Prospective Evaluation of Cardiopulmonary Resuscitation Performed in Dogs and Cats According to the RECOVER Guidelines. Part 1: Prognostic Factors According to Utstein-Style Reporting.

Factors associated with positive cardiopulmonary resuscitation (CPR) outcomes defined according to the veterinary Utstein-style CPR reporting guidelines have not been described since implementation of the Reassessment Campaign on Veterinary Resuscitation (RECOVER) CPR clinical guidelines in 2012. The aims of this study were to assess factors associated with positive CPR outcomes at a U.S. veterinary teaching hospital, to re-evaluate these factors since implementation of the RECOVER guidelines compared to reported factors prior to their publication, and to identify potential additional factors since guideline publication. One-hundred and seventy-two dogs and 47 cats that experienced cardiopulmonary arrest (CPA) and had CPR performed were prospectively included in this observational study. Supervising clinicians were asked to complete a data form on CPR events immediately following completion of CPR efforts. Multivariable logistic regression was used to evaluate the effect of twenty hospital, animal, and arrest variables on the three patient outcomes "any return of spontaneous circulation (ROSC)," "sustained ROSC," and survival to hospital discharge. Cats had significantly higher odds to achieve any ROSC [OR (95%CI) 2.72 (1.12-6.61), p = 0.028] and survive to hospital discharge than dogs [OR (95%CI) 4.87 (1.52-15.58), p = 0.008]. Patients had significantly lower odds of achieving any ROSC if CPA occurred during nighttime hours [OR (95%CI) nighttime = 0.52 (0.27-0.98), p = 0.043], and higher odds if CPA was witnessed [OR (95%CI) 3.45 (1.57-7.55), p = 0.002], if less people were involved in CPR efforts [OR (95%CI) 0.8 (0.66-0.96), p = 0.016], if pulses were palpable during CPR [OR (95%CI) 9.27 (4.16-20.63), p < 0.0005], and if an IV catheter was already in place at the time of CPA [OR (95%CI) 5.07 (2.12-12.07), p = 0.0003]. Odds for survival to hospital discharge were significantly higher if less people were involved in CPR efforts [OR (95%CI) 0.65 (0.46-0.91), p = 0.013] and for patients of the anesthesia service [OR (95%CI) 14.82 (3.91-56.17), p = 0.00007]. Overall, factors associated with improved CPR outcomes have remained similar since incorporation of RECOVER guidelines into daily practice. Witnessed CPA events and high-quality CPR interventions were associated with positive patient outcomes, emphasizing the importance of timely recognition and initiation of CPR efforts. An optimal CPR team size has yet to be determined

A Lyapunov designed model-referenced control system with signum function adaptive control laws

An examination of a model-referenced adaptive control system designed to satisfy the requirements of Lyapunov\u27s direct method is made. It is found that each adaptive control loop requires a multiplier for its implementation. A new design is proposed which replaces the multipliers in the control loops by switches, thereby gaining a significant hardware advantage. A first order system designed by the new method is simulated on an analog computer and some refinements are made. The method is then generalized to include nth order systems. The poles of the model, however, are subject to some restrictions. Finally, the problems associated with extending the design to systems in which the model has arbitrary poles are discussed --Abstract, page ii

Italy Revisited: The Encyclopedia

This is the published version, also available here: http://dx.doi.org/10.1162/0022195043327417

The Effect of Domain and Technical Expertise on the Training Outcomes for Case Management Systems in High Domain Expertise Fields

The successful implementation of an enterprise system requires training and end users in the new systems and procedures. There has been no research reporting a relationship between Domain Expertise (DE) and the successful implementation of an enterprise system. This study sought to begin filling this knowledge gap by exploring the relationship between DE, technical proficiency, training outcomes, and perceived training effectiveness for a new enterprise system, specifically a Case Management System (CMS) in a small and medium enterprise (SME). The research examines different subjects of technical expertise including skills, abilities, and knowledge to increase professional acceptance in the high domain of expertise field. In order to understand the complex nature of expertise and the significant impact, an exploratory approach is undertaken. Purposive sampling was utilized to select the 88 respondents to participate in the research, in which the role of domain expertise and technical expertise is explored. Based upon analysis, research showed the relevance of domain expertise and technical expertise in the deployment of successful case management systems. The results contributed to literature by showing that how training influences soft skills such as tacit knowledge on organizational culture and potential clients, deliver best solutions to the project management. Meanwhile, the outcomes provided significant traits on perceived training effectiveness, which drive increase in knowledge, practical implication, and quality of project delivered, presentation skills, communication and problem-solving abilities. The study also contributed to the literature in terms of defining how technical and domain expertise not only effect the outcomes of case management systems but also develop greater coordination for dealing the intricacies, project difficulties, and task-related complexities

In Search of a Bright Line: Determining When an Employer\u27s Financial Hardship Becomes Undue Under the Americans with Disabilities Act

The employment provisions of the Americans with Disabilities Act have been fully effective since July 26, 1994. These provisions require all employers with fifteen or more employees to reasonably accommodate the disabilities of job applicants and employees. Reasonable accommodation can be very expensive: one in every twenty accommodations now being made costs more than $5,000. Although the ADA permits employers to refuse to make accommodations that would cause an undue hardship, neither the statute nor its implementing regulations provide meaningful guidance regarding how great an accommodation expense must be before the point of undue hardship is attained. Consequently, neither employers nor employees can be sure what level of accommodation the ADA requires. This Article argues that for the ADA to achieve its central objective of integrating millions of Americans with disabilities into the labor force, a very precise definition of undue hardship must be developed. The Article there- fore constructs a quantitative methodology for making undue hardship determinations; the methodology utilizes a private employer\u27s net working capital, net profit, and the size of its labor force to establish the precise point of undue hardship for any proposed accommodation. This methodology is designed to ensure that private employers maintain the ability to maximize profit, and that lower-paid employees are entitled to reasonable accommodation expendi- tures equal to those of higher-paid employees. By enabling employers and employees to determine their financial obligations and entitlements without resorting to litigation, the proposed methodology would truly facilitate the integration of millions of Americans with disabilities into the workforce