The education direction of the ACLS training program

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/30978/1/0000651.pd

Assessing uncertainty in outsourcing clinical services at tertiary health centers

When tertiary health centers face capacity constraint, one feasible strategy to meet service demand is outsourcing clinical services to qualified community providers. Clinical outsourcing enables tertiary health centers to meet the expectations of service timeliness and provides good opportunities to collaborate with other health care providers. However, outsourcing may result in dependence and loss of control for the tertiary health centers. Other parties involved in clinical outsourcing such as local partners, patients, and payers may also encounter potential risks as well as enjoy benefits in an outsourcing arrangement. Recommendations on selecting potential outsourcing partners are given to minimize the risks associated with an outsourcing contract. Copyright © 2006 John Wiley & Sons, Ltd.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/56139/1/858_ftp.pd

Education in adult advanced cardiac life support training programs: Changing the paradigm

To develop a consensus for change in the educational aspects of the Advanced Cardiac Life Support (ACLS) Training Program, the American Heart Association appointed panel members to engage in a consensus process. At a preconference meeting held in the fall of 1991, panel members received broad input from experts in adult education, experienced ACLS educators, and resuscitation scientists. The panel then developed a statement based on the preconference discussions and presented it at the National Conference on CPR and Emergency Cardiac Care held in February 1992. The conference's recommendations and the process that led to them are described in this paper.The key conclusions of the consensus process are as follows. The purpose of ACLS programs is the education of health professionals whose jobs include the management of patients in arrest or near-arrest. The goal of each ACLS course is to have each participant succeed in acquiring the skills and knowledge required for resuscitation. Aspects of the course which threaten failure or raise anxiety should be minimized or eliminated. ACLS course directors are strongly encouraged to design courses whose content and presentation are best suited to the training, experience, and needs of the course participants. Flexibility is strongly encouraged. Evaluation (testing) should be used primarily for its educational value, to help both learners and instructors identify areas needing improvement. The problem learner should be identified as early as possible and should receive intensive remediation to achieve the goal of every participant acquiring the targeted skills and knowledge. Because skill retention is variable, rescuers should practice skills frequently in regular refresher sessions. At a minimum, retraining every two years is strongly recommended.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/30977/1/0000650.pd

Comparison of adrenergic agonists for the treatment of ventricular fibrillation and pulseless electrical activity

The primary role of epinephrine for the treatment of ventricular fibrillation (VF) and pulseless electrical activity (PEA) is to increase blood flow to the myocardium and central nervous system and ultimately improve survival. However, despite the administration of epinephrine, survival following VF or PEA is low. In an attempt to improve outcome from VF and PEA, alternative adrenergic agonists (methoxamine, phenylephrine, norepinephrine) which have different pharmacological properties than epinephrine have been evaluated. In order to determine the role of alternative adrenergic agonists for the treatment of VF and PEA this paper will compare the pharmacological properties and pharmacodynamic effects of these drugs to epinephrine. Specifically, receptor physiology along with the effects of adrenergic agonists on coronary perfusion pressure, survival, myocardial oxygen demand, and cerebral blood flow will be discussed.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/31146/1/0000043.pd

Fast rotating Blue Straggler Stars in the Globular Cluster NGC3201

We used high resolution spectra acquired at the Magellan Telescope to measure radial and rotational velocities of approximately 200 stars in the Galactic globular cluster NGC 3201. The surveyed sample includes Blue Stragglers Stars (BSSs) and reference stars in different evolutionary stages (main sequence turn-off, sub-giant, red giant and asymptotic giant branches). The average radial velocity value ($\langle V_r\rangle = 494.5 \pm 0.5$ km s$^{-1}$) confirms a large systemic velocity for this cluster and was used to distinguish 33 residual field interlopers. The final sample of member stars counts 67 BSSs and 114 reference stars. Similarly to what is found in other clusters, the totality of the reference stars has negligible rotation ($<20$ km s$^{-1}$), while the BSS rotational velocity distribution shows a long tail extending up to $\sim 200$ km s$^{-1}$, with 19 BSSs (out of 67) spinning faster than 40 km s$^{-1}$. This sets the percentage of fast rotating BSSs to $\sim 28\%$. Such a percentage is roughly comparable to that measured in other loose systems ($\omega$ Centauri, M4 and M55) and significantly larger than that measured in high-density clusters (as 47 Tucanae, NGC 6397, NGC 6752 and M30). This evidence supports a scenario where recent BSS formation (mainly from the evolution of binary systems) is occurring in low-density environments. We also find that the BSS rotational velocity tends to decrease for decreasing luminosity and surface temperature, similarly to what is observed in main sequence stars. Hence, further investigations are needed to understand the impact of BSS internal structure on the observed rotational velocities.Comment: Accepted for pubblication in ApJ: 14 pages, 10 figure

Beliefs about control of smoking and smoking behavior: A comparison of different measures in different groups

This study investigated several measures of beliefs about controlling smoking as predictors of cessation and reduction at one and six months after a medically-based control program. Smokers (n = 250 total) attending general medicine clinics at University and Veterans Administration facilities received advice to quit from both physicians and nurses. Beliefs about difficulty resisting urges to smoke in 15 situations, their frequency of occurrence, and general level of difficulty were assessed at baseline. For the University group of patients, significant relationships were found between both general and specific indexes and both cessation and reduction at one month. Although a greater change in smoking was seen at six months, few belief measures remained predictive. At one month, global measures were as useful as specific ones, although difficulty in situations of negative emotion was a consistent and strong predictor. Marked differences between the two sites were found; virtually no measure of difficulty proved predictive for the VA group.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/26910/1/0000476.pd

Small RNA pathway genes identified by patterns of phylogenetic conservation and divergence

Genetic and biochemical analyses of RNA interference (RNAi) and microRNA (miRNA) pathways have revealed proteins such as Argonaute/PIWI and Dicer that process and present small RNAs to their targets. Well validated small RNA pathway cofactors, such as the Argonaute/PIWI proteins show distinctive patterns of conservation or divergence in particular animal, plant, fungal, and protist species. We compared 86 divergent eukaryotic genome sequences to discern sets of proteins that show similar phylogenetic profiles with known small RNA cofactors. A large set of additional candidate small RNA cofactors have emerged from functional genomic screens for defects in miRNA- or siRNA-mediated repression in C. elegans and D. melanogaster1,2 and from proteomic analyses of proteins co-purifying with validated small RNA pathway proteins3,4. The phylogenetic profiles of many of these candidate small RNA pathway proteins are similar to those of known small RNA cofactor proteins. We used a Bayesian approach to integrate the phylogenetic profile analysis with predictions from diverse transcriptional coregulation and proteome interaction datasets to assign a probability for each protein for a role in a small RNA pathway. Testing high-confidence candidates from this analysis for defects in RNAi silencing, we found that about half of the predicted small RNA cofactors are required for RNAi silencing. Many of the newly identified small RNA pathway proteins are orthologues of proteins implicated in RNA splicing. In support of a deep connection between the mechanism of RNA splicing and small RNA-mediated gene silencing, the presence of the Argonaute proteins and other small RNA components in the many species analysed strongly correlates with the number of introns in that species

Education in adult basic life support training programs

The Panel on Educational Issues in Adult Basic Life Support Training Programs reviewed the characteristics of adult learners, aspects of educational theory, issues concerning barriers to learning and performing CPR, and issues concerning testing and evaluation.The panel made the following recommendations: a comprehensive evaluation of the basic life support program with the goal of improving the program design and educational tools must be initiated; adult programs must be designed to motivate laypersons to become trained in CPR, as well as to target relatives and friends of high-risk individuals; and emotional and attitudinal issues, including the student's reluctance to act in an emergency, must be addressed. Programs must incorporate information on the willingness of an individual to perform CPR; CPR programs must be simplified and focus on critical success factors; flexible educational approaches in programs are encouraged; flexible programming that addresses the needs of the allied health professional is encouraged; formal testing should be eliminated for layperson programs; and formal testing for health care providers and instructors should be continued.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/30976/1/0000649.pd

Regional-scale paleofluid system across the Tuscan Nappe–Umbria–Marche Apennine Ridge (northern Apennines) as revealed by mesostructural and isotopic analyses of stylolite–vein networks

We report the results of a multiproxy study that combines structural analysis of a fracture–stylolite network and isotopic characterization of calcite vein cements and/or fault coating. Together with new paleopiezometric and radiometric constraints on burial evolution and deformation timing, these results provide a first-order picture of the regional fluid systems and pathways that were present during the main stages of contraction in the Tuscan Nappe and Umbria–Marche Apennine Ridge (northern Apennines). We reconstruct four steps of deformation at the scale of the belt: burial-related stylolitization, Apenninic-related layer-parallel shortening with a contraction trending NE–SW, local extension related to folding, and late-stage fold tightening under a contraction still striking NE–SW. We combine the paleopiezometric inversion of the roughness of sedimentary stylolites – that constrains the range of burial depth of strata prior to layer-parallel shortening – with burial models and U–Pb absolute dating of fault coatings in order to determine the timing of development of mesostructures. In the western part of the ridge, layer-parallel shortening started in Langhian time (∼15 Ma), and then folding started at Tortonian time (∼8 Ma); late-stage fold tightening started by the early Pliocene (∼5 Ma) and likely lasted until recent/modern extension occurred (∼3 Ma onward). The textural and geochemical (δ18O, δ13C, Δ47CO2 and 87Sr∕86Sr) study of calcite vein cements and fault coatings reveals that most of the fluids involved in the belt during deformation either are local or flowed laterally from the same reservoir. However, the western edge of the ridge recorded pulses of eastward migration of hydrothermal fluids (>140 ∘C), driven by the tectonic contraction and by the difference in structural style of the subsurface between the eastern Tuscan Nappe and the Umbria–Marche Apennine Ridge

The Biological Response to Nanometre-sized Polymer Particles

Recently, nanometre-sized UHMWPE particles generated from hip and knee replacements have been identified in vitro and in vivo. UHMWPE particles in the 0.1-1.0 µm size range have been shown to be more biologically active than larger particles, provoking an inflammatory response implicated in late aseptic loosening of total joint replacements. The biological activity of nanometre-sized particles has not previously been studied. The biological response to clinically-relevant UHMWPE wear particles including nanometre-sized and micrometre-sized, along with polystyrene particles (FluoSpheres 20 nm, 60 nm, 200 nm and 1.0 µm), and nanometre-sized model polyethylene particles (Ceridust 3615®), was determined in terms of osteolytic cytokine release from primary human peripheral blood mononuclear cells (PBMNC’s). Nanometre-sized UHMWPE wear particles, nanometre-sized Ceridust 3615® and 20 nm FluoSpheres had no significant effect on TNF-α, IL-1β, IL-6 and IL-8 release from PBMNC’s at a concentration of 100 μm3 particles per cell after 12 and 24 hours. The micrometre-size UHMWPE wear particles (0.1-1.0 μm) and 60 nm, 200 nm and 1.0 µm FluoSpheres caused significantly elevated osteolytic cytokine release from PBMNC’s. These results indicated that particles below circa 50 nm fail to activate PBMNC’s and that particle size, composition and morphology played a crucial role in cytokine release by particle stimulated macrophages