Evaluation of basic life support interventions for foreign body airway obstructions: A population-based cohort study.

AIM: To quantify the associations of foreign body airway obstruction (FBAO) basic life support (BLS) interventions with FBAO relief and survival to discharge. METHODS: We identified prehospital FBAO patient encounters in Alberta, Canada between Jan 1, 2018 and Dec 31,2021 using the provincial emergency medical services' medical records, deterministically linked to hospital data. Two physicians reviewed encounters to determine cases and extract data. Multivariable logistic regression determined the adjusted odds ratio of FBAO relief (primary outcome) and survival to discharge for the exposure of BLS interventions (abdominal thrusts [AT], chest compressions/thrusts [CC], or combinations) relative to back blows [BB]. Intervention-associated injuries were identified using International Classification of Diseases codes, followed by health records review. RESULTS: We identified 3,677 patient encounters, including 709 FBAOs requiring intervention. Bystanders performed the initial BLS intervention in 488 cases (77.4%). Bystanders and paramedics did not relieve the FBAO in 151 (23.5%) and 11 (16.7%) cases, respectively. FBAOs not relieved before paramedic arrival had a higher proportion of deaths (n = 4[0.4%] versus n = 92[42.4%], p < 0.001). AT and CC were associated with decreased odds of FBAO relief relative to BB (adjusted odds ratio [aOR] 0.49 [95%CI 0.30-0.80] and 0.14 [95%CI 0.07-0.28], respectively). CC were associated with decreased odds of survival to discharge (aOR 0.04 [95%CI 0.01-0.32]). AT, CC, and BB were implicated in intervention-associated injuries in four, nine, and zero cases, respectively. CONCLUSIONS: Back blows are associated with improved outcomes compared to abdominal thrusts and chest compressions. These data can inform prospective studies aimed at improving response to choking emergencies.

A 2-year prospective evaluation of airway clearance devices in foreign body airway obstructions.

Aim: To collect, analyze and report the first prospective, industry-independent, data on airway clearance devices as novel foreign body airway obstruction interventions. Methods: We recruited adult airway clearance device users between July 1, 2021 and June 30, 2023 using a centralized website and email follow-up. The data collection tool captured patient, responder, situation, and outcome variables. Multi-step respondent validation occurred using electronic and geolocation verification, a random selection follow-up process, and physician review of all submitted cases. Results: We recruited 186 airway clearance device users (LifeVac©:157 [84.4%]; Dechoker©:29 [15.6%]). LifeVac© was the last intervention before foreign body airway obstruction relief in 151 of 157 cases. Of these, 150 survived to discharge. A basic life support intervention was used before LifeVac© in 119 cases, including the 6 cases where LifeVac© also failed. We identified two adverse events using LifeVac© (perioral bruising), while we could not ascertain whether another 7 were due to the foreign body or LifeVac© (3 = airway edema; 3 = oropharyngeal abrasions; 1 = esophageal perforation). Dechoker© was the last intervention before obstruction relief in 27 of 29 cases and all cases survived. A basic life support intervention was used before Dechoker© in 21 cases, including both where Dechoker© also failed. We identified one adverse event using Dechoker© (oropharyngeal abrasions). Conclusion: Within these cases, airway clearance devices appear to be effective at relieving foreign body airway obstructions. However, this data should be considered preliminary and hypothesis generating due to several limitations. We urge the resuscitation community to proactively evaluate airway clearance devices to ensure the public remains updated with best practices.

Unraveling the Design Space of Immersive Analytics: A Systematic Review.

Immersive analytics has emerged as a promising research area, leveraging advances in immersive display technologies and techniques, such as virtual and augmented reality, to facilitate data exploration and decision-making. This paper presents a systematic literature review of 73 studies published between 2013-2022 on immersive analytics systems and visualizations, aiming to identify and categorize the primary dimensions influencing their design. We identified five key dimensions: Academic Theory and Contribution, Immersive Technology, Data, Spatial Presentation, and Visual Presentation. Academic Theory and Contribution assess the motivations behind the works and their theoretical frameworks. Immersive Technology examines the display and input modalities, while Data dimension focuses on dataset types and generation. Spatial Presentation discusses the environment, space, embodiment, and collaboration aspects in IA, and Visual Presentation explores the visual elements, facet and position, and manipulation of views. By examining each dimension individually and cross-referencing them, this review uncovers trends and relationships that help inform the design of immersive systems visualizations. This analysis provides valuable insights for researchers and practitioners, offering guidance in designing future immersive analytics systems and shaping the trajectory of this rapidly evolving field.

Validation of ICD-10 codes for studying foreign body airway obstructions: A health administrative data cohort study.

Aim: To validate a case definition for foreign body airway obstructions (FBAO) using International Classification of Diseases version 10 (ICD-10) codes to accurately identify patients in administrative health databases and improve reporting on this injury. Methods: We identified prehospital patient encounters in Alberta, Canada between Jan 1, 2018 and Dec 31, 2021 by querying the provincial emergency medical services' (EMS) patient care records for FBAO-related presentations, EMS protocols, or treatments. We deterministically linked EMS patient encounters to data on emergency department visits and hospital admissions, which included ICD-10 codes. Two physicians independently reviewed encounters to determine true FBAO cases. We then calculated diagnostic accuracy measures (sensitivity, specificity, likelihood ratios) of various algorithms. Results: We identified 3677 EMS patient encounters, 2121 were linked to hospital administrative databases. Of these encounters, 825 (38.9%) were true FBAO. The combination of two ICD-10 codes (T17 = foreign body in the respiratory tract or T18.0 = foreign body in the mouth) was the most specific algorithm (96.9% [95%CI 95.8-97.8%]), while the combination of all FBAO-related ICD-10 codes and R06.8 (other breathing abnormalities) was the most sensitive (75.0% [95%CI 71.9-78.0]). We identified an additional 453 (35.4%) FBAO cases not transported by EMS (due to death or transport refusal), and therefore not linked to the hospital administrative databases. Of these unlinked encounters, 44 (9.7%) cases resulted in the patient's death. Conclusions: FBAO can be identified with reasonable accuracy using health administrative data and ICD-10 codes. All algorithms had a trade-off between sensitivity and specificity, and failed to identify a third of FBAO cases, of which 10% resulted in death.

A systematic review of interventions for resuscitation following drowning.

Objectives: The International Liaison Committee on Resuscitation, in collaboration with drowning researchers from around the world, aimed to review the evidence addressing seven key resuscitation interventions: 1) immediate versus delayed resuscitation; (2) compression first versus ventilation first strategy; (3) compression-only CPR versus standard CPR (compressions and ventilations); (4) ventilation with and without equipment; (5) oxygen administration prior to hospital arrival; (6) automated external defibrillation first versus cardiopulmonary resuscitation first strategy; (7) public access defibrillation programmes. Methods: The review included studies relating to adults and children who had sustained a cardiac arrest following drowning with control groups and reported patient outcomes. Searches were run from database inception through to April 2023. The following databases were searched Ovid MEDLINE, Pre-Medline, Embase, Cochrane Central Register of Controlled Trials. Risk of bias was assessed using the ROBINS-I tool and the certainty of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation. The findings are reported as a narrative synthesis. Results: Three studies were included for two of the seven interventions (2,451 patients). No randomised controlled trials were identified. A retrospective observational study reported in-water resuscitation with rescue breaths improved patient outcomes compared to delayed resuscitation on land (n = 46 patients, very low certainty of evidence). The two observational studies (n = 2,405 patients), comparing compression-only with standard resuscitation, reported no difference for most outcomes. A statistically higher rate of survival to hospital discharge was reported for the standard resuscitation group in one of these studies (29.7% versus 18.1%, adjusted odds ratio 1.54 (95% confidence interval 1.01-2.36) (very low certainty of evidence). Conclusion: The key finding of this systematic review is the paucity of evidence, with control groups, to inform treatment guidelines for resuscitation in drowning.

Investigating the Visual Utility of Differentially Private Scatterplots.

Increasingly, visualization practitioners are working with, using, and studying private and sensitive data. There can be many stakeholders interested in the resulting analyses-but widespread sharing of the data can cause harm to individuals, companies, and organizations. Practitioners are increasingly turning to differential privacy to enable public data sharing with a guaranteed amount of privacy. Differential privacy algorithms do this by aggregating data statistics with noise, and this now-private data can be released visually with differentially private scatterplots. While the private visual output is affected by the algorithm choice, privacy level, bin number, data distribution, and user task, there is little guidance on how to choose and balance the effect of these parameters. To address this gap, we had experts examine 1,200 differentially private scatterplots created with a variety of parameter choices and tested their ability to see aggregate patterns in the private output (i.e. the visual utility of the chart). We synthesized these results to provide easy-to-use guidance for visualization practitioners releasing private data through scatterplots. Our findings also provide a ground truth for visual utility, which we use to benchmark automated utility metrics from various fields. We demonstrate how multi-scale structural similarity (MS-SSIM), the metric most strongly correlated with our study's utility results, can be used to optimize parameter selection. A free copy of this paper along with all supplemental materials is available at https://osf.io/wej4s/.

30-day readmission rates among upper gastrointestinal bleeds: A systematic review and meta-analysis.

BACKGROUND AND AIM: Upper gastrointestinal bleeding (UGIB) is a common emergency, with high rates of hospitalization and in-patient mortality compared to other gastrointestinal diseases. Despite readmission rates being a common quality metric, little data are available for UGIBs. This study aimed to determine readmission rates for patients discharged following an UGIB. METHODS: Adhering to PRISMA guidelines, MEDLINE, Embase, CENTRAL, and Web of Science were searched to October 16, 2021. Randomized and non-randomized studies that reported hospital readmission for patients following an UGIB were included. Abstract screening, data extraction, and quality assessment were conducted in duplicate. A random-effects meta-analysis was performed, with statistical heterogeneity measured using I2 . The GRADE framework, with a modified Downs and Black tool, was used to determine certainty of evidence. RESULTS: Seventy studies were included of 1847 screened abstracted, with moderate interrater reliability. Within these studies, 4 292 714 patients were analyzed with a mean age of 66.6 years, and 54.7% male. UGIB had a 30-day all-cause readmission rate of 17.4% (95% confidence interval [CI] 16.7-18.2%), stratification revealed a higher rate for variceal UGIB [19.6% (95% CI 17.6-21.5%)] than non-variceal [16.8% (95% CI 16.0-17.5%)]. Only one third were readmitted due to recurrent UGIB (4.8% [95% CI 3.1-6.4%]). UGIB due to peptic ulcer bleeding had the lowest 30-day readmission rate [6.9% (95% CI 3.8-10.0%)]. Certainty of evidence was low or very low for all outcomes. CONCLUSIONS: Almost one in five patients discharged after an UGIB are readmitted within 30 days. These data should prompt clinicians to reflect on their own practice to identify areas of strength or improvement.

2022 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces.

This is the sixth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. This summary addresses the most recently published resuscitation evidence reviewed by International Liaison Committee on Resuscitation Task Force science experts. Topics covered by systematic reviews include cardiopulmonary resuscitation during transport; approach to resuscitation after drowning; passive ventilation; minimizing pauses during cardiopulmonary resuscitation; temperature management after cardiac arrest; use of diagnostic point-of-care ultrasound during cardiac arrest; use of vasopressin and corticosteroids during cardiac arrest; coronary angiography after cardiac arrest; public-access defibrillation devices for children; pediatric early warning systems; maintaining normal temperature immediately after birth; suctioning of amniotic fluid at birth; tactile stimulation for resuscitation immediately after birth; use of continuous positive airway pressure for respiratory distress at term birth; respiratory and heart rate monitoring in the delivery room; supraglottic airway use in neonates; prearrest prediction of in-hospital cardiac arrest mortality; basic life support training for likely rescuers of high-risk populations; effect of resuscitation team training; blended learning for life support training; training and recertification for resuscitation instructors; and recovery position for maintenance of breathing and prevention of cardiac arrest. Members from 6 task forces have assessed, discussed, and debated the quality of the evidence using Grading of Recommendations Assessment, Development, and Evaluation criteria and generated consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections, and priority knowledge gaps for future research are listed.

The State of the Art in BGP Visualization Tools: A Mapping of Visualization Techniques to Cyberattack Types.

Internet routing is largely dependent on Border Gateway Protocol (BGP). However, BGP does not have any inherent authentication or integrity mechanisms that help make it secure. Effective security is challenging or infeasible to implement due to high costs, policy employment in these distributed systems, and unique routing behavior. Visualization tools provide an attractive alternative in lieu of traditional security approaches. Several BGP security visualization tools have been developed as a stop-gap in the face of ever-present BGP attacks. Even though the target users, tasks, and domain remain largely consistent across such tools, many diverse visualization designs have been proposed. The purpose of this study is to provide an initial formalization of methods and visualization techniques for BGP cybersecurity analysis. Using PRISMA guidelines, we provide a systematic review and survey of 29 BGP visualization tools with their tasks, implementation techniques, and attacks and anomalies that they were intended for. We focused on BGP visualization tools as the main inclusion criteria to best capture the visualization techniques used in this domain while excluding solely algorithmic solutions and other detection tools that do not involve user interaction or interpretation. We take the unique approach of connecting (1) the actual BGP attacks and anomalies used to validate existing tools with (2) the techniques employed to detect them. In this way, we contribute an analysis of which techniques can be used for each attack type. Furthermore, we can see the evolution of visualization solutions in this domain as new attack types are discovered. This systematic review provides the groundwork for future designers and researchers building visualization tools for providing BGP cybersecurity, including an understanding of the state-of-the-art in this space and an analysis of what techniques are appropriate for each attack type. Our novel security visualization survey methodology-connecting visualization techniques with appropriate attack types-may also assist future researchers conducting systematic reviews of security visualizations. All supplemental materials are available at https://osf.io/tupz6/.

2022 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces.

This is the sixth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. This summary addresses the most recently published resuscitation evidence reviewed by International Liaison Committee on Resuscitation Task Force science experts. Topics covered by systematic reviews include cardiopulmonary resuscitation during transport; approach to resuscitation after drowning; passive ventilation; minimising pauses during cardiopulmonary resuscitation; temperature management after cardiac arrest; use of diagnostic point-of-care ultrasound during cardiac arrest; use of vasopressin and corticosteroids during cardiac arrest; coronary angiography after cardiac arrest; public-access defibrillation devices for children; pediatric early warning systems; maintaining normal temperature immediately after birth; suctioning of amniotic fluid at birth; tactile stimulation for resuscitation immediately after birth; use of continuous positive airway pressure for respiratory distress at term birth; respiratory and heart rate monitoring in the delivery room; supraglottic airway use in neonates; prearrest prediction of in-hospital cardiac arrest mortality; basic life support training for likely rescuers of high-risk populations; effect of resuscitation team training; blended learning for life support training; training and recertification for resuscitation instructors; and recovery position for maintenance of breathing and prevention of cardiac arrest. Members from 6 task forces have assessed, discussed, and debated the quality of the evidence using Grading of Recommendations Assessment, Development, and Evaluation criteria and generated consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections, and priority knowledge gaps for future research are listed.

2022 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces.

This is the sixth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. This summary addresses the most recently published resuscitation evidence reviewed by International Liaison Committee on Resuscitation Task Force science experts. Topics covered by systematic reviews include cardiopulmonary resuscitation during transport; approach to resuscitation after drowning; passive ventilation; minimizing pauses during cardiopulmonary resuscitation; temperature management after cardiac arrest; use of diagnostic point-of-care ultrasound during cardiac arrest; use of vasopressin and corticosteroids during cardiac arrest; coronary angiography after cardiac arrest; public-access defibrillation devices for children; pediatric early warning systems; maintaining normal temperature immediately after birth; suctioning of amniotic fluid at birth; tactile stimulation for resuscitation immediately after birth; use of continuous positive airway pressure for respiratory distress at term birth; respiratory and heart rate monitoring in the delivery room; supraglottic airway use in neonates; prearrest prediction of in-hospital cardiac arrest mortality; basic life support training for likely rescuers of high-risk populations; effect of resuscitation team training; blended learning for life support training; training and recertification for resuscitation instructors; and recovery position for maintenance of breathing and prevention of cardiac arrest. Members from 6 task forces have assessed, discussed, and debated the quality of the evidence using Grading of Recommendations Assessment, Development, and Evaluation criteria and generated consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections, and priority knowledge gaps for future research are listed.

A Systematic Review of Interventions to Reduce Computed Tomography Usage in the Emergency Department.

STUDY OBJECTIVE: Unnecessary computed tomography (CT) scans burden the health care system, leading to increased emergency department (ED) wait times and lengths of stay, costing almost a billion dollars annually. This study aimed to describe ED-based interventions that are most effective at reducing CT imaging while maintaining diagnostic accuracy and patient safety. METHODS: Adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, MEDLINE, Embase, CINAHL, Cochrane Central Register of Controlled Trials, and Google Scholar were searched until December 31, 2020. Randomized and nonrandomized studies that assessed the effect of an ED-based intervention on CT scan usage were included. Abstract screening, data extraction, and quality assessment were conducted in duplicate. The Grading of Recommendation Assessment, Development and Evaluation framework, with the Risk of Bias 2 and Risk of Bias in Nonrandomized Studies - of Interventions tools, was used to determine the certainty of evidence. Significant clinical and statistical heterogeneity precluded meta-analysis; hence, a narrative synthesis was conducted. RESULTS: A total of 149 studies were included of 5,667 screened abstracts, with substantial interrater reliability among reviewers (Cohen's κ>0.60). The CT reduction strategies were categorized into 15 single and 11 multimodal interventions by consensus review. Interventions that consistently reduced CT usage included diagnostic pathways, alternative test availability, specialist involvement, and provider feedback. Family/patient education, clinical decision support tools, or passive guideline dissemination did not consistently reduce usage. Only 44% of studies reported unintended consequences of reduction strategies; however, these showed no increase in missed diagnoses or patient harm. The interventions that engaged multiple specialties during planning/implementation had a greater reduction effect than ED only. The certainty of evidence for the primary outcome was very low. CONCLUSION: Multidisciplinary-led interventions that provided an alternative to CT imaging were the most effective at reducing usage and did so without compromising patient safety.

The link between medical conditions and fatal drownings in Canada: a 10-year cross-sectional analysis.

BACKGROUND: Drowning accounts for hundreds of preventable deaths in Canada every year, but the impact of preexisting medical conditions on the likelihood of death from drowning is not known. We aimed to describe the prevalence of pre-existing medical conditions among people who fatally drowned in Canada and evaluate the risk of fatal drowning among people with common pre-existing medical conditions. METHODS: We reviewed all Canadian unintentional fatal drownings (2007-2016) in the Drowning Prevention Research Centre Canada's database. For each fatal drowning we established whether the person had pre-existing medical conditions and whether those conditions contributed to the drowning. We calculated relative risk (RR) of fatal drowning stratified by age and sex for each pre-existing medical condition using data from the Canadian Chronic Disease Surveillance System. RESULTS: During 2007-2016, 4288 people fatally drowned unintentially in Canada, of whom one-third had a pre-existing medical condition. A pre-existing medical condition contributed to drowning in 43.6% (n = 616) of cases. Fatal drowning occurred more frequently in people with ischemic heart disease (RR 2.7, 95% confidence interval [CI] 2.5-3.0) and seizure disorders (RR 6.3, 95% CI 5.4-7.3) but less frequently in people with respiratory disease (RR 0.12, 95% CI 0.10-0.15). Females aged 20-34 years with a seizure disorder had a 23 times greater risk than their age- and sex-matched cohort (RR 23, 95% CI 14-39). In general, fatal drowning occurred more often while people were bathing (RR 5.9, 95% CI 4.8-7.0) or alone (RR 1.99, 95% CI 1.32-2.97) and less often in males (RR 0.92, 95% CI 0.88-0.95) or in those who had used alcohol (RR 0.72, 95% CI 0.65-0.80), among those with pre-existing medical conditions. INTERPRETATION: The risk of fatal drowning is increased in the presence of some preexisting medical conditions. Tailored interventions aimed at preventing drowning based on pre-existing medical conditions and age are needed. Initial prevention strategies should focus on seizure disorders and bathtub drownings.

Phase One of a Global Evaluation of Suction-Based Airway Clearance Devices in Foreign Body Airway Obstructions: A Retrospective Descriptive Analysis.

Background: Choking is a prevalent source of injury and mortality worldwide. Traditional choking interventions, including abdominal thrusts and back blows, have remained the standard of care for decades despite limited published data. Suction-based airway clearance devices (ACDs) are becoming increasingly popular and there is an urgent need to evaluate their role in choking intervention. The aim of this study was to describe the effectiveness (i.e., resolution of choking symptoms) and safety (i.e., adverse events) of identified airway clearance devices interventions to date. Methods: This retrospective descriptive analysis included any individual who self-identified to manufacturers as having used an ACD as a choking intervention prior to 1 July 2021. Records were included if they contained three clinical variables (patient's age, type of foreign body, and resolution of choking symptoms). Researchers performed data extraction using a standardized form which included patient, situational, and outcome variables. Results: The analysis included 124 non-invasive (LifeVac©) and 61 minimally invasive (Dechoker©) ACD interventions. Median patient age was 40 (LifeVac©, 2−80) and 73 (Dechoker©, 5−84) with extremes of age being most common [<5 years: LifeVac© 37.1%, Dechoker© 23.0%; 80+ years: 27.4%, 37.7%]. Food was the most frequent foreign body (LifeVac© 84.7%, Dechoker© 91.8%). Abdominal thrusts (LifeVac© 37.9%, Dechoker© 31.1%) and back blows (LifeVac© 39.5%, Dechoker© 41.0%) were often co-interventions. Resolution of choking symptoms occurred following use of the ACD in 123 (LifeVac©) and 60 (Dechoker©) cases. Three adverse events (1.6%) were reported: disconnection of bellows/mask during intervention (LifeVac©), a lip laceration (Dechoker©), and an avulsed tooth (Dechoker©). Conclusion: Initial available data has shown ACDs to be promising in the treatment of choking. However, limitations in data collection methods and quality exist. The second phase of this evaluation will be an industry independent, prospective assessment in order to improve data quality, and inform future choking intervention algorithms.

Resuscitation of Drowned Persons During the COVID-19 Pandemic: A Consensus Statement.

Importance: Resuscitation is a niche example of how the COVID-19 pandemic has affected society in the long term. Those trained in cardiopulmonary resuscitation (CPR) face the dilemma that attempting to save a life may result in their own harm. This is most of all a problem for drowning, where hypoxia is the cause of cardiac arrest and ventilation is the essential first step in reversing the situation. Objective: To develop recommendations for water rescue organizations in providing their rescuers with safe drowning resuscitation procedures during the COVID-19 pandemic. Evidence Review: Two consecutive modified Delphi procedures involving 56 participants from 17 countries with expertise in drowning prevention research, resuscitation, and programming were performed from March 28, 2020, to March 29, 2021. In parallel, PubMed and Google Scholar were searched to identify new emerging evidence relevant to each core element, acknowledge previous studies relevant in the new context, and identify knowledge gaps. Findings: Seven core elements, each with their own specific recommendations, were identified in the initial consensus procedure and were grouped into 4 categories: (1) prevention and mitigation of the risks of becoming infected, (2) resuscitation of drowned persons during the COVID-19 pandemic, (3) organizational responsibilities, and (4) organizations unable to meet the recommended guidelines. The common measures of infection risk mitigation, personal protective equipment, and vaccination are the base of the recommendations. Measures to increase drowning prevention efforts reduce the root cause of the dilemma. Additional infection risk mitigation measures include screening all people entering aquatic facilities, defining criteria for futile resuscitation, and avoiding contact with drowned persons by rescuers with a high-risk profile. Ventilation techniques must balance required skill level, oxygen delivery, infection risk, and costs of equipment and training. Bag-mask ventilation with a high-efficiency particulate air filter by 2 trained rescuers is advised. Major implications for the methods, facilities, and environment of CPR training have been identified, including nonpractical skills to avoid being infected or to infect others. Most of all, the organization is responsible for informing their members about the impact of the COVID-19 pandemic and taking measures that maximize rescuer safety. Research is urgently needed to better understand, develop, and implement strategies to reduce infection transmission during drowning resuscitation. Conclusions and Relevance: This consensus document provides an overview of recommendations for water rescue organizations to improve the safety of their rescuers during the COVID-19 pandemic and balances the competing interests between a potentially lifesaving intervention and risk to the rescuer. The consensus-based recommendations can also serve as an example for other volunteer organizations and altruistic laypeople who may provide resuscitation.

A Protocol for the Prospective Evaluation of Novel Suction-Based Airway Clearance Devices in the Treatment of Foreign Body Airway Obstructions.

Background Foreign body airway obstructions (FBAOs, choking) are a significant cause of preventable mortality. Abdominal thrusts, back blows, and chest compressions are traditional interventions. However, suction-based airway clearance devices (ACDs) have recently been marketed as an alternative. Of note, there is limited published evidence regarding their efficacy and safety. Our research has two aims: (1) to investigate what situational and patient factors are frequently identified, and which are associated with relief of the FBAO and survival in individuals with FBAOs treated with an ACD; and (2) to describe the experience of individuals who have used ACDs in response to a FBAO and identify facilitators and barriers to the use of ACDs compared to traditional interventions. Methods and analysis A prospective database will be developed using an online reporting system to capture ACD uses, independent of manufacturers, from July 1st, 2021 to December 31st, 2023. Descriptive statistics will be used to summarize cases, outcomes, and adverse events. Clinically important subgroups will be stratified for analysis, including the severity of obstruction, patient demographics, and training of ACD users. Semi-structured interviews will also be conducted with a subset of ACD users to describe in detail their experience using the device. Themes from these interviews will be assessed using the theoretical domains framework. Discussion This study will improve the evidence surrounding ACDs and compare it to current data for traditional techniques, with the aim of optimizing FBAO treatment. Data on ACDs are urgently needed as these devices are already being used by parents, caregivers, lay rescuers, and healthcare professionals to respond to choking emergencies. This evaluation will provide important information about their effectiveness and any safety concerns which can inform the public, resuscitation guidelines, and future research studies.

Scalable Scalable Vector Graphics: Automatic Translation of Interactive SVGs to a Multithread VDOM for Fast Rendering.

The dominant markup language for Web visualizations-Scalable Vector Graphics (SVG)-is comparatively easy to learn, and is open, accessible, customizable via CSS, and searchable via the DOM, with easy interaction handling and debugging. Because these attributes allow visualization creators to focus on design on implementation details, tools built on top of SVG, such as D3.js, are essential to the visualization community. However, slow SVG rendering can limit designs by effectively capping the number of on-screen data points, and this can force visualization creators to switch to Canvas or WebGL. These are less flexible (e.g., no search or styling via CSS), and harder to learn. We introduce Scalable Scalable Vector Graphics (SSVG) to reduce these limitations and allow complex and smooth visualizations to be created with SVG. SSVG automatically translates interactive SVG visualizations into a dynamic virtual DOM (VDOM) to bypass the browser's slow 'to specification' rendering by intercepting JavaScript function calls. De-coupling the SVG visualization specification from SVG rendering, and obtaining a dynamic VDOM, creates flexibility and opportunity for visualization system research. SSVG uses this flexibility to free up the main thread for more interactivity and renders the visualization with Canvas or WebGL on a web worker. Together, these concepts create a drop-in JavaScript library which can improve rendering performance by 3-9× with only one line of code added. To demonstrate applicability, we describe the use of SSVG on multiple example visualizations including published visualization research. A free copy of this article, collected data, and source code are available as open science at osf.io/ge8wp.

STRATISFIMAL LAYOUT: A modular optimization model for laying out layered node-link network visualizations.

Node-link visualizations are a familiar and powerful tool for displaying the relationships in a network. The readability of these visualizations highly depends on the spatial layout used for the nodes. In this paper, we focus on computing layered layouts, in which nodes are aligned on a set of parallel axes to better expose hierarchical or sequential relationships. Heuristic-based layouts are widely used as they scale well to larger networks and usually create readable, albeit sub-optimal, visualizations. We instead use a layout optimization model that prioritizes optimality - as compared to scalability - because an optimal solution not only represents the best attainable result, but can also serve as a baseline to evaluate the effectiveness of layout heuristics. We take an important step towards powerful and flexible network visualization by proposing Stratisfimal Layout, a modular integer-linear-programming formulation that can consider several important readability criteria simultaneously - crossing reduction, edge bendiness, and nested and multi-layer groups. The layout can be adapted to diverse use cases through its modularity. Individual features can be enabled and customized depending on the application. We provide open-source and documented implementations of the layout, both for web-based and desktop visualizations. As a proof-of-concept, we apply it to the problem of visualizing complicated SQL queries, which have features that we believe cannot be addressed by existing layout optimization models. We also include a benchmark network generator and the results of an empirical evaluation to assess the performance trade-offs of our design choices. A full version of this paper with all appendices, data, and source code is available at osf.io/qdyt9 with live examples at https://visdunneright.github.io/stratisfimal/.

WHO provides 2 conditional recommendations for casirivimab-imdevimab combination therapy in COVID-19.

SOURCE CITATION: Rochwerg B, Agarwal A, Siemieniuk RA, et al. Update to living WHO guideline on drugs for covid-19. BMJ. 2021;374:n2219. 34556469.