Abstract: This comparative study verifies the positive effects on learning by adding tactile senses to a training system for augmented reality (AR) automated external defibrillator (AED) using smart glasses. An AR-AED training system using HoloLense was developed. Then, differences on direct experiences between learning using simple gesture recognition and with added tactile senses using surrounding objects were compared. Vividness, presence, flow, and experientiality were analyzed as points capable of enhancing learning AR and virtual reality (VR). Two groups experienced the AR AED training system and the AED training system adding tactile senses. The vividness, presence, flow, and experientiality of the AR-AED training system with added tactile senses were higher than the AR-AED training system using gesture recognition. Thus, the participants of the tactile sense-added learning group perceive virtual objects to be realer than participants of the gesture recognition-based learning group, and felt that the virtual objects existed in actual environments. Enhanced flow directly related to enhanced learning, which concludes enhanced tactile senses using actual objects affect enhanced learning. Since gesture recognition-based AR-AED training is similar to a simulated stage experience, which is like indirect experiences in the experientiality stage, tactile sense-added learning is close to the exploratory stage and spectator stage of touching and seeing objects. Thus, it is concluded that learning effects would be enhanced by adding tactile senses by connecting the training system with actual objects based on prior studies indicating that vividness, presence, flow, and experientiality have a quantitative correlation with the learning effects. This comparative study verified that tactile interaction through physical interaction with virtual objects is important in education requiring physical training and practical experience, such as AED training.
While a number of questionnaire measuring the various dimensions of bystander cardiopulmonary resuscitation (CPR) [1–4] and AED [2–7] have been published, there are few questionnaires that combine both bystander CPR and automated external defibrillator (AED) measurement [8, 9]. We reported the development and construct vali- dation (exploratory factor analysis, EFA and confirma- tory factor analysis, CFA) of a bilingual (English and local Malay language) questionnaire that comprehensively measures four objectives: (1) the perception of AED placement strategy, (2) the perception on the importance
Congenital long-QT syndrome with 2:1 atrioventricular block presenting in the perinatal period is rare, has a poor prognosis, and leads to high risk for lethal ventricular arrhythmic events. An implantable cardioverter-defibrillator seems to be the most effective treatment in the prevention of arrhythmic sudden cardiac death in patients with long-QT syndrome. Technical limitations and risks associated with implantable cardioverter-defibrillators in asymp- tomatic infants is considered too great to justify use for primary prophylaxis against sudden cardiac death. In this case report we describe the first successful parental use of an automated external defibrillator prescribed for primary prophylaxis against sudden cardiac death in an infant with long-QT syndrome.
In Japan, the placement of the automated external defibrillator (AED) has been advanced since its use by non-medical workers was approved on July 1, 2004. The total sales of AEDs in all of Japan in 2004 were 6,701 sets (H. Kondo, 2012). In 2014 the total became 636,007 sets (Japan Heart Foundation, 2016), increasing by 95 times in ten years. AEDs installed in fire departments total 15,151 sets (2.4%), in medical institutions, 104,721 sets (16.5%), and in public facilities, 516,135 sets (81.2%). By 2016, 1.37 public-access AEDs were installed per square kilometer, amounting to 4.05 AEDs per 1,000 persons (Japan Heart Foundation, 2016). According to Kitamura et al. (2010), when the number of public-access AEDs increased from less than one per square kilometer to four or more, the mean time to electroshock was reduced from 3.7 to 2.2 minutes, and the annual number of patients per 10 million populations who survived with one- month minimal neurologic impairment increased from 2.4 to 8.9. The effect of increasing public- access AEDs is clear from increasing patients who survived with the one-month minimal neurologic impairment.
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fully conditional specification method, with 10 imputations in a model including both individual- and neighborhood-level variables. Categorical variables were imputed as categorical variables, and continuous variables were imputed within the observed range of data. Variables with missing data (number missing or percentage missing) were subject race (N = 337; 24%), individual who initiated CPR (N = 1; 0.07%), first monitored rhythm (N = 1; 0.07%), sustained return of spontaneous circulation (N = 1; 0.07%), neighborhood median household income (N = 15; 1%), neighborhood educational attainment (N = 23; 2%), and neighborhood racial composition (N = 22; 2%). Additional variables used in the multiple imputation process included the following: subject age, subject sex, arrest location, witnessed arrest, individual who initiated CPR, shockable rhythm, AED use, survival rate, and etiology. SAS 9.4 software (SAS Institute, Inc, Cary, NC) was used for all analyses; multiple imputation was performed by using the multiple imputation procedure, the generalized linear mixed models procedure was used for the hierarchical logistic regression modeling, and the results of the hierarchical logistic regression analyses performed on the imputed data sets were combined by using the MIANALYZE procedure. A significance criterion of 0.05 was used for all analyses.
Table 3 shows the rate of pre-hospital ROSC by site. The incidence of CAs at 7 different sites within AED equipped stations (platforms, on trains, paths, stairs, station houses, restrooms and other sites) showed a similar pattern during both years. CAs occurred most frequently on platforms, followed by paths and trains. The rates of bystander CPR and AED use in these sites each year were as follows: 19 bystander CPR; 18 AED in 31 CAs (61.3%; 58.1%) in 2007 and 37; 32 in 43 (86%; 74.4%) in 2008 on platforms; 8; 8 in 12 (66.7%; 66.7%) in 2007 and 10; 10 in 13 (76.9%; 76.9%) in 2008 on trains, and 8; 8 in 15 (53.3%; 53.3%) in 2007 and 19; 15 in 26 (73%; 57.6%) in 2008 in paths, respectively. More cases occurred in station houses in 2008 (15 cases) than in 2007 (3 cases) (Table 3(a), Table 3(b)). The rate of ROSC increased from 8 in 31 cases (25.8%) in 2007 to 14 in 43 cases (32.6%) in 2008 on platforms and from 4 in 15 cases (26.7%) in 2007 to 10 in 26 cases (36.0%) in 2008 in paths. The rate of ROSC was extremely low on trains compared with other sites and showed no improvement over the 2 years (1 in 12 cases [8.3%] in 2007; 1 in 13 cases [7.7%] in 2008).
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In order to overcome the situation, AED kit is utilized to distribute an electrical shock to the victim’s heart to restore a normal rhythm of the patient. AED is a portable device. It is a common treatment for sudden cardiac tachycardia. AED is classified into two types, one is internal defibrillator, were electrodes are placed directly to the victim’s heart. For example Pacemaker. It is a diminutive contrivance that’s placed in the chest (or) abdomen to avail control abnormal heart rhythm. Whereas, External defibrillator electrodes are placed directly on the victim’s heart. For an example AED: It is a portable device utilized within the first 3-5 minutes of a person suffering from a sudden cardiac arrest (SCA) can increase a victim’s chances of survival from currently less than 5% to as much as 70% and higher with the defibrillator on the scene. The shock distributed to the patient’s heart in terms of energy. The waveforms (or) pulses are mainly two types. They are namely Biphasic multipulse and Monophasic multipulse. Monophasic is a unidirectional pulse, energy is distributed in one direction through the victim’s heart. Higher energy up to 200 to 300 joules is applied. Whereas Biphasic multi pulse is bidirectional pulse, energy distributed in both direction through the victim’s heart. Lower energy up to 120 to 200 joules is applied. So, the tissues of the victim’s body will not be affected compared to monophasic pulse.
ACCA: Association of Chartered Certified Accountants; AED: Automated external Defibrillator; AIDS: Acquired Immune Deficiency Syndrome; ALT: Alanine Aminotransferase; ART: Anti-Retroviral Therapy; ARV: Antiretroviral; AST: Aspartate aminotransferase; CAG: Community Antiretroviral Therapy Group; cART: Combination Antiretroviral therapy; CBART: Community Based ART; CD4: T-lymphocyte bearing CD4 receptor; CDC: Centers for Disease Control and Prevention; CHAs: Community health Assistants; CHW: Community Health Workers; CP: Community phlebotomy; CREAT: Creatinine; DBS: Dried Blood Spot; DSD: Differentiated service delivery; DTG: Dolutegravir; EDTA: Ethylene Diamine Tetraacetic Acid; EID: Early Infant Diagnosis; FBC: Full blood count; GCLP: Good Clinical Laboratory Practice; GNCZ: General Nursing Council of Zambia; GRZ: Government of the Republic of Zambia; Hb: Haemoglobin; HBsAg: Hepatitis B virus surface antigen; HCW: Health Care Workers; HIV: Human Immunodeficiency Virus; HIVVL: HIV-1 Viral Load; HNP: HIV Nurse Practitioner; HPCZ: Health Professional Council of Zambia; HTC: HIV Testing and Counselling; MoH: Ministry of Health; MSF: Médecins Sans Frontières; NGO: Non-Governmental Organization; PI: Principal Investigator; PLWHA: People Living with HIV and AIDS; PM: Policy Makers; POC: Point of care; POCT: Point of care testing; PSI: Population service international; QA/ QC: Quality Assurance / Quality Control; SSA: sub-Saharan Africa; TafED: Tenofovir alafenamide, Emtricitabine and Dolutegravir; TAT: Turnaround Time; TDF: Tenofovir Disoproxil Fumarate; UAG: Urban Adherence Group; UNDP: United Nations Development Program; UNESCO: United Nations Education, Scientific and Cultural Organization; UNFPA: United Nations Population Fund; UNICEF: United Nations Children ’ s Fund; UNZABREC: University of Zambia Biomedical Research Ethics Committee; WHO: World Health Organization
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However, there is still much to be done when it comes to preventing the occurrence of external fraud in advance or detecting it in an early stadium. Known cases of external fraud that were committed for a long time, with individual cases going up to 600,000 pounds (£) of damage , call for improved proactive prevention and detection of external fraud. This is strengthened by the rather disappointing fact that in 60% of discovered cases of fraud in the UK, it tends to be discovered by tip-offs or by accident . Although a survey from the AIC reported a very high percentage (90%) of discoveries by internal controls, audits or investigations , a more recent PWC survey  found a very similar percentage (59%) for discovery by tip-offs or by accident as mentioned before. Since there is more evidence for a huge dependency on tip-offs and accidental discoveries, this shows the weakness of current prevention and detection mechanisms. A KPMG survey partly acknowledges this weakness, since 47% of respondents from different organisations indicated that poor internal controls or the overriding of internal controls was the most important factor that contributed to their largest fraud incident . The Dutch government is already trying to prevent some kinds of external fraud by tightening laws , but this only solves a part of the problem. Improving the internal control process on external fraud, by improving controls, is another possibility that can be highly effective . IT could be used to automate parts of mainly manual control processes, which might lead to improved and quicker controlling on such fraud. Implementing more IT controls in the internal control systems of the government could therefore be a solution.
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Vanwege de mobiele dataverbinding worden veel Track and Trace systemen aangeboden met een abonnement waardoor het systeem in verhouding duur is. Een mogelijkheid is om het systeem uit te rusten met een prepaid SIM kaart zodat dit voorkomen kan worden. TrackTrace.nl biedt oplossingen vanaf € 500 waarbij het gebruik van dataverkeer in de situatie van AED’s niet boven de €1 per maand worden geschat. Het is hierbij wel van belang dat de gebruiker ten alle tijden zorgt dat er genoeg saldo op de prepaid SIM kaart staat. Een abonnement voor een dergelijk product kost tussen de € 5 en € 10 per maand, afhankelijk van de afname. De afmetingen van het systeem zijn 64 x 115 x 40 mm waarmee het te groot is om in een AED te plaatsen of aan een dergelijk product te bevestigen. Bovendien moeten de batterijen elke 6 tot 12 maanden worden vervangen.
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EI-AEDs should be avoided in favor of NEI-AEDs in patients requiring concurrent HAART and AED therapy due to the higher potential of virologic failure and reduced efficacy. In areas where EI-AED use cannot be avoided, closer and more frequent monitoring of HIV and seizure control is warranted. Alternative HAART regimens, such as triple NRTIs or integrase-based regi- mens, and use of TDM may be beneficial in managing or avoiding these complex drug interactions when avail- able. In low to middle income regions such as sub- Saharan Africa and parts of Asia, treatment of HIV and comorbid epilepsy and other neurologic conditions will continue to pose great challenges until additional resources become available, such as NEI-AEDs and a wider repertoire of antiretrovirals.
Results: A total of 130 women were randomised to the therapeutic drug monitoring group and 133 to the clinical features monitoring group; 294 women did not have a reduction in serum AED level. A total of 127 women in the therapeutic drug monitoring group and 130 women in the clinical features monitoring group (98% of complete data) were included in the primary analysis. There were no significant differences in the time to first seizure (HR 0.82, 95% CI 0.55 to 1.2) or timing of all seizures after randomisation (HR 1.3, 95% CI 0.7 to 2.5) between both trial groups. In comparison with the group with stable serum AED levels, there were no significant increases in seizures in the clinical features monitoring (odds ratio 0.93, 95% CI 0.56 to 1.5) or therapeutic drug monitoring group (odds ratio 0.93, 95% CI 0.56 to 1.5) associated with a reduction in serum AED levels. Maternal and neonatal outcomes were similar in both groups, except for higher cord blood levels of lamotrigine (MD 0.55 mg/l, 95% CI 0.11 to 1 mg/l) or levetiracetam (MD 7.8 mg/l, 95% CI 0.86 to 14.8 mg/l) in the therapeutic drug monitoring group than in the clinical features monitoring group. There were no differences between the groups on daily AED exposure or quality of life. An increase in exposure to lamotrigine, levetiracetam and carbamazepine significantly increased the cord blood levels of the AEDs, but not maternal or fetal complications. Women with epilepsy perceived the need for weighing up their increased vulnerability to seizures during pregnancy against the side effects of AEDs.
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ABSTRACT: Coronary artery blockage or heart attack which leads to heart failure. The lack of blood supply to the heart leads to death. The people aged above 45 are prone to high risk of heart attack. A defibrillator can treat the heart block, currently, defibrillators are portable and automated. The existing Automated External Defibrillator used occasionally in ambulances to treat patients in the emergency. The proposed model is an Automated Wearable Defibrillator. The device consists of a flexible PCB, battery, relay, adhesive paddle electrode and an accelerated transducer. The project emphasizes the need to treat heart attack by means of automated shock therapy after troponin level analysis. Hence bringing out a much more level device compared to the previous technology. In such a condition, the proposed wearable device monitors the heart continuously and diagnoses the block. Electric shock is discharge as a therapy. This device hence proved to be much more efficient than the current one and seems to be an effective lifesaving equipment.
c. An EMS call-to-shock interval of less than 5 min- utes cannot be achieved reliably with conven- tional EMS services, and a collapse-to-shock in- terval of less than 5 minutes can be achieved reliably (in ⬎ 90% of cases) by training and equipping lay people to function as first respond- ers by recognizing cardiac arrest, telephoning 911 (or other appropriate emergency response num- ber), starting cardiopulmonary resuscitation, and attaching and operating an AED.
The use of automated external defibrillators (AEDs) has been advocated in recent years as a part of the chain of survival to improve outcomes for adult cardiac arrest victims. When AEDs first entered the market, they were not tested for pediatric usage and rhythm interpretation. In addition, the presumption was that children do not experience ventricular fibrillation, so they would not benefit from use of AEDs. Recent literature has shown that children do experience ventricular fibril- lation, and this rhythm has a better outcome than do other cardiac arrest rhythms. At the same time, the arrhythmia software on AEDs has become more extensive and validated for children, and attenuation devices have become available to downregulate the energy delivered by AEDs to allow their use in children. Pedi- atricians are now being asked whether AED programs should be implemented, and where they are being implemented, pediatricians are being asked to provide guidance on the use of AEDs in children. As AED programs expand, pediatricians must advocate on behalf of children so that their needs are accounted for in these programs. For pediatricians to be able to provide guidance and ensure that children are included in AED programs, it is important for pediatricians to know how AEDs work, be up-to-date on the literature regarding pediatric fibrillation and energy delivery, and understand the role of AEDs as life-saving interventions for children.
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Background: Sudden cardiac death (SCD) is a leading cause of death in young athletes. Most of those events occur during exercise and in sports facilities. We sought to assess awareness and attitudes towards automated external defibrillators (AED) in sports facilities in Jeddah, Saudi Arabia. Methods: The survey included 293 individuals who attend 18 different sports facilities in Jeddah, Saudi Arabia to estimate the overall knowledge level of CPR and AED usage and determine general attitudes toward intervening in the setting of sudden cardiac arrest (SCA). We included adult participants who were 18 years of age or older. After explaining the aim of our study, each participant was consented to participate in the survey. The survey included 33 questions to assess demographic characteristics, knowledge, and skills of CPR, confidence to perform CPR and to use AED. Results: A total of 293 candidates completed the questionnaire. Mean age was 28.33 ± 8.22 years. Only 19 candidates who worked in sports facilities agreed to participate in our survey, of those only 10 participants had previous CPR training but only 8 (42.1%) had the self-confidence to do CPR and use AED. Of individuals who participated in the survey, 110 (37%) of them indicated that they were more likely to intervene in an SCA after receiving the proper training. 140 (47.7%) participants of our cohort were reluctant to perform CPR because they were anxious about harming the arrested patient. 108 (36%) of our cohort could explain the purpose of using AED. Unfortunately, 101 (34.5%) of our sample did not know the number of Red Crescent for emergency calls. 73 (53.7%) of the total 136 participants who received CPR training before stated that they are able to use AED. Our survey showed that 264 (90.1%) wished to receive BLS training course if it was announced in order to qualify them for performing CPR and applying AED. Conclusion: Our survey showed insufficient knowledge in all aspects of CPR skills and inadequate knowledge of AED and its purpose of use in sports facilities in Jeddah. We recommend initiating an effective national public campaign to increase the public awareness of the importance of CPR and AED performance using different pathways for education through media and new legislations .
In-hospital cardiac arrest remains a major problem but new technologies allowing fully automatic external defibrillation are available. These technologies allow the concept of “external therapeutic monitoring” of lethal arrhythmias. Since early defibrillation improves outcome by decreasing morbidity and mortality, the use of this device should improve the outcome of in- hospital cardiac arrest victims. Furthermore, the use of these devices could allow safe monitoring and treatment of patients at risk of cardiac arrest who not necessarily must be in conventional monitoring units (Intensive or Coronary Care Units) saving costs with a more meaningful use of resources. The capability to provide early defibrillation within any patient-care areas should be considered as an obligation (“standard of care”) of the modern hospital.
and clinical teams differentiated the responses that were available to the personnel occupying the building. For example, the site did not have an active emergency de- partment until 4 months after the opening of the ambu- latory clinics. This required simulations to incorporate a community call out for 911 services as part of their emergency response plan for a patient deterioration in the building. Internally, the organization and occupying personnel had the strength as healthcare professionals to handle some first aide responses but needed to rely on external support of city emergency services. One large- scale simulation event for the diagnostic imaging depart- ment revealed that emergency medical services’ (EMS) response to the call failed to find the front entrance of the hospital. Assumptions had been made by EMS to show up at the ambulance bays in the ED, which were not functional at the time. Debriefings identified this knowledge barrier, and tours/orientations for all EMS providers were arranged in the following months. Role clarity was also recognized for the protection services personnel as an important way-finder for EMS once they arrived on site. As per the SEIPS model, recognition of system deficiencies identified limitations in the internal environment, barriers with external support such as EMS, the process that needed to be changed in order to access help and ultimately the outcome for staff and pa- tient safety [5, 6].
contrastingly, there was also a slight increase in percentage unemployment (7% in ‘high- access’ AED areas vs 4% in ‘low-access’ areas). No racial differences were found 63 . AED knowledge was higher in North Americans compared to Europeans and ‘Other’ in one study 41 . Another reported that no demographic factor affected knowledge about an AED or the ability to identify one 40 , and age and gender had no effect on either in a third study 93 . In Singapore, those who were male, under 35, spoke the Malay language, had A-
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the right side of the manikin. However, sitting on the left side of the patient may provide a better overview compared with sitting on the right side of the patient. Lack of overview may result in poor access to the mid-axillary line where the left apicolateral AED electrode should be placed. Moreover, the patient’s left arm may hinder access to the left lateral side of the patient’s chest and may contribute to incorrect placement of the left apicolateral AED electrode. In the current study, only a minor part of participants moved the manikin’s left arm when placing the left apicolateral AED electrode irrespective of whether AED electrodes were applied from the left or right side. Sitting on the left side of the patient may become a bar- rier for moving the left arm, as the left arm is “interlocked” between the rescuer and the patient. During the BLS/AED courses, there were no specific instructions to move the left arm. Many resuscitation manikins consist of a torso without arms and training on such manikins may affect the proportion