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Introduction: Despite recent advances in resuscitation, some patients remain in ventricular fibrillation (VF) after multiple defibrillation attempts during out-of-hospital cardiac arrest (OHCA). Vector change defibrillation (VC) and double sequential external defibrillation (DSED) have been proposed as alternate therapeutic strategies for OHCA patients with refractory VF. The primary objective was to determine the feasibility, safety and sample size required for a future cluster randomized controlled trial (RCT) with crossover comparing VC or DSED to standard defibrillation for patients experiencing refractory VF. Secondary objectives were to evaluate the intervention effect on VF termination and return of spontaneous circulation (ROSC). Methods: We conducted a pilot cluster RCT with crossover in four Canadian paramedic services and included all treated adult OHCA patients who presented in VF and received a minimum of three defibrillation attempts. In addition to standard cardiac arrest care, each EMS service was randomly assigned to provide continued standard defibrillation (control), VC or DSED. Services crossed over to an alternate defibrillation strategy after six months. Prior to the launch of the trial, 2,500 paramedics received in-person training for VC and DSED defibrillation using a combination of didactic, video and simulated scenarios. Results: Between March 2018 and September 2019, 152 patients were enrolled. Monthly enrollment varied from 1.4 to 6.1 cases per service. With respect to feasibility, 89.5% of cases received the defibrillation strategy they were randomly allocated to, and 93.1% of cases received a VC or DSED shock prior to the sixth defibrillation attempt. There were no reported cases of defibrillator malfunction, skin burns, difficulty with pad placement or concerns expressed by paramedics, patients, families, or ED staff about the trial. In the standard defibrillation group, 66.6% of cases resulted in VF termination, compared to 82.0% in VC and 76.3% of cases in the DSED group. ROSC was achieved in 25.0%, 39.3% and 40.0% of standard, VC and DSED groups, respectively. Conclusion: Findings from our pilot RCT suggest the DOSE VF protocol is feasible and safe. VF termination and ROSC were higher with VC and DSED compared to standard defibrillation. The results of this pilot trial will allow us to inform a multicenter cluster RCT with crossover to determine if alternate defibrillation strategies for refractory VF may impact patient-centered, clinical outcomes
Studies of suicidal behaviour have provided valuable information about the risk factors associated with these behaviors, yet there is not much information about predictors of transitions from suicidal thoughts to actual suicide behavior.The current study aims to elucidate the mechanisms in which suicidal ideation emerges over time and how suicidal ideation can lead to suicidal actions.We attempt to determine the effects of psychopathology, non-suicidal self-injury (NSSI) and risk behaviors on suicidal behavior. This is examined through our model of youth suicidal behavior based on the theoretical framework of Joiner's Interpersonal Theory of Suicide.
The prospective study design included baseline two follow-up assessments within a year. Follow-up sample included a total of 708 adolescents from schools throughout Israel. the students completed self-report questionnairesregarding suicide ideation and attempts, psychopathology, life style, socio-demographic background, non-suicidal self-injury, life events and social support.
Results indicate that interpersonal distress and internalizing disorders at baseline predicted later levels of suicidal ideation. the effects of interpersonal factors on ideation were partly or fully mediated by internalizing symptoms. We also found that increases in suicidal ideation and in engagement in risk behaviors and NSSI over time were associated with the occurrence of a suicide attempt within the follow up period.
The model identifies the different phases along the path to suicidal behavior, and risk factors associated with each phase. Hopefully this model will improve our understanding of the short-term course of suicidal behavior among adolescents, which may lead to potential improvements for intervention and prevention.
A health coach-led smoking cessation program was implemented in a community of immigrant Chinese Americans. Follow-up was provided face-to-face or over-the-phone to provide support and address barriers. Free nicotine replacement treatment was provided for eligible participants.
The aim is to assess smoking cessation outcome by program components.
Quitting was defined as self-reported smoking abstention for at least 3 months. Factors contributing to successful cessation were evaluated using chi-squared tests and regression analysis. Participants were randomly surveyed to measure the helpfulness of and satisfaction with the program.
The program enrolled 184 participants from November 2015 to January 2017. Participants were mostly men (89%) with a mean age of 44. An intent-to-treat analysis found that 19% quit. Phone counseling had the same success as face-to-face counseling. Each additional session attended was associated with 2.1 times the odds of quitting, P < 0.001. Among the participants who quit, 70% reported the health coach was helpful in their cessation.
A health coach-led smoking cessation program that offered phone-based counseling was successful in reducing smoking. Future programs should consider using a health coach to reduce physician burden and phone-based counseling for difficult-to-access patients to increase program reach.
Lieder and Griffiths rightly urge that computational cognitive models be constrained by resource usage, but they should go further. The brain's primary function is to regulate resource usage. As a consequence, resource usage should not simply select among algorithmic models of “aspects of cognition.” Rather, “aspects of cognition” should be understood as existing in the service of resource management.
Excavations at the 109 hectare site of Kurd Qaburstan on the Erbil plain in the Kurdistan Region of Iraq were conducted by the Johns Hopkins University in 2013 and 2014. The Middle Bronze Age (Old Babylonian period) is the main period of occupation evident on the site, and the project therefore aims to study the character of a north Mesopotamian urban centre of the early second millennium b.c. On the high mound, excavations revealed three phases of Mittani (Late Bronze) period occupation, including evidence of elite residential architecture. On the low mound and the south slope of the high mound, Middle Bronze evidence included domestic remains with numerous ceramic vessels left in situ. Also dating to the Middle Bronze period is evidence of a city wall on the site edges. Later occupations include a cemetery, perhaps of Achaemenid date, on the south slope of the high mound and a Middle Islamic settlement on the southern lower town. Faunal and archaeobotanical analysis provide information on the plant and animal economy of the second millennium b.c. occupations, and geophysical results have documented a thirty-one hectare expanse of dense Middle Bronze Age architecture in the northern lower town.
Firestone & Scholl (F&S) rely on three problematic assumptions about the mind (modularity, reflexiveness, and context-insensitivity) to argue cognition does not fundamentally influence perception. We highlight evidence indicating that perception, cognition, and emotion are constructed through overlapping, distributed brain networks characterized by top-down activity and context-sensitivity. This evidence undermines F&S's ability to generalize from case studies to the nature of perception.
This book is the English translation of Gerald D. Feldman's contributions to the multi-author, two-volume study Österreichische Banken und Sparkassen im Nationalsozialismus und in der Nachkeriegszeit, which was originally published in German by C. H. Beck in 2006. Austrian Banks in the Period of National Socialism focuses on the activities of two major financial institutions, the Creditanstalt-Wiener Bankverein and the Länderbank Wien. It details the ways the two banks served the Nazi regime and how they used the opportunities presented by Nazi rule to expand their business activities. Particular attention is given to the role that the Creditanstalt and Länderbank played in the 'Aryanization' of Jewish-owned businesses. The book also examines the two banks' relations with their industrial clients and considers the question of whether bank officials had any knowledge of their client firms' use of concentration camp prisoners and other forced laborers during World War II.