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The Solar Dynamics Observatory (SDO) is a Sun-observing spacecraft that includes two spectrometers that use aluminum membranes to filter solar radiation. The transmission of those filters degraded by a factor of 5 during the first five years after launch. Previously, we showed that degradation was comparable to that induced in the laboratory by UV synchrotron radiation on similar aluminum filters. Here, we show that a physics-based model fit to the results of our synchrotron exposures can quantitatively describe the SDO degradation if the water vapor pressure p H2O on the SDO is allowed to be a free parameter. The fitted value of p H2O for both spectrometers, approximately 10−8 mbar (10 − 6 Pa ), is consistent with the flux of outgassed water estimated for the thermal blankets on SDO. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Arterial diastolic blood pressure (DBP) greater than 25 mm Hg in infants and greater than 30 mm Hg in children greater than 1 year old during cardiopulmonary resuscitation (CPR) was associated with survival to hospital discharge in one prospective study. We sought to validate these potential hemodynamic targets in a larger multicenter cohort. DESIGN: Prospective observational study. SETTING: Eighteen PICUs in the ICU-RESUScitation prospective trial from October 2016 to March 2020. PATIENTS: Children less than or equal to 18 years old with CPR greater than 30 seconds and invasive blood pressure (BP) monitoring during CPR. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Invasive BP waveform data and Utstein-style CPR data were collected, including prearrest patient characteristics, intra-arrest interventions, and outcomes. Primary outcome was survival to hospital discharge, and secondary outcomes were return of spontaneous circulation (ROSC) and survival to hospital discharge with favorable neurologic outcome. Multivariable Poisson regression models with robust error estimates evaluated the association of DBP greater than 25 mm Hg in infants and greater than 30 mm Hg in older children with these outcomes. Among 1,129 children with inhospital cardiac arrests, 413 had evaluable DBP data. Overall, 85.5% of the patients attained thresholds of mean DBP greater than or equal to 25 mm Hg in infants and greater than or equal to 30 mm Hg in older children. Initial return of circulation occurred in 91.5% and 25% by placement on extracorporeal membrane oxygenator. Survival to hospital discharge occurred in 58.6%, and survival with favorable neurologic outcome in 55.4% (i.e. 94.6% of survivors had favorable neurologic outcomes). Mean DBP greater than 25 mm Hg for infants and greater than 30 mm Hg for older children was significantly associated with survival to discharge (adjusted relative risk [aRR], 1.32; 1.01–1.74; p = 0.03) and ROSC (aRR, 1.49; 1.12–1.97; p = 0.002) but did not reach significance for survival to hospital discharge with favorable neurologic outcome (aRR, 1.30; 0.98–1.72; p = 0.051). CONCLUSIONS: These validation data demonstrate that achieving mean DBP during CPR greater than 25 mm Hg for infants and greater than 30 mm Hg for older children is associated with higher rates of survival to hospital discharge, providing potential targets for DBP during CPR. [ABSTRACT FROM AUTHOR]

We describe the model and construction of a two-flow (or divided-flow) humidity generator, developed at LNE-Cnam, that uses mass flow controllers to mix a stream of dry gas with a stream of humid gas saturated at 28 ∘ C. It can generate a wide range of humidity, with mole fractions in the range of 0.7×10-6

We describe the model and construction of a two-flow (or divided-flow) humidity generator, developed at LNE-CNAM, that uses mass flow controllers to mix a stream of dry gas with a stream of humid gas saturated at 28 °C. It can generate a wide range of humidity, with mole fractions in the range 0.7 × 10-6 < x < 9000 × 10-6, without using low temperature or high pressure. This range is suitable for calibrating balloon-borne instruments that measure humidity in the stratosphere, where x ~5 × 10-6. The generator's novel feature is a saturator that comprises 5 m of silicone tubing immersed in water. Water enters the humid gas stream by diffusing through the wall of the tubing until the gas stream flowing through the tubing is saturated. This design provides a simple, low-cost humidity generator with an accuracy that is acceptable for many applications. The key requirement is that the tubing be long enough to ensure saturation, so that the saturator's output is independent of the dimensions and permeability of the tube. A length of only a few meters was sufficient because the tube was made of silicone; other common polymers have permeabilities that are 1000 times smaller. We verified the model of the transition from unsaturated flow to saturated flow by measuring the humidity while using three tube lengths, two of which were too short for saturation. As a more complete test, we used the generator as a primary device after correcting the calibrations of the mass flow controllers that determined the mixing ratio. At mole fractions 50 × 10-6 < x < 5000 × 10-6, the generator's output mole fraction xgen agreed to within 1 % with the value xcm measured by a calibrated chilled-mirror hygrometer; in other words, their ratio fell in the range xgen/xcm = 1.00 ± 0.01. At smaller mole fractions, their differences fell in range xgen - xcm = ±1 × 10-6. [ABSTRACT FROM AUTHOR]

The history of cardiopulmonary resuscitation and the Society of Critical Care Medicine have much in common, as many of the founders of the Society of Critical Care Medicine focused on understanding and improving outcomes from cardiac arrest. We review the history, the current, and future state of cardiopulmonary resuscitation. [ABSTRACT FROM AUTHOR]

In spite of strict limits on outgassing from organic materials, some spacecraft instruments making long-term measurements of solar extreme ultraviolet (EUV) radiation still suffer significant degradation. While such measures have reduced the rate of degradation, they have not completely eliminated it in some cases. For example, in five years, the aluminum filters used in the Extreme Ultraviolet Variability Experiment (EVE) instruments onboard the Solar Dynamics Observatory (SDO) suffered losses exceeding 40% at 30.4 nm. Comparing those losses with the negligible losses of nearby zirconium filters on the same instruments indicated that the problem was not due to carbonization on the Sun-facing side of the filter. To investigate whether the loss was due to carbon deposition on the downstream face of the Al filter, we exposed the backsides of Al and Zr filters to EUV in the presence of a volatile organic solvent in the laboratory and concluded that this could not be the cause. Given that the residual-gas composition in the SDO spacecraft likely has water vapor as well as organics, these findings suggest that the transmission loss in the Al filter originated with oxidation caused by UV-activated adsorbed water. [ABSTRACT FROM AUTHOR]

Background: Vaccine clinical studies typically provide time-resolved data on adaptive response read-outs in response to the administration of that particular vaccine to a cohort of individuals. However, modeling such data is challenged by the properties of these time-resolved profiles such as non-linearity, scarcity of measurement points, scheduling of the vaccine at multiple time points. Linear Mixed Models (LMM) are often used for the analysis of longitudinal data but their use in these time-resolved immunological data is not common yet. Apart from the modeling challenges mentioned earlier, selection of the optimal model by using information-criterion-based measures is far from being straight-forward. The aim of this study is to provide guidelines for the application and selection of LMMs that deal with the challenging characteristics of the typical data sets in the field of vaccine clinical studies.Methods: We used antibody measurements in response to Hepatitis-B vaccine with five different adjuvant formulations for demonstration purposes. We built piecewise-linear, piecewise-quadratic and cubic models with transformations of the axes with pre-selected or optimized knot locations where time is a numerical variable. We also investigated models where time is categorical and random effects are shared intercepts between different measurement points. We compared all models by using Akaike Information Criterion (AIC), Bayesian Information Criterion (BIC), Deviance Information Criterion (DIC), variations of conditional AIC and by visual inspection of the model fit in the light of prior biological information.Results: There are various ways of dealing with the challenges of the data which have their own advantages and disadvantages. We explain these in detail here. Traditional information-criteria-based measures work well for the coarse selection of the model structure and complexity, however are not efficient at fine tuning of the complexity level of the random effects.Conclusions: We show that common statistical measures for optimal model complexity are not sufficient. Rather, explicitly accounting for model purpose and biological interpretation is needed to arrive at relevant models.Trial Registration: Clinical trial registration number for this study: NCT00805389, date of registration: December 9, 2008 (pro-active registration). [ABSTRACT FROM AUTHOR]

Utstein-style reporting templates provide a structured framework with which to compare systems of care for cardiac arrest. The 2004 Utstein reporting template encompassed both out-of-hospital and in-hospital cardiac arrest. A 2015 update of the Utstein template focused on out-of-hospital cardiac arrest, which makes this update of the in-hospital template timely. Representatives of the International Liaison Committee on Resuscitation developed an updated in-hospital Utstein reporting template iteratively by meeting face-to-face, by teleconference, and by online surveys between 2013 and 2018. Data elements were grouped by hospital factors, patient variables, pre-event factors, cardiac arrest and postresuscitation processes, and outcomes. Elements were classified as core or supplemental by use of a modified Delphi process. Variables were described as core if they were considered essential. Core variables should enable reasonable comparisons between systems and are considered essential for quality improvement programs. Together with core variables, supplementary variables are considered useful for research. [ABSTRACT FROM AUTHOR]

Utstein-style reporting templates provide a structured framework with which to compare systems of care for cardiac arrest. The 2004 Utstein reporting template encompassed both out-of-hospital and in-hospital cardiac arrest. A 2015 update of the Utstein template focused on out-of-hospital cardiac arrest, which makes this update of the in-hospital template timely. Representatives of the International Liaison Committee on Resuscitation developed an updated in-hospital Utstein reporting template iteratively by meeting face-to-face, by teleconference, and by online surveys between 2013 and 2018. Data elements were grouped by hospital factors, patient variables, pre-event factors, cardiac arrest and postresuscitation processes, and outcomes. Elements were classified as core or supplemental by use of a modified Delphi process. Variables were described as core if they were considered essential. Core variables should enable reasonable comparisons between systems and are considered essential for quality improvement programs. Together with core variables, supplementary variables are considered useful for research. [ABSTRACT FROM AUTHOR]

BACKGROUND: The association between chest compression (CC) pause duration and pediatric in-hospital cardiac arrest survival outcomes is unknown. The American Heart Association has recommended minimizing pauses in CC in children to <10 seconds, without supportive evidence. We hypothesized that longer maximum CC pause durations are associated with worse survival and neurological outcomes. METHODS: In this cohort study of index pediatric in-hospital cardiac arrests reported in pediRES-Q (Quality of Pediatric Resuscitation in a Multicenter Collaborative) from July of 2015 through December of 2021, we analyzed the association in 5-second increments of the longest CC pause duration for each event with survival and favorable neurological outcome (Pediatric Cerebral Performance Category ≤3 or no change from baseline). Secondary exposures included having any pause >10 seconds or >20 seconds and number of pauses >10 seconds and >20 seconds per 2 minutes. RESULTS: We identified 562 index in-hospital cardiac arrests (median [Q1, Q3] age 2.9 years [0.6, 10.0], 43% female, 13% shockable rhythm). Median length of the longest CC pause for each event was 29.8 seconds (11.5, 63.1). After adjustment for confounders, each 5-second increment in the longest CC pause duration was associated with a 3% lower relative risk of survival with favorable neurological outcome (adjusted risk ratio, 0.97 [95% CI, 0.95–0.99]; P =0.02). Longest CC pause duration was also associated with survival to hospital discharge (adjusted risk ratio, 0.98 [95% CI, 0.96–0.99]; P =0.01) and return of spontaneous circulation (adjusted risk ratio, 0.93 [95% CI, 0.91–0.94]; P <0.001). Secondary outcomes of any pause >10 seconds or >20 seconds and number of CC pauses >10 seconds and >20 seconds were each significantly associated with adjusted risk ratio of return of spontaneous circulation, but not survival or neurological outcomes. CONCLUSIONS: Each 5-second increment in longest CC pause duration during pediatric in-hospital cardiac arrest was associated with lower chance of survival with favorable neurological outcome, survival to hospital discharge, and return of spontaneous circulation. Any CC pause >10 seconds or >20 seconds and number of pauses >10 seconds and >20 seconds were significantly associated with lower adjusted probability of return of spontaneous circulation, but not survival or neurological outcomes. [ABSTRACT FROM AUTHOR]

2019; 140: e746-e757, 3 Topjian AA, Scholefield BR, Pinto NP,: P-COSCA (Pediatric Core Outcome Set for Cardiac Arrest) in children: An advisory statement from the International Liaison Committee on Resuscitation. To comprehensively address these complex issues, the International Liaison Committee on Resuscitation published its Advisory Statement regarding Pediatric Core Outcome Set for Cardiac Arrest (P-COSCA) in 2021, focusing on survival and life impact ([3]). Albrecht et al ([1]) delineate the major advantages and disadvantages of the Pediatric Cerebral Performance Category (PCPC) scale at hospital discharge for determining good versus bad neurologic outcome following pediatric cardiac arrest. [Extracted from the article]

Over the last 15 years, treatment of comatose post-cardiac arrest patients has evolved to include therapeutic strategies such as urgent coronary angiography with percutaneous coronary intervention (PCI), targeted temperature management (TTM)-requiring mechanical ventilation and sedation-and more sophisticated and cautious prognostication. In 2015, collaboration between the European Resuscitation Council (ERC) and the European Society for Intensive Care Medicine (ESICM) resulted in the first European guidelines on post-resuscitation care. This review addresses the major recent advances in the treatment of cardiac arrest, recent trials that have challenged current practice and the remaining areas of uncertainty. [ABSTRACT FROM AUTHOR]

Background: Based on laboratory cardiopulmonary resuscitation (CPR) investigations and limited adult data, the American Heart Association Consensus Statement on CPR Quality recommends titrating CPR performance to achieve end-tidal carbon dioxide (ETCO2) >20 mmHg.Aims: We prospectively evaluated whether ETCO2 > 20 mmHg during CPR was associated with survival to hospital discharge.Methods: Children ≥37 weeks gestation in Collaborative Pediatric Critical Care Research Network intensive care units with chest compressions for ≥1 min and ETCO2 monitoring prior to and during CPR between July 1, 2013 and June 31, 2016 were included. ETCO2 and Utstein-style cardiac arrest data were collected. Multivariable Poisson regression models with robust error estimates were used to estimate relative risk of outcomes.Results: Blinded investigators analyzed ETCO2 waveforms from 43 children. During CPR, the median ETCO2 was 23 mmHg [quartiles, 16 and 28 mmHg], median ventilation rate was 29 breaths/min [quartiles, 24 and 35 breaths/min], and median duration of CPR was 5 min [quartiles, 2 and 16 min]. Return of spontaneous circulation occurred after 71% of CPR events and 37% of patients survived to hospital discharge. For children with mean ETCO2 during CPR > 20 mmHg, the adjusted relative risk for survival was 0.92 (0.41, 2.08), p = 0.84. The median mean ETCO2 among children who survived to hospital discharge was 20 mmHg [quartiles; 15, 28 mmHg] versus 23 mmHg [16, 28 mmHg] among non-survivors.Conclusion: Mean ETCO2 > 20 mmHg during pediatric in-hospital CPR was not associated with survival to hospital discharge, and ETCO2 was not different in survivors versus non-survivors. [ABSTRACT FROM AUTHOR]

We have measured the apparent critical exponent y characterizing the divergence of the viscosity η∝(T-Tc)-y near the liquid–liquid critical point of the mixture polystyrene in diethyl malonate. The data span the range in reduced temperature of 10-4<(T-Tc)/Tc<10-1. The sample was prepared from the same materials used by Gruner et al. in their capillary viscometer [Macromolecules 23, 510 (1990)]; however our torsion oscillator viscometer had a shear rate 80 times lower. This increased the range of reduced temperatures where shear effects could be neglected. In spite of the large reduction in shear rate and the different viscometry technique, the parameters fitted to our data and those of Gruner et al. are in agreement. For this polymer solution, y is in the range 0.028±0.003, close to recent results for two other polymer solutions measured in capillary viscometers. However, it is significantly smaller than the exponent for pure fluids (0.041± 0.001) and simple binary mixtures (0.042±0.002). It appears that polymer solutions are in a dynamic universality class different from that of simpler fluids. [ABSTRACT FROM AUTHOR]

The flow of the microemulsion dioctylsulfosuccinate (AOT)/decane/water through 0.1 and 1.0 μm diameter pores was studied for water droplet volume fractions ranging from 0 to 0.5. The viscosity of these microemulsions, as measured in a capillary viscometer with a bore of ≊1 mm diameter, exceeds by as much as a factor of 4 theoretical predictions of the viscosity of suspensions of hard or liquid spheres. If droplet clustering causes this viscosity enhancement, then flow of the microemulsions through pores with diameter small compared to the characteristic cluster size should display a large finite-size effect. The apparent viscosity of the microemulsions in pores differed from the viscosity measured in the capillary viscometer by less than 40% for 0.1 μm diameter pores and by less than 8% for 1.0 μm diameter pores. These differences are of the same scale as estimates of two effects: adsorption of droplets on the pore wall and the enhanced flow of suspensions near a wall. The absence of larger finite-size effects implies that clustering of droplets on length scales of 0.1 μm or larger does not contribute substantially to the microemulsion viscosity. [ABSTRACT FROM AUTHOR]

We have measured the viscosity of four binary mixtures near their consolute points: (1) methanol+cyclohexane, (2) isobutyric acid+water, (3) nitroethane+3-methylpentane, and (4) 2-butoxyethanol+water. The viscosity data are consistent with the power-law divergence: η∼|T-Tc|-y, with an apparent viscosity exponent in the range 0.0404

We have measured the viscosity of the three-component microemulsion water/decane/AOT as a function of temperature and droplet volume fraction. At temperatures well below the phase-separation temperature the viscosity is described by treating the droplets as hard spheres suspended in decane. Upon approaching the two-phase region from low temperature, there is a large (as much as a factor of 4) smooth increase of the viscosity which may be related to the percolation-like transition observed in the electrical conductivity. This increase in viscosity is not completely consistent with either a naive electroviscous model or a simple clustering model. The divergence of the viscosity near the critical point (39 °C) is superimposed upon the smooth increase. The magnitude and temperature dependence of the critical divergence are similar to that seen near the critical points of binary liquid mixtures. [ABSTRACT FROM AUTHOR]

Examines the measurements of the viscosity near the consolute point of triethyl n-hyxel ammonium triethy n-hyxel borate in diphenyl ether. Analysis on coexistence for a mean-field ionic fluid; Composition of mean-field ionic fluid; Indication for mean-field static behavior; Presence of critical viscosity enhancement.

Purpose: The purpose of this review is to describe the epidemiology of out-of-hospital cardiac arrest (OHCA), disparities in organisation and outcome, recent advances in treatment and ongoing controversies. We also outline the standard of care that should be provided by the critical care specialist and propose future directions for cardiac arrest research.Methods: Narrative review with contributions from international resuscitation experts.Results: Although it is recognised that survival rates from OHCA are increasing there is considerable scope for improvement and many countries have implemented national strategies in an attempt to achieve this goal. More resources are required to enable high-quality randomised trials in resuscitation.Conclusions: Increasing international collaboration should facilitate resuscitation research and knowledge translation. The International Liaison Committee on Resuscitation (ILCOR) has adopted a continuous evidence review process, which facilitate the implementation of resuscitation interventions proven to improve patient outcomes. [ABSTRACT FROM AUTHOR]

Background: On the basis of laboratory cardiopulmonary resuscitation (CPR) investigations and limited adult data demonstrating that survival depends on attaining adequate arterial diastolic blood pressure (DBP) during CPR, the American Heart Association recommends using blood pressure to guide pediatric CPR. However, evidence-based blood pressure targets during pediatric CPR remain an important knowledge gap for CPR guidelines.Methods: All children ≥37 weeks' gestation and <19 years old in Collaborative Pediatric Critical Care Research Network intensive care units with chest compressions for ≥1 minute and invasive arterial blood pressure monitoring before and during CPR between July 1, 2013, and June 31, 2016, were included. Mean DBP during CPR and Utstein-style standardized cardiac arrest data were collected. The hypothesis was that DBP ≥25 mm Hg during CPR in infants and ≥30 mm Hg in children ≥1 year old would be associated with survival. Primary outcome was survival to hospital discharge. Secondary outcome was survival to hospital discharge with favorable neurological outcome, defined as Pediatric Cerebral Performance Categories 1 to 3 or no worse than prearrest baseline. Multivariable Poisson regression models with robust error estimates were used to estimate the relative risk of outcomes.Results: Blinded investigators analyzed blood pressure waveforms during CPR from 164 children, including 60% <1 year old, 60% with congenital heart disease, and 54% after cardiac surgery. The immediate cause of arrest was hypotension in 67%, respiratory decompensation in 44%, and arrhythmia in 19%. Median duration of CPR was 8 minutes (quartiles, 3 and 27 minutes). Ninety percent survived the event, 68% with return of spontaneous circulation and 22% by extracorporeal life support. Forty-seven percent survived to hospital discharge, and 43% survived to discharge with favorable neurological outcome. Maintaining mean DBP ≥25 mm Hg in infants and ≥30 mm Hg in children ≥1 year old occurred in 101 of 164 children (62%) and was associated with survival (adjusted relative risk, 1.7; 95% confidence interval, 1.2-2.6; P=0.007) and survival with favorable neurological outcome (adjusted relative risk, 1.6; 95% confidence interval, 1.1-2.5; P=0.02).Conclusions: These data demonstrate that mean DBP ≥25 mm Hg during CPR in infants and ≥30 mm Hg in children ≥1 year old was associated with greater likelihood of survival to hospital discharge and survival with favorable neurological outcome. [ABSTRACT FROM AUTHOR]

Objective Postpartum hemorrhage (PPH) is the leading cause of maternal morbidity and mortality. At present, there are no reliable clinical or laboratory indicators to identify which patients might require blood transfusions during a PPH. Serum lactate has long been used as an early biomarker of tissue hypoperfusion in trauma settings. The aim of this study is to understand serum lactate's role in the management of obstetric hemorrhage. Study Design A retrospective chart review was performed of women who delivered between 2016 and 2019 at our institution and experienced a PPH. The patients were divided into two groups: those with a normal serum lactate level, defined as ≤2 mmol/L, and those with an abnormal serum lactate level, defined as >2 mmol/L. Need for packed red blood cell transfusion, as part of the resuscitation, was assessed for both groups. Results During the study period, 938 women experienced PPH. Of these, 108 (11.5%) had a normal serum lactate, ≤2 mmol/L, and 830 (88.5%) had an abnormal lactate, >2 mmol/L. Women with elevated lactate levels were more likely to receive a blood transfusion versus those with a normal lactate level (57.0 vs. 46.3%, p = 0.035, respectively). Additionally, the average number of blood transfusions administered was significantly higher in the abnormal lactate group versus in the normal lactate group (1.34 vs. 0.97, respectively, p = 0.004). In a multivariable linear regression model, increasing serum lactate levels were found to be predictive of requiring more than 1 unit of blood (p < 0.001). Conclusion Women with elevated serum lactate levels were more likely to require blood transfusions during a PPH versus those with a normal serum lactate level. Thus, serum lactate levels are useful as an early indicator of requirement for blood transfusion in the management of obstetric hemorrhage. Key Points Lactate is a biomarker for blood transfusion in trauma. Lactate's role in PPH is unknown. Elevated lactate predicts receiving more blood transfusions. [ABSTRACT FROM AUTHOR]

Indole-2-thione 3 reacted quickly with oxalyl chloride to yield thieno[2,3- b ]indole-2,3-dione 4 together with the isomer thiazolo[3,2- a ]indole-2,3-dione 5 . These thieno[2,3- b ]indole-2,3diones underwent ring expansions when treated with diazomethane and e.g. thieno[2,3- b ]indole-2,3-dione 4 gave the thiopyrano derivative 16 , after two insertions. [ABSTRACT FROM AUTHOR]

The transport of mitochondria and other cellular components along the axonal microtubule cytoskeleton plays an essential role in neuronal survival. Defects in this system have been linked to a large number of neurological disorders. In multiple sclerosis (MS) and associated models such as experimental autoimmune encephalomyelitis (EAE), alterations in axonal transport have been shown to exist before neurodegeneration occurs. Genome-wide association (GWA) studies have linked several motor proteins to MS susceptibility, while neuropathological studies have shown accumulations of proteins and organelles suggestive for transport deficits. A reduced effectiveness of axonal transport can lead to neurodegeneration through inhibition of mitochondrial motility, disruption of axoglial interaction or prevention of remyelination. In MS, demyelination leads to dysregulation of axonal transport, aggravated by the effects of TNF-alpha, nitric oxide and glutamate on the cytoskeleton. The combined effect of all these pathways is a vicious cycle in which a defective axonal transport system leads to an increase in ATP consumption through loss of membrane organization and a reduction in available ATP through inhibition of mitochondrial transport, resulting in even further inhibition of transport. The persistent activity of this positive feedback loop contributes to neurodegeneration in MS. [ABSTRACT FROM AUTHOR]

Importance: Therapeutic hypothermia is used for patients following both out-of-hospital and in-hospital cardiac arrest. However, randomized trials on its efficacy for the in-hospital setting do not exist, and comparative effectiveness data are limited.Objective: To evaluate the association between therapeutic hypothermia and survival after in-hospital cardiac arrest.Design, Setting, and Patients: In this cohort study, within the national Get With the Guidelines-Resuscitation registry, 26 183 patients successfully resuscitated from an in-hospital cardiac arrest between March 1, 2002, and December 31, 2014, and either treated or not treated with hypothermia at 355 US hospitals were identified. Follow-up ended February 4, 2015.Exposure: Induction of therapeutic hypothermia.Main Outcomes and Measures: The primary outcome was survival to hospital discharge. The secondary outcome was favorable neurological survival, defined as a Cerebral Performance Category score of 1 or 2 (ie, without severe neurological disability). Comparisons were performed using a matched propensity score analysis and examined for all cardiac arrests and separately for nonshockable (asystole and pulseless electrical activity) and shockable (ventricular fibrillation and pulseless ventricular tachycardia) cardiac arrests.Results: Overall, 1568 of 26 183 patients with in-hospital cardiac arrest (6.0%) were treated with therapeutic hypothermia; 1524 of these patients (mean [SD] age, 61.6 [16.2] years; 58.5% male) were matched by propensity score to 3714 non-hypothermia-treated patients (mean [SD] age, 62.2 [17.5] years; 57.1% male). After adjustment, therapeutic hypothermia was associated with lower in-hospital survival (27.4% vs 29.2%; relative risk [RR], 0.88 [95% CI, 0.80 to 0.97]; risk difference, -3.6% [95% CI, -6.3% to -0.9%]; P = .01), and this association was similar (interaction P = .74) for nonshockable cardiac arrest rhythms (22.2% vs 24.5%; RR, 0.87 [95% CI, 0.76 to 0.99]; risk difference, -3.2% [95% CI, -6.2% to -0.3%]) and shockable cardiac arrest rhythms (41.3% vs 44.1%; RR, 0.90 [95% CI, 0.77 to 1.05]; risk difference, -4.6% [95% CI, -10.9% to 1.7%]). Therapeutic hypothermia was also associated with lower rates of favorable neurological survival for the overall cohort (hypothermia-treated group, 17.0% [246 of 1443 patients]; non-hypothermia-treated group, 20.5% [725 of 3529 patients]; RR, 0.79 [95% CI, 0.69 to 0.90]; risk difference, -4.4% [95% CI, -6.8% to -2.0%]; P < .001) and for both rhythm types (interaction P = .88).Conclusions and Relevance: Among patients with in-hospital cardiac arrest, use of therapeutic hypothermia compared with usual care was associated with a lower likelihood of survival to hospital discharge and a lower likelihood of favorable neurological survival. These observational findings warrant a randomized clinical trial to assess efficacy of therapeutic hypothermia for in-hospital cardiac arrest. [ABSTRACT FROM AUTHOR]

Objectives: To determine the incidence and epidemiologic characteristics of cardiac arrests among tracheal intubations in PICUs.Design: Retrospective cohort study of prospectively collected data.Setting: Twenty-five diverse PICUs.Patients: Critically ill children requiring tracheal intubation in PICUs.Interventions: Tracheal intubation quality improvement data were prospectively collected for all initial tracheal intubations in 25 PICUs from July 2010 to March 2014 using National Emergency Airway Registry for Children registry.Measurements and Main Results: Tracheal intubation-associated cardiac arrest was defined as chest compressions more than 1 minute occurring during tracheal intubation or within 20 minutes after tracheal intubation. A total of 5,232 pediatric tracheal intubations were evaluated. Tracheal intubation-associated cardiac arrest was reported in 87 (1.7%). Patient factors (demographics and indications for tracheal intubation), provider factors (discipline and training level), and practice factors (tracheal intubation method and use of neuromuscular blockade) were recorded. Hemodynamic instability and oxygenation failure as tracheal intubation indications were associated with cardiac arrests (adjusted odds ratio, 6.3; 95% CI, 3.9-10.3; and adjusted odds ratio, 4.3; 95% CI, 2.6-6.9, respectively). History of difficult airway and cardiac disease were also associated with cardiac arrests (adjusted odds ratio, 2.1; 95% CI, 1.2-3.5; and adjusted odds ratio, 2.1; 95% CI, 1.2-3.9, respectively). Provider and practice factors were not associated with cardiac arrests, and provider factors did not modify the effect of patient factors on cardiac arrests.Conclusions: Tracheal intubation-associated cardiac arrests occurred during 1.7% of PICU tracheal intubations. Tracheal intubation-associated cardiac arrests were much more common with tracheal intubations when the child had acute hemodynamic instability or oxygen failure and when the child had a history of difficult airway or cardiac disease. [ABSTRACT FROM AUTHOR]

Objectives: To determine the incidence of cardiopulmonary resuscitation in PICUs and subsequent outcomes.Design, Setting, and Patients: Multicenter prospective observational study of children younger than 18 years old randomly selected and intensively followed from PICU admission to hospital discharge in the Collaborative Pediatric Critical Care Research Network December 2011 to April 2013.Results: Among 10,078 children enrolled, 139 (1.4%) received cardiopulmonary resuscitation for more than or equal to 1 minute and/or defibrillation. Of these children, 78% attained return of circulation, 45% survived to hospital discharge, and 89% of survivors had favorable neurologic outcomes. The relative incidence of cardiopulmonary resuscitation events was higher for cardiac patients compared with non-cardiac patients (3.4% vs 0.8%, p <0.001), but survival rate to hospital discharge with favorable neurologic outcome was not statistically different (41% vs 39%, respectively). Shorter duration of cardiopulmonary resuscitation was associated with higher survival rates: 66% (29/44) survived to hospital discharge after 1-3 minutes of cardiopulmonary resuscitation versus 28% (9/32) after more than 30 minutes (p < 0.001). Among survivors, 90% (26/29) had a favorable neurologic outcome after 1-3 minutes versus 89% (8/9) after more than 30 minutes of cardiopulmonary resuscitation.Conclusions: These data establish that contemporary PICU cardiopulmonary resuscitation, including long durations of cardiopulmonary resuscitation, results in high rates of survival-to-hospital discharge (45%) and favorable neurologic outcomes among survivors (89%). Rates of survival with favorable neurologic outcomes were similar among cardiac and noncardiac patients. The rigorous prospective, observational study design avoided the limitations of missing data and potential selection biases inherent in registry and administrative data. [ABSTRACT FROM AUTHOR]

Background Experimental autoimmune encephalomyelitis (EAE) is a commonly used experimental model for multiple sclerosis (MS). Experience with this model mainly comes from the field of immunology, while data on its use in studying the neurodegenerative aspects of MS is scarce. New method The aim of this study is to improve and refine methods to assess neurodegeneration and function in EAE. Using the rotarod, a tool used in neuroscience to monitor motor performance, we evaluated the correlation between motor performance, disease severity as measured using a clinical scale and area covered by inflammatory lesions. Results The included parameters are highly correlated in a non-linear manner, with motor performance rapidly decreasing in the intermediate values of the clinical scale. The relation between motor performance and histopathological damage is exclusively determined by lesions in the ventral and lateral columns, based on a new method of analysis of the entire spinal cord. Using a set of definitions for distinct disease milestones, we quantified disease duration as well as severity. Comparison with existing methods The rotarod measures motor performance in a more objective and quantitative manner compared to using a clinical score. The outcome showes a strong correlation to the surface area of inflammatory lesions in the motor systems of the spinal cord. Conclusions These results provide an improved workflow for interpreting the outcome of EAE from a neurological point of view, with the eventual goal of dissecting neurodegeneration and evaluating neuroprotective drugs in EAE for application in MS. [ABSTRACT FROM AUTHOR]

Abstract: We describe a flow standard for gas flows in the range from 0.01sccm to 100sccm with a relative standard uncertainty (68% confidence) of 0.03% at 1sccm (1sccm≡1cm3/min of an ideal gas at 101325Pa and 0°C ≈ 0.74358μmol/s). The flow standard calibrates a secondary meter by withdrawing a piston from a cylinder held at constant pressure P while gas flows from the secondary meter into the cylinder. The flow standard can operate anywhere in the range 10kPa

Objectives: The aim of this study was to evaluate the relative frequency of pediatric in-hospital cardiopulmonary resuscitation events occurring in ICUs compared to general wards. We hypothesized that the proportion of pediatric cardiopulmonary resuscitation provided in ICUs versus general wards has increased over the past decade, and this shift is associated with improved resuscitation outcomes. Design: Prospective and observational study. Setting: Total of 315 hospitals in the American Heart Association’s Get With The Guidelines-Resuscitation database. Patients: Total of 5,870 pediatric cardiopulmonary resuscitation events between January 1, 2000 and September 14, 2010. Cardiopulmonary resuscitation events were defined as external chest compressions longer than 1 minute. Interventions: None. Measurements and Main Results: The primary outcome was proportion of total ICU versus general ward cardiopulmonary resuscitation events over time evaluated by chi-square test for trend. Secondary outcome included return of spontaneous circulation following the cardiopulmonary resuscitation event. Among 5,870 pediatric cardiopulmonary resuscitation events, 5,477 (93.3%) occurred in ICUs compared to 393 (6.7%) in inpatient wards. Over time, significantly more of these cardiopulmonary resuscitation events occurred in the ICU compared to the wards (test for trend: p < 0.01), with a prominent shift noted between 2003 and 2004 (2000–2003: 87–91% vs 2004–2010: 94–96%). In a multivariable model controlling for within center variability and other potential confounders, return of spontaneous circulation increased in 2004–2010 compared with 2000–2003 (relative risk, 1.08; 95% CI, 1.03–1.13). Conclusions: In-hospital pediatric cardiopulmonary resuscitation is much more commonly provided in ICUs than in wards, and the proportion has increased significantly over the past decade, with concomitant increases in return of spontaneous circulation. [ABSTRACT FROM AUTHOR]

ICU without FP; and this association would be attenuated in ICUs where AP TI skill refresher programs exist. 3 ICUs with FP have AP TI refresher: 2 ICUs with required number of TI per year and operating room rotation, and 1 ICU with simulation. B Conclusion: b Attending Physicians in ICUs with FP have limited TI opportunities as the first airway provider and is associated with lower first attempt success rate compared to AP in ICUs without FP. [Extracted from the article]

Standardized CPR data collection included pre-arrest patient characteristics, arterial BPs during first 10 minutes of CPR, intra-arrest interventions and outcomes. B Conclusions: b These data validate that achieving mean DBP during CPR >=25 mmHg for infants or >=30 mmHg for children >=1yo is associated with higher rates of successful ROSC and survival to hospital discharge with favorable neurologic outcome. B Introduction: b A prior Collaborative Pediatric Critical Care Network (CPCCRN) derivation study of 164 patients with ICU cardiac arrests (7/2013-6/2016) established that invasive arterial diastolic BP >=25 mmHg in infants and >=30 mmHg in children >=1yo was associated with survival to hospital discharge with favorable neurologic outcome (aRR 1.6; 1.1-2.5, p=0.02) and survival to discharge (aRR 1.7; 1.2-2.6, p=0.007). [Extracted from the article]

Objectives: The purpose of this study is to develop a method for risk-standardizing hospital survival after cardiac arrest. Background: A foundation with which hospitals can improve quality is to be able to benchmark their risk-adjusted performance against other hospitals, something that cannot currently be done for survival after in-hospital cardiac arrest. Methods: Within the Get With The Guidelines (GWTG)-Resuscitation registry, we identified 48,841 patients admitted between 2007 and 2010 with an in-hospital cardiac arrest. Using hierarchical logistic regression, we derived and validated a model for survival to hospital discharge and calculated risk-standardized survival rates (RSSRs) for 272 hospitals with at least 10 cardiac arrest cases. Results: The survival rate was 21.0% and 21.2% for the derivation and validation cohorts, respectively. The model had good discrimination (C-statistic 0.74) and excellent calibration. Eighteen variables were associated with survival to discharge, and a parsimonious model contained 9 variables with minimal change in model discrimination. Before risk adjustment, the median hospital survival rate was 20% (interquartile range: 14% to 26%), with a wide range (0% to 85%). After adjustment, the distribution of RSSRs was substantially narrower: median of 21% (interquartile range: 19% to 23%; range 11% to 35%). More than half (143 [52.6%]) of hospitals had at least a 10% positive or negative absolute change in percentile rank after risk standardization, and 50 (23.2%) had a ≥20% absolute change in percentile rank. Conclusions: We have derived and validated a model to risk-standardize hospital rates of survival for in-hospital cardiac arrest. Use of this model can support efforts to compare hospitals in resuscitation outcomes as a foundation for quality assessment and improvement. [ABSTRACT FROM AUTHOR]

Near 25 °C,ab initiocalculations of the zero-density viscosity of helium gasηHehave an uncertainty of approximately 0.001%, which is 1/40th of the uncertainty of the best measurements. The uncertainties of the published calculations for neon and argon are probably much larger. This paper presents new measurements of the viscosities of neon, argon, and krypton at 25 °C made with a capillary viscometer that was calibrated with helium. The resulting viscosity ratios areηNe/ηHe = 1.59836 ± 0.00037,ηAr/ηHe = 1.13763 ± 0.00030, andηKr/ηHe = 1.27520 ± 0.00040. The argon ratio agrees with a recent, unpublished calculation to within the combined uncertainty (measurement plus calculation) of 0.032%. The neon ratio is smaller than the calculated value by 0.13%. [ABSTRACT FROM PUBLISHER]

Drowning is a leading cause of accidental death. Survivors may sustain severe neurologic morbidity. There is negligible research specific to brain injury in drowning making current clinical management non-specific to this disorder. This review represents an evidence-based consensus effort to provide recommendations for management and investigation of the drowning victim. Epidemiology, brain-oriented prehospital and intensive care, therapeutic hypothermia, neuroimaging/monitoring, biomarkers, and neuroresuscitative pharmacology are addressed. When cardiac arrest is present, chest compressions with rescue breathing are recommended due to the asphyxial insult. In the comatose patient with restoration of spontaneous circulation, hypoxemia and hyperoxemia should be avoided, hyperthermia treated, and induced hypothermia (32-34 °C) considered. Arterial hypotension/hypertension should be recognized and treated. Prevent hypoglycemia and treat hyperglycemia. Treat clinical seizures and consider treating non-convulsive status epilepticus. Serial neurologic examinations should be provided. Brain imaging and serial biomarker measurement may aid prognostication. Continuous electroencephalography and N20 somatosensory evoked potential monitoring may be considered. Serial biomarker measurement (e.g., neuron specific enolase) may aid prognostication. There is insufficient evidence to recommend use of any specific brain-oriented neuroresuscitative pharmacologic therapy other than that required to restore and maintain normal physiology. Following initial stabilization, victims should be transferred to centers with expertise in age-specific post-resuscitation neurocritical care. Care should be documented, reviewed, and quality improvement assessment performed. Preclinical research should focus on models of asphyxial cardiac arrest. Clinical research should focus on improved cardiopulmonary resuscitation, re-oxygenation/reperfusion strategies, therapeutic hypothermia, neuroprotection, neurorehabilitation, and consideration of drowning in advances made in treatment of other central nervous system disorders. [ABSTRACT FROM AUTHOR]

The two most prevalent outgassing contaminants on spacecraft are organic molecules and water vapor. Adsorbed organic molecules can degrade a solar-viewing instrument when they are cracked by ultraviolet radiation (UV) and become a light-absorbing layer of carbon. In earlier work, we examined the transmission loss of the extreme-ultraviolet (EUV) aluminum filters used onboard the Solar Dynamics Observatory, and we showed that the degradation was not caused by carbonization. Here, by comparing the losses of the spacecraft filters with the losses induced on similar filters by synchrotron radiation, we demonstrate that the degradation was likely due to oxidation caused by the ultraviolet activation of adsorbed water vapor. [ABSTRACT FROM AUTHOR]

The article presents two case studies of a nine year old boy and a two year old boy with neurological injury who was taken to the emergency room. After cardiopulmonary resuscitation both boys returned to successful circulation. Severe neurological injury and nonconclusive status epilepticus has been determined after two hour of electroencephalogram (EEG) in nine year old boy. In two year old boy medical care was provided to monitor postarrest myocardial dysfunction and neurological status.

The article discusses the significant decline of the number and severity of conflicts. It states that the main causes of the decline of conflicts include greater reliance on the United Nations, a larger number of people who have stronger stakes in the stability of their societies, and greater activity by civil society organizations mediating between potential and actual combatants. It highlights the effort of World Academy of Art and Science to promote peace and development.

The static method of measuring equilibrium vapor pressure requires locating the sample at the coldest part of the apparatus to avoid errors due to evaporation and recondensation elsewhere. This paper describes a device that can hold the sample 1 K below the temperature of the surrounding air without a liquid bath. It comprises a pair of thermoelectric elements and two thermometers attached to an insulated aluminum block. The device can operate as high as 200 °C while controlling the sample with a precision of 0.02 K; below 110 °C, the precision is 2 mK. Also described is a method to measure the small temperature offset due to heat flow between the sample and the surrounding aluminum block. The uncertainty due to the offset is small compared to the 6 mK uncertainty due to the thermometer. [ABSTRACT FROM AUTHOR]

Abstract: Several models have been proposed to conceptualize psychological representations of health, illness, and bodily sensations. These models differ as to the cognitive and affective components they include, whether they study the interaction of these components, and whether associations between psychological representations of bodily states and affective and behavioral reactions to these representations are considered conditional. These different conceptualizations and corresponding measurement approaches exist in parallel without resulting in synergistic effects or theoretical advancements within the field. In this paper, we review theoretical models on perception and attitudes and construct an integrative theoretical framework on psychological representation of bodily symptoms as well as more abstract representations of health and disease. The aim of this combination of approaches is to unify the strengths of different research domains in the conceptualization and measurement of mental representations of bodily states. Furthermore, the aim is to specify new, testable predictions and implications about the (conditional) relationship of these mental representations and affective and behavioral consequences. A core element in this integrative model is comparison. We review how comparison processes can change the cognitive and affective reference frame for illness and symptom perception and in turn affective and behavioral reactions. We discuss implications for measurement of illness and symptom representations as well as implications for clinical practice. Finally, we make suggestions for a research agenda to validate the proposed model as well as to address new questions derived from it. [Copyright &y& Elsevier]

The 2009 Atlantic season was marked by below-average tropical cyclone activity with the formation of nine tropical storms, the fewest since the 1997 Atlantic hurricane season. Of these, three became hurricanes and two strengthened into major hurricanes (category 3 or higher on the Saffir--Simpson Hurricane Wind Scale). In addition, there were two tropical depressions that did not reach storm strength. The numbers of tropical storms and hurricanes were below the long-term averages of 11 named storms and 6 hurricanes, although the number of major hurricanes equaled the long-term average of 2. Many of the cyclones remained relatively weak. Only one tropical cyclone, Tropical Storm Claudette, made landfall in the United States, although Ida affected the northern Gulf Coast as a tropical storm before moving inland as an extratropical cyclone. Hurricane Bill and Tropical Storm Danny indirectly affected the East Coast by producing high surf, rip currents, and beach erosion; Bill also produced tropical storm conditions over Bermuda and parts of Atlantic Canada. Hurricane Ida made landfall in Nicaragua and also affected parts of Honduras, the Yucatan Peninsula of Mexico, and western Cuba. Tropical Storm Erika had minor effects on the northern Leeward Islands, mainly in the form of light rain, and Tropical Storm Grace moved through the Azores with little impact. The death toll from the 2009 Atlantic tropical cyclones was six. A verification of National Hurricane Center official forecasts during 2009 is also presented. Official track errors and forecast skill set records for accuracy at lead times between 24 and 72 h. Official intensity forecast errors were mostly larger than the previous 5-yr means, although intensity forecast skill was at or above historical highs since the intensity skill baseline [i.e., Decay-Statistical Hurricane Intensity Forecast model version 5 (Decay-SHIFOR5)] errors were well above average. [ABSTRACT FROM AUTHOR]

Abstract: Aim: The aim of this investigation was to estimate and contrast the global incidence and outcome of out-of-hospital cardiac arrest (OHCA) to provide a better understanding of the variability in risk and survival of OHCA. Methods: We conducted a review of published English-language articles about incidence of OHCA, available through MEDLINE and EmBase. For studies including adult patients and both adult and paediatric patients, we used Utstein data reporting guidelines to calculate, summarize and compare incidences per 100,000 person-years of attended OHCAs, treated OHCAs, treated OHCAs with a cardiac cause, treated OHCA with ventricular fibrillation (VF), and survival-to-hospital discharge rates following OHCA. Results: Sixty-seven studies from Europe, North America, Asia or Australia met inclusion criteria. The weighted incidence estimate was significantly higher in studies including adults than in those including adults and paediatrics for treated OHCAs (62.3 vs 34.7; P <0.001); and for treated OHCAs with a cardiac cause (54.6 vs 40.8; P =0.004). Neither survival to discharge rates nor VF survival to discharge rates differed statistically significant among studies. The incidence of treated OHCAs was higher in North America (54.6) than in Europe (35.0), Asia (28.3), and Australia (44.0) (P <0.001). In Asia, the percentage of VF and survival to discharge rates were lower (11% and 2%, respectively) than those in Europe (35% and 9%, respectively), North America (28% and 6%, respectively), or Australia (40% and 11%, respectively) (P <0.001, P <0.001). Conclusions: OHCA incidence and outcome varies greatly around the globe. A better understanding of the variability is fundamental to improving OHCA prevention and resuscitation. [Copyright &y& Elsevier]

Abstract: The fungus Aspergillus niger has been studied in considerable detail with respect to various industrial applications. Although its central metabolic pathways are established relatively well, the mechanisms that control the adaptation of its metabolism are understood rather poorly. In this study, clustering of co-expressed genes has been performed on the basis of DNA microarray data sets from two experimental approaches. In one approach, low amounts of inducer caused a relatively mild perturbation, while in the other approach the imposed environmental conditions including carbon source starvation caused severe perturbed stress. A set of conserved genes was used to construct gene co-expression networks for both the individual and combined data sets. Comparative analysis revealed the existence of modules, some of which are present in all three networks. In addition, experimental condition-specific modules were identified. Module-derived consensus expression profiles enabled the integration of all protein-coding A. niger genes to the co-expression analysis, including hypothetical and poorly conserved genes. Conserved sequence motifs were detected in the upstream region of genes that cluster in some modules, e.g., the binding site for the amino acid metabolism-related transcription factor CpcA as well as for the fatty acid metabolism-related transcription factors, FarA and FarB. Moreover, not previously described putative transcription factor binding sites were discovered for two modules: the motif 5′-CGACAA is overrepresented in the module containing genes encoding cytosolic ribosomal proteins, while the motif 5′-GGCCGCG is overrepresented in genes related to ‘gene expression’, such as RNA helicases and translation initiation factors. [Copyright &y& Elsevier]

OBJECTIVE: The objective of this study was to assess whether pediatric inpatients who receive cardiopulmonary resuscitation (CPR) for bradycardia with poor perfusion are more likely to survive to hospital discharge than pediatric inpatients who receive CPR for pulseless arrest (asystole/pulseless electrical activity [PEA]), after controlling for confounding characteristics. METHODS: A prospective cohort from the National Registry of Cardiopulmonary Resuscitation was enrolled between January 4, 2000, and February 23, 2008. Patients who were younger than 18 years and had an in-hospital event that required chest compressions for >2 minutes were eligible. Patients were divided into 2 groups on the basis of initial rhythm and pulse state: bradycardia/poor perfusion and asystole/PEA. Patient characteristics, event characteristics, and clinical characteristics were analyzed as possible confounders. Univariate analysis between bradycardia and asystole/PEA patient groups was performed. Multivariable logistic regression was used to determine whether an initial state of bradycardia/poor perfusion was independently associated with survival to discharge. RESULTS: A total of 6288 patients who were younger than 18 years were reported; 3342 met all inclusion criteria. A total of 1853 (55%) patients received chest compressions for bradycardia/poor perfusion compared with 1489 (45%) for asystole/PEA. Overall, 755 (40.7%) of 1353 patients with bradycardia survived to hospital discharge, compared with 365 (24.5%) of 1489 patients with asystole/PEA. After controlling for known confounders, CPR for bradycardia with poor perfusion was associated with increased survival to hospital discharge. CONCLUSIONS: Pediatric inpatients with chest compressions initiated for bradycardia and poor perfusion before onset of pulselessness were more likely to survive to discharge than pediatric inpatients with chest compressions initiated for asystole or PEA. [ABSTRACT FROM AUTHOR]

Abstract: In metabolomics research, it is often important to focus the data analysis to specific areas of interest within the metabolome. In this paper, we describe the application of consensus principal component analysis (CPCA) and canonical correlation analysis (CCA) as a means to explore the relation between metabolome data and (i) biochemically related metabolites and (ii) an amino acid biosynthesis pathway. CPCA searches for major trends in the behavior of metabolite concentrations that are in common for the metabolites of interest and the remainder of the metabolome. CCA identifies the strongest correlations between the metabolites of interest and the remainder of the metabolome. CPCA and CCA were applied to two different microbial metabolomics data sets. The first data set, derived from Pseudomonas putida S12, was relatively simple as it contained metabolomes obtained under four environmental conditions only. The second data set, obtained from Escherichia coli, was much more complex as it consisted of metabolomes obtained under 28 different environmental conditions. In case of the simple and coherent P. putida S12 data set, CCA and CPCA gave similar results as the variation in the subset of the selected metabolites and the remainder of the metabolome was similar. In contrast, CCA and CPCA yielded different results in case of the E. coli data set. With CPCA the trends in the selected subset – the phenylalanine biosynthesis pathway – dominated the results. The main trends were related to high and low phenylalanine productivity, and the metabolites showing a similar behavior in concentration were metabolites regulating the phenylalanine biosynthesis route in the subset and metabolites related to general amino acid metabolism in the remainder of the metabolome. With CCA, neither subset truly dominated the data analysis. CCA described the differences between the wild type and the overproducing strain and the differences between the succinate and glucose grown cells. For the difference between the wild type and the overproducing strain, metabolites from the beginning and the end of aromatic amino acid pathways like erythrose-4-phosphate, tryptophan, and phenylalanine were important for the selected metabolites. CCA and CPCA proved to be complementary data analysis tools that enable the focusing of the data analysis on groups of metabolites that are of specific interest in relation to the remainder of the metabolome. Compared to an ordinary PCA, focusing the data analysis on biologically relevant metabolites lead especially for the complex E. coli data to a better biological interpretation of the data. [Copyright &y& Elsevier]

More than 25% of children survive to hospital discharge after in-hospital cardiac arrests, and 5% to 10% survive after out-of-hospital cardiac arrests. This review of pediatric cardiopulmonary resuscitation addresses the epidemiology of pediatric cardiac arrests, mechanisms of coronary blood flow during cardiopulmonary resuscitation, the 4 phases of cardiac arrest resuscitation, appropriate interventions during each phase, special resuscitation circumstances, extracorporeal membrane oxygenation cardiopulmonary resuscitation, and quality of cardiopulmonary resuscitation. The key elements of pathophysiology that impact and match the timing, intensity, duration, and variability of the hypoxic-ischemic insult to evidence-based interventions are reviewed. Exciting discoveries in basic and applied-science laboratories are now relevant for specific subpopulations of pediatric cardiac arrest victims and circumstances (eg, ventricular fibrillation, neonates, congenital heart disease, extra- corporeal cardiopulmonary resuscitation). Improving the quality of interventions is increasingly recognized as a key factor for improving outcomes. Evolving training strategies include simulation training, just-in-time and just-in-place training, and crisis-team training. The difficult issue of when to discontinue resuscitative efforts is addressed. Outcomes from pediatric cardiac arrests are improving. Advances in resuscitation science and state-of-the-art implementation techniques provide the opportunity for further improvement in outcomes among children after cardiac arrest. [ABSTRACT FROM AUTHOR]

Summary: Aim: This study was designed to test the hypothesis that immediate post-shock chest compressions improve outcome from prolonged ventricular fibrillation (VF) compared with typical “hands off” period (i.e., delayed post-shock compressions) associated with AED use. Materials and methods: After 7.5min of untreated VF, 36 domestic swine (26±1kg) were treated with 200J biphasic shocks and randomly assigned to: (1) 1min of immediate post-shock chest compressions or (2) simulated pre-hospital automated external defibrillator (AED) care with delays in post-shock chest compressions. Return of spontaneous circulation (ROSC) occurred in 7/18 immediate chest compressions animals within 2min of the first shock versus 0/18 AED animals (P <0.01). Ten of 18 immediate chest compressions animals attained ROSC compared with 3/18 AED animals (P <0.05). Nine of 18 immediate chest compressions swine were alive at 24 and 48h compared with 3/18 AED swine (P <0.05). All 48-h survivors had good neurologic outcomes. Among the 21 animals that defibrillated with the first shock, ROSC was attained in 7/10 immediate chest compressions animals within 2min of the first shock compared with 0/11 AED animals (P =0.001), and 48-h survival was attained in 8/10 versus 3/11, respectively (P <0.05). Conclusions: Immediate post-shock chest compressions can substantially improve outcome from prolonged VF compared with simulated pre-hospital AED care. [Copyright &y& Elsevier]

Summary: Aim: Increases in serum cytokines have been reported after successful resuscitation from prolonged ventricular fibrillation (VF). Pro-inflammatory cytokines can stimulate inducible nitric oxide synthase (iNOS) to produce excessive levels of nitric oxide (NO). High levels of both myocardial inflammatory cytokines and nitric oxide levels can depress myocardial contractile function. We hypothesized that myocardial pro-inflammatory cytokines and iNOS activity would increase following successful resuscitation from prolonged ventricular fibrillation cardiac arrest, and that such increases would parallel the development of post-resuscitation myocardial dysfunction. Methods: Ventricular fibrillation cardiac arrest was induced in seven domestic swine (25±5kg). After 10min of untreated VF, the animals were defibrillated and resuscitated. Left ventricular (LV) systolic and diastolic function measurements, serum samples (arterial and coronary sinus) for IL-8 cytokine quantification, and LV myocardial biopsies were collected before, during, and after resuscitation. Quantification of myocardial endothelial (eNOS) and inducible (iNOS) nitric oxide synthase protein levels were determined using immunoblot analyses and protein localization was examined using immunohistochemistry. Results: Post-resuscitation LV systolic and diastolic functions were depressed while increases in both coronary sinus IL-8 levels and myocardial iNOS activity were found. Compared to pre-arrest baseline, levels of iNOS protein increased during VF (p ≤0.05) and continued to increase throughout the post-resuscitation study period of 6h (p ≤0.05). Conclusions: Myocardial inflammatory cytokines and iNOS activity increase during and after prolonged cardiac arrest and successful resuscitation. These increases correspond to the well described decrease in LV function post-resuscitation. [Copyright &y& Elsevier]

Rates of survival to hospital discharge, the study's primary outcome, were 5.8% among patients receiving IV adrenaline and 3.1% among those receiving IO adrenaline. The potential benefit of IO adrenaline for a patient in whom obtaining IV access rather than IO access would cause more considerable delays (e.g., children or adults with vascular access challenges) cannot be explicitly determined. Future prospective studies on this topic should specifically investigate the role of IO adrenaline as a rescue therapy when IV access cannot be promptly obtained and/or when obtaining IV access is likely to substantially delay adrenaline administration. [Extracted from the article]