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BackgroundThe COVID-19 pandemic has profoundly affected out-of-hospital cardiac arrest (OHCA) and disrupted the chain of survival. Even after the end of the pandemic, the risk of new variants and surges persists. Analyzing the characteristics of OHCA during the pandemic is important to prepare for the next pandemic and to avoid repeated negative outcomes. However, previous studies have yielded somewhat varied results, depending on the health care system or the specific characteristics of social structures. ObjectiveWe aimed to investigate and compare the incidence, outcomes, and characteristics of OHCA during the prepandemic and pandemic periods using data from a nationwide multicenter OHCA registry. MethodsWe conducted a multicenter, retrospective, observational study using data from the Korean Cardiac Arrest Resuscitation Consortium (KoCARC) registry. This study included adult patients with OHCA in South Korea across 3 distinct 1-year periods: the prepandemic period (from January to December 2019), early phase pandemic period (from July 2020 to June 2021), and late phase pandemic period (from July 2021 to June 2022). We extracted and contrasted the characteristics of patients with OHCA, prehospital time factors, and outcomes for the patients across these 3 periods. The primary outcomes were survival to hospital admission and survival to hospital discharge. The secondary outcome was good neurological outcome. ResultsFrom the 3 designated periods, a total of 9031 adult patients with OHCA were eligible for analysis (prepandemic: n=2728; early pandemic: n=2954; and late pandemic: n=3349). Witnessed arrest (P.05). ConclusionsDuring the pandemic, especially amid community COVID-19 surges, the incidence of OHCA increased while survival rates and good neurological outcome at discharge decreased. Prehospital OHCA factors, which are directly related to OHCA prognosis, were adversely affected by the pandemic. Ongoing discussions are needed to maintain the chain of survival in the event of a new pandemic. Trial RegistrationClinicalTrials.gov NCT03222999; https://classic.clinicaltrials.gov/ct2/show/NCT03222999

Point-of-care ultrasound (POCUS) is a rapidly developing technology that has the potential to revolutionize emergency and critical care medicine. The use of POCUS can improve patient care by providing real-time clinical information. However, appropriate usage and proper training are crucial to ensure patient safety and reliability. This article discusses the various applications of POCUS in emergency and critical care medicine, the importance of training and education, and the future of POCUS in medicine.

IntroductionThis review compares the efficacy of video laryngoscopy (VL) with direct laryngoscopy (DL) for successful tracheal intubation in critically ill or emergency-care patients.MethodsWe searched the MEDLINE, Embase, and Cochrane Library databases for randomized controlled trials (RCTs) that compared one or more video laryngoscopes to DL. Sensitivity analysis, subgroup analysis, and network meta-analysis were used to investigate factors potentially influencing the efficacy of VL. The primary outcome was the success rate of first-attempt intubation.ResultsThis meta-analysis included 4244 patients from 22 RCTs. After sensitivity analysis, the pooled analysis revealed no significant difference in the success rate between VL and DL (VL vs. DL, 77.3% vs. 75.3%, respectively; OR, 1.36; 95% CI, 0.84–2.20; I2 = 80%; low-quality evidence). However, based on a moderate certainty of evidence, VL outperformed DL in the subgroup analyses of intubation associated with difficult airways, inexperienced practitioners, or in-hospital settings. In the network meta-analysis comparing VL blade types, nonchanneled angular VL provided the best outcomes. The nonchanneled Macintosh video laryngoscope ranked second, and DL ranked third. Channeled VL was associated with the worst treatment outcomes.DiscussionThis pooled analysis found, with a low certainty of evidence, that VL does not improve intubation success relative to DL. Channeled VL had low efficacy in terms of intubation success compared with nonchanneled VL and DL.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=285702, identifier: CRD42021285702.

Abstract We aimed to assess the evidence regarding the usefulness of brain imaging as a diagnostic tool for delayed neurological sequelae (DNS) in patients with acute carbon monoxide poisoning (COP). Observational studies that included adult patients with COP and DNS were retrieved from Embase, MEDLINE, and Cochrane Library databases in December 2020 and pooled using a random-effects model. Seventeen studies were systematically reviewed. Eight and seven studies on magnetic resonance imaging (MRI) and computed tomography (CT), respectively, underwent meta-analysis. The pooled sensitivity and specificity of MRI for diagnosis of DNS were 70.9% (95% confidence interval [CI] 64.8–76.3%, I2 = 0%) and 84.2% (95% CI 80.1–87.6%, I2 = 63%), respectively. The pooled sensitivity and specificity of CT were 72.9% (95% CI 62.5–81.3%, I2 = 8%) and 78.2% (95% CI 74.4–87.1%, I2 = 91%), respectively. The areas under the curve for MRI and CT were 0.81 (standard error, 0.08; Q* = 0.74) and 0.80 (standard error, 0.05, Q* = 0.74), respectively. The results indicate that detecting abnormal brain lesions using MRI or CT may assist in diagnosing DNS in acute COP patients.

In this study, we propose a multi-GPU-based 8KVR stitching system that operates in real time on both local and cloud machine environments. The proposed system first obtains multiple 4 K video inputs, decodes them, and generates a stitched 8KVR video stream in real time. The generated 8KVR video stream can be downloaded and rendered omnidirectionally in player apps on smartphones, tablets, and head-mounted displays. To speed up processing, we adopt group-of-pictures-based distributed decoding/encoding and buffering with the NV12 format, along with multi-GPU-based parallel processing. Furthermore, we develop several algorithms such as equirectangular projection-based color correction, real-time CG overlay, and object motion-based seam estimation and correction, to improve the stitching quality. From experiments in both local and cloud machine environments, we confirm the feasibility of the proposed 8KVR stitching system with stitching speed of up to 83.7 fps for six-channel and 62.7 fps for eight-channel inputs. In addition, in an 8KVR live streaming test on the 5G MEC/cloud, the proposed system achieves stable performances with 8 K@30 fps in both indoor and outdoor environments, even during motion.

IntroductionThe transcranial approach (TCA) has historically been used to remove craniopharyngiomas. Although the extended endoscopic endonasal approach (EEA) to these tumors has been more commonly accepted in the recent two decades, there is debate over whether this approach leads to better outcomes. The goal of this systematic review and meta-analysis was to more comprehensively understand the benefits and limitations of these two approaches in craniopharyngioma resection based on comparative studies.MethodsWe conducted a systematic literature search in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses recommendations using MEDLINE, EMBASE, and the Cochrane Library. A total of 448 articles were screened. Data were extracted and analyzed using proportional meta-analysis. Eight comparative studies satisfied the inclusion criteria. The extent of resection, visual outcomes, and postoperative complications such as endocrine dysfunction and cerebrospinal fluid (CSF) leakage were compared.Results and discussionEight studies, involving 376 patients, were included. Resection by EEA led to a greater rate of gross total resection (GTR) (odds ratio [OR], 2.42; p = 0.02; seven studies) with an incidence of 61.3% vs. 50.5% and a higher likelihood of visual improvement (OR, 3.22; p < 0.0001; six studies). However, TCA resulted in a higher likelihood of visual deterioration (OR, 3.68; p = 0.002; seven studies), and was related, though not significantly, to panhypopituitarism (OR, 1.39; p = 0.34; eight studies) and diabetes insipidus (OR, 1.14; p = 0.58; seven studies). Although TCA showed significantly lower likelihoods of CSF leakage (OR, 0.26; 95% confidence interval [CI], 0.10–0.71; p = 0.008; eight studies) compared to EEA, there was no significant difference in meningitis (OR, 0.92; 95% CI, 0.20–4.25; p = 0.91; six studies) between the two approaches. When both approaches can completely resect the tumor, EEA outperforms TCA in terms of GTR rate and visual outcomes, with favorable results in complications other than CSF leakage, such as panhypopituitarism and diabetes insipidus. Although knowledge of and competence in traditional microsurgery and endoscopic surgery are essential in surgical decision-making for craniopharyngioma treatment, when both approaches are feasible, EEA is associated with favorable surgical outcomes.Systematic review registrationhttp://www.crd.york.ac.uk/PROSPERO/, identifier CRD42021234801.

Objective With trends in population aging an increasing number of older patients are visiting the emergency department (ED). This study aimed to identify the characteristics of ED utilization and risk factors for in-hospital mortality in older patients who visited EDs. Methods This nationwide observational study used National Emergency Department Information System data collected during a 2-year period from January 2016 to December 2017. The characteristics of older patients aged 70 years or older were compared with those of younger patients aged 20 to 69 years. Risk factors associated with in-hospital mortality were analyzed by multivariable logistic regression. Results A total of 6,596,423 younger patients and 1,737,799 older patients were included. In the medical and nonmedical older patient groups, significantly higher proportions of patients were transferred from another hospital, utilized emergency medical services, had Korean Triage and Acuity Scale scores of 1 and 2, required hospitalization, and required intensive care unit admission in the older patient group than in the younger patient group. ED and post-hospitalization mortality rates increased with age; in particular, older medical patients aged 90 or older had an in-hospital mortality rate of 9%. Older age, male sex, transfer from another hospital, emergency medical service utilization, a high Korean Triage and Acuity Scale score, systolic blood pressure 20/min, heart rate >100/min, body temperature

Abstract Background The effects of the body mass index (BMI) on outcomes of patients resuscitated from cardiac arrest are controversial. Therefore, the current study investigated the association between the BMI and the favourable neurologic outcomes and survival to discharge of patients resuscitated from out-of-hospital cardiac arrest (OHCA). Methods This multicentre, prospective, nationwide OHCA registry-based study was conducted using data from the Korean Cardiac Arrest Resuscitation Consortium (KoCARC). We enrolled hospitals willing to collect patient height and weight and included patients who survived to the hospital between October 2015 and June 2018. The included patients were categorised into the underweight (

We present a novel segmentation-based seam cutting algorithm to generate visually plausible high-resolution 360-degree video efficiently. While the demand for an efficient video stitching algorithm for generating immersive videos has increased, it has received limited attention in the literature. Furthermore, stitched videos often suffer from distorted objects, temporal inconsistency and time constraints. Thus, in this paper, we propose an efficient seam finding algorithm that preserves objects from distortion, minimizes temporal inconsistency, and reduces processing time. One of the fundamental steps in image and video stitching is the estimation of seam boundary. To do this, the proposed algorithm leverages a convolutional neural networks-based instance segmentation algorithm that provides more accurate object regions. It computes energy surfaces considering the regions and then estimates seam boundary by discovering a minimal energy path with minimal computations. We validate the proposed algorithm using real-world high-resolution 360-degree sequences. The experimental results verify that the proposed algorithm can produce seam boundaries that avoid objects with better temporary consistency. The proposed algorithm reduces the number of pixels passed through objects by approximately 30% on average compared to the existing algorithms. The qualitative comparisons furthermore demonstrate that the proposed algorithm consistently produces more perceptually pleasing results.

AbstractBackground: The coronavirus disease 2019 (COVID-19) pandemic has caused deaths and shortages in medical resources worldwide, making the prediction of patient prognosis and the identification of risk factors very important. Increasing age is already known as one of the main risk factors for poor outcomes, but the effect of body mass index (BMI) on COVID-19 outcomes in older patients has not yet been investigated. Aim: We aimed to determine the effect of BMI on the severity and mortality of COVID-19 among older patients in South Korea. Methods: Data from 1272 COVID-19 patients (≥60 years old) were collected by the Korea Centers for Disease Control and Prevention. The odds ratios (ORs) of severe infection and death in the BMI groups were analyzed by logistic regression adjusted for covariates.Results: The underweight group (BMI

Background and objectives: The optic nerve sheath diameter (ONSD) is indicative of elevated intracranial pressure. However, the usefulness of the ONSD for predicting neurologic outcomes in cardiac arrest survivals has been debatable. Reportedly, the ONSD/eyeball transverse diameter (ETD) ratio is a more reliable marker for identifying intracranial pressure than sole use of ONSD. Materials and Methods: This retrospective study aimed to investigate the prognostic value of the ONSD/ETD ratio in out-of-hospital cardiac arrest (OHCA) patients. We studied the brain computed tomography scans of adult OHCA patients with return of spontaneous circulation, who visited a single hospital connected with a Korean university between January 2015 and September 2020. We collected baseline characteristics and patient information from electronic medical records and ONSD and ETD were measured by two physicians with a pre-defined protocol. According to their neurologic outcome upon hospital discharge, patients were divided into good neurologic outcome (GNO; cerebral performance category [CPC] 1–2) and poor neurologic outcome (PNO; CPC 3–5) groups. We evaluated the ONSD/ETD ratio between the GNO and PNO groups to establish its prognostic value for neurologic outcomes. Results: Of the 100 included patients, 28 had GNO. Both the ONSD and ETD were not significantly different between the two groups (ONSD, 5.48 mm vs. 5.66 mm, p = 0.054; ETD, 22.98 mm vs. 22.61 mm, p = 0.204). However, the ONSD/ETD ratio was significantly higher in the PNO group in the univariate analysis (0.239 vs. 0.255, p = 0.014). The area under the receiver operating characteristic curve of ONSD/ETD ratio for predicting PNO was 0.66 (95% confidence interval, 0.56–0.75; p = 0.006). There was no independent relationship between the ONSD/ETD ratio and PNO in multivariate analysis (aOR = 0.000; p = 0.173). Conclusions: The ONSD/ETD ratio was more reliable than sole use of ONSD and might be used to predict neurologic outcomes in OHCA survivors.

Branded service encounters, in which various aspects of frontline employees are strategically aligned with the firm’s brand positioning, can be achieved along several dimensions such as employee appearance, manner, and personality. While previous research has mainly focused on behavioral traits of employees, this research examines the employee’s physical appearance in association with the brand personality trait across two studies. Study 1 shows that salesperson look-brand personality congruence enhances brand affect by inducing positive affect. Specifically, a brand-congruent look of a salesperson increases positive affect among customers by confirming their prior expectations about what a salesperson of a certain brand should look like as a brand representative. Study 2 reveals that the positive impact of salesperson look-brand personality congruence on brand affect is significant only for customers with high social anxiety whereas this effect disappears for those with low social anxiety. These findings extend previous research on branded service encounters by showing why and when frontline employees’ physical appearance shapes customers’ affective responses toward the brand.

Background: Current guidelines recommended that chest compression depths during cardiopulmonary resuscitation (CPR) should be at least one-fifth of the external chest anteriorposterior (AP) diameter. The chest AP diameter increases because of dorsal kyphosis, senile emphysema, and poor lung compliance associated with aging. This study aimed to compare the proportion of the heart compressed by chest compression (based on the ejection fraction [EF]) in geriatric and nongeriatric patients. Methods: We performed a retrospective analysis of the chest computed tomography findings obtained between January 2010 and August 2016 and measured the chest anatomical parameters such as the perpendicular external and internal chest AP diameters with the heart AP diameter. Based on values of these parameters, EFs with 50- and 60-mm depths were obtained. In addition, we investigated and compared the proportion of 50- and 60-mm depths and heart AP to external chest AP diameter between the 2 groups. Results: We randomly selected and analyzed 100 of 1,921 geriatric and 100 of 22,090 nongeriatric populations from a database. The means±standard deviations of EFs with 50- and 60-mm depths for geriatric and nongeriatric people were 37.1%±12.1% vs. 43.2%±13.8% and 47.5%±12.8% vs. 54.6%±14.8%, respectively (all p＜0.001). The proportion of 50- and 60-mm depths and heart AP to external chest AP diameter were significantly different between the 2 groups (all p＜0.05). Conclusion: Chest compression depths based on current guidelines are not sufficient for geriatric patients during CPR; hence, deeper chest compressions would be considered.

Background This study aimed to investigate the relationship between body mass index (BMI) and sufficient chest compression depth (CCD) in obese patients by a mathematical model. Methods and Results This retrospective analysis was performed with chest computed tomography images conducted between 2006 and 2018. We classified the selected individuals into underweight (

Kovax® antivenom is the main treatment for toxins produced by the Gloydius species. However, research on adverse reactions after Kovax® antivenom administration is scarce. We aimed to identify the incidence and characteristics of adverse reactions after Kovax® antivenom administration. We conducted a retrospective review of the medical records of snakebite patients in Korea between January 2008 and September 2019. We identified the frequency, characteristics, and treatments of adverse reactions to Kovax® antivenom. There were 150 patients with snakebites, of whom 121 (80.7%) patients received Kovax® antivenom. Adverse reactions occurred in five patients (4.1%). Acute adverse reactions within 24 h of antivenom administration occurred in two patients (1.7%). The symptoms of patients with acute adverse reactions were nausea, diaphoresis, dizziness, and hypotension. Delayed adverse reactions that occurred 24 h after antivenom administration were reported in three patients (2.5%). One patient had a skin rash after 10 days, and two patients had fever 37 and 48 h after antivenom use. In conclusion, most patients were managed safely after Kovax® antivenom, and the incidence of adverse reactions was low. Severe adverse reactions occurred in a small percentage of patients, and there were no deaths.

The purpose of the current study was to examine how individual, economic, and psychological factors contributed to the financial concerns of Asian Christian immigrants in the U.S. during the COVID-19 pandemic (i.e., the impact of COVID-19 on employment status and income change, intolerance of uncertainty, hope, and personal meaning in life). The sample consisted of 103 immigrants from three East Asian countries affiliated with Christian churches. A hierarchical regression analysis was conducted to observe how the aforementioned variables predicted the participants' financial worries. The results showed that intolerance of uncertainty accounted for a significant amount of variance in financial worries among the participants, but the impact of COVID-19, hope, and meaning in life did not predict significant variance. Implications for practice and future research were discussed. [ABSTRACT FROM AUTHOR]

We propose a new remote gaze tracking system as an intelligent TV interface. Our research is novel in the following three ways: first, because a user can sit at various positions in front of a large display, the capture volume of the gaze tracking system should be greater, so the proposed system includes two cameras which can be moved simultaneously by panning and tilting mechanisms, a wide view camera (WVC) for detecting eye position and an auto-focusing narrow view camera (NVC) for capturing enlarged eye images. Second, in order to remove the complicated calibration between the WVC and NVC and to enhance the capture speed of the NVC, these two cameras are combined in a parallel structure. Third, the auto-focusing of the NVC is achieved on the basis of both the user’s facial width in the WVC image and a focus score calculated on the eye image of the NVC. Experimental results showed that the proposed system can be operated with a gaze tracking accuracy of ±0.737°~±0.775° and a speed of 5~10 frames/s.