Paramedic-Performed Carotid Artery Ultrasound Heralds Return of Spontaneous Circulation in Out-of-Hospital Cardiac Arrest: A Case Report.

Point-of-Care Ultrasound (POCUS) has been demonstrated to have multiple applications in the care of critically ill and injured patients, especially given its portability and ease of use. These characteristics of POCUS make it ideal for use in the prehospital environment as well. We present a case that highlights a novel application of ultrasound in the prehospital management of out-of-hospital cardiac arrest (OHCA).

First Responder CPR and Survival Differences in Texas Minority and Lower Socioeconomic Status Neighborhoods.

INTRODUCTION: First responder (FR) cardiopulmonary resuscitation (CPR) is an important component of out-of-hospital cardiac arrest (OHCA) care. However, little is known about FR CPR disparities. METHODS: We linked the 2014-2021 Texas Cardiac Arrest Registry to Enhance Survival (TX-CARES) database to census tract data. We included non-traumatic OHCAs that were not witnessed by 9-1-1 responders and did not receive bystander CPR. We defined census tracts as having >50% of a race/ethnicity: White, Black, or Hispanic/Latino. We also stratified patients into quartiles based on socioeconomic status (SES): household income, high school graduation, and unemployment. We also combined race/ethnicity and income to create a total of five mixed strata, comparing lower income and minority census tracts to high income White census tracts. We created mixed model logistic regression models, adjusting for confounders and modeling census tract as a random intercept. Using the models, we compared FR CPR rates for census race/ethnicity (Black and Hispanic/Latino compared to White), and SES quartiles (2nd, 3rd, and 4th quartiles compared to 1st quartiles). Secondarily, we evaluated the association between FR CPR and survival for all strata. RESULTS: We included 21,966 OHCAs, and 57.4% had FR CPR. Evaluating the association between census tract characteristic and FR CPR, majority Black (aOR 0.30, 95% CI 0.22-0.41) had a lower bystander CPR rate when compared to majority White. The lowest income quartile had a lower rate of bystander CPR (aOR 0.80, 95% CI 0.65-0.98). The worst unemployment quartile was also associated with a lower rate of FR CPR (aOR 0.75, 95% CI 0.61-0.92). Combining race/ethnicity and income, middle income majority Black (30.0%; aOR 0.27, 95% CI 0.17-0.46) and low income >80% Black (31.8%; aOR 0.27, 95% CI 0.10-0.68) had lower rates of FR CPR in comparison to high income majority White. There were no associations between Hispanic or lower high school graduation and lower rates of FR CPR. We found no association between FR CPR and survival for all three strata. CONCLUSION: While we identified disparities in FR CPR in low SES and majority Black census tracts, we identified no association between FR CPR and survival in Texas.

Activation of Alkynes by a Redox-Active Carboranyl Diphosphine and Formation of Boron-Containing Phosphacycles.

In this work, we report the reactivity of the carboranyl diphosphine, 1-PtBu2-2-PiPr2-C2B10H10, with terminal alkynes, resulting in the formation of boron-containing phosphacycles. The reported system combines the nucleophilic activation of electron-deficient terminal alkynes via electron-rich phosphine groups with the redox behavior of carborane clusters to promote a sequence of metal-free intramolecular B-H bond activation and cyclization, creating an alkenylphosphonium cycle fused with a reduced open nido-carborane cluster.

Metal-Free Bond Activation by Carboranyl Diphosphines.

We report metal-free bond activation by the carboranyl diphosphine 1-PtBu2-2-PiPr2-C2B10H10. This main group element system contains basic binding sites and possesses the ability to cycle through two-electron redox states. The reported reactions with selected main group hydrides and alcohols occur via the formal oxidation of the phosphine groups and concomitant reduction of the boron cage. These transformations, which are driven by the cooperation between the electron-donating exohedral substituents and the electron-accepting cluster, differ from those of "regular" phosphines and are reminiscent of oxidative addition to transition metal centers, thus representing a new approach to metal-free bond activation.

Can non-contrast head CT and stroke severity be used for stroke triage? A population-based study.

BACKGROUND AND PURPOSE: Acute ischemic stroke (AIS) patients may benefit from endovascular thrombectomy (EVT) up to 24 h since last known normal (LKN). Advanced imaging is required for patient selection. Small or rural hospitals may not have sufficient CT technician and radiology support to rapidly acquire and interpret images. We estimated transfer rates using non-contrast head CT and stroke severity to select patients to be transferred to larger centers for evaluation. METHODS: We identified all AIS among residents of the study region in 2010. Only cases age ≥ 18 with baseline mRS 0-2 that presented to an ED were included. Among cases that presented between 6 and 24 h from LKN, those without evidence of acute infarct on head CT and with initial NIHSS ≥6 or ≥ 10 were identified. RESULTS: Of 1359 AIS cases, 448 (33.0%) presented between 6 and 24 h, of which 383 (85.5%) showed no evidence of acute infarct on CT. Of cases with no acute infarct on CT, 89/383 (23.2%) had NIHSS ≥6, of which 66 (74.2%) initially presented to a hospital without thrombectomy capabilities; and 51/383 (13.3%) had NIHSS ≥10, of which 40 (78.4%) presented to a non-thrombectomy hospital. CONCLUSIONS: In our population, 40-66 AIS patients annually (0.8-1.3/week, or 3-5 patients/100,000 persons/year) may present to non-thrombectomy hospitals and need to be transferred using non-contrast CT and stroke severity as screening tools. Such an approach may sufficiently mitigate the impact of delays in treatment on outcomes, without overburdening the referring nor accepting hospitals.

Redox-active carborane clusters in bond activation chemistry and ligand design.

Icosahedral closo-dodecaboranes have the ability to accept two electrons, opening into a dianionic nido-cluster. This transformation can be utilized to store electrons, drive bond activation, or alter coordination to metal cations. In this feature article, we present cases for each of these applications, wherein the redox activity of carborane facilitates the generation of unique products. We highlight the effects of exohedral substituents on reactivity and the stability of the products through conjugation between the cluster and exohedral substituents. Futher, the utilization of the redox properties and geometry of carborane clusters in the ligand design is detailed, both in the stabilization of low-valent complexes and in the tuning of ligand geometry.

Agency factors associated with first response systems that improve out-of-hospital cardiac arrest outcomes.

BACKGROUND: Data are conflicting regarding the association between first responder (FR) intervention and improved outcomes after out-of-hospital cardiac arrest (OHCA). We evaluated characteristics of agencies that have positive associations between FR interventions and outcomes. METHODS: We analyzed the 2016-2021 national Cardiac Arrest Registry to Enhance Survival (CARES). We defined the exposures as FR CPR and AED. The outcome was survival with favorable neurologic status. We used logistic regression models to evaluate the association between FR interventions with OHCA outcome for each agency, stratifying agencies into positive association (95% confidence interval above 1) and no/inverse association (95% confidence below or including 1). We compared characteristics between cohorts. RESULTS: For the association between FR CPR and outcomes, 21 agencies caring for 42,856 OHCAs had a positive association; 371 agencies caring for 449,824 OHCAs had no association. For FR AED, 47 agencies caring for 103,120 OHCAs had a positive association; 262 agencies caring for 327,761 OHCAs had no association. Comparing agency characteristics for FR CPR, agencies with a positive association had more annual OHCAs (+300), lower FR CPR rate (-11.3%), and lower FR AED rate (-10.8%). Comparing FR AED, agencies with a positive association had more OHCAs per year (+150.5), lower FR CPR rate (-6.8%), lower FR AED rate (-13.3%), lower response time (-0.6 minutes), and more OHCAs from high-income neighborhoods (+3.7%). CONCLUSION: FR AED more commonly had a positive association with outcomes than FR CPR. Agencies with better outcomes from FR interventions treated more OHCAs and had lower rates of FR intervention.

Building Graduate Student Capacity as Future Researchers Through a Research and Training Award Program.

BACKGROUND: With the global shortage of doctor of philosophy-prepared nursing faculty and an aging nursing professorate, the nursing profession is at risk of having fewer nurses doing research and fewer faculty to supervise the next generation of nurse researchers. METHOD: A research training award for graduate nursing students was piloted with the intent of providing a research-intensive experiential learning opportunity that would contribute to graduate students' future roles as nurse researchers. This article describes the program design, implementation, and evaluation. FINDINGS: The Graduate Student Research Training Awards afforded students an opportunity to develop research and methodologic skills and achieve student-centered outcomes. These awards build their capacity as future researchers by both empowering them and increasing their confidence in research. The input and evaluation from graduate students was integral to the success of the program. CONCLUSION: Graduate student research training awards can be a valuable experiential learning opportunity in research intensive graduate programs. [J Nurs Educ. 2016;55(5):284-287.].