Test of a Smock System on CPR Primary Emergency Measures and Medical Errors During Simulated Emergencies

Rates of survival of victims of sudden cardiac arrest (SCA) using cardio pulmonary resuscitation (CPR) have shown little improvement over the past three decades. Since registered nurses (RNs) comprise the largest group of healthcare providers in U.S. hospitals, it is essential that they are competent in performing the four primary measures (compression, ventilation, medication administration, and defibrillation) of CPR in order to improve survival rates of SCA patients. The purpose of this experimental study was to test a color-coded SMOCK system on:1) time to implement emergency patient care measures 2) technical skills performance 3) number of medical errors, and 4) team performance during simulated CPR exercises. The study sample was 260 RNs (M 40 years, SD=11.6) with work experience as an RN (M 7.25 years, SD=9.42).Nurses were allocated to a control or intervention arm consisting of 20 groups of 5-8 RNs per arm for a total of 130 RNs in each arm. Nurses in each study arm were given clinical scenarios requiring emergency CPR. Nurses in the intervention group wore different color labeled aprons (smocks) indicating their role assignment (medications, ventilation, compression, defibrillation, etc) on the code team during CPR. Findings indicated that the intervention using color-labeled smocks for pre-assigned roles had a significant effect on the time nurses started compressions (t=3.03, p=0.005), ventilations (t=2.86, p=0.004) and defibrillations (t=2.00, p=.05) when compared to the controls using the standard of care. In performing technical skills, nurses in the intervention groups performed compressions and ventilations significantly better than those in the control groups. The control groups made significantly (t=-2.61, p=0.013) more total errors (7.55 SD 1.54) than the intervention group (5.60, SD 1.90). There were no significant differences in team performance measures between the groups. Study findings indicate use of colored labeled smocks during CPR emergencies resulted in: shorter times to start emergency CPR; reduced errors; more technical skills completed successfully; and no differences in team performance.

The Trier Social Stress Test: principles and practice

Researchers interested in the neurobiology of the acute stress response in humans require a valid and reliable acute stressor that can be used under experimental conditions. The Trier Social Stress Test (TSST) provides such a testing platform. It induces stress by requiring participants to make an interview-style presentation, followed by a surprise mental arithmetic test, in front of an interview panel who do not provide feedback or encouragement. In this review, we outline the methodology of the TSST, and discuss key findings under conditions of health and stress-related disorder. The TSST has unveiled differences in males and females, as well as different age groups, in their neurobiological response to acute stress. The TSST has also deepened our understanding of how genotype may moderate the cognitive neurobiology of acute stress, and exciting new inroads have been made in understanding epigenetic contributions to the biological regulation of the acute stress response using the TSST. A number of innovative adaptations have been developed which allow for the TSST to be used in group settings, with children, in combination with brain imaging, and with virtual committees. Future applications may incorporate the emerging links between the gut microbiome and the stress response. Future research should also maximise use of behavioural data generated by the TSST. Alternative acute stress paradigms may have utility over the TSST in certain situations, such as those that require repeat testing. Nonetheless, we expect that the TSST remains the gold standard for examining the cognitive neurobiology of acute stress in humans.

A Novel Range Test

In a range test, one party holds a ciphertext and needs to test whether the message encrypted in the ciphertext is within a certain interval range. In this paper, a range test protocol is proposed, where the party holding the ciphertext asks another party holding the private key of the encryption algorithm to help him. These two parties run the protocol to implement the test. The test returns TRUE if and only if the encrypted message is within the certain interval range. If the two parties do not conspire, no information about the encrypted message is revealed from the test except what can be deduced from the test result. Advantages of the new protocol over the existing related techniques are that it achieves correctness, soundness, °exibility, high e±ciency and privacy simultaneously.

Experiences in Passively Detecting Session Hijacking Attacks in IEEE 802.11 Networks

Current IEEE 802.11 wireless networks are vulnerable to session hijacking attacks as the existing standards fail to address the lack of authentication of management frames and network card addresses, and rely on loosely coupled state machines. Even the new WLAN security standard - IEEE 802.11i does not address these issues. In our previous work, we proposed two new techniques for improving detection of session hijacking attacks that are passive, computationally inexpensive, reliable, and have minimal impact on network performance. These techniques utilise unspoofable characteristics from the MAC protocol and the physical layer to enhance confidence in the intrusion detection process. This paper extends our earlier work and explores usability, robustness and accuracy of these intrusion detection techniques by applying them to eight distinct test scenarios. A correlation engine has also been introduced to maintain the false positives and false negatives at a manageable level. We also explore the process of selecting optimum thresholds for both detection techniques. For the purposes of our experiments, Snort-Wireless open source wireless intrusion detection system was extended to implement these new techniques and the correlation engine. Absence of any false negatives and low number of false positives in all eight test scenarios successfully demonstrated the effectiveness of the correlation engine and the accuracy of the detection techniques.