Survival Rates After Pediatric Traumatic Out-of-Hospital Cardiac Arrest Suggest an Underappreciated Therapeutic Opportunity.

OBJECTIVES: Children with traumatic arrests represent almost one third of annual pediatric out-of-hospital cardiac arrests (OHCAs). However, traumatic arrests are often excluded from study populations because survival posttraumatic arrest is thought to be negligible. We hypothesized that children treated and transported by emergency medical services (EMS) personnel after traumatic OHCA would have lower survival compared with children treated after medical OHCA. METHODS: We performed a secondary, observational study of children younger than 18 years treated and transported by 78 EMS agencies in southwestern Pennsylvania after OHCA from 2010 to 2014. Etiology was determined as trauma or medical by EMS services. We analyzed patient, cardiac arrest, and resuscitation characteristics and ascertained vital status using the National Death Index. We used multivariable logistic regression to test the association of etiology with mortality after covariate adjustment. RESULTS: Forty eight of 209 children (23%) had traumatic OHCA. Children with trauma were older than those with medical OHCA (13.2 [3.8-15.9] vs 0.5 [0.2-2.4] years, P < 0.001). Prehospital return of spontaneous circulation frequency for trauma versus medical etiology was similar (90% vs 87%, P = 0.84). Patients with trauma had higher mortality (69% vs 45% P = 0.004). CONCLUSIONS: More than 8 of 10 children with EMS treated and transported OHCA achieved return of spontaneous circulation. Despite lower survival rates than medical OHCA patients, almost one third of children with a traumatic etiology survived throughout the study period. Future research programs warrant inclusion of children with traumatic OHCA to improve outcomes.

Long-Term Outcomes of Out-of-Hospital Cardiac Arrest Care at Regionalized Centers.

STUDY OBJECTIVE: It is unknown whether regionalization of postarrest care by interfacility transfer to cardiac arrest receiving centers reduces mortality. We seek to evaluate whether treatment at a cardiac arrest receiving center, whether by direct transport or early interfacility transfer, is independently associated with long-term outcome. METHODS: We performed a retrospective cohort study including adults resuscitated from out-of-hospital cardiac arrest in southwestern Pennsylvania and neighboring Ohio, West Virginia, and Maryland, which includes approximately 5.7 million residents in urban, suburban, and rural counties. Patients were treated by 1 of 78 ground emergency medical services agencies or 2 air medical transport agencies between January 1, 2010, and November 30, 2014. Our primary exposures of interest were interfacility transfer to a cardiac arrest receiving center within 24 hours of arrest or any treatment at a cardiac arrest receiving center regardless of transfer status. Our primary outcome was vital status, assessed through December 31, 2014, with National Death Index records. We used unadjusted and adjusted survival analyses to test the independent association of cardiac arrest receiving center care, whether through direct or interfacility transport, on mortality. RESULTS: Overall, 5,217 cases were observed for 3,629 person-years, with 3,865 total deaths. Most patients (82%) were treated at 42 non-cardiac arrest receiving centers with median annual volume of 17 cases (interquartile range 1 to 53 cases per center annually), whereas 18% were cared for at cardiac arrest receiving centers receiving at least 1 interfacility transfer per month. In adjusted models, treatment at a cardiac arrest receiving center was independently associated with reduced hazard of death compared with treatment at a non-cardiac arrest receiving center (adjusted hazard ratio 0.84; 95% confidence interval 0.74 to 0.94). These effects were unchanged when analysis was restricted to patients brought from the scene to the treating hospital. No other hospital characteristic, including total out-of-hospital cardiac arrest patient volume and cardiac catheterization capabilities, independently predicted outcome. CONCLUSION: Both early interfacility transfer to a cardiac arrest receiving center and direct transport to a cardiac arrest receiving center from the scene are independently associated with reduced mortality.

Subject positions in screening mammography and implications for informed choice.

OBJECTIVE: Screening mammography has potential benefits as well as harms, but these are not always communicated to women. We therefore explored how women discuss screening mammography, the subject positions made available in their discourse, and the implications of these for informed choice. Design: We conducted 16 individual interviews with women aged 44-72 years who were attenders (n = 11) and non-attenders (n = 5) of screening, and analysed transcripts through Foucauldian Discourse Analysis. Main Outcome Measures: A semi-structured interview guide, informed by literature and researcher expertise, was used to collect data. Results: The women constructed screening mammography as either helpful or potentially harmful. We identified three subject positions-The Responsible Woman (who attends screening), The Irresponsible Woman (who does not attend screening), and the Judicious Woman (who engages in alternate breast health practices). Conclusion: These subject positions have the potential to limit women's choices, constrain shared decision-making with health professionals, and restrict women's engagement in risk-reducing behaviours. An expanded range of options ultimately offers an alternate future in which women's autonomy to control their own bodies is better supported.

Exploring breast health practices of post-menopausal women: Implications to informed consent.

In light of the contention surrounding breast health practices, the research aimed to explore post-menopausal women's experiences of such practices. Semi-structured interviews were conducted in July and August 2015 with 13 Australian women aged 54-74 years. Data were analysed thematically. Participants deemed their engagement with breast health practices as the 'right' thing. However, engaging in these 'right' practices appeared to be fostered by misconceptions. The findings suggest that women may not be making evidence-informed decisions to engage in breast screening; identify contemporary barriers to promoting informed decisions; and may inform information pertinent to breast screening policy, campaigns and decision aid designs.

A Systematic Review of Women's Knowledge of Screening Mammography.

In light of the contention surrounding the benefit-to-harm ratio of screening mammography, this systematic review aimed to understand women's knowledge of screening mammography. The search yielded 35 studies of varying methodologies, published/completed between 1992 and 2017. Data was collected between November 2017 and February 2018 and utilised publications from member countries of the International Cancer Screening Network- Breast Cancer Division. Data was analysed using a narrative synthesis. The results of the review suggest that most women are aware of mammograms, however there was large variability regarding the awareness of false positives/negatives and about the purpose of screening. Some topics (e.g. radiation, commencement age) are well understood by women; however, others are not (e.g., cessation age, overdiagnosis, and mortality reduction). The findings need to be considered in light of the variability of methods used to assess women's knowledge and there is a need to develop psychometrically validated and culturally appropriate measures of knowledge regarding screening mammography. Further, the lack of consensus regarding what women 'should' know in order to provide informed consent has implications for understanding what informed consent in breast screening means in practice.

Student Attitudes toward Learning Analytics in Higher Education: "The Fitbit Version of the Learning World".

Increasingly, higher education institutions are exploring the potential of learning analytics to predict student retention, understand learning behaviors, and improve student learning through providing personalized feedback and support. The technical development of learning analytics has outpaced consideration of ethical issues surrounding their use. Of particular concern is the absence of the student voice in decision-making about learning analytics. We explored higher education students' knowledge, attitudes, and concerns about big data and learning analytics through four focus groups (N = 41). Thematic analysis of the focus group transcripts identified six key themes. The first theme, "Uninformed and Uncertain," represents students' lack of knowledge about learning analytics prior to the focus groups. Following the provision of information, viewing of videos and discussion of learning analytics scenarios three further themes; "Help or Hindrance to Learning," "More than a Number," and "Impeding Independence"; represented students' perceptions of the likely impact of learning analytics on their learning. "Driving Inequality" and "Where Will it Stop?" represent ethical concerns raised by the students about the potential for inequity, bias and invasion of privacy and the need for informed consent. A key tension to emerge was how "personal" vs. "collective" purposes or principles can intersect with "uniform" vs. "autonomous" activity. The findings highlight the need the need to engage students in the decision making process about learning analytics.