Basic life support teaching in the second year predraduate medical curriculum: quality of acquisition after 6 months

Purpose of the study: Basic life support (BLS) and automated externaldefibrillation (AED) represent important skills to be acquired duringpregraduate medical training. Since 3 years, our medical school hasintroduced a BLS-AED course (with certification) for all second yearmedical students. Few reports about quality and persistence over timeof BLS-AED learning are available to date in the medical literature.Comprehensive evaluation of students' acquired skills was performedat the end of the 2008 academic year, 6 month after certification.Materials and methods: The students (N = 142) were evaluated duringa 9 minutes «objective structured clinical examination» (OSCE) station.Out of a standardized scenario, they had to recognize a cardiac arrestsituation and start a resuscitation process. Their performance wererecorded on a PC using an Ambuman(TM) mannequin and the AmbuCPR software kit(TM) during a minimum of 8 cycles (30 compressions:2 ventilations each). BLS parameters were systematically checked. Nostudent-rater interactions were allowed during the whole evaluation.Results: Response of the victim was checked by 99% of the students(N = 140), 96% (N = 136) called for an ambulance and/or an AED. Openthe airway and check breathing were done by 96% (N = 137), 92% (N =132) gave 2 rescue breaths. Pulse was checked by 95% (N=135), 100%(N = 142) begun chest compression, 96% (N = 136) within 1 minute.Chest compression rate was 101 ± 18 per minute (mean ± SD), depthcompression 43 ± 8 mm, 97% (N = 138) respected a compressionventilationratio of 30:2.Conclusions: Quality of BLS skills acquisition is maintained during a6-month period after a BLS-AED certification. Main targets of 2005 AHAguidelines were well respected. This analysis represents one of thelargest evaluations of specific BLS teaching efficiency reported. Furtherfollow-up is needed to control the persistence of these skills during alonger time period and noteworthy at the end of the pregraduatemedical curriculum.

Ripening and quality of 'Laetitia' plums following harvest and cold storage as affected by inhibition of ethylene action

The inhibition of ethylene action by 1-methylcyclopropene (1-MCP) extends shelf and storage life of many climacteric fruits. However, 1-MCP appears to have limited effects on stone fruit depending on specie and cultivar. The effects of 1-MCP on ripening and quality of 'Laetitia' plums were determined during ripening at 23ºC following harvest and cold storage. Japanese plums (Prunus salicina, cv. Laetitia) were harvested at mature pre-climacteric stage, cooled to 2ºC within 36 hours of harvest and then treated with 0, 0.05, 0.10, 0.50 or 1.00 muL L-1 of 1-MCP at 1°C for 24 hours. Following treatment, fruits were either held at 23ºC for 16 days or stored at 1ºC for 50 days. Fruits were removed from cold storage at 10-day intervals and allowed to ripe at 23°C for five days. A delay of climacteric respiration and ethylene production by 1-MCP treatment during ripening following harvest and cold storage was associated to a slow rate of fruit softening. 1-MCP treatment also delayed the loss of titratable acidity and changes of flesh and skin color, whereas it had little or no effect on soluble solids content. 1-MCP effects were concentration- and storage duration-dependent and, generally, a saturation fruit response to 1-MCP occurred between 0.5 and 1.0 muL L-1. During ripening, 1-MCP treated fruits attained quality similar to that of controls. Results indicated that 1-MCP treatment may extend shelf life (23ºC) and storage life (1ºC) of 'Laetitia' plums by approximately six and 20 days, respectively.

Analysis of raw hams using SELDI-TOF-MS to predict the final quality of dry-cured hams

The relationship between protein profiles of Gluteus medius (GM) muscles of raw hams obtained from 4 pure breed pigs (Duroc, Large White, Landrace, and Piétrain) with the final quality of the Semimembranosus and Biceps femoris muscles of dry-cured hams was investigated. As expected, Duroc hams showed higher levels of marbling and intramuscular fat content than the other breeds. Piétrain hams were the leanest and most conformed, and presented the lowest salt content in dry-cured hams. Even if differences in the quality traits (colour, water activity, texture, composition, intramuscular fat, and marbling) of dry-cured hams were observed among the studied breeds, only small differences in the sensory attributes were detected. Surface-enhanced laser desorption/ionisation time-of-flight mass spectrometry (SELDI-TOF-MS) was used to obtain the soluble protein profiles of GM muscles. Some associations between protein peaks obtained with SELDI-TOF-MS and quality traits, mainly colour (b*) and texture (F0, Y2, Y90) were observed. Candidate protein markers for the quality of processed dry-cured hams were identified

Grain yield and seed quality of soybean selected for high protein content

The objective of this work was to evaluate the effects of selection for high protein on seed physiological quality and grain yield of soybean. Four populations of BC1F4 and four of F4, each from a cross between a commercial variety and a line bearing high protein seeds, were used. The high protein content selection has a tendency to affect negatively the seed physiological quality. Estimates of correlation coefficients between protein content and grain yield were mostly negative but varied among populations. It is possible to obtain lines with high protein content, keeping the grain yield and the seed physiological quality of their respective recurrent progenitors.

Dementoituneiden asiakkaiden hoidon laadun havainnointi- pilottitutkimus Dementia Care Mapping -menetelmällä

Summary: Assessment of the quality of care of people with dementia - Dementia Care Mapping pilot

Qualité de vie après traitement de l'insuffisance veineuse superficielle primaire. [Quality of life in patients traited for primary superficial venous insufficiency].

Venous symptoms and quality of life (QOL) of 78 patients (54 women, mean age 49,5±13,3 years) with primary superficial venous insufficiency (PSVI) were compared at one year after treatment with crossectomy and stripping (C/S, 56 patients) or endovenous laser ablation (EVLA, 22 patients) using the VEINES-QOL questionnaire. Both treatments significantly (p<0,001) improved the scores for venous symptoms (difference 10,6±9,9 and 9,9±8,2 score points for C/S and EVLA, respectively) and QOL (difference 10,3±8,7 and 8,4±6,6 score points for C/S and EVLA, respectively). No difference was found between treatments regarding symptoms or QOL improvement (p=0,30). We conclude that C/S and EVLA are equally effective in improving symptoms and QOL in PSVI.

Effects of an early intervention on maternal post-traumatic stress symptoms and the quality of mother-infant interaction: The case of preterm birth

Preterm birth may represent a traumatic situation for both parents and a stressful situation for the infant, potentially leading to difficulties in mother-infant relationships. This study aimed to investigate the impact of an early intervention on maternal posttraumatic stress symptoms, and on the quality of mother-infant interactions, in a sample of very preterm infants and their mothers. Half of the very preterm infants involved in the study (n=26) were randomly assigned to a 3-step early intervention program (at 33 and 42 weeks after conception and at 4 months' corrected age). Both groups of preterm infants (with and without intervention) were compared to a group of full-term infants. The impact of the intervention on maternal posttraumatic stress symptoms was assessed 42 weeks after conception and when the infants were 4 and 12 months of age. The impact of the intervention on the quality of mother-infant interactions was assessed when the infants were 4 months old. Results showed a lowering of mothers' posttraumatic stress symptoms between 42 weeks and 12 months in the group of preterm infants who received the intervention. Moreover, an enhancement in maternal sensitivity and infant cooperation during interactions was found at 4 months in the group with intervention. In the case of a preterm birth, an early intervention aimed at enhancing the quality of the mother-infant relationship can help to alleviate maternal post-traumatic stress symptoms and may have a positive impact on the quality of mother-infant interactions.

Standards of care and novel approaches in the management of glioblastoma multiforme.

Glioblastoma multiforme (GBM) is the most common malignant primary brain tumor in adults. Standard therapeutic approaches provide modest improvement in the progression-free and overall survival, necessitating the investigation of novel therapies. We review the standard treatment options for GBM and evaluate the results obtained in clinical trials for promising novel approaches, including the inhibition of angiogenesis, targeted approaches against molecular pathways, immunotherapies, and local treatment with low voltage electric fields.

Forage yield and quality of a dense thorny and thornless "jurema-preta" stand

The objective of this work was to compare forage production and quality of thorny and thornless "jurema-preta" (Mimosa tenuiflora (Willd.) Poiret) in a dense planted stand, subjected to annual pruning of fine branches, in Patos, PB, Brazil. The experiment consisted of two treatments (thornless and thorny "jurema-preta") in a complete randomized block design, with ten replicates of two linear plots subdivided in time. Forage mass and chemical composition of fine branches and the basal diameter of plants were measured during five years. Pruning decreased (p<0.05) increments in basal diameter and forage production. Annual dry matter yields reached 4,108 and 5,833 kg ha-1, respectively, for thornless and thorny plants, and forage quality was similar (p>0.05) for both genotypes. This roughage fodder (minimum NDF and ADF averages were 56±1.1% and 43±1.0%, respectively) had low P and K concentrations. Its average crude protein content was greater than 9.9±0.5%, which exceeds the minimum necessary for animal maintenance. Both "jurema-preta" genotypes tolerated pruning of fine branches and contributed with a significant amount of roughage fodder for animal maintenance in the dry season.

cGMP-dependent protein kinase type I is implicated in the regulation of the timing and quality of sleep and wakefulness.

Many effects of nitric oxide (NO) are mediated by the activation of guanylyl cyclases and subsequent production of the second messenger cyclic guanosine-3',5'-monophosphate (cGMP). cGMP activates cGMP-dependent protein kinases (PRKGs), which can therefore be considered downstream effectors of NO signaling. Since NO is thought to be involved in the regulation of both sleep and circadian rhythms, we analyzed these two processes in mice deficient for cGMP-dependent protein kinase type I (PRKG1) in the brain. Prkg1 mutant mice showed a strikingly altered distribution of sleep and wakefulness over the 24 hours of a day as well as reductions in rapid-eye-movement sleep (REMS) duration and in non-REM sleep (NREMS) consolidation, and their ability to sustain waking episodes was compromised. Furthermore, they displayed a drastic decrease in electroencephalogram (EEG) power in the delta frequency range (1-4 Hz) under baseline conditions, which could be normalized after sleep deprivation. In line with the re-distribution of sleep and wakefulness, the analysis of wheel-running and drinking activity revealed more rest bouts during the activity phase and a higher percentage of daytime activity in mutant animals. No changes were observed in internal period length and phase-shifting properties of the circadian clock while chi-squared periodogram amplitude was significantly reduced, hinting at a less robust oscillator. These results indicate that PRKG1 might be involved in the stabilization and output strength of the circadian oscillator in mice. Moreover, PRKG1 deficiency results in an aberrant pattern, and consequently a reduced quality, of sleep and wakefulness, possibly due to a decreased wake-promoting output of the circadian system impinging upon sleep.

Postharvest quality of peaches harvested from integrated and conventional production systems

Over three years the postharvest quality of 'Marli' peaches harvested from the integrated (IFP) and conventional production (CFP) systems was evaluated. The peaches were harvested from commercial orchards of Prunus persica at two locations close to the city of São Jerônimo, RS, Brazil, and stored at 0.5°C for 10, 20 or 30 days. The peaches were evaluated at harvest, at retrieval from storage and after ripening periods at 20°C. No differences in fruit weight losses were determined. Decay incidence was low, and no differences were detected amongst systems in both 2001 and 2002 seasons, but in the 2000 season CFP peaches were more decayed. Flesh firmness of peaches from the IFP system were greater than CFP fruits in the years 2000 and 2001. In 2002, firmness changed little during storage and ripening. Peaches from the IFP in 2000 had higher titratable acidity and lower soluble solids. In the 2000 season, flesh browning was observed in decayed fruits, always at ripening after 20 or 30 days of cold storage Chilling injuries such as browning, woolliness and leatheriness ocurred in 2002. There were no differences amongst systems related to peach quality.

Design Guide for Improved Quality of Roadway Subgrades and Subbases, TR-525, 2008

The performance of a pavement depends on the quality of its subgrade and subbase layers; these foundational layers play a key role in mitigating the effects of climate and the stresses generated by traffic. Therefore, building a stable subgrade and a properly drained subbase is vital for constructing an effective and long lasting pavement system. This manual has been developed to help Iowa highway engineers improve the design, construction, and testing of a pavement system’s subgrade and subbase layers, thereby extending pavement life. The manual synthesizes current and previous research conducted in Iowa and other states into a practical geotechnical design guide [proposed as Chapter 6 of the Statewide Urban Design and Specifications (SUDAS) Design Manual] and construction specifications (proposed as Section 2010 of the SUDAS Standard Specifications) for subgrades and subbases. Topics covered include the important characteristics of Iowa soils, the key parameters and field properties of optimum foundations, embankment construction, geotechnical treatments, drainage systems, and field testing tools, among others.

The definition of quality of life in solid organ transplantation: A psychological qualitative model

Quality of life has been extensively discussed in acute and chronic illnesses. However a dynamic model grounded in the experience of patients in the course of transplantation has not been to our knowledge developed. In a qualitative longitudinal study, patients awaiting solid organ transplantation participated in semi-structured interviews: Exploring topics pre-selected on previous research literature review. Creative interview was privileged, open to themes patients would like to discuss at the different steps of the transplantation process. A qualitative thematic and reflexive analysis was performed, and a model of the dimensions constitutive of quality of life from the perspective of the patients was elaborated. Quality of life is not a stable construct in a long lasting illness-course, but evolves with illness constraints, treatments and outcomes. Dimensions constitutive of quality of life are defined, each of them containing different sub-categories depending on the organ related illness co-morbidities and the stage of illness-course.

Subgroup And Quality Of Life Analyses Of The Phase Iii Clinical Trial Of Novottf-100a Versus Best Standard Chemotherapy For Recurrent Glioblastoma

BACKGROUND: NovoTTF is a portable device delivering low-intensity, intermediate-frequency, electric fields using noninvasive, disposable scalp electrodes. These fields physically interfere with cell division. Preliminary studies in recurrent and newly diagnosed glioblastoma (GBM) have shown promising results. A phase III study in recurrent GBM has recently been concluded. METHODS: Adults (KPS ≥ 70%) with recurrent GBM (any recurrence) were randomized (stratified by surgery and center) to either NovoTTF administered continuously (20-24 hours/day, 7 days/week) or the best available chemotherapy (best physician choice [BPC]). Primary endpoint was overall survival (OS); 6-month progression-free survival (PFS6), 1-year survival, and QOL were secondary endpoints. RESULTS: Two hundred thirty-seven patients were randomized (28 centers in the United States and Europe) to either NovoTTF alone (120 patients) or BPC (117 patients). Patient characteristics were balanced, median age was 54 years (range, 23-80 years), median KPS was 80% (range, 50-100). One quarter had surgery for recurrence, and over half were at their second or more recurrence. A survival advantage for the device group was seen in patients treated according to protocol (median OS, 7.8 months vs. 6.1 months; n = 185; p = 0.01). Moreover, subgroup analysis in patients with better prognostic baseline characteristics (KPS ≥ 80%; age ≤ 60; 1st-3rd recurrence) demonstrated a robust survival benefit for NovoTTF patients compared to matched BPC patients (median OS, 8.8 months vs. 6.6 months; n = 110; p < 0.01). In this group, 1-year survival was 35% vs. 20% and PFS6 was 25.6% vs. 7.7%. Interestingly, in patients who failed bevacizumab prior to the trial, OS was also significantly extended by NovoTTF (4.4 months vs. 3.1 months; n = 23 vs. n = 21; p < 0.02). Quality of life was equivalent or superior in NovoTTF patients. CONCLUSIONS: NovoTTF, a noninvasive, novel cancer treatment modality shows significant therapeutic efficacy with improved quality of life. The impact of NovoTTF was more pronounced when patients with better baseline prognostic factors were treated. A large scale phase III clinical trial in newly diagnosed GBM is currently being conducted.

Yield and fruit quality of apple from conventional and organic production systems

The objective of this study was to assess the yield and fruit quality of apple produced with a conventional and an organic production systems in Southern Brazil. The orchards consisted of alternate rows from 10 to 12-year old 'Royal Gala' and 'Fuji' apple trees on M.7 rootstocks, grown as slender spindles, on 4x6 m spacing. Eighteen apple trees of each cultivar and management system were randomly selected and assessed for nutrition, flowering, fruit set, yield, and fruit quality during two growing seasons (2002/2003 and 2003/2004). The organic management system resulted in lower concentrations of K, Mg, and N in leaves and fruits, and in smaller fruits for both cultivars, and lower fruit yield for 'Fuji' than from the conventional production system. For both cultivars, fruits from the organic orchard harvested at commercial maturity had a more yellowish skin background color, higher percentage of blush in the fruit skin, higher soluble solids content, higher density, higher flesh firmness, and higher severity of russet than fruits from the conventional orchard. Fruit from the organic orchard had lower titratable acidity in 'Royal Gala', and higher incidence of moldy core and lower incidence of watercore in 'Fuji', than fruit from the conventional orchard. A non-trained sensory panel detected no significant differences for fruit attributes of taste, flavor and texture between fruit from the production systems for either cultivar.