37 research outputs found

    An evaluation of 9-1-1 calls to assess the effectiveness of dispatch-assisted cardiopulmonary resuscitation (CPR) instructions: design and methodology

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    <p>Abstract</p> <p>Background</p> <p>Cardiac arrest is the leading cause of mortality in Canada, and the overall survival rate for out-of-hospital cardiac arrest rarely exceeds 5%. Bystander cardiopulmonary resuscitation (CPR) has been shown to increase survival for cardiac arrest victims. However, bystander CPR rates remain low in Canada, rarely exceeding 15%, despite various attempts to improve them. Dispatch-assisted CPR instructions have the potential to improve rates of bystander CPR and many Canadian urban communities now offer instructions to callers reporting a victim in cardiac arrest. Dispatch-assisted CPR instructions are recommended by the International Guidelines on Emergency Cardiovascular Care, but their ability to improve cardiac arrest survival remains unclear.</p> <p>Methods/Design</p> <p>The overall goal of this study is to better understand the factors leading to successful dispatch-assisted CPR instructions and to ultimately save the lives of more cardiac arrest patients. The study will utilize a before-after, prospective cohort design to specifically: 1) Determine the ability of 9-1-1 dispatchers to correctly diagnose cardiac arrest; 2) Quantify the frequency and impact of perceived agonal breathing on cardiac arrest diagnosis; 3) Measure the frequency with which dispatch-assisted CPR instructions can be successfully completed; and 4) Measure the impact of dispatch-assisted CPR instructions on bystander CPR and survival rates.</p> <p>The study will be conducted in 19 urban communities in Ontario, Canada. All 9-1-1 calls occurring in the study communities reporting out-of-hospital cardiac arrest in victims 16 years of age or older for which resuscitation was attempted will be eligible. Information will be obtained from 9-1-1 call recordings, paramedic patient care reports, base hospital records, fire medical records and hospital medical records. Victim, caller and system characteristics will be measured in the study communities before the introduction of dispatch-assisted CPR instructions (before group), during the introduction (run-in phase), and following the introduction (after group).</p> <p>Discussion</p> <p>The study will obtain information essential to the development of clinical trials that will test a variety of educational approaches and delivery methods for telephone cardiopulmonary resuscitation instructions. This will be the first study in the world to clearly quantify the impact of dispatch-assisted CPR instructions on survival to hospital discharge for out-of-hospital cardiac arrest victims.</p> <p>Trial Registration</p> <p>ClinicalTrials.gov NCT00664443</p

    Nusinersen treatment significantly improves hand grip strength, hand motor function and MRC sum scores in adult patients with spinal muscular atrophy types 3 and 4

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    Abstract Background Nusinersen recently became available as the first treatment for Spinal Muscular Atrophy (SMA) and data on its effectiveness and safety in adult SMA patients are still scarce. Methods We evaluated the effectiveness and safety of nusinersen treatment during 14 months in 16 adult patients with SMA types 3 and 4 in a prospective study, and retrospectively detailed the natural history of 48 adult SMA patients types 2, 3 and 4. Results Hand grip strength (p = 0.03), hand motor function (p = 0.04) as assessed by a sub-score of the Revised Upper Limb Module (RULM) and the Medical Research Council (MRC) sum score (p = 0.04) improved significantly at month 14. Importantly, the MRC sum score had declined significantly (p &lt; 0.01) prior to start of treatment in these patients. A minimal clinically important difference (MCID) in the Hammersmith Functional Motor Scale Expanded (HFMSE) and RULM scores was achieved in 31% and 50% of the patients, respectively, but the mean changes from baseline failed to reach significance. Forced Vital Capacity (FVC) transiently increased at month 6 (p = 0.01), whereas the Peak Expiratory Flow (PEF) did not. The Activity Limitations scale declined significantly prior to start of treatment (p &lt; 0.01) and showed an improvement with nusinersen which was not significant. The safety evaluation did not reveal serious adverse events and no signs of nephrotoxicity or antisense oligonucleotide (ASO)-mediated inflammation. Conclusions We conclude that hand grip strength and hand motor function, as well as MRC sum scores improved significantly in nusinersen-treated adult patients with SMA types 3 and&nbsp;4.</p

    In Situ Plasma-Grown Silicon-Oxide for Polysilicon Passivating Contacts

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    Large-scale manufacturing of polysilicon-based passivating contacts for high-efficiency crystalline silicon (c-Si) solar cells demands simple fabrication of thermally stable SiOx films with well controlled microstructure and nanoscale thickness to enable quantum-mechanical tunneling. Here, plasma-dissociated CO2 is investigated to grow in situ thin (<2 nm) SiOx films on c-Si wafers as tunnel-oxides for plasma-deposited, hole-collecting (i.e., p-type) polysilicon contacts. It is found that such plasma processing offers excellent thickness control and superior structural integrity upon thermal annealing at 1000 °C, compared to state-of-the-art wet-chemical oxides. As a result, p-type polysilicon contacts are achieved on n-type c-Si wafers that combine excellent surface passivation, resulting in an implied open-circuit voltage exceeding 700 mV, with a contact resistance as low as 0.02 Ω cm2

    Nusinersen treatment significantly improves hand grip strength, hand motor function and MRC sum scores in adult patients with spinal muscular atrophy types 3 and 4

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    BACKGROUND: Nusinersen recently became available as the first treatment for Spinal Muscular Atrophy (SMA) and data on its effectiveness and safety in adult SMA patients are still scarce. METHODS: We evaluated the effectiveness and safety of nusinersen treatment during 14 months in 16 adult patients with SMA types 3 and 4 in a prospective study, and retrospectively detailed the natural history of 48 adult SMA patients types 2, 3 and 4. RESULTS: Hand grip strength (p = 0.03), hand motor function (p = 0.04) as assessed by a sub-score of the Revised Upper Limb Module (RULM) and the Medical Research Council (MRC) sum score (p = 0.04) improved significantly at month 14. Importantly, the MRC sum score had declined significantly (p < 0.01) prior to start of treatment in these patients. A minimal clinically important difference (MCID) in the Hammersmith Functional Motor Scale Expanded (HFMSE) and RULM scores was achieved in 31% and 50% of the patients, respectively, but the mean changes from baseline failed to reach significance. Forced Vital Capacity (FVC) transiently increased at month 6 (p = 0.01), whereas the Peak Expiratory Flow (PEF) did not. The Activity Limitations scale declined significantly prior to start of treatment (p < 0.01) and showed an improvement with nusinersen which was not significant. The safety evaluation did not reveal serious adverse events and no signs of nephrotoxicity or antisense oligonucleotide (ASO)-mediated inflammation. CONCLUSIONS: We conclude that hand grip strength and hand motor function, as well as MRC sum scores improved significantly in nusinersen-treated adult patients with SMA types 3 and 4.status: publishe

    Interplay between temperature and bandgap energies on the outdoor performance of perovskite/silicon tandem solar cells

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    Perovskite/silicon tandem solar cells promise power conversion efficiencies beyond the Shockley–Queisser limit of single-junction devices; however, their actual outdoor performance is yet to be investigated. Here we fabricate 25% efficient two-terminal monolithic perovskite/silicon tandem solar cells and test them outdoors in a hot and sunny climate. We find that the temperature dependence of both the silicon and perovskite bandgaps—which follow opposing trends—shifts the devices away from current matching for two-terminal tandems that are optimized at standard test conditions. Consequently, we argue that the optimal perovskite bandgap energy at standard test conditions is <1.68 eV for field performance at operational temperatures greater than 55 °C, which is lower compared with earlier findings. This implies that bromide-lean perovskites with narrower bandgaps at standard test conditions—and therefore better phase stability—hold great promise for the commercialization of perovskite/silicon tandem solar cells

    Lessons learned from the first outdoor test of perovskite/silicon tandem solar cells

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    Perovskite/silicon tandem solar cells promise power conversion efficiencies (PCE) beyond the thermodynamic limit of single-junction devices. This potential has been unveiled via several champion devices, however, their actual outdoor performance is yet to be investigated. Here, we fabricate 25 %-efficient two-Terminal (2T) monolithic perovskite/silicon tandem solar cells and test them outdoors to reveal the characteristics of these devices specifically in hot and sunny climates, which are the ideal locations to operate such efficient photovoltaic devices. In this article, we summarize our observation on the perovskite/silicon tandem solar cells under actual operational conditions and discuss the lessons we take from our interpretations
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