Circumstances Of Use Research Articles

Simulation of elastic guided waves in concrete structures: A parametric study for construction materials

Concrete buildings constructed globally are susceptible to diverse circumstances of use and exposure to environmental elements. Diverse varieties of construction materials are used in the building sector to fabricate edifices and constructions. Architects and construction project managers use these classifications of materials and products to precisely determine the materials and techniques employed in building projects. This study presents a simulation of elastic guided waves in concrete structures, which is motivated by the vast variety of uses of such structures. The elastic-guided wave technique is a technology used for nondestructive assessment. This approach utilizes acoustic waves that travel along an extended structure, directed by its limits. This enables the propagation of waves over a significant distance while minimizing energy dissipation. Currently, the Elastic guided wave method is extensively used for the examination and evaluation of various engineering structures, namely for inspecting metallic pipelines globally. From a single place, it is possible to investigate distances of several hundred meters in some instances. Additionally, there are apps available for the examination of rail tracks, rods, and metal plate constructions. In this research, a novel mathematical model is introduced for accurately replicating elastic guided waves in concrete structures in practical applications. To reinforce the current concrete structure using mathematics, graphene oxide powders with improved mechanical properties are obtained using the role of the mixture, and the Halpin-Tsai micromechanical model is used. After obtaining the mathematical modeling of the current concrete structure using the theory of shear deformation with four unknown high-order terms and Hamilton’s principle, the equations are solved using free and forced wave propagation approaches. Finally, some applicable suggestions for improving the efficiency and dynamic stability of the presented concrete structure reinforced by graphene oxide powders are presented in detail in the results section.

“Once upon a time [...]”: Stimulating management research through vignettes

This methodological essay aims to present and reflect on some aspects to be considered when constructing and using vignettes as a data collection instrument. Characteristics, advantages and possible limitations of vignettes, practical circumstances of use, and frequently used formats are presented. These jointly-addressed aspects contribute to using vignettes in research in Administration, regardless of the perspective of the studies. As the vignette is a data collection instrument fairly used in Administration, this article can guide future researchers serving as a source for those more interested in understanding the characteristics of carrying out a study using vignettes.

Usability of a mobile application for the clinical follow-up of patients with chronic obstructive pulmonary disease and home oxygen therapy

BackgroundTechnological health tools (e-Health) may potentially facilitate the treatment of patients with chronic diseases through development of self-management and -care skills in patients and caregivers. However, these tools are usually marketed without prior analysis and without providing any context to final users, which frequently results in low adherence to their use. PurposeTo determine the usability of and satisfaction toward a mobile app for the clinical monitoring of patients with chronic obstructive pulmonary disease (COPD) receiving oxygen therapy at home. MethodsThis was a participative-qualitative study focused on final users—with direct intervention by patients and professionals—consisting of three phases as follows: (i) medium-fidelity mockups design, (ii) development of a usability test for each user profile, and (iii) assessment of the satisfaction level regarding the usability of the mobile app. A sample was established and selected through non-probability convenience sampling and was divided into two groups as follows: healthcare professionals (n = 13) and patients (n = 7). Each participant received a smartphone with mockup designs. The “think-aloud” method was applied in the usability test. Participants were audio recorded and the anonymous transcriptions were analyzed, highlighting fragments about mockups characteristics and the usability test. The difficulty level of the tasks was assessed with a scale from 1 (very easy) to 5 (too difficult), and task non-completion was considered a critical mistake. The satisfaction level related to test usability was assessed with a 4-score Likert scale ranging from 4 (totally agree) to 1 (totally disagree). ResultsRegarding the difficulty level, >60% of professionals described most tasks as “very easy” and 70% of patients as “easy.” No participant made critical mistakes and both groups reported a high satisfaction level regarding the usability variables. The patient and professionals group required 18 and 11 min to complete all tasks, respectively. ConclusionsParticipants described the app as intuitive and easy to use. The usability satisfaction results show a high level of satisfaction for both groups. This positive assessment and performance in user tests showed that the mobile application was able to be apprehended and used by participants in the circumstances of use in the usability tests. Usability evaluation through satisfaction surveys and qualitative data analysis allows for greater insight into the use of mobile applications in healthcare.

Alcohol use disorder treatment delivered outside hepatology clinic.

Alcohol use disorder treatment delivered outside hepatology clinic.

Aged spaces in an era of austerity: Food bank use by older people

AbstractIn the context of austerity and the COVID‐19 pandemic, this paper draws on 17 interviews conducted with frontline staff and volunteers to explore the use of food banks by older people in a highly deprived North‐West borough. Despite high levels of poverty amongst this age group, older people are infrequent users of food banks and it is their absence from these spaces, as opposed to their use of and experiences within food banks, that has often gained attention. By foregrounding this age group, this paper highlights different circumstances of use, generational dynamics involving heightened feelings of shame, and how food banks function as social spaces for older people. In doing so, this paper adds to literature in gerontology around spaces of ageing, as well as research on food banks, by highlighting how experiences in these spaces are differentiated by age. This paper advances discussions around the impact of austerity on the everyday lives of older people. Due to the timing of this research, it also gives insight into how older people and informal social spaces have been affected by the COVID‐19 pandemic.

Epidemiological profile of pesticide poisoning cases in the State of Sergipe, Brazil: a retrospective analysis from 2007 to 2021

We aimed to characterize the epidemiological profile of reported cases of pesticide poisoning in the state of Sergipe between 2007 and 2021. Secondary data were obtained from the National Database of Notifiable Diseases Information System (SINAN) and National Toxicological Information System (SINITOX), through the Department of Informatics of the Unified Health System (DATASUS) and analysis performed using the free tool Google Sheets. During the studied period, 960 cases of exogenous pesticide poisoning were registered in the state. The municipality of Aracaju had the highest percentage of the number of cases. The incidence prevailed in females, in the 20-39 age group, in the brown race and among those with incomplete primary education. The most used toxic agent was rodenticide, suicide attempt predominated as a circumstance of use. Most cases resulted from a single acute exposure, confirmed by the clinical-epidemiological method, and evolved to a cure without sequelae. This study traced the epidemiological profile of the State of Sergipe with regard to the intoxication of the population and, in addition, brought little explored data and information that directly impacts policies aimed at reducing morbidity and mortality resulting from the use of pesticides.

Regarding normothermic regional perfusion: Arguing by insistence is not a strong argument

Regarding normothermic regional perfusion: Arguing by insistence is not a strong argument

Clamping cerebral circulation—breach of the dead donor rule?

To the Editor, As a former medical director of lung transplantation and ICU physician for 30 years, I know, firsthand, the importance of maximizing organ donation for dying patients. This must always be done with utmost respect for the life of the donor. I believe some of the arguments and assertions made by Parent et al.1Parent B Caplan A Moazami N Montgomery RA. Response to American College of Physician’s statement on the ethics of transplant after normothermic regional perfusion.Am J Transplant. 2022; (10.1111/ajt.16947): 1-4Google Scholar on normothermic regional perfusion (NRP) are worthy of scrutiny and deeper conversation. The authors challenge the “statement of concern” regarding NRP published in 2021 by the American College of Physicians (ACP).2American College of Physicians Ethics, determination of death, and organ transplantation in normothermic regional perfusion (NRP) with controlled donation after circulatory determination of death (cDCD): American College of Physicians Statement of Concern. https://www.acponline.org/acp_policy/policies/ethics_determination_of_death_and_organ_transplantation_in_nrp_2021.pdf. Published 2021. Accessed February 12, 2022.Google Scholar The authors explain that the practice of controlled Donation after Circulatory Determination of Death using NRP (cDCD NRP) is well established in many countries. Yet the ethical boundaries of this practice must be considered in the context of each country’s legal definition of death and the dead donor rule. Confusion, in my opinion, revolves around the ambiguity of the use of the terms circulation and resuscitation. Generally, when we use extracorporeal membrane oxygenation (ECMO) to supply the human body with systemic circulation, it is for the purpose of resuscitation and sustaining life. In the circumstances of use of ECMO for NRP, are these two practices suddenly completely distinct? The crux of the authors’ argument is that the person has been declared dead, and, therefore, the re-establishment of systemic circulation is only to preserve the organs and save them from warm ischemic injury. Yet part of the procedure is to add the unique intervention of occlusion of cerebral circulation to prevent the possibility of neuronal activity in the brain, which would obviously create (as the authors write) “questions around the circulatory determination of death.” Precisely. The dead donor rule (DDR) states that a patient cannot be killed by, or for, organ procurement. To justify this added procedure of clamping circulation to the brain itself, the authors feel compelled to explain: “The brain remains a ‘black box’ and the degree or extent of neuronal death cannot be ascertained.” The clamping of circulation is obviously to ensure brain death, yet the authors repeatedly state the DDR is not violated because the patient has been declared dead. Because brain death is, by definition, the cessation of all brain activity, is not this “circulatory” logic? A tautology? Is the re-establishment of circulation a violation of the donor’s DNR order? Indeed, one could argue that with systemic circulation re-established and a question of ongoing neuronal activity (as posed by the authors), the donor could at that point even be sent back to the ICU to determine brain activity over the next 24 to 48 h, as is common practice when we are attempting to establish brain death. Do the authors believe that a procedure to clamp cerebral circulation to cut-off flow to a human brain is worthy of a great deal more consideration before we “update the legal definition of death?” The authors of this manuscript have no conflicts of interest to disclose as described by the American Journal of Transplantation.

PM 7/40 (5) Globodera rostochiensis and Globodera pallida

PM 7/40 (5) <i>Globodera rostochiensis</i> and <i>Globodera pallida</i>

Valuing Personal Consumption: Cost Versus Value and the Impact of Insurance

"An ideal income tax would perhaps differentiate among individuals according to their talents for using funds in consumption; but ... income taxes must [be based upon] measurable quantities! ... [c]onsumption, as an element of income, must be measured ... by outlays for consumption purposes."Andy is excited. He has finally been able to get the money together for an expensive new car. After years of making do with a used car or cheaper models he is about to pick up a new $50,000 Mercedes sedan. But alas! Andy's dream of years of driving comfort are soon shattered. The car is a lemon. It is constantly in the shop for repairs wasting Andy's time and eventually costing him several thousand dollars. In the end, it never drives as well as expected.Would an ideal tax system, as Simons suggests, take some account of Andy's misfortune? Should we, if we could, somehow determine what the car is really worth and allow Andy a deduction for the difference between that amount and his outlay of $50,000? Alternatively, should we ideally allow a deduction for the extraordinary cost of repairs, the amount spent beyond what would normally be expected? Is our failure to take account of Andy's misfortune a concession to administerability rather than a matter of principle? This article explores the answer to that question as well as whether recoveries, from insurance or otherwise, should be taxable, if such losses are disallowed.There are a number of reasons why there might be a great deal of difference between the amount of enjoyment derived from a consumer purchase and the cost to the individual on the market. Consumer surplus, circumstance of use, variation in quality, events subsequent to purchase, and changes in market price may explain the discrepancy between actual enjoyment and cost.

Low-dose ketamine infusions reduce opioid use in pediatric and young adult oncology patients.

Ketamine is an NMDA-receptor antagonist with analgesic and opioid-sparing properties. Although well studied in adults, more robust evidence supporting ketamine's use for pediatric pain management is needed. This retrospective study evaluates ketamine's opioid-sparing effectiveness in pediatric and young adult oncology and hematology patients. Continuous ketamine infusions administered for pain management between 2010-2020 were reviewed. Data including demographic characteristics, oncology/hematology and pain diagnoses, concurrent pain medications, and ketamine infusions' dose and duration were collected. Opioid consumption data based on delivery via patient-controlled analgesia were collected 1 day before (D1), all days during (cumulatively named D2), and 1 day after (D3) ketamine infusions and calculated as morphine-equivalent doses (mg/kg/day). Data were reported for the entire study group as well as for distinct oncology and end-of-life categories, and short-term acute pain circumstances which included vaso-occlusive crises in hematology patients. Side effects were reviewed. Significantly lower daily opioid consumption was noted in the oncology group, while decreases were not significant in the end-of-life group and in the overall study population. The acute pain group did not show an opioid reduction associated with the ketamine infusions. A largely tolerable side-effect profile was observed, with no differences among each group's incidence. Ketamine infusions were associated with significantly reduced opioid consumption for oncology patients. The opioid-sparing effects of ketamine may vary according to clinical diagnoses and circumstances of use. Overall, low-dose ketamine infusions present an acceptable safety profile in pediatric and young adult patients; nevertheless, individual risks and benefits should be considered.

Jak uporządkować terminologiczny chaos w glottodydaktyce i po co?

How to put order into the terminological chaos in language pedagogy and what should one want to do this for?&#x0D; The terminology used in language pedagogy does not constitute a coherent system because it is not based on definitions of terms but rather on descriptions of prototypes and illustrating them with examples. As a result, different terms overlap. This is disadvantageous for discourse in language pedagogy, because it enforces terms to be redefined anew in every statement. The current article proposes a way to order and systematize terminology referring to, on the one hand, languages as viewed from the perspective of language pedagogy, and on the other, to the phenomenon of bi- and multilingualism. Based on five systematically employed criteria, a discrete set of terms has been obtained which reflect the language pedagogical (i.e. prepared from the point of view of language pedagogy) classification of languages. The first criterion allows also a bi- or multilingual person to be unambiguously distinguished from a polyglot. The first term describes someone who has acquired two or more native languages, while the second a person who has learned several or many foreign languages. The criteria of competence or of circumstances of use, which have so far been in common use, do not allow for such a clear distinction.

Management of Poisoning and Drug Overdose

Drug overdose and poisoning are leading causes of emergency department visits and hospital admissions in the United States, accounting for more than 500,000 emergency department visits and 11,000 deaths each year. This chapter discusses the approach to the patient with poisoning or drug overdose, beginning with the initial stabilization period in which the physician proceeds through the ABCDs (airway, breathing, circulation, dextrose, decontamination) of stabilization. The management of some of the more common complications of poisoning and drug overdose are summarized and include coma, hypotension and cardiac dysrhythmias, hypertension, seizures, hyperthermia, hypothermia, and rhabdomyolysis. The physician should also perform a careful diagnostic evaluation that includes a directed history, physical examination, and the appropriate laboratory tests. The next step is to prevent further absorption of the drug or poison by decontaminating the skin or gastrointestinal tract and, possibly, by administering antidotes and performing other measures that enhance elimination of the drug from the body. The diagnosis and treatment of overdoses of a number of specific drugs and poisons that a physician may encounter, as well as food poisoning and smoke inhalation, are discussed. Tables present the ABCDs of initial stabilization of the poisoned patient; mechanisms of drug-induced hypotension; causes of cardiac disturbances; drug-induced seizures; drug-induced hyperthermia; autonomic syndromes induced by drugs or poison; the use of the clinical laboratory in the initial diagnosis of poisoning; methods of gastrointestinal decontamination; methods of and indications for enhanced drug removal; toxicity of common beta blockers; common stimulant drugs; corrosive agents; dosing of digoxin-specific antibodies; poisoning with ethylene glycol or methanol; manifestations of excessive acetylcholine activity; common tricyclic and other antidepressants; seafood poisonings; drugs or classes that require activated charcoal treatment; and special circumstances for use of activated charcoal. This review contains 3 figures, 22 tables, and 198 references.

Illegal use of physical force and special means against prisoners: criminological characteristics and preventive measures

The subject. The article outlines the criminological characteristics of the ilegal use of physical force and special means against persons deprived of their liberty. The purpose of the article is confirmation or confutation of the hypothesis that the reasons for the unlawful use of force methods against convicts are related to the nature of the illegal actions of such convicts. The methodological base of the study was an analysis of 15 cases of unlawful use of physical force and special means by employees of the correctional facilities against imprisoned convicts committed in the period from 2016 to 2019. The author analyzed 12 sentences on bringing employees of the correctional facilities to criminal responsibility for the unlawful use of these forceful methods, as well as a survey of about 190 employees serving in various positions in the correctional facilities where unlawful use of force was carried out. In addition the scientific works of other authors that affect this issue were studied. The main results, scope of application. The criminological characteristics of the illegal use of physical force and special means by employees of the correctional facilities against imprisoned persons are presented. The article includes a description of such victims; a description of the circumstances of use of force; a description of the employees of the correctional facilities who allowed unlawful use of force; the reasons and conditions that contribute to the implementation of this use. Based on the above, some measures are proposed that contribute to the optimal solution of the issue of prevention of the unlawful use of force in the Russian penitentiary practice. Conclusions. The unlawful use of physical forces and special means was carried out against convicts who have destructive moral and psychological qualities, are characterized by a high degree of criminal infection, express a negative attitude towards order and conditions of serving sentences and do not obey the legal requirements of correctional staff. A generalization of the personal characteristics of employees who unlawfully use physical force and (or) special means indicating that they are characterized by positive psychological qualities in general. They strive to be guided by the regulations governing the professional activities of the penal system officer and are positively active in fulfilling their duties. The most probable reasons for the unlawful use of forceful methods of influence against convicts are related to the nature of the unlawful actions of such convicts, provocations, negative features of service due to the specifics of places of deprivation of liberty. Measures taken to prevent the occurrence of negative phenomena in domestic politics can have a positive impact on improving the functioning of the penal correction system, which is in line with legal regulations of a national and international nature.

Comparative biological properties of the four stereoisomers of difethialone, a second-generation anticoagulant rodenticide, in rats: development of a model allowing to choose the appropriate stereoisomeric ratio.

The current management of rodent pest populations is based on second-generation anticoagulant rodenticides (SGAR). These molecules, of which difethialone is part, are much more efficient than the first generation. Nevertheless, this efficiency comes with a major drawback, SGARs are tissue persistent that increases the exposure of rodent predators to them. According to its chemical structure, difethialone has four stereoisomers, whose specific inhibition potency and pharmacokinetic have never been described and might be useful to design new eco-friendly rodenticides. The study aimed to investigate the ability to inhibit anticoagulant target enzyme (VKORC1) and the pharmacokinetics in rats of the four difethialone stereoisomers in rats. We show that stereoisomers are all highly efficient to inhibit VKORC1 activity, but they have distinct initial half-life with 6.0h, 25.4h, 69.3h, and 82.3h for, respectively, E4-trans, E2-cis, E1-trans, and E3-cis stereoisomer. These results open the way of the development of eco-friendly and efficient rodenticide by mixing some of these stereoisomers. Preferential incorporation of the E4-trans stereoisomer (high inhibitory VKORC1 potency, relatively shorter liver half-life) into difethialone rodenticides baits might result in a more eco-friendly product than current commercially available difethialone formulations. In addition, we put forward modelling to help design bait according to the circumstance of use (presence of non-target species, food competition, etc.) by modulating the theorical AUC and and the theorical concentration of the product at the death of the rodent pest. Thus, this modeling might allow to diminish the use of laboratory animal in assay.

Epigenetic Regulation of Hippocampal Fosb Expression Controls Behavioral Responses to Cocaine.

Drug addiction results in part from maladaptive learning, including the formation of strong associations between the drug and the circumstances of consumption. However, drug-induced changes in gene expression underlying the saliency of these associations remain understudied. Consolidation of explicit memories occurs within the hippocampus, and we have shown that spatial learning induces expression of the transcription factor ΔFosB in hippocampus and that this induction is critical for learning. Drugs of abuse also upregulate ΔFosB in hippocampus, but the mechanism of its induction by cocaine and its role in hippocampus-dependent cocaine responses is unknown. We investigated differences in mouse dorsal and ventral hippocampal ΔFosB expression in response to chronic cocaine, because these regions appear to regulate distinct cocaine-related behaviors. We found that cocaine-mediated induction of ΔFosB was subregion-specific, and that ΔFosB transcriptional activity in both the dorsal and ventral hippocampus is necessary for cocaine conditioned place preference. Further, we characterize changes in histone modifications at the FosB promoter in hippocampus in response to chronic cocaine and found that locus-specific epigenetic modification is essential for FosB induction and multiple hippocampus-dependent behaviors, including cocaine place preference. Collectively, these findings suggest that exposure to cocaine induces histone modification at the hippocampal FosB gene promoter to cause ΔFosB induction critical for cocaine-related learning.SIGNIFICANCE STATEMENT Although cocaine addiction is driven in part by the formation of indelible associations between the drug and the environment, paraphernalia, and circumstances of use, and although this type of associative learning is dependent upon changes in gene expression in a brain region called the hippocampus, the mechanisms by which cocaine alters hippocampal gene expression to drive formation of these associations is poorly understood. Here, we demonstrate that chronic cocaine engages locus-specific changes in the epigenetic profile of the FosB gene in the hippocampus, and that these alterations are required for cocaine-dependent gene expression and cocaine-environment associations. This work provides novel insight into addiction etiology and potential inroads for therapeutic intervention in cocaine addiction.

Effective antimicrobial resistance communication: the role of information design

Getting the message across about the dangers of antimicrobial resistance (AMR) and how to prevent it is a global priority. This article discusses the role of information design in the effective communication of information about AMR, and suggests that the design process—user input, iteration and consideration of circumstances of use—is key to successful communication. To illustrate this, using material from the Otto and Marie Neurath Isotype Collection at the University of Reading, this article considers the work of Otto and Marie Neurath who developed the Isotype system for visual education in the 1920s. They collaborated with scientists, writers and illustrators to ensure that messages were both accurate and relevant for their intended audiences, so that people could make their own decisions based on factual explanation. Their use of pictograms and schematic illustrations, consistent use of colours to represent meaning, and carefully considered relationships between text and image provided a distinctive visual ‘look and feel’. The charts designed by the Neuraths to educate people about health included a series made in the 1930s for the US National Tuberculosis Association to explain the dangers of, and how to prevent TB. This article reviews how these charts were designed, including the designated role of the ‘transformer’ who worked to ensure that scientific facts were presented in an understandable form. The way of working and the verbal and graphic characteristics of the charts deserve serious consideration for effective communication of information about AMR today. Particularly relevant are the use of schematic images using scale and simplification to attract attention, the use of story-telling to engage people, not overwhelming readers with too much information, and using straightforward language. The article asserts that cross-disciplinary working is key to successful explanation about the dangers of AMR. It illustrates this with reference to a research project, influenced by the Isotype approach to public health communication, that brings together academics and practitioners in information design, architecture, ergonomics and human factors, and pharmacy in communicating information about AMR to people using community pharmacies.

Emotional Labour of Caregivers Confronted With Aggressive Brain-injured Patients

BackgroundAggressive behaviours are common with people who have suffered brain injuries and induce difficult emotions among certified nursing assistants and medical-psychological assistants who take care of them. These caregivers carry out emotional labour whose content and strategies are little known. AimThe study explores the emotional labour of certified nursing assistants and medical-psychological assistants faced with the aggressive behaviours of brain-injured patients. MethodsSemi-structured interviews were conducted with 37 caregivers. Interviews were analysed via a thematic content analysis. ResultsThe analysis shows that the emotional labour of caregivers varies in accordance with the state of “consciousness” or “non-consciousness” that they attribute to the brain-injured patient with regard to this aggressive behaviour. This is a deep acting strategy. Moreover, caregivers shut off their emotions in order not to transmit them to the patient. This surface acting has the first objective for the caregiver of maintaining control of the situation and a second objective of protecting the patient emotionally and therefore of being perceived as a “good” caregiver. Emotional labour also meets a need to preserve the professional self-image and professional status negatively affected in the interaction with the aggressive brain-injured patient. ConclusionsOur study specifies the different strategies of the emotional labour of caregivers and their circumstances of use when they are confronted with aggressive behaviour by brain-injured patients. Targeted support for this emotional labour, such as training and practical analysis, is essential for the development of care practices promoting a caring relationship.

Comparison of Perioperative Outcomes between Open, Laparoscopic, and Robotic Distal Pancreatectomy: an Analysis of 1815 Patients from the ACS-NSQIP Procedure-Targeted Pancreatectomy Database

BackgroundRobotic surgery is gaining acceptance for distal pancreatectomy (DP). Nevertheless, no multi-institutional data exist to demonstrate the ideal clinical circumstances for use and the efficacy of the robot compared to the open or laparoscopic techniques, in terms of perioperative outcomes. MethodsThe 2014 ACS-NSQIP procedure-targeted pancreatectomy data for patients undergoing DP were analyzed. Demographics and clinicopathological and perioperative variables were compared between the three approaches. Univariate and multivariable analyses were used to evaluate outcomes. ResultsOne thousand eight hundred fifteen DPs comprised 921 open distal pancreatectomies (ODPs), 694 laparoscopic distal pancreatectomies (LDPs), and 200 robotic distal pancreatectomies (RDPs). The three groups were comparable with respect to demographics, ASA score, relevant comorbidities, and malignant histology subtype. Compared to the ODP group, patients undergoing RDP had lower T-stages of disease (P = 0.0192), longer operations (P = 0.0030), shorter hospital stays (P < 0.0001), and lower postoperative 30-day morbidity (P = 0.0476). Compared to the LDP group, RDPs were longer operations (P < 0.0001) but required fewer concomitant vascular resections (P = 0.0487) and conversions to open surgery (P = 0.0068). On multivariable analysis, neoadjuvant therapy (P = 0.0236), malignant histology (P = 0.0124), pancreatic reconstruction (P = 0.0006), and vascular resection (P = 0.0008) were the strongest predictors of performing an ODP. ConclusionsThe open, laparoscopic, and robotic approaches to distal pancreatectomy offer particular advantages for well-selected patients and specific clinicopathological contexts; therefore, clearly demonstrating the most suitable use and superiority of one technique over another remains challenging.

Automated external defibrillator and operator performance in out-of-hospital cardiac arrest

AimAn increasing number of failing automated external defibrillators (AEDs) is reported: AEDs not giving a shock or other malfunction. We assessed to what extent AEDs are ‘failing’ and whether this had a device-related or operator-related cause. MethodsWe studied analysis periods from AEDs used between January 2012 and December 2014. For each analysis period we assessed the correctness of the (no)-shock advice (sensitivity/specificity) and reasons for an incorrect (no)-shock advice. If no shock was delivered after a shock advice, we assessed the reason for no-shock delivery. ResultsWe analyzed 1114 AED recordings with 3310 analysis periods (1091 shock advices; 2219 no-shock advices). Sensitivity for coarse ventricular fibrillation was 99% and specificity for non-shockable rhythm detection 98%. The AED gave an incorrect shock advice in 4% (44/1091) of all shock advices, due to device-related (n=15) and operator-related errors (n=28) (one unknown). Of these 44 shock advices, only 2 shocks caused a rhythm change. One percent (26/2219) of all no-shock advices was incorrect due to device-related (n=20) and operator-related errors (n=6). In 5% (59/1091) of all shock advices, no shock was delivered: operator failed to deliver shock (n=33), AED was removed (n=17), operator pushed ‘off' button (n=8) and other (n=1). Of the 1073 analysis periods with a shockable rhythm, 67 (6%) did not receive an AED shock. ConclusionErrors associated with AED use are rare (4%) and when occurring are in 72% caused by the operator or circumstances of use. Fully automatic AEDs may prevent the majority of these errors.