COMPARISON OF TWO INTRAOSSEOUS ACCESS DEVICES EMPLOYED DURING SIMULATED CARDIOPULMONARY RESUSCITATION. A PROSPECTIVE, RANDOMIZED, CROSSOVER, MANIKIN STUDY

BACKGROUND: Intraosseous injection is an alternative method used regarding unsuccessful intravenous access during many emergency situations. The aim of the present study was to compare injections made by the Bone Injection Gun (BIG) with NIO Adult intraosseous access devices during simulated CPR performed by paramedics. METHODS: 40 paramedics took part in this prospective, randomized, crossover, manikin study. The participants were chosen at random, while each paramedic performed an intraosseous injection with the Bone Injection Gun (BIG) or with the NIO Adult Intraosseous access device. The effectiveness of the intraosseous injection was analyzed as times T1, T2, and T3. Time T1 is de ned as the time-lapse from placing the intraosseous device into one’s hand to performing the intraosseous injection; Time T2 is the time-lapse from placing the intraosseous device into one’s hand to the moment of stabilizing it at the injection site; while Time T3 is de ned as the time-lapse from putting the intraosseous device into one’s hand, attaching the syringe with a test aspiration, to connecting the infusion line. Attitudes toward the use of intraosseous access during resuscitation were also analyzed in the present study. RESULTS: The ef cacy of intraosseous access obtained with the use of NIO was at 100% where the ef cacy of the use of BIG was at 95%. The average time of T1 was similar in the groups randomized to use BIG and NIO, repre- sented as 5.4±3.5 vs. 3.5±2.5 s, respectively (p=0.014); the average time of T2 was 17.5±4.5 vs. 3.5±2.5 s, respectively (p<0.001); while the average time of T3 was 25±5.5 vs. 11.5±2.5 s, respectively (p<0.001). No- tably, 90% of the study’s participating paramedics preferred to use the NIO during cardiopulmonary resuscitation (p < 0.001). CONCLUSIONS: The present study shows that after a short period of training paramedics can perform an intraos- seous injection with a high degree of ef ciency. Thus, the authors stress the need for training medical personnel to have the skill to perform intraosseous injections along with knowledge and understanding of the indications and contraindication for IO access

Comparison of Functional Physical Fitness between Migrants and Non-Migrants in Poland

After the Second World War Polish borders were shifted into west and it forced large number of people to migrate from the east and central Poland to the western areas in the 1940s and 1950s. It dramatically changed the living condition. The aim of the study was to compare of functional physical fitness of migrants and non-migrants in older ages. Body height and weight were measured and 6 tests of the Senior Functional Fitness Test set were carried out in 785 men and women aged 60-80 during 2015-2016 years in two regions of Poland: the south-wester Lower Silesia (Dolnośląskie) and south-eastern (Podkarpackie), regarded as a migrants and non-migrants. Sex and region differences were assessed by a nova, with NIR post hoc test. Additionally, Pearson’s χ2 test and t-Student tests for independent groups were also used. The seniors of south-western Poland are characterized by a significantly higher level of functional physical fitness compared to seniors from south-eastern Poland. It can be assumed that a higher level of education, more favourable socioeconomic conditions and more proactive approach to own health of Lower Silesians (migrants), allowed them to remain independent in everyday life and age with dignity

INTENSITY OF STRESS AND SYMPTOMS OF JOB EXHAUSTION AMONG PARAMEDICS IN POLAND

BACKGROUND: The aim of this article is to show how the features of job exhaustion depend of the amount of work-related stress. MATERIALS AND METHODS: This research included a randomly selected group of 456 paramedics, aged between 21 and 51, working at hospital emergency departments and in mobile emergency teams. The authors used the Maslach Burnout Inventory Form and Perceived Job Stress Questionnaire Form. RESULTS: The most important factors in uencing general amount of stress in a paramedic’s job include as follows: the sense of responsibility; the sense of insecurity impacted with the system of work; and the sense of psychic workload. However, less important factors in uencing stress include: unpleasant work conditions; a lack of support; a lack of control; a sense of threat. CONCLUSIONS: Paramedics are exposed to job exhaustion syndrome which causes a lessening of feeling safe in their work place. The risk factors in uencing job exhaustion syndrome include as follows: uncertainty of work system; sense of psychic workload caused by work; poor social contacts causing a lack of assistance from others; a lack of positive motivators in one’s job, such as various rewards

Outlier Dimensions that Disrupt Transformers are Driven by Frequency

While Transformer-based language models are generally very robust to pruning, there is the recently discovered outlier phenomenon: disabling only 48 out of 110M parameters in BERT-base drops its performance by nearly 30% on MNLI. We replicate the original evidence for the outlier phenomenon and we link it to the geometry of the embedding space. We find that in both BERT and RoBERTa the magnitude of hidden state coefficients corresponding to outlier dimensions correlate with the frequencies of encoded tokens in pre-training data, and they also contribute to the “vertical” self-attention pattern enabling the model to focus on the special tokens. This explains the drop in performance from disabling the outliers, and it suggests that to decrease anisotopicity in future models we need pre-training schemas that would better take into account the skewed token distributions

Kreacja bohaterów w powieści Jury Stankiewicza Kochać noc – prawo szczurów w kontekście przemian literackich przełomu XX i XXI wieku

Uniwersytet Warszawski18319

Comparison of Functional Physical Fitness between Migrants and Non-Migrants in Poland

After the Second World War Polish borders were shifted into west and it forced large number of people to migrate from the east and central Poland to the western areas in the 1940s and 1950s. It dramatically changed the living condition. The aim of the study was to compare of functional physical fitness of migrants and non-migrants in older ages. Body height and weight were measured and 6 tests of the Senior Functional Fitness Test set were carried out in 785 men and women aged 60-80 during 2015-2016 years in two regions of Poland: the south-wester Lower Silesia (Dolnośląskie) and south-eastern (Podkarpackie), regarded as a migrants and non-migrants. Sex and region differences were assessed by a nova, with NIR post hoc test. Additionally, Pearson’s χ2 test and t-Student tests for independent groups were also used. The seniors of south-western Poland are characterized by a significantly higher level of functional physical fitness compared to seniors from south-eastern Poland. It can be assumed that a higher level of education, more favourable socioeconomic conditions and more proactive approach to own health of Lower Silesians (migrants), allowed them to remain independent in everyday life and age with dignity

Etiological factors and treatment of chylothorax in paediatric patients - a systematic review

Chylothorax is an accumulation of chyle in the pleural cavity. It is a relatively rare cause of pleural effusion in children and its annual incidence is 14 cases per 100 000 children in Europe.  The pleural fluid triglyceride level greater than 110 mg/dl with a cholesterol level lower than 200 mg/dl confirms the diagnosis of chylothorax. Medical imaging are also necessary such as a non-invasive and easily accessible lung ultrasound. Symptoms of this disease are tachypnea, dyspnea, and in some cases dry cough. This review aims to summarize the current literature regarding chylothorax in children, analyze its possible etiologies and treatments. The causes of chylothorax are varied. It may appear after surgical interventions, traumas, infections and also be congenital. Iatrogenic factors are the most common cause of chylothorax in children with cardiothoracic surgeries. Management of chylothorax can be quite complex and highly variable, depending on patient’s condition and their response to the introduced treatment. Conservative treatment consisting of nutrition therapy, chest drain, and pharmacotherapy is typically a first-line of treatment. Diet modification consist in dietary supplements enriched with medium chain triglycerides (MCT) or starting the patient on a total parenteral nutrition (TPN). In most of the analyzed cases the conservative treatment alone proved sufficient in the management of chylothorax. In case of its failure, surgical treatment was a secondary therapy choice. One of the most common surgical procedures for pleural effusion is a thoracic duct ligation (TDL) or pleurodesis and both of these methods are highly effective therapy for chylothorax. This review of the literature reveals a wide variety of causes and methods of treatment of chylothorax. There are no clear standards of management and the therapy is adjusted to the clinical condition of the patient

Audit Assessment of the Effectiveness of Public Procurement Procedures

The article seeks describing the benefits and challenges faced by auditors in assessing the effectiveness of public procurement procedures in terms of applying the methodology for calculating efficiency, economy and effectiveness, taking into account the risks of procurement in e-auctions. Quantitative risk parameters are calculated using data of probabilistic indicators of procurement risk assessment according to the ratio of the number of relevant procedures (sub-threshold and above-threshold) to the total number of procurement procedures. Statistical valuation methods are used for the cost risk assessments and calculation of the aggregate risk indicator of public procurement. The calculations are performed using the data of the open e-procurement system ProZorro for all announced procurements in 2018-2019. We analyzed the methods, indicators and the extent to which the study of the public procurement effectiveness via bibliographic and case studies is performed. As a result, the majority of methods cover four components of assessing the public procurement efficiency - targeted efficiency, cost-effectiveness, organizational efficiency, efficiency of budget expenditures for public procurement. This does not provide an assessment of the automated systems’ impact on the procurement procedures results and on possible savings due to the use of certain procurement procedures. To comprehensively assess the procurement efficiency in e-bidding, the authors propose considering four key risks: the risk of cancellation of the procurement procedure, the risk that the procurement procedure will not take place, the risk of appealing the procurement, the risk of disqualification. As a result of risks calculations under the sub-threshold and above-threshold procurement, individual values of risks and their aggregate indicator are determined. This will adjust the scope of audit procedures to verify individual procurements and identify weaknesses in the procurement management system. We believe that the methodology of auditing the procurement effectiveness, taking into account the quantitative and qualitative parameters of procurement risks, will be a useful audit tool to determine the effectiveness of the use of public funds under individual procurements and identify areas of cost-effectiveness for the state budget funds