Automated external defibrillator (AED) use among paramedics in the Emergency Department – what are the obstacles in using the automated external defibrillator in the pre-hospital care settings?

This study determined factors that influence usage of automated external defibrillation (AED) on out-of-hospital cardiac arrest among paramedics in Emergency Department of Universiti Kebangsaan Malaysia Medical Centre (UKMMC). It was a cross sectional prospective study conducted between December 2013 and January 2014. Paramedics from Emergency Department were enrolled and assessed using the self-filled questionnaire consisting of multiple sections including knowledge assessment, training and practice. In total, 53 paramedics participated in this study. Only 62% participants used AEDs previously. Not more than 83% participants admitted that they would use it if required. A positive correlation was observed between age and work experience with knowledge on AED usage (p=0.001 and p=0.005, respectively). Government’s institute graduates possess better knowledge and higher confidence level than private institutions graduates (p<0.001). Positive correlation existed between working experience and confidence level in deciding to use (p=0.006), application (p=0.019) and troubleshooting in regards of AED use (p=0.002). The main factor for low confidence level of AED use was lack of training (73.6%) which resulted in reduced confidence to initiate use (45.3%). Eighty eight percent agreed that training is essential before any AED use. Forty one percent felt that Malaysian public is not ready for AEDs use. As a conclusion, AED usage and knowledge among paramedics is still poor and further training is crucial for the improvement of pre-hospital care in Malaysia

Experimental Investigation of pump propagating direction in double-pass Er3+-doped fiber amplifiers

In this paper, the impacts of pump propagating direction in double-pass Erbium-doped fiber amplifier are experimentally demonstrated. The double-pass optical amplifier architecture is constructed using a fiber loop mirror that consists of a circulator to reflect the amplified signal back into the Erbium-doped fiber. The gain and noise figure performance of the double-pass optical amplifier is not affected by the direction of pump light, forward- or backward-pumped scheme. The population inversion along the Erbium-doped fiber is locked to a specific fraction due to the double-pass amplification of the signal

Marshall Stability of Porous Asphalt Mixture Incorporating Kenaf Fiber

Porous asphalt mixture (PA), known as open-graded surfaces over a stone bed underneath, allows water to go through. These factors can affect the porous asphalt mixture adhesive strength. The high amount of course aggregate promotes the structure of air voids have certain impacts on the acoustic properties of porous asphalt. The materials properties are consisting of both aggregate and bitumen tests. This study also details out the aggregates sieve analysis test to develop new aggregate gradation for PA. According to five ASEAN countries’ specifications, the sieve analysis test was done. The countries included are Malaysia, Vietnam, Thailand, Singapore, and Indonesia. The test for the binder includes the softening point, penetration, and ductility. This study also investigates the addition of kenaf fiber in the mixture as an additive. Mechanical performance test for PA using Marshall Stability test to identify the strength and the properties of the conventional PA with the addition of kenaf fiber compared to the new gradation of PA incorporating kenaf fiber. From the results, the addition of 0.3% kenaf modified PA improved the performance of PA in terms of Marshall Stability and volumetric properties

A triangular MIMO array antenna with a double negative metamaterial superstrate to enhance bandwidth and gain

Multiple-input-multiple-output (MIMO) array antenna integrated with the double negative metamaterial superstrate is presented. The triangular metamaterial unit cell is designed by combining two triangular elements positioned in complementary on the same plane at different sizes. Such design with more gaps is used to excite rooms for more capacitance effects to shift the resonance frequency thus enlarging the bandwidth of the MIMO antenna. The unit cell is arranged in 7 × 7 periodic array created a superstrate metamaterial plane where the Cstray exists in parallel between the two consecutive cells. It is found that the existence of Cstray and gaps for each unit cells significantly influenced the bandwidth of the MIMO antenna. The higher value of the capacitance will lead to the negativity of permittivity. The superstrate plane is then located on top of the 4 × 2 MIMO with a gap of 5 mm. The integration resulted in improving the bandwidth to 12.45% (5.65-6.4GHz) compared to only 3.49% bandwidth (5.91-6.12GHz) of the MIMO antenna itself. Moreover, the negative permeability characteristic is created by a strong magnetic field between the complementary unit cells to have 14.05-dBi peak gain. Besides that, the proposed antenna managed to minimize the mutual coupling and improve the mean effective gain, envelope correlation coefficient, and multiplexing efficiency

A triangular MIMO array antenna with a double negative metamaterial superstrate to enhance bandwidth and gain

Multiple-input-multiple-output (MIMO) array antenna integrated with thedouble negative metamaterial superstrate is presented. The triangularmetamaterial unit cell is designed by combining two triangular elements posi-tioned in complementary on the same plane at different sizes. Such designwith more gaps is used to excite rooms for more capacitance effects to shift theresonance frequency thus enlarging the bandwidth of the MIMO antenna. Theunit cell is arranged in 7×7 periodic array created a superstrate metamaterialplane where theCstrayexists in parallel between the two consecutive cells. It isfound that the existence ofCstrayand gaps for each unit cells significantlyinfluenced the bandwidth of the MIMO antenna. The higher value of thecapacitance will lead to the negativity of permittivity. The superstrate plane isthen located on top of the 4×2 MIMO with a gap of 5 mm. The integrationresulted in improving the bandwidth to 12.45% (5.65-6.4GHz) compared toonly 3.49% bandwidth (5.91-6.12GHz) of the MIMO antenna itself. Moreover,the negative permeability characteristic is created by a strong magnetic fieldbetween the complementary unit cells to have 14.05-dBi peak gain. Besidesthat, the proposed antenna managed to minimize the mutual coupling andimprove the mean effective gain, envelope correlation coefficient, and mul-tiplexing efficiency

Malignant Arrhythmia and Cardiac Arrest in the Operating Room

  Malignant arrhythmias and cardiac arrest in the operating room are critical events that pose significant risks to patient safety and outcomes. This research paper aims to provide a comprehensive review of the current literature on the incidence, risk factors, and management of malignant arrhythmias and cardiac arrest in the operating room. The paper will also explore the potential role of advanced monitoring and early detection systems in improving the timely recognition and management of these life-threatening events. Additionally, the paper will discuss malignant arrhythmia and cardiac arrest in the operating room thoroughly as definitions. Ultimately, the findings of this research paper will contribute to a better understanding of the challenges and opportunities in addressing malignant arrhythmias and cardiac arrest in the operating room, with the goal of improving patient safety and outcomes

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P &lt; 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)