Mean Duration Of Pauses Research Articles

1163: QUALITY IMPROVEMENT INITIATIVES REDUCE CHEST COMPRESSION PAUSES DURING PEDIATRIC ECPR

Introduction: Prolonged chest compression (CC) pauses in cardiopulmonary resuscitation (CPR) are associated with worse survival during in-hospital cardiac arrests. Procedures necessary to gain access for extracorporeal CPR (ECPR) can potentially prolong CC pauses during extracorporeal membrane oxygenation (ECMO) cannulation. Implementation of targeted quality improvement initiatives to improve team communication may reduce CC pauses during pediatric ECPR. Methods: Baseline data from a pediatric intensive care unit (PICU) in a tertiary care children’s hospital demonstrated significantly longer CC pauses and lower CC fraction (CCF) during ECMO cannulation when compared to similar metrics pre-cannulation. An intervention designed to improve CC metrics during ECPR was implemented, including: 1. Sharing of baseline CC data with ECPR stakeholders 2. Standardization of counting CC pauses out loud to improve team awareness of pause length 3. Creation of a reporting aid to assist with ECPR documentation and 4. Interdisciplinary ECPR simulation sessions every other month to practice communication during cannulation. CC pause characteristics were compared pre- and post- intervention using unpaired t-tests. Results: Eleven ECPRs were analyzed pre-intervention and five ECPRs post-intervention. CC pause characteristics (mean duration of pauses, individual longest pause, and CCF) improved in both pre- and during ECMO cannulation epochs post-intervention when compared to their pre-intervention counterparts. During ECMO cannulation, mean length of CC pauses was 30 seconds (pre-intervention) vs 13 seconds (post-intervention) (p < 0.02). The longest CC pause during ECMO cannulation was 337 seconds (pre-intervention) compared with 69 seconds (post-intervention) (p = 0.03). CCF during ECMO cannulation pre-intervention and post-intervention was 68% vs 83% respectively (p = 0.03). Conclusions: CC pause metrics during the cannulation phase of pediatric ECPR improved significantly after quality improvement interventions including baseline CC data review, verbal communication of CC pause length and interdisciplinary ECPR simulations. Future aims include correlating CC pause characteristics with clinical outcomes.

The effect of cognitive load on temporal and disfluency patterns of speech

AbstractThis paper investigates how variation in the complexity of speech tasks is reflected in the temporal characteristics and disfluency patterns of speech. We examined temporal characteristics (speech rate, global articulation rate, ratio of pauses, frequency of pauses, and mean duration of pauses) and disfluency markers (overall frequency of disfluencies; frequency of filled pauses, filler words, whole-word repetitions, part-word repetitions, broken words, prolonged sounds, and revisions; frequency of disfluency clusters) in four speech production tasks (consecutive interpreting, sight translation, spontaneous speech and extemporaneous speech) with twelve speakers.Our hypothesis, according to which the examined parameters will differ across the four tasks, was partly confirmed by the data; even though not all speech tasks differed significantly in all the examined parameters, our investigation revealed that there were significant differences between some tasks in four parameters, and between others in nine out of the fourteen parameters examined. Our data also suggest that in terms of the temporal characteristics and disfluency markers examined, the four tasks can be represented on a continuum based on the cognitive load associated with each task. At one end of the continuum and generating the least cognitive load is spontaneous speech, and at the other, generating the most cognitive load, is sight translation.

Antiangiogenic Concentrations of Vinflunine Increase the Interphase Microtubule Dynamics and Decrease the Motility of Endothelial Cells

Angiogenesis is a key event in tumor progression and metastasis. This complex process, which constitutes a potent target for cancer therapy, is inhibited by very low concentrations of microtubule-targeting drugs (MTD). However, the intimate mechanisms of the antiangiogenic activity of MTDs remain unclear. Recently, we have shown that low antiangiogenic and noncytotoxic concentrations of paclitaxel induced an unexpected increase in microtubule dynamics in endothelial cells. In this study, we showed that vinflunine, the newest Vinca alkaloid, increased microtubule dynamic instability in human endothelial cells after 4-hour incubation at low concentrations (29% and 54% at 0.1 and 2 nmol/L). The growth and shortening rates were increased, and the percentage of time spent in pause and the mean duration of pauses were decreased, as previously observed with paclitaxel. As opposed to paclitaxel, the transition frequencies were not significantly disturbed by vinflunine. Moreover, low concentrations of vinflunine did not affect mitotic index and anaphase/metaphase ratio. Interestingly, these low vinflunine concentrations that increased microtubule dynamics exhibited an antiangiogenic effect through the inhibition of both morphogenesis and random motility. Capillary tube formation on Matrigel was decreased up to 44%. The cell speed and the random motility coefficient were decreased (13% and 19% and 13% and 33% at 0.1 and 2 nmol/L, respectively) and the persistent time was statistically increased. Altogether, our results confirm that the increase in microtubule dynamics is involved in MTD antiangiogenic activity and highlight the crucial role of interphase microtubule dynamics in angiogenesis.

Epidemiology, Clinical Features, and Follow-Up of Patients With Syncope and a Positive Adenosine Triphosphate Test Result

We sought to evaluate epidemiology, clinical features, and outcomes of patients with syncope and an abnormal response to adenosine triphosphate (ATP). Syncope remains of unknown origin in almost 30% of the patients. Injection of ATP induces in some of these patients, but not in control patients, a ventricular pause > or =6 s. Patients with syncope of unknown origin had an intravenous injection of 20 mg of ATP. All patients had a tilt test. Among 214 patients, 19 (8.9%) had a positive ATP test result. The proportion of positive test results was higher (p < 0.002) in women (14.3%) than in men (2.2%). Ten patients (4.7%) had positive ATP and tilt test results. These patients (exclusively women) were older (p < 0.05) at the time of their fist syncope than the 67 patients with a negative ATP test result but a positive tilt test result. There was a trend for these two test results to be correlated (p = 0.07). Side effects were of short duration and benign. The mean duration of pauses was longer in women (p = 0.009). During a mean period of 31 +/- 14 months, recurrences of syncope were reported in 25% of patients. The ATP test is a safe test with an "abnormal" result in <10% of patients with syncope of unknown origin. The profile of these patients is characteristic.

Randomised controlled trials of staged teaching for basic life support: 1. Skill acquisition at bronze stage

We have investigated a method of teaching community CPR in three stages instead of in a single session. These have been designated bronze, silver, and gold stages. The first involves only opening of the airway and chest compression with back blows for choking, the second adds ventilation in a ratio of compressions to breaths of 50:5, and the third is a conversion to conventional CPR. In a controlled randomised trial of 495 trainees we compared the performance in tests immediately after instruction of those who had received a conventional course and those who had had the simpler bronze level tuition. The tests were based on video recordings of simulated resuscitation scenarios and the readouts from recording manikins. Differences occurred as a direct consequence of ventilation being required in one group and not the other, some variation probably followed from unforeseen minor changes in the way that instruction was given, whilst others may have followed from the greater simplicity in the new method of training. A careful approach was followed by slightly more trainees in the conventional group whilst appreciably more in the bronze group remembered to shout for help (44% vs. 71%). A clear advantage was also seen for bronze level training in terms of those who opened the airway as taught (35% vs. 56%), for checking breathing (66% vs. 88%), and for mentioning the need to phone for an ambulance (21% vs. 32%). Little difference was observed in correct or acceptable hand position between the conventional group who were given detailed guidance and the bronze group who were instructed only to push on the centre of the chest. The biggest differences related to the number of compressions given. The mean delay to first compression was 63 s and 34 s, and the mean duration of pauses between compressions was 16 s and 9 s, respectively. Average performed rates were similar in the two groups, but more in the conventional group compressed too slowly whereas more in the bronze group compressed too rapidly. Observations were made for only three cycles of compression, but extrapolating these to the 8 min often considered a watershed for chances of survival for victims of cardiac arrest, an average of 308 compressions would be expected from those using conventional CPR compared with 675 for those using bronze level CPR. The implications of this difference are discussed.

TALK AND SILENCE SEQUENCES IN INFORMAL CONVERSATIONS III: INTERSPEAKER INFLUENCE

Literature on the structure of two-person conversations has consistently found that partners become more similar in mean duration of pauses and switching pauses over the course of interaction. Evidence on influence in vocalization duration is primarily negative. No direct evidence of interspeaker influence on a moment-to-moment basis is available. In this study 12 dyadic conversations are analyzed for interspeaker influence, with the use of time series regression procedures. Two versions of the data are presented: a probability summary including the probability of breaking mutual silences, continuing simultaneous talk, and continuing talking alone and a turn summary including vocalization, pause, and switching pause duration. Results show that (1) moment-to-moment influences are present in both versions of the data, (2) these influences differ from dyad to dyad, (3) the influences are both positive (matching) and negative (compensating), and (4) the magnitude of interspeaker influence on a temporal basis is small but detectable. In addition, there are overall tendencies to match in switching pause, probability of continued simultaneous speech, and probability of breaking mutual silences. Dyads show both compensation and matching on vocalization duration and pause-related variables. Implications of these data for past and future explanation of social interaction are explored.