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Refractory Out of Hospital Cardiac Arrest (r-OHCA) is common and the benefit versus harm of intra-arrest transport of patients to hospital is not clear. To assess the rate of survival to hospital discharge in adult patients with r-OHCA, initial rhythm pulseless ventricular tachycardia (VT)/ventricular fibrillation (VF) or Pulseless Electrical Activity (PEA) treated with 1 of 2 locally accepted standards of care: 1 expedited transport from scene; or 2 ongoing advanced life support (ALS) resuscitation on-scene. We hypothesize that expedited transport from scene in r-OHCA improves survival with favorable neurological status/outcome. Phase III, multi-center, partially blinded, prospective, intention-to-treat, safety and efficacy clinical trial with contemporaneous registry of patient ineligible for the clinical trial. Eligible patients for inclusion are adults with witnessed r-OHCA; estimated age 18 to 70, assumed medical cause with immediate bystander cardiopulmonary resuscitation (CPR); initial rhythm of VF/pulseless VT, or PEA; no return of spontaneous circulation following 3 shocks and/or 15 minutes of professional on-scene resuscitation; with mechanical CPR available. Two hundred patients will be randomized in a 1:1 ratio to either expedited transport from scene or ongoing ALS at the scene of cardiac arrest. Two urban regions in NSW Australia. Primary: survival to hospital discharge with cerebral performance category (CPC) 1 or 2. Secondary: safety, survival, prognostic factors, use of ECMO supported CPR and functional assessment at hospital discharge and 4 weeks and 6 months, quality of life, healthcare use and cost-effectiveness. The EVIDENCE trial will determine the potential risks and benefits of an expedited transport from scene of cardiac arrest. [ABSTRACT FROM AUTHOR]

Lung transplantation is an acceptable and potentially life-saving treatment option for coronavirus disease 2019 (COVID-19)–induced acute respiratory distress syndrome and pulmonary fibrosis. This study was conducted to determine whether recipients of lung transplantation (LT) for COVID-19–related lung disease have comparable outcomes to other recipients with a similar level of lung dysfunction. The Organ Procurement and Transplant Network database was queried for adult LT candidates between 2006 and 2021. Recipients with COVID-19–related respiratory failure were matched 1:2 using a nearest-neighbor algorithm. Kaplan-Meier methods with log-rank tests were used to compare long-term survival. A proportional hazards model was used to calculate risk of death. A total of 37,333 LT candidates from all causes were compared with 334 candidates from COVID-19–related respiratory failure. COVID-19 recipients were more likely to be younger (50 vs 57 years, P <.001), male (79% vs 60%, P <.001), require extracorporeal membrane oxygenation (56.3% vs 4.0%, P <.001), and have worse lung function (lung allocation score, 82.4 vs 47.8; P <.001) at transplantation. Subsequently, 227 COVID-19 recipients were matched with 454 controls. Patients who received a transplant for COVID-19 had similar rates of mechanical ventilation, extracorporeal membrane oxygenation, postoperative complications, and functional status at discharge compared with controls. There was no difference in overall survival or risk of death from COVID-19 (hazard ratio, 0.82; 95% CI, 0.45-1.53; P =.54). Six-month survival for recipients of LT for COVID-19–related respiratory failure was comparable to that of other LT recipients. [ABSTRACT FROM AUTHOR]

• Driving through floodwaters is a leading cause of flood-related death, injury, and rescue. • Little is known about learner driver beliefs in times of flood. • We used the theory of planned behaviour across formative and predictive studies. • Social cognition factors and past behaviour predicted driver willingness. • Theory-based targets should be the basis of intervention programs for novice drivers. Driving through floodwater is a significant cause of flood-related injury and mortality, and opportunities exist to embed safe driving messages regarding floodwaters to novice drivers in graduated driver licensing schemes. To inform future educational efforts, we investigated the beliefs and attitudes of Australian learner drivers about driving and avoiding driving through floodwaters. Methods: The study adopted a cross-sectional correlational design with measures drawn from the theory of planned behaviour and administered within an online survey. Phase 1 (N = 44 learner drivers) aimed to identify the core beliefs associated with driving through floodwater. Phase 2 (N = 250 learner drivers) tested these beliefs predicting willingness to drive through floodwater as well as the social psychological factors that predict learner drivers' willingness to drive and avoid driving through floodwater using a pre-tested scenario. Analyses comprised descriptive statistics, linear regression, and structural equation models. Results: Ten key beliefs were identified as predicting willingness to drive through floodwater. These included perceived advantages and disadvantages, perceived social approval from important others, and perceived facilitators and barriers regarding driving through floodwater in the presented scenario. Structural equation models of social cognition constructs of the theory of planned behaviour revealed attitude, subjective norm, and perceived behavioural control predicted both willingness to drive and avoid driving through floodwater. Past experience as a passenger also predicted these social cognition constructs, although this differed across models. Discussion: Results highlight the importance of modelling safe driving behaviour for young passengers. The strong association between subjective norm and willingness to drive through floodwater further highlights the importance of those supervising learner drivers to establish expectations around avoiding driving through the floodwater if it is encountered on a driving route. Conclusion: Social cognition factors from the theory of planned behaviour predict willingness to drive and avoid driving though floodwater. Theory-based targets should be considered for the development of intervention programs for novice drivers, such as those holding learner licenses. [ABSTRACT FROM AUTHOR]

Rarely performed procedures can cause stress and communication challenges in emergency situations. A simulation was developed to practice and improve team performance and procedural workflow when it has been determined that a liver transplant patient will need veno-veno bypass. The scenario involved a patient predetermined to need veno-veno bypass to allow team members to practice procedural workflow and communication. The simulation used a checklist outlining steps of the procedure and expected communication needed among surgeon, anesthesiologist, nurses, and perfusion team members. Perfusion and nursing supplied equipment to simulate the veno-veno bypass. Debriefing and a brief survey followed the simulation. During the simulation participants performed steps outlined in the checklist. During debriefing, discussion occurred regarding equipment usage, step order, time documentation, and medication use. Additional discussions occurred regarding modifying perfusion tubing and supplies. Participants rated their confidence in understanding communication (4.2), ability to work with others (4.6), knowledge of supplies (4.4), and use of closed-loop communication (4.4) on a scale of 1 (not at all confident) to 5 (extremely confident) (n = 5). Participants concluded going through veno-veno bypass steps was a positive experience. Surgeons acknowledged there were multiple ways to perform this procedure and agreed it should be done the same way each time for standardization. Nursing staff commented they liked reviewing equipment in a nonemergency situation. The checklist will be turned into a resource for future operating room procedures. The perfusion team made modifications to their equipment based on surgeon recommendations. Future training is planned when new members join the team. [ABSTRACT FROM AUTHOR]

Background: Scabies is a contagious skin disease resulting from Sarcoptes scabiei infestation. There are no approved over-the-counter treatments, and approved prescription products have disadvantages, including potential resistance. Spinosad, an insecticide derived from fermentation of a soil actinobacterium, shows promise as a potential treatment agent.Objective: Combined results from 2 controlled clinical studies were used to evaluate the efficacy of 0.9% spinosad topical suspension in the eradication of scabies.Methods: Each study included index subjects (the youngest household members with active scabies) and up to 5 other members in each household. Subjects applied 0.9% spinosad or vehicle once. Primary efficacy was the percentage of index subjects with complete cure on day 28. Additional efficacy included clinical cure, microscopic cure, and lesion counts.Results: Spinosad at 0.9% is not equivalent to vehicle in the percentage of index subjects achieving complete cure on day 28 (78.1% vs 39.6%, respectively; P < .0001; n = 206). Additional efficacy analyses confirmed the consistent treatment effect of 0.9% spinosad. No safety signals were observed.Limitations: The studies used small sample sizes to assess equivalency.Conclusions: Spinosad at 0.9% performed better than vehicle in the treatment of scabies in these studies of subjects of 4 years of age or older following 1 application of study drug. [ABSTRACT FROM AUTHOR]

The authors argue that the Federal Reserve Board is not influenced by the president as much as is publicly perceived, drawing on analyses of the institutional interaction between the Board and the executive office. Data provided ranges from 1953 to 1992 and includes number of seats each president filled, number of months their appointees served, and whether appointees were economists or fellow partisans.

The authors propose a novel pressure-regulated method for balloon-expandable transcatheter heart valve (THV) deployment, aimed at optimizing prosthesis-annulus apposition while preventing significant tissue injury. The optimal method for balloon-expandable THV deployment remains debated. Current protocols are volume dependent, relying on under- and overfilling of the deployment apparatus. During deployment, the annular wall tension exerted by the expanding prosthesis is determined by maximal THV diameter and balloon pressure (Laplace's law). Three hundred thirty consecutive patients with severe native aortic stenosis who underwent TAVR with SAPIEN 3 THVs were included. One hundred and six patients were considered at high risk for annular rupture. THVs were deployed until reaching a predetermined balloon pressure. Postdilatation was performed to reduce mild or greater angiographic paravalvular regurgitation (PVR). Using a biomechanical model, annular wall stress was estimated for each case and assessed against rates of postdilatation, mild or greater PVR on transthoracic echocardiography, new permanent pacemaker placement or left bundle branch block, and annular rupture. Patients with wall stress >3 MPa had reduced postdilatation rate (P < 0.001) and reduced final PVR (P = 0.014). Annular rupture occurred in 2 of 3 high-risk patients with wall stress >3.5 MPa (3.69 and 3.84 MPa); no rupture occurred in 95 high-risk patients with wall stress ≤3.5 MPa. We defined a single target deployment pressure per THV size to ensure deployment within target wall stress levels of 3 to 3.5 MPa: 6.25 atm for 23-mm THVs, 5.5 atm for 26-mm THVs, and 5 atm for 29-mm THVs. Patients within this target range (n = 136) had a 10.0% postdilatation rate, 12.7% mild PVR, and no moderate to severe PVR. The relationship between balloon filling volume and associated pressure and wall stress was inconsistent. Pressure-regulated THV deployment is a simple, reproducible, safe, and effective method, regardless of high-risk anatomical complexities. [Display omitted] [ABSTRACT FROM AUTHOR]

Engaging nursing students in research is essential to enhance evidence-based practice in nursing. This paper outlines undergraduate students' research experiences with palliative care research team at a School of Nursing in rural Appalachia through the Research Apprenticeship Program (RAP). Students engage in research endeavors at the early stage of their education. Each principal investigator (PI) provided a synopsis of the research project through RAP. RAP staff reviewed all students' applications and notified the PI mentor based on students' research interests. Once students and PIs agree to work together, specific trainings are initiated, including enrolling students in an introductory research course. Students were engaged in a variety of research related activities. Disruption on research activities during COVID-19 pandemic was also reported and addressed. Students shared the benefits and research challenges they experienced. Lessons learned can be adapted to mentoring plans for students in the future. [ABSTRACT FROM AUTHOR]