Maternal collapse: Challenging the four-minute rule

AbstractIntroductionThe current approach to, cardiopulmonary resuscitation of pregnant women in the third trimester has been to adhere to the “four-minute rule”: If pulses have not returned within 4min of the start of resuscitation, perform a cesarean birth so that birth occurs in the next minute. This investigation sought to re-examine the evidence for the four-minute rule.MethodsA literature review focused on perimortem cesarean birth was performed using the same key words that were used in formulating the “four-minute rule.” Maternal and neonatal injury free survival rates as a function of arrest to birth intervals were determined, as well as actual incision to birth intervals.ResultsBoth maternal and neonatal injury free survival rates diminished steadily as the time interval from maternal arrest to birth increased. There was no evidence for any specific survival threshold at 4min. Skin incision to birth intervals of 1min occurred in only 10% of women.ConclusionOnce a decision to deliver is made, care providers should proceed directly to Cesarean birth during maternal cardiac arrest in the third trimester rather than waiting for 4min for restoration of the maternal pulse. Birth within 1min from the start of the incision is uncommon in these circumstances

Strategy for the development of a new stick formula without microplastics

Plastic is a synthetic, malleable, and durable material that has been used for various applications since its invention in the late 19th century. During its very long-time degradation process, mechanical and/or photochemical processes fragment plastic into increasingly smaller fragments called microplastics (MPs). In the cosmetic field, MPs are directly added to many products for various functions, including to exploit their exfoliating and structuring power. Unfortunately, it has been realized that MPs are not retained in purification plants and therefore end up in the aquatic environment causing a high problem of environmental pollution. Polyethene (PE) is the most widely used MP in cosmetics due to its use as a structuring agent, to provide consistency to formulations and as a key ingredient in lipsticks and mascaras. Given the limitations imposed by regulations and the growing demand from consumers for chemical-free and eco-friendly products, the common synthetic and petroleum-based waxes used in lipstick formulations, such as PE, must necessarily be replaced by natural waxes of plant origin. In this paper we report the development of a chemical-free and eco-friendly cosmetic stick. To achieve the goal, it was necessary to study the compatibility of the ABWAX® Revowax, natural alternative to PE, with oils and colours to predict the behaviour of these structuring waxes in more complex systems. Through a systematic comparative study, the two waxes showed similar thermal characteristics and showed similar penetration curves, presenting overall comparable performance in the MP-free finished product. We can therefore consider ABWAX® Revowax natural wax a valid alternative to PE

Virtual and augmented reality as enablers for improving the service on distributed assets

The evolution of Augment and Virtual Reality is enabling new solutions. This paper addresses creation of applications to support service and maintenance of distributed systems. Indeed this approach could be applied to devices provided as service for industrial and individual use and could introduce new capabilities in terms of training for operators, control and remote service support. The paper presents a case study devoted to lead the introduction of these innovative solutions in industrial and health care system

Optimization of selective laser sintering process conditions using stable sintering region approach

The optimization of process parameters represents one of the major drawbacks of selective laser sintering (SLS) technology since it is largely empirical and based on performing a series of trial-and-error builds. This approach is time con-suming, costly, and it ignores the properties of starting powders. This paper provides new results into the prediction of processing conditions starting from the material properties. The stable sintering region (SSR) approach has been applied to two different polymer-based powders: a polyamide 12 filled with chopped carbon fibers and polypropylene. This study shows that the laser exposure parameters suitable for successful sintering are in a range that is significantly smaller than the SSR. For both powders, the best combination of mechanical properties, dimensional accuracy, and porosity level are in fact, achieved by using laser energy density values placed in the middle of the SSR

Alcohol-associated liver disease and behavioral and medical cofactors: unmet needs and opportunities

Chronic liver disease is a leading cause of death in the US and is often preventable. Rising burden, cost, and fatality due to liver disease are driven by intensified alcohol use in the US population and the contributions of comorbid conditions. This mini-review focuses on the topic of liver health in the context of chronic, behavioral cofactors of disease, using research-based examples from the Brown University Center for Addiction and Disease Risk Exacerbation (CADRE). Our aim is to illustrate the current challenges and opportunities in clinical research addressing liver health in the context of behavioral and medical comorbidity and to highlight next steps in this crucial area of public health research and clinical care

Obstructive Sleep Apnea Detection Methods Based on Heart Rate Variability Analysis: Opportunities for a Future Cinc Challenge

[EN] The effects of sleep-related disorders, such as obstructive sleep apnea (OSA), can be devastating either in children or adults. Misdiagnosis may lead to severe cardiovascular diseases. Besides, OSA consequences are often related to bad job performance, and road accidents. Nowadays, polysomnography (PSG) is still considered the gold standard for OSA diagnosis, but the required facilities are extremely high, thus reducing availability worldwide. For this reason, simpler and cost-effective diagnosing methods have been proposed in the late years. In this regard, the heart rate variability (HRV) has been demonstrated to strongly reflect apnea episodes during sleep. Hence, this work reviews the latest advances in the evaluation of OSA from the HRV perspective to consider its potentialities for a future revisited CinC Challenge.This research has been supported by grants DPI201783952-C3 from MINECO/AEI/FEDER EU, SBPLY/17/180501/000411 from Junta de Comunidades de Castilla-la Mancha and AICO/2019/036 from Generalitat Valenciana. Moreover, Daniele Padovano has held graduate research scholarships from Escuela Polit ' ecnica de Cuenca and Instituto de Tecnolog ' ias Audiovisuales, University of CastillaLa ManchaPadovano, D.; Martinez-Rodrigo, A.; Pastor, JM.; Rieta, JJ.; Alcaraz, R. (2020). Obstructive Sleep Apnea Detection Methods Based on Heart Rate Variability Analysis: Opportunities for a Future Cinc Challenge. IEEE. 1-4. https://doi.org/10.22489/CinC.2020.400S1

On the Generalization of Sleep Apnea Detection Methods Based on Heart Rate Variability and Machine Learning

[EN] Obstructive sleep apnea (OSA) is a respiratory disorder highly correlated with severe cardiovascular diseases that has unleashed the interest of hundreds of experts aiming to overcome the elevated requirements of polysomnography, the gold standard for its detection. In this regard, a variety of algorithms based on heart rate variability (HRV) features and machine learning (ML) classifiers have been recently proposed for epoch-wise OSA detection from the surface electrocardiogram signal. Many researchers have employed freely available databases to assess their methods in a reproducible way, but most were purely tested with cross-validation approaches and even some using solely a single database for training and testing procedures. Hence, although promising values of diagnostic accuracy have been reported by some of these methods, they are suspected to be overestimated and the present work aims to analyze the actual generalization ability of several epoch-wise OSA detectors obtained through a common ML pipeline and typical HRV features. Precisely, the performance of the generated OSA detectors has been compared on two validation approaches, i.e., the widely used epoch-wise, k-fold cross-validation and the highly recommended external validation, both considering different combinations of well-known public databases. Regardless of the used ML classifiers and the selected HRV-based features, the external validation results have been 20 to 40% lower than those obtained with cross-validation in terms of accuracy, sensitivity, and specificity. Consequently, these results suggest that ML-based OSA detectors trained with public databases are still not sufficiently general to be employed in clinical practice, as well as that larger, more representative public datasets and the use of external validation are mandatory to improve the generalization ability and to obtain reliable assessment of the true predictive power of these algorithms, respectively.This research has received financial support from public grants PID2021-00X128525-IV0 and PID2021-123804OB-I00 of the Spanish Government 10.13039/501100011033 jointly with the European Regional Development Fund, SBPLY/17/180501/000411 and SBPLY/21/180501/000186 from Junta de Comunidades de Castilla-La Mancha, and AICO/2021/286 from Generalitat Valenciana. Moreover, Daniele Padovano holds a predoctoral scholarship 2022-PRED-20642, which is cofinanced by the operating program of European Social Fund (ESF) 2014-2020 of Castilla-La Mancha.Padovano, D.; Martínez-Rodrigo, A.; Pastor, JM.; Rieta, JJ.; Alcaraz, R. (2022). On the Generalization of Sleep Apnea Detection Methods Based on Heart Rate Variability and Machine Learning. IEEE Access. 10:92710-92725. https://doi.org/10.1109/ACCESS.2022.320191192710927251

Traumatic brain injury and suicide risk

Among the various consequences of traumatic brain injury (TBI), evidence supports the notion that individuals exposed to such events may be at higher risk of suicide. We therefore aim at reviewing the literature by focusing on possible association between TBI and features of the suicidal spectrum, such as suicidal ideation, suicide attempts and completed suicides. We carried out a computerized search for reports of studies involving TBI and suicide risk. A total of 35 reports provide data with preliminary support of this association. Seven articles showed a direct correlation between TBI and completed suicides. Thirteen articles have shown a direct relationship between TBI and suicide attempts; five articles demonstrated a positive correlation with suicidal ideation and suicidality. We also found negative results failing to show a correlation between TBI and completed suicides (one article), suicide attempts (one article) and suicidality (one article). In addition, one article showed that patients who received psychological treatment (CBT therapy) after suffering a head injury showed a significant reduction in suicidal ideation. These preliminary findings encourage further testing of the association between TBI and suicide risk regardless of the psychiatric history. Furthermore, those who have a history of psychiatric illness before the TBI present a greater risk of suicide than those who do not have psychiatric precedents

Perampanel and Visuospatial Skills in Children With Epilepsy

Introduction: Perampanel (PER) is a non-competitive AMPA glutamate receptor antagonist approved for focal and generalized seizures as add-on therapy. PER does not seem to negatively affect the cognitive profile in children and adolescents, but its influence on visuospatial abilities is still to be assessed. The aim of our study was to assess visuospatial skills through a standardized neuropsychological evaluation in adolescents taking PER for 12 months. Methods: Our sample included 46 adolescents aged 12–18 years with focal and generalized drug-resistant epilepsy already in therapy with one or two antiseizure medications. Changes in visuospatial perception and memory were assessed by the Rey–Osterrieth Complex Figure Test at baseline (before taking PER) and after 12 months of pharmacological treatment. Executive functions and non-verbal intelligence were also assessed at baseline. Results: After 12 months of PER therapy, the mean scores on the Rey–Osterrieth Complex Figure Test remained almost unchanged for both visuospatial perception and visuospatial memory skills. At baseline, visuospatial memory was related to executive function, and visuospatial perception was related to executive function and non-verbal intelligence. Conclusions: Adjunctive treatment with PER did not negatively affect visuospatial skills. No adverse event effects have been reported after 12 months of follow-up, and this suggests a good tolerability in the middle-to-long term