Identifying veterinary surgeons' barriers to, and potential solutions for, improving antimicrobial stewardship among sheep farmers in Northern Ireland.

Background: In order to improve antimicrobial stewardship (AMS), including changes in antimicrobial prescribing and use, an enhanced understanding is needed of the barriers that veterinary surgeons (vets) encounter to institute such change. Methods: A qualitative approach, using grounded theory, was followed. Interviews and discussion groups, with vets and farm industry stakeholders in Northern Ireland (NI), were undertaken to identify and explore attitudes and behaviours surrounding AMS, with a particular emphasis on the barriers vets encountered and the context within which they were working. Results: Seven inter-related themes associated with improving AMS among their sheep farming clients were identified. The first six addressed barriers were working under commercial and practical constraints, farmer behaviour, multiple medicine sources, poor prescribing practice, a perceived lack of incentive or facilitation to improve AMS and a perceived lack of action by regulators to challenge poor AMS. The seventh theme revealed suggestions vets considered that may improve AMS in NI, including greater state intervention in recording and regulating medicine sales. Conclusions: Improving AMS will require vets and their client farmers to change behaviour. This will involve concerted effort over an extended period of time to enact and embed change. Veterinary surgeons believe that further action by the industry and state to develop centralised antimicrobial sales recording and by the state to enforce prescribing regulations will aid their efforts. However, critical to achieving this is the development of a sustainable and funded mechanism to create more meaningful farmer-vet consultation around flock health prior to every prescription to improve AMS and sheep welfare.

Behavioural Factors Influencing the Intention to Adopt Sheep Scab Control Measures in Northern Ireland.

Sheep scab, caused by infestation with the ectoparasitic mite Psoroptes ovis, is an endemic disease in the Northern Ireland (NI) sheep flock and constitutes significant economic and welfare burdens for the NI farming industry. Despite its endemic nature, historically, little research has been undertaken to support the control of the disease in NI. This study offers the first attempt to analyse the psychological and behavioural factors influencing farmers' intentions to implement effective sheep scab control measures in NI. To achieve our objective, quantitative data from a sample of 126 sheep farmers were statistically analysed using an extended theory of planned behaviour approach in an ordered logistic regression modelling framework. Our analyses showed that sheep scab remains an issue of concern in Northern Ireland. The attitudes of the farmers, as well as perceived behavioural control, emotional effect, membership of Business Development Groups (BDGs), and higher education qualifications, were found to be statistically significant factors influencing farmers' intentions to adopt sheep scab control measures. This study provides a solid foundation for how to promote behavioural changes among sheep farmers to improve their ability to implement effective disease control measures, helping to tackle this challenging disease in a more sustainable way in the future.

Antibiotic use in the Northern Irish sheep flock: What lessons can be learnt from medicine records and farmer attitudes to improve stewardship of these essential medicines?

Stewardship of antibiotics used in livestock production has come under increasing scrutiny, from both the animal welfare point of view and due to concerns that antibiotic use in livestock may pose a risk to human health through selection pressure to drive development of antibiotic resistant strains of bacteria. Despite this concern, however, antibiotic consumption in the sheep sector is currently poorly described. This study determines the range and quantities of antibiotics used in the Northern Irish (NI) sheep flock as well as exploring drivers for their use. A mixed-methods approach was utilised, with an anonymous online scoping survey, analysis of the medicine records from 52 NI sheep farms and semi-structured interviews undertaken with 27 farmers. Eighteen farmers contributed both records and participated in interviews. Veterinary medicine records were derived from two sources: on-farm medicine books (seven) or veterinary practice sales data (51). As six of these farmers provided information from both sources a total of 52 unique farms participated. Overall, antibiotic use in sheep on the 52 farms sampled was low, with a median value of 11.35 mgPCU-1 (mean 13.63 mgPCU-1, sd 10.7; range 0-45.29 mgPCU-1), with all farms below 50 mgkg-1. Critically important antibiotics accounted for 0.21% of all antibiotics purchased. Lameness was the main driver of antibiotic use identified by this study. Others included a range of prophylactic treatments such as oral antibiotics to prevent watery mouth, injectable antibiotics to prevent abortion and following assisted lambing. Farmers acknowledged some of these uses had become habitual over time. The veterinary medicine sales records demonstrated significant sales of antibiotics not authorised for use in sheep, on an ongoing, rather than case-by-case, basis. Farmers were positive about their veterinarian's ability and knowledge to improve flock welfare and productivity, but were unwilling to pay for this advice. However, veterinarians may have facilitated weak medicine stewardship through a failure to adequately challenge farmers seeking antibiotics. Farmers did not maintain accurate or up-to-date on farm medicine or production records in the majority of cases. Despite this lack of on-farm recording, veterinary sales records can be studied in consultation with farmers to provide veterinarians with a farm-specific insight into antibiotic use and related attitudes and behaviours. Farmers and veterinarians can then identify areas and behaviours to target collaboratively, improving antibiotic and wider medicine stewardship, whilst simultaneously improving flock health and productivity.

Improving analgesia provision for sheep: An analysis of farm medicine records and attitudes towards pain relief on sheep farms in Northern Ireland.

Background: Management of pain is critical to improve the welfare of farmed livestock and meet consumer expectations. There is limited published information about the use of analgesic drugs in the sheep sector. Methods: A mixed-method approach was followed. The range of analgesic drugs used on 52 Northern Irish sheep farms was determined through analysis of medicine purchase records. Through interview and discussion groups, with both farmer and veterinarian participants, attitudes towards the use and adoption of such medicines were explored. Results: The use of non-steroidal anti-inflammatory drugs (NSAIDs) was widespread and highly variable. One-third of farmers in the sample did not purchase any NSAID. Meloxicam was the most commonly purchased NSAID by mass (72%) and standardised dose (73%). During interviews and discussions, farmers outlined the benefits they saw in using NSAIDs and how veterinarians influenced their uptake of these medicines. Use of corticosteroid was evidenced on 50% of the farms that supplied medicine records for analysis. Conclusions: Veterinarians can influence farmers to adopt NSAIDs for the provision of analgesia in their sheep and farmers observed the benefits they delivered. However, many farmers are still to be reached with this message, perhaps due to being largely self-sufficient and rarely engaging with veterinarians. Veterinarians have the opportunity to challenge farmers about the provision of analgesia, especially when farmers seek antibiotics for painful conditions such as lameness. Currently, the lack of an authorised product in the UK, with associated treatment guidance and industry promotion, may limit veterinarians' confidence in prescribing drugs for pain control in sheep.

Ventricular fibrillation waveform properties influenced by thoracic impedance guided chest compressions in a porcine model.

BACKGROUND AND OBJECTIVE: Quantitative measures extracted from ventricular fibrillation (VF) waveform reflect the metabolic state of the myocardium and are associated with survival outcome. The quality of delivered chest compressions during cardiopulmonary resuscitation are also linked with survival. The aim of this research is to explore the viability and effectiveness of a thoracic impedance (TI) based chest compression (CC) guidance system to control CC depth within individual subjects and influence VF waveform properties. METHODS: This porcine investigation includes an analysis of two protocols. CC were delivered in 2 min episodes at a constant rate of 110 CC min-1. Subject-specific CC depth was controlled using a TI-thresholding system where CC were performed according to the amplitude (ZRMS, 0.125 to 1.250 Ω) of a band-passed TI signal (ZCC). Protocol A was a retrospective analysis of a 12-porcine study to characterise the response of two VF waveform metrics: amplitude spectrum area (AMSA) and mean slope (MS), to varying CC quality. Protocol B was a prospective 12-porcine study to determine if changes in VF waveform metrics, due to CC quality, were associated with defibrillation outcome. RESULTS: Protocol A: A directly proportional relationship was observed between ZRMS and CC depth applied within each subject (r = 0.90; p <0.001). A positive relationship was observed between ZRMS and both AMSA (p <0.001) and MS (p <0.001), where greater TI thresholds were associated with greater waveform metrics. PROTOCOL B: MS was associated with return of circulation following defibrillation (odds ratio = 2.657; p = 0.043). CONCLUSION: TI-thresholding was an effective way to control CC depth within-subjects. Compressions applied according to higher TI thresholds evoked an increase in AMSA and MS. The response in MS due to deeper CC resulted in a greater incidence of ROSC compared to shallow chest compressions.

Migraine care practices in primary care: results from a national US survey.

BACKGROUND: Primary care clinicians play a critical role in diagnosis and treatment of migraine, yet barriers exist. This national survey assessed barriers to diagnosis and treatment of migraine, preferred approaches to receiving migraine education, and familiarity with recent therapeutic innovations. METHODS: The survey was created by the American Academy of Family Physicians (AAFP) and Eli Lilly and Company and distributed to a national sample through the AAFP National Research Network and affiliated PBRNs from mid-April through the end of May 2021. Initial analyses were descriptive statistics, ANOVAs, and Chi-Square tests. Individual and multivariate models were completed for: adult patients seen in a week; respondent years since residency; and adult patients with migraine seen in a week. RESULTS: Respondents who saw fewer patients were more likely to indicate unclear patient histories were a barrier to diagnosing. Respondents who saw more patients with migraine were more likely to indicate the priority of other comorbidities and insufficient time were barriers to diagnosing. Respondents who had been out of residency longer were more likely to change a treatment plan due to attack impact, quality of life, and medication cost. Respondents who had been out of residency shorter were more likely to prefer to learn from migraine/headache research scientists and use paper headache diaries. CONCLUSIONS: Results demonstrate differences in familiarity with migraine diagnosis and treatment options based on patients seen and years since residency. To maximise appropriate diagnosis within primary care, targeted efforts to increase familiarity and decrease barriers to migraine care should be implemented.

Treatment of Insertional Achilles Tendinopathy Using Adjunct Electroacupuncture Therapy: A Randomized Controlled Trial.

Objective: Achilles tendinopathy is a common musculoskeletal condition associated with decreased functionality. The insertional variant (<2cm from the calcaneus) is less responsive to eccentric-exercise therapy. This study looked at the effect of electroacupuncture (EA) + eccentric exercise for treating insertional Achilles tendinopathy. Materials and Methods: Fifty-two active duty and Department of Defense beneficiaries older than 18 years of age with insertional Achilles tendinopathy were randomized to treatment with either eccentric exercise or eccentric exercise with EA. They were evaluated at 0, 2, 4, 6, and 12 weeks. The treatment group received EA treatment in the first 4 visits. The Victorian Institute of Sports Assessment-Achilles Questionnaire (VISA-A; scored 0-100; higher score = increased function) was used to assess the patients and patient-reported pain (0-10, increasing pain with score) pre- and post-demonstration of the exercises during each visit. Results: Both the treatment group (53.6% reduction; confidence interval [CI]: 2.1, 3.9; P < 0.001) and the control group (37.5% reduction; CI: 0.4, 2.9; P = 0.023) reported decreased pain between the first and last visit. The treatment group had reduced pain (mean difference [MD] = 1.0; P < 0.01) between pre- and post-eccentric-exercise performance at each visit, while the control group did not (MD = -0.3; P = 0.065). VISA-A scores did not show a difference in functional improvement between the groups (P = 0.296). Conclusions: EA as an adjunct to eccentric therapy significantly improves short-term pain control for insertional Achilles tendinopathy.

What's up with everyone?': The effectiveness of a digital media mental health literacy campaign for young people.

BACKGROUND: In 2021, the Arts and Humanities Research Council commissioned a mass-media mental health campaign called "What's up With Everyone?" Here, innovative co-created messages were professionally storied and animated by an internationally recognized production company and focused on improving mental health literacy in five core areas: competition, social media, perfectionism, loneliness and isolation, and independence. AIMS: This study examines the impact of the "What's up With Everyone?" campaign on young people's mental health awareness. METHODS: Seventy-one (19 males, 51 females, M age = 19.20 years, SD = 1.66, range = 17-22) young people completed a one-sample, pre-post experiment to measure changes in knowledge, attitudes, confidence, and stigma of mental health struggles, as well as help-seeking for mental ill-health before and following exposure to animations. RESULTS: Paired and one-sample t-tests revealed that knowledge, attitudes, confidence, and willingness to seek support improved at post-test. There were also significant reductions in the stigma towards depression following the animations. CONCLUSIONS: Continued long-term investment in campaigns such as "What's up With Everyone?" seems warranted given the impact on mental health awareness, help-seeking, and stigma.

Young People's Trust in Cocreated Web-Based Resources to Promote Mental Health Literacy: Focus Group Study.

BACKGROUND: There is a pressing need to create resources to promote mental health literacy among young people. Digital media is one of the methods that can be used to successfully promote mental health literacy. Although digital mental health resources are generally favorably perceived by young people, one of the essential factors in whether they choose to use these interventions is trust. OBJECTIVE: The objective of this study was to explore young people's trust-related concerns about and recommendations for the cocreated mental health website "What's Up With Everyone" by using TrustScapes. Our aim was to use the findings to improve the trustworthiness of the website and to inform future creators of web-based mental health resources. METHODS: In total, 30 young people (mean age 19, SD 1.509; range 17-21 years) participated in TrustScapes focus groups. Thematic analysis was carried out to analyze both the TrustScapes worksheets and audio transcripts. RESULTS: Qualitative analysis revealed that the mental health website contains elements perceived to be both trustworthy and untrustworthy by young people. The relatable and high-quality design, which was achieved by cocreating the website with a team of design professionals and young people, was considered to increase trust. Creators' credibility also positively affected trust, but the logos and other information about the creators were recommended to be more salient for users. Suggestions were made to update the privacy policy and cookie settings and include communication functions on the platform to improve the trustworthiness of the website. CONCLUSIONS: Factors perceived to be trustworthy included the website's relatable, high-quality design and creators' credibility, whereas those perceived to be untrustworthy included the privacy policy and cookie settings. The findings highlighted the significance of collaborating with end users and industrial partners and the importance of making the trust-enabling factors salient for users. We hope that these findings will inform future creators of web-based mental health resources to make these resources as trustworthy and effective as possible.

Exploring sustainable care pathways - a scoping review.

BACKGROUND: Patients with mental health problems experience numerous transitions into and out of hospital. AIM: The review studies assessing clinical care pathways between psychiatric hospitalization and community health services. METHODS: We used publications between 2009-2020 to allow a broad scoping review of the published research. Sixteen review-articles were identified, 12 primary studies were chosen, both on care pathways in the transition between psychiatric hospital and community. RESULTS: Organizational issues: Systems and procedures to ensure clear responsibilities and transparency at each stage of the pathways of care. RESOURCES: Information-technology in objectively improving patient outcome. Information/documentation: Providing patients with adequate structured information and documented plans at the appropriate time. Patient/families: Continuous collaborative decision-making. Clinical care and teamwork: Collaboration between mental health and other professionals to guarantee that planned activities meet patient need. ETHICAL ISSUES: Respectful communication and patient-centred, non-humiliating care. CONCLUSIONS: System and procedures ensure clear responsibilities and transparency. Information technology support decision-making and referral and objectively improve patient outcomes in care pathways. Collaboration between mental health and other professionals guarantee that planned activities meet patients' needs along with regular meetings sharing key information. Around-the-clock ambulant-teams important to transition success. Informed-shared decision-making between parties, support patient participation and respectful communication.

Schizophrenia.

Schizophrenia is the most common psychotic mental disorder, and those affected have two to four times higher mortality than the general population. Genetic and environmental factors increase the risk of developing schizophrenia, and substance use disorder (particularly cannabis) may have the strongest link. Schizophrenia typically develops in young adulthood and is characterized by the presence of positive and negative symptoms. Positive symptoms include hallucinations, delusions, and disorganized speech. Negative symptoms include blunted affect, alogia, avolition, asociality, and anhedonia. Symptoms must be present for at least six months and be severe for at least one month to make a diagnosis. Because schizophrenia is debilitating, it should be treated with antipsychotics, and early treatment decreases long-term disability. Treatment should be individualized, and monitoring for effectiveness and adverse effects is important. Patients with a first episode of psychosis who receive a formal diagnosis of schizophrenia should be treated in a coordinated specialty care program. Second-generation antipsychotics are the preferred first-line treatment because they cause fewer extrapyramidal symptoms. Patients with schizophrenia who are treated with second-generation antipsychotics are at increased risk of cardiovascular disease and should receive at least annual metabolic screening and counseling with interventions to prevent weight gain and encourage smoking cessation. Treatment-resistant schizophrenia should be treated with clozapine. Adjunctive treatments include electroconvulsive therapy, antidepressants, and cognitive behavior therapy for psychosis. Family and social support are keys to improved outcomes.

Transcutaneous Pulsed RF Energy Transfer Mitigates Tissue Heating in High Power Demand Implanted Device Applications: In Vivo and In Silico Models Results.

This article presents the development of a power loss emulation (PLE) system device to study and find ways of mitigating skin tissue heating effects in transcutaneous energy transmission systems (TETS) for existing and next generation left ventricular assist devices (LVADs). Skin thermal profile measurements were made using the PLE system prototype and also separately with a TETS in a porcine model. Subsequent data analysis and separate computer modelling studies permit understanding of the contribution of tissue blood perfusion towards cooling of the subcutaneous tissue around the electromagnetic coupling area. A 2-channel PLE system prototype and a 2-channel TETS prototype were implemented for this study. The heating effects resulting from power transmission inefficiency were investigated under varying conditions of power delivery levels for an implanted device. In the part of the study using the PLE setup, the implanted heating element was placed subcutaneously 6-8 mm below the body surface of in vivo porcine model skin. Two operating modes of transmission coupling power losses were emulated: (a) conventional continuous transmission, and (b) using our proposed pulsed transmission waveform protocols. Experimental skin tissue thermal profiles were studied for various levels of LVAD power. The heating coefficient was estimated from the porcine model measurements (an in vivo living model and a euthanised cadaver model without blood circulation at the end of the experiment). An in silico model to support data interpretation provided reliable experimental and numerical methods for effective wireless transdermal LVAD energization advanced solutions. In the separate second part of the study conducted with a separate set of pigs, a two-channel inductively coupled RF driving system implemented wireless power transfer (WPT) to a resistive LVAD model (50 Ω) to explore continuous versus pulsed RF transmission modes. The RF-transmission pulse duration ranged from 30 ms to 480 ms, and the idle time (no-transmission) from 5 s to 120 s. The results revealed that blood perfusion plays an important cooling role in reducing thermal tissue damage from TETS applications. In addition, the results analysis of the in vivo, cadaver (R1Sp2) model, and in silico studies confirmed that the tissue heating effect was significantly lower in the living model versus the cadaver model due to the presence of blood perfusion cooling effects.

Creative Long Covid: A qualitative exploration of the experience of Long Covid through the medium of creative narratives.

BACKGROUND: Healthcare is witnessing a new disease with the emergence of Long Covid; a condition which can result in myriad symptoms, varying in frequency and severity. As new data are emerging to help inform treatment guidelines, the perspectives of those living with Long Covid are essential in informing healthcare practice. The research aimed to collect the narratives of people living with Long Covid to better understand the lived experience of this condition. In attempting to narrate complex or traumatic experiences the arts and humanities can offer alternative ways of expressing embodied narratives, representing rich sources of meaning. Therefore, the research specifically sought to elicit creative expressions from participants with lived experience of Long Covid. METHODS: Data were collected via an online repository where participants could submit their pieces of creative writing. Data were collected between August 2021 and January 2022 and a total of 28 submissions were received from participants. These were mostly written creative narratives. However, a small number were submitted as audio or video files of spoken word poetry or songs. Data collection was stopped once data saturation was achieved. RESULTS: The submissions were subjected to thematic analysis and five themes were generated. These five themes are Identity, social relationships, symptoms, interaction with healthcare systems and time. The results provide an insight into the experience of Long Covid as detailed by the participants' creative narratives. CONCLUSION: The results from this study provide a unique insight into the lived experience of Long Covid. In relation to clinical practice, the results suggest that adjustment reaction and loss of sense of self could be added as common symptoms. PATIENT AND PUBLIC CONTRIBUTION: Before undertaking the research, Long Covid community groups were contacted to discuss the potential value of this study and it was widely supported. One of the leading Long Covid support groups was also involved in disseminating information regarding the project. As part of ongoing work within this project, members of the team are actively disseminating the results within Long Covid communities and seeking to develop arts-based workshops specifically for people with Long Covid.

Sheep scab in Northern Ireland: Its distribution, costs and farmer knowledge about prevention and control.

Sheep scab (psoroptic mange), which is endemic in the United Kingdom (UK) flock, has a significant, negative impact on sheep welfare. Nothing has previously been published about the distribution of sheep scab in Northern Ireland (NI), nor about Northern Irish farmers' knowledge and behaviours relating to the disease, its treatment, prevention and control. Between March and June 2021 an online questionnaire on the disease was completed by sheep farmers in NI. Forty-four respondents out of a total of 122 valid returns (36%) indicated that they had at least one outbreak of sheep scab in their flock within the previous five years. These flocks were spread throughout NI and included flocks grazing on common land. Farmers reporting sheep scab in their flock considered movements of sheep between flocks to be the main cause of flock infestation. Respondents demonstrated knowledge gaps in relation to the parasite biology, disease transmission, prevention and treatment options, as well as a lack of awareness of some of the relevant industry guidelines. We highlight that some farmers rely on clinical signs alone to rule out the possibility that newly purchased sheep are infested with sheep scab before mixing them with their flock. This activity poses a high risk for the introduction of sheep scab into previously uninfested flocks. The inadequacy of some farmers' quarantine rules, or their inability to follow them, was also reported by farmers as being the cause of their flock infestation. Sheep scab outbreaks were shown to result in significant financial cost, with some farmers reporting their most recent outbreak had cost over £2500 ($3329). The paper also highlights that in addition to the animal health and welfare impact and financial cost, sheep scab was reported to have a social cost: 94 respondents (79%) agreed that a sheep scab outbreak caused emotional stress to affected farmers. These findings have provided evidence of the widespread nature of sheep scab in the NI flock, and of the knowledge gaps and behaviours which need to be addressed to improve sheep scab control. This will require a combination of focused research, knowledge exchange between farmers, advisors, policy makers and regulators, and co-developed disease control plans at a flock and national level.

What's Up With Everyone? A qualitative study on young people's perceptions of cocreated online animations to promote mental health literacy.

INTRODUCTION: Adolescence and young adulthood are especially critical times to learn about mental health, given that 75% of mental health issues are developed by the age of 24. Animations have great potential to effectively deliver mental health information to young people. A series of five short animated films to promote mental health literacy were created with and for young people in partnership with the multi-award-winning independent animation studio, Aardman Animations. The aim of this study was to explore young people's perceptions of the cocreated animated films. METHODS: Seven Youth Juries were conducted to capture young people's opinions and recommendations about the content related to mental health literacy and presentation style of the cocreated animated films. Thematic analysis was used to analyse the audio transcripts. RESULTS: Many participants reported a view that the animated films had the potential to promote mental health literacy, especially for understanding mental health and reducing stigma. Some recommendations were provided to improve the films, such as including subtitles and having a better transition to the companion website. CONCLUSION: Cocreated animations have great potential to promote the mental health literacy of young people. We hope that the findings from the present study will inform future media development to make them as effective as possible. PATIENT OR PUBLIC CONTRIBUTION: Young people were actively involved in the development, production, implementation and evaluation (up to the time before data analysis) of the animated films.

Patient outcomes of a clinician curriculum on how to deliver a diabetes diagnosis.

AIMS: To investigate the effects of a curriculum that teaches medical decision making and interpersonal communication in the context of prediabetes (preDM) and type 2 diabetes (T2DM). METHODS: This evaluation was an active-controlled trial of 56 patients, including patients who received their diagnosis from intervention-trained clinicians or a control group. Patients attended a research appointment for informed consent and collection of baseline measures. Over the following six months, both groups were mailed surveys and informational handouts monthly. Upon conclusion, we recorded the most recent A1c from the patient's record. RESULTS: An analysis of covariance test revealed patients who received a T2DM diagnosis from an intervention-trained clinician reported higher reassurance from the diagnosing clinician and had a higher perception of threat. Although not statistically significant, patients with T2DM in the intervention group had a lower A1c at follow up and patients in the intervention group reported less poor eating and a higher degree of diet decision making. CONCLUSIONS: The curriculum itself does not influence glycemic control, but our results demonstrate the positive impact on patients of the curriculum to teach critical skills to clinicians delivering a diabetes diagnosis.

Pediatric defibrillation shocks alone do not cause heart damage in a porcine model.

AIM: Automated external defibrillators (AEDs) use various shock protocols with different characteristics when deployed in pediatric mode. The aim of this study is to assess and compare the safety and efficacy of different AED pediatric protocols using novel experimental approaches. METHODS: Two defibrillation protocols (A and B) were assessed across two studies: Protocol A: escalating (50-75-90 J) defibrillation waveform with higher voltage, shorter duration and equal phase durations. Protocol B; non-escalating (50-50-50 J) defibrillation waveform with lower voltage, longer duration and unequal phase durations.Experiment 1: Isolated shock damage was assessed following shocks to 12 anesthetized pigs. Animals were randomized into two groups, receiving three shocks from Protocol A (50-75-90 J) or B (50-50-50 J). Cardiac function, cardiac troponin I (cTnI), creatine phosphokinase (CPK) and histopathology were analyzed. Experiment 2: Defibrillation safety and efficacy were assessed through shock success, ROSC, ST-segment deviation and contractility following 16 randomized shocks from protocol A or B delivered to 10 anesthetized pigs in VF. RESULTS: Experiment 1: No clinically meaningful difference in cTnI, CPK, ST-segment deviation, ejection fraction or histopathological damage was observed following defibrillation with either protocol. No difference was observed between protocols at any timepoint. Experiment 2: all defibrillation types demonstrated shock success and ROSC ≥ 97.5%. Post-ROSC contractility was similar between protocols. CONCLUSIONS: There is no evidence that administration of clinically relevant shock sequences, without experimental confounders, result in significant myocardial damage in this model of pediatric resuscitation. Typical variations in AED pediatric mode settings do not affect defibrillation safety and efficacy.

Depressive symptoms, social support, and health-related quality of life: A community-based study in Shanghai, China.

BACKGROUND: Depressive symptoms erode both physical and mental aspects of health-related quality of life (HRQoL). Social support (SS) may improve HRQoL through its direct effects or buffering effects. The association among depressive symptoms, SS, and HRQoL has been studied in specific groups, but research in the general adult population remains limited. This study examined the association among depressive symptoms, SS, and HRQoL, including exploring whether SS (including its three dimensions: subjective SS, objective SS and support utilization) mediated or moderated the relationship between depressive symptoms and HRQoL among community-based adults. METHODS: We conducted a cross-sectional survey in six communities in Shanghai, China, and 1642 adult participants with complete information on depressive symptoms and/or SS, and HRQoL were included. Linear regression analysis was used to investigate the association among depressive symptoms, SS, and HRQoL. In addition, we explored the mediating and moderating role of SS in the relationship between depressive symptoms and HRQoL. RESULTS: More depressive symptoms were associated with lower physical HRQoL (B = -0.64, p < .001) and lower mental HRQoL (B = -0.83, p < .001). SS (B = 0.07, p = .02), specifically subjective SS (B = 0.09, p = .03), was positively related to mental HRQoL. After adjusting for covariates, we found no evidence for a mediating role of SS in the relationship between depressive symptoms and HRQoL, while SS (subjective SS and objective SS) moderated the association between depressive symptoms and mental HRQoL. LIMITATIONS: Due to the low voluntary participation rate of employees, participants represented approximately 50% of the individuals approached, thus limiting the generalizability of our findings. Data collected through self-report scales could lead to information bias. CONCLUSIONS: SS does not appear to underlie the relationship between depressive symptoms and HRQoL. However, interventions to increase SS (in particular, subjective SS and objective SS) should be studied to determine whether they may be beneficial in alleviating the adverse impact of depressive symptoms on mental HRQoL.

Digital video interventions and mental health literacy among young people: a scoping review.

BACKGROUND: Mental health literacy is important as it relates to understanding mental illness, increasing help-seeking efficacy, and reducing mental illness-related stigma. One method to improve the mental health literacy of young people is a digital video intervention. AIMS: A scoping review was conducted to map existing research in the area of digital video interventions for mental health literacy among young people. METHODS: The scoping review was conducted following the PRISMA-ScR checklist. All results were screened based on our inclusion criteria. RESULTS: Seventeen studies were selected for analysis. In most studies (n = 14), a digital video was the only intervention whereas three studies took a multi-intervention approach. Only two of the digital video interventions were co-created with people with mental illness or university students. All studies showed positive results in favor of digital video interventions in at least one component of mental health literacy or compared to one of the comparison conditions. CONCLUSIONS: Digital video interventions represent effective tools for enhancing mental health literacy. However, there is a need for active involvement of end-users in co-creation and to attend to the production quality so that the digital video intervention is as relevant, informed, and effective as possible.