Prehospital Tibial Intraosseous Drug Administration is Associated with Reduced Survival Following Out of Hospital Cardiac Arrest: A study for the CARES Surveillance Group

BACKGROUND: Recent reports have questioned the efficacy of intraosseous (IO) drug administration for out-of-hospital cardiac arrest (OHCA) resuscitation. Our aim was to determine whether prehospital administration of resuscitative medications via the IO route was associated with lower rates of return of spontaneous circulation (ROSC) and survival to hospital discharge than peripheral intravenous (IV) infusion in the setting of OHCA. METHODS: We obtained data on all OHCA patients receiving prehospital IV or IO drug administration from the three most populous counties in Michigan over three years. Data was from the Michigan Cardiac Arrest Registry to Enhance Survival (CARES) database. The association between route of drug administration and outcomes was tested using a matched propensity score analysis. RESULTS: From a total of 10,626 OHCA patients, 6869 received parenteral drugs during their prehospital resuscitation (37.8% by IO) and were included in analysis. Unadjusted outcomes were lower in patients with IO vs. IV access: 18.3% vs. 23.8% for ROSC (p \u3c 0.001), 3.2% vs. 7.6% for survival to hospital discharge (p \u3c 0.001), and 2.0% vs. 5.8% for favorable neurological function (p \u3c 0.001). After adjustment, IO route remained associated with lower odds of sustained ROSC (OR 0.72, 95% CI 0.63-0.81, p \u3c 0.001), hospital survival (OR 0.48, 95% CI 0.37-0.62, p \u3c 0.001), and favorable neurological outcomes (OR 0.42, 95% CI 0.30-0.57, p \u3c 0.001). CONCLUSION: In this cohort of OHCA patients, the use of prehospital IO drug administration was associated with unfavorable clinical outcomes

Evaluating Current Practices in Shelf Life Estimation

The current International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) methods for determining the supported shelf life of a drug product, described in ICH guidance documents Q1A and Q1E, are evaluated in this paper. To support this evaluation, an industry data set is used which is comprised of 26 individual stability batches of a common drug product where most batches are measured over a 24 month storage period. Using randomly sampled sets of 3 or 6 batches from the industry data set, the current ICH methods are assessed from three perspectives. First, the distributional properties of the supported shelf lives are summarized and compared to the distributional properties of the true shelf lives associated with the industry data set, assuming the industry data set represents a finite population of drug product batches for discussion purposes. Second, the results of the ICH poolability^ tests for model selection are summarized and the separate shelf life distributions from the possible alternative models are compared. Finally, the ICH methods are evaluated in terms of their ability to manage risk. Shelf life estimates that are too long result in an unacceptable percentage of nonconforming batches at expiry while those that are too short put the manufacturer at risk of possibly having to prematurely discard safe and efficacious drug product. Based on the analysis of the industry data set, the ICH-recommended approach did not produce supported shelf lives that effectively managed risk. Alternative approaches are required

Input of PBDE exposure in juvenile Chinook salmon along their out-migrant pathway through the Snohomish River, WA

Polybrominated diphenyl ether (PBDE) flame retardant inputs to Puget Sound may be impairing the health of juvenile Chinook salmon and reducing their early marine survival in the Salish Sea, possibly contributing to their decline and limiting their recovery. Previous studies have shown Chinook salmon outmigrating from the Snohomish River accumulate PBDEs at concentrations high enough to alter their immune response, increasing their susceptibility to naturally occurring diseases; however, the source of PBDEs is unknown. Our study objective was to determine where in the Snohomish River system migrating Chinook salmon are exposed to and accumulate PBDEs, and to assess the source so that corrective actions can be implemented. Levels of PBDEs and other persistent organic pollutants were measured in salmon from the upstream tributaries of the Snoqualmie and Skykomish regions, representing the cumulative exposure from all sources prior to entering the Snohomish River, and were compared to those in salmon from subsequent downstream regions of the mainstem to assess where salmon are exposed and the exposure source. Additionally, contaminant levels were measured in salmon sampled from distributary channels of the lower delta to evaluate the extent of PBDE exposure in the outmigrating Snohomish River population. Analyses of the contaminant and body burden data reveal that juvenile Chinook salmon are primarily exposed to and accumulate PBDEs at two sites within the lower delta of the Snohomish River, both located in the immediate vicinity of a wastewater treatment plant outfall. Identification of the region within the Snohomish watershed where salmon are most exposed to PBDEs, as well as the source, allows environmental managers to establish corrective actions to control PBDE inputs. Ultimately, reductions in PBDE exposure should improve the health of Chinook salmon and enhance their marine survival

Celebrating 20 Years of the ExCEEd Teaching Workshop

In response to the clear need for faculty training, the American Society of Civil Engineers (ASCE) developed and funded Project ExCEEd (Excellence in Civil Engineering Education) which is celebrating its twentieth year of existence. For the past two decades, 38 ExCEEd Teaching Workshops (ETW) have been held at six different universities. The program has 910 graduates from over 267 different U.S. and international colleges and universities. The ExCEEd effort has transformed from one that relied on the grass roots support of its participants to one that is supported and embraced by department heads and deans. This paper summarizes the history of Project ExCEEd, describes the content of the ETW, assesses its effectiveness, highlights changes in the program as a result of the assessment, and outlines the future direction of the program

The Grizzly, December 1, 1978

Task Force Reviews Health Services; Bookstore Also Discussed • New Curriculum Approved • SAC Discusses New Frat & Allocations • Biology Department Alters Curriculum • A Good Editorial • Let\u27s See Co-Ed Dorms • A Mutually Advantageous Symbiosis • Letters to the Editor: Sleeping Awareness; Disturbing Guyana Attitudes • Portrait of the Professor: Dr. Patrick J. Mulvanny • Parking: Problem At Ursinus • If Zacharias Could See Us Now... • Think Snow • The Rocky Horror Show: A Celluloid Wasteland • Audio Corner: Loudspeakers • Thompson-Gay Soon To Be Theater • Logic & Dance • Drinking Myths • Hopes High For Hoops • Football Ends On Good Note • Ursinus Girls Drown Dickinson • Marathon Men Compete • Bears Net .500 Against Florida Foes • First Winter Weather Day ; Stimeling Exhibit To Be Presentedhttps://digitalcommons.ursinus.edu/grizzlynews/1008/thumbnail.jp

Celebrating 20 Years of the ExCEEd Teaching Workshop

In response to the clear need for faculty training, the American Society of Civil Engineers (ASCE) developed and funded Project ExCEEd (Excellence in Civil Engineering Education) which is celebrating its twentieth year of existence. For the past two decades, 38 ExCEEd Teaching Workshops (ETW) have been held at six different universities. The program has 910 graduates from over 267 different U.S. and international colleges and universities. The ExCEEd effort has transformed from one that relied on the grass roots support of its participants to one that is supported and embraced by department heads and deans. This paper summarizes the history of Project ExCEEd, describes the content of the ETW, assesses its effectiveness, highlights changes in the program as a result of the assessment, and outlines the future direction of the program

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead