Cardiac arrest is the leading cause of death in the United States. By reviewing and analyzing the successes and failures of resuscitation efforts, it has been possible to identify critical components which have come to be known as the “Chain of Survival:” Early Recognition, Early CPR, Early Defibrillation, Early ALS, and Early Post Resuscitative Care. A failure in any one of the five links will result in a failed resuscitation. Early Recognition is the beginning of the resuscitation effort and includes a number of related components. Witnessed cardiac arrests, those that are seen or heard to occur, have a significantly higher chance of survival than those which are unwitnessed. Properly identifying agonal gasps: irregular, forceful, reflexive breaths which can occur during cardiac arrest, is key to recognition of arrest and activation of the emergency response system. Emergency dispatchers trained to recognize cardiac arrest, as well as to initiate Early CPR via telephonic instruction, have been identified as key personnel in the resuscitation effort. Once professional rescuers have been dispatched, response delays due to distance and traffic can be costly. The use of new technologies like GPS and traffic signal preemption (as well as the use of Police, Fire and EMS in conjunction) has been shown to make it possible to get qualified persons to the scene of a cardiac arrest more safely and more quickly. Once on scene, early, high quality CPR has been shown to dramatically improve survival. After just 8 minutes without assistance, a victim of cardiac arrest has a near zero percent chance of survival. CPR of high quality has been shown to help maintain survivability until more definitive care can be obtained. Early Defibrillation is another key component to survival in many cardiac arrests. While CPR can sustain organ function briefly, cardiac arrest is rarely reversed without defibrillation. Increasingly widespread prevalence of public automated external defibrillators (AEDs) has made Early Defibrillation easier. Furthermore, increased use of AEDs by lay and professional rescuers has called into question the value of more traditional, higher risk interventions like intubation and medication administration. Early ALS interventions have been a staple of resuscitation for decades, but there is little data to support the use of these interventions during cardiac arrest. Early Post-Resuscitative Care, however, has been shown to be an area where invasive ALS interventions can and do make a difference in improved survival. By looking at the body of research for links in the Chain of Survival, opportunities for improvement of resuscitation were identified. Persons who spend significant time around an individual at high risk for heart disease should be educated on possible precipitating symptoms of a myocardial infarct or other early signs of potential cardiac arrest. Persons likely to encounter a cardiac arrest should likewise be trained not only in how to recognize cardiac arrest (through the combination of unresponsiveness and abnormal breathing) but also to initiate basic care via compressions-only CPR. Emergency dispatchers should be increasingly trained to recognize cardiac arrest, as well how to effectively provide dispatcher assisted CPR. The focus of these efforts should be high quality CPR and the early deployment of defibrillation. The use of AEDs by bystanders should be encouraged whenever possible. The emphasis on CPR and use of an AED should be paramount, with invasive ALS interventions eschewed for the simpler and more effective therapies. Once ROSC has been obtained, the use of ALS interventions in unstable patients has been shown not only to prevent death due to transient hemodynamic instability, but also to improve the likelihood of survival with little to no neurological deficit. By embracing the chain of survival, and identifying the critical areas in need of research and improvement, it is possible to provide recommendations that may lead to improved survival from cardiac arrest.

Improved strategic location of an Emergency Medical Service (EMS) facility can significantly increase EMS efficiency. Urban planners need to consider a location that satisfies multiple criteria in order to make an informed decision about a future EMS facility site. Apart from basic criteria such as parcel value and size, decision-makers need to consider area and population coverage from potential parcels. Geographic Information Systems (GIS) provide an adequate analysis environment for EMS facility siting as many considered criteria are of a spatial nature. However, urban planners making decisions about an EMS facility site often lack the necessary expertise to make full use of challenging GIS tools. In order to help urban planners in the analysis process, this research developed a Spatial Decision Support System (SDSS) for EMS facility siting. The system was developed in ESRI ArcGIS (9.3) using the Visual Basic for Applications (VBA) programming environment. The objective of the system was to integrate spatial data, analysis, and visualization in a single system to help users evaluate a facility siting problem. The system's performance was tested using data for the Town of Blacksburg, VA. In addition, the system was evaluated by local planners and GIS staff with experience in EMS facility siting. Planners agreed the system enables more comprehensive and straightforward use of GIS for EMS facility siting analysis than other available siting tools. Potential improvements include a simpler user interface, synthesis of geoprocessing techniques, reduction of analysis time through automation, and better decision-making by improved visualization of results. / Master of Science

Sepsis is a complicated disorder in which an infection has reached the bloodstream and caused a cascade of events that in time will lead to death. Interventions aimed at identifying sepsis early in its progression are imperative to stopping the process. The purpose of this study is to examine the current state of the literature regarding sepsis screening tools utilized by emergency medical services. A literature review exploring the various tools in place was conducted to see their value in predicting sepsis and secondary what the initiation of a sepsis alert has on the patients’ outcome. Results found included that sepsis screening tools when in place decrease time to identification, decrease time to antibiotics, increase amount of fluid administration, and overall reduce hospital stay and mortality rate. With these findings educational training for EMS providers and the introduction of generalized protocols are of the upmost importance. Further research is needed to be done to create a consistent tool to be used by all EMS agencies that has a validated predictive value of sepsis.

Miljöledningssystem ger struktur åt miljöarbetet samt hjälper företag att använda resurser på ett sådant sätt som hjälper de att uppnå förbättringar för miljön. Den inverkan som företaget har på miljön bedöms utifrån ett helhetsperspektiv. Dessa aspekter, i samband med relevant miljölagstiftning, styr miljöarbetet så att positiva effekter uppnås. Miljömål och miljöpolicy säkerställer så att ledningen är engagerade samt engagerar ett arbete för att reducera miljöpåverkan och uppnå konstanta förbättringar gällande miljöfrågorna. Ett miljöledningssystem ger företag möjlighet att kommunicera att deras miljöarbete utövas på ett reellt sätt. Syftet med implementeringen av miljöledningssystemet ISO 14001 är att företag ska ha det lättare att arbeta med miljöfrågor samt förbättra kommunikationen mellan intressenter och företag. Syftet med denna uppsats är att undersöka hur små- och medelstora företag upplever implementeringen av miljöledningssystem enligt ISO 14001 samt hur ledningen i dessa företag motiverar och utbildar de anställda kring ISO 14001. Studien utgår från en kvalitativ metod och tre företag har haft rollen som informanter vars svar redovisats i den insamlade empirin. Utifrån informanternas svar har paralleller dragits till tidigare forskning samt teorier. Resultaten har visat att företagen har svårigheter med ISO 14001 och att både ledningen och anställda inte är tillräckligt utbildade kring ISO 14001 och miljöledningssystem. Vid implementering av miljöledningssystem är det viktigt att både ledningen och anställda är välutbildade, motiverade samt engagerade för att dynamiken i företaget ska fungera / Environmental management system provides a structure for environmental work and helps companies use resources in a way that helps them achieve environmental improvements. The impact the company has on the environment is assessed from a holistic perspective. These aspects, in conjunction with relevant environmental legislation, govern the environmental work so that positive effects are achieved. Environmental goals and environmental policy ensure that management is committed and engaged in work to reduce environmental impacts and achieve constant improvements regarding the environmental issues. An environmental management system enables companies to communicate that their environmental work is practiced in a trustworthy way. The aim of the implementation of the environmental management system ISO 14001 to make it easier for companies to work with environmental issues and improve communication between stakeholders and companies. The aim of this paper is to investigate how SMEs experience the implementation of environmental management systems according to ISO 14001 as well as how management in these companies motivates and educates employees regarding ISO 14001. The study is based on a qualitative approach and three companies have played the role of informants whose answers are reported in the collected empirical data. Based on the informants' answers, parallels have been drawn to previous research and theories. The results have shown that companies have difficulties with ISO 14001 and that both management and employees are not sufficiently educated around ISO 14001 and environmental management system. When implementing environmental management systems, it is important that both management and employees are well-educated, motivated and committed to the dynamics of the company

No / Ethylmethanesulphonate (EMS), benzidine (BZD) and benzo[a]pyrene (B[a]P) were assayed for ability to induce mutation at the hprt locus of wild-type L5178Y mouse lymphoma cells. EMS was assayed in the absence of metabolic activation, B[a]P in the presence of metabolic activation (S-9 mix) and BZD both in the absence and presence of S-9. Treatment with EMS minus S-9 and B[a]P plus S-9, especially when the S-9 content of the incubation was 2% (v/v), produced strong dose-related increases in mutant frequency. BZD failed to induce mutation at the hprt locus, either in the absence or presence of S-9.

The foundation of modern-day emergency medical service (EMS) systems began in 1966, based on hospital medical care. Demand for evidence to support prehospital practices that have been in existence for the past half-century has continued to grow; yet, researchers have not adequately explored the relationship between the medical certification level of emergency first responders and the amount of time an ambulance spends on the scene. The purpose of this quantitative study was to examine and compare ambulance scene times for emergency responses when basic life support (BLS) certified first responders or advanced life support (ALS) first responders are first on the scene, and whether the level of first responder training reduces the time spent on the scene by a paramedic ambulance. A final research question dealt with whether there is a relationship between how long the first responder is on the scene and the amount of time an ambulance spends at the scene of an emergency. The publicly available archival data used for the study were from a community that had BLS and ALS first responders. Data analysis involved t-tests of the hypotheses for the first 2 research questions and a linear regression analysis of the hypotheses for the third research question. The findings showed that there is a clear difference in ambulance scene times based on the certification level of the first responders. Advanced life support first responders significantly reduced the scene time of ambulances when they arrived at the scene prior to the ambulance. Positive social change could result from this study if understanding the impact that ALS first responders have on ambulance scene times leads EMS planning managers to deploy resources more strategically, thus improving the efficiency of the public safety system and saving lives.

<p>The electronic music studio ”Elektronmusikstudion” (EMS) inStockholm was initiated in 1963. It has had several different managers throughout the years. EMS soon became a rather costly project. Furthermore there have been several conflicts among staff and users wich has contributed to EMS fairly turbulent history. One main conflict concerns the issue wether EMS should be a research facility or a studio for composers. The many different managers of EMS have contributed to a rather unstructured filing of records. To facilitate the understanding of the documents in this archive, and because there is very little written about EMS history, I’ve included a rather comprehensive description of EMS organizational history.</p><p>The subject of this one year master’s thesis is to describe and examine difficulties I’ve encountered in the archival process. My main issues comprise the organization and separation of some of the documents, especially those concerning the conception and organization of EMS and also the abundant technical documentation. Also the question of office of origin has been a concern.</p>

The electronic music studio ”Elektronmusikstudion” (EMS) inStockholm was initiated in 1963. It has had several different managers throughout the years. EMS soon became a rather costly project. Furthermore there have been several conflicts among staff and users wich has contributed to EMS fairly turbulent history. One main conflict concerns the issue wether EMS should be a research facility or a studio for composers. The many different managers of EMS have contributed to a rather unstructured filing of records. To facilitate the understanding of the documents in this archive, and because there is very little written about EMS history, I’ve included a rather comprehensive description of EMS organizational history. The subject of this one year master’s thesis is to describe and examine difficulties I’ve encountered in the archival process. My main issues comprise the organization and separation of some of the documents, especially those concerning the conception and organization of EMS and also the abundant technical documentation. Also the question of office of origin has been a concern.

Title: Methods of processing macroseismic data and their application to the 2008 earthquake swarm in western Bohemia Author: Bc. Pavla Procházková Department: Department of Geophysics Supervisor: doc. RNDr. Oldřich Novotný, CSc. Consultant: RNDr. Pavla Hrubcová, PhD. Supervisor's e-mail address: on@karel.troja.mff.cuni.cz Abstract: Abstract: This work evaluates macroseismic observations of the earthquake swarm which occurred in West Bohemia in 2008. The first chapters are devoted to the explanation of basic terms, the geological description of the region and the history of earthquakes in the region. The historical development of macroseismic scales and a detailed description of the EMS-98, used for the evaluation of the 2008 earthquake swarm data, are contained in the following chapters. The main part of the present work deals with the manual macroseismic evaluation of the swarm followed by a description of the program for the automatic evaluation of data. The program results were found to agree with the manual evaluation. In the next part there is a detailed description of a program for drawing isoseismal lines. In the appendix the reader can find an overview of macroseismic scales, sample questionnaires and suggestions to improve the Czech questionnaire. Keywords: macroseismical intensity, EMS-98...

L'acide ascorbique (AsA, vitamine C) est l'un des composés parmi les plus importants chez les eucaryotes. En raison de son potentiel antioxydant élevé, l'AsA représente un trait important de la qualité nutritionnelle des végétaux. Au-delà de sa valeur bénéfique pour la santé, une augmentation de la teneur en AsA des fruits bénéficierait probablement à la qualité post-récolte et à la résistance aux pathogènes. Pour mieux comprendre ces régulations chez les plantes et leurs impacts sur la qualité des fruits, une collection de tomates EMS hautement mutée (cv. Micro-Tom) a été criblée pour identifier des mutants dont les fruits sont enrichis en AsA. Cette stratégie de génétique directe associant le criblage à une approche de cartographie par séquençage devait permettre d’identifier de nouveaux gènes liés au caractère AsA+. L'un des mutants, noté P21H6, présentait un enrichissement en AsA de 2 à 4 fois supérieur à celui du WT, et fut le premier à être génétiquement caractérisé. Cette étude a permis de mettre en évidence une nouvelle classe de photorécepteurs impliqués dans la détection de la lumière bleue, appelée SlPLP, en tant que régulateur négatif de l'accumulation d'AsA dans la tomate. Le rôle de PLP dans le phénotype AsA+ du fruit a été confirmé par une stratégie de mutagenèse dirigée, avant d’entreprendre sa caractérisation fonctionnelle. Nous avons démontré que SlPLP interagit avec SlGGP (GDP-L-galactose phosphorylase), une enzyme clé de la voie du L-Galactose, sous contrôle de la lumière bleue et que cette interaction a lieu dans le cytoplasme et le noyau. Nos résultats renforcent le rôle central du GGP dans la biosynthèse de l'AsA et suggèrent un nouveau mécanisme de régulation par la lumière bleue de la fonction du GGP, en plus de son activité métabolique. Parallèlement, nous avons entrepris la caractérisation d’un autre mutant, le P17C5-3, qui présentait le plus fort taux d'AsA (jusqu'à 10 fois le WT). Outre le phénotype AsA+, le mutant P17C5 présentait de fortes altérations morphologiques, notamment l’absence de graines, rendant la mise en place de la stratégie de cartographie difficile. Grâce à un croisement avec la variété commerciale M82, la mutation causale pu être identifiée dans un ORF cis-régulateur en amont de GGP. Ce résultat confirme le rôle clé de GGP dans la voie L-Galactose. Des études préliminaires liées au phénotype parthénocarpique suggèrent un problème de stérilité mâle associé aux processus de développement du pollen. Enfin, dans l’étude de la qualité des fruits après la récolte, des expériences de stress froid effectuées avec les fruits P21H6 semblent démontrer que l’augmentation de la teneur en AsA améliore la durée de conservation et la capacité de maturation des fruits. Dans l'ensemble, nos résultats confirment la position clé de la protéine GGP dans la voie de biosynthèse de l'AsA, et fournissent des outils et du matériel végétal précieux pour décortiquer la régulation de l'AsA et son rôle physiologique dans la qualité des fruits et les caractères post-récolte. / Ascorbic acid (AsA, vitamin C) is one of the most important biochemical in living organisms. Due to its high antioxidant potential, AsA represents an important trait of nutritional quality in fruits and vegetables. In addition to its beneficial health value in fruit consumption, increasing fruit AsA content would likely affect postharvest quality and resistance to pathogens. Thus, understanding the regulation of AsA accumulation in order to improve crop species of agronomical interest is an important issue in plant breeding for many fleshy fruit species. To get a better understanding of the regulation of AsA level in plants and its impact on fruit quality, a highly mutagenized EMS tomato collection (cv. Micro-Tom) was screened for AsA+ fruit mutants. This forward genetic strategy combined with a mapping-by-sequencing approach, had allowed identifying new genes related to the AsA+ trait. One of the mutant line named P21H6, displayed an AsA-enrichment 2 to 4 fold that of the WT, and was the first to be genetically characterized. It allowed highlighting a new class of photoreceptor involved in blue light sensing named SlPLP as a negative regulator of AsA accumulation in tomato. We confirmed the role of the PLP in the fruit AsA+ phenotype using a directed mutagenesis strategy, undertaking its functional characterization. We demonstrate that PLP interacts with GGP (GDP-L-galactose phosphorylase), a key enzyme of the L-Galactose pathway, under blue light control and that this interaction takes place in the cytoplasm and the nucleus. Our results strengthen the central role of GGP in the AsA biosynthesis and suggest a new regulation mechanism by blue light of the GGP function in addition to its metabolic activity. Besides we started the characterization another mutant, the P17C5-3, which displayed the highest level of AsA (up to 10 times the WT). Beyond its AsA+ content, the P17C5 mutant showed strong morphological alterations including a seedless phenotype making the mapping difficult at first. Thanks to the crossing with the commercial M82 tomato cultivar, the causal mutation was identified in a cis-acting ORF, upstream of the GGP gene. This result confirmed the key role of GGP in the L-Galactose pathway. Preliminary studies related to the parthenocarpic phenotype suggest a problem of male sterility associated with pollen development processes. Finally, in the study of the post-harvest fruit quality, chilling stress experiments carried out with the P21H6 fruits seem to demonstrate that increasing AsA content improve the fruit shelf life and its maturation capacity. Taken as a whole, our results confirmed the key position of the GGP protein in the AsA biosynthesis pathway and they provided precious tools and plant material for deciphering the regulation of AsA and its physiological role in fruit quality and post-harvest traits.