Compromised cardiopulmonary resuscitation quality due to regurgitation during endotracheal intubation: a randomised crossover manikin simulation study.

BACKGROUND: Regurgitation is a complication common during cardiopulmonary resuscitation (CPR). This manikin study evaluated the effect of regurgitation during endotracheal intubation on CPR quality. METHODS: An airway-CPR manikin was modified to regurgitate simulated gastric contents into the oropharynx during chest compression during CPR. In total, 54 emergency medical technician-paramedics were assigned to either an oropharyngeal regurgitation or clean airway scenario and then switched to the other scenario after finishing the first. The primary outcomes were CPR quality metrics, including chest compression fraction (CCF), chest compression depth, chest compression rate, and longest interruption time. The secondary outcomes were intubation success rate and intubation time. RESULTS: During the first CPR-intubation sequence, the oropharyngeal regurgitation scenario was associated with a significantly lower CCF (79.6% vs. 85.1%, P < 0.001), compression depth (5.2 vs. 5.4 cm, P < 0.001), and first-pass success rate (35.2% vs. 79.6%, P < 0.001) and greater longest interruption duration (4.0 vs. 3.0 s, P < 0.001) than the clean airway scenario. During the second and third sequences, no significant difference was observed in the CPR quality metrics between the two scenarios. In the oropharyngeal regurgitation scenario, successful intubation was independently and significantly associated with compression depth (hazard ratio = 0.47, 95% confidence interval, 0.24-0.91), whereas none of the CPR quality metrics were related to successful intubation in the clean airway scenario. CONCLUSION: Regurgitation during endotracheal intubation significantly reduces CPR quality. TRIAL REGISTRATION: ClinicalTrials.gov, NCT05278923 , March 14, 2022.

Effect of Pharmacological and Neurostimulation Interventions for Cognitive Domains in Patients with Bipolar Disorder: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials.

INTRODUCTION: The priority of interventions to alleviate cognitive deficits in patients with bipolar disorder (BD) is inconclusive. We systematically evaluate the efficacy of pharmacological or neurostimulation interventions for cognitive function in BD through a network meta-analysis. METHODS: The PubMed, PsycINFO, Embase, and Cochrane Library databases were searched from database inception to September 30, 2021. Following PRISMA guidelines, all eligible studies were randomized controlled trials of adult bipolar patients that provided detailed cognitive outcomes. Studies were excluded if participants limited to comorbid substance use disorder or the intervention was a psychotherapy. Network meta-analysis comparing different interventions was conducted for 8 cognitive domains. Partially ordered set with Hasse diagram was used to resolve conflicting rankings between outcomes. The study was preregistered on PROSPERO database (CRD42020152044). RESULTS: Total 21 RCTs including 42 tests for assessing intervention effects on cognition were retrieved. Adjunctive erythropoietin (SMD = 0.61, 95% CI = 0.00-1.23), Withania somnifera (SMD = 0.58, 95% CI = 0.03-1.13), and galantamine (SMD = 1.22, 95% CI = 0.10-2.35) was more beneficial for attention, working memory, and verbal learning in euthymic BD patients than treatment as usual, respectively. Hasse diagram suggested ranking of choice when multiple domains were combined. CONCLUSION: Considerable variability in measurements of cognitive domains in BD was observed, and no intervention resulted in superior benefits across all domains. We suggested interventions priority can be tailored according to individual patients' cognitive deficits. As current findings from relatively small and heterogeneous dataset, future trials with consensus should be applied for building further evidence.

The suction-assisted laryngoscopy assisted decontamination technique toward successful intubation during massive vomiting simulation: A pilot before-after study.

This study demonstrated a training program of the suction-assisted laryngoscopy assisted decontamination (S.A.L.A.D.) technique for emergency medical technician paramedic (EMT-P). The effectiveness of the training program on the improvements of skills and confidence in managing soiled airway was evaluated.In this pilot before-after study, 41 EMT-P participated in a training program which consisted of 1 training course and 3 evaluation scenarios. The training course included lectures, demonstration, and practice and focused on how to perform endotracheal intubation in soiled airway with the S.A.L.A.D technique. The first scenario was performed on standard airway mannequin head with clean airway (control scenario). The second scenario (pre-training scenario) and the third scenario (post-training scenario) were performed in airway with simulated massive vomiting. The post-training scenario was applied immediately after the training course. All trainees were requested to perform endotracheal intubation for 3 times in each scenario. The "pass" of a scenario was defined as more than twice successful intubation in a scenario. The intubation time, count of successful intubation, pass rate, and the confidence in endotracheal intubation were evaluated.The intubation time in the post-training scenario was significantly shorter than that in the pre-training scenario (P = .031). The pass rate of the control, pre-training, and post-training scenario was 100%, 82.9%, and 92.7%, respectively. The proportion of trainees reporting confident or very confident in endotracheal intubation in soiled airway increased from 22.0% to 97.6% after the training program. Kaplan-Meier analysis revealed that the adjusted hazard ratio of successful intubation for post-training versus pre-training scenario was 2.13 (95% confidence interval of 1.57-2.91).The S.A.L.A.D. technique training could efficiently help EMT-P performing endotracheal intubation during massive vomiting simulation.

Spatial Clustering of Dengue Fever Incidence and Its Association with Surrounding Greenness.

With more than 58,000 cases reported by the country's Centers for Disease Control, the dengue outbreaks from 2014 to 2015 seriously impacted the southern part of Taiwan. This study aims to assess the spatial autocorrelation of the dengue fever (DF) outbreak in southern Taiwan in 2014 and 2015, and to further understand the effects of green space (such as forests, farms, grass, and parks) allocation on DF. In this study, two different greenness indexes were used. The first green metric, the normalized difference vegetation index (NDVI), was provided by the long-term NASA MODIS satellite NDVI database, which quantifies and represents the overall vegetation greenness. The latest 2013 land use survey GIS database completed by the National Land Surveying and Mapping Center was obtained to access another green metric, green land use in Taiwan. We first used Spearman's rho to find out the relationship between DF and green space, and then three spatial autocorrelation methods, including Global Moran's I, high/low clustering, and Hot Spot were employed to assess the spatial autocorrelation of DF outbreak. In considering the impact of social and environmental factors in DF, we used generalized linear mixed models (GLMM) to further clarify the relationship between different types of green land use and dengue cases. Results of spatial autocorrelation analysis showed a high aggregation of dengue epidemic in southern Taiwan, and the metropolitan areas were the main hotspots. Results of correlation analysis and GLMM showed a positive correlation between parks and dengue fever, and the other five green space metrics and land types revealed a negative association with DF. Our findings may be an important asset for improving surveillance and control interventions for dengue.

Large-field-of-view wide-spectrum artificial reflecting superposition compound eyes.

In nature, reflecting superposition compound eyes (RSCEs) found in shrimps, lobsters and some other decapods are extraordinary imaging systems with numerous optical features such as minimum chromatic aberration, wide-angle field of view (FOV), high sensitivity to light and superb acuity to motion. Here, we present life-sized, large-FOV, wide-spectrum artificial RSCEs as optical imaging devices inspired by the unique designs of their natural counterparts. Our devices can form real, clear images based on reflection rather than refraction, hence avoiding chromatic aberration due to dispersion by the optical materials. Compared to imaging at visible wavelengths using conventional refractive lenses of comparable size, our artificial RSCEs demonstrate minimum chromatic aberration, exceptional FOV up to 165° without distortion, modest aberrations and comparable imaging quality without any post-image processing. Together with an augmenting cruciform pattern surrounding each focused image, our large-FOV, wide-spectrum artificial RSCEs possess enhanced motion-tracking capability ideal for diverse applications in military, security, medical imaging and astronomy.