Abstract 18435: ETCO2 Alone is Inadequate to Verify CPR Quality

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Chengcheng Hu ◽  
Dan Spaite ◽  
Tyler Vadeboncoeur ◽  
Cameron Hypes ◽  
Ryan A Murphy ◽  
...  
Keyword(s):  
Secondary Analysis ◽  
Covariance Structure ◽  
Ventilation Rate ◽  
Quality Monitoring ◽  
Mixed Effect ◽  
Mixed Effect Models ◽  
Random Intercept ◽  
Wide Range ◽  
Cpr Quality ◽  
End Tidal

Background: Previous studies have described modest correlation between end-tidal CO 2 (ETCO 2 ) and CPR quality during resuscitation of cardiac arrest patients, but it is unclear whether ETCO 2 alone can indicate CPR quality. The present study investigated whether ETCO 2 adequately identifies the quality of CPR provided during out-of-hospital cardiac resuscitation. Methods: ETCO 2 was monitored with side-stream CO 2 (Philips/Respironics) and CPR quality measured with an accelerometer-based system (E Series, ZOLL Medical) during the treatment of consecutive adult OHCA patients with presumed cardiac etiology by 2 EMS agencies in the Arizona SHARE QI Program between 10/08-06/13. Minute-by-minute ETCO 2 and CPR quality were extracted. ETCO 2 values were log transformation to achieve approximate normality. Linear mixed effect models were fitted to use (transformed) ETCO 2 level to predict four CPR variables: chest compression (CC) depth, CC rate, CC release velocity (CCRV), and ventilation rate (VR). A random intercept for each case was included and a spatial power covariance structure assumed for measurements over time. Results: 230 subjects (median age 69 yrs, 69% male) with 1581 minutes of data were studied. Transformed ETCO 2 was significant for CC depth (p< 0.0001), CCRV (p=0.003) and VR (p<0.0001), but only explained 3.7%, 2.7%, and 10.0% of the total variance for these variables, respectively. Transformed ETCO 2 was not a significant predictor for CC rate (p=0.89). The Figure illustrates the overlap in CC depth over quartiles of ETCO 2 , demonstrating that any specific ETCO 2 level could be found over a wide range of CC depths. Conclusion: In this secondary analysis, ETCO 2 was not an independent indicator of CC rate but was a weak predictor for CC depth, CCRV and VR. These findings suggest that ETCO 2 may be not be an adequate substitute for CPR quality monitoring. Future studies should investigate how ETCO 2 and CPR quality monitoring can be used in conjunction to optimize CPR.

Local Control and Toxicity of Multilevel Spine Stereotactic Body Radiotherapy

Neurosurgery ◽  
2019 ◽  
Author(s):  
Whitney H Beeler ◽  
Kelly A Speth ◽  
Michael T Broderick ◽  
Neil K Jairath ◽  
Dena Ballouz ◽  
...  
Keyword(s):  
Local Control ◽  
Stereotactic Body Radiotherapy ◽  
Time To Event ◽  
Mixed Effect ◽  
Cox Models ◽  
Single Level ◽  
Mixed Effect Models ◽  
Random Intercept ◽  
Significant Difference ◽  
One Year

Abstract BACKGROUND Spine stereotactic body radiotherapy (sSBRT) is commonly limited to 1 or 2 vertebral levels given a paucity of efficacy and toxicity data when more than 2 levels are treated. OBJECTIVE To prove our hypothesis that multilevel sSBRT could provide similar rates of local control (LC) (primary endpoint) and toxicity as single-level treatment using the same clinical target, planning target, and planning organ-at-risk volumes. METHODS We analyzed consecutive cases of sSBRT treated from 2013 to 2017. Time-to-event outcomes for single-level and multilevel cases were compared using mixed effect Cox models and differences in toxicity rates were evaluated using linear mixed effect models. All models incorporate a patient-level random intercept to account for any within-patient correlation across cases. RESULTS There were 101 single-level and 84 multilevel sSBRT cases (2-7 continuous vertebral levels). One-year LC was 95% vs 85%, respectively. After adjusting for baseline covariates, dose delivered, and accounting for within-patient correlation, there was no significant difference in time to local failure (hazard ratio, HR 1.79 [0.59-5.4]; P = .30). Pain improved in 83.5% of the 139 initially symptomatic tumors. There were no significant differences in grade 2+ acute or late toxicities between single-level and multilevel sSBRT. CONCLUSION With rigorous patient immobilization, quality assurance, and image guidance, multilevel sSBRT provides high rates of LC, similar to single-level treatment, without need for larger planning volume margins. Efforts to improve prognostication and case selection for multilevel sSBRT are warranted to ensure that the benefits of improved LC over palliative radiation are justified.

Abstract 15: Increasing Compression Rate and Depth Positively Correlate with End-Tidal Carbon Dioxide During Actual CPR Performance

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Kelsey Sheak ◽  
Douglas J Wiebe ◽  
Saeed Babaeizadeh ◽  
Trevor C Yuen ◽  
Dana Zive ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Linear Regression Analysis ◽  
Ventilation Rate ◽  
Quality Data ◽  
Depth Range ◽  
Rate Range ◽  
Resuscitation Guidelines ◽  
Cpr Quality ◽  
End Tidal ◽  
Hospital Cardiac Arrest

Background: Current resuscitation guidelines suggest the use of continuous capnography to monitor the effectiveness of CPR. While laboratory data support this concept, little published clinical data exist to support this recommendation. The quantitative relationship between chest compression (CC) delivery and capnographic measurement (specifically, end-tidal CO 2 (ETCO 2 )) is poorly understood, and has important implications for CPR quality assessment. Objectives: We hypothesized that increasing rate and depth of CC will be associated in real-time with increasing ETCO 2 during both in-hospital cardiac arrest (IHCA) and out-of-hospital cardiac arrest (OHCA). Methods: In a multicenter cohort study, we captured time synchronized ETCO 2 and CPR quality data from resuscitation events at 4 sites between 04/2006 [[Unable to Display Character: &#8211;]] 05/2013 using CPR-sensing defibrillators (Philips Mrx-QCPR). ETCO 2 and CC rate and depth were averaged over 15-sec epochs. A linear regression analysis was performed to evaluate the relationship between CCs and ETCO 2 . Results: 29,028 epochs were processed for analysis from 583 arrest events (227 IHCA, 356 OHCA). Average age of the entire cohort was 63.7±17.1 and 213 (37%) were female. ROSC was achieved in 42% of IHCA patients and 27% of OHCA patients. CC rate range was 95-125 per min, CC depth range was 31-59 mm and ventilation rate range was 4-48 per min. CC rate was not significantly associated with ETCO 2 . CC depth was significantly associated with increased ETCO 2 . For every 10 mm increase in depth, ETCO 2 increased by 1.4 mmHg (p<.001). Ventilation rate was inversely related to higher ETCO 2 . For every 10 breaths per min increase in ventilation rate, ETCO 2 was decreased by 3.0 mmHg (p<.001) (see table). Conclusions: ETCO 2 during CPR directly correlated with CC depth, supporting the possible role of capnography as an approach to monitor the quality of CPR delivery. Confounding by ventilation rate may be an important consideration for future work.

scholarly journals Adherence to Ketogenic and Mediterranean Study Diets in a Crossover Trial: The Keto–Med Randomized Trial

Nutrients ◽  
2021 ◽  
Vol 13 (3) ◽  
pp. 967
Author(s):  
Matthew J. Landry ◽  
Anthony Crimarco ◽  
Dalia Perelman ◽  
Lindsay R. Durand ◽  
Christina Petlura ◽  
...  
Keyword(s):  
Randomized Trial ◽  
Randomized Clinical Trials ◽  
Secondary Analysis ◽  
Critical Factor ◽  
Detailed Examination ◽  
Diet Patterns ◽  
Time Points ◽  
Study Results ◽  
Wide Range ◽  
Diet Pattern

Adherence is a critical factor to consider when interpreting study results from randomized clinical trials (RCTs) comparing one diet to another, but it is frequently not reported by researchers. The purpose of this secondary analysis of the Keto–Med randomized trial was to provide a detailed examination and comparison of the adherence to the two study diets (Well Formulated Ketogenic Diet (WFKD) and Mediterranean Plus (Med-Plus)) under the two conditions: all food being provided (delivered) and all food being obtained by individual participants (self-provided). Diet was assessed at six time points including baseline (x1), week 4 of each phase when participants were receiving food deliveries (x2), week 12 of each phase when participants were preparing and providing food on their own (x2), and 12 weeks after participants completed both diet phases and were free to choose their own diet pattern (x1). The adherence scores for WFKD and Med-Plus were developed specifically for this study. Average adherence to the two diet patterns was very similar during both on-study time points of the intervention. Throughout the study, a wide range of adherence was observed among participants—for both diet types and during both the delivery phase and self-provided phase. Insight from this assessment of adherence may aid other researchers when answering the important question of how to improve behavioral adherence during dietary trials. This study is registered at clinicaltrials.gov NCT03810378.

scholarly journals A hierarchical bivariate meta-analysis of diagnostic test accuracy to provide direct comparisons of immunoassays vs. indirect immunofluorescence for initial screening of connective tissue diseases

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Michelle Elaine Orme ◽  
Carmen Andalucia ◽  
Sigrid Sjölander ◽  
Xavier Bossuyt
Keyword(s):  
Connective Tissue ◽  
Indirect Immunofluorescence ◽  
Meta Analysis ◽  
Connective Tissue Diseases ◽  
Test Accuracy ◽  
Initial Screening ◽  
Case Control Studies ◽  
Cross Sectional ◽  
Mixed Effect ◽  
Mixed Effect Models

AbstractObjectivesTo compare indirect immunofluorescence (IIF) for antinuclear antibodies (ANA) against immunoassays (IAs) as an initial screening test for connective tissue diseases (CTDs).MethodsA systematic literature review identified cross-sectional or case-control studies reporting test accuracy data for IIF and enzyme-linked immunosorbent assays (ELISA), fluorescence enzyme immunoassay (FEIA), chemiluminescent immunoassay (CLIA) or multiplex immunoassay (MIA). The meta-analysis used hierarchical, bivariate, mixed-effect models with random-effects by test.ResultsDirect comparisons of IIF with ELISA showed that both tests had good sensitivity (five studies, 2321 patients: ELISA: 90.3% [95% confidence interval (CI): 80.5%, 95.5%] vs. IIF at a cut-off of 1:80: 86.8% [95% CI: 81.8%, 90.6%]; p = 0.4) but low specificity, with considerable variance across assays (ELISA: 56.9% [95% CI: 40.9%, 71.5%] vs. IIF 1:80: 68.0% [95% CI: 39.5%, 87.4%]; p = 0.5). FEIA sensitivity was lower than IIF sensitivity (1:80: p = 0.005; 1:160: p = 0.051); however, FEIA specificity was higher (seven studies, n = 12,311, FEIA 93.6% [95% CI: 89.9%, 96.0%] vs. IIF 1:80 72.4% [95% CI: 62.2%, 80.7%]; p < 0.001; seven studies, n = 3251, FEIA 93.5% [95% CI: 91.1%, 95.3%] vs. IIF 1:160 81.1% [95% CI: 73.4%, 86.9%]; p < 0.0001). CLIA sensitivity was similar to IIF (1:80) with higher specificity (four studies, n = 1981: sensitivity 85.9% [95% CI: 64.7%, 95.3%]; p = 0.86; specificity 86.1% [95% CI: 78.3%, 91.4%]). More data are needed to make firm inferences for CLIA vs. IIF given the wide prediction region. There were too few studies for the meta-analysis of MIA vs. IIF (MIA sensitivity range 73.7%–86%; specificity 53%–91%).ConclusionsFEIA and CLIA have good specificity compared to IIF. A positive FEIA or CLIA test is useful to support the diagnosis of a CTD. A negative IIF test is useful to exclude a CTD.

scholarly journals Neurophysiological and behavioural effects of conventional and high definition tDCS

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Fabio Masina ◽  
Giorgio Arcara ◽  
Eleonora Galletti ◽  
Isabella Cinque ◽  
Luciano Gamberini ◽  
...  
Keyword(s):  
Response Times ◽  
Power Reduction ◽  
Alpha Power ◽  
High Definition ◽  
Mixed Effect ◽  
State Dependency ◽  
Mixed Effect Models ◽  
Beta Power ◽  
Neurophysiological Data ◽  
Spectrum Density

AbstractHigh-definition transcranial direct current stimulation (HD-tDCS) seems to overcome a drawback of traditional bipolar tDCS: the wide-spread diffusion of the electric field. Nevertheless, most of the differences that characterise the two techniques are based on mathematical simulations and not on real, behavioural and neurophysiological, data. The study aims to compare a widespread tDCS montage (i.e., a Conventional bipolar montage with extracephalic return electrode) and HD-tDCS, investigating differences both at a behavioural level, in terms of dexterity performance, and a neurophysiological level, as modifications of alpha and beta power as measured with EEG. Thirty participants took part in three sessions, one for each montage: Conventional tDCS, HD-tDCS, and sham. In all the conditions, the anode was placed over C4, while the cathode/s placed according to the montage. At baseline, during, and after each stimulation condition, dexterity was assessed with a Finger Tapping Task. In addition, resting-state EEG was recorded at baseline and after the stimulation. Power spectrum density was calculated, selecting two frequency bands: alpha (8–12 Hz) and beta (18–22 Hz). Linear mixed effect models (LMMs) were used to analyse the modulation induced by tDCS. To evaluate differences among the montages and consider state-dependency phenomenon, the post-stimulation measurements were covariate-adjusted for baseline levels. We observed that HD-tDCS induced an alpha power reduction in participants with lower alpha at baseline. Conversely, Conventional tDCS induced a beta power reduction in participants with higher beta at baseline. Furthermore, data showed a trend towards a behavioural effect of HD-tDCS in participants with lower beta at baseline showing faster response times. Conventional and HD-tDCS distinctively modulated cortical activity. The study highlights the importance of considering state-dependency to determine the effects of tDCS on individuals.

scholarly journals Limited not lazy: a quasi-experimental secondary analysis of evidence quality evaluations by those who hold implausible beliefs

2020 ◽  
Vol 5 (1) ◽  
Author(s):  
Kristy A. Martire ◽  
Bethany Growns ◽  
Agnes S. Bali ◽  
Bronte Montgomery-Farrer ◽  
Stephanie Summersby ◽  
...  
Keyword(s):  
Secondary Analysis ◽  
Past Research ◽  
Linear Mixed Effect Model ◽  
High Quality ◽  
Mixed Effect ◽  
High Quality Evidence ◽  
Effect Model ◽  
Evidence Quality ◽  
Quasi Experimental ◽  
Quality Evidence

AbstractPast research suggests that an uncritical or ‘lazy’ style of evaluating evidence may play a role in the development and maintenance of implausible beliefs. We examine this possibility by using a quasi-experimental design to compare how low- and high-quality evidence is evaluated by those who do and do not endorse implausible claims. Seven studies conducted during 2019–2020 provided the data for this analysis (N = 746). Each of the seven primary studies presented participants with high- and/or low-quality evidence and measured implausible claim endorsement and evaluations of evidence persuasiveness (via credibility, value, and/or weight). A linear mixed-effect model was used to predict persuasiveness from the interaction between implausible claim endorsement and evidence quality. Our results showed that endorsers were significantly more persuaded by the evidence than non-endorsers, but both groups were significantly more persuaded by high-quality than low-quality evidence. The interaction between endorsement and evidence quality was not significant. These results suggest that the formation and maintenance of implausible beliefs by endorsers may result from less critical evidence evaluations rather than a failure to analyse. This is consistent with a limited rather than a lazy approach and suggests that interventions to develop analytical skill may be useful for minimising the effects of implausible claims.

scholarly journals Developing Relative Humidity and Temperature Corrections for Low-Cost Sensors Using Machine Learning

Sensors ◽  
2021 ◽  
Vol 21 (10) ◽  
pp. 3338
Author(s):  
Ivan Vajs ◽  
Dejan Drajic ◽  
Nenad Gligoric ◽  
Ilija Radovanovic ◽  
Ivan Popovic
Keyword(s):  
Machine Learning ◽  
Air Quality ◽  
Relative Humidity ◽  
Low Cost ◽  
Quality Monitoring ◽  
Air Quality Monitoring ◽  
Lower Accuracy ◽  
Wide Range ◽  
The Impact ◽  
Monitoring Stations

Existing government air quality monitoring networks consist of static measurement stations, which are highly reliable and accurately measure a wide range of air pollutants, but they are very large, expensive and require significant amounts of maintenance. As a promising solution, low-cost sensors are being introduced as complementary, air quality monitoring stations. These sensors are, however, not reliable due to the lower accuracy, short life cycle and corresponding calibration issues. Recent studies have shown that low-cost sensors are affected by relative humidity and temperature. In this paper, we explore methods to additionally improve the calibration algorithms with the aim to increase the measurement accuracy considering the impact of temperature and humidity on the readings, by using machine learning. A detailed comparative analysis of linear regression, artificial neural network and random forest algorithms are presented, analyzing their performance on the measurements of CO, NO2 and PM10 particles, with promising results and an achieved R2 of 0.93–0.97, 0.82–0.94 and 0.73–0.89 dependent on the observed period of the year, respectively, for each pollutant. A comprehensive analysis and recommendations on how low-cost sensors could be used as complementary monitoring stations to the reference ones, to increase spatial and temporal measurement resolution, is provided.

scholarly journals Recombining Your Way Out of Trouble: The Genetic Architecture of Hybrid Fitness under Environmental Stress

2019 ◽  
Vol 37 (1) ◽  
pp. 167-182 ◽  
Author(s):  
Zebin Zhang ◽  
Devin P Bendixsen ◽  
Thijs Janzen ◽  
Arne W Nolte ◽  
Duncan Greig ◽  
...  
Keyword(s):  
Environmental Stress ◽  
Evolutionary Potential ◽  
Genetic Trait ◽  
Hybrid Fitness ◽  
Mixed Effect ◽  
Mixed Effect Models ◽  
Hybrid Genome ◽  
Chromosome Associations ◽  
Low Coverage ◽  
Negative Epistasis

Abstract Hybridization between species can either promote or impede adaptation. But we know very little about the genetic basis of hybrid fitness, especially in nondomesticated organisms, and when populations are facing environmental stress. We made genetically variable F2 hybrid populations from two divergent Saccharomyces yeast species. We exposed populations to ten toxins and sequenced the most resilient hybrids on low coverage using ddRADseq to investigate four aspects of their genomes: 1) hybridity, 2) interspecific heterozygosity, 3) epistasis (positive or negative associations between nonhomologous chromosomes), and 4) ploidy. We used linear mixed-effect models and simulations to measure to which extent hybrid genome composition was contingent on the environment. Genomes grown in different environments varied in every aspect of hybridness measured, revealing strong genotype–environment interactions. We also found selection against heterozygosity or directional selection for one of the parental alleles, with larger fitness of genomes carrying more homozygous allelic combinations in an otherwise hybrid genomic background. In addition, individual chromosomes and chromosomal interactions showed significant species biases and pervasive aneuploidies. Against our expectations, we observed multiple beneficial, opposite-species chromosome associations, confirmed by epistasis- and selection-free computer simulations, which is surprising given the large divergence of parental genomes (∼15%). Together, these results suggest that successful, stress-resilient hybrid genomes can be assembled from the best features of both parents without paying high costs of negative epistasis. This illustrates the importance of measuring genetic trait architecture in an environmental context when determining the evolutionary potential of genetically diverse hybrid populations.

scholarly journals What makes or breaks higher education community engagement in the South African rural school context: A multiple-partner perspective

2017 ◽  
Vol 13 (2) ◽  
pp. 177-196 ◽  
Author(s):  
Eugene Gabriel Machimana ◽  
Maximus Monaheng Sefotho ◽  
Liesel Ebersöhn
Keyword(s):  
Higher Education ◽  
Service Learning ◽  
Community Engagement ◽  
School Context ◽  
Secondary Analysis ◽  
Rural School ◽  
Multiple Partner ◽  
Social Challenges ◽  
Education Community ◽  
Wide Range

The purpose of this study is to inform global citizenship practice as a higher education agenda by comparing the retrospective experiences of a range of community engagement partners and including often silent voices of non-researcher partners. Higher education–community engagement aims to contribute to social justice as it constructs and transfers new knowledge from the perspectives of a wide range of community engagement partners. This qualitative secondary analysis study was framed theoretically by the transformative–emancipatory paradigm. Existing case data, generated on retrospective experiences of community engagement partners in a long-term community engagement partnership, were conveniently sampled to analyse and compare a range of community engagement experiences ( parents of student clients ( n = 12: females 10, males 2), teachers from the partner rural school ( n = 18: females 12, males 6), student-educational psychology clients ( n = 31: females 14, males 17), Academic Service-Learning ( ASL) students ( n = 20: females 17, males 3) and researchers ( n = 12: females 11, males 1). Following thematic in-case and cross-case analysis, it emerged that all higher education–community engagement partners experienced that socio-economic challenges (defined as rural school adversities, include financial, geographic and social challenges) are addressed when an higher education–community engagement partnership exists, but that particular operational challenges (communication barriers, time constraints, workload and unclear scope, inconsistent feedback, as well as conflicting expectations) hamper higher education–community engagement partnership. A significant insight from this study is that a range of community engagement partners experience similar challenges when a university and rural school partner. All community engagement partners experienced that higher education–community engagement is challenged by the structural disparity between the rural context and operational miscommunication.

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