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Acute pancreatitis (AP) is an acute inflammatory process of the pancreas, the incidence of which is increasing, and the management of which requires multidisciplinary intervention. Our work is a prospective analysis of 356 cases of BP collected in the emergency services, Visceral A and B surgery, and resuscitation of the Hassan II teaching hospital in Fez over a 2-year period from April 2017 to May 2019. The goal of our job is to analyze the epidemiological aspects of PA and mainly to verify the reliability and the feasibility of the new SIRS score in the evaluation of the severity of PA in our context. The mean age was 55±17.29 with a clear female predominance. The diagnosis of BP was established in front of an evocative clinical picture associated with lipasemia> 3x normal in 91.5% of cases. Abdominal CT revealed a predominance of PA stage E balthazar with 37.5% followed by stage C with 32.5%. Biliary etiology is predominant in 78.4% of cases followed by origin Admission SIRS was present in 48% of cases and was persistent beyond 48 hours in 18% of cases. All of the patients who developed a complication during BP had a positive SIRS at admission. The superinfection of the necrosis flows was present in 75.8% of the patients having a persistent SIRS beyond 48h. The complications were mainly dominated by the superinfection of the necrosis flows found in 15% of the cases. According to the Atlanta classification, we found : Medical treatment was initiated in all patients while endoscopic and surgical treatment were much less common In the light of our study, it was concluded that the SIRS score is a simple, precise and specific means for predicting and evaluating the severity of acute pancreatitis taking into account the drawbacks of other multifactorial scores. [ABSTRACT FROM AUTHOR]

During the 18th and 19th centuries, a new sensibility toward death developed in several countries. In addition to the danger posed by corpses to health, medicine also sought to better define the boundaries between life and death. Complaints about people buried with signs of life raised the issue of apparent death and highlighted the need for physicians to more accurately identify signs of death in the body. This article uses medical journals and other documents to examine the issue of apparent death in the context of Rio de Janeiro (Brazil) in the 19th century. After presenting general aspects of the debate on apparent death in medicine at the time and its implications, using Portugal as an example, this article examines this debate in the Brazilian case.

Research literature has highlighted the occurrence of deathbed vision (DBV), deathbed coincidence (DBC), and after- death communication (ADC) phenomena. To better inform the mental health profession about how psychotherapists respond to and are affected by working with these client experiences, we interviewed four therapists in private practice in the United Kingdom who reported having worked with clients who disclosed one or more of the phenomena. Using interpretative phenomenological analysis (IPA), we identified three main themes from their accounts: (a) making sense of inexplicable transpersonal experiences on a professional and personal level, (b) experiencing personal transformation, and (c) perceiving clients' therapeutic benefits from addressing DBV, DBC, and ADC experiences. We discuss these findings in the context of the existing literature along with implications for clinical practice and possible future research directions. [ABSTRACT FROM AUTHOR]

Near- death experiences (NDEs) are transpersonal events reported by individuals to have occurred while they were physically and/or psychologically close to death, whereas shared death experiences (SDEs) are transpersonal events reported by individuals to have occurred around the time of death of another person. In this paper, we compare the features and aftereffects reported in a study of 617 NDEs to those reported in a study of 164 SDEs. We found that NDEs and SDEs have a remarkably similar set of common features and aftereffects as well as key differences. When viewed together, these similarities and differences support the idea that NDEs and SDEs are different perspectives of a singular phenomenon, namely the transition between physical and non- physical existence. [ABSTRACT FROM AUTHOR]

Near-death experiences (NDEs) are known to occur in individuals who go through the first stages of physical death but can also happen as a nontypical manifestation of several forms of non-ordinary states of consciousness. In this exploratory study, we assessed the possibility of inducing the phenomenological components of an NDE through hypnosis using a specific script in a group setting. Participants were 7 males (38.9%) and 11 females (61.1%) ranging in age from 15 to 59 years with a mean age of 35.9. NDE Scale (Greyson, 1983) scores among the 17 participants whose total scores met the criterion of 7 or higher were seemingly indistinguishable, in both content and intensity, from scores of spontaneous near-death experiencers. Older participants scored higher on the three non-cognitive subscales. The core phenomenological components were prevalently affective, pointing to the likelihood that expectations played a role in induced experiences, as may also be the case with spontaneous NDEs that were in some way anticipated. However, we were unable to conclude that, beyond phenomenology, a hypnotically induced experience was equivalent to a spontaneous episode. To affirm that a shift from ordinary consciousness, facilitated by hypnosis, is adequate to bring someone close to a theoretical mental threshold that might be called Near-Death Consciousness, in which a comparable event could be hypothetically achieved, at least four variables should be considered: the context, content, intensity of deviation from ordinary consciousness, and aftereffects of the experience. [ABSTRACT FROM AUTHOR]

The present study deals with apparent death, a multi-layered theme running through European cultural history, cultural and culture-forming phenomenon, which is located on the border of historical eras, various scientific disciplines, serious research, and the area curiosities.

Background: Annually, 14 million newborns require stimulation to initiate breathing at birth and 6 million require bag-mask-ventilation (BMV). Many countries have invested in facility-based neonatal resuscitation equipment and training. However, there is no consistent tracking for neonatal resuscitation coverage.Methods: The EN-BIRTH study, in five hospitals in Bangladesh, Nepal, and Tanzania (2017-2018), collected time-stamped data for care around birth, including neonatal resuscitation. Researchers surveyed women and extracted data from routine labour ward registers. To assess accuracy, we compared gold standard observed coverage to survey-reported and register-recorded coverage, using absolute difference, validity ratios, and individual-level validation metrics (sensitivity, specificity, percent agreement). We analysed two resuscitation numerators (stimulation, BMV) and three denominators (live births and fresh stillbirths, non-crying, non-breathing). We also examined timeliness of BMV. Qualitative data were collected from health workers and data collectors regarding barriers and enablers to routine recording of resuscitation.Results: Among 22,752 observed births, 5330 (23.4%) babies did not cry and 3860 (17.0%) did not breathe in the first minute after birth. 16.2% (n = 3688) of babies were stimulated and 4.4% (n = 998) received BMV. Survey-report underestimated coverage of stimulation and BMV. Four of five labour ward registers captured resuscitation numerators. Stimulation had variable accuracy (sensitivity 7.5-40.8%, specificity 66.8-99.5%), BMV accuracy was higher (sensitivity 12.4-48.4%, specificity > 93%), with small absolute differences between observed and recorded BMV. Accuracy did not vary by denominator option. < 1% of BMV was initiated within 1 min of birth. Enablers to register recording included training and data use while barriers included register design, documentation burden, and time pressure.Conclusions: Population-based surveys are unlikely to be useful for measuring resuscitation coverage given low validity of exit-survey report. Routine labour ward registers have potential to accurately capture BMV as the numerator. Measuring the true denominator for clinical need is complex; newborns may require BMV if breathing ineffectively or experiencing apnoea after initial drying/stimulation or subsequently at any time. Further denominator research is required to evaluate non-crying as a potential alternative in the context of respectful care. Measuring quality gaps, notably timely provision of resuscitation, is crucial for programme improvement and impact, but unlikely to be feasible in routine systems, requiring audits and special studies. [ABSTRACT FROM AUTHOR]

Hardly any other folklore subject or motif can offer a more colourful bouquet in genre than apparent death, ranging from fairy tales and romantic legends to rumours, ballads, and jokes. The historical origin of stories of apparent death extends back to antiquity, probably also relying on some true events; however, the formation and spread of folktales on this subject falls into the Enlightenment period in Europe. The emergence and development of this topic relate to medical and religious practices, journalism and literature. The article focuses on the traditional context of apparent death in eighteenth-nineteenthcentury Europe, including Estonia. [ABSTRACT FROM AUTHOR]

Storylines associated with apparent death are known all over the world. Hardly any other subject or motif of folklore can offer a more coloured bouquet in genre than apparent death, ranging from fairy tales and romantic legends and narratives to rumours, ballads, and jokes. The earlier texts of our folklore archives date back to the late 1880s, but the vast majority of Estonian apparent death stories were collected in the second half of the 20th century. The historical origin of the stories of apparent death reaches to antiquity and probably also relies on some truthful occasions, but the formation and spread of folk tales on this subject fall into the Enlightenment period in Europe. The article focuses on the context of apparent death stories in 18th-19th century Europe, including Estonia. The emergence and developments of this topic relate to medical and religious practices, journalism and literature. [ABSTRACT FROM AUTHOR]

The present study deals with apparent death, a multi-layered theme running through European cultural history, cultural and culture-forming phenomenon, which is located on the border of historical eras, various scientific disciplines, serious research, and the area curiosities. [ABSTRACT FROM AUTHOR]

Mortality is an obvious if uncomfortable part of the human condition, yet it is impossible to study its impact on anyone who experiences it. Reports of phenomena associated with death such as out-of-the-body (OBE) and near death experiences (NDE) can only be studied post-hoc, since it is impossible to design a scientific study where an experimental group experiences death (and returns) and a control group does not. Yet NDEs seem to have a profound influence on the subsequent lives of people and are therefore worthy of study. Terror Management Theory, which argues that death anxiety contributes to in-group solidarity and hostility to out-groups, relies on studies that manipulate opinions and cannot be based on experiential evidence. Here we introduce a potential methodology that uses immersive virtual reality (VR) for the study of mortality and NDEs. Participants are embodied in alternate bodies in a beautiful island along with two companions. They explore the island and carry out tasks together. The mechanism of embodiment produces strong illusions of ownership over their life-sized virtual bodies. Over time each participant witnesses the death of the two companions and then her own death—which includes the reported features of an NDE (OBE, life review, the tunnel leading to white light) followed by a period of observation of the continuing activities in the virtual world on an external screen. Fifteen female participants experienced 6 sessions in the island, each starting as a child and gradually maturing, and eventually ageing and dying. Sixteen control subjects formed a waiting group. We introduce this as a methodology for the study of these issues, and present promising results, suggesting that those who experienced the island report life attitude changes, becoming more concerned with others and more interested in global rather than material issues compared to the control group. The results are based on a small sample size, and should be considered as indicative of the possibilities of this new methodology as a way forward for future studies in this field. [ABSTRACT FROM AUTHOR]

Background:Teleneonatology may improve the quality of high-risk newborn resuscitations performed by general providers in community settings. Variables that affect teleneonatology utilization have not been identified. Introduction:The objective of our mixed-methods study was to understand the barriers and facilitators experienced by local care providers who receive teleneonatology services. Materials and Methods:In October 2015, an electronic survey was sent to 349 teleneonatology participants at 6 community hospitals to assess user satisfaction, technology usability and acceptability, and impact on patient care. From December 2015 to June 2016, 49 participants were involved in focus groups and individual interviews to better understand barriers and facilitators of teleneonatology implementation. Qualitative data were analyzed using a thematic approach. Results:Survey response rate was 31.8% (N = 111). Of 93 survey respondents, 88 (94.6%) agreed that teleneonatology was needed at their hospitals, and of 52 participants, 50 (96.2%) believed that teleneonatology consults were helpful. We identified multiple facilitators and barriers to program implementation in education and training, process and work flow, communication, and technology. Discussion:Local care teams believed that teleneonatology was valuable for connection to a remote neonatologist. Successful program implementation may be facilitated by communicating the value of teleneonatology, engaging local stakeholders in program training and education, maintaining supportive professional relationships, and designing simple, highly reliable clinical work flows. Conclusions:Teleneonatology is viewed as an innovative, valuable service by local care teams. The identified barriers and facilitators to program use should be considered when implementing a teleneonatology program. [ABSTRACT FROM AUTHOR]

I argue that we can interpret the stories told by near-death experiences (NDEs) in a naturalistic way. Thus, the profound significance of NDEs need not come from a supernaturalistic conception of them, according to which in an NDE the individual is in touch with a heavenly realm. We can respect the sincerity of NDE reports, but we can capture their meaning in a naturalistic framework. [ABSTRACT FROM AUTHOR]

Introduction. Diagnosing death represents an activity that carries a great deal of public responsibility for medical professionals and is continually exposed to the control of citizens and media. Although this is a taboo subject in medical circles, unfortunately in medical practice there are situations when the physician issues a death diagnosis form without even examining the person or for an already buried person. Such physician’s action is impermissible and it leads to the possibility of professional and criminal law punishment. Case Outline. By giving examples from practice, we wish to point out the need for exceptional caution when confirming and diagnosing death in order to diagnose the true, i.e. rule out apparent death and consequently avoid the mistake of declaring dead someone still alive. Conclusion. When confirming and declaring death, exceptional caution of the physician is necessary so as not to declare dead someone still alive!

The care of surgical patients with obstructive sleep apnoea (OSA) invokes concerns with safety and liability because of the risk that exists for perioperative death or near-death. The purpose of this review is to analyse the available literature to identify risk factors for perioperative critical complications in patients with OSA. Literature reports were screened for life threatening complications and deaths in surgical patients with OSA. The critical complications were sub-grouped as death/near-death events (death and anoxic brain damage) vs critical respiratory events (CRE)/other events and analysed for various risk factors. Both univariate and multivariate analyses were conducted to identify the potential risk factors.In total, 15 case reports and two medico-legal reports, comprising of 60 total patients with OSA were included in our analysis. Overall, there were 43 deaths or near-death events and 12 critical respiratory events and five other life threatening events. Ten patients (17%) with OSA were undiagnosed before surgery. Only 31% (11/35) were on preoperative continuous positive airway pressure (CPAP), with 36% (4/11) of them continuing CPAP in the postoperative period. The majority of them received a morphine equivalent daily dose less than 10 mg. Eighty percent of the events occurred in the first 24 h and 67% occurred on the general hospital ward.Patients with OSA are at risk of critical complications including death during the initial 24 h after surgery. Morbid obesity, male sex, undiagnosed OSA, partially treated/untreated OSA, opioids, sedatives, and lack of monitoring are risk factors for death or near-death events. [ABSTRACT FROM AUTHOR]

This article addresses whether cardiopulmonary resuscitation (CPR) and sustained physiological support should ever be permitted in individuals who are diagnosed as brain dead and who had held previously expressed moral or religious objections to the currently accepted criteria for such a determination. It contrasts how requests for care would normally be treated in cases involving a brain-dead individual with previously expressed wishes to donate and a similarly diagnosed individual with previously expressed beliefs that did not conform to a brain-based conception of death. The paper first focuses narrowly on requests for CPR and then expands its scope to address extended physiological support. It describes how refusing the brain-dead non-donor's requests for either CPR or extended support would represent enduring harm to the antemortem or previously autonomous individual by negating their beliefs and self-identity. The paper subsequently discusses potential implications of policy that would allow greater accommodations to those with conscientious objections to currently accepted brain-based death criteria, such as for cost, insurance, higher brain formulations and bedside communication. The conclusion is that granting wider latitude to personal conceptions around the definition of death, rather than forcing a contested definition on those with valid moral and religious objections, would benefit both individuals and society. [ABSTRACT FROM AUTHOR]

The relevance of the Treatise written by Calmet, in his time, is undeniable for many reasons; first, because of the popularity and the controversy it caused amongst intellectual and general people; second, because of the large amount of information it provides on the subject of this research: the fake dead and the buried alive; and third, because with his writings, Calmet contributes to the establishment of the characteristics of the literary myth of the vampire. His detailed descriptions of the dead on their graves will later strengthen his influence in vampire literature of the nineteenth century. Anthropology and literature will converge in Calmet's Treatise given that, by tracking his stories of the false dead, valuable information will be provided for the creation of one of the most important creatures in global literature: the vampire. [ABSTRACT FROM AUTHOR]

Background: Burn patients who require CPR before admission to a burn center are anecdotally known to suffer higher mortality than those who do not require pre-hospital CPR.Study Design: A retrospective chart review identified adult patients admitted to our burn center between 2013 and 2015. Included patients met 1 or both of the following criteria: 20% or more total body surface area burned and need for intubation before admission to our facility. We sought to identify predictors of early death, late death, and survival among burn patients who underwent CPR before admission.Results: Of the 80 patients meeting inclusion criteria, 17.5% underwent CPR before arrival at our facility. Seventy-nine percent of these died, compared with 29% of the patients who did not require CPR (p = 0.0005). Seventy-one percent of CPR patients died within 48 hours of admission, compared with 8% of non-CPR patients (p < 0.0001). The major predictor of death vs survival after CPR was lower initial arterial pH.Conclusions: Patients who undergo CPR before transfer to a burn center are at high risk for early death. Predictors of death and early death after CPR may include elevated initial lactate and lower initial arterial pH. [ABSTRACT FROM AUTHOR]

Background: Over 200,000 babies die yearly in Nigeria, of which about 26% is due to birth asphyxia. Effective neonatal resuscitation (NR) using basic equipment is capable of preventing up to 30% of deaths associated with perinatal asphyxia. However, NR is only effective where caregivers have sufficient knowledge and required skills. The frequent industrial actions by health workers in the public sector have brought to the fore the importance of private health facilities in healthcare delivery. Thus, there is a need to assess training of health workers and availability of basic equipment in private health institutions in Kano. Aim: To assess availability of trained providers on NR and resuscitation equipment in private health facilities in Kano. Materials and Methods: This is a cross sectional survey of 85 conveniently sampled private institutions that provide obstetric care as part of their services in Kano metropolis. A semi-structured self-administered questionnaire was used to collect data from each facility. Results: Seventy eight filled questionnaires were retrieved and analyzed. There were 25 specialist clinics, 44 general practice facilities, and nine maternity homes/primary healthcare (PHC). Only 29 (37.2%) of the facilities have caregivers trained on NR in attendance during normal deliveries. Thirty four (43.5%) facilities have written protocol on NR. Only two (22.2%) of the maternity homes/PHC have functional ambu bags; the corresponding figures for specialist and general practice clinics are 16 (64%) and 24 (54.5%) respectively. Conclusion: There is insufficient number of trained personnel on newborn resuscitation, and low availability of newborn resuscitation equipment in private health institutions in Kano metropolis. [ABSTRACT FROM AUTHOR]

This paper provides a review of the literature on Near Death Experience (NDE). Several recurring features of the NDE, and their frequency, are presented. The issue of cultural variations of NDE being the subject of a debate, we chose to expose the data that support the cultural invariance hypothesis, but also those that reveal an impact of culture. In light of recent research in neurophysiology and psychology, severalmechanisms potentially involved in NDE are described and discussed in relation to the two main current theoretical approaches that dominate this topic (i.e. “in-brain” and “out-of-brain” approaches). In a more applied perspective, it appears that NDE leads to positive life changes, but also to major disruptions that raise the question of therapeutic care of patients who experienced an NDE. [ABSTRACT FROM AUTHOR]

Cardiopulmonary resuscitation (CPR) must be interrupted for reliable rhythm analysis in current automatic external defibrillators because of artifacts produced by chest compressions. However, interruptions in CPR adversely affect the restoration of spontaneous circulation and survival. Suppressing CPR artifacts by digital signal processing techniques is a promising method to enable rhythm analysis during chest compressions, which would eliminate CPR interruptions for rhythm analysis. Although numerous methods have been developed to suppress CPR artifacts, the accuracy of rhythm analysis is still inadequate due to the residual artifact components in the filtered signal. This study proposes an enhanced adaptive filtering method to suppress CPR artifacts. A total of 183 shockable and 453 nonshockable segments of ECG signal, together with CPR-related reference signal, were extracted from 233 out of hospital cardiac arrest patients. The method was optimized on a training set with 85 shockable and 211 nonshockable segments, and evaluated on a testing set with 98 shockable and 242 nonshockable segments. Compared with artifact corrupted ECG signals, the signal-to-noise ratio (SNR) increased from −9.8 ± 12.5 to 11.2 ± 11.8 dB, and the accuracy was improved from 74.1% to 92.0% after filtering with the proposed method. Compared with the traditional adaptive filter, the SNR was improved by 1.7 dB and the accuracy was improved by 5.6 points. These results indicated that the proposed method could effectively suppress the chest compression related artifacts and improve the accuracy of rhythm analysis during uninterrupted CPR. [ABSTRACT FROM AUTHOR]

Aim: Differentiating between a newly deceased patient and the lifeless patient in whom immediate resuscitation is required may be facilitated by a pre-hospital anaesthesiologist. The purpose of our study was to investigate to what extent and why the pre-hospital anaesthesiologist pronounced life extinct in situations where an emergency medical technician (EMT) would have been required to resuscitate.Methods: All lifeless patients seen pre-hospitally by the anaesthesiologist-manned Mobile Emergency Care Unit in Odense, Denmark, from 2010 to 2014 were retrospectively studied.Results: Of 17 035 contacts, 1275 patients were lifeless without reliable signs of death. In 642 of these patients (3.8%) resuscitation was initiated (median age 68 years). The remaining 633 patients (3.7%) were declared dead at the scene without any resuscitation attempt (median age 77 years). These latter patients would have been attempted resuscitated, had the anaesthesiologist not been present. In 54.5% of cases where documentation was available in the patient records, reasons for not resuscitating these patients included time elapsed from incident to contact with physician, 'overall assessment', chronic disease, or do-not-resuscitate order.Conclusion: In one patient in 30, the MECU refrained from futile resuscitation in cases where legislation required an EMT to initiate resuscitation. This practice reduced unethical attempts of resuscitation, reduced unnecessary emergency ambulance transports, and reduced the work load of the hospital resuscitation teams for one unnecessary alarm every third day. Differentiating between lifeless patients and dead patients not exhibiting reliable signs of death, however, is a complex task which is only sparsely documented. [ABSTRACT FROM AUTHOR]

A broad pattern of correlations between mechanisms of brain function impairment and self-transcendence is shown. The pattern includes such mechanisms as cerebral hypoxia, physiological stress, transcranial magnetic stimulation, trance-induced physiological effects, the action of psychoactive substances and even physical trauma to the brain. In all these cases, subjects report self-transcending experiences often described as 'mystical' and 'awareness-expanding,' as well as self-transcending skills often described as 'savant.' The idea that these correlations could be rather trivially accounted for on the basis of disruptions to inhibitory neural processes is reviewed and shown to be implausible. Instead, this paper suggests that an as-of-yet unrecognized causal principle underlying the entire pattern might be at work, whose further elucidation through systematic research could hold great promise. [ABSTRACT FROM AUTHOR]

Background: Extracorporeal cardiopulmonary resuscitation (E-CPR) is increasingly used as a rescue method in the management of cardiac arrest and provides the opportunity to rapidly induce therapeutic hypothermia. The survival after a cardiac arrest is related to post-arrest cardiac function, and the application of therapeutic hypothermia post-arrest is hypothesized to improve cardiac outcome. The present animal study compares normothermic and hypothermic E-CPR considering resuscitation success, post-arrest left ventricular function and magnitude of myocardial injury.Methods: After a 15-min untreated ventricular fibrillation, the pigs (n = 20) were randomized to either normothermic (38 °C) or hypothermic (32-33 °C) E-CPR. Defibrillation terminated ventricular fibrillation after 5 min of E-CPR, and extracorporeal support continued for 2 h, followed by warming, weaning and a stabilization period. Magnetic resonance imaging and left ventricle pressure measurements were used to assess left ventricular function pre-arrest and 5 h post-arrest. Myocardial injury was estimated by serum concentrations of cardiac TroponinT and Aspartate transaminase (ASAT).Results: E-CPR resuscitated all animals and the hypothermic strategy induced therapeutic hypothermia within minutes without impairment of the resuscitation success rate. All animals suffered a severe global systolic left ventricular dysfunction post-arrest with 50-70% reductions in stroke volume, ejection fraction, wall thickening, strain and mitral annular plane systolic excursion. Serum concentrations of cardiac TroponinT and ASAT increased considerably post-arrest. No significant differences were found between the two groups.Conclusions: Two-hour therapeutic hypothermia during E-CPR offers an equal resuscitation success rate, but does not preserve the post-arrest cardiac function nor reduce the magnitude of myocardial injury, compared to normothermic E-CPR. Trial registration FOTS 4611/13 registered 25 October 2012. [ABSTRACT FROM AUTHOR]

Aim: To provide therapeutic hypothermia (TH) to survivors after out-of-hospital cardiac arrest (OHCA), inter-hospital transfers (IHT) are frequently required. The safety of IHT remains controversial. The aim of this study was to investigate whether the effect of TH on brain recovery after OHCA differs between IHT and direct arrival groups.Methods: We identified patients with OHCA of presumed cardiac aetiology who were resuscitated by emergency medical services and experienced return-of-spontaneous circulation in 27 hospitals between January and December 2014. The main exposure variables were TH and IHT. The primary endpoint was discharge with good neurological recovery. We compared outcomes between the TH and non-TH groups using multivariable logistic regression with an interaction term between TH and IHT, after adjusting for potential confounders.Results: Among 1616 patients, 576 patients were included in the final analyses. Neurologic recovery was better in the TH group (46.2%) than in the non-TH group (20.1%) (adjusted odds ratio [aOR] 2.03 [95% confidence interval (CI) 1.24-3.33]). In the interaction model for the outcome of good neurological recovery, the aOR for TH was 2.82 (95% CI 1.59-5.01) in the direct transfer group vs. 0.76 (95% CI 0.29-2.01) in the IHT group. The measure of interaction on the multiplicative scale in this model was also statistically significant (OR 0.27 [95% CI 0.07-0.83]; p=0.02).Conclusion: IHT modified the effect of TH on neurological recovery for survivors of OHCA. TH is significantly less beneficial for good neurological recovery in patients who arrive via IHT than for those who arrive directly. [ABSTRACT FROM AUTHOR]

The article reflects on dynamic measures to guide fluid resuscitation. Topics discussed include potential methods to deliver volume resuscitation, method to assess need for fluid resuscitation, and limitations about widespread use of dynamic measures to assess responsiveness to volume. Also being discussed are biologically plausible surrogate outcomes measures in critical illness not associated with improved mortality.

In 1891 the Italian psychiatrist Enrico Morselli (1852–1929) described taphophobia, defining it as an extreme condition of claustrophobia due to the fear of being buried alive. This rare psychopathological phenomenon reflects an ancient fear, and its origin is not known. Taphophobia is closely linked to the problem of apparent death and premature burial. In the nineteenth century, scientists and authors paid particular attention to the issue of apparent death, and special devices (safety coffins) were invented to ensure that premature burial was avoided. Nowadays taphophobia is quite a rare psychiatric disorder; different forms of social anxiety disorders are much more widespread. Its modern equivalent could be the fear of organs harvested from a patient who is still alive. [ABSTRACT FROM AUTHOR]

In the post-nuclear deal scenario, Iran has reformulated the terms of the oil contract model, called the Iran Petroleum Contract (IPC), to attract international investments and technology in field development. In addition, it has ramped up production and competitively priced its oil to Asia and Europe so as to recapture the market share lost during the sanctions period. Any further enhancement of production capacity, however, requires expansion of green fields and resuscitation of brown fields under the IPC. The success of this effort will depend upon Iran's domestic political stability as much as the international environment, where sanctions are held in abeyance and oil prices continue to rise to a level that unlocks the investment capital of the big oil companies. Nonetheless, in a scenario of increasing global commitment to adopt green energy, whether oil companies would still want to make long-term investments in large hydrocarbon projects in general, remains an open question. [ABSTRACT FROM AUTHOR]

When can a man be declared ‘really dead’? Being able to determine whether an individual’s life has ended or not implies two important considerations, whether we can resuscitate him and avoid premature burial, the fear of which is termed ‘taphophobia’. By the end of the 18th century, several scientists were involved in the study of apparent death and resuscitation. Pietro Manni was an obstetrician who, affected by his brother’s death and his inability to help him, devoted himself to the study of apparent death, which became his aim in life. His Practical handbook for the care of the apparently dead is a detailed essay on resuscitation with a precise arrangement of topics – ventilation, tracheostomy, electricity and asphyxia in newborns – organised into chapters and paragraphs that resemble current texts on resuscitation. [ABSTRACT FROM AUTHOR]

Introduction: Fall from height leads to many serious and fatal injuries every year. This study was conducted to identify the pattern of injuries after a fall from height. Materials and Method: 73 victims were considered into the study based on the suspicious deaths with an allegation of fall from height. Post mortem report, first information report, inquest report, any attempts at resuscitation, chemical reports and other forensic reports wer taken into consideration in the study. Results: Out of the 73 cases studies, 59(80.8%) were males and 14 (19.2%) were females. The most common age group was 21-30 years followed by 31-40 years. Of the victims, most common profession was construction workers with 37 victims followed by 11 toddy collectors. Head injury was the most common site of primary impact followed by fall to side of the body. The most common bone to be injured was the skull as that was the primary contact area in most of the cases followed by rib and vertebrae. Conclusion: Fall from height can be prevented by taking proper measures and care as most of the accidents are caused due to negligence and inexperience during work. [ABSTRACT FROM AUTHOR]

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Aim: Neonatal infections carry a heavy burden of morbidity and mortality. Poor practice can result in unintentional colonisation of medical equipment with potentially pathogenic organisms. This study will determine the prevalence and type of bacterial contamination on exposed neonatal resuscitation equipment in different clinical settings and explore simple measures to reduce contamination risk.Methods: A survey determined the rates of resuscitation equipment usage. All environmentally exposed items were identified on resuscitaires hospital-wide and swabbed for bacterial contamination. A new cleaning and storage policy was implemented and the prevalence of environmentally exposed equipment re-measured post-intervention.Results: Resuscitation equipment was used in 28% of neonatal deliveries. Bacterial colony forming units were present on 44% of the 236 exposed equipment pieces swabbed. There was no significant difference in contamination rates between equipment types. Coagulase negative staphylococcus was the most prevalent species (59 pieces, 25%) followed by Escherichia coli and Enterobacter cloacae (20 pieces, 9% each). Opened items stored inside plastic remained sterile, whilst those in low-use areas had significantly less contamination than those in high-use areas (22% vs. 51%, P < 0.05). Implementing a simple educational programme led to a significant reduction in environmentally exposed equipment (79% reduction, P < 0.01).Conclusions: Pathogenic bacteria can colonise commonly used pieces of neonatal resuscitation equipment. Whilst the clinical significance remains uncertain, equipment should be kept packaged until required and discarded once open, even if unused. Standardising cleaning policies results in rapid and significant improvements in equipment storage conditions, reducing microbial colonisation opportunities. [ABSTRACT FROM AUTHOR]

According to pioneering German chemist Karl von Reichenbach, the odic force is an invisible spiritual energy that is responsible for all life. Spirit messages received by Johannes Greber, a German Catholic priest, nearly a century after Reichenbach's research, appear to validate his research and give further meaning to it. Where there is life, there is spirit. And where there is spirit, there is the odic force. This force manifests itself in three ways: 1) condensed od, or ectoplasm, 2) odic vibrations, which make possible our thoughts and sensations, and 3) the odic field, which records our every thought, word and deed. This article focuses on the odic field and its indispensable role in psychic crime solving, psychometry and the life review aspect of the near-death experience. [ABSTRACT FROM AUTHOR]

Background: Implications from the pragmatic, randomize, optimal platelet and plasma ratios (PROPPR) trial are critical for remote damage control resuscitation (DCR). Utilizing DCR principals in remote settings can combat early mortality from hemorrhage. Identifying the appropriate transfusion strategy is mandatory prior to adopting prehospital hemostatic resuscitation strategies.Study Design and Methods: The PROPPR study was examined in relation to the following questions: 1) Why is it important to have blood products in the prehospital setting?; 2) Which products should be investigated for prehospital hemostatic resuscitation?; 3) What is the appropriate ratio of blood product transfusion?; and 4) What are the appropriate indications for hemostatic resuscitation?Results: PROPPR demonstrates that early and balanced blood product transfusion ratios reduced mortality in all patients at 3 hours and death from exsanguination at 24 hours (p = 0.03). The median time to death from exsanguination was 2.3 hours, highlighting the need for point-of-injury DCR capabilities. A 1:1:1 transfusion ratio of plasma:platelets:packed red blood cells increased the percentage of patients achieving anatomic hemostasis (p = 0.006). PROPPR used the assessment of blood consumption score to identify patients likely to require ongoing hemostatic resuscitation. The critical administration threshold predicted patient mortality and identified patients likely to require ongoing hemostatic resuscitation.Conclusion: A balanced resuscitation strategy demonstrates an early survival benefit, decreased death from exsanguination at 24 hours and a greater likelihood of achieving hemostasis in critically injured patients receiving a 1:1:1 ratio of plasma:platelets:PRBCs. This finding highlights the need to import DCR principals to remote locations. [ABSTRACT FROM AUTHOR]

Objectives: To characterize intensivist handoff practices and expectations and to explore perceptions of the patient safety implications of attending handoffs.Design: Cross-sectional electronic survey administered in 2014.Setting: One hundred sixty-nine U.S. hospitals with critical care training programs accredited by the Accreditation Council for Graduate Medical Education.Subjects: Academic intensivists were recruited via e-mail invitation from a database of 1,712 eligible academic intensivists.Interventions: None.Measurements and Main Results: Six hundred sixty-one intensivists completed the survey (completion rate, 38.6%). Responses were received from at least one individual at 147 of 169 unique hospitals (87.0%) represented in the study database. Five hundred seventy-three (87%) respondents reported participating in handoffs at the end of each ICU rotation. A variety of communication methods were used for end-of-rotation handoffs, including in-person discussion (92.9%), telephone calls (83.9%), e-mail messages (69.0%), computer-generated documents (64.6%), and text messages (23.6%). Mean satisfaction with current handoff process was rated as 68.4 on a scale from 0 to 100 (SD, 22.6). Respondents (55.4%) said that attending handoffs should be standardized, but only 13.3% (76/572) of those participating in end-of-rotation handoffs reported using a standardized process. Specific handoff topics, including active clinical issues and resuscitation status, were reportedly discussed less frequently than would be ideal (p < 0.001 for the difference between reported frequency and ideal frequency). In free-text comments, 76 respondents (11.5%) expressed skepticism that attending handoffs were necessary given the presence of residents and fellows and given a lack of agreement about necessary content. Two hundred respondents (30.8%) reported knowing of an adverse event (inappropriate treatment, cardiac arrest, and death) attributable to inadequate attending handoffs.Conclusions: ICU attending handoffs in the United States exhibit marked heterogeneity, and intensivists do not agree about the value of attending handoffs. In addition, some intensivists perceive a link between suboptimal attending handoffs, inappropriate treatment, and serious adverse events that warrants further study. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to assess whether there was a significant difference in the complications of cardiopulmonary resuscitation (CPR) between out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA) survivors using multidetector computed tomography (MDCT). Subjects and Methods: We performed a retrospective analysis of prospective registry data. We enrolled both OHCA and IHCA patients who underwent successful CPR. We classified chest injuries secondary to chest compression into rib fractures, sternum fractures, and uncommon complications such as lung contusions and extrathoracic complications. We compared these complications according to CPR locations. We also analysed risk factors for CPR complications using multiple regression analysis and classification and regression tree analysis. Results: During the study period, a total of 148 patients were included in the primary analysis. Rib fractures were detected more in OHCA survivors than in IHCA survivors (74 patients (83.2%) vs. 37 patients (62.7%), p=0.05), and frequency of multiple rib fractures was higher in OHCA survivors than IHCA survivors (69 patients (77.5%) vs. 34 patients (57.6%), p=0.01). Although other complications were not significantly different between the groups, there was a trend for OHCA survivors to sustain more serious and direct high-energy related complications. Older age, longer CPR, and OHCA were significantly associated with incidence of rib fractures, multiple rib fractures, and number of rib fractures. Conclusions: Rib fractures were more likely to occur in OHCA survivors, and serious complications tended to occur more often in OHCA compared to IHCA survivors. [ABSTRACT FROM AUTHOR]

Research inspired by terror management theory has established that being reminded of the inevitability of death (i.e., 'mortality salience') leads people to express more negative attitudes toward out-groups. We examined the hypothesis that being affiliated with a religion may buffer individuals against this negative impact of mortality salience. Two studies, conducted in two cultures that differ in their emphasis on religiosity (the United Kingdom and Italy), supported this hypothesis. Specifically, we found that mortality salience resulted in more negative out-group attitudes only among participants not affiliated with any religion. Further, this buffering effect of religious affiliation was not moderated by participants' specific religious orientations or by their levels of social dominance orientation. In addition, the buffering effect did not hold when prejudice against the target out-group was not proscribed by religious authorities. Implications for research on religion, prejudice, and terror management are discussed. [ABSTRACT FROM AUTHOR]

Near-death experiences (NDEs) are vivid experiences that often occur in life-threatening conditions, usually characterized by a transcendent tone and clear perceptions of leaving the body and being in a different spatiotemporal dimension. Such experiences have been reported throughout history in diverse cultures, and are reported today by 10% to 20% of people who have come close to death. Although cultural expectations and parameters of the brush with death influence the content of some NDEs, near-death phenomenology is invariant across cultures. That invariance may reflect universal psychological defenses, neurophysiological processes, or actual experience of a transcendent or mystical domain. Research into these alternative explanations has been hampered by the unpredictable occurrence of NDEs. Regardless of the causes or interpretations of NDEs, however, they are consistently associated with profound and long-lasting aftereffects on experiencers, and may have important implications for non-experiencers as well. [ABSTRACT FROM AUTHOR]

Medical emergency when occurs in a dental environment should be handled efficiently and effectively in order to sustain life until medical help arrives. This study aimed to enhance knowledge amongst dental practitioners about the possible risks of a medical emergency to improve patient care. A questionnaire based study was conducted in the dental teaching hospitals of the twin cities, Rawalpindi and Islamabad in 2015. The questionnaire comprised of three sections to assess dentists' perception and dentists' knowledge on the commonly faced medical emergencies along with dentists' confidence in performing Basic Life Support (BLS). 215 questionnaires were distributed out of which 192 were returned. The study sample included 122 female and 70 male dentists with a minimum clinical experience of one year. The results showed 71.4% received a formal BLS training while 84.4% wanted to receive the training. Moreover, the mean medical emergency score obtained was 5.28 out of a maximum of 10. 55.2% of the dental practitioners felt confident in performing Cardio Pulmonary Resuscitation (CPR), out of which, 80.5 % had the correct knowledge of performing a CPR according to this study. The most significant finding was almost half of the dentists lack the knowledge and necessary training. Hence, in order to improve quality of patient care annual BLS courses should be made mandatory. [ABSTRACT FROM AUTHOR]

This article addresses the two related issues of near-death experience and life-threatening illness with a view to helping survivors and helping professionals appreciate how to make sense of the experience whilst considering future living and future service provision. The article is based on two related research studies, citing literature from different disciplines of nursing, women's health, spirituality and near death. This research was undertaken in the light of these experiences affecting so many aspects of life and living. The need to "dialogue with death" (Easwaran, 2008: Foreword) and life-threatening illness is the key message as opposed to shunning what is not readily understood and appreciated. [ABSTRACT FROM AUTHOR]

The author presents tips to physicians on how to diagnose the exact time of the death of a patient or a person. Topics discussed include the question of exactly when a person is actually dead, premature burial and resuscitation. Other topics include legislation defining death, physical signs of death, and diagnosing death after at least two minutes of electrical asystole or mechanical asystole is confirmed.

The first specific techniques and triages for medical resuscitation developed in the XVIII century, specifically to rescue the drowned persons. The topic of resuscitation in strictly connected to the theme of the apparent death, to the dread of the "buried alive", to the progress of forensic medicine and to the administrative and legislative policies. The contribute aims to focus on the contribution of the medical and pathologic nosology about the conception of the apparent death, read as asphyxia. [ABSTRACT FROM AUTHOR]

In talking with near-death experiencers (NDErs), we had encountered cases of what we called spontaneous mediumship experiences (SMEs) in which the NDEr experienced an uninvited visit by a deceased person who asked the NDEr to convey a message to another living person. We were unable to find reference to this phenomenon in the existing NDE literature. In this article, we present a brief case study and results of an exploratory quantitative study of SMEs among NDErs. We created a 38-item online survey and recruited adult participants primarily through the International Association for Near-Death Studies' approximately 45 local U.S. groups. The 89 participants were predominantly female White non-Latina/o. Whereas 15% of participants reported at least one SME prior to their first or only NDE, 56% reported at least one following it. Participants reporting deeper NDEs were significantly more likely to report at least one post-NDE SME, with a medium effect. Number of reported post-NDE SMEs ranged from 1 to over 20. Of those who reported degree of distress related to their SMEs, only 4% indicated very or extremely distressful. Of participants who responded, 28% reported having sought help with their SMEs, 62% reported they had found at least one helpful coping strategy, and the most frequent source of helpful coping strategies was reportedly personal experience. We discuss implications of these findings for healthcare providers working with NDErs and for consciousness researchers. Based on our results, further research, both quantitative and qualitative, seems warranted regarding this apparently heretofore uninvestigated NDE aftereffect. [ABSTRACT FROM AUTHOR]