Factors affecting the quality of cardiopulmonary resuscitation in inpatient units: perception of nurses

Abstract OBJECTIVE To identify, in the perception of nurses, the factors that affect the quality of cardiopulmonary resuscitation (CPR) in adult inpatient units, and investigate the influence of both work shifts and professional experience length of time in the perception of these factors. METHOD A descriptive, exploratory study conducted at a hospital specialized in cardiology and pneumology with the application of a questionnaire to 49 nurses working in inpatient units. RESULTS The majority of nurses reported that the high number of professionals in the scenario (75.5%), the lack of harmony (77.6%) or stress of any member of staff (67.3%), lack of material and/or equipment failure (57.1%), lack of familiarity with the emergency trolleys (98.0%) and presence of family members at the beginning of the cardiopulmonary arrest assistance (57.1%) are factors that adversely affect the quality of care provided during CPR. Professional experience length of time and the shift of nurses did not influence the perception of these factors. CONCLUSION The identification of factors that affect the quality of CPR in the perception of nurses serves as parameter to implement improvements and training of the staff working in inpatient units.

OVERLAND FLOW AND SURFACE RUNOFF / Hydrological Science and Engineering

Cape Verde, off the coast of Senegal in western Africa, is a volcanic archipelago where soil and water conservation techniques play an important role in the overall subsistence of half a million inhabitants. In fact, the step slopes in the more agricultural islands due to it's volcanic origin, together with semi-arid and arid environments (the country is located in the Sahelian region), characterized by a very irregular wet season, with high intensity rainfall events, make life tough. The hard conditions lead during the first half of the XX century to frequent cycles of drought with severe implications on the local populations, with impressive numbers of deaths by famine, and a decrease of the number of local inhabitants by more than halve in some islands. Maintain the soil in place and the water inside the soil was there after a mater of survival, and the CapeVerdians implemented over the last half century a number of soil and water conservation techniques that cover all the landscape. In this work, we monitored a number of slope soil and water conservation techniques, such as terraces, half moons, live barriers, etc, together with two cultural strategies, used to plant corn and beans on one side and peanuts on the other, with a semi-quantitative methodology, to evaluate their effectiveness. A discussion is given on the costs and effectiveness of the techniques to reduce overland flow production and therefore erosion, and to promote rainfall infiltration.

Surgical site infections in colon surgery: the patient, the procedure, the hospital, and the surgeon.

Objective: To determine the role of the surgeon in the occurrence of surgical site infection (SSI) following colon surgery, with respect to his or her adherence to guidelines and his or her experience.Design, Setting, and Patients: Prospective cohort study of 2393 patients who underwent colon surgery performed by 31 surgeons in 9 secondary and tertiary care public Swiss hospitals, recruited from a surveillance program for SSI between March 1, 1998, and December 31, 2008, and followed up for 1 month after their operation.Main Outcome Measures: Risk factors for SSI were identified in univariate and multivariate analyses that included the patients' and procedures' characteristics, the hospitals, and the surgeons as candidate covariates. Correlations were sought between surgeons' individual adjusted risks, their self-reported adherence to guidelines, and the delay since their board certification.Results: A total of 428 SSIs (17.9%) were identified, with hospital rates varying from 4.0% to 25.2% and individual surgeon rates varying from 3.7% to 36.1%. Features of the patients and procedures associated with SSI in univariate analyses were male sex, age, American Society of Anesthesiologists score, contamination class, operation duration, and emergency procedure. Correctly timed antibiotic prophylaxis and laparoscopic approach were protective. Multivariate analyses adjusting for these features and for the hospitals found 4 surgeons with higher risk of SSI (odds ratio [OR] = 2.37, 95% confidence interval [CI], 1.51-3.70; OR = 2.19, 95% CI, 1.41-3.39; OR = 2.15, 95% CI, 1.02-4.53; and OR = 1.97, 95% CI, 1.18-3.30) and 2 surgeons with lower risk of SSI (OR = 0.43, 95% CI, 0.19-0.94; and OR = 0.19, 95% CI, 0.04-0.81). No correlation was found between surgeons' individual adjusted risks and their adherence to guidelines or their experience.Conclusion: For reasons beyond adherence to guidelines or experience, the surgeon may constitute an independent risk factor for SSI after colon surgery.

Clusterin in neurological disorders: molecular perspectives and clinical relevance.

Firstly discovered in rete testis fluid, clusterin is a glycoprotein present in most of the other biological fluids. Several isoforms of clusterin are encoded from a single gene located on chromosome 8 in human species. Among the different isoforms, the secreted form of clusterin is expressed by a variety of tissues, including the nervous system under normal conditions. This form is presumed to play an anti-apoptotic role and seems to be a major determinant in cell survival and neuroplasticity after stroke. In animal models of this pathology, both neuronal and astroglial subpopulations express high levels of clusterin early after the ischemic damage. Recent lines of evidence point also to its possible involvement in neurodegenerative disorders. It is thought that in Alzheimer's disease the association between amyloidogenic peptides and clusterin contributes to limit Aβ species misfolding and facilitates their clearance from the extracellular space. Thus, intercellular and intracellular factors that modulate local clusterin expression in the nervous system may represent potent targets for neurodegenerative disease therapies. In this review we provide a critical overview of the most recent data on the involvement of clusterin in neurodegenerative diseases with special reference to their putative clinical relevance.

Nymphal development of Podisus nigrispinus (Heteroptera, Pentatomidae) preying on larvae of Anticarsia gemmatalis (Lepidoptera, Noctuidae) fed with resistant and susceptible soybeans

Nymphal development of the predator Podisus nigrispinus (Dallas) fed with a susceptible (UFV 16) or an insect resistant soybean genotype (IAC 17) and with larvae of the prey Anticarsia gemmatalis Hübner (Lepidoptera, Noctuidae) reared on these genotypes, was evaluated. Survival and duration of each instar and of total nymphal stage, besides weight of nymphs at the beginning of each instar and of adults of P. nigrispinus soon after emergence, were also evaluated. Nymphal survival of this predator was similar with both genotypes (64.41% for the UFV 16 and 72.88% for the IAC 17). Duration of second and fourth instars for nymphs that originated females, of fourth instar for those that originated males, of the nymphal period for males (20.21 and 17.94 days) and females (19.76 and 18.19 days) was longer on the IAC 17 than on the UFV 16. Weight of third instar nymphs (3.12 mg and 2.42 mg) for those that originated males and of fifth instar (26.20 mg and 23.86 mg) for those that originated females and female weight after emergence (65.76 mg and 58.68 mg) was lower with the IAC 17 than with the UFV 16. Sex ratio of P. nigrispinus was not affected by the resistant soybean IAC 17.

Three essays on organizations and their external environment

Abstract: The literature on the various links between organizations and their external environment is very extensive and fragmented. This thesis is comprised of three separate essays, each examining specific research questions related to these links. The first essay deals with the notion of industry life cycle and how the geographical concentration of an industry is linked to the particular life cycle stage in which the industry finds itself. The aim of this first essay is firstly to verify if the evolution of the Swiss hotel industry fits some of the stylized facts of the industry life cycle. The second aim is to verify if there is evidence of geographical clustering of the hotel industry, and by extension of tourism. The third aim is to verify a hypothesis that industry decline manifests itself mainly by company closures in decentralized locations. The importance for organizational survival and performance of adapting and reacting to environmental changes has long been ascertained. This adaptation requires managers, under conditions of uncertainty, to identify relevant changes in their external environment and to interpret the possible effects of those changes on their organization. Furthermore, it requires finding and adopting organizational responses in reaction to the environmental changes. The second essay explores how managers perceive their environment by reporting the results of two workshops held with managers from the European hotel industry. In the third essay we examine in more detail the role of uncertainty in the interpretation by executives of environmental changes. We integrate existing theories of interpretation and uncertainty into one framework, which we then test using national survey data from the hotel industry. In all three essays we are able to provide some evidence to support our main hypotheses, but.also make suggestions far further research into the topics examined.

Analysis of past and future dam formation and failure in the Santa Cruz River (San Juan province, Argentina)

Around 11.5 * 106 m3 of rock detached from the eastern slope of the Santa Cruz valley (San Juan province, Argentina) in the first fortnight of January 2005. The rockslide?debris avalanche blocked the course, resulting in the development of a lake with maximum length of around 3.5 km. The increase in the inflow rate from 47,000?74,000 m3/d between April and October to 304,000 m3/d between late October and the first fortnight of November, accelerated the growing rate of the lake. On 12 November 2005 the dam failed, releasing 24.6 * 106 m3 of water. The resulting outburst flood caused damages mainly on infrastructure, and affected the facilities of a hydropower dam which was under construction 250 km downstream from the source area. In this work we describe causes and consequences of the natural dam formation and failure, and we dynamically model the 2005 rockslide?debris avalanche with DAN3D. Additionally, as a volume ~ 24 * 106 m3of rocks still remain unstable in the slope, we use the results of the back analysis to forecast the formation of a future natural dam. We analyzed two potential scenarios: a partial slope failure of 6.5 * 106 m3 and a worst case where all the unstable volume remaining in the slope fails. The spreading of those potential events shows that a new blockage of the Santa Cruz River is likely to occur. According to their modeled morphometry and the contributing watershed upstream the blockage area, as the one of 2005, the dams would also be unstable. This study shows the importance of back and forward analysis that can be carried out to obtain critical information for land use planning, hazards mitigation, and emergency management.

Drivers and sources of supply flexibility: An exploratory study

Purpose - There has been much research on manufacturing flexibility, but supply chain flexibility is still an under-investigated area. This paper focuses on supply flexibility, the aspects of flexibility related to the upstream supply chain. Our purpose is to investigate why and how firms increase supply flexibility.Methodology/Approach An exploratory multiple case study was conducted. We analyzed seven Spanish manufacturers from different sectors (automotive, apparel, electronics and electrical equipment).Findings - The results show that there are some major reasons why firms need supply flexibility (manufacturing schedule fluctuations, JIT purchasing, manufacturing slack capacity, low level of parts commonality, demand volatility, demand seasonality and forecast accuracy), and that companies increase this type of flexibility by implementing two main strategies: to increase suppliers responsiveness capability and flexible sourcing . The results also suggest that the supply flexibility strategy selected depends on two factors: the supplier searching and switching costs and the type of uncertainty (mix, volume or delivery).Research limitations - This paper has some limitations common to all case studies, such as the subjectivity of the analysis, and the questionable generalizability of results (since the sample of firms is not statistically significant).Implications - Our study contributes to the existing literature by empirically investigating which are the main reasons for companies needing to increase supply flexibility, how they increase this flexibility, and suggesting some factors that could influence the selection of a particular supply flexibility strategy.

KIT mutations and dose selection for imatinib in patients with advanced gastrointestinal stromal tumours.

A recent randomized EORTC phase III trial, comparing two doses of imatinib in patients with advanced gastrointestinal stromal tumours (GISTs), reported dose dependency for progression-free survival. The current analysis of that study aimed to assess if tumour mutational status correlates with clinical response to imatinib. Pre-treatment samples of GISTs from 377 patients enrolled in phase III study were analyzed for mutations of KIT or PDGFRA by combination of D-HPLC and direct sequencing of tumour genomic DNA. Mutation types were correlated with patients' survival data. The presence of exon 9-activating mutations in KIT was the strongest adverse prognostic factor for response to imatinib, increasing the relative risk of progression by 171% (P<0.0001) and the relative risk of death by 190% (P<0.0001) when compared with KIT exon 11 mutants. Similarly, the relative risk of progression was increased by 108% (P<0.0001) and the relative risk of death by 76% (P=0.028) in patients without detectable KIT or PDGFRA mutations. In patients whose tumours expressed an exon 9 KIT oncoprotein, treatment with the high-dose regimen resulted in a significantly superior progression-free survival (P=0.0013), with a reduction of the relative risk of 61%. We conclude that tumour genotype is of major prognostic significance for progression-free survival and overall survival in patients treated with imatinib for advanced GISTs. Our findings suggest the need for differential treatment of patients with GISTs, with KIT exon 9 mutant patients benefiting the most from the 800 mg daily dose of the drug.

Concomitant Cisplatin and Hyperfractionated Radiotherapy in Locally Advanced Head and Neck Cancer: Ten-year Follow-up of a Randomized Phase III Trial (SAKK 10/94)

Purpose/Objective(s): To analyze the long-term outcome of treatment with concomitant cisplatin and hyperfractionated radiotherapy in locally advanced head and neck cancer compared with hyperfractionated radiotherapy alone.Materials/Methods: From July 1994 to July 2000 a total of 224 patients with squamous cell carcinoma of the head and neck were randomized to either hyperfractionated radiotherapy (median dose 74.4 Gy; 1.2 Gy twice daily) or the same radiotherapy combined with two cycles of concomitant cisplatin (20mg/m2 for 5 consecutive days of weeks 1 and 5). The primary endpoint was time to any treatment failure; secondary endpoints were locoregional failure, metastatic failure, overall survival, and late toxicity assessed according to RTOG criteria. The trial was registered at the National Institutes of Health (www.clinicaltrials.gov; identifier number: NCT00002654).Results: Median follow-up was 9.5 years (range, 0.1 - 15.4 years). Median time to any treatment failure was not significantly different between treatment arms (p = 0.19). Locoregional control (p\0.05), distant metastasis-free survival (p = 0.02) and cancer specific survival (p = 0.03) were significantly improved in the combined treatment arm, with no difference in late toxicity between treatment arms. However, overall survival was not significantly different (p = 0.19). Conclusions: After long-term follow-up combined treatment with cisplatin and hyperfractionated, radiotherapy maintained an improved locoregional control, distant metastasis-free survival, and cancer specific survival as compared to hyperfractionated radiotherapy alone with no difference in late toxicity.Author Disclosure: P. Ghadjar, None; M. Simcock, None; G. Studer, None; A.S. Allal, None; M. Ozsahin, None; J. Bernier, None; M. To¨ pfer, None; F. Zimmermann, None; C. Glanzmann, None; D.M. Aebersold, None.

The influence of environmental conditions on immune responses, morphology and recapture probability of nestling house martins (Delichon urbica)

Nestling birds produced later in the season are hypothesized to be of poor quality with a low probability of survival and recruitment. In a Spanish population of house martins (Delichon urbica), we first compared reproductive success, immune responses and morphological traits between the first and the second broods. Second, we investigated the effects of an ectoparasite treatment and breeding date on the recapture rate the following year. Due probably to a reverse situation in weather conditions during the experiment, with more rain during rearing of the first brood, nestlings reared during the second brood were in better condition and had stronger immune responses compared with nestlings from the first brood. Contrary to other findings on house martins, we found a similar recapture rate for chicks reared during the first and the second brood. Furthermore, ectoparasitic house martin bugs had no significant effect on the recapture rate. Recaptured birds had similar morphology but higher immunoglobulin levels when nestlings compared with non-recaptured birds. This result implies that a measure of immune function is a better predictor of survival than body condition per se.

Epidémiologie et prévention du mélanome cutané en Suisse. [Epidemiology and prevention of melanoma in Switzerland].

[Quintessence] - L'incidence du mélanome malin augmente rapidement depuis plus de 50 ans. - La Suisse, avec 1700 nouveaux cas diagnostiqués par an, est, avec la Norvège, le pays d'Europe le plus touché par le mélanome. - Des différences régionales sont récemment apparues avec une incidence plus élevée dans les cantons romands. - Les changements observés en Suisse dans l'attitude et le comportement face au soleil sont trop récents et modestes pour influencer l'incidence. - La détection précoce effectuée depuis près de 20 ans a permis d'augmenter la survie et le taux de mélanomes fins sans toutefois altérer l'incidence des lésions épaisses. - La mortalité associée au mélanome malin a récemment diminué, d'abord chez les femmes. L'efficacité de la prévention devrait se confirmer à terme si les efforts entrepris se poursuivent. [Auteurs] [Summary] - The incidence of malignant melanoma has steadily increased in Caucasian populations over the last 50 years. - With some 1700 new cases per year, Switzerland has, with Norway, the highest rate of melanoma in Europe. - Regional differences within Switzerland are emerging, with a higher incidence in western (French-speaking) cantons. - Observed changes in sun protection attitudes and knowledge in the Swiss population have yet to impact on the incidence trend. - Early detection, as pursued since the mid-1980s in Switzerland, has led to a substantial increase in survival and rates of thin melanoma, without major change in rates of thick melanoma. - Mortality from melanoma has recently decreased, initially in women. The effectiveness of prevention campaigns should eventually be confirmed if current efforts persist. [Authors]

Feasibility and electromagnetic compatibility study of the ClearPEM front-end electronics for simultaneous PET-MR imaging

In this work we present a first feasibility study of the ClearPEM technology for simultaneous PET-MR imaging. The mutual electromagnetic interference (EMI) effects between both systems were evaluated on a 7 T magnet by characterizing the response behavior of the ClearPEM detectors and front-end electronics to pulsed RF power and switched magnetic field gradients; and by analyzing the MR system performance degradation from noise pickup into the RF receiver chain, and from magnetic susceptibility artifacts caused by PET front-end materials.

Biology and reproductive capacity of Spodoptera eridania (Cramer) (Lepidoptera, Noctuidae) in different soybean cultivars

This study aimed to evaluate the development, survival and reproductive capacity of Spodoptera eridania in four soybean cultivars. The experiment was conducted in the laboratory, in a climatic chamber at 25 °C ± 1 °C, 70 ± 10% relative humidity and 12 h photophase. The cultivars used were: FMT Tabarana, BRS/MT Pintado, FMT Tucunaré and Monsoy 8757, all conventional cultivars with medium cycles. All cultivars tested allowed the development of S. eridania. However, Monsoy 8757 was the cultivar that most affected the prolonged in the duration larval, pupal and total cycle, showed lower pupal weight as well as reduction in the intrinsic rate increase. These results contribute to the management of this species in regions of outbreaks in soybean areas.

Radiothérapie externe accélérée postopératoire des carcinomes épidermoïdes localement évolués de la sphère ORL: étude prospective de phase II [Prospective study of accelerated postoperative radiation therapy in patients with squamous-cell carcinoma of the head and neck]

PURPOSE: To assess the feasibility and efficacy of accelerated postoperative radiation therapy (RT) in patients with squamous-cell carcinoma of the head and neck (SCCHN). PATIENTS AND METHODS: Between December 1997 and July 2001, 68 patients (male to female ratio: 52/16; median age: 60-years (range: 43-81) with pT1-pT4 and/or pN0-pN3 SCCHN (24 oropharynx, 19 oral cavity, 13 hypopharynx, 5 larynx, 3 unknown primary, 2 maxillary sinus, and 2 salivary gland) were included in this prospective study. Postoperative RT was indicated because extracapsular infiltration (ECI) was observed in 20 (29%), positive surgical margins (PSM) in 20 (29%) or both in 23 patients (34%). Treatment consisted of external beam RT 66 Gy in 5 weeks and 3 days. Median follow-up was 15 months. RESULTS: According to CTC 2.0, acute morbidity was acceptable: grade 3 mucositis was observed in 15 (22%) patients, grade 3 dysphagia in 19 (28%) patients, grade 3 skin erythema in 21 (31%) patients with a median weight loss of 3.1 kg (range: 0-16). No grade 4 toxicity was observed. Median time to relapse was 13 months; we observed only three (4%) local and four (6%) regional relapses, whereas eight (12%) patients developed distant metastases without any evidence of locoregional recurrence. The 2 years overall-, disease-free survival, and actuarial locoregional control rates were 85, 73 and 83% respectively. CONCLUSION: The reduction of the overall treatment time using postoperative accelerated RT with weekly concomitant boost (six fractions per week) is feasible with local control rates comparable to that of published data. Acute RT-related morbidity is acceptable.