Identification of Post-cardiac Arrest Blood Pressure Thresholds Associated With Outcomes in Children: An ICU-Resuscitation Study

INTRODUCTION: Though early hypotension after pediatric in-hospital cardiac arrest (IHCA) is associated with inferior outcomes, ideal post-arrest blood pressure (BP) targets have not been established. We aimed to leverage prospectively collected BP data to explore the association of post-arrest BP thresholds with outcomes. We hypothesized that post-arrest systolic and diastolic BP thresholds would be higher than the currently recommended post-cardiopulmonary resuscitation BP targets and would be associated with higher rates of survival to hospital discharge. METHODS: We performed a secondary analysis of prospectively collected BP data from the first 24 h following return of circulation from index IHCA events enrolled in the ICU-RESUScitation trial (NCT02837497). The lowest documented systolic BP (SBP) and diastolic BP (DBP) were percentile-adjusted for age, height and sex. Receiver operator characteristic curves and cubic spline analyses controlling for illness category and presence of pre-arrest hypotension were generated exploring the association of lowest post-arrest SBP and DBP with survival to hospital discharge and survival to hospital discharge with favorable neurologic outcome (Pediatric Cerebral Performance Category of 1-3 or no change from baseline). Optimal cutoffs for post-arrest BP thresholds were based on analysis of receiver operator characteristic curves and spline curves. Logistic regression models accounting for illness category and pre-arrest hypotension examined the associations of these thresholds with outcomes. RESULTS: Among 693 index events with 0-6 h post-arrest BP data, identified thresholds were: SBP \u3e 10th percentile and DBP \u3e 50th percentile for age, sex and height. Fifty-one percent (n = 352) of subjects had lowest SBP above threshold and 50% (n = 346) had lowest DBP above threshold. SBP and DBP above thresholds were each associated with survival to hospital discharge (SBP: aRR 1.21 [95% CI 1.10, 1.33]; DBP: aRR 1.23 [1.12, 1.34]) and survival to hospital discharge with favorable neurologic outcome (SBP: aRR 1.22 [1.10, 1.35]; DBP: aRR 1.27 [1.15, 1.40]) (all p \u3c 0.001). CONCLUSIONS: Following pediatric IHCA, subjects had higher rates of survival to hospital discharge and survival to hospital discharge with favorable neurologic outcome when BP targets above a threshold of SBP \u3e 10th percentile for age and DBP \u3e 50th percentile for age during the first 6 h post-arrest

Development of a multiple coil magneto-rheological smart damper to improve the seismic resilience of building structures

The incremental research progress on Magneto-Rheological (MR) damper and its response motivated many researchers and engineers to focus on this topic in the last decade. Methods: MR damper is classified as a semi-active vibration controlling device owing to its mechanical simplicity, low power usage, large response reduction, perfect damping mechanism, good stability, quick reaction time and robust interface. Results: In the current investigation, experimental studies were performed for the design, development, and testing of a new type of MR damper. A proposed approach was adopted for the magnetic generation using multi-coils to produce more shear force in the flow gap. The study investigates time history responses of the proposed system under an array of strong ground motions at both element and structure levels. Numerical hybrid simulation using OpenSees has also been carried out on a building structure to show the effectiveness of the new device. Conclusion: The performance of the investigated structure equipped with the proposed system indicates a large reduction in displacement and an increase in damping force under major seismic events

Preparation and analysis of zero gases for the measurement of trace VOCs in air monitoring

Air quality observations are performed globally to monitor the status of the atmosphere and its level of pollution and to assess mitigation strategies. Regulations of air quality monitoring programmes in various countries demand high-precision measurements for harmful substances often at low trace concentrations. These requirements can only be achieved by using high-quality calibration gases including high-purity zero gas. For volatile organic compound (VOC) observations, zero gas is defined as being hydrocarbon-free and can be, for example, purified air, nitrogen or helium. It is essential for the characterisation of the measurement devices and procedures, for instrument operation as well as for calibrations. Two commercial and one self-built gas purifiers were tested for their VOC removal efficiency following a standardised procedure. The tested gas purifiers included one adsorption cartridge with an inorganic media and two types of metal catalysts. A large range of VOCs were investigated, including the most abundant species typically measured at air monitoring stations. Both catalysts were able to remove a large range of VOCs whilst the tested adsorption cartridge was not suitable to remove light compounds up to C4. Memory effects occurred for the adsorption cartridge when exposed to higher concentration. This study emphasises the importance of explicitly examining a gas purifier for its intended application before applying it in the field

From Concept to Publication: Effectiveness of the International Network for Simulation-Based Pediatric Innovation, Research, and Education Project Development Process at Generating Simulation Scholarship

BACKGROUND: As simulation matures, it is critical to develop pathways for researchers. A recent analysis, however, demonstrates a low conversion rate between abstract and peer-reviewed journal publication in our field. The International Network for Simulation-based Pediatric Innovation, Research, and Education has used the ALERT Presentation process for the past decade as a means of accelerating research. In this study, we analyze the scholarly products attributable to ALERT Presentations. METHODS: Surveys were distributed to all International Network for Simulation-based Pediatric Innovation, Research, and Education Advanced Look Exploratory Research Template (ALERT) Presentation first authors from January 2011 through January 2020. Presenters were asked to provide information on abstracts, grants, journal publications, and book chapters related to their ALERT Presentation, as well as basic demographic information. A structured literature search was conducted for those ALERT Presentations whose authors did not return a survey. The resulting database was descriptively analyzed, and statistical correlations between demographic variables and scholarship were examined. RESULTS: One hundred sixty-five new ALERT presentations were presented over 10 years. We identified 361 associated scholarly works (170 conference abstracts, 125 peer-reviewed journal publications, 65 grants, and 1 book chapter). Sixty-one percent (101 of 165) of ALERT Presentations produced at least 1 item of scholarship, and 59% (34 of 58) of ALERT Presentations that resulted in at least 1 abstract also led to at least 1 peer-reviewed journal article. Presenter gender was associated with likelihood of journal publication. CONCLUSIONS: The ALERT Presentation process is an effective approach for facilitating the development of projects that result in disseminated scholarship. Wider adoption may benefit other simulation and education research networks

Defining Leadership Competencies for Pediatric Critical Care Fellows: Results of a National Needs Assessment.

INTRODUCTION: Physicians in training, including those in Pediatric Critical Care Medicine, must develop clinical leadership skills in preparation to lead multidisciplinary teams during their careers. This study seeks to identify multidisciplinary perceptions of leadership skills important for Pediatric Critical Care Medicine fellows to attain prior to fellowship completion. METHODS: We performed a multi-institutional survey of Pediatric Critical Care Medicine attendings, fellows, and nurses. Subjects were asked to rate importance of 59 leadership skills, behaviors, and attitudes for Pediatric Critical Care practitioners and to identify whether these skills should be achieved before completing fellowship. Skills with the highest ratings by respondents were deemed essential. RESULTS: Five hundred and eighteen subjects completed the survey. Of 59 items, only one item ( displays honesty and integrity ) was considered essential by all respondents. When analyzed by discipline, nurses identified 21 behaviors essential, fellows 3, and attendings 1 (p \u3c 0.05). Nurses differed (p \u3c 0.05) from attendings in their opinion of importance in 64% (38/59) of skills. CONCLUSIONS: Despite significant variability among Pediatric Critical Care attendings, fellows, and nurses in identifying which clinical leadership competencies are important for graduating Pediatric Critical Care fellows, they place the highest importance on skills in self-management and self-awareness. Leadership skills identified as most important may guide the development of interventions to improve trainee education and interprofessional care

Preparation and analysis of zero gases for the measurement of trace VOCs in air monitoring

Air quality observations are performed globally to monitor the status of the atmosphere and its level of pollution and to assess mitigation strategies. Regulations of air quality monitoring programmes in various countries demand high-precision measurements for harmful substances often at low trace concentrations. These requirements can only be achieved by using high-quality calibration gases including high-purity zero gas. For volatile organic compound (VOC) observations, zero gas is defined as being hydrocarbon-free and can be, for example, purified air, nitrogen or helium. It is essential for the characterisation of the measurement devices and procedures, for instrument operation as well as for calibrations. Two commercial and one self-built gas purifiers were tested for their VOC removal efficiency following a standardised procedure. The tested gas purifiers included one adsorption cartridge with an inorganic media and two types of metal catalysts. A large range of VOCs were investigated, including the most abundant species typically measured at air monitoring stations. Both catalysts were able to remove a large range of VOCs whilst the tested adsorption cartridge was not suitable to remove light compounds up to C4. Memory effects occurred for the adsorption cartridge when exposed to higher concentration. This study emphasises the importance of explicitly examining a gas purifier for its intended application before applying it in the field