Mechanical chest-compression devices: current and future roles

Purpose of review: It is recognised that the quality of CPR is an important predictor of outcome from cardiac arrest yet studies consistently demonstrate that the quality of CPR performed in real life is frequently sub-optimal. Mechanical chest compression devices provide an alternative to manual CPR. This review will consider the evidence and current indications for the use of these devices. Recent findings: Physiological and animal data suggest that mechanical chest compression devices are more effective than manual CPR. However there is no high quality evidence showing improved outcomes in humans. There are specific circumstances where it may not be possible to perform manual CPR effectively e.g. during ambulance transport to hospital, en-route to and during cardiac catheterisation, prior to organ donation and during diagnostic imaging where using these devices may be advantageous. Summary: There is insufficient evidence to recommend the routine use of mechanical chest compression devices. There may be specific circumstances when CPR is difficult or impossible where mechanical devices may play an important role in maintaining circulation. There is an urgent need for definitive clinical and cost effectiveness trials to confirm or refute the place of mechanical chest compression devices during resuscitation

Dynamic regulation of CD4+ regulatory T cells by radiation treatment

Radiotherapy remains effective at treating primary, early-stage tumors, however it produces nominal results in late-stage and metastatic tumors. This has led to a shift towards more targeted immune-based therapies. Yet the use of most approved cancer immunotherapies is limited to only a few cancer types and in the absence of effective anti-tumor immunity tumors can successfully evade immune surveillance. Tumors employ multiple mechanisms for avoiding immune elimination including down-regulation of positive signals to tumor specific CD8+ cytotoxic T cells (CTLs) and the accumulation of CD4+ regulatory T (TREG) cells which can suppress the anti-tumor activity of effector CTLs. Radiation has been reported to enhance anti-tumor immunity through such mechanisms as tumor cell death or phenotypic modulation of tumor cells, however the impact of radiotherapy on TREGcells is less clear. The goal of this dissertation was to investigate the direct effect of radiation on the phenotypic characteristics and functional activity of induced TREGcells and to examine the indirect effect of radiation on TREGfrequency. We found that exposure to sub-lethal radiation decreased the expression of Foxp3 in TREGcells and differentially modulated the expression of several TREGsignature molecules. This loss of Foxp3 and modulation of several TREGassociated molecules resulted in a reduction of suppressive activity. Radiation has previously been shown to modulate the expression of genes in tumor cells that can impact T cell activity such as OX40L and 4-1BBL. Thus, a secondary goal of the research was to assess the effect of radiation-induced expression of tumoral OX40L and 4-1BBL on TREGnumber in two commonly used tumor models, 4T1 and MC38. Additionally, we examined 4T1 and MC38 tumors for changes in immune cell composition post-treatment. We found that radiation differentially modulated OX40L and 4-1BBL expression in our tumor models, as well as reduced TREGfrequency. However, induced expression of OX40L did not correlate with the observed decrease in TREGfrequency. Further, we found that radiotherapy differentially modulated the immune cell profile of 4T1 and MC38 tumors. These findings could support the design for rationale combinations of cancer immunotherapies with radiation treatment

Technological Disruption in Entertainment: Navigating the Film Industry\u27s Dynamic Relationship to the Consumer

The following thesis acts as a critical cultural progression report surrounding the current technological disruption in the entertainment industry and its impact on consumers. This begins with a study of the history starting in 1910 and covers the urbanization of America during the Industrial Revolution, the developing fan experience, a history of consumer demands in relation to oligopolistic principles and the blockbuster method, the invention and influence of the television, and the current effect of technological advancement in the entertainment industry. Following this historical overview, four chapters will study different methods of analysis covering the intricacies of the current technological disruption using four theories: population ecology, media systems dependency, the mainstream cult, and convergence and participatory culture. The culmination of this work will consist of drawing together the history, the theories, and the contemporary examples into a conclusion about the fate of the media oligopoly in which this researcher points to the importance of seamless integration between the media industry and the consumer by way of three possible outcomes

Presenting whilst retreating in the age of the corporate lanyard

It seems a little curious, that until recently, most of us hadn’t even heard of the word lanyard, let alone knew what it meant or where it came from, given its ubiquitous presence in our daily lives. Rooted in 15th century maritime history, lanyard derives from the French word lanière, meaning strap or thong, which was made from scraps of rope on board ships, presenting a hands-free solution to working on a vessel, whilst keeping weapons close at hand. It is from this utility, as an attachment, that the history of lanyards is largely a military one, gracing different traditions over the centuries. Lanyards were used to connect a sword, pistol or whistle to a uniform by cavalry and naval officers. This is where decoration meets function; a soldier’s or sailor’s status determining what braiding or colour combination might apply. Any appraisal of the lanyard now within a contemporary context cannot ignore this antecedence, which is so central to the object’s DNA

Measuring inconsistency in research ethics committee review

Abstract Background The review of human participant research by Research Ethics Committees (RECs) or Institutional Review Boards (IRBs) is a complex multi-faceted process that cannot be reduced to an algorithm. However, this does not give RECs/ IRBs permission to be inconsistent in their specific requirements to researchers or in their final opinions. In England the Health Research Authority (HRA) coordinates 67 committees, and has adopted a consistency improvement plan including a process called “Shared Ethical Debate” (ShED) where multiple committees review the same project. Committee reviews are compared for consistency by analysing the resulting minutes. Methods We present a description of the ShED process. We report an analysis of minutes created by research ethics committees participating in two ShED exercises, and compare them to minutes produced in a published “mystery shopper” exercise. We propose a consistency score by defining top themes for each exercise, and calculating the ratio between top themes and total themes identified by each committee for each ShED exercise. Results Our analysis highlights qualitative differences between the ShED 19, ShED 20 and “mystery shopper” exercises. The quantitative measure of consistency showed only one committee across the three exercises with more than half its total themes as top themes (ratio of 0.6). The average consistency scores for the three exercises were 0.23 (ShED19), 0.35 (ShED20) and 0.32 (mystery shopper). There is a statistically significant difference between the ShED 19 exercise, and the ShED 20 and mystery shopper exercises. Conclusions ShED exercises are effective in identifying inconsistency between ethics committees and we describe a scoring method that could be used to quantify this. However, whilst a level of inconsistency is probably inevitable in research ethics committee reviews, studies must move beyond the ShED methodology to understand why inconsistency occurs, and what an acceptable level of inconsistency might be

Dates of birth and seasonal changes in well-being among 4904 subjects completing the seasonal pattern assessment questionnaire

Background: Abnormal distributions of birthdates, suggesting intrauterine aetiological factors, have been found in several psychiatric disorders, including one study of out-patients with Seasonal Affective Disorder (S.A.D.). We investigated birthdate distribution in relation to seasonal changes in well-being among a cohort who had completed the Seasonal Pattern Assessment Questionnaire (SPAQ). Method: A sample of 4904 subjects, aged 16 to 64, completed the SPAQ. 476 were cases of S.A.D. on the SPAQ and 580 were cases of sub-syndromal S.A.D. (S-S.A.D.). 92 were interview confirmed cases of S.A.D. Months and dates of birth were compared between S.A.D. cases and all others, between S.A.D. and S-S.A.D. cases combined and all others, and between interview confirmed cases and all others. Seasonality, as measured through seasonal fluctuations in well-being on the Global Seasonality Scores (GSS) of the SPAQ, was compared for all subjects by month and season of birth. Results: There was no evidence of an atypical pattern of birthdates for subjects fulfilling criteria for S.A.D., for the combined S.A.D. / S-S.A.D. group or for interview confirmed cases. There was also no relationship between seasonality on the GSS and month or season of birth. Limitations: Diagnoses of S.A.D. made by SPAQ criteria are likely to be overinclusive. Conclusion: Our findings differ from studies of patients with more severe mood disorders, including psychiatric out-patients with S.A.D. The lack of association between seasonality and birthdates in our study adds credence to the view that the aetiology of S.A.D. relates to separable factors predisposing to affective disorders and to seasonality

Employer Perceptions of Newly Credentialed Athletic Trainers as They Transition to Practice

Please enjoy Volume 5, Issue 1 of the JSMAHS. In this issue you will find Professional and under graduate research abstracts, case reports, and critically appraised topics. Thank you for viewing this 5th Annual OATA Special Edition