Assessing variations in care delivered to rural out of hospital cardiac arrest patients in the interfacility transfer setting.

Objective: There is significant variation in out-of-hospital cardiac arrest (OHCA) outcomes between different regions. We sought to evaluate outcomes of OHCA patients in the interfacility transfer (IFT) setting, between critical care transport (LifeFlight) and community Emergency Medical Services (EMS), in the state of Maine.

Methods: This was a retrospective analysis of our institution's electronic medical record and the Maine EMS database.

Emergency Department SpO/FiO Ratios Correlate with Mechanical Ventilation and Intensive Care Unit Requirements in COVID-19 Patients.

Background: Patients with coronavirus 2019 (COVID-19) are at high risk for respiratory dysfunction. The pulse oximetry/fraction of inspired oxygen (SpO/FiO) ratio is a non-invasive assessment of respiratory dysfunction substituted for the PaO:FiO ratio in Sequential Organ Failure Assessment scoring. We hypothesized that emergency department (ED) SpO/FiO ratios correlate with requirement for mechanical ventilation in COVID-19 patients.

Effects of polyphenol in women with polycystic ovary syndrome: A systematic review and meta-analysis of randomized controlled trials.

Objective: Polycystic ovary syndrome (PCOS) is an endocrinopathy with a high prevalence in women of reproductive age. Different treatments were tested to increase insulin sensitivity and hormone regulation, and recently polyphenols have emerged as a promising option for these women. We aimed to perform a systematic review and meta-analysis of randomized clinical trials (RCTs) comparing polyphenols to placebo in PCOS.

Standardizing post-cardiac arrest care across rural-urban settings - qualitative findings on proposed post-cardiac arrest learning community intervention.

Background: Standardization of post-cardiac arrest care between emergency department arrival and intensive care unit admission can be challenging, particularly for rural centers, which can experience significant delays in interfacility transfer. One approach to addressing this issue is to form a post-cardiac arrest learning community (P-CALC) consisting of emergency department (ED) and intensive care unit (ICU) physicians and nurses who use data, shared resources, and collaboration to improve post-cardiac arrest care. MaineHealth, the largest regional health system in Maine, launched its P-CALC in 2022.

Optimizing PROM Implementation in Orthopedic Clinics for Longitudinal Outcome Monitoring: Lessons from a Multisite Study.

Background: Systematic patient-reported outcome measure (PROM) collection is challenging for clinics, particularly when patients are not in the office. The Arthritis care through Shared Knowledge (ASK) study deployed multimodal approaches to collect PROMs using a clinical microsystem framework.

Conceptual Model: Informed by the clinical microsystem model, the authors coached 12 orthopedic practices to implement shared processes to support best practices for PROM collection and use.

Impact of sex on ventral hernia repair outcomes: A systematic review and meta-analysis.

Background: Given the variability in abdominal physiology and hernia presentation between sexes, better comprehension of sex-related differences in outcomes would tailor surgical approach and counseling regarding postoperative outcomes. This meta-analysis aims to appraise the effect of sex on the outcomes of ventral hernia repair.

Methods: A literature search in PubMed, EMBASE and Cochrane selected studies comparing outcomes of ventral hernia repair between sexes.

Management and outcomes of obturator hernias: a systematic review and meta-analysis.

Purpose: Obturator Hernia (OH) is a rare type of abdominal wall hernia. It usually occurs in elderly women with late symptomatic presentation, increasing mortality rates. Surgery is the standard of care for OH, and laparotomy with simple suture closure of the defect is commonly used.

Millimeter-wave to near-terahertz sensors based on reversible insulator-to-metal transition in VO.

In the quest for low power bio-inspired spiking sensors, functional oxides like vanadium dioxide are expected to enable future energy efficient sensing. Here, we report uncooled millimeter-wave spiking detectors based on the sensitivity of insulator-to-metal transition threshold voltage to the incident wave. The detection concept is demonstrated through actuation of biased VO switches encapsulated in a pair of coupled antennas by interrupting coplanar waveguides for broadband measurements, on silicon substrates.

The Effect of Resuscitation Residents on the Duration of Pre-induction of Targeted Temperature Management in Out-of-Hospital Cardiac Arrest.

Background The Resuscitation Rotation is a novel second-year emergency medicine rotation focusing on the highest acuity patients, including out-of-hospital cardiac arrest (OHCA). The resuscitation resident (RR) functions as an extra physician during resuscitation and post return of spontaneous circulation (ROSC). The objective of this study is to examine if the presence of a RR decreases the pre-induction interval of targeted temperature management (TTM) for patients following OHCA.

Predictors of poor outcome in tocilizumab treated patients with Sars-CoV-2 related severe respiratory failure: A multicentre real world study.

Introduction: Despite Tocilizumab is now recognized as a concrete therapeutic option in patients with severe SARS-CoV-2 related respiratory failure, literature lacks about factors influencing the response to it in this context. Therefore, the aim of our study was to provide evidence about predictors of poor outcome in Tocilizumab treated patients in the real-world practice.

Materials And Methods: We retrospectively analyzed clinical, laboratory and chest computer tomography (CCT) data of patients firstly admitted in non Intensive Care Units (ICU) and suffering from severe respiratory failure, who were treated with the IL-6 antagonist Tocilizumab.

The cardiovascular, metabolic, fetal and neonatal effects of CPAP use in pregnant women: a systematic review.

Continuous positive airway pressure (CPAP) is the standard treatment for obstructive sleep apnea (OSA), but its outcomes for the pregnant are still undefined. This study aims to review current CPAP intervention during pregnancy, discuss published trials, and propose relevant issues that have yet to be addressed satisfactorily about the cardiovascular, metabolic, fetal, and neonatal effects of CPAP treatment during gestation. Two authors independently conducted a systematic review until March 28th, 2021 on PubMed, BVS, and Cochrane Library, using PRISMA guidelines, and risk of bias.

Assessing the impact of resuscitation residents on the treatment of cardiopulmonary resuscitation patients.

Background: The management of cardiac arrest patients receiving cardiopulmonary resuscitation (CPR) is an essential aspect of emergency medicine (EM) training. At our institution, we have a 1-month Resuscitation Rotation designed to augment resident training in managing critical patients. The objective of this study is to compare 30-day mortality between cardiac arrest patients with resuscitation resident (RR) involvement versus patients without.

Resuscitation Resident Impact in the Treatment of Sepsis.

Background The resuscitation of septic patients is a fundamental skill of emergency medicine (EM) training. We developed a required rotation designed to augment resident training in resuscitating critically ill patients in the emergency department (ED). The purpose of this study was to evaluate the successful completion of sepsis core measures alongside clinical outcomes between patients with a resuscitation resident (RR) involved in care versus patients without.

Effect of Lower Blood Pressure Goals on Left Ventricular Structure and Function in Patients With Subclinical Hypertensive Heart Disease.

Background: Subclinical hypertensive heart disease (SHHD) is a precursor to heart failure. Blood pressure (BP) reduction is an important component of secondary disease prevention in patients with SHHD. Treating patients with SHHD utilizing a more intensive BP target (120/80 mm Hg), may lead to improved cardiac function but there has been limited study of this, particularly in African Americans (AAs).

How far are we from automatic crystal structure solution via molecular-replacement techniques?

Although the success of molecular-replacement techniques requires the solution of a six-dimensional problem, this is often subdivided into two three-dimensional problems. REMO09 is one of the programs which have adopted this approach. It has been revisited in the light of a new probabilistic approach which is able to directly derive conditional distribution functions without passing through a previous calculation of the joint probability distributions.

Nano-opto-electro-mechanical switches operated at CMOS-level voltages.

Combining reprogrammable optical networks with complementary metal-oxide semiconductor (CMOS) electronics is expected to provide a platform for technological developments in on-chip integrated optoelectronics. We demonstrate how opto-electro-mechanical effects in micrometer-scale hybrid photonic-plasmonic structures enable light switching under CMOS voltages and low optical losses (0.1 decibel).

Left ventricular non-compaction; an unusual presentation with supraventricular tachycardia in the emergency department.

Left ventricular non-compaction (LVNC) is a cardiomyopathy with altered ventricular wall anatomy. This condition is characterized by the presence of prominent left ventricular trabeculae, a thin compacted layer, and deep intertrabecular recesses that are continuous with the left ventricular cavity and separated from the epicardial coronary. Left ventricular non-compaction can present with acute heart failure, arrhythmias, or sudden cardiac death.

Microwave plasmonic mixer in a transparent fibre-wireless link.

To cope with the high bandwidth requirements of wireless applications1, carrier frequencies are shifting towards the millimetre-wave and terahertz bands2-5. Conversely, data is normally transported to remote wireless antennas by optical fibres. Therefore, full transparency and flexibility to switch between optical and wireless domains would be desirable6,7.

CAB: a cyclic automatic model-building procedure.

The program Buccaneer, a well known fast and efficient automatic model-building program, is also a tool for phase refinement: indeed, input phases are used to calculate electron-density maps that are interpreted in terms of a molecular model, from which new phase estimates may be obtained. This specific property is shared by all other automatic model-building programs and allows their cyclic use, as is usually performed in other phase-refinement methods (for example electron-density modification techniques). Buccaneer has been included in a cyclic procedure, called CAB, aimed at increasing the rate of success of Buccaneer and the quality of the molecular models provided.

Reconfigurable photonic generation of broadband chirped waveforms using a single CW laser and low-frequency electronics.

Broadband radio-frequency chirped waveforms (RFCWs) with dynamically tunable parameters are of fundamental interest to many practical applications. Recently, photonic-assisted solutions have been demonstrated to overcome the bandwidth and flexibility constraints of electronic RFCW generation techniques. However, state-of-the-art photonic techniques involve broadband mode-locked lasers, complex dual laser systems, or fast electronics, increasing significantly the complexity and cost of the resulting platforms.

An assessment of repeat computed tomography utilization in the emergency department in the setting of blunt trauma.

Purpose: Computed tomography (CT) is a standard imaging modality utilized during the evaluation of trauma patients in the emergency department (ED). However, while it is common to utilize intravenous (IV) contrast as an adjunct, the use of multiple CT scans and how it impacts patient flow can lead to changes in patient management. Our objectives are to assess length of stay (LOS) and rates of acute kidney injury (AKI), when two CT scans of the abdomen/pelvis are performed compared to one CT scan.

Phasing via pure crystallographic least squares: an unexpected feature.

Crystallographic least-squares techniques, the main tool for crystal structure refinement of small and medium-size molecules, are for the first time used for ab initio phasing. It is shown that the chief obstacle to such use, the least-squares severe convergence limits, may be overcome by a multi-solution procedure able to progressively recognize and discard model atoms in false positions and to include in the current model new atoms sufficiently close to correct positions. The applications show that the least-squares procedure is able to solve many small structures without the use of important ancillary tools: e.

Synergy among phase-refinement techniques in macromolecular crystallography.

Ab initio and non-ab initio phasing methods are often unable to provide phases of sufficient quality to allow the molecular interpretation of the resulting electron-density maps. Phase extension and refinement is therefore a necessary step: its success or failure can make the difference between solution and nonsolution of the crystal structure. Today phase refinement is trusted to electron-density modification (EDM) techniques, and in practice to dual-space methods which try, via suitable constraints in direct and in reciprocal space, to generate higher quality electron-density maps.

Photonic integrated circuit implementation of a sub-GHz-selectivity frequency comb filter for optical clock multiplication.

We report a photonic integrated circuit implementation of an optical clock multiplier, or equivalently an optical frequency comb filter. The circuit comprises a novel topology of a ring-resonator-assisted asymmetrical Mach-Zehnder interferometer in a Sagnac loop, providing a reconfigurable comb filter with sub-GHz selectivity and low complexity. A proof-of-concept device is fabricated in a high-index-contrast stoichiometric silicon nitride (SiN/SiO) waveguide, featuring low loss, small size, and large bandwidth.

About difference electron densities and their properties.

Difference electron densities do not play a central role in modern phase refinement approaches, essentially because of the explosive success of the EDM (electron-density modification) techniques, mainly based on observed electron-density syntheses. Difference densities however have been recently rediscovered in connection with the VLD (Vive la Difference) approach, because they are a strong support for strengthening EDM approaches and for ab initio crystal structure solution. In this paper the properties of the most documented difference electron densities, here denoted as F - F, mF - F and mF - DF syntheses, are studied.