A scoping review to determine the barriers and facilitators to initiation and performance of bystander cardiopulmonary resuscitation during emergency calls

Background: To maximise out-of-hospital cardiac arrest (OHCA) patients’ survival, bystanders should perform continuous, good quality cardiopul- monary resuscitation (CPR) until ambulance arrival. Objectives: To identify published literature describing barriers and facilitators between callers and call-takers, which affect initiation and perfor- mance (continuation and quality) of bystander CPR (B-CPR) throughout the OHCA emergency call. Eligibility criteria: Studies were included if they reported on the population (emergency callers and call-takers), concept (psychological, physical and communication barriers and facilitators impacting the initiation and performance of B-CPR) and context (studies that analysed OHCA emergency calls). Sources of evidence: Medline, CINAHL, Cochrane CENTRAL, Embase, Scopus and ProQuest were searched from inception to 9 March 2022. Charting methods: Study characteristics were extracted and presented in a narrative format accompanied by summary tables. Results: Thirty studies identified factors that impacted B-CPR initiation or performance during the emergency call. Twenty-eight studies described barriers to the provision of CPR instructions and CPR initiation, with prominent themes being caller reluctance (psychological), physical ability (phys- ical), and callers hanging up the phone prior to CPR instructions (communication). There was little evidence examining barriers and facilitators to ongoing CPR performance (2 studies) or CPR quality (2 studies). Conclusions: This scoping review using emergency calls as the source, described barriers to the provision of B-CPR instructions and B-CPR ini- tiation. Further research is needed to explore facilitators and barriers to B-CPR continuation and quality throughout the emergency call, and to exam- ine the effectiveness of call-taker strategies to motivate callers to perform B-CPR

Control of Signaling in a MAP-kinase Pathway by an RNA-Binding Protein

Signaling-protein mRNAs tend to have long untranslated regions (UTRs) containing binding sites for RNA-binding proteins regulating gene expression. Here we show that a PUF-family RNA-binding protein, Mpt5, represses the yeast MAP-kinase pathway controlling differentiation to the filamentous form. Mpt5 represses the protein levels of two pathway components, the Ste7 MAP-kinase kinase and the Tec1 transcriptional activator, and negatively regulates the kinase activity of the Kss1 MAP kinase. Moreover, Mpt5 specifically inhibits the output of the pathway in the absence of stimuli, and thereby prevents inappropriate cell differentiation. The results provide an example of what may be a genome-scale level of regulation at the interface of signaling networks and protein-RNA binding networks

The changing role of the local news media in enabling citizens to engage in local democracies

Using Leeds City Council in the United Kingdom as a case study, we analyse comparatively the changing role of local journalism in the public communications and engagement strategies of local government. Drawing on over 20 semi-structured interviews with elected politicians, Council strategists, mainstream journalists, and citizen journalists, the article explores perceptions of the mainstream news media's role versus new modes of communication in engaging and communicating with citizens. We evaluate the Council's perceptions of its online and offline practices of engagement with different publics, and focus in particular on their interactions with journalists, the news media, and citizen journalists. The article considers how moves towards digital modes of engagement are changing perceptions of the professional role orientations of journalists in mediating between the Council and the general public

Barriers to CPR initiation and continuation during the emergency call relating to out-of-hospital cardiac arrest: A descriptive cohort study

Aim: To describe the barriers to cardiopulmonary resuscitation (CPR) initiation and continuation in emergency calls for out-of-hospital cardiac arrest (OHCA). Methods: We analysed 295 consecutive emergency calls relating to OHCA over a four-month period (1 January – 30 April 2021). Calls included were paramedic-confirmed, non-traumatic, non-EMS-witnessed OHCA, where the caller was with the patient. Calls were listened to in full and coded in terms of barriers to CPR initiation and continuation, and patient and caller characteristics. Results: Overall, CPR was performed in 69% of calls and, in 85% of these, callers continued performing CPR until EMS arrival. Nearly all callers (99%) experienced barriers to CPR initiation and/or continuation during the call. The barriers identified were classified into eight categories: reluc tance, appropriateness, emotion, bystander physical ability, patient access, leaving the scene, communication failure, caller actions and call-taker instructions. Of these, bystander physical ability was the most prevalent barrier to both CPR initiation and continuation, occurring in 191 (65%) calls, followed by communication failure which occurred in 160 (54%) calls. Callers stopping or interrupting CPR performance due to being fatigued was lower than expected (n = 54, 26% of callers who performed CPR). Barriers to CPR initiation that related to bystander physical ability, caller actions, communication failure, emotion, leaving the scene, patient access, procedural barriers, and reluctance were mostly overcome by the caller (i.e., CPR was performed). Conclusion: Barriers to CPR initiation and continuation were commonly experienced by callers, however they were frequently overcome. Future research should investigate the strategies that were successful

Lanthanide Complexes that Respond to Changes in Cyanide Concentration in Water

Cyanide ions are shown to interact with lanthanide complexes of phenacylDO3A derivatives in aqueous solution, giving rise to changes in the luminescence and NMR spectra. These changes are the consequence of cyanohydrin formation, which is favored by the coordination of the phenacyl carbonyl group to the lanthanide center. These complexes display minimal affinity for fluoride and can detect cyanide at concentrations less than 1 μm. By contrast, lanthanide complexes with DOTAM derivatives display no affinity for cyanide in water, but respond to changes in fluoride concentration

Morbidity and mortality in homeless individuals, prisoners, sex workers, and individuals with substance use disorders in high-income countries: a systematic review and meta-analysis.

BACKGROUND: Inclusion health focuses on people in extremely poor health due to poverty, marginalisation, and multimorbidity. We aimed to review morbidity and mortality data on four overlapping populations who experience considerable social exclusion: homeless populations, individuals with substance use disorders, sex workers, and imprisoned individuals. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, and the Cochrane Library for studies published between Jan 1, 2005, and Oct 1, 2015. We included only systematic reviews, meta-analyses, interventional studies, and observational studies that had morbidity and mortality outcomes, were published in English, from high-income countries, and were done in populations with a history of homelessness, imprisonment, sex work, or substance use disorder (excluding cannabis and alcohol use). Studies with only perinatal outcomes and studies of individuals with a specific health condition or those recruited from intensive care or high dependency hospital units were excluded. We screened studies using systematic review software and extracted data from published reports. Primary outcomes were measures of morbidity (prevalence or incidence) and mortality (standardised mortality ratios [SMRs] and mortality rates). Summary estimates were calculated using a random effects model. FINDINGS: Our search identified 7946 articles, of which 337 studies were included for analysis. All-cause standardised mortality ratios were significantly increased in 91 (99%) of 92 extracted datapoints and were 11·86 (95% CI 10·42-13·30; I2=94·1%) in female individuals and 7·88 (7·03-8·74; I2=99·1%) in men. Summary SMR estimates for the International Classification of Diseases disease categories with two or more included datapoints were highest for deaths due to injury, poisoning, and other external causes, in both men (7·89; 95% CI 6·40-9·37; I2=98·1%) and women (18·72; 13·73-23·71; I2=91·5%). Disease prevalence was consistently raised across the following categories: infections (eg, highest reported was 90% for hepatitis C, 67 [65%] of 103 individuals for hepatitis B, and 133 [51%] of 263 individuals for latent tuberculosis infection), mental health (eg, highest reported was 9 [4%] of 227 individuals for schizophrenia), cardiovascular conditions (eg, highest reported was 32 [13%] of 247 individuals for coronary heart disease), and respiratory conditions (eg, highest reported was 9 [26%] of 35 individuals for asthma). INTERPRETATION: Our study shows that homeless populations, individuals with substance use disorders, sex workers, and imprisoned individuals experience extreme health inequities across a wide range of health conditions, with the relative effect of exclusion being greater in female individuals than male individuals. The high heterogeneity between studies should be explored further using improved data collection in population subgroups. The extreme health inequity identified demands intensive cross-sectoral policy and service action to prevent exclusion and improve health outcomes in individuals who are already marginalised. FUNDING: Wellcome Trust, National Institute for Health Research, NHS England, NHS Research Scotland Scottish Senior Clinical Fellowship, Medical Research Council, Chief Scientist Office, and the Central and North West London NHS Trust

Feasibility and effects of intra-dialytic low-frequency electrical muscle stimulation and cycle training: A pilot randomized controlled trial

Background and objectives: Exercise capacity is reduced in chronic kidney failure (CKF). Intra-dialytic cycling is beneficial, but comorbidity and fatigue can prevent this type of training. Low–frequency electrical muscle stimulation (LF-EMS) of the quadriceps and hamstrings elicits a cardiovascular training stimulus and may be a suitable alternative. The main objectives of this trial were to assess the feasibility and efficacy of intra-dialytic LF-EMS vs. cycling Design, setting, participants, and measurements: Assessor blind, parallel group, randomized controlled pilot study with sixty-four stable patients on maintenance hemodialysis. Participants were randomized to 10 weeks of 1) intra-dialytic cycling, 2) intra-dialytic LF-EMS, or 3) non-exercise control. Exercise was performed for up to one hour three times per week. Cycling workload was set at 40–60% oxygen uptake (VO2) reserve, and LF-EMS at maximum tolerable intensity. The control group did not complete any intra-dialytic exercise. Feasibility of intra-dialytic LF-EMS and cycling was the primary outcome, assessed by monitoring recruitment, retention and tolerability. At baseline and 10 weeks, secondary outcomes including cardio-respiratory reserve, muscle strength, and cardio-arterial structure and function were assessed. Results: Fifty-one (of 64 randomized) participants completed the study (LF-EMS = 17 [77%], cycling = 16 [80%], control = 18 [82%]). Intra-dialytic LF-EMS and cycling were feasible and well tolerated (9% and 5% intolerance respectively, P = 0.9). At 10-weeks, cardio-respiratory reserve (VO2 peak) (Difference vs. control: LF-EMS +2.0 [95% CI, 0.3 to 3.7] ml.kg-1.min-1, P = 0.02, and cycling +3.0 [95% CI, 1.2 to 4.7] ml.kg-1.min-1, P = 0.001) and leg strength (Difference vs. control: LF-EMS, +94 [95% CI, 35.6 to 152.3] N, P = 0.002 and cycling, +65.1 [95% CI, 6.4 to 123.8] N, P = 0.002) were improved. Arterial structure and function were unaffected. Conclusions: Ten weeks of intra-dialytic LF-EMS or cycling improved cardio-respiratory reserve and muscular strength. For patients who are unable or unwilling to cycle during dialysis, LF-EMS is a feasible alternative

Methylphenidate Attenuates Rats' Preference for a Novel Spatial Stimulus Introduced into a Familiar Enviroment: Assessment Using a Force Plate Actometer

Methylphenidate is a psychostimulant widely used in the treatment of attention deficit hyperactivity disorder (ADHD). Here we report a novel paradigm that affords inferences about habituation and attention to a novel stimulus in a familiar environment in a single test session without prior training of the animals. The paradigm was used to assess the effects of methylphenidate (2.5 and 5.0 mg/kg, sc) in young adult, male, Long-Evans rats. Methylphenidate increased locomotor activity during the initial exposure to the test apparatus in a non-dose-related manner. However, upon introduction of a novel spatial stimulus (an alcove) in the familiar environment, methylphenidate-treatment resulted in dose-related increases in distance traveled and inhibition of long dwell times in the alcove, the latter behavior being characteristic of vehicle-treated rats’ response to the alcove condition. These results demonstrate the utility of this paradigm in the elucidation of the behavioral effects of a drug commonly used in the treatment of ADHD. Findings also suggest that species-typical response preferences in rats (e.g., refuge-seeking) may emerge in experimental settings that add spatial novelty to otherwise featureless test enclosures commonly used to assess locomotor activity