Waveform analysis-guided treatment versus a standard shock-first protocol for the treatment of out-of-hospital cardiac arrest presenting in ventricular fibrillation: Results of an international randomized, controlled trial
Freese J.P.,MetroTech Center |
Jorgenson D.B.,Philips |
Liu P.-Y.,Fred Hutchinson Cancer Research Center |
Innes J.,London Ambulance Service |
And 7 more authors.
Circulation | Year: 2013
BACKGROUND - Ventricular fibrillation (VF) waveform properties have been shown to predict defibrillation success and outcomes among patients treated with immediate defibrillation. We postulated that a waveform analysis algorithm could be used to identify VF unlikely to respond to immediate defibrillation, allowing selective initial treatment with cardiopulmonary resuscitation in an effort to improve overall survival. METHODS AND RESULTS - In a multicenter, double-blind, randomized study, out-of-hospital cardiac arrest patients in 2 urban emergency medical services systems were treated with automated external defibrillators using either a VF waveform analysis algorithm or the standard shock-first protocol. The VF waveform analysis used a predefined threshold value below which return of spontaneous circulation (ROSC) was unlikely with immediate defibrillation, allowing selective treatment with a 2-minute interval of cardiopulmonary resuscitation before initial defibrillation. The primary end point was survival to hospital discharge. Secondary end points included ROSC, sustained ROSC, and survival to hospital admission. Of 6738 patients enrolled, 987 patients with VF of primary cardiac origin were included in the primary analysis. No immediate or long-term survival benefit was noted for either treatment algorithm (ROSC, 42.5% versus 41.2%, P=0.70; sustained ROSC, 32.4% versus 33.4%, P=0.79; survival to admission, 34.1% versus 36.4%, P=0.46; survival to hospital discharge, 15.6% versus 17.2%, P=0.55, respectively). CONCLUSIONS - Use of a waveform analysis algorithm to guide the initial treatment of out-of-hospital cardiac arrest patients presenting in VF did not improve overall survival compared with a standard shock-first protocol. Further study is recommended to examine the role of waveform analysis for the guided management of VF. © 2013 American Heart Association, Inc.
Park H.J.,5Water Street |
Roess R.P.,MetroTech Center
Procedia Computer Science | Year: 2015
On-ramp junctions on freeways are subject to vehicle merging interactions between main travel lanes and ramp flows. The turbulence created by these interactions often causes congestion, and can lead to breakdown when the combined volume from the ramp and the mainline exceed the capacity of the downstream freeway segment. This study discusses a potential application for freeway control policy at the ramp junction-The Lane Operation Restriction (LOR) policy. This policy would provide particular attention to traffic operation improvements at on-ramp junctions with relatively high flow rates from the ramp. Principles of LOR policy would be based on empirical data and analysis findings. The empirical data are analyzed upstream and downstream of on-ramp junctions on six-lane freeways using a database for the National Cooperative Highway Research Program (NCHRP) 3-37. It was observed that lanes 2 (middle lane) and 3 (median side lane) show a higher density-speed relationship than the shoulder lane upstream of the junctions. In addition, the breakdown condition and congestion spread across all freeway travel lanes when the flow of lane 1 (shoulder side lane) is suddenly increased to near capacity at the ramp influence areas. A simulation analysis employing the LOR policy is introduced evaluating the ramp junction influence areas, its downstream and upstream areas. It concludes that traffic operations in the vicinity of on-ramp junctions can be significantly improved when upstream vehicles are guided to shift from lane 1 to lanes 2 and 3 before arriving at on-ramp junctions and restraint lane changes at the ramp influence area. © 2015 The Authors. Published by Elsevier B.V.
News Article | February 15, 2017
Red Lion Hotels Corporation (RLHC) has announced a new package for winter travelers at Red Lion Inn & Suites Brooklyn. This special offer allows guests to experience classic NYC attractions, including 5th Avenue’s Winter Window Displays, Restaurant Week and ice skating in Central Park. “There’s something magical about New York City during the winter season,” Dany Jean-Philippe the director of sales and revenue. “In addition to the bright lights of some of the city’s most sought-after attractions, Brooklyn and Manhattan alike bustles with holiday cheer and the renewed spirit of a new year. We want our guests to take advantage of this special time with personalized service at affordable rates.” Located in Gowanus, Red Lion Inn & Suites Brooklyn is the first RLHC property in New York City, which celebrated its grand opening after completing a series of multi-million dollar renovations. Nestled just 20 minutes away from Manhattan via subway, Red Lion Inn & Suites Brooklyn is located near Metrotech Center, Barclays Center, the Brooklyn Academy of Music, and the Brooklyn Bridge. Positioned by the New York Times as a destination to explore the ‘real’ Brooklyn on a budget, Red Lion Inn & Suites invites guests with authentic New York experiences. Amenities at Red Lion Inn & Suites Brooklyn include 42-inch screen TVs with access to HBO premium channels; high-speed Wi-Fi; Tempurpedic mattresses; marble sinks; Cascadia products; and onsite parking. Guests can also take advantage of onsite concierge service to book tour and Woodberry transfer services. About Red Lion Inn and Suites Brooklyn: Centrally located in the Gowanus area of Brooklyn, Red Lion Inn & Suites Brooklyn is the first Red Lion Hotel Operated in New York City and Brooklyn, NY. Red Lion Inn & Suites Brooklyn is operated by Boast Hotels since December 2013.
Panciroli R.,University Niccolo Cusano |
Porfiri M.,Metrotech Center
Procedia Engineering | Year: 2014
In this work, a non-intrusive pressure reconstruction method based on particle image velocimetry (PIV) is utilized to investigate hydroelastic phenomena associated with the water entry of flexible structures. Experiments are conducted on flexible cantilevered wedges entering the water in free fall. PIV is leveraged to evaluate the effect of the mutual interaction between the fluid flow and structural deformation on the distributed hydrodynamic loading. The wedge compliance is found to strongly influence the hydrodynamic loading, resulting into marked oscillations in the distribution and evolution of the pressure on the wetted surface of the impacting body. © 2014 The Authors. Published by Elsevier Ltd.
Isbister K.,Metrotech Center |
Abe K.,Metrotech Center
TEI 2015 - Proceedings of the 9th International Conference on Tangible, Embedded, and Embodied Interaction | Year: 2015
We present an ongoing project exploring the use of costumes as game controllers. This collaboration between an artist and a researcher involves creating and evaluating a game for two players that uses costumes to drive core mechanics and interactions. We aim to give players a sense of transformation and connection, and to create an engaging spectacle for others. We discuss the design of the game, iterations in its form, and our plans for conducting user research with the finished game.
Pourhashem H.,Metrotech center |
Kalkhoran I.M.,Metrotech center
8th AIAA Flow Control Conference | Year: 2016
The present computational study aims to examine the effectiveness of a downstream microjet fluidic injection (DMFI) scheme in altering the mixing characteristics of supersonic jets in an effort to reduce supersonic jet noise. DMFI scheme, based on our previous experimental study involves perpendicular injection into a supersonic cross flow using four equally spaced injection ports placed on an injection tube which extends downstream of a Mach number 1.5 nozzle. Results of the present numerical investigation indicate good agreement with the previous experimental results; further demonstrating the effectiveness of DMFI scheme in altering the stability characteristics of the shear layer and hence mixing enhancement. The findings suggest that for a constant momentum flux ratio, injection at various axial locations leads to different levels of shear layer penetration. It is shown that perpendicular fluidic injection near the location where local shock wave is expected to occur and subsequent merging of this shock wave with the upstream separation bow shock, modifies the shear layer considerably and results in improved mixing and shear layer spreading. The DMFI scheme shows augmentation of turbulence intensity levels in the vicinity of the nozzle, leading to reduction of downstream turbulence intensities, which consequently influences the noise radiation into the far field. © 2016, American Institute of Aeronautics and Astronautics Inc, AIAA. All rights reserved.
Dottori S.,University of Rome Tor Vergata |
Flamini V.,Metrotech center |
Vairo G.,University of Rome Tor Vergata
International Journal of Computational Methods in Engineering Science and Mechanics | Year: 2016
ABSTRACT: In this paper stents employed to treat peripheral artery disease are analyzed through a three-dimensional finite-element approach, based on a large-strain and large-displacement formulation. Aiming to evaluate the influence of some stent design parameters on stent mechanics and on the biomechanical interaction between stent and arterial wall, quasi-static and dynamic numerical analyses are carried out by referring to computational models of commercially and noncommercially available versions of both braided self-expandable stents and balloon-expandable stents. Addressing isolated device models, opening mechanisms and flexibility of both opened and closed stent configurations are numerically experienced. Moreover, stent deployment into a stenotic peripheral artery and possible postdilatation angioplasty (the latter for the self-expandable device only) are simulated by considering different idealized vessel geometries and accounting for the presence of a stenotic plaque. Proposed results highlight important differences in the mechanical response of the two types of stents, as well as a significant influence of the vessel shape on the stress distributions arising upon the artery-plaque system. Finally, computational results are used to assess both the stent mechanical performance and the effectiveness of the stenting treatment, allowing also to identify possible critical conditions affecting the risk of stent fracture, tissue damage, and/or pathological tissue response. © 2016 Taylor & Francis Group, LLC.
Alherz A.I.,Metrotech Center |
Tanweer O.,NYU Langone Medical Center |
Flamini V.,Metrotech Center
Journal of Biomechanics | Year: 2016
Dual-layer stents and multi-layer stents represent a new paradigm in endovascular interventions. Multi-layer stents match different stent designs in order to offer auxiliary functions. For example, dual-layer stents used in the endovascular treatment of intracranial aneurysms, like the FREDTM (MicroVention, CA) stent, combine a densely braided inner metallic mesh with a loosely braided outer mesh. The inner layer is designed to divert blood flow, whereas the outer one ensures microvessels branching out of the main artery remain patent. In this work, the implemented finite element (FE) analysis identifies the key aspects of dual-stent mechanics. In particular, dual-layer stents used in the treatment of intracranial aneurysms require the ability to conform to very narrow passages in their closed configuration, while at the same time they have to provide support and stability once deployed. This study developed a numerical framework for the analysis of dual-layer stents for endovascular intracranial aneurysm treatment. Our results were validated against analytical methods. For the designs considered, we observed that foreshortening was in average 37.5%±2.5%, and that doubling the number of wires in the outer stent increased bending moment by 23%, while halving the number of wires of the inner stent reduced von Mises stress by 2.3%. This framework can be extended to the design optimization of multi-layer stents used in other endovascular treatments. © 2016 Elsevier Ltd.
Zeig-Owens R.,Yeshiva University |
Zeig-Owens R.,Metrotech Center |
Webber M.P.,Yeshiva University |
Webber M.P.,Metrotech Center |
And 13 more authors.
The Lancet | Year: 2011
The attacks on the World Trade Center (WTC) on Sept 11, 2001 (9/11) created the potential for occupational exposure to known and suspected carcinogens. We examined cancer incidence and its potential association with exposure in the first 7 years after 9/11 in firefighters with health information before 9/11 and minimal loss to follow-up. We assessed 9853 men who were employed as firefighters on Jan 1, 1996. On and after 9/11, person-time for 8927 firefighters was classified as WTC-exposed; all person-time before 9/11, and person-time after 9/11 for 926 non-WTC-exposed firefighters, was classified as non-WTC exposed. Cancer cases were confirmed by matches with state tumour registries or through appropriate documentation. We estimated the ratio of incidence rates in WTC-exposed firefighters to non-exposed firefighters, adjusted for age, race and ethnic origin, and secular trends, with the US National Cancer Institute Surveillance Epidemiology and End Results (SEER) reference population. CIs were estimated with overdispersed Poisson models. Additional analyses included corrections for potential surveillance bias and modified cohort inclusion criteria. Compared with the general male population in the USA with a similar demographic mix, the standardised incidence ratios (SIRs) of the cancer incidence in WTC-exposed firefighters was 1·10 (95 CI 0·98-1·25). When compared with non-exposed firefighters, the SIR of cancer incidence in WTC-exposed firefighters was 1·19 (95 CI 0·96-1·47) corrected for possible surveillance bias and 1·32 (1·07-1·62) without correction for surveillance bias. Secondary analyses showed similar effect sizes. We reported a modest excess of cancer cases in the WTC-exposed cohort. We remain cautious in our interpretation of this finding because the time since 9/11 is short for cancer outcomes, and the reported excess of cancers is not limited to specific organ types. As in any observational study, we cannot rule out the possibility that effects in the exposed group might be due to unidentified confounders. Continued follow-up will be important and should include cancer screening and prevention strategies. National Institute for Occupational Safety and Health. © 2011 Elsevier Ltd.
Weakley J.,Yeshiva University |
Webber M.P.,Yeshiva University |
Gustave J.,Metrotech Center |
Kelly K.,Metrotech Center |
And 4 more authors.
Preventive Medicine | Year: 2011
Objectives: To compare the prevalence of self-reported respiratory diagnoses in World Trade Center-exposed Fire Department of New York City firefighters to the prevalence in demographically similar National Health Interview Survey participants by year; and, 2) to describe the prevalence of World Trade Center-related symptoms up to 9. years post-9/11. Methods: We analyzed 45,988 questionnaires completed by 10,999 firefighters from 10/2/2001 to 9/11/2010. For comparison of diagnosis rates, we calculated 95% confidence intervals around yearly firefighter prevalence estimates and generated odds ratios and confidence intervals to compare the odds of diagnoses in firefighters to the National Health Interview Survey prevalence, by smoking status. Results: Overall, World Trade Center-exposed firefighters had higher respiratory diagnosis rates than the National Health Interview Survey; Fire Department of New York City rates also varied less by smoking status. In 2009, bronchitis rates in firefighters aged 45-65 were 13.3 in smokers versus 13.1 in never-smokers while in the National Health Interview Survey, bronchitis rates were doubled for smokers: 4.3 vs. 2.1. In serial cross-sectional analyses, the prevalence of most symptoms stabilized by 2005, at ~. 10% for cough to ~. 48% for sinus. Conclusions: We found generally higher rates of respiratory diagnoses in World Trade Center-exposed firefighters compared to US males, regardless of smoking status. This underscores the impact of World Trade Center exposure and the need for continued monitoring and treatment of this population. © 2011 Elsevier Inc.