Prospektive Untersuchung eines multimodalen Reanimationskurses für medizinische Laien

In dieser Arbeit wurde ein speziell konzipiertes Training eines multimodalen Reanimationskurses evaluiert, welches zum Ziel hat Lerninhalte sowie praktische Fähigkeiten der Reanimation an Laien zu vermitteln. Um die Effektivität des Trainings zu überprüfen und wissenschaftlich einzuordnen, wurden die Ergebnisse im Rahmen der vorliegenden Studie erhoben und ausgewertet. Fragestellungen der Untersuchung waren zu einem, ob der multimodale Kurs zu einer Verbesserung der Qualität der Wiederbelebungsmaßnahmen führen kann und ob diese Kenntnisse über einen Zeitraum von sechs Monaten erhalten bleiben. Neben der Erfassung der einzelnen Reanimationsparameter wurde ein Reanimationsscore zur Vergleichbarkeit der Ergebnisse entwickelt und ausgewertet. Insgesamt wurden 100 Reanimationen untersucht. Der Reanimationsscore zeigte eine signifikante Verbesserung der Reanimationsparameter im Vergleich vor und nach dem Training (6,1 vs. 9,2; p< 0,001) sowie eine ebenfalls signifikante Verbesserung des Ausgangsbefundes vor dem Training im Vergleich zur Evaluation nach sechs Monaten (6,1 vs. 8,8; p< 0,001). Zwischen dem Zeitpunkt nach dem Training und nach sechs Monaten zeigte sich keine signifikante Veränderung (9,1 vs. 8,8; p = 0,42), was für einen anhaltenden Lernerfolg spricht. Im Detail konnten signifikante Verbesserungen bei der Anzahl und Frequenz der Thoraxkompressionen pro Zyklus (20,8 auf 26,6, p= 0,04), der Drucktiefe bei Thoraxkompression (0,45 vs. 0,80; p = 0,007), der Anzahl (0,8 vs. 2,0; p= 0,005) und dem Anteil korrekt gewählter Volumina (0,27 vs. 0,77; p = 0,001) der Beatmungshübe festgestellt werden. Bei der No-Flow Zeit kam es zwar zu einem signifikanten Anstieg nach dem Training und nach sechs Monaten (8,4 s vs. 11,9 s; p = 0,001), doch dank der Verbesserung der anderen Beatmungsparameter kam es insgesamt zu einer besseren Reanimationsperformance. Keine signifikante Veränderung fand sich bei der Thoraxentlastung. Zusätzlich wurde untersucht, ob die Masken-Beutelbeatmung in der Hand von medizinischen Laien eine Alternative für Laien zur Mund-zu-Mund Beatmung darstellt. Durch die Verwendung der Masken-Beutelbeatmung konnte in unserer Studie keine Verbesserung der Reanimationsparameter erzielt werden. Hier kam es zu signifikant längeren No-Flow-Zeiten im Vergleich zur Mund-zu-Mund-Beatmung sowohl nach dem Training (8,4 vs. 12,0; p = <0,001) als auch im Follow-Up (11,9 vs. 14,1; p = 0,032). Neben der erhöhten No¬ Flow-Zeit konnte auch ein signifikant niedrigerer Anteil korrekt gewählter Atemzugvolumina bei der Beutelbeatmung unmittelbar nach dem Training (0,85 vs. 0,53; p = <0,001) und nach sechs Monaten (0,77 vs. 0,40; p = 0,002) festgestellt werden. Die korrekte Anzahl an Beatmungshüben zeigte ebenfalls signifikante schlechtere Werte für die Masken¬ Beutelbeatmung im Vergleich zur Mund-zu-Mund-Beatmung sowohl nach dem Training (1,9 vs. 1,4; p = 0,006) als auch im Follow-Up (2,0 vs. 0,8; p = 0,001). Insgesamt führte der multimodale Reanimationskurs bei den Teilnehmern zu einer deutlichen Verbesserung der Reanimationsparameter, die auch bei einer Kontrolluntersuchung nach 6 Monaten weiterhin nachweisbar war. Nachdem sich keine Verbesserung der Reanimationsleistung durch Anwendung einer Masken-Beutelbeatmung erzielen ließ, muss die Ausstattung von Kindertagesstatten mit einem Beatmungsbeutel zum aktuellen Zeitpunkt kritisch gesehen werden

Bringing light into the dark : overview of environmental impacts of carbon fiber production and potential levers for reduction

Carbon fibers (CFs) are a crucial material for lightweight structures with advanced mechanical performance. However, there is still a paucity of detailed understanding regarding the environmental impacts of production. Previously, mostly singled-out scenarios for CF production have been assessed, often based on scarce transparent inventory data. To expand the current knowledge and create a robust database for future evaluation, a life cycle assessment (LCA) was carried out. To this end, a detailed industry-approved LCI is published, which also proved plausible against the literature. Subsequently, based on a global scenario representing the market averages for precursor and CF production, the most relevant contributors to climate change (EF3.1 climate change, total) and the depletion of fossil energy carriers (EF3.1 resource use, fossil) were identified. The energy consumption in CF manufacturing was found to be responsible for 59% of the climate change and 48% of the fossil resource use. To enable a differentiated discussion of manufacturing locations and process energy consumption, 24 distinct scenarios were assessed. The findings demonstrate the significant dependence of the results on the scenarios’ boundary conditions: climate change ranges from 13.0 to 34.1 kg CO2 eq./kg CF and resource use from 262.3 to 497.9 MJ/kg CF. Through the investigated scenarios, the relevant reduction potentials were identified. The presented results help close an existing data gap for high-quality, regionalized, and technology-specific LCA results for the production of CF.German Federal Ministry for Education and Research (BMBF

Implementation and Evaluation of Resuscitation Training for Childcare Workers

BACKGROUND AND OBJECTIVE: Children spend a large amount of time in daycare centers or schools. Therefore, it makes sense to train caregivers well in first-aid measures in children. The aim of this study is to evaluate whether a multimodal resuscitation training for childcare workers can teach adherence to resuscitation guidelines in a sustainable way. MATERIALS AND METHODS: Caregivers at a daycare center who had previously completed a first-aid course received a newly developed multimodal resuscitation training in small groups of 7–8 participants by 3 AHA certified PALS instructors and providers. The 4-h focused retraining consisted of a theoretical component, expert modeling, resuscitation exercises on pediatric manikins (Laerdal Resusci Baby QCPR), and simulated emergency scenarios. Adherence to resuscitation guidelines was compared before retraining, immediately after training, and after 6 months. This included evaluation of chest compressions per round, chest compression rate, compression depth, full chest recoil, no-flow time, and success of rescue breaths. For better comparability and interpretation of the results, the parameters were evaluated both separately and summarized in a resuscitation score reflecting the overall adherence to the guidelines. RESULTS: A total of 101 simulated cardiopulmonary resuscitations were evaluated in 39 participants. In comparison to pre-retraining, chest compressions per round (15.0 [10.0–29.0] vs. 30.0 [30.0–30.0], p < 0.001), chest compression rate (100.0 [75.0–120.0] vs. 112.5 [105–120.0], p < 0.001), correct compression depth (6.7% [0.0–100.0] vs. 100.0% [100.0–100.0], p < 0.001), no-flow time (7.0 s. [5.0–9.0] vs. 4.0 s. [3.0–5.0], p < 0.001), success of rescue breaths (0.0% [0.0–0.0] vs. 100.0% [100.0–100.0], p < 0.001), and resuscitation score were significantly improved immediately after training (3.9 [3.2–4.9] vs. 6.3 [5.6–6.7], p < 0.001). At follow-up, there was no significant change in chest compression rate and success of rescue breaths. Chest compressions per round (30.0 [15.0–30.0], p < 0.001), no-flow time (5.0 s. [4.0–8.0], p < 0.001), compression depths (100.0% [96.7–100.0], p < 0.001), and resuscitation score worsened again after 6 months (5.7 [4.7–6.4], p = 0.03). However, the results were still significantly better compared to pre-retraining. CONCLUSION: Our multimodal cardiopulmonary resuscitation training program for caregivers is effective to increase the resuscitation performance immediately after training. Although the effect diminishes after 6 months, adherence to resuscitation guidelines was significantly better than before retraining

A Dynamic Role of TBX3 in the Pluripotency Circuitry

Pluripotency represents a cell state comprising a fine-tuned pattern of transcription factor activity required for embryonic stem cell (ESC) self-renewal. TBX3 is the earliest expressed member of the T-box transcription factor family and is involved in maintenance and induction of pluripotency. Hence, TBX3 is believed to be a key member of the pluripotency circuitry, with loss of TBX3 coinciding with loss of pluripotency. We report a dynamic expression of TBX3 in vitro and in vivo using genetic reporter tools tracking TBX3 expression in mouse ESCs (mESCs). Low TBX3 levels are associated with reduced pluripotency, resembling the more mature epiblast. Notably, TBX3-low cells maintain the intrinsic capability to switch to a TBX3-high state and vice versa. Additionally, we show TBX3 to be dispensable for induction and maintenance of naive pluripotency as well as for germ cell development. These data highlight novel facets of TBX3 action in mESCs

Observation of WWWWWW Production in pppp Collisions at s\sqrt s =13 TeV with the ATLAS Detector

International audienceThis Letter reports the observation of $WWW$ production and a measurement of its cross section using 139 fb$^{-1}$ of proton-proton collision data recorded at a center-of-mass energy of 13 TeV by the ATLAS detector at the Large Hadron Collider. Events with two same-sign leptons (electrons or muons) and at least two jets, as well as events with three charged leptons, are selected. A multivariate technique is then used to discriminate between signal and background events. Events from $WWW$ production are observed with a significance of 8.0 standard deviations, where the expectation is 5.4 standard deviations. The inclusive $WWW$ production cross section is measured to be $820 \pm 100\,\text{(stat)} \pm 80\,\text{(syst)}$ fb, approximately 2.6 standard deviations from the predicted cross section of $511 \pm 18$ fb calculated at next-to-leading-order QCD and leading-order electroweak accuracy

Observation of WWWWWW Production in pppp Collisions at s\sqrt s =13 TeV with the ATLAS Detector

International audienceThis Letter reports the observation of $WWW$ production and a measurement of its cross section using 139 fb$^{-1}$ of proton-proton collision data recorded at a center-of-mass energy of 13 TeV by the ATLAS detector at the Large Hadron Collider. Events with two same-sign leptons (electrons or muons) and at least two jets, as well as events with three charged leptons, are selected. A multivariate technique is then used to discriminate between signal and background events. Events from $WWW$ production are observed with a significance of 8.0 standard deviations, where the expectation is 5.4 standard deviations. The inclusive $WWW$ production cross section is measured to be $820 \pm 100\,\text{(stat)} \pm 80\,\text{(syst)}$ fb, approximately 2.6 standard deviations from the predicted cross section of $511 \pm 18$ fb calculated at next-to-leading-order QCD and leading-order electroweak accuracy