adulteration of raw heparin with oversulfated chondroitin sulfate (OSCS) in 2007–2008 spawned a global crisis resulting in extensive revisions to the pharmacopeia monographs on heparin and prompting the FDA to recommend the development of additional physicochemical methods for the analysis of heparin purity. The analytical chemistry community quickly responded to this challenge, developing a wide variety of innovative approaches, several of which are reported in this special issue. This review provides an overview of methods of heparin isolation and digestion, discusses known heparin contaminants, including OSCS, and summarizes recent publications on heparin impurity analysis using sensors, near-IR, Raman, and NMR spectroscopy, as well as electrophoretic and chromatographic separations