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The potential use of cannabidiol (CBD) as a nutraceutical to support improved health and welfare has been of increasing interest. In particular, CBD has been shown to decrease anxiety in humans and small animals. While there is little research published on the effects of CBD supplementation in horses, its use is increasing rapidly. The objective of this study was to determine the effect of feeding a pelleted CBD supplement on equine reactivity and heart rate (HR). Seventeen stock-type geldings were divided into control (CON) or treatment (TRT) groups. The TRT group received 100 mg of CBD once daily. Control horses were maintained on their standard diet without supplementation. A novel object test was used to evaluate changes in HR and reactivity before and after 6 weeks of supplementation. Heart rate was recorded before, at, and after exposure to the novel object. Reactivity when the horse was exposed to the novel object was scored live and through video review. There was no difference in starting, stimulus, or final HR, but TRT horses exhibited less reactivity after 6 weeks of supplementation. Results suggest that CBD supplementation may lower reactivity in horses. [ABSTRACT FROM AUTHOR]

Supportive relationships between children and teachers contribute to children's academic success and social-emotional development (e.g., self-efficacy). However, it is unclear how changes in these relationships might translate to changes in educational expectations. In this study, we used data from the National Longitudinal Study of Adolescent to Adult Health (Add Health; N = 20,745) to test how changes in relationship closeness relate to children's expectations for their future educational achievement, as well as how this association differs based on parental expectations, socioeconomic status, and academic aptitude. Cross-lagged regression models indicated that changes in teacher-child closeness positively relate to changes in child educational expectations; multi-group analyses reflect that this association is strongest for children whose parents hold low expectations and for those with lower levels of academic aptitude. We discuss implications for promoting positive academic and social-emotional development within school settings. • Teacher-child relationships relate to student educational expectations. • Improving these relationships can improve expectations for under-resourced students. • Interventions targeting relationship quality can promote positive child development [ABSTRACT FROM AUTHOR]

Parasite resistance to some commonly used anthelmintics is increasing and egg reappearance period (ERP) appears to be decreasing. The objective of this project was to evaluate the efficacy of ivermectin (IVE) and moxidectin (MOX) on fecal egg counts (FECs) and ERP in horses. Fecal samples (n = 46) were collected and evaluated for parasite eggs using the Modified McMaster Fecal Egg Count technique. Eggs per gram (EPG) of feces were recorded. Horses were randomly allocated based on prestudy FEC (low, <200 EPG; moderate, 200–500 EPG; high, >500 EPG), age (young, ≤15 years; old, ≥16 years), and housing (stall or pasture). Treatments included control (CON, no treatment, n = 10), IVE (n = 10), or MOX (n = 10). Fecal samples were collected and evaluated every 2 weeks for 12 weeks after treatment. Statistical analysis was performed using PROC MIXED of SAS. Fixed effects included treatment, age, and location with week as a repeated measure. Fecal egg count reduction tests were 100% for IVE and MOX, indicating that both anthelmintics were effective. However, parasite eggs began to appear in IVE horses in week 6 and MOX horses in week 8. Currently reported ERP for IVE and MOX are 6 to 8 weeks and 10 to 12 weeks, respectively, suggesting decreased efficacy of MOX. In pastured horses, MOX was more effective in reducing FEC than IVE (1.84 vs. 6.43 EPG, respectively; P = .01). Data suggest that anthelmintic use improved internal parasite control and that MOX may have greater efficacy than IVE; however, the shorter ERP for MOX may indicate that MOX efficacy may be decreasing. [ABSTRACT FROM AUTHOR]

The Veterans Health Affairs Office of Academic Affiliations (OAA) has invested in the creation of academic-practice partnerships to transform the care of veterans and their families. This article details how a long-standing relationship between the University of Alabama at Birmingham School of Nursing and the Birmingham Veterans Affairs Medical Center grew into such a partnership. The three programs that now exist within the Birmingham Veterans Affairs Nursing Academic Partnership (VANAP) umbrella are described, including an undergraduate VA nurse scholars program that has sustained beyond OAA funding, a VANAP graduate education program for psychiatric mental health nurse practitioners (NPs), and a Mental Health NP Residency. Key features of the programs are noted as are outcomes and lessons learned for building mutual goals and a sustainable academic-practice partnership. With the recent passage of the Veterans Choice Program, the importance of educating all nurses about veterans and veterans' health is stressed. [ABSTRACT FROM AUTHOR]

Anaemia is common in the ICU patient and is usually due to the interplay between many different factors. Although often this can be safely managed conservatively, red cell transfusion is commonly required. Patients who refuse blood products and patients with critical bleeding pose a particular management challenge. Coagulopathy is also frequently encountered in ICU. It is critical to evaluate the causes and bleeding risk in such patients, as this will determine the subsequent management. In the stable patient it is often not necessary to correct the coagulopathy. Heparin resistance is failure to reach therapeutic targets using heparin as measured by commonly used laboratory tests. It is influenced by a number of factors relating to the nature of heparin and its mode of action and may result in failure to achieve intended clinical outcomes. Heparin-induced thrombocytopenia (HIT) is an immune-mediated syndrome caused by heparin-dependent antibodies leading to platelet activation and subsequent thrombocytopenia. Awareness and prompt treatment are essential to prevent morbidity and mortality resulting from the development of thrombosis, which can occur in half of patients with HIT. [ABSTRACT FROM AUTHOR]

Much of the recent work in transfusion practice has shifted to focus on the patient, after efforts over previous decades to ensure the quality and safety of blood products. After the commencement of hemovigilance and transfusion practice improvement programs, the introduction of transfusion practitioners (TP) into health care services and blood centers has continued to increase worldwide. Since this relatively new role was introduced, much work of the TP has focused on patient and staff education, adverse events, transfusion governance, and monitoring of transfusion practices within organizations. The complex nature of the transfusion process makes the TP an integral link in the transfusion chain. Together with hospital transfusion teams and committees, the TP works collaboratively to facilitate the transfusion change management programs and initiatives. Recently, the TP role has evolved to include an emphasis on patient blood management and, to some extent, is shaped by national standards and regulations. These established roles of the TP, together with the ever-changing field of transfusion medicine, provide new opportunities and challenges for a role that is continuing to evolve worldwide. [ABSTRACT FROM AUTHOR]

The use of extracorporeal membrane oxygenation (ECMO) support for cardiac and respiratory failure has increased in recent years. Improvements in ECMO oxygenator and pump technologies have aided this increase in utilization. Additionally, reports of successful outcomes in supporting patients with respiratory failure during the 2009 H1N1 pandemic and reports of ECMO during cardiopulmonary resuscitation have led to increased uptake of ECMO. Patients requiring ECMO are a heterogenous group of critically ill patients with cardiac and respiratory failure. Bleeding and thrombotic complications remain a leading cause of morbidity and mortality in patients on ECMO. In this review, we describe the mechanisms and management of hemostatic, thrombotic and hemolytic complications during ECMO support. [ABSTRACT FROM AUTHOR]

Background: The importance of antibody-mediated rejection (AMR) following lung transplantation remains contentious. In particular, the diagnostic criteria suggested to define AMR, namely the presence of donor-specific antibodies (DSA), C4d immunoreactivity, histological features and allograft dysfunction are not always readily applicable or confirmatory in lung transplantation. Methods: In a retrospective single-center study of 255 lung transplant recipients (LTR), we identified 9 patients in whom a clinical diagnosis of AMR was made within 12 months of transplant, and define the immunological, histological, clinical features, as well as the therapeutic response of this cohort. Results: Nine LTR with AMR underwent combination therapy with high-dose intravenous corticosteroid, intravenous immunoglobulin, plasmapheresis and rituximab. Following therapy, while the total number of the original DSA dropped by 17%, and the median value of the mean fluorescence intensity (mfi) of the originally observed DSA decreased from 5292 (IQR 1319-12,754) to 2409 (IQR 9 2 0 - 6 8 2 5 ) (p < 0.001 ), clinical outcomes were variable with a number of patients progressing to either chronic lung allograft dysfunction or death within 12 month. Conclusion: AMR in lung transplantation remains both a diagnostic and therapeutic challenge, but when clinically suspected is associated with a variable response to therapy and poor long-term outcomes. [ABSTRACT FROM AUTHOR]

Summary: During an infection the antigen-nonspecific memory CD8 T cell compartment is not simply an inert pool of cells, but becomes activated and cytotoxic. It is unknown how these cells contribute to the clearance of an infection. We measured the strength of T cell receptor (TCR) signals that bystander-activated, cytotoxic CD8 T cells (BA-CTLs) receive in vivo and found evidence of limited TCR signaling. Given this marginal contribution of the TCR, we asked how BA-CTLs identify infected target cells. We show that target cells express NKG2D ligands following bacterial infection and demonstrate that BA-CTLs directly eliminate these target cells in an innate-like, NKG2D-dependent manner. Selective inhibition of BA-CTL-mediated killing led to a significant defect in pathogen clearance. Together, these data suggest an innate role for memory CD8 T cells in the early immune response before the onset of a de novo generated, antigen-specific CD8 T cell response. [ABSTRACT FROM AUTHOR]

Abstract: Anaemia is common in the intensive care unit (ICU) patient and is usually due to the interplay between many different factors. Although often this can be safely managed conservatively, red cell transfusion is commonly required. Patients who refuse blood products and patients with critical bleeding pose a particular management challenge. Coagulopathy is also frequently encountered in ICU. It is critical to evaluate the causes and bleeding risk in such patients, as this will determine the subsequent management. In the stable patient it is often not necessary to correct the coagulopathy. Heparin resistance is failure to reach therapeutic targets using heparin as measured by commonly used laboratory tests. It is influenced by a number of factors relating to the nature of heparin and its mode of action and may result in failure to achieve intended clinical outcomes. Heparin-induced thrombocytopenia (HIT) is an immune-mediated syndrome caused by heparin-dependent antibodies leading to platelet activation and subsequent thrombocytopenia. Awareness and prompt treatment are essential to prevent morbidity and mortality resulting from the development of thrombosis, which can occur in half of patients with HIT. [Copyright &y& Elsevier]

The actin cytoskeleton can be influenced by phospholipids and lipid-modifying enzymes. In animals the phosphatidylinositol phosphate kinases (PIPKs) are associated with the cytoskeleton through a scaffold of proteins; however, in plants such an interaction was not clear. Our approach was to determine which of the plant PIPKs interact with actin and determine whether the PIPK-actin interaction is direct. Our results indicate that AtPIPK1 interacts directly with actin and that the binding is mediated through a predicted linker region in the lipid kinase. AtPIPK1 also recruits AtPI4Kβ1 to the cytoskeleton. Recruitment of AtPI4Kβ1 to F-actin was dependent on the C-terminal catalytic domain of phosphatidylinositol-4-phosphate 5-kinase but did not require the presence of the N-terminal 251 amino acids, which includes 7 putative membrane occupation and recognition nexus motifs. In vivo studies confirm the interaction of plant lipid kinases with the cytoskeleton and suggest a role for actin in targeting PIPKs to the membrane. [ABSTRACT FROM AUTHOR]

Abstract: Cadmium is determined in urine samples collected from patients with age-related diseases. The urine is simply diluted 1:1 with water and placed on a tungsten coil electrothermal vaporizer treated with 200μg of a permanent Pd modifier. A straightforward vaporization program is used to deliver the Cd vapor to an inductively coupled plasma atomic emission spectrometer. A high resolution spectrometer and a charge coupled device detector provide spectra across a 4.8nm window encompassing two separate Cd emission lines: 226.5 and 228.8nm. The limit of detection is 0.2μg/L at each wavelength, and the linear dynamic range spans three orders of magnitude. The accuracy as measured with a urine standard reference material is 94%. The Pd modifier continues to be effective even after 150 vaporization cycles. Direct analysis of urine with the Pd modifier using simple aqueous calibration solutions provides results that are comparable to those observed after a much more complex method: chelation, extraction, and internal standardization without the modifier. The mean concentrations found by the two techniques differ by only 9%. The permanent Pd modifier allows direct analysis of limited sample volumes with decreased risks of contamination. [Copyright &y& Elsevier]

The type I B family of phosphatidylinositol phosphate kinases (PIPKs) contain a characteristic region of Membrane Occupation and Recognition Nexus (MORN) motifs at the N terminus. These MORN motifs are not found in PIPKs from other eukaryotes. To understand the impact of the additional N-terminal domain on protein function and subcellular distribution, we expressed truncated and full-length versions of AtPIPK1, one member of this family of PIPKs, in Escherichia coli and in tobacco cells grown in suspension culture. Deletion of the N-terminal MORN domain (amino acids 1-251) of AtPIPK1 increased the specific activity of the remaining C-terminal peptide (ΔMORN) >4-fold and eliminated activation by phosphatidic acid (PtdOH). PtdOH activation could also be eliminated by mutating Pro396 to Ala (P396A) in the predicted linker region between the MORN and the kinase homology domains. AtPIPK1 is product-activated and the MORN domain binds Ptdlns(4,5)P2. Adding back the MORN peptide to ΔMORN or to the PtdOH-activated full-length protein increased activity ~2-fold. Furthermore, expressing the MORN domain in vivo increased the plasma membrane PtdlnsP kinase activity. When cells were exposed to hyperosmotic stress, the MORN peptide redistributed from the plasma membrane to a lower phase or endomembrane fraction. In addition, endogenous PtdlnsP kinase activity increased in the endomembrane fraction of hyperosmotically stressed cells. We conclude that the MORN peptide can regulate both the function and distribution of the enzyme in a manner that is sensitive to the lipid environment. [ABSTRACT FROM AUTHOR]

Endothelin-1 (ET1) and ATP stimulate contraction and hypertrophy of vascular smooth muscle cells (VSMC) by activating diverse signalling pathways. In this study, we show that in VSMC, ET1 and ATP stimulate transient and sustained activation of protein kinase A (PKA), respectively. Using a dominant negative PKA mutant (PKA-DN), we examined the functional significance of PKA activation in the signalling of ET1 and ATP. Overexpression of PKA-DN did not alter the ET1- or ATP-induced phosphorylation of the extracellular signal-regulated protein kinase, Erk2. ATP stimulated a profound, PKA-dependent activation of cAMP-response element (CRE), whereas the effect of ET1 was negligible. Both ET1 and ATP stimulated serum response factor (SRF)-dependent gene expression. Overexpression of PKA-DN potentiated the effects of ET1 and ATP on SRF activity, whereas stimulation of PKA by isoproterenol, forskolin or by overexpression of the PKA catalytic subunit decreased SRF activity. These data demonstrate that (i) PKA negatively regulates SRF activity and (ii) ET1 and ATP stimulate opposing pathways, whose balance determines the net activity of SRF. [Copyright &y& Elsevier]

Transcription factors play important roles in regulating cell growth and differentiation. In this study, treatment of the MTC cell line, TT, with phorbol 12-myristate 13-acetate (PMA) was shown to reduce neurite outgrowth which may be associated with de-differentiation and loss of the transformed phenotype. Northern blotting revealed that PMA transiently induced early growth response gene 1 (Egr-1) expression and decreased RET expression. Transient transfection analyses using 5′-deletion constructs of the basal RET promoter, demonstrated the requirement of a region between −70 and −33 bp for PMA-inducible expression. Gel shift and supershift studies demonstrated that PMA induced Egr-1 formed part of a complex capable of binding to the RET minimal promoter. Overexpression of Egr-1 displaced both sephacryl and phosphocellulose protein 1 (Sp1) and Sp3 from a GC-box element previously found to be important for RET basal expression. Furthermore, use of a raf-1 inducible TT cell line, that has been previously shown to downregulate RET expression, revealed that this downregulation may be linked to the induction of Egr-1. Our data suggest that regulation of RET expression during development and in medullary thyroid carcinoma may be determined, at least in part, by this complex of Sp and Egr-1 proteins. [Copyright &y& Elsevier]

Stress can impact the health and well-being of animals negatively. Behavioral and physiological changes, particularly serum cortisol, offer objective and easy-to-use methods of evaluating stress in horses. However, limited studies support a positive relationship between changes in stress-related serum cortisol concentrations and stress-related behaviors in horses. This study assessed differences in stress-related behaviors and serum cortisol concentrations in horses used in a therapeutic riding program (TRH) or university riding program (UNI). Riders were grouped by disability type (TRH) or by experience level (UNI) to determine equine stress impacts. Two trained observers evaluated equine behavior during multiple riding lessons. Behaviors were scored live and via video to assess the accuracy of live scoring. Blood samples for serum cortisol concentrations were collected before, immediately after, and 30 minutes after riding lessons. Serum cortisol concentrations decreased from before to after a riding lesson (TRH, P ≤.01; UNI, P =.0004) and increased over the course of the study (TRH ≤ 0.0002; UNI, P ≤.0001). All serum cortisol concentrations remained within or below normal ranges. Overall behavior scores were relatively low in horses participating in both riding programs. Similar behavior scores were observed in horses ridden by novice and experienced riders (P ≥.1662); however, behavior scores differed in TRH horses ridden by one group of disabled riders during a riding lesson (P ≤.0431). A relationship between stress-related behavior and cortisol concentration changes was not shown clearly, but data suggest that horses were in a low-stress environment. • Serum cortisol concentration was higher before riding compared with after, but values were within normal range. • Overall serum cortisol concentrations remained within or below normal ranges. • Behavior scores were influenced by the rider disability group. • Overall behavior scores were low. • Data suggest horses in the evaluated programs were not stressed. [ABSTRACT FROM AUTHOR]

With increasing public scrutiny on animal welfare, it behooves those involved in the equine industry to revisit best management practices to ensure these support healthy horses. There is little published research on how horses are used in the equine industry, particularly in therapeutic horseback riding (THR) programs. Although there is a large amount of information on the benefits of THR programs to the participants, there is little published information available about the horses. Therefore, the objective of this survey was to gather data regarding horse use and care in Professional Association of Therapeutic Horsemanship International (PATH Intl.)–affiliated THR programs in the United States to help establish a foundation for a standard of care. A 20-question survey sent to 659 PATH Intl.–affiliated THR programs returned a 40% response rate. Demographics demonstrated that the median number of horses in each program was 10; geldings outnumbered mares; most horses were between 16 and 20 years of age; and Quarter Horse or stock-type breeds predominated. Median session length was 8 weeks and median lesson length was 45 minutes. Horses were typically ridden by clients 4 days/week and 2 hours/day. Most horses were donated to the programs, participated for approximately 7 years, and left because of aging. Limb lameness and back soreness were the top health issues noted, with only a small percentage of colic and ulcers reported. More horses received nonsteroidal anti-inflammatory drugs for a lameness issue, chiropractic adjustment, and massage than any other supplemental care or complementary therapy. Based on data gathered in this survey, THR horses were not worked excessively. Horses were ridden less than PATH Intl.'s maximum recommendation of 6 hours/day and 6 days/week and less than those used in university programs. Horses in THR programs also appeared to have fewer reported health issues as compared with data in other national reports. • Most therapy horses were geldings, aged 16–20 years, and a stock-type breed. • Horses were ridden an average of 4 days/week and 2 hours/day. • Limb lameness and back soreness were the top health issues reported. • Chiropractic adjustment, massage, and NSAIDs were the most common complementary therapies. • Horses were typically ridden less than the PATH Intl. maximum recommendation. [ABSTRACT FROM AUTHOR]

Abstract: Mannich bases are prepared from the selective α-reduction of acyl aziridines using silyllithium reagents. The reaction proceeds via an aziridine ring-opening assisted Brook rearrangement. [Copyright &y& Elsevier]

• Age, sex, and race/ethnicity do not affect efficacy against symptomatic COVID-19. • Common underlying health conditions also do not impact vaccine efficacy. • There is no association between household or workplace exposure and vaccine efficacy. • Vaccines delivered through different platforms demonstrate overall high efficacy. Questions remain regarding the effect of baseline host and exposure factors on vaccine efficacy (VE) across pathogens and vaccine platforms. We report placebo-controlled data from four Phase 3 COVID-19 trials during the early period of the pandemic. This was a cross-protocol analysis of four randomized, placebo-controlled efficacy trials (Moderna/mRNA1273, AstraZeneca/AZD1222, Janssen/Ad26.COV2.S, and Novavax/NVX-CoV2373) using a harmonized design. Trials were conducted in the United States and international sites in adults ≥ 18 years of age. VE was assessed for symptomatic and severe COVID-19. We analyzed 114,480 participants from both placebo and vaccine arms, enrolled July 2020 to February 2021, with follow up through July 2021. VE against symptomatic COVID-19 showed little heterogeneity across baseline socio-demographic, clinical or exposure characteristics, in either univariate or multivariate analysis, regardless of vaccine platform. Similarly, VE against severe COVID-19 in the single trial (Janssen) with sufficient endpoints for analysis showed little evidence of heterogeneity. COVID-19 VE is not influenced by baseline host or exposure characteristics across efficacy trials of different vaccine platforms and countries when well matched to circulating virus strains. This supports use of these vaccines, regardless of platform type, as effective tools in the near term for reducing symptomatic and severe COVID-19, particularly for older individuals and those with common co-morbidities during major variant shifts. Clinical trial registration numbers: NCT04470427, NCT04516746, NCT04505722, and NCT04611802. [ABSTRACT FROM AUTHOR]

In rodents and humans, the gut bacteria-derived metabolite trimethylamine N -oxide (TMAO) has been implicated in the progression of cardiovascular disease, chronic kidney disease, fatty liver, and insulin resistance; however, the effects of TMAO on dairy cattle health and milk production have not been defined. We aimed to determine whether intravenous TMAO infusion modifies measures of liver health, glucose tolerance, and milk production in early-lactation cows. Eight early-lactation Holstein cows (30.4 ± 6.41 d in milk; 2.88 ± 0.83 lactations) were enrolled in a study with a replicated 4 × 4 Latin square design. Cows were intravenously infused TMAO at 0 (control), 20, 40, or 60 g/d for 6 d. Washout periods lasted 9 d. Intravenous glucose tolerance tests (GTT) occurred on d 5. Blood was collected daily. Milk was collected on d −1, 0, 5, and 6. Urine was collected on d −1 and 6. Circulating metabolites, milk components, and TMAO concentrations in milk, urine, and plasma were quantified. Data were analyzed using a mixed model that included the fixed effects of treatment. Concentrations of TMAO in plasma, milk, and urine increased linearly with increasing dose. Dry matter intake and milk production were not modified by treatment. Daily plasma triacylglycerol, fatty acid (FA), and glucose concentrations were not modified. Serum albumin, total protein, globulin, total bilirubin, direct bilirubin, aspartate aminotransferase, γ-glutamyl transferase, and glutamate dehydrogenase concentrations were also not modified by treatment. Serum GTT glucose, FA, and insulin concentrations were not modified by treatment. Plasma total, reduced, and oxidized glutathione concentrations were also not modified by treatment. We conclude that a 6-d intravenous infusion of TMAO does not influence measures of liver health, glucose tolerance, or milk production in early-lactation dairy cows. [ABSTRACT FROM AUTHOR]

Background Patients with eating disorders (EDs) are often considered a high-risk population to refeed. Current research advises using “start low, go slow” refeeding methods (∼1,000 kcal/day, advancing ∼500 kcal/day every 3 to 4 days) in adult patients with severe EDs to prevent the development of refeeding syndrome (RFS), typically characterized by decreases in serum electrolyte levels and fluid shifts. Objective To compare the incidence of RFS and related outcomes using a low-calorie protocol (LC) (1,000 kcal) or a higher-calorie protocol (HC) (1,500 kcal) in medically compromised adult patients with EDs. Design This was a retrospective pre-test–post-test study. Participants/setting One hundred and nineteen participants with EDs, medically admitted to a tertiary hospital in Brisbane, Australia, between December 2010 and January 2017, were included (LC: n=26, HC: n=93). The HC refeeding protocol was implemented in September 2013. Main outcome measures Differences in prevalence of electrolyte disturbances, hypoglycemia, edema, and RFS diagnoses were examined. Statistical analysis performed χ 2 tests, Kruskal-Wallis H test, analysis of variance, and independent t tests were used to compare data between the two protocols. Results Descriptors were similar between groups (LC: 28±9 years, 96% female, 85% with anorexia nervosa, 31% admitted primarily because of clinical symptoms of exacerbated ED vs HC: 27±9 years, 97% female, 84% with anorexia nervosa, 44% admitted primarily because of clinical symptoms of exacerbated ED, P >0.05). Participants refed using the LC protocol had higher incidence rates of hypoglycemia (LC: 31% vs HC: 10%, P =0.012), with no statistical or clinical differences in electrolyte disturbances (LC: 65% vs HC: 45%, P =0.079), edema (LC: 8% vs HC: 6%, P =0.722) or diagnosed RFS (LC: 4% vs HC: 1%, P =0.391). Conclusions A higher-calorie refeeding protocol appears to be safe, with no differences in rates of electrolyte disturbances or clinically diagnosed RFS and a lower incidence of hypoglycemia. Future research examining higher-calorie intakes, similar to those studied in adolescent patients, may be beneficial. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Globally, one third of deaths each year are from cardiovascular diseases, yet no strong evidence supports any specific method of CPR instruction in a resource-limited setting. We hypothesized that both existing and novel CPR training programs significantly impact skills of hospital-based healthcare providers (HCP) in Botswana. Methods: HCP were prospectively randomized to 3 training groups: instructor led, limited instructor with manikin feedback, or self-directed learning. Data was collected prior to training, immediately after and at 3 and 6months. Excellent CPR was prospectively defined as having at least 4 of 5 characteristics: depth, rate, release, no flow fraction, and no excessive ventilation. GEE was performed to account for within subject correlation. Results: Of 214 HCP trained, 40% resuscitate ≥1/month, 28% had previous formal CPR training, and 65% required additional skills remediation to pass using AHA criteria. Excellent CPR skill acquisition was significant (infant: 32% vs. 71%, p <0.01; adult 28% vs. 48%, p <0.01). Infant CPR skill retention was significant at 3 (39% vs. 70%, p <0.01) and 6months (38% vs. 67%, p <0.01), and adult CPR skills were retained to 3months (34% vs. 51%, p =0.02). On multivariable analysis, low cognitive score and need for skill remediation, but not instruction method, impacted CPR skill performance. Conclusions: HCP in resource-limited settings resuscitate frequently, with little CPR training. Using existing training, HCP acquire and retain skills, yet often require remediation. Novel techniques with increased student: instructor ratio and feedback manikins were not different compared to traditional instruction. [Copyright &y& Elsevier]