Naloxone Administration Route in Opioid Overdose: A Review of Vermont EMS Data

Objective: Emergency Medical System (EMS) personnel administer the direct opioid antagonist naloxone in cases of opioid overdose via intramuscular (IM), intravenous (IV), subcutaneous (SQ), intraosseous (IO), or intranasal (IN) routes. Some early studies suggest that the intranasal route of administration is of similar effectiveness to injectable routes. The main objective of our study was to compare the efficacy of intravenous and intraosseous (IV/IO) routes of naloxone administration to the intranasal (IN) route in suspected opioid overdoses in Vermont. Methods: We reviewed retrospective data from Vermont EMS Statewide Incident Reporting Network (SIREN) between April 2014 and August 2016. We included all patients that were entered into SIREN and administered naloxone during the study period. Predictor variables were route of administration, medication dosage, crew member level, and cardiac arrest (yes or no). We conducted a binary logistic regression in SPSS to predict improvement in patient condition. Results: Our sample consisted of 1139 cases of first-dose naloxone administration. 1076 cases contained sufficient data to be analyzed. Patients who experienced a cardiac arrest were less likely to respond to naloxone (OR 10.8, 95% CI (5.908-19.694)). Route of administration, crew member level, and dosage (in the normal therapeutic range of 0.1-2mg) did not have a statistically significant effect on patient response to naloxone. Conclusions: Our findings, in conjunction with other recent research, suggest that intranasal administration is a safe and effective route when compared with intravenous and intraosseous routes. Intranasal administration has several distinct advantages over injectable routes, including the potential to reduce the risk of needle-stick injuries and blood-borne pathogen transmissions and to be handled by individuals with less medical training. In cases of cardiac arrest, we recommend that providers focus on treatments with proven benefit, including CPR and proper ventilation and oxygenation

Modelling of masonry arches strengthened at extrados with FRCM

Masonry arches are amongst the most fascinating structures of the World's historical and architectural heritage. Their vulnerability to earthquakes pointed out the necessity of their preservation. Fiber Reinforced Cementitious Mortar (FRCM) composites have been recently used as a more sustainable alternative to FRPs in the strengthening of masonry structures, since they can overcome the limits FRP show as strengthening systems: poor behavior to high temperature, delamination with significant loss of material at the bonded surface, lack of vapor permeability, impossibility of application on humid surfaces, incompatibility of resins with masonry, high cost and reduced reversibility of the installation. These aspects have a critical relevance in the case of historical structures, whose features have to be preserved, and motivate researches about the use of FRCM on masonry structures, from both experimental and analytical points of view. In this paper, the results of numerical analyses performed on arches unstrengthened and strengthened at the extrados with PBO-FRCM composites are presented, taking as reference the experimental tests published in [1] and [2]. The aim of this research is to further investigate the benefits that the use of FRCM composites have on the mechanical performance of masonry. The used model, implemented in the finite element code DIANA FEA, succeeded in reproducing the mechanical behavior of the considered arches in terms of collapse mechanism, load carrying capacity and ductility.- (undefined

Revisiting the Mechanism of the Meso-to-α Transition of Isotactic Polypropylene and Ethylene-Propylene Random Copolymers

In this work, we have conducted in situ simultaneous small- and wide-angle X-ray scattering and Raman spectroscopy experiments to investigate the fundamental differences in the mechanism of the mesomorphic to α phase transition of the isotactic polypropylene homopolymer and the random ethylene-propylene copolymer. Via quantitative analysis of the results coming from the three techniques, we found that in the homopolymer, chain interlock and chain extension occur during the transition. However, these processes are not necessary for the transition to occur. Indeed, the presence of randomly distributed ethylene co-units hinders the chain interlock process in the early stages of the phase transition (T > 60 °C) and suppresses the chain elongation process at the later stages (T > 90 °C). Consequently, the mesomorphic to α-phase transition in the random copolymer occurs with inclusion of the ethylene co-units inside the crystal lattice, causing increased lateral interchain distance and larger crystalline sizes. Our results show how differences exist in the way solid phase transitions occur at the molecular scale when co-monomers are included into the macromolecular chains, leading to a better understanding of the thermal behavior of semi-crystalline polymers

La transversalidad de la ética en la enseñanza de las Ciencias Económicas

Mainstreaming in teaching ethics is the core objective of the present project considering the career of public accountant, together with the recognition of values from the philosophical and theological order to establish the feasibility of transmission of ethical values in the classroom and determine their added value for students. It is therefore necessary to identify the variables that influence professional codes of ethics, and analyze whether they reach to promote conduct that meet the expectations of today’s organizations and communities. This paper proposes consideration of principles of conduct that include professional performance oriented sustainable development, including respect for man and the environment within a framework of integrity in personal and professional performance contexts. In this period we have especially considered the implication that ethics has not only for classroom space but rather to the whole university. Teaching ethics is unthinkable without a strong commitment to organizational level also. New reflections on the subject at the international level, progress on understanding no longer an isolated subject, but to a university ethically compromised. In this regard, we have again laying a foundation which involves thinking ethically, but updated in organization view. On the other hand, we have reflected the importance that have the value as new paradigms of academic teaching. Finally, we have seen how the university ethical commitment is anorder of the magisterium of the Church, especially the Latin American and Francis himself, then stop in the fundamental importance of positive leadership as a tool for social change and commitment. Awakening that interest, it is the task not only of teachers of ethics, but for the academia in general. With this approach, we have held meetings with teachers in the area of accounting to promote mainstreaming of teaching ethics in undergraduate courses. We hope from the experience observed during the next school year to approach a model of courtly work that contributes to the quality ofeducation based on values.La transversalidad en la enseñanza de la ética, junto con el reconocimiento de valores, es el principal objetivo del presente proyecto, orientado la carrera de Contador Público. La finalidad es establecerl a viabilidad de la transmisión de valores éticos en el aula y determinar el valor agregado para los alumnos. Para ello, es necesario identificar las variables que influyen en los códigos de ética profesional, y analizar si alcanzan para impulsar una conducta que responda a las expectativas de las organizaciones y de las comunidades actuales. Este trabajo propone la consideración de principios de conducta que contemplen la actuación profesional en contextos orientados hacia el desarrollo sustentable, que incluyen respeto por el hombre y por el ambiente en un marco de integridad en el desempeño personal y profesional, ambiental y de gobernabilidad. En este período hemos ahondado especialmente en la consideración de la implicancia que la ética reviste no solo para espacio áulico sino, antes bien, para la universidad toda. Es impensado enseñar ética si esto no reviste de un fuerte compromiso a nivel también organizacional. Las nuevas reflexiones en la materia, a nivel internacional, avanzan sobre la comprensión no ya de una asignatura aislada, sino hacia una universidad éticamente comprometida. En este sentido, hemos vuelto a sentar las bases sobre qué implica pensar éticamente, pero actualizadas en vista a las organizaciones. Por otro lado, hemos reflexionado sobre la importancia que poseen los valores como nuevos paradigmas de la enseñanza académica. Por último, hemos visto cómo el compromiso ético-universitario es un pedido del magisterio de la Iglesia, especialmente del latinoamericano y del mismo Francisco, para luego detenernos en la fundamental importancia del liderazgo positivo como herramienta de cambio y compromiso social. Despertar ese interés es tarea no solo de los docentes de ética, sino de todos los que hacen al ámbito académico. Con este enfoque, hemos realizado encuentros con docentes del área de Contabilidad para impulsar la transversalidad de la enseñanza de la ética en los cursos de grado. Esperamos, a partir de la experiencia que se observe durante el próximo ciclo lectivo, poder aproximarnos a un modelo de trabajo áulico que contribuya a la calidad de la enseñanza basada en valores

An effective numerical modelling strategy for FRCM strengthened curved masonry structures

Fabric Reinforced Cementitious Matrix (FRCM) composites are currently considered a very effective solution for strengthening masonry constructions. However, the mechanical interactions governing the response and the strength of FRCM reinforced masonry structures are very complex, especially in the case of curved structures. Moreover, these interactions involve several interfaces between different materials. Thus, the development of accurate numerical models for curved FRCM reinforced masonry structures comes up against several difficulties, and models too complex for practical applications can be obtained. In addition, several mechanical parameters needed for the calculations are generally inaccessible by conventional experimental tests. Here, a suitable numerical modelling strategy for FRCM strengthened curved masonry structures is proposed to combine the accuracy in simulating the actual behaviour in terms of stiffness, strength and collapse mechanisms with a reasonable simplicity, making the proposed approach usable also by practitioners, by adopting commercial codes and at a moderate computational effort. The relatively small number of mechanical parameters characterizing the model can be determined by ordinary experimental tests on materials or by literature formulations. The proposed modelling strategy is validated with respect to experimental data found in literature concerning a FRCM reinforced masonry barrel vault, and then is employed for studying the seismic capacity of the vault through a pushover analysis. A broad sensitivity analysis sheds light on the effect of variations of the mechanical parameters on the predicted overall behaviour, showing the robustness of the results obtainable through the proposed approach concerning inaccuracies in the determination of the parameters often very difficult to determine by ordinary experimental tests on masonry structures.Funding: Financial support from ReLUIS (Italian Department of Civil Protection) and from the Italian Ministry of University and Research (MUR) in the framework of Project PRIN2020 #20209F3A37 is gratefully acknowledged

Uncontrolled asthma: assessing quality of life and productivity of children and their caregivers using a cross-sectional Internet-based survey

<p>Abstract</p> <p>Background</p> <p>Results of a national survey of asthmatic children that evaluated management goals established in 2004 by the National Asthma Education and Prevention Program (NAEPP) indicated that asthma symptom control fell short on nearly every goal.</p> <p>Methods</p> <p>An Internet-based survey was administered to adult caregivers of children aged 6-12 years with moderate to severe asthma. Asthma was categorized as uncontrolled when the caregiver reported pre-specified criteria for daytime symptoms, nighttime awakening, activity limitation, or rescue medication based on the NAEPP guidelines. Children's health-related quality of life (HRQOL) and caregivers' quality of life (QOL) were assessed using the Child Health Questionnaire Parent Form 28 (CHQ-PF28) and caregiver's work productivity using a modified Work Productivity and Activity Impairment Questionnaire. Children with uncontrolled vs. controlled asthma were compared.</p> <p>Results</p> <p>360 caregivers of children with uncontrolled asthma and 113 of children with controlled asthma completed the survey. Children with uncontrolled asthma had significantly lower CHQ-PF28 physical (mean 38.1 vs 49.8, uncontrolled vs controlled, respectively) and psychosocial (48.2 vs 53.8) summary measure scores. They were more likely to miss school (5.5 vs 2.2 days), arrive late or leave early (26.7 vs 7.1%), miss school-related activities (40.6 vs 6.2%), use a rescue inhaler at school (64.2 vs 31.0%), and visit the health office or school nurse (22.5 vs 8.8%). Caregivers of children with uncontrolled asthma reported significantly greater work and activity impairment and lower QOL for emotional, time-related and family activities.</p> <p>Conclusions</p> <p>Poorly controlled asthma symptoms impair HRQOL of children, QOL of their caregivers, and productivity of both. Proper treatment and management to improve symptom control may reduce humanistic and economic burdens on asthmatic children and their caregivers.</p