Yhdysvaltain Presidentti Gerald R. Ford 18/11 1975

Kirje 18.11.1975

Introducing systematic dispatcher-assisted cardiopulmonary resuscitation (telephone-CPR) in a non-Advanced Medical Priority Dispatch System (AMPDS): implementation process and costs.

OBJECTIVE: In order to improve the quality of our Emergency Medical Services (EMS), to raise bystander cardiopulmonary resuscitation rates and thereby meet what is becoming a universal standard in terms of quality of emergency services, we decided to implement systematic dispatcher-assisted or telephone-CPR (T-CPR) in our medical dispatch center, a non-Advanced Medical Priority Dispatch System. The aim of this article is to describe the implementation process, costs and results following the introduction of this new "quality" procedure. METHODS: This was a prospective study. Over an 8-week period, our EMS dispatchers were given new procedures to provide T-CPR. We then collected data on all non-traumatic cardiac arrests within our state (Vaud, Switzerland) for the following 12months. For each event, the dispatchers had to record in writing the reason they either ruled out cardiac arrest (CA) or did not propose T-CPR in the event they did suspect CA. All emergency call recordings were reviewed by the medical director of the EMS. The analysis of the recordings and the dispatchers' written explanations were then compared. RESULTS: During the 12-month study period, a total of 497 patients (both adults and children) were identified as having a non-traumatic cardiac arrest. Out of this total, 203 cases were excluded and 294 cases were eligible for T-CPR. Out of these eligible cases, dispatchers proposed T-CPR on 202 occasions (or 69% of eligible cases). They also erroneously proposed T-CPR on 17 occasions when a CA was wrongly identified (false positive). This represents 7.8% of all T-CPR. No costs were incurred to implement our study protocol and procedures. CONCLUSIONS: This study demonstrates it is possible, using a brief campaign of sensitization but without any specific training, to implement systematic dispatcher-assisted cardiopulmonary resuscitation in a non-Advanced Medical Priority Dispatch System such as our EMS that had no prior experience with systematic T-CPR. The results in terms of T-CPR delivery rate and false positive are similar to those found in previous studies. We found our results satisfying the given short time frame of this study. Our results demonstrate that it is possible to improve the quality of emergency services at moderate or even no additional costs and this should be of interest to all EMS that do not presently benefit from using T-CPR procedures. EMS that currently do not offer T-CPR should consider implementing this technique as soon as possible, and we expect our experience may provide answers to those planning to incorporate T-CPR in their daily practice.

The major genetic determinants of HIV-1 control affect HLA class I peptide presentation.

Infectious and inflammatory diseases have repeatedly shown strong genetic associations within the major histocompatibility complex (MHC); however, the basis for these associations remains elusive. To define host genetic effects on the outcome of a chronic viral infection, we performed genome-wide association analysis in a multiethnic cohort of HIV-1 controllers and progressors, and we analyzed the effects of individual amino acids within the classical human leukocyte antigen (HLA) proteins. We identified >300 genome-wide significant single-nucleotide polymorphisms (SNPs) within the MHC and none elsewhere. Specific amino acids in the HLA-B peptide binding groove, as well as an independent HLA-C effect, explain the SNP associations and reconcile both protective and risk HLA alleles. These results implicate the nature of the HLA-viral peptide interaction as the major factor modulating durable control of HIV infection.

Tolerância de genótipos de cafeeiro ao alumínio em solução nutritiva. II. Teores de P, Ca e Al e eficiência ao P e Ca

Foi instalado um experimento, em janeiro de 1994, em casa de vegetação do Departamento de Fitotecnia da Universidade Federal de Viçosa, Estado de Minas Gerais. Com o objetivo de avaliar o efeito do alumínio nos teores de P, Ca e Al e na eficiência ao fósforo e cálcio de nove genótipos de café, as plantas foram crescidas em solução nutritiva com 0 e 0,296 mmol L-1 de alumínio, com pH 4,0, por um período de 115 dias. Após esse período, as plantas foram divididas em folhas superiores, folhas inferiores, primeiro par de folhas totalmente expandido, caule e raízes, para a determinação da matéria seca e de concentrações de fósforo, cálcio e alumínio. A tolerância ao alumínio foi associada ao menor acúmulo de fósforo nas raízes, à menor redução na translocação desse nutriente para a parte aérea, à menor redução na absorção de cálcio e à maior eficiência no uso do fósforo e do cálcio. Foi observado grande acúmulo de alumínio nas raízes, bem como um transporte restrito do elemento para a parte aérea, para todos os genótipos de café.

Chemical labelling of oyster shells used for time-calibrated high-resolution Mg/Ca ratios: A tool for estimation of past seasonal temperature variations

The geochemical compositions of biogenic carbonates are increasingly used for palaeoenvironmental reconstructions. The skeletal delta O-18 temperature relationship is dependent on water salinity, so many recent studies have focused on the Mg/Ca and Sr/Ca ratios because those ratios in water do not change significantly on short time scales. Thus, those elemental ratios are considered to be good palaeotemperature proxies in many biominerals, although their use remains ambiguous in bivalve shells. Here, we present the high-resolution Mg/Ca ratios of two modern species of juvenile and adult oyster shells, Crassostrea gigas and Ostrea edulis. These specimens were grown in controlled conditions for over one year in two different locations. In situ monthly Mn-marking of the shells has been used for day calibration. The daily Mg/Ca.ratios in the shell have been measured with an electron microprobe. The high frequency Mg/Ca variation of all specimens displays good synchronism with lunar cycles, suggesting that tides strongly influence the incorporation of Mg/Ca into the shells. Highly significant correlation coefficients (0.70<R<0.83, p<0.0001) between the Mg/Ca ratios and the seawater temperature are obtained only for juvenile C. gigas samples, while metabolic control of Mg/Ca incorporation and lower shell growth rates preclude the use of the Mg/Ca ratio in adult shells as a palaeothermometer. Data from three juvenile C. gigas shells from the two study sites are selected to establish a relationship: T = 3.77Mg/Ca + 1.88, where T is in degrees C and Mg/Ca in mmol/mol. (c) 2012 Elsevier B.V. All rights reserved.

Cathleen ni Houlihan vastaan John Bull : irlantilaisnaisten kamppailu kansallisen itsemääräämisoikeuden ja naisasian puolesta

Sari Oikarinen

Contribuição dos mecanismos de fluxo de massa e de difusão para o suprimento de K, Ca e Mg a plantas de arroz

O transporte de nutriente até à superfície das raízes pode ocorrer por fluxo de massa ou por fluxo de massa e difusão, dependendo da atividade do nutriente na solução do solo e da exigência nutricional da planta. Objetivou-se verificar a contribuição dos mecanismos de fluxo de massa e de difusão para o suprimento de potássio, de cálcio e de magnésio a plantas de arroz, em experimento realizado em casa de vegetação. Aplicaram-se em amostra de Latossolo Variação Una, os seguintes tratamentos: Na2CO3, K2CO3, CaCO3 e MgCO3. Aos 75 dias da semeadura, as plantas de arroz foram colhidas e determinadas as quantidades de potássio, de cálcio e de magnésio nelas acumuladas, bem como a concentração desses nutrientes na solução do solo. Essas concentrações, multiplicadas pelo volume de água transpirado, foram usadas para calcular o suprimento por fluxo de massa. A difusão foi estimada por diferença entre a quantidade do nutriente acumulado no vegetal e a transportada por fluxo de massa. Verificou-se que o potássio foi transportado predominantemente por difusão, exceto no tratamento com K2CO3, que gerou altos teores de K na solução de solo, tornando o fluxo de massa suficiente para atender à demanda das plantas. O cálcio e o magnésio foram transportados por fluxo de massa. Segundo os resultados, a difusão foi o principal mecanismo de transporte de potássio nas condições do experimento; todavia, o fluxo de massa pode satisfazer isoladamente a demanda nutricional da planta, quando a concentração de potássio na solução do solo for muito elevada.