A multi-center study on the attitudes of Malaysian emergency health care staff towards allowing family presence during resuscitation of adult patients

BACKGROUND The practice of allowing family members to witness on-going active resuscitation has been gaining ground in many developed countries since it was first introduced in the early 1990s. In many Asian countries, the acceptability of this practice has not been well studied. AIM We conducted a multi-center questionnaire study to determine the attitudes of health care professionals in Malaysia towards family presence to witness ongoing medical procedures during resuscitation. METHODS Using a bilingual questionnaire (in Malay and English language), we asked our respondents about their attitudes towards allowing family presence (FP) as well as their actual experience of requests from families to be allowed to witness resuscitations. Multiple logistic regression was used to analyze the association between the many variables and a positive attitude towards FP. RESULTS Out of 300 health care professionals who received forms, 270 responded (a 90% response rate). Generally only 15.8% of our respondents agreed to allow relatives to witness resuscitations, although more than twice the number (38.5%) agreed that relatives do have a right to be around during resuscitation. Health care providers are significantly more likely to allow FP if the procedures are perceived as likely to be successful (e.g., intravenous cannulation and blood taking as compared to chest tube insertion). Doctors were more than twice as likely as paramedics to agree to FP (p-value = 0.002). This is probably due to the Malaysian work culture in our health care systems in which paramedics usually adopt a 'follow-the-leader' attitude in their daily practice. CONCLUSION The concept of allowing FP is not well accepted among our Malaysian health care providers

Critical Analysis of the Profitability of Demand Response for End-Consumers and Aggregators with Flat-Rate Retail Pricing

Aggregators are considered essential to extend demand response (DR) to small residential and service sector consumers. Both sectors currently have untapped load flexibility, which is considered key to support renewable resource integration. Aggregators can offer this flexibility in bulk to other power system parties. This paper addresses the question under which conditions DR can be profitable for both aggregators and end-consumers. The paper builds further on existing research that shows end-consumer preference for flat-rate tariffs. The aim is to find the range of flat-rate retail prices for different photovoltaic (PV) feed-in-Tariffs which make DR profitable for both aggregator and end-consumers. For this purpose, an optimisation model which minimises costs through load scheduling is presented. The model is applied using two approaches: optimising from aggregator's and from end-consumers' perspective. The results show that only the aggregator's perspective yields a range of flat-rate retail prices that are profitable for both actors. However, both the price range and the expected profits of DR are small.</p

The physiology of the pedunculopontine nucleus: implications for deep brain stimulation

This brief review resolves a number of persistent conflicts regarding the location and characteristics of the mesencephalic locomotor region, which has in the past been described as not locomotion-specific and is more likely the pedunculopontine nucleus (PPN). The parameters of stimulation used to elicit changes in posture and locomotion we now know are ideally suited to match the intrinsic membrane properties of PPN neurons. The physiology of these cells is important not only because it is a major element of the reticular activating system, but also because it is a novel target for the treatment of gait and postural deficits in Parkinson’s disease (PD). The discussion explains many of the effects reported following deep brain stimulation (DBS) of the PPN by different groups and provides guidelines for the determination of long-term assessment and effects of PPN DBS. A greater understanding of the physiology of the target nuclei within the brainstem and basal ganglia, amassed over the past decades, has enabled increasingly better patient outcomes from DBS for movement disorders. Despite these improvements, there remains a great opportunity for further understanding of the mechanisms through which DBS has its effects and for further development of appropriate technology to effect these treatments. We review the scientific basis for one of the newest targets, the PPN, in the treatment of PD and other movement disorders, and address the needs for further investigation.Fil: Garcia Rill, E.. University Of Arkansas For Medical Sciences; Estados UnidosFil: Hyde, J.. University Of Arkansas For Medical Sciences; Estados UnidosFil: Kezunovic, N.. University Of Arkansas For Medical Sciences; Estados UnidosFil: Urbano Suarez, Francisco Jose. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Fisiología, Biología Molecular y Neurociencias. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Fisiología, Biología Molecular y Neurociencias; ArgentinaFil: Petersen, E.. University Of Arkansas For Medical Sciences; Estados Unido

Towards DDoS attack resilient wide area monitoring systems

The traditional physical power grid is evolving into a cyber-physical Smart Grid (SG) that links the cyber communication and computational elements with the physical control functions to dynamically integrate varied and geographically distributed energy producers/ consumers. In the SG, the cyber elements of Wide Area Measurement Systems (WAMS) are deployed to provide the critical monitoring of the state of power transmission and distribution to accomplish real-time control of the grid. Unfortunately, the increasing adoption of such computing/communication cyber-technologies essential to providing the SG operations also opens the risk of the SG being vulnerable to cyberattacks. In particular, attacks such as Denial-of-Service (DoS) and Distributed DoS (DDoS) are of primary concern for WAMS where such attacks can compromise its safety-critical accuracy and responsiveness characteristics. To prevent DoS/DDoS attacks at the transport and application layer from affecting the WAMS operations, we propose a proactive and robust extension of the Multipath-TCP (MPTCP) transportation protocol that mitigates such attacks by using a novel stream hopping MPTCP mechanism, termed as MPTCP-H. The proposed MPTCP-H hides the open port numbers of the connection from an attacker by renewing (over time) the subflows over new port numbers without perturbing the WAMS data traffic. Our results demonstrate MPTCP-H to be both effective and efficient (for reduced latency and congestion), and also applicable to the communication frameworks of other similar Critical Infrastructures. © 2017 Association for Computing Machinery

Gamma band activity in the RAS-intracellular mechanism

Gamma band activity participates in sensory perception, problem solving, and memory. This review considers recent evidence showing that cells in the reticular activating system (RAS) exhibit gamma band activity, and describes the intrinsic membrane properties behind such manifestation. Specifically, we discuss how cells in the mesopontine pedunculopontine nucleus, intralaminar parafascicular nucleus, and pontine SubCoeruleus nucleus dorsalis all fire in the gamma band range when maximally activated, but no higher. The mechanisms involve high-threshold, voltage-dependent P/Q-type calcium channels, or sodium-dependent subthreshold oscillations. Rather than participating in the temporal binding of sensory events as in the cortex, gamma band activity in the RAS may participate in the processes of preconscious awareness and provide the essential stream of information for the formulation of many of our actions. We address three necessary next steps resulting from these discoveries: an intracellular mechanism responsible for maintaining gamma band activity based on persistent G-protein activation, separate intracellular pathways that differentiate between gamma band activity during waking versus during REM sleep, and an intracellular mechanism responsible for the dysregulation in gamma band activity in schizophrenia. These findings open several promising research avenues that have not been thoroughly explored. What are the effects of sleep or REM sleep deprivation on these RAS mechanisms? Are these mechanisms involved in memory processing during waking and/or during REM sleep? Does gamma band processing differ during waking versus REM sleep after sleep or REM sleep deprivation?Fil: Garcia Rill, E.. University Of Arkansas For Medical Sciences; Estados UnidosFil: Kezunovic, N.. University Of Arkansas For Medical Sciences; Estados UnidosFil: D'Onofrio, S.. University Of Arkansas For Medical Sciences; Estados UnidosFil: Luster, B.. University Of Arkansas For Medical Sciences; Estados UnidosFil: Hyde, J.. University Of Arkansas For Medical Sciences; Estados UnidosFil: Bisagno, Veronica. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Farmacológicas. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Instituto de Investigaciones Farmacológicas; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Fisiología, Biología Molecular y Neurociencias. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Fisiología, Biología Molecular y Neurociencias; ArgentinaFil: Urbano Suarez, Francisco Jose. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Farmacológicas. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Instituto de Investigaciones Farmacológicas; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Fisiología, Biología Molecular y Neurociencias. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Fisiología, Biología Molecular y Neurociencias; Argentin