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Background: Out-of-hospital ventricular fibrillation (VF) cardiac arrest is a leading cause of death. Quantitative analysis of the VF electrocardiogram (ECG) can predict patient outcomes and could potentially enable a patient-specific, guided approach to resuscitation. However, VF analysis during resuscitation is confounded by cardiopulmonary resuscitation (CPR) artifact in the ECG, challenging continuous application to guide therapy throughout resuscitation. We therefore sought to design a method to predict VF shock outcomes during CPR., Methods: Study data included 4577 5-s VF segments collected during and without CPR prior to defibrillation attempts in N = 1151 arrest patients. Using training data (460 patients), an algorithm was designed to predict the VF shock outcomes of defibrillation success (return of organized ventricular rhythm) and functional survival (Cerebral Performance Category 1-2). The algorithm was designed with variable-frequency notch filters to reduce CPR artifact in the ECG based on real-time chest compression rate. Ten ECG features and three dichotomous patient characteristics were developed to predict outcomes. These variables were combined using support vector machines and logistic regression. Algorithm performance was evaluated by area under the receiver operating characteristic curve (AUC) to predict outcomes in validation data (691 patients)., Results: AUC (95% Confidence Interval) for predicting defibrillation success was 0.74 (0.71-0.77) during CPR and 0.77 (0.74-0.79) without CPR. AUC for predicting functional survival was 0.75 (0.72-0.78) during CPR and 0.76 (0.74-0.79) without CPR., Conclusion: A novel algorithm predicted defibrillation success and functional survival during ongoing CPR following VF arrest, providing a potential proof-of-concept towards real-time guidance of resuscitation therapy., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Objectives: To identify predictors of falls in older breast and prostate cancer survivors., Methods: This retrospective cohort study analyzed population-based Surveillance, Epidemiology and End Results-Medicare Health Outcomes Survey (SEER-MHOS) linkage. Inclusion criteria were age >65 years at cancer diagnosis, first primary female breast or prostate cancer, cancer staging information available, completion of baseline MHOS during years 2-3 and follow-up MHOS during years 4-5 post-diagnosis, and falls information available. Data from 437 breast and 660 prostate cancer survivors were analyzed. Multivariable logistic regression was constructed to evaluate variables from baseline MHOS with relation to falls from follow-up MHOS. Model accuracy was assessed using area under receiver-operating-characteristic curve (AUC)., Results: At follow-up MHOS, 26% of breast and 22% of prostate cancer survivors reported falls in the past 12 months. In breast cancer, a history of falls (odds ratio (OR) = 4.95, 95% confidence interval (CI) = 2.44-10.04) and sensory impairment in feet (OR = 3.33, 95%CI = 1.51-7.32) were significant predictors of falls. In prostate cancer, a history of falls (OR = 3.04, 95%CI = 1.79-5.15), unmarried (OR = 1.82, 95%CI = 1.12-2.95), lower physical summary score of quality-of-life(OR = 0.96, 95%CI = 0.94-0.98), urinary incontinence (OR = 1.69, 95%CI = 1.08-2.65), older age at diagnosis (OR = 1.05, 95%CI = 1.01-1.09), and shorter time post-diagnosis (OR = 0.96, 95%CI = 0.93-0.99) were significant predictors of falls. AUC was 0.67 and 0.77 for breast and prostate cancer, respectively, indicating moderate accuracy of models in detecting fallers., Conclusions: Asking older breast and prostate cancer survivors about falls in the past 12 months is imperative in fall prevention. Further examination of deficits specific to each cancer is necessary to assess fall risks., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Objective: To determine the prevalence of falls and balance/walking problems in the past 12months among older cancer survivors before and after cancer diagnosis., Materials and Methods: We analyzed cross-sectional data from individuals aged ≥65years with first primary cancer from the Surveillance, Epidemiology, and End Results and Medicare Health Outcomes Survey (SEER-MHOS) linkage (n=12,659). The first MHOS completed by each survivor from 0 to 2years before cancer diagnosis to 1-4years after cancer diagnosis were included. We estimated unadjusted and demographic-adjusted prevalence of falls and balance/walking problems for each type of cancer during five one-year time periods before and after cancer diagnosis., Results: Adjusted prevalence of falls was significantly higher post-diagnosis than pre-diagnosis in prostate (12% during years 1-2 pre-diagnosis vs. 17%-20% during years 1-4 post-diagnosis)(p=0.01) and lung cancer (17% during years 1-2 pre-diagnosis vs. 28% during years 1-2 post-diagnosis)(p=0.019). Adjusted prevalence of balance/walking problems were significantly higher post-diagnosis than pre-diagnosis in non-Hodgkin's lymphoma (26% during years 1-2 pre-diagnosis vs. 45% during years 1-2 post-diagnosis)(p=0.012), breast (32% during years 1-2 pre-diagnosis vs. 41% during years 3-4 post-diagnosis)(p=0.001), prostate (22% during years 1-2 pre-diagnosis vs. 28%-29% during years 1-4 post-diagnosis)(p=0.012), and lung cancer (33% during years 1-2 pre-diagnosis vs. 40% during year 0-1 pre-diagnosis and 46% during years 1-2 post-diagnosis)(p=0.018). Prevalence did not differ across time periods in other cancers., Conclusions: Falls and balance/walking problems may become more frequent after the diagnosis of some cancers. Screening, surveillance, and interventions need to consider functional deficits and cancer diagnosis., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

White-nose syndrome (WNS) is a lethal infection of bats caused by the psychrophilic fungus Pseudogymnoascus destructans (Pd). Since the first cases of WNS were documented in 2006, it is estimated that as many as 5.5million bats have succumbed in the United States-one of the fastest mammalian die-offs due to disease ever observed, and the first known sustained epizootic of bats. WNS is contagious between bats, and mounting evidence suggests that a persistent environmental reservoir of Pd plays a significant role in transmission as well. It is unclear, however, the relative contributions of bat-to-bat and environment-to-bat transmission to disease propagation within a colony. We analyze a mathematical model to investigate the consequences of both avenues of transmission on colony survival in addition to the efficacy of disease control strategies. Our model shows that selection of the most effective control strategies is highly dependent on the primary route of WNS transmission. Under all scenarios, however, generalized culling is ineffective and while targeted culling of infected bats may be effective under idealized conditions, it primarily has negative consequences. Thus, understanding the significance of environment-to-bat transmission is paramount to designing effective management plans., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Pertussis is a highly infectious respiratory disease that has been on the rise in many countries worldwide over the past several years. The drivers of this increase in pertussis incidence remain hotly debated, with a central and long-standing hypothesis that questions the ability of vaccines to eliminate pertussis transmission rather than simply modulate the severity of disease. In this paper, we present age-structured case notification data from all provinces of Thailand between 1981 and 2014, a period during which vaccine uptake rose substantially, permitting an evaluation of the transmission impacts of vaccination. Our analyses demonstrate decreases in incidence across all ages with increased vaccine uptake - an observation that is at odds with pertussis case notification data in a number of other countries. To explore whether these observations are consistent with a rise in herd immunity and a reduction in bacterial transmission, we analyze an age-structured model that incorporates contrasting hypotheses concerning the immunological and transmission consequences of vaccines. Our results lead us to conclude that the most parsimonious explanation for the combined reduction in incidence and the shift to older age groups in the Thailand data is vaccine-induced herd immunity., (Copyright © 2016 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: Quantitative measures of the ventricular fibrillation waveform at the outset of resuscitation are associated with survival. However, little is known about the course of these measures during resuscitation and how this course is related to outcome., Objective: The purpose of this study was to determine how waveform measures change over the course of resuscitation and whether these changes might be used to guide resuscitation., Methods: We evaluated 390 persons treated by emergency providers following out-of-hospital ventricular fibrillation arrest. We assessed the ventricular fibrillation waveform using the amplitude spectrum area (AMSA) from the defibrillator's continuous electrocardiogram measured before each of the first three shocks. We used logistic regression to evaluate the relationship of AMSA and the change in AMSA with favorable neurologic survival as determined by the Cerebral Performance Category at hospital discharge 1-2., Results: Of the 390 patients who received an initial shock, 273 required a second shock and 210 required a third shock. The mean (standard deviation) for AMSA was 9.64 (0.52) for the 873 total shock cycles. AMSA₁ measured before the first shock was strongly associated with favorable neurologic survival (odds ratio [OR] 3.40, 95% confidence interval [CI] [2.48, 4.66] for 1 SD change). We observed a similar relationship for second-shock AMSA₂ (OR 3.53, 95% CI [2.42, 5.14]) and third-shock AMSA₃ (OR 3.10, 95% CI [2.03, 4.73]). The median change in AMSA was 0.24 for ΔAMSA₁₋₂ and 0.21 for ΔAMSA₂₋₃. A positive median change in AMSA between shocks was associated with favorable neurologic survival (OR 1.44, 95% CI [1.16, 1.80] for ΔAMSA₁₋₂ and OR 1.31, 95% CI [1.01, 1.71] for ΔAMSA₂₋₃)., Conclusion: Given their prognostic and dynamic qualities, quantitative waveform measures may provide an effective real-time strategy to guide individual treatment and improve survival., (© 2014 Heart Rhythm Society Published by Heart Rhythm Society All rights reserved.)

Background: Red blood cell transfusions may or may not improve oxygen delivery to the tissues. Some studies suggest transfusion might contribute to adverse outcomes. This study investigated the association between hemoglobin concentration and transfusion with outcome in cyanotic neonates undergoing Norwood operations., Methods: Infants 6 weeks old or younger with hypoplastic left heart syndrome undergoing staged Norwood operations between September 1996 and July 2005 were included. Demographics and preoperative, operative, and postoperative variables were collected prospectively. Hemoglobin concentration, transfusion, fluid balance, and chest tube losses were collected retrospectively. The association of variables with outcomes, including early and 2-year mortality, mental and psychomotor developmental indices at 18 to 24 months of age, and ventilator days were determined by univariate and multiple regression analyses., Results: Ninety-four patients had Norwood operations. Excluded were 10 requiring postoperative extracorporeal life support and 2 with chromosomal abnormalities. By multiple regression analysis, only a higher nadir hemoglobin on days 2 to 5 postoperatively was associated with higher early mortality (odds ratio, 2.09; 95% confidence interval [CI], 1.14 to 3.87; p = 0.018), and the highest preoperative dopamine dose and highest epinephrine dose on day 2 to 5 postoperatively were associated with 2-year mortality; however, neither hemoglobin concentration nor number of transfusions were associated with mental or psychomotor developmental indices. The number of transfusions on day 2 to 5 postoperatively was associated with ventilator days in multiple variable analysis (effect size, 1.85; 95% CI, 0.33 to 3.36; p = 0.018)., Conclusions: This single-center cohort study found transfusion was not associated with improved outcomes in neonates undergoing Norwood operations., (Copyright (c) 2010 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)