Retention of mouth-to-mouth, mouth-to-mask and mouth-to-face shield ventilation

Background: Retention of mouth-to-mouth, mouth-to-mask and mouth-to-face shield ventilation techniques is poorly understood.Methods: A prospective randomised clinical trial was undertaken in January 2004 in 70 candidates randomly assigned to training in mouth-to-mouth, mouth-to-mask or mouth-to-face shield ventilation. Each candidate was trained for 10 min, after which tidal volume, respiratory rate, minute volume, peak airway pressure and the presence or absence of stomach inflation were measured. 58 subjects were reassessed 1 year later and study parameters were recorded again. Data were analysed with ANOVA, \textgreekq2 and McNemar tests.Results: Tidal volume, minute volume, peak airway pressure, ventilation rate and stomach inflation rate increased significantly at reassessment with all ventilation techniques compared with the initial assessment. However, at reassessment, mean (SD) tidal volume (960 (446) vs 1008 (366) vs 1402 (302) ml; p<0.05), minute volume (12 (5) vs 13 (7) vs 18 (3) l/min; p<0.05), peak airway pressure (14 (8) vs 17 (13) vs 25 (8) cm H2O; p<0.05) and stomach inflation rate (63% vs 58% vs 100%; p<0.05) were significantly lower with mouth-to-mask and mouth-to-face shield ventilation than with mouth-to-mouth ventilation. The ventilation rate at reassessment did not differ significantly between the ventilation techniques.Conclusions: One year after a single episode of ventilation training, lay persons tended to hyperventilate; however, the degree of hyperventilation and resulting stomach inflation were lower when a mouth-to-mask or a face shield device was employed. Regular training is therefore required to retain ventilation skills; retention of skills may be better with ventilation devices

Autoresuscitation (Lazarus phenomenon) after termination of cardiopulmonary resuscitation - a scoping review.

Autoresuscitation describes the return of spontaneous circulation after termination of resuscitation (TOR) following cardiac arrest (CA). We aimed to identify phenomena that may lead to autoresuscitation and to provide guidance to reduce the likelihood of it occurring. We conducted a literature search (Google Scholar, MEDLINE, PubMed) and a scoping review according to PRISMA-ScR guidelines of autoresuscitation cases where patients undergoing CPR recovered circulation spontaneously after TOR with the following criteria: 1) CA from any cause; 2) CPR for any length of time; 3) A point was reached when it was felt that the patient had died; 4) Staff declared the patient dead and stood back. No further interventions took place; 5) Later, vital signs were observed. 6) Vital signs were sustained for more than a few seconds, such that staff had to resume active care. Sixty-five patients with ROSC after TOR were identified in 53 articles (1982-2018), 18 (28%) made a full recovery. Almost a third made a full recovery after autoresuscitation. The following reasons for and recommendations to avoid autoresuscitation can be proposed: 1) In asystole with no reversible causes, resuscitation efforts should be continued for at least 20 min; 2) CPR should not be abandoned immediately after unsuccessful defibrillation, as transient asystole can occur after defibrillation; 3) Excessive ventilation during CPR may cause hyperinflation and should be avoided; 4) In refractory CA, resuscitation should not be terminated in the presence of any potentially-treatable cardiac rhythm; 5) After TOR, the casualty should be observed continuously and ECG monitored for at least 10 min

The Efficacy of Renal Replacement Therapy for Rewarming of Patients in Severe Accidental Hypothermia-Systematic Review of the Literature.

Renal replacement therapy (RRT) can be used to rewarm patients in deep hypothermia. However, there is still no clear evidence for the effectiveness of RRT in this group of patients. This systematic review aims to summarize the rewarming rates during RRT in patients in severe hypothermia, below or equal to 32 °C. This systematic review was registered in the PROSPERO International Prospective Register of Systematic Reviews (identifier CRD42021232821). We searched Embase, Medline, and Cochrane databases using the keywords hypothermia, renal replacement therapy, hemodialysis, hemofiltration, hemodiafiltration, and their abbreviations. The search included only articles in English with no time limit, up until 30 June 2021. From the 795 revised articles, 18 studies including 21 patients, were selected for the final assessment and data extraction. The mean rate of rewarming calculated for all studies combined was 1.9 °C/h (95% CI 1.5-2.3) and did not differ between continuous (2.0 °C/h; 95% CI 0.9-3.0) and intermittent (1.9 °C/h; 95% CI 1.5-2.3) methods (p &gt; 0.9). Based on the reviewed literature, it is currently not possible to provide high-quality recommendations for RRT use in specific groups of patients in accidental hypothermia. While RRT appears to be a viable rewarming strategy, the choice of rewarming method should always be determined by the specific clinical circumstances, the available resources, and the current resuscitation guidelines

Nonassociative strict deformation quantization of C*-algebras and nonassociative torus bundles

In this paper, we initiate the study of nonassociative strict deformation quantization of C*-algebras with a torus action. We shall also present a definition of nonassociative principal torus bundles, and give a classification of these as nonassociative strict deformation quantization of ordinary principal torus bundles. We then relate this to T-duality of principal torus bundles with $H$-flux. We also show that the Octonions fit nicely into our theory.Comment: 15 pages, latex2e, exposition improved, to appear in LM

ACSM Expert Consensus Statement: Injury Prevention and Exercise Performance during Cold-Weather Exercise

ABSTRACT: Cold injury can result from exercising at low temperatures and can impair exercise performance or cause lifelong debility or death. This consensus statement provides up-to-date information on the pathogenesis, nature, impacts, prevention, and treatment of the most common cold injuries

Etablierung der homöopathischen Mastitistherapie in einem biologisch-dynamisch wirtschaftenden Milcherzeugerbetrieb unter Berücksichtigung ökologischer, epidemiologischer und ökonomischer Gesichtspunkte.

6 Summary The dairy cow mastitis as a disease with an immense economic impact is widely spread in organic as well as in conventional farms. Due to the lack of alternatives to antibiotic treatment, most therapeutical measures are based on antibiotics even in organic farms and against common regulations. In contrary to these procedures the EU regulations (Council Regulation EC 1804/99)as well as the consumer’s anticipation demand the possibly lowest levels of residual charges of dairy products and environment. A two and a half year study in a bio-dyn dairy herd in Brandenburg (Germany) with 300 dairy cows suffering from udder health problems was conducted to evaluate if clinical mastitis in dairy cows is to control successfully with homeopathic remedies to minimize antibiotic treatment. To assess the efficacy of the homeopathic treatment the investigations are made using a double blind placebo controlled study design (RCCT). Using a predetermined treatment protocol and a certain diagnostic pattern to match right remedies in the sense of the homeopathic remedy pictures, the intention of the chosen treatment schedule was to provide a very transparent concept which can be used also by unexperienced veterinarians. For treatment of acute mastitis the following remedies were used: Phytolacca D6, Bryonia D6 , Echinacea D6 and Belladonna D6. Aconitum D6 was added in case of fever at the beginning of disease. Cases of chronical and subclinical mastitis were treated by Echinacea D6, Phytolacca D6 and Hepar sulfuris D8. In the first part of the study nearly all mastitis cases were treated only with homeopathics avoiding antibiotics strictly. The unsatisfying results in this part lead to a modification in the second part in which in case of certain infections (S.aureus, Sc.spp.) a limited use of antibiotics was admitted. Furthermore, selected udders with subclinical and chronical infections with these kind of bacteria were dried off antibiotically. Simultaneously the farmer was engaged to intensify the efforts to optimize preventive and environmental measures in the herd. In the second part of the study 126 cows (148 quarters) suffered from clinical mastitis (Verum: n=60; Placebo: n=66). The cure rates were nearly identical. In the whole population the clinical cure rate (CCR) immediately after treatment was 95%, 7 to 8 weeks after treatment 65%. The 107 clinically affected quarters which were infected by pathogenic bacteria showed a bacteriological cure rate (BCR) of 55% each and a complete bacterio-cytological cure rate (BCCR) of 35% and 40% after 4-5 weeks and 7-8 weeks after treatment, respectively. During the observation time of 8 weeks a total of 12 cows in each of the treatment groups produced a homologous recurrent infection. 6 cows in the verum group and 4 cows in the placebo group developed a new infection in one of the other quarters. The treatment results seems to be satisfying while the enhanced but still not optimized environmental conditions in the herd are possibly responsible for the high amount of new infections and recurrences. Looking at the results of the study at all, the use of antibiotics could be decreased by 75% due to the therapy management (in spite of the change of it because of unsatisfying results) in combination with preventive measures. Additionally the herd udder health could be increased. So the mean herd somatic cell count decreased by 75.000 somatic cells/ml to 165.000 somatic cells/ml. Furthermore, the milk yield increased by 250 kg to 6.500 kg/cow/year. The count of infections with S. aureus in the herd decreased dramatically. The decreasing input of antibiotics in mastitis therapy in the project farm lead to a decrease of 36.000 kg antibiotically loaded milk compared to a hypothetic conventional mastitis management. Furthermore, the omission of withdrawal times after homeopathic treatment resulted in a benefit of additional production milk of 25.000 kg. The antibiotics minimizing therapy concept of the second part of this investigation which could be evaluated under practice conditions can be recommended for other farms too if simultaneous herd prevention measures can be assured by the farm manager to ensure good preconditions for the convalescence of the cows. The cure rates after placebo are unexpected high. Due to these results it is profoundly debatable whether the strategies of conventional therapy of bovine mastitis are suitable to ensure herd udder health. It should be evaluated which part of the cure rate is amounted by self cure and which other factors have an effect on the healing. The nearly identical cure rates in both treatment groups do not allow the proof of homeopathic efficacy at all. Indeed, comparing the bacteriologically caused mastitis cases (107 quarters), there is a significantly higher cure rate in the verum group (p < 0.05)

Treatability study on the use of by-product sulfur in Kazakhstan for the stabilization of hazardous and radioactive wastes

The Republic of Kazakhstan generates significant quantities of excess sulfur from the production and refining of petroleum reserves. In addition, the country also produces hazardous, and radioactive wastes which require treatment/stabilization. In an effort to find secondary uses for the elemental sulfur, and simultaneously produce a material which could be used to encapsulate, and reduce the dispersion of harmful contaminants into the environment, BNL evaluated the use of the sulfur polymer cement (SPC) produced from by-product sulfur in Kazakhstan. This thermoplastic binder material forms a durable waste form with low leaching properties and is compatible with a wide range of waste types. Several hundred kilograms of Kazakhstan sulfur were shipped to the U.S. and converted to SPC (by reaction with 5 wt% organic modifiers) for use in this study. A phosphogypsum sand waste generated in Kazakhstan during the purification of phosphate fertilizer was selected for treatment. Waste loading of 40 wt% were easily achieved. Waste form performance testing included compressive strength, water immersion, and Accelerated Leach Testing. 14 refs., 7 figs., 6 tabs

Data and methods to calculate cut-off values for serum potassium and core temperature at hospital admission for extracorporeal rewarming of avalanche victims in cardiac arrest.

The data and estimation methods presented in this article are associated with the research article, "Cut-off values of serum potassium and core temperature at hospital admission for extracorporeal rewarming of avalanche victims in cardiac arrest: a retrospective multi-centre study" [1]. In this article we estimate recommended cut-off values for in-hospital triage with respect to extracorporeal rewarming. With only 6 survivors of 103 patients collected over a period of 20 years the ability to estimate reliable threshold values is limited. In addition, because the number of avalanche victims is also limited, a significantly larger dataset is unlikely to be obtained. We have therefore adapted two non-parametric estimation methods (bootstrapping and exact binomial distribution) to our specific needs and performed a simulations to confirm validity and reliability

Coreceptor and cytokine concentrations may not explain differences in disease progression observed in HIV-1 clade A and D infected Ugandans.

BACKGROUND: The use of cellular coreceptors and modulation of cytokine concentrations by HIV to establish a productive infection is well documented. However, it is unknown whether the expression of these proteins affects the course of HIV clade A and D disease, reported to have different progression rates. METHODOLOGY/PRINCIPAL FINDINGS: We investigated whether the number of CD4(+) T-cells expressing CCR5 or CXCR4, the density of these coreceptors and concentrations of specific immune proteins linked to HIV pathogenesis vary between individuals infected with HIV clade A or D. We undertook additional analyses stratifying participants by early (CD4>500 cells/µl) or late (CD4<200 cells/µl) disease stage. Whole blood samples were taken from 50 HIV-1 infected individuals drawn from cohorts in rural south-west Uganda. Late stage participants had less than half the number of CD4(+)/CCR5(+) T-cells (p = 0.0113) and 5.6 times fewer CD4(+)/CXCR4(+) cells (p<0.0001) than early stage participants. There was also a statistically significant difference in the density of CXCR4 on CD4(+) cells between clade A and D infected early stage participants (142 [A] vs 84 [D]; p = 0.0146). Across all participants we observed significantly higher concentration of Th(1) cytokines compared to Th(2) (66.4 vs 23.8 pg/ml; p<0.0001). Plasma concentrations of IFNγ and IL-2 were 1.8 and 2.4 fold lower respectively in Late-D infected participants compared to Late-A participants. MIP-1β levels also decreased from 118.0 pg/ml to 47.1 pg/ml (p = 0.0396) as HIV disease progressed. CONCLUSIONS/SIGNIFICANCE: We observed specific alterations in the abundance of CD4(+)/CCR5(+) and CD4(+)/CXCR4(+) T-cells, and concentrations of immune proteins across different HIV clades and as infection progresses. Our results suggest that these changes are unlikely to explain the observed differences in disease progression between subtype A and D infections. However, our observations further the understanding of the natural progression of non-clade B HIV infection and how the virus adapts to exploit the host environment