A Complete Redesign of the Cardiopulmonary Resuscitation (CPR) and Automated External Defibrillator (AED) Learning Experience

Survival following sudden cardiac arrest in the community can be framed as a complex systems problem for which systems thinking and design methodologies may be applied. Focusing on the subsystem of the learning experience of cardiopulmonary resuscitation and use of an automated external defibrillator (CPR/AED), we used a systems approach to understand the current state of learning and a design methodology to identify improvements. A systems diagnosis identified six elements within the learning experience - need for training, opportunity for training, training class characteristics, perceived competence, anticipated event characteristics, and perceived readiness to act – each of which had positive and negative meanings and outcomes. As the elements are interactive and complex, the expected central property of learning – likelihood to act - may not be realized because of significant conflicts and obstructions. Design methodology identified 250 elements for an ideal CPR/AED learning experience which could be arranged as a containing system with eight interactive categories. Based on a system thinking and design methodology approach we suggested ten changes to improve the current state of the CPR/AED learning experience

Emissions pathways, climate change, and impacts on California

The magnitude of future climate change depends substantially on the greenhouse gas emission pathways we choose. Here we explore the implications of the highest and lowest Intergovernmental Panel on Climate Change emissions pathways for climate change and associated impacts in California. Based on climate projections from two state-of-the-art climate models with low and medium sensitivity (Parallel Climate Model and Hadley Centre Climate Model, version 3, respectively), we find that annual temperature increases nearly double from the lower B1 to the higher A1fi emissions scenario before 2100. Three of four simulations also show greater increases in summer temperatures as compared with winter. Extreme heat and the associated impacts on a range of temperature-sensitive sectors are substantially greater under the higher emissions scenario, with some interscenario differences apparent before midcentury. By the end of the century under the B1 scenario, heatwaves and extreme heat in Los Angeles quadruple in frequency while heat-related mortality increases two to three times; alpine subalpine forests are reduced by 50–75%; and Sierra snowpack is reduced 30–70%. Under A1fi, heatwaves in Los Angeles are six to eight times more frequent, with heat-related excess mortality increasing five to seven times; alpine subalpine forests are reduced by 75–90%; and snowpack declines 73–90%, with cascading impacts on runoff and streamflow that, combined with projected modest declines in winter precipitation, could fundamentally disrupt California’s water rights system. Although interscenario differences in climate impacts and costs of adaptation emerge mainly in the second half of the century, they are strongly dependent on emissions from preceding decades

Homologous recombination DNA repair defects in PALB2- associated breast cancers

Abstract: Mono-allelic germline pathogenic variants in the Partner And Localizer of BRCA2 (PALB2) gene predispose to a high-risk of breast cancer development, consistent with the role of PALB2 in homologous recombination (HR) DNA repair. Here, we sought to define the repertoire of somatic genetic alterations in PALB2-associated breast cancers (BCs), and whether PALB2-associated BCs display bi-allelic inactivation of PALB2 and/or genomic features of HR-deficiency (HRD). Twenty-four breast cancer patients with pathogenic PALB2 germline mutations were analyzed by whole-exome sequencing (WES, n = 16) or targeted capture massively parallel sequencing (410 cancer genes, n = 8). Somatic genetic alterations, loss of heterozygosity (LOH) of the PALB2 wild-type allele, large-scale state transitions (LSTs) and mutational signatures were defined. PALB2-associated BCs were found to be heterogeneous at the genetic level, with PIK3CA (29%), PALB2 (21%), TP53 (21%), and NOTCH3 (17%) being the genes most frequently affected by somatic mutations. Bi-allelic PALB2 inactivation was found in 16 of the 24 cases (67%), either through LOH (n = 11) or second somatic mutations (n = 5) of the wild-type allele. High LST scores were found in all 12 PALB2-associated BCs with bi-allelic PALB2 inactivation sequenced by WES, of which eight displayed the HRD-related mutational signature 3. In addition, bi-allelic inactivation of PALB2 was significantly associated with high LST scores. Our findings suggest that the identification of bi-allelic PALB2 inactivation in PALB2-associated BCs is required for the personalization of HR-directed therapies, such as platinum salts and/or PARP inhibitors, as the vast majority of PALB2-associated BCs without PALB2 bi-allelic inactivation lack genomic features of HRD

The Solubility of Gases in Liquids 6. Solubility of N\u3csub\u3e2\u3c/sub\u3e, O\u3csub\u3e2\u3c/sub\u3e, CO, CO\u3csub\u3e2\u3c/sub\u3e, CH\u3csub\u3e4\u3c/sub\u3e, and CF\u3csub\u3e4\u3c/sub\u3e in Methylcyclohexane and Toluene at 283 to 313 K

The solubilities of N2, O2, CO, CO2, CH4, and CF4 in methylcyclohexane and toluene have been determined at 1 atm pressure in the range 283 to 313 K. The solubility, Gibbs energy, enthalpy, and entropy of solution for 1 atm partial pressure of gas and 298.15 K have been calculated from the experimental results. These values have been compared with the results obtained through application of the scaled particle theory to gas solubilities. Agreement is generally good. This theory is also used to discuss the different behavior of alicyclic and aromatic solvents with respect to gas solubility

The Solubility of Gases in Liquids 6. Solubility of N\u3csub\u3e2\u3c/sub\u3e, O\u3csub\u3e2\u3c/sub\u3e, CO, CO\u3csub\u3e2\u3c/sub\u3e, CH\u3csub\u3e4\u3c/sub\u3e, and CF\u3csub\u3e4\u3c/sub\u3e in Methylcyclohexane and Toluene at 283 to 313 K

The solubilities of N2, O2, CO, CO2, CH4, and CF4 in methylcyclohexane and toluene have been determined at 1 atm pressure in the range 283 to 313 K. The solubility, Gibbs energy, enthalpy, and entropy of solution for 1 atm partial pressure of gas and 298.15 K have been calculated from the experimental results. These values have been compared with the results obtained through application of the scaled particle theory to gas solubilities. Agreement is generally good. This theory is also used to discuss the different behavior of alicyclic and aromatic solvents with respect to gas solubility

Rotator Interval Plication: The “Seamster” Technique

The indications and best technique for plication of the rotator interval capsule, performed as a supplemental procedure at the time of arthroscopic shoulder stabilization, remain a controversial topic. There are currently no well-accepted surgical indication guidelines that have been established. Several biomechanical studies, however, have demonstrated the important contribution of the rotator interval capsule to stability of the glenohumeral joint, and the utilization of rotator interval plication in patients with glenohumeral instability has been supported in several publications. The indications for and surgical steps to accomplish the arthroscopic “seamster” technique for rotator interval plication, used by the authors for >20 years, is described

Arthroscopic 360° Shoulder Labral Reconstruction: A Stepwise Approach

Combined lesions of the glenoid labrum are a relatively common finding in shoulder instability patients. Even so, relatively few studies have been published evaluating outcomes after repair of these complex labral detachments. To achieve a successful outcome, accurate identification of all pathologic lesions in the shoulder combined with an organized, stepwise approach to sometimes circumferential labral fixation is required. Repair of 360° labral tears can be effectively and efficiently achieved by implementing the reproducible steps and sequence described to reconstruct these circumferential labral tears