Association between Conversion to Shockable Rhythms and Survival with Favorable Neurological Outcomes for Out-of-Hospital Cardiac Arrests.

BACKGROUND: The initial cardiac rhythm in out-of-hospital cardiac arrest (OHCA) portends different prognoses and affects treatment decisions. Initial shockable rhythms are associated with good survival and neurological outcomes but there is conflicting evidence for those who initially present with non-shockable rhythms. The aim of this study is to evaluate if OHCA with conversion from non-shockable (i.e., asystole and pulseless electrical activity) rhythms to shockable rhythms compared to OHCA remaining in non-shockable rhythms is associated with better survival and neurological outcomes. METHOD: OHCA cases from the Pan-Asian Resuscitation Outcomes Study registry in 13 countries between January 2009 and February 2018 were retrospectively analyzed. Cases with missing initial rhythms, age <18 years, presumed non-medical cause of arrest, and not conveyed by emergency medical services were excluded. Multivariable logistic regression analysis was performed to evaluate the relationship between initial and subsequent shockable rhythm, survival to discharge, and survival with favorable neurological outcomes (cerebral performance category 1 or 2). RESULTS: Of the 116,387 cases included. 11,153 (9.6%) had initial shockable rhythms and 9,765 (8.4%) subsequently converted to shockable rhythms. Japan had the lowest proportion of OHCA patients with initial shockable rhythms (7.3%). For OHCA with initial shockable rhythm, the adjusted odds ratios (aOR) for survival and good neurological outcomes were 8.11 (95% confidence interval [CI] 7.62-8.63) and 15.4 (95%CI 14.1-16.8) respectively. For OHCA that converted from initial non-shockable to shockable rhythms, the aORs for survival and good neurological outcomes were 1.23 (95%CI 1.10-1.37) and 1.61 (95%CI 1.35-1.91) respectively. The aORs for survival and good neurological outcomes were 1.48 (95%CI 1.22-1.79) and 1.92 (95%CI 1.3 - 2.84) respectively for initial asystole, while the aOR for survival in initial pulseless electrical activity patients was 0.83 (95%CI 0.71-0.98). Prehospital adrenaline administration had the highest aOR (2.05, 95%CI 1.93-2.18) for conversion to shockable rhythm. CONCLUSION: In this ambidirectional cohort study, conversion from non-shockable to shockable rhythm was associated with improved survival and neurologic outcomes compared to rhythms that continued to be non-shockable. Continued advanced resuscitation may be beneficial for OHCA with subsequent conversion to shockable rhythms.

Design and Application of Materials for Sequestration and Immobilization of 99Tc.

99Technetium (99Tc) is a hazardous radionuclide that poses a serious environmental threat. The wide variation and complex chemistries of liquid nuclear waste streams containing 99Tc often create unique, site specific challenges when sequestering and immobilizing the waste in a matrix suitable for long-term storage and disposal. Therefore, an effective management plan for 99Tc containing liquid radioactive wastes (such as storage (tanks) and decommissioned wastes) will likely require a variety of suitable materials/matrixes capable of adapting to and addressing these challenges. In this review, we discuss and highlight the key developments for effective removal and immobilization of 99Tc liquid waste in inorganic waste forms. Specifically, we review the synthesis, characterization, and application of materials for the targeted removal of 99Tc from (simulated) waste solutions under various experimental conditions. These materials include (i) layered double hydroxides (LDHs), (ii) metal-organic frameworks (MOFs), (iii) ion-exchange resins (IERs) as well as cationic organic polymers (COPs), (iv) surface modified natural clay materials (SMCMs), and (v) graphene-based materials (GBMs). Second, we discuss some of the major and recent developments toward 99Tc immobilization in (i) glass, (ii) cement, and (iii) iron mineral waste forms. Finally, we present future challenges that need to be addressed for the design, synthesis, and selection of suitable matrixes for the efficient sequestration and immobilization of 99Tc from targeted wastes. The purpose of this review is to inspire research on the design and application of various suitable materials/matrixes for selective removal of 99Tc present globally in different radioactive wastes and its immobilization in stable/durable waste forms.

Enhancement of biogranules development using magnetized powder activated carbon.

Biogranulation has emerged as a viable alternative biological wastewater treatment approach because of its strong biodegradability potential, toxicity tolerance, and biomass retention features. However, this process requires a long duration for biogranules formation to occur. In this study, magnetic powder activated carbon (MPAC) was used as support material in a sequencing batch reactor to enhance biogranules development for wastewater treatment. Two parallel SBRs (designated R1 and R2) were used, with R1 serving as a control without the presence of MPAC while R2 was operated with MPAC. The biodegradability capacity and biomass properties of MPAC biogranules were compared with a control system. The measured diameter of biogranules for R1 and R2 after 8 weeks of maturation were 2.2 mm and 3.4 mm, respectively. The integrity coefficient of the biogranules in R2 was higher (8.3%) than that of R1 (13.4%), indicating that the addition of MPAC improved the structure of the biogranules in R2. The components of extracellular polymeric substances were also higher in R2 than in R1. Scanning electronic microscopy was able to examine the morphological structures of the biogranules which showed there were irregular formations compacted together. However, there were more cavities situated in R1 biogranules (without MPAC) when compared to R2 biogranules (with MPAC). Dye removal reached 65% and 83% in R1 and R2 in the post-development stage. This study demonstrates that the addition of MPAC could shorten and improve biogranules formation. MPAC acted as the support media for microbial growth during the biogranulation developmental process.

The global research trend on microbially induced carbonate precipitation during 2001-2021: a bibliometric review.

Microbially induced carbonate precipitation (MICP) is a remarkable method that creates sustainable cementitious binding material for use in geotechnical/structural engineering and environmental engineering. This is due to the increasing demand for alternative environmentally friendly technologies and materials that result in minimal or zero carbon footprint. In contrast to the previously published literature, through bibliometric analysis, this review paper focuses on the current prospects and future research trends of MICP technology via the Scopus database and VOSviewer analysis. The objective of the study was to determine the annual publications and citations trend, most contributing countries, the leading journals, prolific authors, productive institutions, funding sponsors, trending author keywords, and research directions of MICP. There were a total of 1058 articles published from 2001 to 2021 on MICP. The result demonstrated that the volume of publications is increasing. China, Construction and Building Materials, Satoru Kawasaki, Nanyang Technological University, and the National Natural Science Foundation of China are the leading country, journal, author, institution, and funding sponsor in terms of total publications. Through the co-occurrence analysis of the author keywords, MICP was revealed to be the most frequently used author keyword with 121 occurrences, a total link strength of 213, and 152 links to other author keywords. Furthermore, co-occurrence analysis of text data revealed that researchers are concentrating on four important research areas: precipitation, MICP, compressive strength, and biomineralization. This review can provide information to researchers that can lead to novel ideas and research collaboration or engagement on MICP technology.

Pre-hospital airway management and survival outcomes after paediatric out-of-hospital cardiac arrests.

BACKGROUND: Paediatric out-of-hospital cardiac arrest (OHCA) results in high mortality and poor neurological outcomes. We conducted this study to describe and compare the effects of pre-hospital airway management on survival outcomes for paediatric OHCA in the Asia-pacific region. METHODS: We performed a retrospective analysis of the Pan Asian Resuscitation Outcomes Study (PAROS) data from January 2009 to June 2018. PAROS is a prospective, observational, multi-centre cohort study from eleven countries. The primary outcomes were one-month survival and survival with favourable neurological status, defined as Cerebral Performance Category1 or 2. We performed multivariate analyses of the unmatched and propensity matched cohort. RESULTS: We included 3131 patients less than 18 years in the study. 2679 (85.6%) children received bag-valve-mask (BVM) ventilations, 81 (2.6%) endotracheal intubations (ETI) and 371 (11.8%) supraglottic airways (SGA). 792 patients underwent propensity score matching. In the matched cohort, advanced airway management (AAM: SGA and ETI) when compared with BVM group was associated with decreased one-month survival [AAM: 28/396 (7.1%) versus BVM: 55/396 (13.9%); adjusted odds ratio (aOR), 0.46 (95% CI, 0.29 - 0.75); p = 0.002] and survival with favourable neurological status [AAM: 8/396 (2.0%) versus BVM: 31/396 (7.8%); aOR, 0.22 (95% CI, 0.10 - 0.50); p < 0.001]. For SGA group, we observed less 1-month survival [SGA: 24/337 (7.1%) versus BVM: 52/337 (15.4%); aOR, 0.41 (95 %CI, 0.25-0.69), p = 0.001] and survival with favourable neurological status. CONCLUSION: In children with OHCA in the Asia-Pacific region, pre-hospital AAM was associated with decreased one-month survival and less favourable neurological status.

Influence of comorbidities and clinical prediction model on neurological prognostication post out-of-hospital cardiac arrest.

BACKGROUND: Survival with good neurological function post out-of-hospital cardiac arrest (OHCA), defined as cerebral performance category (CPC) 1-2, ranges from 1.6% to 3% in Asia. We aim to study the influence of comorbidities and peri-OHCA event factors on neurological recovery and develop a model that can help clinicians predict neurological function among patients with post-OHCA admitted to the hospital. METHODS: This was a retrospective cohort study. All patients admitted post-OHCA from 1 January 2011 to 31 December 2015 to a tertiary centre were identified through the hospital OHCA registry. Patients who survived till hospital admission were included. Logistic regression was used to identify patient and peri-arrest factors that were significantly associated with survival with CPC 1-2. The significant factors for survival with CPC 1-2 were then put into a multivariable model and the discriminative ability was tested using the receiver operator characteristic (ROC) curve. Calibration and internal validation of the model were also performed. External validation in a small prospective cohort was also performed. RESULTS: In our derivation cohort of 129 patients, 30.23% survived with CPC 1-2. Significant factors associated with survival with good neurological outcomes were age-adjusted Charlson Comorbidity Index ≤5, time to first return of spontaneous circulation ≤40 min, the presence of immediate bystander cardiopulmonary resuscitation and shockable rhythms. We also developed a nomogram which showed good internal (ROC curve 0.84; 95% CI 0.77 to 0.91) and external validation (ROC curve 0.90; 95% CI 0.81 to 1.00).

The Pan-Asian Resuscitation Outcomes Study (PAROS) clinical research network: what, where, why and how.

Out-of-hospital cardiac arrest (OHCA) is a global health concern with an incidence rate of 50-60 per 100,000 person-years. To improve OHCA survival rates, several cardiac arrest registries have been set up in North America and Europe, such as the Resuscitation Outcomes Consortium, Cardiac Arrest Registry to Enhance Survival, Ontario Prehospital Advanced Life Support and European Registry of Cardiac Arrest. In Asia, however, there was previously no concerted effort in prehospital emergency care research owing to differences in prehospital emergency medical services systems, data collection methods and outcome reporting between countries. Recognising the need for a collaborative prehospital emergency care research group in Asia, researchers from seven countries in the Asia-Pacific region (including Japan, South Korea, Taiwan, Thailand, United Arab Emirates-Dubai, Singapore and Malaysia) established the Pan-Asian Resuscitation Outcomes Study (PAROS) clinical research network in 2010. This paper gives the overview, methodology and research accomplishments of the PAROS network.

A multicenter controlled trial on knowledge and attitude about cardiopulmonary resuscitation among secondary school children in Malaysia.

BACKGROUND: We performed a multicenter controlled trial to assess the knowledge and attitude (KA) about cardiopulmonary resuscitation (CPR) among secondary school children in a district in Malaysia. METHODS: This was a prospective intervention study. The primary endpoint of the study was to determine the level of KA about resuscitation after CPR training. The six schools and classes from selected schools were chosen by randomization among the form three and four classes using sealed envelopes. A fully validated questionnaire consisting of three sections (sociodemographic, knowledge and attitude) was given to the pupils before and 2 weeks after the intervention. The intervention group was given a lecture, video show, pamphlet and 1-h practical session on CPR training. The control group received a placebo in order to overcome the learning effect. The maximum scores for the knowledge and attitude sections were 72 and 28, respectively. Repeated measures ANOVA analysis was used for specific objectives to determine the changes in knowledge and attitude level pre- and post-intervention for both study groups. P-values less than 0.05 were taken as significant at 95% confidence intervals. RESULTS: The mean (SD) total knowledge scores for the intervention (n = 216) and control (n = 252) groups were 62.43 (13.68) and 62.29 (12.11), respectively (maximum score 72) (p > 0.05). On the other hand, the mean (SD) total attitude scores for the intervention and the control groups were 19.33 (4.51) and 17.85 (4.52), respectively (maximum score 28) (p < 0.001). There were significant differences in mean knowledge and attitude scores between the intervention and control groups with regard to time (pre- and post-intervention). The mean difference in knowledge and attitude scores between both study groups was 8.31 (p < 0.001) and 2.39 (p < 0.001), respectively. CONCLUSIONS: The level of knowledge and attitudes of secondary school children was shown to be acceptable prior to the intervention. Furthermore, a brief CPR training program improved their level of knowledge and attitudes significantly as compared to those who had never been trained.