Comparison of Out-of-Hospital Cardiac Arrests Occurring in Schools and Other Public Locations: A 12-Year Retrospective Study.

Objective: Out-of-hospital cardiac arrests (OHCA) in schools and universities are uncommon. However, these institutions must plan and prepare for such events to ensure the best outcomes. To evaluate their preparedness we assessed baseline characteristics, survival outcomes and 12-year trends for OHCA in schools/universities compared to other public locations.Methods: We conducted a retrospective analysis of OHCA in schools/universities and public locations between 2008 and 2019 using Victorian Ambulance Cardiac Arrest Registry data.Results: We included 9,037 EMS attended cases, 131 occurred in schools/universities and 8,906 in public locations. Compared to public locations, a significantly higher proportion of EMS treated cases in schools/universities received bystander cardiopulmonary resuscitation (CPR) (95.5% vs. 78.5%, p < 0.001), public access defibrillation (PAD) (26.1% vs. 9.9%, p < 0.001) and presented in shockable rhythms (69.4% vs. 50.9%, p < 0.001). Unadjusted survival to hospital discharge rates were also significantly higher in schools/universities (39.6% vs. 24.2%, p < 0.001). The long-term unadjusted trends for bystander CPR in schools/universities increased from 91.7% (2008-10) to 100% (2017-19) (p-trend = 0.025), for PAD from 4.2% (2008-10) to 47.5% (2017-19) (p-trend < 0.001) and for survival to hospital discharge from 16.7% (2008-10) to 57.5% (2017-19) (p-trend = 0.004). However, after adjustment for favorable cardiac arrest factors, such as younger age, bystander CPR and PAD, survival was similar between schools/universities and public locations.Conclusion: The majority of OHCA in schools and universities were witnessed and received bystander CPR, however less than half received PAD. Developing site-specific cardiac emergency response plans and providing age appropriate CPR training to primary, secondary and university students would help improve PAD rates.

Tenecteplase versus Alteplase for Stroke Thrombolysis Evaluation Trial in the Ambulance (Mobile Stroke Unit-TASTE-A): protocol for a prospective randomised, open-label, blinded endpoint, phase II superiority trial of tenecteplase versus alteplase for ischaemic stroke patients presenting within 4.5 hours of symptom onset to the mobile stroke unit.

INTRODUCTION: Mobile stroke units (MSUs) equipped with a CT scanner are increasingly being used to assess and treat stroke patients' prehospital with thrombolysis and transfer them to the most appropriate hospital for ongoing stroke care and thrombectomy when indicated. The effect of MSUs in both reducing the time to reperfusion treatment and improving patient outcomes is now established. There is now an opportunity to improve the efficacy of treatment provided by the MSU. Tenecteplase is a potent plasminogen activator, which may have benefits over the standard of care stroke lytic alteplase. Specifically, in the MSU environment tenecteplase presents practical benefits since it is given as a single bolus and does not require an infusion over an hour like alteplase. OBJECTIVE: In this trial, we seek to investigate if tenecteplase, given to patients with acute ischaemic stroke as diagnosed on the MSU, improves the rate of early reperfusion. METHODS AND ANALYSIS: TASTE-A is a prospective, randomised, open-label, blinded endpoint (PROBE) phase II trial of patients who had an ischaemic stroke assessed in an MSU within 4.5 hours of symptom onset. The primary endpoint is early reperfusion measured by the post-lysis volume of the CT perfusion lesion performed immediately after hospital arrival. ETHICS AND DISSEMINATION: The study was approved by the Royal Melbourne Hospital Human Ethics committee. The findings will be published in peer-reviewed journals, presented at academic conferences and disseminated among consumer and healthcare professional audiences. TRIAL REGISTRATION NUMBER: NCT04071613.

Paramedic streaming upon arrival in emergency department: A prospective study.

OBJECTIVE: The role of paramedics in hospital triage or streaming models has not been adequately explored and is potentially a missed opportunity for enhanced patient flow. The aim of the present study was to assess the concordance between a streaming decision by paramedics with the decision by nurses after arrival to the ED. METHODS: A prospective observational study was conducted. Paramedics were met at the entrance to the hospital and asked which destination they thought was appropriate (the index test). The ED nurse streaming decision was the reference standard. Cases of discordance were reviewed and assessed for clinical risk by an independent expert panel that was blinded. RESULTS: We collected data from 500 cases that were transported by ambulance consisting of 55% males with a median age of 57 years (interquartile range 38-75). The overall concordance between paramedics' and streaming decision was 86.4% (95% confidence interval 83.1-89.1). The concordance was highest among patients streamed to resuscitation and general cubicles. Among discordant cases (n = 68), 39 were streamed to a more acute destination than the paramedic suggested. Of the 68 discordant cases, 56 were deemed to be of no clinical risk. CONCLUSIONS: Despite limited knowledge of patient load within the ED, paramedics can allocate a streaming destination with high accuracy and this appears to be associated with low clinical risks. Early pre-hospital notification of streaming destination with proactive allocation of ED destination presents a real opportunity to minimise off-load times and improve patient flow.

The impact of bystander relation and medical training on out-of-hospital cardiac arrest outcomes.

AIM: In this study, we investigate the impact of bystander relation and medical training on survival to hospital discharge in out-of-hospital cardiac arrest (OHCA) patients receiving bystander cardiopulmonary resuscitation (CPR). METHODS: A retrospective analysis was performed on non-traumatic OHCA patients receiving bystander CPR and Emergency Medical Service (EMS) attempted resuscitation from 2015 through 2017. Adjusted logistic regression was used to assess the association between related versus unrelated and layperson versus medically trained bystander CPR providers and survival to hospital discharge. RESULTS: A total of 4464 OHCA were eligible for inclusion, of which 2385 (53.4%) received CPR from a relative, 468 (10.5%) from a work colleague or friend and 1611 (36.1%) from a stranger. Layperson's provided CPR in 3703 (83.0%) OHCA and medically trained professionals in 761 (17.0%). After adjustment for arrest characteristics, there was no difference in survival to hospital discharge between related versus unrelated CPR (adjusted odds ratio [AOR] 0.92, 95% confidence interval [CI]: 0.68-1.23, p = 0.555). However, bystander CPR by a medically trained provider rather than a layperson, was associated with an increase in the odds of survival by 47% (AOR 1.47, 95% CI: 1.09-2.00, p = 0.012) in the overall population and 73% (AOR 1.73, 95% CI: 1.21-2.49; p = 0.003) in patients with an initial shockable arrest. Adjusting for public access defibrillation significantly attenuated the effect of medically trained bystander CPR in initial shockable arrests (AOR 1.42, 95% CI: 0.97-2.07; p = 0.073). CONCLUSION: This study supports ongoing efforts to crowdsource a larger number of first responders with medical training to OHCA patients to assist with the provision of CPR and early defibrillation.

Effect of temperature on the biological parameters of the cabbage aphid Brevicoryne brassicae.

The cabbage aphid, Brevicoryne brassicae, is a pest of many plants of the Brassicaceae family including cabbage, Brassica oleracea Linnaeus, 1753. We investigated the effect of temperature on the biological parameters of B. brassicae using different temperature-based models incorporated in the Insect Life Cycle Modelling (ILCYM) software. Nymphs of first stage were individually placed in the incubators successively set at 10°C, 15°C, 20°C, 25°C, 30°C, and 35°C; 75 ± 5% RH; and L12: D12-hr photoperiods. We found that first nymph reached the adult stage after 18.45 ± 0.04 days (10°C), 10.37 ± 0.26 days (15°C), 6.42 ± 0.07 days (20°C), 5.076 ± 0.09 days (25°C), and 5.05 ± 0.10 days (30°C), and failed at 35°C. The lower lethal temperatures for B. brassicae were 1.64°C, 1.57°C, 1.56°C, and 1.62°C with a thermal constant for development of 0.88, 0.87, and 0.08, 0.79 degree/day for nymphs I, II, III, and IV, respectively. The temperatures 10, 30, and 35°C were more lethal than 15, 20, and 25°C. Longevity was highest at 10°C (35.07 ± 1.38 days). Fertility was nil at 30°C and highest at 20°C (46.36 ± 1.73 nymphs/female). The stochastic simulation of the models obtained from the precedent biological parameters revealed that the life table parameters of B. brassicae were affected by the temperature. The net reproduction rate was highest at 20°C and lowest at 30°C. The average generation time decreased from 36.85 ± 1.5 days (15°C) to 6.86 ± 0.1 days (30°C); the intrinsic rate of increase and the finite rate of increase were highest at 25°C. In general, the life cycle data and mathematical functions obtained in this study clearly illustrate the effect of temperature on the biology of B. brassicae. This knowledge will contribute to predicting the changes that may occur in a population of B. Brassiace in response to temperature variation.

Early ECPR for out-of-hospital cardiac arrest: Best practice in 2018.

Extracorporeal CPR is a second line treatment for refractory cardiac arrest, as written in the latest International Guidelines. Optimal timing, patient selection, location and method of implementation vary across the world. The objective here is to present an international consensus on the pillars of an ECPR program. The major aspect the group agrees on in that ECPR should be implemented within 60 minutes of collapse. With this in mind, the program should be built according to local resources knowing that the optimal team will require pre-established specific roles with personnel dedicated to resuscitation and others to ECPR.

Meta-analysis of survival prediction with Palliative Performance Scale.

This paper aims to reconcile the use of Palliative Performance Scale (PPSv2) for survival prediction in palliative care through an international collaborative study by five research groups. The study involves an individual patient data meta-analysis on 1,808 patients from four original datasets to reanalyze their survival patterns by age, gender, cancer status, and initial PPS score. Our findings reveal a strong association between PPS and survival across the four datasets. The Kaplan-Meier survival curves show each PPS level as distinct, with a strong ordering effect in which higher PPS levels are associated with increased length of survival. Using a stratified Cox proportional hazard model to adjust for study differences, we found females lived significantly longer than males, with a further decrease in hazard for females not diagnosed with cancer. Further work is needed to refine the reporting of survival times/probabilities and to improve prediction accuracy with the inclusion of other variables in the models.

Russian honey bee (Hymenoptera: Apidae) colonies: Acarapis woodi (Acari: Tarsonemidae) infestations and overwintering survival.

Honey bee, Apis mellifera L. (Hymenoptera: Apidae), colonies infested by parasitic mites are more prone to suffer from a variety of stresses, including cold temperature. We evaluated the overwintering ability of candidate breeder lines of Russian honey bees, most of which are resistant to both Varroa destructor Anderson & Trueman and Acarapis woodi (Rennie), during 1999-2001. Our results indicate that Russian honey bee colonies (headed by original and supersedure queens) can successfully overwinter in the north, even during adverse weather conditions, owing to their frugal use of food stores and their resistance to tracheal mite infestations. In contrast, colonies of Italian honey bees consumed more food, had more mites, and lost more adult bees than Russian honey bees, even during unusually mild winter conditions.

Donor facial composite allograft recovery operation: Cleveland and Boston experiences.

BACKGROUND: Complexity of logistic issues related to facial transplantation includes donor tissue recovery, recipient preparation, and operative execution. Limited information is available on the intricate process associated with facial allograft procurement in the United States. METHODS: The face transplant teams at the Cleveland Clinic and Brigham and Women's Hospital have combined their experiences regarding collaboration with organ procurement organizations and institutional review boards, and outlined technical and logistic challenges encountered during the process of facial allograft procurement and compared them with those of solid organ procurement. RESULTS: In a collaborative effort, both programs have created comprehensive guidelines for all aspects involved in donor facial allograft procurement. CONCLUSIONS: The authors suggest that every face transplant team should develop a thorough understanding of the local and regional legislative issues related to organ and tissue donation and ethical concerns surrounding this procedure. The recovery plan has to be communicated extensively among all members of the team. The Cleveland and Boston teams hope their experiences may help other teams in the process of building new face transplant programs. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.