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The electron configuration of flavin cofactors, FMN and FAD, is a critical factor governing the reactivity of NADPH-cytochrome P450 reductase (CPR). The current view of electron transfer by the mammalian CPR, based on equilibrium redox potentials of the flavin cofactors, is that the two electron-reduced FMN hydroquinone (FMNH2), rather than one electron-reduced FMN semiquinone, serves as electron donor to the terminal protein acceptors. However, kinetic and thermodynamic studies on the CPR species originated from different organisms have shown that redox potentials measured at distinct electron transfer steps differ from redox potentials determined by equilibrium titration. Collectively, previous observations suggest that the short-lived transient semiquinone species may carry electrons in diflavin reductases. In this work, we have investigated spectroscopic properties of the CPR-bound FAD and FMN reduced at 77 K by radiolytically-generated thermalized electrons. Using UV-vis spectroscopy, we demonstrated that upon cryo-reduction of oxidized yeast CPR (yCPR) containing an equimolar ratio of both FAD and FMN, or FAD alone, neutral semiquinones were trapped at 77 K. During annealing at the elevated temperatures, unstable short-lived neutral semiquinones relaxed to spectroscopically distinct air-stable neutral semiquinones. This transition was independent of pH within the 6.0-10.7 range. Our data on yeast CPR are in line with the previous observations of others that the flavin short-lived transient semiquinone intermediates may have a role in the electron transfer by CPR at physiological conditions.

Introduction: Most medical schools teach cardiopulmonary resuscitation (CPR) during the final year in course curriculum to prepare students to manage the first minutes of clinical emergencies. Little is known regarding the optimal method of instruction for this critical skill. Simulation has been shown in similar settings to enhance performance and knowledge. We evaluated the comparative effectiveness of high-fidelity simulation training vs. standard manikin training for teaching medical students the American Heart Association (AHA) guidelines for high-quality CPR.  Methods: This was a prospective, randomized, parallel-arm study of 70 fourth-year medical students to either simulation (SIM) or standard training (STD) over an eight-month period. SIM group learned the AHA guidelines for high-quality CPR via an hour session that included a PowerPoint lecture with training on a high-fidelity simulator. STD group learned identical content using a low-fidelity Resusci Anne® CPR manikin. All students managed a simulated cardiac arrest scenario with primary outcome based on the AHA guidelines definition of high-quality CPR (specifies metrics for compression rate, depth, recoil, and compression fraction). Secondary outcome was time to emergency medical services (EMS) activation. We analyzed data via Kruskal-Wallis rank sum test. Outcomes were performed on a simulated cardiac arrest case adapted from the AHA Advanced Cardiac Life Support (ACLS) SimMan® Scenario manual. Results: Students in the SIM group performed CPR that more closely adhered to the AHA guidelines of compression depth and compression fraction. Mean compression depth was 4.57 centimeters (cm) (95% confidence interval [CI] [4.30-4.82]) for SIM and 3.89 cm (95% CI [3.50-4.27]) for STD, p=0.02.  Mean compression fraction was 0.724 (95% CI [0.699-0.751]) for SIM group and 0.679 (95% CI [0.655-0.702]) for STD, p=0.01. There was no difference for compression rate or recoil between groups. Time to EMS activation was 24.7 seconds (s) (95% CI [15.7-40.8]) for SIM group and 79.5 s (95% CI [44.8-119.6]) for STD group, p=0.007.  Conclusion: High-fidelity simulation training is superior to low-fidelity CPR manikin training for teaching fourth-year medical students implementation of high-quality CPR for chest compression depth and compression fraction.

This editorial addresses concerns of program directors that the new program requirements by the ACGME will adversely affect emergency medicine faculty and resident training.  In this editorial, we address the specific concerns of program directors in emergency medicine.

The Candidate Phyla Radiation (CPR) comprises a huge group of bacteria that have small genomes that rarely encode CRISPR-Cas systems for phage defense. Consequently, questions remain about their mechanisms of phage resistance and the nature of phage that infect them. The compact CRISPR-CasY system (Cas12d) with potential value in genome editing was first discovered in these organisms. Relatively few CasY sequences have been reported to date, and little is known about the function and activity of these systems in the natural environment. Here, we conducted a genome-resolved metagenomic investigation of hot spring microbiomes and recovered CRISPR systems mostly from Roizmanbacteria that involve CasY proteins that are divergent from published sequences. Within population diversity in the spacer set indicates current in situ diversification of most of the loci. In addition to CasY, some Roizmanbacteria genomes also encode large type I-B and/or III-A systems that, based on spacer targeting, are used in phage defense. CRISPR targeting identified three phage represented by complete genomes and a prophage, which are the first reported for bacteria of the Microgenomates superphylum. Interestingly, one phage encodes a Cas4-like protein, a scenario that has been suggested to drive acquisition of self-targeting spacers. Consistent with this, the Roizmanbacteria population that it infects has a CRISPR locus that includes self-targeting spacers and a fragmented CasY gene (fCasY). Despite gene fragmentation, the PAM sequence is the same as that of other CasY reported in this study. Fragmentation of CasY may avoid the lethality of self-targeting spacers. However, the spacers may still have some biological role, possibly in genome regulation. The findings expand our understanding of CasY diversity, and more broadly, CRISPR-Cas systems and phage of CPR bacteria.

Abstract In the incarcerated population, the largest ethnic and racial group is Black people. Heart disease is known as the leading causes of death in the United States which can lead to cardiac arrest. Layperson cardiopulmonary resuscitation (CPR) has been shown to provide a benefit and increase likelihood of return of spontaneous circulation (ROSC). Recent research shows that in witnessed out of hospital cardiac arrests, the likelihood of receiving bystander CPR was found to be less among Black or Hispanic people when compared to White persons. One neglected area for layperson CPR training are these correctional facilities. This population is known to have higher rates of diabetes, high blood pressure and coronary artery disease, all of which contribute to an increased risk of acute coronary syndrome. A search was performed of the NEMSIS database. When comparing witnessed cardiac arrest, incidents without bystander interventions occurred more frequently than expected if the arrest was witnessed by a family member or other lay person. These interventions included bystander CPR or AED placement with or without defibrillation. The data presented shows that there is an unmet need of additional lay person CPR training in correctional facilities which could be implemented for little cost.

Aim To investigate bystanders’ CPR involvement in out-of-hospital cardiac arrest (OHCA) events, their current knowledge regarding OHCA and BLS measures, their willingness to learn BLS measures with the usage of AEDs, as well as current practices. Methods This cross-sectional study included: data regarding all OHCA events treated at the Emergency Medical Service of Canton Sarajevo between January 2015 and December 2019, and an online anonymous questionnaire that examined knowledge, attitudes and practices regarding basic life support (BLS) and automated external defibrillators (AEDs). Results A total of 328 (24.0 %) of 1362 OHCA events achieved the return of spontaneous circulation (ROSC). OHCA incidence was 62/100.000 inhabitants per year. Male gender (p=0.043) and younger age (p

Abstract Background Medical emergencies are complex and stressful, especially for the young and inexperienced. Cognitive aids (CA) have been shown to facilitate management of simulated medical emergencies by experienced teams. In this randomized trial we evaluated guideline adherence and treatment efficacy in simulated medical emergencies managed by residents with and without CA. Methods Physicians attending educational courses executed simulated medical emergencies. Teams were randomly assigned to manage emergencies with or without CA. Primary outcome was risk reduction of essential working steps. Secondary outcomes included prior experience in emergency medicine and CA, perceptions of usefulness, clinical relevance, acceptability, and accuracy in CA selection. Participants were grouped as “medical” (internal medicine and neurology) and “perioperative” (anesthesia and surgery) regarding their specialty. The study was designed as a prospective randomized single-blind study that was approved by the ethical committee of the University Duisburg-Essen (19-8966-BO). Trial registration: DRKS, DRKS00024781. Registered 16 March 2021—Retrospectively registered, http://www.drks.de/DRKS00024781 . Results Eighty teams participated in 240 simulated medical emergencies. Cognitive aid usage led to 9% absolute and 15% relative risk reduction. Per protocol analysis showed 17% absolute and 28% relative risk reduction. Wrong CA were used in 4%. Cognitive aids were judged as helpful by 94% of the participants. Teams performed significantly better when emergency CA were available (p

Purpose: This study aims to assess the diagnostic utility of C-reactive protein (CRP) to albumin ratio (CAR) for predicting elevated D-dimer levels in COVID-19. Materials and Methods: This retrospective cohort study collected data from 145 hospitalized patients with confirmed COVID-19 in a university hospital. Patients were divided into two groups based on their D-dimer levels, as elevated D‐dimer levels and normal D-dimer levels. Demographic data, comorbidities, clinical symptoms, CAR, and laboratory results were obtained from the patients’ medical records and compared between the groups. Results: The mean age of patients was 52.9±17.9 years, and 76 of them were male. The median of CAR was significantly higher in those with higher D-dimer (134.1 vs. 20.7). CRP, procalcitonin, leukocyte, neutrophil, lactate dehydrogenase, ferritin, and fibrinogen were higher in patients with elevated D-dimer levels. There was a highly significant positive correlation between CAR and D-Dimer. Logistic regression analysis revealed that CAR was a significant determinant for elevated D‐dimer levels . The area under the ROC curve (AUC) was 0.741 for CAR. The verified cut-off value of CAR for predicting elevated D‐dimer levels in patients with COVID-19 was 81.8, with a sensitivity of 58% and a specificity of 70%. Conclusion: Our study revealed that CAR was significantly correlated with D-dimer and can be used to predict elevated D‐dimer levels in patients with COVID-19.

Background: Cardiac arrest is an unpredictable incident where the heart stops working very quickly, becoming a major health concern globally, especially during the COVID-19 pandemic. Death occurs when the victim is delayed in obtaining cardiopulmonary resuscitation (CPR). All levels of society, especially undergraduate nursing students, must be able to perform CPR by increasing their ability to become qualified CPR bystanders. Objectives: This research aims to analyze factors related to the self-efficacy of undergraduate nursing students (motivation and awareness) in performing CPR on undergraduate nursing students in Indonesia. Methods: This is quantitative research with a cross-sectional approach, using a purposive sampling technique. Sample in this research 290 students. Data collection was carried out from January 2021 to February 2021 through google form online questionnaire containing: demographic data, the dependent variable which is motivation and awareness, and the dependent variable which is nurse efficacy. Statistical test for bivariate using spearmen rho and multivariate using logistic regression. Results: The results showed that most undergraduate nursing students had good efficacy when facing cardiac arrests, with 166 (57.2%). The results of the binary logistic regression showed that the factors associated with nursing undergraduate efficacy were motivation (OR=1.106 95% CI = 0.497-2,458 p-value 0.000) and awareness (OR = 18.575 95% CI = 7,798-44,245 p-value 0.000). Conclusion: Good efficacy of nursing undergraduate students can be attained through collaboration between student motivation and awareness in performing CPR on victims with cardiac arrest.

Abstract Background Nearly 90% of out-of-hospital cardiac arrest (OHCA) patients are witnessed, yet only 2.3% received bystander cardiopulmonary resuscitation (CPR) in Pakistan. This study aimed to determine retention of knowledge and skills of Hands-Only CPR among community participants in early recognition of OHCA and initiation of CPR in Karachi, Pakistan. Methods Pre and post-tests were conducted among CPR training participants from diverse non-health-related backgrounds from July 2018 to October 2019. Participants were tested for knowledge and skills of CPR before training (pre-test), immediately after training (post-test), and 6 months after training (re-test). All the participants received CPR training through video and scenario-based demonstration using manikins. Post-training CPR skills of the participants were assessed using a pre-defined performance checklist. The facilitator read out numerous case scenarios to the participants, such as drowning, poisoning, and road traffic injuries, etc., and then asked them to perform the critical steps of CPR identified in the scenario on manikins. The primary outcome was the mean difference in the knowledge score and skills of the participants related to the recognition of OHCA and initiation of CPR. Results The pre and post-tests were completed by 652 participants, whereas the retention test after 6 months was completed by 322 participants. The mean knowledge score related to the recognition of OHCA, and initiation of CPR improved significantly (p

Abstract Background The increased use of metagenomics and single-cell genomics led to the discovery of organisms from phyla with no cultivated representatives and proposed new microbial lineages such as the candidate phyla radiation (CPR or Patescibacteria). These bacteria have peculiar ribosomal structures, reduced metabolic capacities, small genome, and cell sizes, and a general host-associated lifestyle was proposed for the radiation. So far, most CPR genomes were obtained from groundwaters; however, their diversity, abundance, and role in surface freshwaters is largely unexplored. Here, we attempt to close these knowledge gaps by deep metagenomic sequencing of 119 samples of 17 different freshwater lakes located in Europe and Asia. Moreover, we applied Fluorescence in situ Hybridization followed by Catalyzed Reporter Deposition (CARD-FISH) for a first visualization of distinct CPR lineages in freshwater samples. Results A total of 174 dereplicated metagenome-assembled genomes (MAGs) of diverse CPR lineages were recovered from the investigated lakes, with a higher prevalence from hypolimnion samples (162 MAGs). They have reduced genomes (median size 1 Mbp) and were generally found in low abundances (0.02–14.36 coverage/Gb) and with estimated slow replication rates. The analysis of genomic traits and CARD-FISH results showed that the radiation is an eclectic group in terms of metabolic capabilities and potential lifestyles, ranging from what appear to be free-living lineages to host- or particle-associated groups. Although some complexes of the electron transport chain were present in the CPR MAGs, together with ion-pumping rhodopsins and heliorhodopsins, we believe that they most probably adopt a fermentative metabolism. Terminal oxidases might function in O2 scavenging, while heliorhodopsins could be involved in mitigation against oxidative stress. Conclusions A high diversity of CPR MAGs was recovered, and distinct CPR lineages did not seem to be limited to lakes with specific trophic states. Their reduced metabolic capacities resemble the ones described for genomes in groundwater and animal-associated samples, apart from Gracilibacteria that possesses more complete metabolic pathways. Even though this radiation is mostly host-associated, we also observed organisms from different clades (ABY1, Paceibacteria, Saccharimonadia) that appear to be unattached to any other organisms or were associated with ‘lake snow’ particles (ABY1, Gracilibacteria), suggesting a broad range of potential life-strategies in this phylum. Video Abstract

Introduction and objective: Epinephrine is the most important and primary drug that resuscitation team use to reverse cardiac arrest. The provision of epinephrine is currently suggested by both the American Heart Association and the European Resuscitation Council. It is vital to improving the return of spontaneous circulation (ROSC), however the evidence for the use of adrenaline in resuscitation is inconclusive. Materials and methods: The literature was reviewed in the Pubmed database, in the Via Medica Journals database, and in the guidelines of the Polish Society of Anesthesiology, European Resuscitation Council and the American Heart Association with the use of keywords. State of knowledge: There is a clear evidence of an association between epinephrine and increased return of spontaneous circulation (ROSC). Its action is based on stimulation of alpha- and beta-adrenergic receptors. Epinephrine have a role in resuscitation, during CPR it increases the probability of restoring cardiac activity with pulses, which is intermediate step toward long-term survival. However, there are conflicting results regarding long-term survival and functional recovery, particularly neurological outcome. Conclusions: Research shows that epinephrine administration in patients with cardiac arrest increases the chance of restoring spontaneous circulation and patient survival to hospital admission and discharge. However, there are arguments questioning the validity of using epinephrine in resuscitation. Publications show that the compound contributes to post-resuscitation syndrome, which reduces a patient's chance of long-term survival. There are a number of conflicting studies that vary widely in the results presented. The current evidence is insufficient to either confirm or exclude the efficacy of epinephrine, which is why it is still recommended in the latest resuscitation guidelines by the European Resuscitation Council (ERC 2021) and the American Heart Association (AHA 2020).

Overdose education and naloxone distribution (OEND) programs are widely accepted to reduce opioid overdose deaths. However, there is currently no validated instrument to evaluate the skills of learners completing these programs. Such an instrument could provide feedback to OEND instructors and allow researchers to compare different educational curricula. The aim of this study was to identify medically appropriate process measures with which to populate a simulation-based evaluation tool. Researchers conducted interviews with 17 content experts, including healthcare providers and OEND instructors from south-central Appalachia, to collect detailed descriptions of the skills taught in OEND programs. Researchers used three cycles of open coding, thematic analysis, and consulted currently available medical guidelines to identify thematic occurrences in qualitative data. There was consensus among content experts that the appropriate nature and sequence of potentially lifesaving actions during an opioid overdose is dependent on clinical presentation. Isolated respiratory depression requires a distinct response compared to opioid-associated cardiac arrest. To accommodate these different clinical presentations, raters populated an evaluation instrument with the detailed descriptions of overdose response skills, such as naloxone administration, rescue breathing, and chest compressions. Detailed descriptions of skills are essential to the development of an accurate and reliable scoring instrument. Furthermore, evaluation instruments, such as the one developed from this study, require a comprehensive validity argument. In future work, the authors will integrate the evaluation instrument in high-fidelity simulations, which are safe and controlled environments to study trainees’ application of hands-on skills, and conduct formative assessments.

Background: Both skeletal and visceral injuries are reported after cardiopulmonary resuscitation (CPR). This subgroup analysis of a randomized clinical study describes/compares autopsy documented injury patterns caused by two mechanical, piston-based chest compression devices: standard LUCAS® 2 (control) and LUCAS® 2 with active decompression (AD, intervention) in non-survivors with out-of-hospital cardiac arrest (CA). Method: We compared injuries documented by autopsies (medical/forensic) after control and intervention CPR based on written relatives consent to use patients’ data. The pathologists were blinded for the device used. The cause of CA and injuries reported were based on a prespecified study autopsy template. We used Pearson's chi-squared test and logistic regression analysis with an alpha level of 0.05. Results: 221 patients were included in the main study (April 2015–April 2017) and 207 did not survive. Of these, 114 (55%, 64 control and 50 intervention) underwent medical (N = 73) or forensic (N = 41) autopsy. The cause of CA was cardiac 53%, respiratory 17%, overdose/intoxication 14%, ruptured aorta 10%, neurological 1%, and other 5%. There were no differences between control and intervention in the incidence of rib fractures (67% vs 72%; p-value = 0.58), or sternal fractures (44% vs 48%; p-value = 0.65), respectively. The most frequent non-skeletal complication was bleeding (26% of all patients) and intrathoracic was the most common location. Ten of the 114 patients had internal organ injuries, where lungs were most affected. Conclusion: In non-survivors of OHCA patients, the most frequent cause of cardiac arrest was cardiogenic. Skeletal and non-skeletal fractures/injuries were found in both control and intervention groups. Bleeding was the most common non-skeletal complication. Internal organ injuries were rare.

Background: High-quality cardiopulmonary resuscitation (CPR) is foundational to all resuscitative efforts. Spaced practice improves learners’ skill retention. We evaluated the implementation of a quarterly CPR curriculum and skills training program for a dedicated chest compressor team to improve the quality of CPR performed during in-hospital cardiac arrest (IHCA) events and its impact on patient survival of event. Methods: Baseline observations on CPR performance within the hospital were collected in October 2018. The CPR quarterly training program was implemented in November 2018. Training included use of high-fidelity simulation manikins and team members received real-time feedback scores related to compression rate, depth and recoil. High-quality CPR scores were set at ≥ 70%. Yearly IHCA event survival data was examined in relation to the implementation of training. Results: Quarterly CPR training of the team led to retention of CPR skills (chest compression rate, depth, and recoil). The team’s initial CPR training performance average score was 49.1%, increasing to 80.3%, with 95% (n = 37) of participants achieving a higher score after feedback during their initial training. A two-sample t-test was used for numerical data and chi-square was used for proportional data analysis. The survival of event prior to this training was 61.0% January-October 2018. Post -training, event survival rose to 73.5% (p-value 0.03) in 2019. Conclusion: Implementation of a team that attends quarterly CPR training with a high-fidelity simulation manikin is attainable. This training resulted in improved CPR quality and benefited IHCA event survival.

Aim: To understand the fear and willingness to respond of smartphone activated first responders during the COVID-19 pandemic. Methods: We invited smartphone activated first responders registered with the GoodSAM application in Victoria, Australia to take part in an online survey in November 2020. We assessed willingness to respond to an alert and provide CPR during the pandemic and administered the Fear of COVID-19 Scale questionnaire. Regression analysis was conducted to investigate associations between occupation, clinical training, and years of clinical experience with willingness to respond and fear of COVID-19. Results: The survey response rate was 5.1%. Responders (n = 348) had a median age (interquartile range) of 46 years (33–55). Most (67%) were aged 30–59 years and 43% were female. Responders spanned several occupations including paramedics (12.6%), registered nurses (14.7%), and non-clinical individuals (21.8%). Most (92%) reported they would feel comfortable responding to a GoodSAM alert during the pandemic. Almost all (>95%) reported they would provide CPR. About 20% reported being afraid of COVID-19 but only 3.2% reported they had a high-level of fear of COVID-19. The odds of paramedics being willing to respond to an alert was reduced by 73% during the pandemic (OR 0.27, 95% CI 0.11 to 0.69). No other associations were found with willingness or fear of COVID-19. Conclusion: Although willingness was high and fear of COVID-19 was low, some smartphone activated first responders were less willing to respond to an alert during the pandemic. These findings may inform future pandemic planning and decision-making around pausing first-responder programs.

Background: The purpose of this literature review is to explore parents' experiences of witnessing their child being resuscitated in hospital settings. Methods: An integrative literature review using the databases CINAHL, PubMed and PsycInfo to retrieve articles published between 2011 and 2021 on parent-witnessed resuscitation. Results: This review found strong evidence of the benefit of parents being present during their child's resuscitation, with three common themes emerging: need to be present, communication and seeing to believe. Parents and the healthcare team benefit from being present, and parents feel they have more positive experiences when they are allowed to choose their level of presence. Conclusion: The benefits of parental witnessed resuscitation are shown throughout the review, however, this may not always be adopted in practice. Hospital policies or resuscitation training do not cover parent-witnessed resuscitation, therefore implementation of mandatory hospital policy regarding this issue should be introduced to practice to create continuity of high-quality care. [ABSTRACT FROM AUTHOR]

Background & Objective: Code blue is an emergency management system that allows for a rapid professional response to the patients of cardiopulmonary arrest (CPA) in hospitals. The time to initiate the call and the response of the 'Code Blue Team' may vary in different hospitals, and it me be linked with the survival of the victim. We examined and compared the code blue application utilized in our hospital before and during the COVID-19 pandemic. Methodology: Code Blue Call (CBC) logs from March 01, 2018 to March 31, 2022 were retrospectively analyzed. The study period was divided into two parts: March 01, 2018-February 28, 2020 (Group I, pre-pandemic period) and March 01, 2020-March 31, 2022 (Group II, pandemic period). Results: During the study period, a total of 1542 CBC's were received, of which 837 (54.3%) were 'true' CBC's. Of the 837 true CBC's included in the study, 477 (56.7%) were for male patients and 360 (43.3%) were for the females. We evaluated the month-wise distribution of the CBC's; the month with the highest number of calls in Group I was January 2019 (n = 29, 17.3%), while in Group II it was December 2020 (n = 59, 23.1%). The arrival time of the code blue team was significantly different between the groups, e.g., 3.15 ± 0.52 vs. 3.81 ± 0.58 min in Group I vs. Group II respectively. Conclusion: The intervention times of the code blue team and the success of cardiopulmonary resuscitation were observed to be comparable during the pre-pandemic and pandemic periods. The duration of commencement of intervention is important for the efficacy of cardiopulmonary resuscitation during a pandemic. [ABSTRACT FROM AUTHOR]

Summary: A 10‐h‐old 56‐kg Thoroughbred filly was presented for treatment of partial failure of passive transfer of immunity and presumed neonatal maladjustment syndrome (NMS). The filly was hospitalised, and supportive care initiated. On Day 5 of hospitalisation, seizures were observed and were controlled with IV administration of diazepam. Due to progression of clinical signs of NMS, magnetic resonance imaging of the filly's brain was performed. During the early anaesthetic recovery period, the filly exhibited cardiopulmonary arrest (CPA) at which point cardiopulmonary cerebral resuscitation (CPCR) was performed for a total of 48 min. During this time, ventricular fibrillation (VF) was observed on ECG and the filly was defibrillated three times at 1–2‐min intervals using 2–4 J/kg of monophasic electrical defibrillation. The filly successfully recovered from CPCR, was discharged 5 days later and was reported healthy 12 months post‐discharge. [ABSTRACT FROM AUTHOR]

Objective: To evaluate cardiopulmonary resuscitation (CPR) skills performance and retention in schoolchildren aged 8 to 12 years following instruction by their teachers and with the guidance of a school nurse using paediatric manikins. Design: Descriptive simulation trial. Method: A school nurse provided support to six schoolteachers as they taught a modified 40-minute CPR course. Pupils were shown an out-of-hospital cardiac-arrest recognition video followed by a CPR simulation using paediatric manikins. 117 schoolchildren aged 8 to 12 years received the training. Both the schoolchildren and teachers completed a survey before and afterwards. Children completed an out-of-hospital cardiac-arrest recognition test and a 1-minute CPR test 1 week later. Results: After training, schoolchildren increased their self-efficacy as rescuers (8 ± 2 vs 10 ± 2; p < 0.001). Irrespective of age differences, 74% of schoolchildren performed the entire out-of-hospital cardiac-arrest recognition sequence correctly. Children aged 11 to 12 years and 10 to 11 years performed higher quality CPR (49% and 47%, respectively) compared to 8 to 9 year olds (14%, p = 0.008 and p = 0.014). Children aged 11 to 12 years outperformed younger children aged 8 to 9 years with respect to compression depth (48 ± 6 mm vs 43 ± 5 mm, p = 0.008) Conclusion: Schoolchildren's teachers, who were guided by a nurse using paediatric manikins, taught children aged 10 to 12 years to perform high-quality CPR. We suggest integrating paediatric manikins as part of children's CPR training as feedback from successful CPR performance increases motivation and confidence to act as a rescuer as well as improves skills retention. [ABSTRACT FROM AUTHOR]

Background: Prompt, effective CPR greatly increases the chances of survival in out-of-hospital c ardiac arrest. However, it is often not provided, even by people who have previously undertaken training. Psychological and behavioural factors are likely to be important in relation to CPR initiation by lay-people but have not yet been systematically identified. Methods: Aim: to identify the psychological and behavioural factors associated with CPR initiation amongst lay-people. Design: Systematic review Data sources: Cochrane Library, MEDLINE, EMBASE, CINAHL, PsycInfo and Google Scholar. Study eligibility criteria: Primary studies reporting psychological or behavioural factors and data on CPR initiation involving lay-people published (inception to 31 Dec 2021). Study appraisal and synthesis methods: Potential studies were screened independently by two reviewers. Study characteristics, psychological and behavioural factors associated with CPR initiation were extracted from included studies, categorised by study type and synthesised narratively. Results: One hundred and five studies (150,820 participants) comprising various designs, populations and of mostly weak quality were identified. The strongest and most ecologically valid studies identified factors associated with CPR initiation: the overwhelming emotion of the situation, perceptions of capability, uncertainty about when CPR is appropriate, feeling unprepared and fear of doing harm. Current evidence comprises mainly atheoretical cross-sectional surveys using unvalidated measures with relatively little formal testing of relationships between proposed variables and CPR initiation. Conclusions: Preparing people to manage strong emotions and increasing their perceptions of capability are likely important foci for interventions aiming to increase CPR initiation. The literature in this area would benefit from more robust study designs. Systematic review registration: PROSPERO: CRD42018117438. [ABSTRACT FROM AUTHOR]

Background: Overweight/obesity can affect fertility, increase the risk of pregnancy complications, and affect the outcome of assisted reproductive technology (ART). However, due to confounding factors, the accuracy and uniformity of published findings on IVF outcomes have been disputed. This study aimed to assess the effects of both male and female body mass index (BMI), individually and in combination, on IVF outcomes. Methods: This retrospective cohort study included 11,191 couples undergoing IVF. Per the Chinese BMI standard, the couples were divided into four groups: normal; female overweight/obesity; male overweight/obesity; and combined male and female overweight/obesity. The IVF outcomes of the four groups were compared and analysed. Results: Regarding the 6569 first fresh IVF-ET cycles, compared with the normal weight group, the female overweight/obesity and combined male/female overweight/obesity groups had much lower numbers of available embryos and high-quality embryos (p < 0.05); additionally, the fertilization (p < 0.001) and normal fertilization rates (p < 0.001) were significantly decreased in the female overweight/obesity group. The combined male/female overweight/obesity group had significant reductions in the available embryo (p = 0.002), high-quality embryo (p = 0.010), fertilization (p = 0.001) and normal fertilization rates (p < 0.001); however, neither male or female overweight/obesity nor their combination significantly affected the clinical pregnancy rate (CPR), live birth rate (LBR) or abortion rate (p > 0.05). Conclusion: Our findings support the notion that overweight/obesity does not influence pregnancy success; however, we found that overweight/obesity affects the fertilization rate and embryo number and that there are sex differences. [ABSTRACT FROM AUTHOR]

Purpose: As a Doppler sonographic parameter, the cerebroplacental ratio (CPR) provides information about fetal hemodynamics and the redistribution of fetal blood volume in response to a metabolic change. The present study was undertaken to determine the extent to which CPR can be used as a valid parameter in routine obstetric assessment. We investigated whether CPR can be used to assess the neonatal outcome in appropriate for gestational age (AGA) fetuses and its association with secondary cesarean section due to fetal distress. Methods: In this retrospective analysis 1739 pregnant women were admitted to the University Women's Clinic Magdeburg, Germany, between January 2016 and December 2017. Of them, 710 AGA fetuses were eligible for analysis. SGA fetuses with an estimated fetal weight < 10th percentile were excluded from the study. The AGA fetuses were divided in two groups based on the CPR: 669 fetuses showed a normal CPR ≥ 1.08; 41 fetuses showed a decreased CPR < 1.08. Results: In our study cohort decreased CPR in AGA fetuses was associated with threefold increased rate of cesarean sections due to fetal distress (p < 0.001). Our data suggested that low CPR is a reliable predictor of an impaired neonatal outcome in AGA fetuses in terms of a lower birth weight, transfer to neonatology, longer length of hospitalization, and the presence of severe morbidity. Conclusion: Decreased CPR in AGA fetuses correlated with impaired neonatal outcome and secondary cesarean section due to fetal distress. The potential role of CPR for obstetric screening should be investigated in further studies. [ABSTRACT FROM AUTHOR]

• Children with pre-hospital traumatic cardiopulmonary arrest, particularly in those without pre-hospital ROSC have poor outcomes. • All children who did not obtain pre-hospital ROSC succumbed to their injuries in our study. • Prolonged CPR is common but rarely beneficial. • Where possible, parents should be allowed to witness and/or participate in end-of-life care. The survival of traumatic cardiopulmonary arrest (TCA) requiring pre-hospital cardiopulmonary resuscitation (P-CPR) is abysmal across age groups. We aim to describe the mechanisms of injury and outcomes of children suffering from TCA leading to P-CPR at our institution. A retrospective review was conducted to identify children ages 0-17 years who suffered TCA leading to P-CPR at our institution between 5/2009 and 3/2020. For analysis, patients were stratified into those still undergoing CPR at arrival and those who attained pre-hospital return of spontaneous circulation (ROSC). Primary outcome was discharge alive from the hospital. P-CPR was initiated for 48 patients who had TCA; 23 had pre-hospital ROSC. Of the 25 children undergoing CPR at presentation, none survived to discharge. The median duration of CPR, from initiation to time of death declaration was 34 min [29,50]. Seventeen patients died after resuscitation attempts in the ED, while 8 died after admission to the PICU. Of the 23 patients who attained pre-hospital ROSC, 6 survived to discharge. All survivors required intensive rehabilitation services at discharge and at most recent follow-up, 5 had residual deficits requiring medical attention. There are poor outcomes in children with pre-hospital traumatic cardiopulmonary arrest, particularly in those without pre-hospital ROSC. These data further support the need for standardized guidelines for resuscitation in children with traumatic cardiopulmonary arrest. [ABSTRACT FROM AUTHOR]

Introduction: Late-onset intrauterine fetal growth restriction (IUGR) is a common pregnancy complication diagnosed in 5–10% of pregnant women worldwide. Under the impact of hypoxia, the fetus develops a protective mechanism of adaptive changes occurring in the cerebral circulation ("brain-sparing effect"). Materials and methods: We conducted detailed longitudinal Doppler examinations and the monitoring of the fetal condition in 53 IUGR fetuses. Doppler measurements of the pulsatility index in the fetal tibial (TA-PI), umbilical (UA-PI), and middle cerebral arteries (MCA-PI) were performed, and the cerebral placental ratio (CPR) was determined on a weekly basis from the 33rd week to the birth. Results: The longitudinal analysis showed a significant increase in the TA-PI. The UA showed a plateau, but no increase was detected near term. The MCA-PI and CPR showed a progressive decrease in values from inclusion to delivery. Our findings indicate that the increase in the TA-PI was the first sign of the aggravating state of the fetus with the changes registered from the 35th week. The parameters of the UA-PI did not show significant changes, while the MCA and CPR became abnormal later from the 37th week. Conclusions: These observations can serve towards the development of guidelines for detecting the deteriorating signs and intervention timing in IUGR during late pregnancies. [ABSTRACT FROM AUTHOR]

Immediate resuscitation is crucial for the survival of a patient with cardiac arrest. Research has suggested that self-led bystander cardiopulmonary resuscitation (CPR) is significantly associated with favourable neurological outcomes for patients. Furthermore, medical students play an important role in providing public CPR training to the community. This study aims to evaluate the effects of a CPR training programmes and a public training event on the knowledge, attitudes, and perceived competency towards CPR among medical students. The quasi-experimental study was conducted among the medical students in clinical years studying at a private medical institution in Malaysia. The intervention group received CPR training for two sessions and participated as trainers in a community-training event; the control group was excluded from these activities. A total of 106 students (intervention group, n = 51; control group, n = 55) participated in this study. The total knowledge score (5.24 ± 1.67 vs 3.75 ± 1.22, P < 0.001), attitude score (22.38 ± 3.67 vs 20.82 ± 2.33, P = 0.011), and perceived competencies to perform CPR and automated external defibrillator (AED) (7.22 ± 2.33 vs 4.93 ± 2.40, P < 0.001) were significantly higher among the participants in the intervention group compared to those in the control group after the intervention. Meanwhile, concerns regarding initiating CPR was significantly higher in the intervention group compared to the control group (12.44 ± 5.15 vs 9.55 ± 3.96, P = 0.002). The results suggested that CPR training is beneficial for students and should be organised regularly. In addition to providing physical skills training, such sessions should explain legal implications of initiating CPR and should encourage and assure students to do so in case of an emergency. [ABSTRACT FROM AUTHOR]

Background & Objective: Patients suffering from cardiac arrest (CA) have poor prognosis and survival. The association of pre-arrest comorbidity with unsuccessful resuscitation in patients with CA is far from clear. The aim of the present study was to investigate the association between pre-existing comorbidity and unsuccessful resuscitation following CA in Iranian patients. Materials & Methods: Data of all the patients with CA (1320 patients) who were admitted to Baqiyatallah Hospital (Tehran, Iran), and underwent cardiopulmonary resuscitation (CPR) from 2018 to 2020 were retrospectively reviewed. We analyzed the association of comorbidity data with the mortality rate and unsuccessful CPR. Results: In the present study, 794 (60.2%) patients were female. Most CAs occurred in the hospital (1289). The case fatality rate (CFR) of CA was 69.92%. Additionally, of the 1320 patients, CPR was unsuccessful in 1271 (96.3%) patients. Our data analysis revealed that gender had no significant relationship with the mortality rate and unsuccessful CPR. However, age was significantly associated with mortality, but not with unsuccessful CPR. CA, respiratory distress, and impaired consciousness were significantly associated with mortality. Furthermore, cardiomyopathy, coronary artery bypass grafting (CABG), renal disease (P=0.032), and poisoning had a significant correlation with mortality. In addition, CABG and congestive heart failure (CHF) were significantly correlated with the unsuccessful CPR. Conclusion: The present study suggested that CABG and CHF had a significant relationship with unsuccessful resuscitation. Furthermore, cardiomyopathy, CABG, renal disease, and poisoning were significantly associated with mortality. [ABSTRACT FROM AUTHOR]

Objective: This paper aims to investigate the duration of the pricing & reimbursement (P&R) procedures submitted in Italy by pharmaceutical marketing authorization holders (MAH) for drugs indicated for rare diseases. Methods: All the data used in this analysis were publicly available on different sources of the Italian Ministry of Health, the Italian Medicines Agency (AIFA) and other official websites. The information was systematically collected to investigate the timeline (days) needed to complete the P&R process. The process was divided into 6 simplified steps and the median and range of days needed for each phase were estimated based on data reported in official/published documents. The analysis was stratified considering every single step of the assessment phase and included segmentation of drugs into indications for rare diseases, Orphan designation, Innovation assessment and Managed entry agreements (MEAs). Results: Overall, 181 first indication procedures were submitted to AIFA in the period considered and, of these, 167 (92.3%) were completed and 129 procedures were considered for the final analysis and the median duration of the entire process (MAH submission to final Gazette publication) was 434 days (range 176.0-918.0). The duration of procedures for rare diseases (n = 53) was longer than those for non-rare-disease procedures (n = 76) (463.0 days vs 407.5 days respectively). Among rare disease procedures, orphan designation and MEAs represent predictors for time prolongation while innovation is associated with a shorter assessment time. Conclusion: The study describes the time spent in each phase of the assessment and the appraisal process and demonstrates that uncertainty represents the main driver for the increment in the overall time. [ABSTRACT FROM AUTHOR]

Circular Polarization Ratio (CPR) and bistatic angle (β), obtained using Arecibo Observatory Planetary Radar, are the two important parameters for determining the presence of water–ice on the lunar surface. In this paper investigation on the possibility of water–ice deposits on the Erlanger crater floor, located in the Permanently Shadowed Regions (PSRs) of the lunar surface has been done using bistatic Mini-RF synthetic aperture radar (SAR) data. In order to better characterize the Erlanger crater, topographic, morphology map, temperature map, PSR map, Lunar Reconnaissance Orbiter Wide Angle Camera (WAC) image, circular polarization ratio (CPR), m-χ decomposition method and bistatic angle (β) were utilized. We have found that the Erlanger crater and its surroundings comply with the CPR > 1 condition Spudis et al. (Geophysical Research Letter 37, 2010). In the crater floor, it was also observed that parameter β was very high, which is not a favorable condition for the water–ice regions possible. Furthermore, observations have been obtained using the m-χ decomposition method. Based on a comprehensive analysis from the SAR parameter and m-χ decomposition, the Erlanger crater exhibits characteristics of non-icy regions. Additionally, topography, morphology, temperature, and hydrogen map-based information have been observed. The comprehensive analysis suggested that the Erlanger is a young and fresh crater. From the pixels-based analysis it has been found that the availability of the possible water–ice deposits within the crater rim is very less. [ABSTRACT FROM AUTHOR]

Background: There is a higher incidence of cardiac arrest in economically deprived areas; however, data show that bystander cardiopulmonary resuscitation (CPR) in those areas is lower. This results in lower survival rates, placing those communities at a double disadvantage. This systematic review explored the barriers and facilitators to engaging with bystander CPR in deprived communities. Methods: Studies were eligible for inclusion if they addressed any barrier or facilitator to performing bystander CPR or being trained in CPR or training others. Studies had to either be set in a deprived area or examine a deprived population. Selected studies were published between January 2000 and December 2017 and reported on primary research. No language limitations were applied. Searches were conducted in the following databases: Cumulative Index to Nursing and Allied Health Literature (CINAHL), MEDLINE, PsycINFO, PubMed, and Web of Science Core Collection. Unpublished 'grey' literature was also searched as well as the reference lists of any relevant studies. Results: The systematic review highlighted several main factors acting as barriers or facilitators to engaging with bystander CPR in deprived communities: (1) the willingness to learn or perform CPR, (2) the confidence to perform CPR, and (3) self-reported likelihood of performing CPR. The review also revealed additional barriers to engaging with CPR which are specific to – or more acute for – individuals from socioeconomically deprived backgrounds or areas. Discussion: We found little evidence suggesting that the willingness to perform or learn bystander CPR is lower in deprived communities compared to the general population. However, the confidence to perform CPR in deprived communities was affected by some measures of socioeconomic status. The results also crucially highlighted other barriers more acute in deprived communities: the risk to personal safety in administering CPR; the fear of legal consequences; and the lack of community cohesion and other cultural barriers. [ABSTRACT FROM AUTHOR]