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Survival after out-of-hospital cardiac arrest was studied in a suburban community (population 304000) before and after addition of paramedic services. During period 1 emergency medical technicians provided basic emergency care (cardiopulmonary resuscitation at the scene of collapse and during the journey to hospital). In period 2 additional care was given at the scene of collapse by paramedics capable of advanced emergency care (defibrillation, endotracheal intubation, drugs). During the 3-yr study 585 patients with cardiac arrest caused by heart disease received prehospital emergency resuscitation. Paramedic services improved the rate of live admission to the coronary-care or intensive-care unit from 19% to 34% (p less than 0.001) and the rate of discharge from 7% to 17% (p less than 0.01). The mean time from collapse to delivery of advanced emergency care was 27.5 min during period 1 with technician services, and 7.7 min during period 2 with paramedic services. Ventricular fibrillation caused cardiac arrest in nearly all patients who survived; it occurred in 91 of the 160 (57%) patients during period 1 whose rhythms were determined and in 192 of the 343 (56%) patients during period 2. The decreased time from collapse to delivery of advanced emergency care accounted for the improved survival with paramedic services.
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PMID:Out-of-hospital cardiac arrest: improved survival with paramedic services. 610 90

We have compared the effectiveness of two different mobile coronary care systems with regard to mortality from cardiac arrest (CA) outside hospital in Gothenburg, Sweden. In period 1, the mobile coronary care unit (MCCU) was part of a randomized study of the effect of an MCCU versus standard ambulances on early mortality from ischaemic heart disease. The MCCU was single, hospital based and manned by two CCU nurses and two ambulance drivers. The organization ran on workdays 08.00 a.m. to 17.00 p.m. from October, 1973 to May, 1978, corresponding to twelve months of effective time. One-year data for the MCCU have been calculated by extrapolating to a 100% allocation to the MCCU. In period 2, from November, 1980, through December, 1981, also corresponding to twelve months of effective time, the system was reorganized to a mobile intensive care unit (MICU) manned by paramedics 24 h all days of the week, and part of the time by CCU nurses. The MICU was dispatched to all suspected emergencies and the treatment capacity was defibrillation, endotracheal intubation and, part of the time, drugs. Simultaneously with the MICU, the nearest standard ambulance was dispatched and the first crew to arrive started cardiopulmonary resuscitation (CPR). Comparing the extrapolated data from period 1 with the exact data from period 2, there was an increase in period 2 of dispatches to subjects in CA due to heart disease from 59 to 181. The retrieval of subjects in ventricular fibrillation (VF) increased from 20 to 87 as a result of reduced delay times from the collapse to alarm, start of CPR and defibrillation.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Resuscitation of patients in cardiac arrest outside hospital. Comparison of two different organizations of mobile coronary care in one community. 670 2

In this paper an exact description of the observed transverse magnetization of spin 12 nuclei, coupled to quadrupolar spins which are subjected to RF irradiation, is presented. It is shown that for on-resonance CW decoupling at weak to intermediate irradiation levels, the transverse decay of the spin 12 magnetization is modulated with a period of 1/nu(2), where nu(2) is the amplitude of the decoupling irradiation. When the spin 12 signal is created as a spin echo, and the quadrupolar resonance continuously irradiated during the echo evolution, the echo amplitudes experience much stronger modulation with period 2/nu(2). In previous treatments of such spin systems, the regime of weak decoupling power was usually neglected, and approximate analytical expressions seeking to define the "adequate" or "minimal" decoupling power, necessary to achieve the collapse of the spin 12 multiplet into a single narrow line, were derived. It is demonstrated here, both by experiments and by simulations using a full Redfield formalism, that simple analytical predictions for the T(2) decay of the spin 12 magnetization are still possible, even when the scalar relaxation is not in the "fast exchange" limit and the transverse decay is considerably modulated due to insufficient decoupling power. In this case, the expected single exponential decay rate is obtained for the nonmodulated component of the signal. The theoretical solution for spin I = 12 coupled to S = 3 is derived, and results for the proton decay in (10)B-enriched sodium borocaptate in aqueous solution are presented. The effects of irradiation by several composite pulse decoupling sequences are also considered. Copyright 1999 Academic Press.
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PMID:Line narrowing of I = 12 spins coupled to quadrupolar nuclei in liquids: effects of weak decoupling fields 1052 49

The emergence, spread, and persistence of antimicrobial resistance (AMR) remains a pressing global concern. Increased promotion of commercial small-scale agriculture within low-resource settings has facilitated an increased use in antimicrobials as growth promoters globally, creating antimicrobial-resistant animal reservoirs. We conducted a longitudinal field study in rural Ecuador to monitor the AMR of Escherichia coli populations from backyard chickens and children at three sample periods with approximately 2-month intervals (February, April, and June 2017). We assessed AMR to 12 antibiotics using generalized linear mixed effects models (GLMM). We also sampled and assessed AMR to the same 12 antibiotics in one-day-old broiler chickens purchased from local venders. One-day-old broiler chickens showed lower AMR at sample period 1 compared to sample period 2 (for 9 of the 12 antibiotics tested); increases in AMR between sample periods 2 and 3 were minimal. Two months prior to the first sample period (December 2016) there was no broiler farming activity due to a regional collapse followed by a peak in annual farming in February 2017. Between sample periods 1 and 2, we observed significant increases in AMR to 6 of the 12 antibiotics in children and to 4 of the 12 antibiotics in backyard chickens. These findings suggest that the recent increase in farming, and the observed increase of AMR in the one-day old broilers, may have caused the increase in AMR in backyard chickens and children. Small-scale farming dynamics could play an important role in the spread of AMR in low- and middle-income countries.
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PMID:Impacts of small-scale chicken farming activity on antimicrobial-resistant Escherichia coli carriage in backyard chickens and children in rural Ecuador. 3178 32