Minute Delay Research Articles

Immediate Detection of DDoS Attacks with using NetFlow on Cisco Devices IOS

Background/Objectives: DDoS attacks are usually detected by analysis of the applications that are installed in or close to the current system are carried out. Methods/Statistical Analysis: Although this method is easy to deploy, but nonurgent and sensitive detection of DDoS attacks that reasons are first, the fact that the write current by interrupting the current collector is normally the data for application analysis creates pieces that caused a delay of several minutes to be recognized. Second, if the attack traffic may be strengthened by the process of sending the original package small enough to be part of a small stream. Findings: In this research paper will show how to detect DDoS attacks on the sender instead of the current collection, the data close to the source and immediate fashion, which had access to a streaming surveillance infrastructure with development needs. In this study, to examine whether the detection system may operate on the same network platform is widely deployed Cisco IOS devices. Since the ultimate goal of the research is to identify the attackers and its objectives, the use of NetFlow. Applications/Improvements: In this paper, the DDoS attack detection prototype has been shown to produce a constant load on the underlying platform, even under attack, stressing that detects DDoS attack can be a Cisco Catalyst 6500 models used in production networks.

Investigation on the Effect of Crystal Orientation Dependence of Pulse Porous Silicon for White Light Emission

Porous silicon (PS) was formed by using an electrochemical pulse etching (PC) and conventional direct current (DC) etching techniques. The study aims to compare the effect of crystal orientations (n-type (100) and n-type (111)) on the formation of the PS under various conditions. For DC etching technique, the silicon wafers were etched in Hydrofluoric (HF) based solution with a current density of J=10 mA/cm2 for 30 minutes. While for the PC process, an electroless chemical etching with a different delay time (Td) of 0 min and 2 min were imposed before PC process starts. After that, the pulse current of J=10 mA/cm2 with the cycle time (T) of 10 ms and pause time (Toff) of 4ms were supplied in 30 min etching time in HF based electrolyte. Three samples from n-type (100) are DC1, PC1 and PC2 while the three samples from n-type (111) are DC2, PC3, and PC4 respectively. Field Emission Scanning Electron Microscopy (FESEM) images showed that the samples from n-type (100) produce more uniform circular structures and dense compared to n-type (111). The introduction of 2 minutes delay during PC process resulted in better structural of PS formation and also the optical properties shown by the Raman and Photoluminescence (PL) spectroscopies. For PL observation, the as grown Si shows no emission at the visible spectrum while all the PS samples (DC and PC techniques) exhibited significant broad spectrum between 500 nm to 900 nm respectively. It can be seen that the uniform circular pore of n-type (100) enhanced the PL emission indicated by the higher PL intensity (PC1 and PC2) compared to PC3 and PC4 from n-type (111). Raman spectroscopy showed that an improvement in the crystalline quality of PS in PC technique compared to DC indicated by the reduction of full width at half maximum (FWHM).

The Race against Protease Activation Defines the Role of ESCRTs in HIV Budding.

HIV virions assemble on the plasma membrane and bud out of infected cells using interactions with endosomal sorting complexes required for transport (ESCRTs). HIV protease activation is essential for maturation and infectivity of progeny virions, however, the precise timing of protease activation and its relationship to budding has not been well defined. We show that compromised interactions with ESCRTs result in delayed budding of virions from host cells. Specifically, we show that Gag mutants with compromised interactions with ALIX and Tsg101, two early ESCRT factors, have an average budding delay of ~75 minutes and ~10 hours, respectively. Virions with inactive proteases incorporated the full Gag-Pol and had ~60 minutes delay in budding. We demonstrate that during budding delay, activated proteases release critical HIV enzymes back to host cytosol leading to production of non-infectious progeny virions. To explain the molecular mechanism of the observed budding delay, we modulated the Pol size artificially and show that virion release delays are size-dependent and also show size-dependency in requirements for Tsg101 and ALIX. We highlight the sensitivity of HIV to budding “on-time” and suggest that budding delay is a potent mechanism for inhibition of infectious retroviral release.

Processor-Network Speed Scaling for Energy–Delay Tradeoff in Smartphone Applications

Many smartphone applications, e.g., file backup, are intrinsically delay-tolerant so that data processing and transfer can be delayed to reduce smartphone battery usage. In the literature, these energy--delay tradeoff issues have been addressed independently in the forms of Dynamic Voltage and Frequency Scaling (DVFS) problems and network selection problems when smartphones have multiple wireless interfaces. In this paper, we jointly optimize the CPU speed and network speed to determine how much more energy can be saved through the joint optimization when applications can tolerate delays. We propose a dynamic speed scaling scheme called SpeedControl that jointly adjusts the processing and networking speeds using four controls: application scheduling, CPU speed control, wireless interface selection, and transmit power control. Through invoking the Lyapunov drift-plus-penalty technique, the scheme is demonstrated to be near optimal because it substantially reduces energy consumption for a given delay constraint. This paper is the first to reveal the energy--delay tradeoff relationship from a holistic perspective for smartphones with multiple wireless interfaces, DVFS, and multitasking capabilities. The trace-driven simulations based on real measurements of CPU power, network power, WiFi/3G throughput, and CPU workload demonstrate that SpeedControl can reduce battery usage by more than 42% through trading a 10 minutes delay when compared with the same delay in existing schemes; moreover, this energy conservation level increases as the WiFi coverage extends.

Heterogeneity in global gene expression profiles between biopsy specimens taken peri-surgically from primary ER-positive breast carcinomas.

BackgroundGene expression is widely used for the characterisation of breast cancers. Variability due to tissue heterogeneity or measurement error or systematic change due to peri-surgical procedures can affect measurements but is poorly documented. We studied the variability of global gene expression between core-cuts of primary ER+ breast cancers and the impact of delays to tissue stabilisation due to sample X-ray and of diagnostic core cutting.MethodsTwenty-six paired core-cuts were taken immediately after tumour excision and up to 90 minutes delay due to sample X-ray; 57 paired core-cuts were taken at diagnosis and 2 weeks later at surgical excision. Whole genome expression analysis was conducted on extracted RNA. Correlations and differences were assessed between the expression of individual genes, gene sets/signatures and intrinsic subtypes.ResultsTwenty-three and 56 sample pairs, respectively, were suitable for analysis. The range of correlations for both sample sets were similar with the majority being >0.97 in both. Correlations between pairs for 18 commonly studied genes were also similar between the studies and mainly with Pearson correlation coefficients >0.6 except for a small number of genes, which had a narrow-dynamic range (e.g. MKI67, SNAI2). There was no systematic difference in intrinsic subtyping between the first and second sample of either set but there was c.15 % discordance between the subtype assignments between the pairs, mainly where the subtyping of individual samples was less certain. Increases in the expression of several stress/early-response genes (e.g. FOS, FOSB, JUN) were found in both studies and confirmed findings in earlier smaller studies. Increased expression of IL6, IGFBP2 and MYC (by 17 %, 14 % and 44 %, respectively) occurred between the samples taken 2 weeks apart and again confirmed findings from an earlier study.ConclusionsThere is generally good correlation in gene expression between pairs of core-cuts except where genes have a narrow dynamic range. Similar correlation coefficients to the average gene expression profiles of intrinsic subtype, particularly LumA and LumB, can lead to discordances between assigned subtypes. Substantial changes in expression of early-response genes occur within an hour after surgery and in IL6, IGFB2 and MYC as a result of diagnostic core-cut biopsy.Trial registrationTrial number CRUK/07/015. Study start date September 2008.Electronic supplementary materialThe online version of this article (doi:10.1186/s13058-016-0696-2) contains supplementary material, which is available to authorized users.

Conditioned context aversion learning in the laboratory mouse.

It is well known that pairing of large contextual changes with illness can cause conditioned context aversion in laboratory rats. The aim of present study was to develop a paradigm to study this phenomenon in laboratory mice, a species widely employed in neurobehavioral studies. Genetically heterogeneous mice, drinking from plastic bottles in the colony room, learned to avoid glass bottles after a single conditioning trial when drinking from these was paired with injections of lithium chloride. The aversion was independent of any difference in the taste of water in plastic vs. glass bottles. When the variation in the visual stimulus was less distinct, development of a strong aversion required two conditioning trials and was not retained as well. The results also showed that conditioned context aversion, just like conditioned taste aversion, could also be developed across a 30-minute CS-UCS delay. The fact that taste was not a factor in distinguishing drinking from glass and plastic water bottles raises the possibility that, contextual stimuli, not taste, may have been the CS when rats (in Garcia's original experiments) avoided drinking from plastic bottles that had been paired with radiation. The development of contextual aversion conditioning protocols for mice will enable the molecular resources available for this species to be exploited. Furthermore, representation of the CS by discrete rather than the multimodal CSs typically used in most studies on contextual conditioning offers more focus when considering its neuroanatomical basis.

Association Between Time to Reperfusion and Outcome Is Primarily Driven by the Time From Imaging to Reperfusion.

A progressive decline in the odds of favorable outcome as time to reperfusion increases is well known. However, the impact of specific workflow intervals is not clear. We studied the mechanical thrombectomy group (n=103) of the prospective, randomized REVASCAT (Randomized Trial of Revascularization With Solitaire FR Device Versus Best Medical Therapy in the Treatment of Acute Stroke due to Anterior Circulation Large Vessel Occlusion Presenting Within Eight Hours of Symptom Onset) trial. We defined 3 workflow metrics: time from symptom onset to reperfusion (OTR), time from symptom onset to computed tomography, and time from computed tomography (CT) to reperfusion. Clinical characteristics, core laboratory-evaluated Alberta Stroke Program Early CT Scores (ASPECTS) and 90-day outcome data were analyzed. The effect of time on favorable outcome (modified Rankin scale, 0-2) was described via adjusted odds ratios (ORs) for every 30-minute delay. Median admission National Institutes of Health Stroke Scale was 17.0 (14.0-20.0), reperfusion rate was 66%, and rate of favorable outcome was 43.7%. Mean (SD) workflow times were as follows: OTR: 342 (107) minute, onset to CT: 204 (93) minute, and CT to reperfusion: 138 (56) minute. Longer OTR time was associated with a reduced likelihood of good outcome (OR for 30-minute delay, 0.74; 95% confidence interval [CI], 0.59-0.93). The onset to CT time did not show a significant association with clinical outcome (OR, 0.87; 95% CI, 0.67-1.12), whereas the CT to reperfusion interval showed a negative association with favorable outcome (OR, 0.72; 95% CI, 0.54-0.95). A similar subgroup analysis according to admission ASPECTS showed this relationship for OTR time in ASPECTS<8 patients (OR, 0.56; 95% CI, 0.35-0.9) but not in ASPECTS≥8 (OR, 0.99; 95% CI, 0.68-1.44). Time to reperfusion is negatively associated with favorable outcome, being CT to reperfusion, as opposed to onset to CT, the main determinant of this association. In addition, OTR was strongly associated to outcome in patients with low ASPECTS scores but not in patients with high ASPECTS scores. URL: http://www.clinicaltrials.gov. Unique identifier: NCT01692379.

Abstract 147: ECG to Decision Time - Small Delays Deciding to Transfer a STEMI Patient Adds Much Larger Delays to Reperfusion Time

Background: Non-PCI capable facilities are faced with a time critical challenge to transfer a STEMI patient to a PCI capable hospital for Primary PCI within 120 minutes of first medical contact. Once a 12-Lead ECG is obtained and printed, a period of time elapses before STEMI is recognized, and a decision is made to transfer the patient for Primary PCI. It seems logical that the ECG-to-Decision time should not impact the subsequent Decision-to-PCI time. We evaluated the impact of the time spent from ECG-to-Decision time on the subsequent Decision-to-PCI time. Methods: Data was combined, and retrospectively analyzed on 157 consecutive STEMI cases first identified at 32 non-PCI capable facilities, and transferred to one of two different PCI capable hospitals located in either Duluth, Minnesota, or Fargo, North Dakota. There were 124 cases from September 2013 through February 2015 at one hospital, and 33 cases from May 2013 through February 2015 at the other. Decision time was defined by the call time for inter-facility transport for Primary PCI, or the call time to the PCI capable hospital to request activation of the Cath Lab. Findings: 30% of patients had an ECG-to-Decision time of less than 5 minutes, with mean &amp; median Decision-to-PCI times of 93 min. &amp; 86 min. (range 38-231; SD = 34.8). Another 30% of patients had an ECG to Decision time between 5 to 9 minutes, with mean &amp; median Decision-to-PCI times of 102 min. &amp; 103 min. (range 46 - 158; SD = 23.3). 40% of patients had an ECG-to-Decision time of 10 minutes or greater, with mean &amp; median Decision-to-PCI time of 131 &amp; 124 minutes (range 58 - 239; SD = 47.9). For a 5-9 minute delay in ECG-to-Decision time, an additional 17 minute delay was added to the median Decision-to-PCI time. If the ECG-to-Decision time was delayed 10 minutes or more, an additional 38 minute delay was added to the median Decision-to-PCI time. Conclusion: We observed an escalating impact of delay on Decision-to-PCI time as the result of smaller increases in delay of ECG-to-Decision time. Our data suggests that a realistic goal for ECG-to-Decision time of under 5 minutes should be considered for non-PCI capable facilities, to avoid escalating delays in Primary PCI time for STEMI patients.

Application of pyrolysis process in processing of mixed food wastes

Abstract The food industry produces large amounts of solid and also liquid wastes. Different waste materials and their mixtures were pyrolysed in the laboratory pyrolysis unit to a final temperature of 800°C with a 10 minute delay at the final temperature. After the pyrolysis process of the selected wastes a mass balance of the resulting products, off-line analysis of the pyrolysis gas and evaluation of solid and liquid products were carried out. The highest concentration of methane, hydrogen and carbon monoxide were analyzed during the 4th gas sampling at a temperature of approx. 720–780°C. The concentration of hydrogen was measured in the range from 22 to 40 vol.%. The resulting iodine numbers of samples CHFO, DS, DSFW reach values that indicate the possibility of using them to produce the so-called “disposable sorbents” in wastewater treatment. The WC condensate can be directed to further processing and upgrading for energy use.

Abstract 2: Good Outcome After Successful Recanalization is Time Dependent in the Swift Prime Randomized Controlled Trial

Background and Purpose: The SWIFT PRIME trial demonstrated superior outcomes in patients presenting with disabling acute ischemic stroke (AIS) who underwent endovascular therapy vs. intravenous tissue plasminogen activator (t-PA) alone. We sought to understand the relationship between functional independence and time to reperfusion in study patients assigned to thombectomy. Methods: SWIFT PRIME is a global, multi-center, prospective, randomized, open, blinded endpoint study comparing functional outcomes in AIS subjects treated with either IV t-PA alone or IV t-PA in combination with Solitaire stent retriever device. Among patients in whom substantial reperfusion (TICI 2b/3) was achieved, we analyzed the effect onindependent outcome (mRS 0-2) of time from stroke onset to reperfusion (OTR) and from qualifying imaging to reperfusion Results: Among 83 patients undergoing thrombectomy, substantial reperfusion was achieved in 73 (88%). A marked effect of OTR was noted (Figure 1A). The rate of functional independence was 87% if reperfusion was achieved 150 minutes from symptoms onset. The absolute rate of good outcomes decreased by 10% over the next 60 minutes of delay in OTR and by 15% with every 60 minute delay there-after. Faster post-arrival workflow speed improved outcomes among patients presenting directly to study hospitals (Figure 1B). Conclusions: Speed of reperfusion is a dominant determinant of functional outcome among patients treated with stent retrievers. In the early period after, every 6 minute delay in reperfusion causes 1 more out of 100 treated patients to not achieve functional independence.

Abstract TP304: Use, Time Delay and Outcomes of the Drip-and-Ship Thrombolysis Paradigm for Patients With Acute Ischemic Stroke

Introduction: The utilization of drip-and-ship thrombolysis paradigm, clinical characteristics and outcomes of patients treated with the paradigm could vary with regional stroke care system. Hypothesis: We hypothesized that clinical characteristics and functional outcomes of patients treated with drip-and-ship paradigm would be different from those of patients treated via direct visit. Methods: From a multicenter stroke registry, we identified acute ischemic stroke patients treated with tPA who arrived hospital within 6 hours from the symptom onset. Functional outcomes at three months after the stroke were classified as favorable (modified Rankin Scale score [mRS] 0 to 1) or unfavorable (mRS 2-6). Using multivariable analysis, we compared the modified Rankin scale (mRS) score at 3 months and symptomatic intracranial hemorrhages (SICH) between patients treated with drip-and-ship paradigm and those treated via direct visit. Results: Among 1,843 patients who met the eligible criteria, 244 patients (13.2%; 95% CI, 11.7-14.9) were treated using drip-and-ship paradigm. Patients treated with drip-and-ship paradigm had shorter onset to needle time compared with patients treated via direct visit (median[IQR], 110 minutes[79-150] vs 126 minutes[90-173], p&lt;0.001). After multivariable analysis, patients treated with drip-and-ship paradigm had significantly greater risk of unfavorable functional outcome (mRS 2-6) at 3 months after the stroke compared with patients treated via direct visit (OR 2.15; 95% CI, 1.50-3.08; p &lt; 0.001). SICH also occurred more frequently in patients treated with drip-and-ship paradigm (OR 1.78; 95% CI, 1.02-3.12; p =0.04). Of 1,843 patients, 509 patients (27.6%, 71 patients with drip-and-ship paradigm and 438 patients via direct visit) received subsequent endovascular recanalization therapy. The use of drip-and-ship paradigm caused approximately 105 minute delay in onset to groin puncture time compared with those treated via direct visit (305 minutes[260-345] vs 200 minutes[155-245], p&lt;0.001). Conclusions: Drip-and-ship thrombolysis paradigm was used in less than 15% of patients treated with tPA, and use of the paradigm caused a significant delay in onset to groin puncture time for endovascular therapy.

Thrombus Aspirated from Patients with ST-Elevation Myocardial Infarction: Association between 3-Nitrotyrosine and Inflammatory Markers - Insights from ARTERIA Study.

Recent studies have demonstrated that inflammatory cells are a component that plays a role in thrombus formation in ST-elevation myocardial infarction (STEMI). 3-nitrotyrosine (3-NO2-Tyr), a specific marker for protein modification by nitric oxide-derived oxidants, is increased in human atherosclerotic lesions. The purpose of this study was to determine the possible association of inflammatory markers of coronary thrombi with nitroxidative stress. Intracoronary thrombus (n=51) and blood from the systemic circulation were obtained by thromboaspiration in 138 consecutive STEMI patients presenting for primary percutaneous coronary intervention (PCI). Each blood and intracoronary thrombus were measured simultaneously the following biomarkers: C-reactive protein (CRP), 3-NO2-Tyr, soluble CD 40 ligand (sCD40L), vascular cellular adhesion molecule-1 (VCAM-1) and haemoglobin content (only in coronary thrombus).Time delay in minutes from symptom onset to PCI was 244 ± 324. Serum CRP was positively correlated to CRP content in the thrombus (r= 0.395; p = 0.02) and serum sCD40L was negatively correlated to sCD40L in the thrombus (r= -0.394; p = 0.02). Patients were divided into tertiles according to thrombi 3-NO2-Tyr concentration: 1sttertile (<0.146ng/mg), 2ndtertile (0.146-0.485ng/mg) and 3rdtertile (>0.485ng/mg). Thus, thrombus in the highest tertile had significantly higher levels of CRP (p=0.002), VCAM-1 (p=0.003) and haemoglobin (p=0.002). In conclusion, the present study demonstrated that coronary thrombi with higher levels of 3-NO2-Tyr content often contain more inflammatory markers which could have a direct impact on the efficacy of drugs or devices used for coronary reperfusion.

THE EFFECTIVENESS OF TELEMEDICINE IN HEALTH CARE PROVISION DURING AUTONOMOUS TRIPS

The objective of the present paper is to evaluate telemedicine sessions involving onboard medical specialists on trip and medical specialist at coastal bases upon using different hardware and operation modes. It is found that the standard shipborne hardware and the videoconference platform POLYCOM allow real-time communication at an acceptable sound and image quality only when distances between ships and coastal bases are small. BGAN INMARSAT portable satellite-mediated communication station and INMARSAT communication channel provide for better sound and image quality at greater distances, but with a 15-minute delay. The complimentary employment of telephone communication makes it possible to obtain advices from qualified specialists residing at coastal bases.

Perbandingan Penyangatan Senyawa Pengontras Nano Partikel Emas Dendrimer Poly (Amidoamine) Konsentrasi dan Delay Time Berbeda pada Hepar Tikus dengan Pemeriksaan Computed Tomography

Background: Computed tomography (CT) is one of the diagnostic imaging tool that is most commonly available in hospitals today. But unlike Magnetic Resonance Imaging (MRI) and nuclear medicine imaging modalities, CT has not been considered as a molecular imaging modality because it does not have a specifc-targeted contrast agents. Diagnostic quality of CT scans can be improved by using specifc-targeted contrast agents. Gold nanoparticles (AuNPs) can be used as X-ray contrast agents that can overcome some of the limitations of the iodine-based contrast agents. Higher atomic numbers than iodine and its ability to be able to bind to the dendrimer support that AuNPS could be developed as a specifc-targeted contrast agents.Objectives: The purpose of this study was to determine the enhancement relationship of AuNPs-Poly(amido)amine in the rat liver with di?erent concentration and delay time on CT scans.Materials and Methods: This research is an experimental study with a statistical analysis to determine enhancement di?erences on rat liver given AuNPs-PAMAM with di?erent concentration and delay time. The samples were divided into 4 groups, each consisting of 6 rats. The independent variables in this study were the delay time and the concentration of AuNPs-PAMAM, the dependent variables was the enhancement on rat liver.Results: The results obtained showed that the average value enhancement of AuNPs-PAMAM is highest in 10 minutes delay time at a concentration of 1 mg/dL. Statistical analysis showed that there were signifcant di?erences between AuNPs-PAMAM contrast enhancement in the rat liver with di?erent concentration and delay time on CT scan with p-value less than alpha (0.000 &lt;0.05).Conclusions: Concentration and delay time contribute to the average value enhancement of AuNPs-PAMAM contrast agent on CT scan. This new type of contrast agent can be further developed as a more specifc-targeted contrast agent for CT scan examination.

Five-year evolution of reperfusion strategies and early mortality in patients with ST-segment elevation myocardial infarction in France.

To assess 5-year evolutions in reperfusion strategies and early mortality in patients with ST-segment elevation myocardial infarction. Using data from the French RESCUe network, we studied patients with ST-segment elevation myocardial infarction treated in mobile intensive care units between 2009 and 2013. Among 2418 patients (median age 62 years; 78.5% male), 2119 (87.6%) underwent primary percutaneous coronary intervention and 299 (12.4%) pre-hospital thrombolysis (94.0% of whom went on to undergo percutaneous coronary intervention). Use of primary percutaneous coronary intervention increased from 78.4% in 2009 to 95.9% in 2013 ( Ptrend<0.001). Median delays included: first medical contact to percutaneous coronary intervention centre 48 minutes; first medical contact to balloon inflation 94 minutes; and percutaneous coronary intervention centre to balloon inflation 43 minutes. Times from symptom onset to first medical contact and first medical contact to thrombolysis remained stable during 2009-2013, but times from symptom onset to first balloon inflation, and first medical contact to percutaneous coronary intervention centre to first balloon inflation decreased ( P<0.001). Among patients with known timings, 2146 (89.2%) had a first medical contact to percutaneous coronary intervention centre delay ⩽90 minutes, while 260 (10.8%) had a longer delay, with no significant variation over time. Primary percutaneous coronary intervention use increased over time in both delay groups, but was consistently higher in the ⩽90 versus >90 minutes delay group (83.0% in 2009 to 97.7% in 2013; Ptrend<0.001 versus 34.1% in 2009 to 79.2% in 2013; Ptrend<0.001). In-hospital (4-6%) and 30-day (6-8%) mortalities remained stable from 2009 to 2013. In the RESCUe network, the use of primary percutaneous coronary intervention increased from 2009 to 2013, in line with guidelines, but there was no evolution in early mortality.

Cortisol and stimulus-induced arousal level differentially impact memory for items and backgrounds

ABSTRACTMost studies examine the effects of stress on memory for visual information test memory for entire scenes. However, arousal levels may differentially influence memory for backgrounds as opposed to items. Participants encoded scenes that included a negative-high-arousal, negative-moderate-arousal, or neutral item on a neutral background. After a 30-minute (Experiment 1) or 48-hour delay (Experiment 2), participants underwent a stressor or control task while heart rate was recorded. A recognition memory task was then given with items and backgrounds presented separately. High-arousal images had a greater detriment in background memory than moderate-arousal images. Further, though there was evidence that change in cortisol level at retrieval was associated with impaired memory for items, it was not associated with detriments in background memory. Increased heart rate was associated with impaired memory for both items and backgrounds. This suggests that the level of sympathetic and cortisol reactivity differentially affects memory for items and backgrounds.

Abstract 10436: The Association of Time to First Epinephrine Administration With Neurological Outcomes in Out of hospital Cardiac Arrest in Japan: Sos-kanto 2012 Study Report

Introduction: The clinical effectiveness of the timing of first epinephrine administration (EA) including prehospital setting has not been established, especially in regards to neurological outcomes in patients subsequently receiving intensive care after admission. Study Objectives: The aim of this study was to evaluate the effectiveness of time to first EA on neurological outcomes following OHCA. Methods: This was a multicenter retrospective cohort study in Japan from January 2012 to March 2013. We used data from the Survey of Survivors after Cardiac Arrest in the Kanto Area in 2012 (SOS-KANTO 2012) database. All adult patients who were registered in this database and were administered epinephrine were included; unwitnessed OHCA and initial asystolic rhythms were excluded. Collected variables included age, gender, activities of daily living, witnessed status, bystander CPR, first documented rhythm, cause, and intensive care after admission. Multivariate logistic regression was performed to investigate the association between time to first EA and 1) ROSC, 2) 1-month survival, and 3) 1-month favorable neurological outcome. Results: Of 16,452 OHCAs, 5,281 met the inclusion criteria (male, 63.1%; mean age, 71.5 years). Mean time between call to first EA is 33.7min. 1,501patients (28.4%) had ROSC. Multivariate logistic regression showed that the earlier the EA, the better chance of ROSC if initial documented rhythm was both VF/VT (adjusted odds ratio [OR] for one minute delay, 0.98; 95% confidence interval [CI], 0.97-0.99) and Asystole/PEA (adjusted OR, 0.97; 95%CI, 0.97-0.98). In contrast, the earlier the EA, the better chance of 1-month survival if initial documented rhythm was only Asystole/PEA (adjusted OR, 0.95; 95%CI, 0.93-0.98). There were no significant differences between early EA and good neurological outcomes (VF/VT, 1.01 [95% CI, 0.97-1.04] and Asystole/PEA, 1.01 [95% CI, 0.96-1.05]). Conclusions: If initial documented rhythm was VF/VT, early EA was associated with increased chance of only ROSC. In contrast, early EA was associated with increased chance of ROSC and 1 month survival if initial documented rhythm was Asystole/PEA. Time to first EA was not associated with good neurological outcomes in any initial documented rhythm.

The Relationship between Emergency Response Time and Out-Of-Hospital Cardiac Arrest Prognosis: A Meta-Analysis

Objective To assess the relationship between emergency response time and prognosis of patients with out-of-hospital cardiac arrest. Design Systematic review. Methods Relevant observational studies were identified by a search of PubMed and ISI databases to 30 January 2014. Primary outcome was survival to discharge. The weighted mean differences (WMD) for response time were calculated for those survivals to discharge and death in hospital. We also carried out a dose response meta-analysis for assessing summary odds ratio (OR) of survival by response time. Results A total of 13 studies with 804,998 patients included in the meta-analysis. The WMD of response time between survivals to discharge group and death in hospital group was 1.976 (95% confidence interval [CI] = 1.161-2.792; p&lt;0.001). Sensitivity analyses by only included prospective cohorts showed the WMD of response time between two groups was 1.115 (95% CI=0.508-1.723; p&lt;0.001). Dose-response relationship between response time and survival to discharge risk was observed statistically significant (χ2=39.86, p&lt;0.001). In linear model, the summary OR was 0.914 (95% CI=0.889-0.940) for every 1 minutes delay in response time. In spline model, the survival OR decreased along with the response time, especially when response time less than 7 minutes. Conclusions Emergency response time is an important risk factor for prognosis after OHCA in adults. The EMS team must arrive as soon as possible to the site of the event. (Hong Kong j.emerg.med. 2015;22:345-351)

Differential Effects of Music and Video Gaming During Breaks on Auditory and Visual Learning.

The interruption of learning processes by breaks filled with diverse activities is common in everyday life. This study investigated the effects of active computer gaming and passive relaxation (rest and music) breaks on auditory versus visual memory performance. Young adults were exposed to breaks involving (a) open eyes resting, (b) listening to music, and (c) playing a video game, immediately after memorizing auditory versus visual stimuli. To assess learning performance, words were recalled directly after the break (an 8:30 minute delay) and were recalled and recognized again after 7 days. Based on linear mixed-effects modeling, it was found that playing the Angry Birds video game during a short learning break impaired long-term retrieval in auditory learning but enhanced long-term retrieval in visual learning compared with the music and rest conditions. These differential effects of video games on visual versus auditory learning suggest specific interference of common break activities on learning.

A Smart/Efficient Method to Facilitate Highway Pedestrian Protection

Background/Objectives: To ensure pedestrian safety in highways predominantly at night. Application: By introducing piezoelectric sensors embedded on highways, which automates the notification lamps that help both pedestrian and drivers to know each other’s presence. Methods/Statistical Analysis: The basic method we implement is getting the feed of digital HIGH and digital LOW from the piezoelectric crystals. The state of the pedestrian cross decides the output signal of the notification lamp. This helps the fast drivers on the highway to adjust their acceleration with prior alert of movement on the road. The prototype result with few minutes delay of glowing, the notification lamp can be set in real time with little more depending on the length of the cross. Findings: The night time travelers on the highway have the difficulty of vision due to optical problems of the front vehicle glass. The irritation due to high beam of the opposite vehicles distract the proper vision of the road. The pedestrians from local area are becoming a casualty of this situation. And the speed at which the drivers come is not possible to reduce in small period of time. Prior alert is required for this.