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Human prenatal skin is populated by innate immune cells, including macrophages, but whether they act solely in immunity or have additional functions in morphogenesis is unclear. Here we assembled a comprehensive multi-omics reference atlas of prenatal human skin (7-17 post-conception weeks), combining single-cell and spatial transcriptomics data, to characterize the microanatomical tissue niches of the skin. This atlas revealed that crosstalk between non-immune and immune cells underpins the formation of hair follicles, is implicated in scarless wound healing and is crucial for skin angiogenesis. We systematically compared a hair-bearing skin organoid (SkO) model derived from human embryonic stem cells and induced pluripotent stem cells to prenatal and adult skin 1 . The SkO model closely recapitulated in vivo skin epidermal and dermal cell types during hair follicle development and expression of genes implicated in the pathogenesis of genetic hair and skin disorders. However, the SkO model lacked immune cells and had markedly reduced endothelial cell heterogeneity and quantity. Our in vivo prenatal skin cell atlas indicated that macrophages and macrophage-derived growth factors have a role in driving endothelial development. Indeed, vascular network remodelling was enhanced following transfer of autologous macrophages derived from induced pluripotent stem cells into SkO cultures. Innate immune cells are therefore key players in skin morphogenesis beyond their conventional role in immunity, a function they achieve through crosstalk with non-immune cells., Competing Interests: Competing interests: J.L. and K.R.K., with the Indiana University Research and Technology Corporation, have a patent relating to the methodology and composition of SkOs (PCT/US2016/058174). K.R.K. is a consultant for StemCell Technologies. All other authors declare no competing interests., (© 2024. The Author(s).)

This is the eighth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations; a more comprehensive review was done in 2020. This latest summary addresses the most recent published resuscitation evidence reviewed by the International Liaison Committee on Resuscitation task force science experts. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the quality of the evidence, using Grading of Recommendations Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections. In addition, the task forces list priority knowledge gaps for further research., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

A key step in platelet production is the migration of megakaryocytes to the vascular sinusoids within the bone marrow. This homing is mediated by the chemokine CXCL12 and its receptor CXCR4. CXCR4 is also a positive regulator of platelet activation and thrombosis. Pim-1 kinase has been shown to regulate CXCR4 signalling in other cell types, and we have previously described how Pim kinase inhibitors attenuate platelet aggregation to CXCL12. However, the mechanism by which Pim-1 regulates CXCR4 signalling in platelets and megakaryocytes has yet to be elucidated. Using human platelets, murine bone marrow-derived megakaryocytes, and the megakaryocyte cell line MEG-01, we demonstrate that pharmacological Pim kinase inhibition leads to reduced megakaryocyte and platelet function responses to CXCL12, including reduced megakaryocyte migration and platelet granule secretion. Attenuation of CXCL12 signalling was found to be attributed to the reduced surface expression of CXCR4. The decrease in CXCR4 surface levels was found to be mediated by rapid receptor internalisation, in the absence of agonist stimulation. We demonstrate that pharmacological Pim kinase inhibition disrupts megakaryocyte and platelet function by reducing constitutive CXCR4 surface expression, decreasing the number of receptors available for agonist stimulation and signalling. These findings have implications for the development and use of Pim kinase inhibitors for the treatment of conditions associated with elevated circulating levels of CXCL12/SDF1α and increased thrombotic risk.

Objective: A lack of access to psychiatric services for adult ADHD is a recognised issue in South Australia and nationally. This study aims to explore the practices of local psychiatrists and their attitudes towards adult ADHD, with a view to determining any barriers influencing accessibility to treatment., Methods: We developed an online survey to examine the aims of the study. Free text boxes were included to obtain qualitative data. Quantitative data were tallied and presented as percentages. Qualitative data (free text responses) were analysed thematically., Results: 73 out of 322 psychiatrists responded (22.7%). The greatest barrier to seeing adult ADHD was the fear of being inundated with cases (68.5%), followed by lack of experience managing ADHD (32.9%), and potential drug-seeking behaviour of patients (31.5%). Two overarching qualitative themes were identified: practical barriers and attitudinal barriers., Conclusion: ADHD service provision is complex and relates to many systemic factors such as public versus private, funding, and service organisation. More psychiatrists need to become involved in treating ADHD so that the work is more widely spread. Increased training in ADHD is also needed to increase confidence in managing the condition., Competing Interests: DisclosureThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Standardized reporting of data is crucial for out-of-hospital cardiac arrest (OHCA) research. While the implementation of first responder systems dispatching volunteers to OHCA is encouraged, there is currently no uniform reporting standard for describing these systems. A steering committee established a literature search to identify experts in smartphone alerting systems. These international experts were invited to a conference held in Hinterzarten, Germany, with 40 researchers from 13 countries in attendance. Prior to the conference, participants submitted proposals for parameters to be included in the reporting standard. The conference comprised five workshops covering different aspects of smartphone alerting systems. Proposed parameters were discussed, clarified, and consensus was achieved using the Nominal Group Technique. Participants voted in a modified Delphi approach on including each category as a core or supplementary element in the reporting standard. Results were presented, and a writing group developed definitions for all categories and items, which were sent to participants for revision and final voting using LimeSurvey web-based software. The resulting reporting standard consists of 68 core items and 21 supplementary items grouped into five topics (first responder system, first responder network, technology/algorithm/strategies, reporting data, and automated external defibrillators (AED)). This proposed reporting standard generated by an expert opinion group fills the gap in describing first responder systems. Its adoption in future research will facilitate comparison of systems and research outcomes, enhancing the transfer of scientific findings to clinical practice., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: ‘MPM is chair of Region of Lifesavers, shareholder of SmartResQ ApS, and received speaker honoraria from Stryker. RG is Board Director of Guidelines, European Resuscitation Council, and chair of the Task Force Education, Implementation and Teams, International Liaison Committee on Resuscitation. TS is member of the editorial board, Resuscitation and Resuscitation Plus, member of the science and education committee BLS of the ERC, and member of the ILCOR social media working group. CDD is member of the editorial board of the journal Resuscitation, treasurer of the UK Resuscitation Council and ALS working group member of ILCOR. AA is a consultant with Boston Scientific, Backbeat, Biosense Webster, Cairdac, Corvia, Daiichi-Sankyo, Medtronic, Merit, Microport CRM, and Philips; received speaker fees from Daiichi-Sankyo, Boston Scientific, Biosense Webster, Medtronic, Microport CRM, and Philips; participates in clinical trials sponsored by Boston Scientific, Medtronic, Microport CRM, and Zoll Medical; and has intellectual properties assigned to Boston Scientific, Biosense Webster, and Microport CRM. TB has research, clinical and educational roles in resuscitation care, including in first responder systems. He is a member of the Pre-Hospital Emergency Care Council (Ireland). EB is working group member in ESCAPE-NET and PARQ COST action. BB is treasurer of the European Resuscitation Council (ERC), Chairman of the German Resuscitation Council (GRC), Member of the Advanced Life Support (ALS) Task Force of the International Liaison Committee on Resuscitation (ILCOR), Member of the Executive Committee of the German Interdisciplinary Association for Intensive Care and Emergency Medicine (DIVI), Founder of the “Deutsche Stiftung Wiederbelebung”, Federal Medical Advisor of the German Red Cross (DRK), Co-Editor of “Resuscitation”, Editor of the Journal “Notfall + Rettungsmedizin”, Co-Editor of the Brazilian Journal of Anesthesiology. He received fees for lectures from the following companies: Forum für medizinische Fortbildung (FomF), Baxalta Deutschland GmbH, ZOLL Medical Deutschland GmbH, C.R. Bard GmbH, GS Elektromedizinische Geräte G. Stemple GmbH, Novartis Pharma GmbH, Philips GmbH Market DACH, Bioscience Valuation BSV GmbH. HJB is member of the executive committee of the German Resuscitation Council and vice chair of Region of Lifesavers. SC is member of the editorial board of the journal Resuscitation, member of the advisory board drone delivery Canada and received speaker honoraria from Zoll Medical. ED is shareholder of EVapp VZW, Belgium. DF is co-founder and operations manager of the Heartrunner Citizen Responder System, Sweden and member of the tech&ops committee of EENA (European Emergency Number Association). FLH is shareholder of FirstAED ApS, Denmark. MJ is a working group leader in the EU-funded network PARQ-COST, focusing on cardiac arrest research. JJ is CEO of the non-profit organisation Region der Lebensretter e.V. TAK is employed at Stan B.V. running the national citizen responder network HartSlagNu in the Netherlands. MK is chief medical director, Vienna Emergency Medical Service, and executive president PULS – Austrian Cardiac Arrest Association. KM is member of the editorial board of the journal Resuscitation. SO is employed at the German Red Cross and is board member of the GRC. DDS provided unpaid scientific consulting to CPRSave, a company developing a novel SAS system, and his department received a small grant from the PulsePoint Foundation to increase SAS participation in Allegheny County, PA, US. AS is vice president of the Italian Resuscitation Council (IRC). JSchwietring is chief medical director, ADAC (air rescue) LRG gGmbH. FS is chair elect, European Resuscitation Council and chair, ILCOR Social Media Working Group. PS is chair of the medical committee, Ontario Para & Summer Games and board member, Peel Paramedic Association. HLT is co-founder of PacingCure. He has received funding from the European Union's Horizon 2020 research and innovation programme under acronym ESCAPE-NET, registered under grant agreement No 733381, and the COST Action PARQ (grant agreement No CA19137) supported by COST (European Cooperation in Science and Technology). GT is employed at Resuscitec GmbH, shareholder of Resuscitec GmbH, and board member of the GRC and Region der Lebensretter. JGanter is board member of Region of Lifesavers. SV is president of EVapp NGO, and shareholder Prior-IT BV. CM, KCT, RB, MLC, RC, DD, MME, DE, MCTG, JGronewald, MH, LH, TM, KM, WMN, JSowa, RS, JU, WAW have no conflicts of interest.’., (Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.)

Objectives: To evaluate oxygen saturation and vital signs measured in the community by emergency medical services (EMS) as clinical markers of COVID-19-positive patient deterioration., Design: A retrospective data analysis., Setting: Patients were conveyed by EMS to two hospitals in Hampshire, UK, between 1 March 2020 and 31 July 2020., Participants: A total of 1080 patients aged ≥18 years with a COVID-19 diagnosis were conveyed by EMS to the hospital., Primary and Secondary Outcome Measures: The primary study outcome was admission to the intensive care unit (ICU) within 30 days of conveyance, with a secondary outcome representing mortality within 30 days of conveyance. Receiver operating characteristic (ROC) analysis was performed to evaluate, in a retrospective fashion, the efficacy of different variables in predicting patient outcomes., Results: Vital signs measured by EMS staff at the first point of contact in the community correlated with patient 30-day ICU admission and mortality. Oxygen saturation was comparably predictive of 30-day ICU admission (area under ROC (AUROC) 0.753; 95% CI 0.668 to 0.826) to the National Early Warning Score 2 (AUROC 0.731; 95% CI 0.655 to 0.800), followed by temperature (AUROC 0.720; 95% CI 0.640 to 0.793) and respiration rate (AUROC 0.672; 95% CI 0.586 to 0.756)., Conclusions: Initial oxygen saturation measurements (on air) for confirmed COVID-19 patients conveyed by EMS correlated with short-term patient outcomes, demonstrating an AUROC of 0.753 (95% CI 0.668 to 0.826) in predicting 30-day ICU admission. We found that the threshold of 93% oxygen saturation is prognostic of adverse events and of value for clinician decision-making with sensitivity (74.2% CI 0.642 to 0.840) and specificity (70.6% CI 0.678 to 0.734)., Competing Interests: Competing interests: MI-K is the National Clinical Lead Deterioration and National Specialist Advisor Sepsis, NHS England and NHS Improvement., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)