Hospital employees' theoretical knowledge on what to do in an in-hospital cardiac arrest

<p>Abstract</p> <p>Background</p> <p>Guidelines recommend that all health care professionals should be able to perform cardiopulmonary resuscitation (CPR), including the use of an automated external defibrillator. Theoretical knowledge of CPR is then necessary.</p> <p>The aim of this study was to investigate how much theoretical knowledge in CPR would increase among all categories of health care professionals lacking training in CPR, in an intervention hospital, after a systematic standardised training. Their results were compared with the staff at a control hospital with an ongoing annual CPR training programme.</p> <p>Methods</p> <p>Health care professionals at two hospitals, with a total of 3144 employees, answered a multiple-choice questionnaire before and after training in CPR. Bootstrapped chi-square tests and Fisher's exact test were used for the statistical analyses.</p> <p>Results</p> <p>In the intervention hospital, physicians had the highest knowledge pre-test, but other health care professionals including nurses and assistant nurses reached a relatively high level post-test. Improvement was inversely related to the level of previous knowledge and was thus most marked among other health care professionals and least marked among physicians.</p> <p>The staff at the control hospital had a significantly higher level of knowledge pre-test than the intervention hospital, whereas the opposite was found post-test.</p> <p>Conclusions</p> <p>Overall theoretical knowledge increased after systematic standardised training in CPR. The increase was more pronounced for those without previous training and for those staff categories with the least medical education.</p

Evidence Gap and Intervention Heat Maps of Climate Change Adaptation in Low- and Middle-Income Countries

In the face of the predicted and actual severity of climate change, there has been considerable interest in understanding what does and does not work to increase the ability of human and environmental systems to adapt to changing climate. This paper presents an evidence gap map and examines evidence on adaptation between 2007 and 2018. We analyse evidence related to the effectiveness of adaptation measures. The evidence gap map is derived from systematically and exhaustively reviewing adaptation-related high-quality evidence from evaluation and research in developing countries, from both peer-reviewed and grey literature. The resulting literature was mapped onto a conceptual framework that included the type of intervention, the sector of activity and types of outcome measured. We examined 464 papers in detail. The results show that there is a large share of adaptation-related evidence on agriculture, and within it on the economic returns of technological and nature-based solutions. The main evidence gaps include a scarcity of evidence on adaptation interventions in the water sector, and on measures aimed at reducing exposure to climate events. We also note there is a scarcity of studies that examine social and institutional outcomes of climate-change adaptation interventions. Not surprisingly, there are few studies that use experimental designs. Most studies use quasi-experimental designs and multivariate analyses. An online version of the evidence gap map can be found at: https://egmopenaccess.3ieimpact.org/evidence-maps/adaptegmieu.We alsointroduce an innovation: In international development cooperation, ideally projects/investments should be evidence-based and effective. For countries, donors and development actors, a comparison of the project/investment portfolio with the available evidence in the form of an Intervention Heat Map (IHM) indicates whether the portfolio operates in evidence-rich or evidence-scarce fields. It helps prioritizing the generation of new evidence for climate change adaptation, either through rigorous impact evaluations or through evidence synthesis such as meta-analyses or in-depth reviews. This study provides this systematic overlay of the evidence gap map with the CCA portfolios of the GCF and Germany’s bilateral commitments in international development cooperation (German Cooperation).In concordance with the evidence, the IHM shows that much of the CCA portfolios cover agriculture and the sector relating to society, economy and health and promotes adaptive capacity. However, these projects/investments are also aiming to improve the enabling environment, where there is a lack of evidence, suggesting a possibility to improve upon and generate further evidence in the future. Furthermore, the IHM shows few project/investment interventions in the GCF and German Cooperation portfolios aimed at adoption of CCA and decreasing exposure of shocks and stressors as well as intervention types in the water and land use and built environment sectors, and project/investment interventions related to financial and market mechanismsand built infrastructure and structural interventions. Compared to the evidence, while there is a wealth of information on adoption and some on financial mechanism, these aforementioned limited project/investment interventions are also gaps in evidence. The allocation of funds is balanced among sectors but also seems to more match the nature of the intervention types.The current evidence base on CCA suggests that efforts should be directed towards improving the evidence base in the water sector, which is one of the most important in CCA. Finally, given that the CCA portfolios examined mostly are aimed at outcomes within the enabling environment, evidence regarding these interventions should be improved. This is also the case for other areas where projects/investments are allocated but evidence is lacking.Mit Blick auf das prognostizierte und tatsächliche Ausmaß des Klimawandels ist es von großem Interesse, zu verstehen, welche Maßnahmen die Anpassungsfähigkeit menschlicher und ökologischer Systeme an den Klimawandel erhöhen und welche nicht. In der vorliegenden Studie wird eine Evidence Gap Map (EGM - Karte der Evidenzlücken) erstellt, die anschaulich zeigt, wo Evidenz zur Effektivität von Anpassungsmaßnahmen verfügbar ist und wo Lücken bestehen. Sie ist das Ergebnis einer umfassenden und systematischen Analyse von qualitativ hochwertiger Evidenz zwischen 2007 und 2018. Die Daten stammen aus Evaluierungen und Forschungsarbeiten zu Maßnahmen in Ländern mit niedrigem und mittlerem Einkommen, aus begutachteter sowie aus grauer Literatur. Diese Literaturquellen wurden in einer konzeptionellen Matrix abgebildet, die Interventionstypen, Anpassungssektoren und Kategorien der Wirkungen umfasst. Insgesamt wurden 464 wissenschaftliche Arbeiten im Detail ausgewertet. Dabei wurde deutlich, dass ein Großteil der Evidenzdaten zur Anpassung an den Klimawandel in der Landwirtschaft und hier vor allem zu den wirtschaftlichen Erträgen technologischer und naturbasierter Lösungsansätze zu finden ist. Die zentralen Evidenzlücken zeigen sich vor allem in geringen Erkenntnissen über Anpassungsinterventionen im Wassersektor und über Maßnahmen mit dem Ziel die Exposition gegenüber Klimaereignissen zu verringern. Außerdem gibt es nur eine geringe Anzahl an Studien, die die sozialen und institutionellen Wirkungen von Anpassungsmaßnahmen im Zusammenhang mit dem Klimawandel untersuchen. Erwartungsgemäß setzen nur wenige Untersuchungen experimentelle Designs ein. Die Mehrzahl der Studien arbeitet mit multivariaten Analysen oder quasi-experimentellen Designs. Eine Online-Version der Karte der Evidenzlücken ist verfügbar unter: https://egmopenaccess.3ieim-pact.org/evidence-maps/adaptegmieu. Zusätzlich wird eine Innovation eingeführt: Im Idealfall sollten Projekte/Investitionen in der internationalen Entwicklungszusammenarbeit evidenzbasiert und effektiv gestaltet werden. Ein Vergleich des Projekt-/Investitionsportfolios mit den verfügbaren Evidenzen in Form einer Intervention Heat Map (IHM - Karte der Interventionsmaßnahmen) signalisiert den beteiligten Ländern, Gebern und Entwicklungsakteuren, ob ihr Portfolio in evidenzstarken oder evidenzschwachen Bereichen agiert. Dies unterstützt sie dabei, Prioritäten bei der Generierung neuer Evidenz für Maßnahmen zur Anpassung an den Klimawandel zu setzen, entweder durch wissenschaftliche, rigorose Wirkungsevaluierungen oder durch Evidenzsynthese wie Meta-Analysen oder vertiefende Reviews. Die vorliegende Studie bietet diese systematische Verknüpfung der EGM mit dem Investitionsportfolio des Green Climate Fund (GCF) und dem bilateralen Projektportfolio Deutschlands zur Anpassung an den Klimawandel in der internationalen Entwicklungszusammenarbeit. Die IHM verdeutlicht übereinstimmend mit den vorliegenden Evidenzdaten, dass viele Projekte/Investitionen der Portfolios zur Anpassung an den Klimawandel den Landwirtschaftsbereich und den Sektor mit gesellschaftlichem, wirtschaftlichem und gesundheitlichem Bezug abdecken und Anpassungsfähigkeiten fördern. Diese Projekte/Investitionen zielen jedoch auch auf die Verbesserung des förderlichen Umfelds ab, wozu bisher Evidenzlücken existieren. Dies weist auf eine künftige Möglichkeit zur Optimierung und Generierung weiterer Evidenzen hin. Darüber hinaus bildet die IHM nur wenige Projekt-/Investitionsmaßnahmen in den Portfolios des GCF und der deutschen Entwicklungszusammenarbeit ab, die auf eine Aufnahme von Anpassungsaktivitäten an den Klimawandel, eine Reduzierung der Exposition gegenüber klimatischen Schocks und Stressoren sowie Interventionen in den Bereichen Wasser- und Landnutzung, sowie bebaute Umgebung ab-zielen. Ebenso wenige richten sich auf Projekte/Investitionen im Rahmen von Finanz- und Marktmechanismen, Infrastrukturmaßnahmen und strukturellen Interventionen. Gemessen am Evidenzumfang gibt es zahlreiche Evidenzen bezüglich der Aufnahme von Anpassungsmaßnahmen und einige zu Finanzmechanismen. Die vorgenannten begrenzten Projekt-/Investitionsmaßnahmen weisen jedoch ebenfalls Evidenzlücken auf. Die Mittelzuweisung ist sektoral ausgewogen, entspricht aber auch mehr den unterschiedlichen Interventionstypen. Der aktuelle Stand der Evidenzbasis zu Anpassungsmaßnahmen an den Klimawandel verdeutlicht, dass diesbezügliche Aktivitäten auf eine Verbesserung der Evidenzlage im Wassersektor, einem zentralen Bereich der Anpassung an den Klimawandel, ausgerichtet werden sollten. Angesichts der Tatsache, dass die untersuchten Portfolios zur Klimawandelanpassung auf Wirkungen im Rahmen eines förderlichen Umfelds ausgerichtet sind, sollte die Evidenzlage bei diesen Interventionen verbessert werden. Dies gilt auch für andere Bereiche, in denen Projekte/Investitionen vergeben werden, für die jedoch keine oder wenige Evidenzen vorliegen

Combinatorial omics analysis reveals perturbed lysosomal homeostasis in collagen VII-deficient keratinocytes

The extracellular matrix protein collagen VII is part of the microenvironment of stratified epithelia and critical in organismal homeostasis. Mutations in the encoding gene COL7A1 lead to the skin disorder dystrophic epidermolysis bullosa (DEB), are linked to skin fragility and progressive inflammation-driven fibrosis that facilitates aggressive skin cancer. So far, these changes have been linked to mesenchymal alterations, the epithelial consequences of collagen VII loss remaining under- addressed. As epithelial dysfunction is a principal initiator of fibrosis, we performed a comprehensive transcriptome and proteome profiling of primary human keratinocytes to generate global and detailed images of dysregulated epidermal molecular pathways linked to loss of collagen VII. These revealed downregulation of interaction partners of collagen VII on mRNA and protein level, but also increased abundance of S100 pro- inflammatory proteins in primary DEB keratinocytes. Increased TGF-β signaling due to loss of collagen VII was associated with enhanced activity of lysosomal proteases in both keratinocytes and skin of collagen VII-deficient individuals. Thus, loss of a single structural protein, collagen VII, has extra- and intracellular consequences, resulting in inflammatory processes that enable tissue destabilization and promote keratinocyte- driven, progressive fibrosis

ACCESS TO CREDIT AS A DETERMINANT OF AUTONOMOUS ADAPTATION TO CLIMATE CHANGE:A meta-analysis of the evidence in low- and middle-income countries

This study assesses the role that access to credit plays in determining the uptake of adaptation measures in the agricultural sector. To this end, this meta-analysis synthesizes relevant studies contained in a recently published evidence gap map (EGM) on the effectiveness of climate change adaptation interventions in low- and middle-income countries. The results show a significant disparity of effects, with a large proportion of studies showing that credit-related variables do not significantly affect decisions to adopt adaptation measures. Furthermore, our meta-regression shows that certain study design elements have a strong correlation with the studies' results, such as estimation method, number of covariates and selection of control variables. We conclude that narrower definitions of credit variables, together with counterfactual study designs, should be used to obtain more reliable and robust evidence on the subject. From a policy perspective, access to credit, while important and relevant for building resilience and encouraging investments, might not be a sufficient factor in encouraging autonomous adaptation. When designing financial products, it is essential to consider the preferences among highly vulnerable households and individuals, who may channel resources towards other needs.Diese Studie untersucht die Rolle des Zugangs zu Krediten für die Aufnahme von Maßnahmen zur Anpassung an den Klimawandel im Agrarsektor. Dazu werden in dieser Metaanalyse die - für diese Forschungsfrage relevanten - Studien synthetisiert, welche in einer kürzlich veröffentlichten Karte der Evidenzlücken (Evidence Gap Map, EGM) über die Wirksamkeit von Anpassungsmaßnahmen in Ländern mit niedrigem und mittlerem Einkommen enthalten sind. Die Ergebnisse zeigen signifikante Unterschiede in den Auswirkungen. Ein großer Anteil der Studien zeigt, dass kreditbezogene Variablen die Entscheidungen zur Aufnahme von Anpassungsmaßnahmen nicht signifikant beeinflussen. Darüber hinaus zeigt eine Meta-Regression, dass bestimmte Elemente des Studiendesigns eine starke Korrelation mit den Ergebnissen der Studien aufweisen, wie beispielsweise die Schätzmethode, die Anzahl der Kovariaten und die Auswahl der Kontrollvariablen. Eine Schlussfolgerung ist, dass eine engere Definition der Variable "Zugang zu Krediten" zusammen mit kontrafaktischen Studiendesigns verwendet werden sollten, um zuverlässigere und robustere Evidenz zu diesem Thema zu generieren. Aus politischer Sicht ist der Zugang zu Krediten zwar wichtig und relevant für Resilienzstärkung und Investitionen, aber möglicherweise kein ausreichender Faktor zur Förderung autonomer Anpassung. Bei der Gestaltung von Finanzprodukten ist es von entscheidender Bedeutung, die Präferenzen von hochgradig vulnerablen Haushalten und Individuen zu berücksichtigen, die ihre Ressourcen möglicherweise für andere Bedürfnisse einsetzen

Towards a methodical framework for comprehensively assessing forest multifunctionality

Funded by Deutsche Forschungsgemeinschaft. Grant Number: DFG FOR 891/1-3 National Natural Science Foundation of China. Grant Numbers: 30710103907, 30930005, 31170457, 31210103910 Swiss National Science Foundation (SNSF) Sino-German Centre for Research Promotion in Beijing. Grant Number: GZ 986Peer reviewedPublisher PD

Characterization of photomorphogenic responses and signaling cascades controlled by phytochrome-A expressed in different tissues:Photomorphogenesis in far-red light

The photoreceptor phytochrome A acts as a light-dependent molecular switch and regulates responses initiated by very low fluences of light (VLFR) and high fluences (HIR) of far-red light. PhyA is expressed ubiquitously, but how phyA signaling is orchestrated to regulate photomorphogenesis is poorly understood. To address this issue, we generated transgenic Arabidopsis thaliana phyA-201 mutant lines expressing the biologically active phyA-YFP photoreceptor in different tissues, and analyzed the expression of several reporter genes, including ProHY5:HY5-GFP and Pro35S:CFP-PIF1, and various FR-HIR-dependent physiological responses. We show that phyA action in one tissue is critical and sufficient to regulate flowering time and root growth; control of cotyledon and hypocotyl growth requires simultaneous phyA activity in different tissues; and changes detected in the expression of reporters are not restricted to phyA-containing cells. We conclude that FR-HIR-controlled morphogenesis in Arabidopsis is mediated partly by tissue-specific and partly by intercellular signaling initiated by phyA. Intercellular signaling is critical for many FR-HIR induced responses, yet it appears that phyA modulates the abundance and activity of key regulatory transcription factors in a tissue-autonomous fashion

Cerebrospinal Fluid B Cells Correlate with Early Brain Inflammation in Multiple Sclerosis

Background: There is accumulating evidence from immunological, pathological and therapeutic studies that B cells are key components in the pathophysiology of multiple sclerosis (MS). Methodology/Principal Findings: In this prospective study we have for the first time investigated the differences in the inflammatory response between relapsing and progressive MS by comparing cerebrospinal fluid (CSF) cell profiles from patients at the onset of the disease (clinically isolated syndrome, CIS), relapsing-remitting (RR) and chronic progressive (CP) MS by flow cytometry. As controls we have used patients with other neurological diseases. We have found a statistically significant accumulation of CSF mature B cells (CD19+CD1382) and plasma blasts (CD19+CD138+) in CIS and RRMS. Both B cell populations were, however, not significantly increased in CPMS. Further, this accumulation of B cells correlated with acute brain inflammation measured by magnetic resonance imaging and with inflammatory CSF parameters such as the number of CSF leukocytes, intrathecal immunoglobulin M and G synthesis and intrathecal production of matri

Rationale for a Swedish cohort consortium

We herein outline the rationale for a Swedish cohort consortium, aiming to facilitate greater use of Swedish cohorts for world-class research. Coordination of all Swedish prospective population-based cohorts in a common infrastructure would enable more precise research findings and facilitate research on rare exposures and outcomes, leading to better utilization of study participants' data, better return of funders' investments, and higher benefit to patients and populations. We motivate the proposed infrastructure partly by lessons learned from a pilot study encompassing data from 21 cohorts. We envisage a standing Swedish cohort consortium that would drive development of epidemiological research methods and strengthen the Swedish as well as international epidemiological competence, community, and competitiveness.Peer reviewe

Decompressive craniectomy plus best medical treatment versus best medical treatment alone for spontaneous severe deep supratentorial intracerebral haemorrhage:a randomised controlled clinical trial

BACKGROUND: It is unknown whether decompressive craniectomy improves clinical outcome for people with spontaneous severe deep intracerebral haemorrhage. The SWITCH trial aimed to assess whether decompressive craniectomy plus best medical treatment in these patients improves outcome at 6 months compared to best medical treatment alone.METHODS: In this multicentre, randomised, open-label, assessor-blinded trial conducted in 42 stroke centres in Austria, Belgium, Finland, France, Germany, the Netherlands, Spain, Sweden, and Switzerland, adults (18-75 years) with a severe intracerebral haemorrhage involving the basal ganglia or thalamus were randomly assigned to receive either decompressive craniectomy plus best medical treatment or best medical treatment alone. The primary outcome was a score of 5-6 on the modified Rankin Scale (mRS) at 180 days, analysed in the intention-to-treat population. This trial is registered with ClincalTrials.gov, NCT02258919, and is completed.FINDINGS: SWITCH had to be stopped early due to lack of funding. Between Oct 6, 2014, and April 4, 2023, 201 individuals were randomly assigned and 197 gave delayed informed consent (96 decompressive craniectomy plus best medical treatment, 101 best medical treatment). 63 (32%) were women and 134 (68%) men, the median age was 61 years (IQR 51-68), and the median haematoma volume 57 mL (IQR 44-74). 42 (44%) of 95 participants assigned to decompressive craniectomy plus best medical treatment and 55 (58%) assigned to best medical treatment alone had an mRS of 5-6 at 180 days (adjusted risk ratio [aRR] 0·77, 95% CI 0·59 to 1·01, adjusted risk difference [aRD] -13%, 95% CI -26 to 0, p=0·057). In the per-protocol analysis, 36 (47%) of 77 participants in the decompressive craniectomy plus best medical treatment group and 44 (60%) of 73 in the best medical treatment alone group had an mRS of 5-6 (aRR 0·76, 95% CI 0·58 to 1·00, aRD -15%, 95% CI -28 to 0). Severe adverse events occurred in 42 (41%) of 103 participants receiving decompressive craniectomy plus best medical treatment and 41 (44%) of 94 receiving best medical treatment.INTERPRETATION: SWITCH provides weak evidence that decompressive craniectomy plus best medical treatment might be superior to best medical treatment alone in people with severe deep intracerebral haemorrhage. The results do not apply to intracerebral haemorrhage in other locations, and survival is associated with severe disability in both groups.FUNDING: Swiss National Science Foundation, Swiss Heart Foundation, Inselspital Stiftung, and Boehringer Ingelheim.</p

Toward a methodical framework for comprehensively assessing forest multifunctionality

Biodiversity-ecosystem functioning (BEF) research has extended its scope from communities that are short-lived or reshape their structure annually to structurally complex forest ecosystems. The establishment of tree diversity experiments poses specific methodological challenges for assessing the multiple functions provided by forest ecosystems. In particular, methodological inconsistencies and nonstandardized protocols impede the analysis of multifunctionality within, and comparability across the increasing number of tree diversity experiments. By providing an overview on key methods currently applied in one of the largest forest biodiversity experiments, we show how methods differing in scale and simplicity can be combined to retrieve consistent data allowing novel insights into forest ecosystem functioning. Furthermore, we discuss and develop recommendations for the integration and transferability of diverse methodical approaches to present and future forest biodiversity experiments. We identified four principles that should guide basic decisions concerning method selection for tree diversity experiments and forest BEF research: (1) method selection should be directed toward maximizing data density to increase the number of measured variables in each plot. (2) Methods should cover all relevant scales of the experiment to consider scale dependencies of biodiversity effects. (3) The same variable should be evaluated with the same method across space and time for adequate larger-scale and longer-time data analysis and to reduce errors due to changing measurement protocols. (4) Standardized, practical and rapid methods for assessing biodiversity and ecosystem functions should be promoted to increase comparability among forest BEF experiments. We demonstrate that currently available methods provide us with a sophisticated toolbox to improve a synergistic understanding of forest multifunctionality. However, these methods require further adjustment to the specific requirements of structurally complex and long-lived forest ecosystems. By applying methods connecting relevant scales, trophic levels, and above? and belowground ecosystem compartments, knowledge gain from large tree diversity experiments can be optimized