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

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

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

Comparing daily drivers of problem drinking among older and younger adults: An electronic daily diary study using smartphones

© 2018 Elsevier B.V. Background: By 2030, numbers and proportions of older adults with substance-use problems are expected to increase. While risk factors for problem drinking in late life have been identified, it remains unknown whether these factors drive daily drinking among older problem drinkers. This study examined the daily drivers of drinking among problem drinkers, moderated by age, utilizing ecological momentary assessment (EMA). Method: Participants (N = 139), ages 20–73, received daily EMA online surveys completed via a smartphone prior to initiation of treatment. Multilevel modeling tested the moderating impact of age on within- and between-person relationships between drinking and focal predictors (mood, loneliness, boredom, stress, poor sleep, social factors, alcohol salience, commitment and confidence not to drink heavily). Results: Older adults reported greater alcohol consumption when daily boredom levels were higher. Heavier drinking among younger adults was associated with poorer sleep quality. Greater daily confidence, daily commitment and daily alcohol salience did not impact drinking to the same extent for older adults as for younger adults. Greater person-level commitment predicted reduced drinking equivalently across age, but low person-level commitment predicted greater drinking among older adults compared to their younger counterparts. Conclusion: Older adults may have unique daily drivers of drinking that are not fully realized in current research and intervention efforts. Addressing the growing substance-use treatment needs among this population will require identifying the unique drivers of drinking among older adults, such as boredom, when compared to younger adults

Wearable and interactive mixed reality solutions for fault diagnosis and assistance in manufacturing systems: Implementation and testing in an aseptic bottling line

Thanks to the spread of technologies stemming from the fourth industrial revolution, also the topic of fault diagnosis and assistance in industrial contexts has benefited. Indeed, several smart tools were developed for assisting with maintenance and troubleshooting, without interfering with operations and facilitating tasks. In line with that, the present manuscript aims at presenting a web smart solution with two possible applications installed on an Android smartphone and Microsoft HoloLens. The solution aims at alerting the operators when an alarm occurs on a machine through notifications, and then at providing the instructions needed for solving the alarm detected. The two devices were tested by the operators of an industrial aseptic bottling line consisting of five machines in real working conditions. The usability of both devices was positively rated by these users based on the System Usability Scale (SUS) and additional appropriate statements. Moreover, the in situ application brought out the main difficulties and interesting issues for the practical implementation of the solutions tested

TREATMENT OF CLASS I MALOCCLUSION WITH FRANKEL APPLIANCE

Aim. The aim of this paper is to evaluate the effect of the Frankel in child with class I malocclusion, maxillary and mandibular contraction, and anterior teeth crowding. Materials and methods. 5 patients with a class I division I malocclusion, maxillary and mandibular contraction and anterior crowding was enrolled in the present study. All patients presented with a stage CS2, CS3 or CS4. Patients with CS5 were not enrolled in the study. Before wearing the Frankel, on each patient head radiographs were taken in lateral plane with the head fixed in a cephalostat with a filmfocus distance of 4 m and a midsagittal-to-film distance of 0,1 m. Cephalometric analysis and casts analysis was performed before phase 1 treatment (T1), and immediately following phase 2 treatment (T2). In addition to standard cephalometric evaluation, another analysis, based on the distance of the basion, A and B to the T line, was done. Patients were instructed to wear the Frankel for 16 hours per day, during the night and afternoon, removing it only to eat and brush. Active treatment lasted 24 months for all patients. A statistical analysis of cephalometric and casts values before and after treatment was done.Results. After 24 months of treatment the cephalometric effects observed were: an increase of the anterior facial height (mean 3,8 mm), an increase of the distance of the basion to the T line (mean 3,6 mm), a incisors tip control (upper incisors mean 0°, lower incisors - 3,2°) and a sagittal maxillary growth control (the mean distance of A to T line was 0°, the mean distance of B to T line was of - 2,2 mm). On cast authors observed an expansion of the upper and lower arches (anterior upper arch expansion mean 2 mm, posterior upper arch expansion mean 2,5 mm; lower arch mean 1 mm) with anterior crowding resolution and incisors sagittal control. Conclusions. Authors evaluated that Frankel had a great repeal to control jaw growth, an increase of maxillary and mandibular expansion, an increase of the anterior facial height with a good control of incisors inclination

Neurologic outcome of postanoxic refractory status epilepticus after aggressive treatment

OBJECTIVE: To investigate neurologic outcome of patients with cardiac arrest with refractory status epilepticus (RSE) treated with a standardized aggressive protocol with antiepileptic drugs and anesthetics compared to patients with other EEG patterns. METHODS: In the prospective cohort study, 166 consecutive patients with cardiac arrest in coma were stratified according to 4 independent EEG patterns (benign, RSE, generalized periodic discharges [GPDs], malignant nonepileptiform) and multimodal prognostic indicators. Primary outcomes were survival and cerebral performance category (CPC) at 6 months. RESULTS: RSE occurred in 36 patients (21.7%) and was treated with an aggressive standardized protocol as long as multimodal prognostic indicators were not unfavorable. RSE started after 3 \ub1 2.3 days after cardiac arrest and lasted 4.7 \ub1 4.3 days. A benign EEG pattern was recorded in 76 patients (45.8%); a periodic pattern (GPDs) was seen in 13 patients (7.8%); and a malignant nonepileptiform EEG pattern was recorded in 41 patients (24.7%). The 4 EEG patterns were highly associated with different prognostic indicators (low-flow time, clinical motor seizures, N20 responses, neuron-specific enolase, neuroimaging). Survival and good neurologic outcome (CPC 1 or 2) at 6 months were 72.4% and 71.1% for benign EEG pattern, 54.3% and 44.4% for RSE, 15.4% and 0% for GPDs, and 2.4% and 0% for malignant nonepileptiform EEG pattern, respectively. CONCLUSIONS: Aggressive and prolonged treatment of RSE may be justified in patients with cardiac arrest with favorable multimodal prognostic indicators

LIN7 regulates the filopodia and neurite promoting activity of IRSp53

The insulin receptor substrate protein of 53\u2005kDa (IRSp53) is critically involved in the formation of filopodia and neurites through mechanisms that have only in part been clarified. Here, we investigated the role of the small scaffold protein LIN7, an interactor of IRSp53. We found that formation of actin-filled protrusions in neuronal NSC34 cells and neurites in neuroblastoma N2A depends on motifs mediating the LIN7:IRSp53 association, as both the coexpression of LIN7 with IRSp53 or the expression of the L27-IRSp53 chimera (a fusion protein between IRSp53 and the LIN7L27 domain for plasma membrane protein complexes association) prevented actin-deficient protrusions induced by overexpressed IRSp53, and enhanced the formation of actin-filled protrusions. The regulatory role of LIN7 in IRSp53-mediated extension of filopodia was demonstrated by live-cell imaging experiments in neuronal N2A cells. Moreover, LIN7 silencing prevented the extension of filopodia and neurites, induced by ectopic expression of IRSp53 or serum starvation, respectively in undifferentiated and differentiated N2A cells. The expression of full length IRSp53 or the LIN7\u394PDZ mutant lacking the domain for association with IRSp53 was unable to restore neuritogenesis in LIN7 silenced cells. Conversely, defective neuritogenesis could be rescued by the expression of RNAi-resistant full length LIN7 or chimeric L27-IRSp53. Finally, LIN7 silencing prevented the recruitment of IRSp53 in Triton X-100 insoluble complexes, otherwise occurring in differentiated cells. Collectively these data indicate that LIN7 is a novel regulator of IRSp53, and that their association is required to promote the formation of actin-dependent filopodia and neurites