Advanced Cardiac Resuscitation Evaluation (ACRE): A randomised single-blind controlled trial of peer-led vs. expert-led advanced resuscitation training

<p>Abstract</p> <p>Background</p> <p>Advanced resuscitation skills training is an important and enjoyable part of medical training, but requires small group instruction to ensure active participation of all students. Increases in student numbers have made this increasingly difficult to achieve.</p> <p>Methods</p> <p>A single-blind randomised controlled trial of peer-led vs. expert-led resuscitation training was performed using a group of sixth-year medical students as peer instructors. The expert instructors were a senior and a middle grade doctor, and a nurse who is an Advanced Life Support (ALS) Instructor.</p> <p>A power calculation showed that the trial would have a greater than 90% chance of rejecting the null hypothesis (that expert-led groups performed 20% better than peer-led groups) if that were the true situation. Secondary outcome measures were the proportion of High Pass grades in each groups and safety incidents.</p> <p>The peer instructors designed and delivered their own course material. To ensure safety, the peer-led groups used modified defibrillators that could deliver only low-energy shocks.</p> <p>Blinded assessment was conducted using an Objective Structured Clinical Examination (OSCE). The checklist items were based on International Liaison Committee on Resuscitation (ILCOR) guidelines using Ebel standard-setting methods that emphasised patient and staff safety and clinical effectiveness.</p> <p>The results were analysed using Exact methods, chi-squared and t-test.</p> <p>Results</p> <p>A total of 132 students were randomised: 58 into the expert-led group, 74 into the peer-led group. 57/58 (98%) of students from the expert-led group achieved a Pass compared to 72/74 (97%) from the peer-led group: Exact statistics confirmed that it was very unlikely (p = 0.0001) that the expert-led group was 20% better than the peer-led group.</p> <p>There were no safety incidents, and High Pass grades were achieved by 64 (49%) of students: 33/58 (57%) from the expert-led group, 31/74 (42%) from the peer-led group. Exact statistics showed that the difference of 15% meant that it was possible that the expert-led teaching was 20% better at generating students with High Passes.</p> <p>Conclusions</p> <p>The key elements of advanced cardiac resuscitation can be safely and effectively taught to medical students in small groups by peer-instructors who have undergone basic medical education training.</p

Transitions to food democracy through multilevel governance

status: publishe

Evaluating the potential of ecological niche modelling as a component in marine non-indigenous species risk assessments

Marine biological invasions have increased with the development of global trading, causing the homogenization of communities and the decline of biodiversity. A main vector is ballast water exchange from shipping. This study evaluates the use of ecological niche modelling (ENM) to predict the spread of 18 non-indigenous species (NIS) along shipping routes and their potential habitat suitability (hot/cold spots) in the Baltic Sea and Northeast Atlantic. Results show that, contrary to current risk assessment methods, temperature and sea ice concentration determine habitat suitability for 61% of species, rather than salinity (11%). We show high habitat suitability for NIS in the Skagerrak and Kattegat, a transitional area for NIS entering or leaving the Baltic Sea. As many cases of NIS introduction in the marine environment are associated with shipping pathways, we explore how ENM can be used to provide valuable information on the potential spread of NIS for ballast water risk assessment

Irradiation-Hyperthermia in Canine Hemangiopericytomas: Large-Animal Model for Therapeutic Response

Results of irradiation-hyperthermia treatment in 11 dogs with naturally occurring hemangiopericytomas are reported. Similarities of canine and human hemangiopericytomas are described. Orthovoltage X-irradiation followed by microwaveinduced hyperthermia resulted in a 91% objective response rate. A statistical procedure was given to evaluate quantitatively the clinical behavior of locally invasive, nonmetastatic tumors in dogs that were undergoing therapy for control of local disease. The procedure used a small sample size and demonstrated distribution of the data on a scaled response as well as transformation of the data through classical parametric and nonparametric statistical methods. These statistical methods set confidence limits on the population mean and placed tolerance limits on a population percentage. Application of the statistical methods to human and animal clinical trials is apparent

Production and investigation of heavy neutron rich nuclei

A project devoted to the production and study of neutron rich heavy nuclei (GALS - project) is being realized at Flerov Laboratory for Nuclear Reactions (FLNR) - JINR. GALS is planned to exploit available beams from the U-400M cyclotron in low energy multi-nucleon transfer reactions to study exotic neutron rich nuclei located in the "north-east" region of nuclear map. Products from 4.5 to 9 MeV/nucleon heavy-ion collisions, such as 136Xe on 208Pb, are to be captured in a gas cell and selectively laser-ionized in a sextupole (quadrupole) ion guide extraction system

Production and investigation of heavy neutron rich nuclei

A project devoted to the production and study of neutron rich heavy nuclei (GALS - project) is being realized at Flerov Laboratory for Nuclear Reactions (FLNR) - JINR. GALS is planned to exploit available beams from the U-400M cyclotron in low energy multi-nucleon transfer reactions to study exotic neutron rich nuclei located in the "north-east" region of nuclear map. Products from 4.5 to 9 MeV/nucleon heavy-ion collisions, such as 136Xe on 208Pb, are to be captured in a gas cell and selectively laser-ionized in a sextupole (quadrupole) ion guide extraction system