Effects of Feedback nn Skills During Cardiopulmonal Reanimation Training

Sudden cardiac arrest is one of the main causes of death in Europe. Early initiation and qualitative performance of cardiopulmonary resuscitation can reduce mortality. In order to perform cardio-pulmonary resuscitation of appropriate quality, theoretical and practical knowledge is needed which can be improved by clinical simulation. The aim of the study was to find out the effect of feedback on participants' skills during cardiopulmonary resuscitation training. Hypothesis - feedback improves participants' skills during cardiopulmonary resuscitation training. Research Method - randomized controlled simulation study. Research instruments - observation protocol, questionnaire. A total of 32 employees of State Emergency Medical Service (medical practitioners) participated in the study. The hypothesis was confirmed - feedback improves participants' skills during cardiopulmonary resuscitation training. The total evaluation of cardiopulmonary resuscitation in the intervention group, which performed the cardiopulmonary resuscitation scenario with the feedback function is higher (92,13%) compared to the control group (77%). Most of the participants in the intervention group fully agree that the use of feedback function during training improves the overall cardiopulmonary resuscitation skills. The results of the study indicate that the development of cardiopulmonary resuscitation training programs for medical students and practitioners requires the inclusion of practical activities with clinical simulations with feedbackpublishersversionPeer reviewe

Guidelines to inform the generation of clinically relevant and realistic blast loading conditions for primary blast injury research

‘Primary’ blast injuries (PBIs) are caused by direct blast wave interaction with the human body, particularly affecting air-containing organs. With continued experimental focus on PBI mechanisms, recently on blast traumatic brain injury, meaningful test outcomes rely on appropriate simulated conditions. Selected PBI predictive criteria (grouped into those affecting the auditory system, pulmonary injuries and brain trauma) are combined and plotted to provide rationale for generating clinically relevant loading conditions. Using blast engineering theory, explosion characteristics including blast wave parameters and fireball dimensions were calculated for a range of charge masses assuming hemispherical surface detonations and compared with PBI criteria. While many experimental loading conditions are achievable, this analysis demonstrated limits that should be observed to ensure loading is clinically relevant, realistic and practical. For PBI outcomes sensitive only to blast overpressure, blast scaled distance was demonstrated to be a useful parameter for guiding experimental design as it permits flexibility for different experimental set-ups. This analysis revealed that blast waves should correspond to blast scaled distances of 1.75<Z<6.0 to generate loading conditions found outside the fireball and of clinical relevance to a range of PBIs. Blast waves with positive phase durations (2–10 ms) are more practical to achieve through experimental approaches, while representing realistic threats such as improvised explosive devices (ie, 1–50 kg trinitrotoluene equivalent). These guidelines can be used by researchers to inform the design of appropriate blast loading conditions in PBI experimental investigations

Intervention Research, Establishing Fidelity of the Independent Variable in Nursing Clinical Trials

Background: Internal validity of a randomized clinical trial of a nursing intervention is dependent on intervention fidelity. Although several methods have been developed, evaluating audio or audiovisual tapes for prescribed and proscribed interventionist behaviors is considered the gold standard test of treatment fidelity. This approach requires development of a psychometrically sound instrument to meaningfully categorize and quantify interventionist behaviors. b Objective: To outline critical steps necessary to develop a treatment fidelity instrument. b Methods: A comprehensive literature review was conducted to determine procedures used by other researchers. The literature review produced five quantitative studies of treatment fidelity, all in the field of psychotherapy, and two replication studies. A synthesis of methodologies across studies combined with researchers’ experiences resulted in identification of the steps necessary to develop a treatment fidelity measure. b Results: Seven sequential steps were identified as essential to the development of a valid and reliable measure of treatment fidelity. These steps include (a) identification of the essential elements of the experimental and control treatment modalities; (b) construction of scale items; (c) development of item scaling; (d) identification of the units for coding; (e) item testing and revision; (f) specification of rater qualifications and development of rater training program; and (g) development and completion of pilot testing to test psychometric properties. Development of the Possibilities Project Psychotherapy Coding Questionnaire is described as an illustration of the seven-step process. b Discussion: The results show the essential steps that are unique to the development of treatment fidelity measures and show the feasibility of using these steps to construct a psychometrically sound treatment-specific fidelity measure. b Key Words: internal validity & intervention fidelity & randomized clinical trialshttp://deepblue.lib.umich.edu/bitstream/2027.42/65122/2/Stein Fidelity.pd

Consumption of the whole-grain rye bread and progression of prostate cancer

Funding Information: This study was supported by the project framework of the European Regional Development Fund (ERAF) No. 2010/0273/2DP/2.1.1.0/10/APIA/VIAA/083 „Assessment of Local Origin Cereal Species’ Potential and Development of Varieties for Specific Dietary Foods Production”. Copyright: Copyright 2013 Elsevier B.V., All rights reserved.Whole-grain rye intake has been suggested to have anti-cancer effect, including changes in serum hormones and reduced prostate specific antigen (PSA) in animals and humans. In this study, we investigated the effect of high intake of whole-grain rye bread on prostate cancer progression as assessed by PSA concentration in men diagnosed with prostate cancer. Fifteen men with prostate cancer who did not receive prior therapy were randomised and given a daily supplement of 250 g refined wheat bread for two weeks and, afterwards, 250 g whole-grain rye bread for six weeks. Blood samples were taken from fasting men at baseline and after two and six weeks to measure the PSA and sex hormones. The dietary intake was: energy intake 3452 kcal; protein intake 166 g, carbohydrate intake 334 g, fat 149 g, saturated fat intake 52 g, and fibre intake 40 g. Plasma total PSA, free PSE, testosterone concentrations and free androgen index tended to be higher after refined white bread treatment and lower after whole-grain rye treatment. However, none of the differences were statistically significant. There were no significant changes in sex hormone binding globulin, luteinising hormone, and follicle stimulating hormone. In this intervention trial, whole-grain rye consumption did not result in significant changes in PSA and sex hormones, which may be related to high fat intake. Further prospective trials are indicated to evaluate the potential of whole-grain rye bread, taking into account other factors.publishersversionPeer reviewe

MOLECULAR MODELING AS A VISUALIZATION TOOL IN DESIGN OF DNA CROSSLINKED POLYACRYLAMIDE

ABSTRACT Polymers such as polyacrylamide form a diverse class of biomaterials in use today. The experimental research performed by our group has demonstrated how a critical concentration of crosslinking DNA strands can lead to gel formation in the polyacrylamide. The removal or addition of DNA strands can reverse or significantly increase the stiffness and strength of the gel. DNA is a versatile material for the exploration of nanoscale structures because its hybridization chemistry is very specific. DNA crosslinked gels use end-modified DNA oligonucleotides in the gels. The ability to choose the base sequence in the DNA crosslinks offers an opportunity to engineer the nanoscale structure of this material. However, it is extremely difficult to visualize the sequence of events that occurs when DNA is crosslinked with polyacrylamide. Computer modeling is a tool that enables the researchers to study the structural aspects of the newly engineered DNA crosslinkers. In this study, polyacrylamide gel crosslinked with DNA has been assayed with respect to energy and size using AMBER 7.0 software [1]. Since DNA-crosslinked gels are likely to find a range of applications it is important to know how to tailor the gel composition for a particular application. It is also of interest to know what the composition is that would induce the greatest change in stiffness. The molecular models generated in AMBER survey the mechanical properties of the gel as a function of crosslinker density, polyacrylamide density, and crosslinker length. The structure of an equilibrium state is computed using an explicitly solvated model. Visual inspection of the model determines other mechanical properties of the gel and helps predict chemical interactions. A long-term goal of this work is to use computer assisted modeling techniques to guide the experiments, to predict linker stiffness, and to examine other mechanical properties of the DNA crosslinker

The Pharmacogenomics of Inhaled Corticosteroids and Lung Function Decline in COPD

Inhaled corticosteroids (ICS) are widely prescribed for patients with chronic obstructive pulmonary disease (COPD), yet with variable outcomes and adverse reactions which may be genetically determined. The primary aim of the study was to identify the genetic determinants for FEV1 changes related to ICS therapy. In the Lung Health Study 2 (LHS-2), 1116 COPD patients were randomised to the ICS, triamcinolone acetonide (n=559), or placebo (n=557) with spirometry performed every 6 months for 3 years. We performed a pharmacogenomic genome-wide association study (GWAS) for the genotype-by-ICS treatment effect on 3 years of forced expiratory volume in 1 s (FEV1) changes (estimated as slope) in 802 genotyped LHS-2 participants. Replication was performed in 199 COPD patients randomised to the ICS, fluticasone or placebo. A total of five loci showed genotype-by-ICS interaction at p&lt;5×10-6; of these, SNP rs111720447 on chromosome 7 was replicated (discovery p=4.8×10-6, replication p=5.9×10-5) with the same direction of interaction effect. ENCODE data revealed that in glucocorticoid treated (dexamethasone) A549 alveolar cell line, glucocorticoid receptor binding sites were located near SNP rs111720447. In stratified analyses of LHS-2, genotype at SNP rs111720447 was significantly associated with rate of FEV1 decline in patients taking ICS (C allele beta=56.35 mL·year-1, 95% confidence interval (CI)=29.96, 82.76 mL·yr-1) and also in patients who were assigned to placebo, though the relationship was weaker and in the opposite direction than that in the ICS group (C allele beta=-27.57 mL·year-1, 95% CI=-53.27, -1.87 mL·yr-1). The study uncovered genetic factors associated with FEV1 changes related to ICS in COPD patients, which may provide new insight on the potential biology of steroid responsiveness in COPD.</p

Meta-analysis of genome-wide association studies of asthma in ethnically diverse North American populations.

Asthma is a common disease with a complex risk architecture including both genetic and environmental factors. We performed a meta-analysis of North American genome-wide association studies of asthma in 5,416 individuals with asthma (cases) including individuals of European American, African American or African Caribbean, and Latino ancestry, with replication in an additional 12,649 individuals from the same ethnic groups. We identified five susceptibility loci. Four were at previously reported loci on 17q21, near IL1RL1, TSLP and IL33, but we report for the first time, to our knowledge, that these loci are associated with asthma risk in three ethnic groups. In addition, we identified a new asthma susceptibility locus at PYHIN1, with the association being specific to individuals of African descent (P = 3.9 × 10(-9)). These results suggest that some asthma susceptibility loci are robust to differences in ancestry when sufficiently large samples sizes are investigated, and that ancestry-specific associations also contribute to the complex genetic architecture of asthma

ITGB5 and AGFG1 variants are associated with severity of airway responsiveness

Background: Airway hyperresponsiveness (AHR), a primary characteristic of asthma, involves increased airway smooth muscle contractility in response to certain exposures. We sought to determine whether common genetic variants were associated with AHR severity. Methods: A genome-wide association study (GWAS) of AHR, quantified as the natural log of the dosage of methacholine causing a 20% drop in FEV1, was performed with 994 non-Hispanic white asthmatic subjects from three drug clinical trials: CAMP, CARE, and ACRN. Genotyping was performed on Affymetrix 6.0 arrays, and imputed data based on HapMap Phase 2, was used to measure the association of SNPs with AHR using a linear regression model. Replication of primary findings was attempted in 650 white subjects from DAG, and 3,354 white subjects from LHS. Evidence that the top SNPs were eQTL of their respective genes was sought using expression data available for 419 white CAMP subjects. Results: The top primary GWAS associations were in rs848788 (P-value 7.2E-07) and rs6731443 (P-value 2.5E-06), located within the ITGB5 and AGFG1 genes, respectively. The AGFG1 result replicated at a nominally significant level in one independent population (LHS P-value 0.012), and the SNP had a nominally significant unadjusted P-value (0.0067) for being an eQTL of AGFG1. Conclusions: Based on current knowledge of ITGB5 and AGFG1, our results suggest that variants within these genes may be involved in modulating AHR. Future functional studies are required to confirm that our associations represent true biologically significant findings

Relevant factors in the design of composite ballistic helmets

[EN] In this paper, the design methodology of composite ballistic helmets has been enhanced considering biomechanical requirements by means of finite element analysis. Modern combat helmets lead to a new type of non-penetrating injury, the Behind Helmet Blunt Trauma (BHBT), generated by the deformation of the inner face of the helmet, the so-called backface deformation (BFD). Current standard testing methodologies use BFD as the main measure in ballistic testing. Nonetheless, this work discusses the relationship between this mechanical parameter and the head trauma (BHBT) by studying different head injury criteria. A numerical model consisting of a helmet and a human head is developed and validated with experimental data from literature. The consequences of non-penetrating high-speed ballistic impacts upon the human head protected by an aramid combat helmet are analysed, concluding that the existing testing methodologies fail to predict many types of head injuries. The influence of other parameters like bullet velocity or head dimensions is analysed. Usually, a single-sized helmet shell is manufactured and the different sizes are adjusted by varying the foam pad thickness. However, one of the conclusions of this work is that pad thickness is critical to avoid BHBT and must be considered in the design process.The authors thank the financial support received from the Spanish Ministry of Economy and Competitiveness (MINECO) and the European Regional Development Fund (ERDF-FEDER) through the project RTC-2015-3887-8, and from the Conselleria d'Educació, Investigació, Cultura i Esport of the Generalitat Valenciana through the program PROMETEO 2016/007.Palomar-Toledano, M.; Lozano-Mínguez, E.; Rodriguez-Millán, M.; Miguélez, MH.; Giner Maravilla, E. (2018). Relevant factors in the design of composite ballistic helmets. Composite Structures. 201:49-61. https://doi.org/10.1016/j.compstruct.2018.05.076S496120

Genetic variants affecting cross-sectional lung function in adults show little or no effect on longitudinal lung function decline

Background: Genome-wide association studies have identified numerous genetic regions that influence cross-sectional lung function. Longitudinal decline in lung function also includes a heritable component but the genetic determinants have yet to be defined. Objectives: We aimed to determine whether regions associated with cross-sectional lung function were also associated with longitudinal decline and to seek novel variants which influence decline. Methods: We analysed genome-wide data from 4167 individuals from the Busselton Health Study cohort, who had undergone spirometry (12 695 observations across eight time points). A mixed model was fitted and weighted risk scores were calculated for the joint effect of 26 known regions on baseline and longitudinal changes in FEV1 and FEV1/FVC. Potential additional regions of interest were identified and followed up in two independent cohorts. Results: The 26 regions previously associated with cross-sectional lung function jointly showed a strong effect on baseline lung function (p=4.44×10−16 for FEV1/FVC) but no effect on longitudinal decline (p=0.160 for FEV1/FVC). This was replicated in an independent cohort. 39 additional regions of interest (48 variants) were identified; these associations were not replicated in two further cohorts. Conclusions: Previously identified genetic variants jointly have a strong effect on cross-sectional lung function in adults but little or no effect on the rate of decline of lung function. It is possible that they influence COPD risk through lung development. Although no genetic variants have yet been associated with lung function decline at stringent genome-wide significance, longitudinal change in lung function is heritable suggesting that there is scope for future discoveries