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The installation of planetary and lunar human outposts might be an important step for future solar system exploration by both public space agencies and private companies. Humans living and working in these artificially created habitats will possibly depend, among other life support approaches, on bio-regenerative life support systems to produce and recycle oxygen and water, and to produce food. A variety of natural resources suitable life support can be readily found on Mars, and to a lesser extent on the Moon. Instead of launching all resources (e.g., water, propellant, food and other materials) from Earth, it could potentially be much more cost effective to send automated machinery to harvest resources from the Martian surface and atmosphere in preparation for the arrival of humans. The exploration of these natural resource deposits, the concentration of the raw materials contained in them, and the feasibility of mining and refinement are open questions that require further consideration. Here we address the concept of harvesting resources in situ by reviewing the potential of several large deposits of hydrated minerals found on the surface of Mars thanks to previous orbital detections. We also present estimates of water volumes potentially retrievable from specific deposits and describe additional uses of the hydrated minerals for example as fertilizer for food production. • Hydrated sulfate deposit contains important resources for landed crews. • Bio-regenerative Life-Support Systems could reduce logistics from Earth to Mars. • Several regions on Mars bear large exploitable resource potential. • Water is abundantly available in selected deposits. • Prolonged human presence on Mars could profit from the use of local resources. [ABSTRACT FROM AUTHOR]

Space habitats typically have elevated CO2 and NASA is considering growing leafy greens in space to supplement astronauts' diets. Dragoon' and 'Outredgeous' lettuce, 'Amara' mustard, 'Extra Dwarf' pak choi, shungiku, 'Red Russian' kale, 'Toscano' kale, and 'Barese' Swiss chard were grown for 4 weeks at 400, 1500, 3000, and 6000 ppm CO2. Shoot fresh mass at 28 days was greater for one of more elevated CO2 levels for all species/cultivars except 'Toscano' kale. Fresh mass varied by species/cultivar, with pak choi and 'Dragoon' lettuce showing the greatest yields. Super-elevated CO2 (6000 ppm) reduced shoot mass for both lettuce cvs. compared to 3000 ppm. Elevated CO2 increased K levels for most species/cultivars but decreased Mg for some species/cultivars. CO2 affected Vitamin B1 and Vitamin C content but had no effect on Vitamin K. 'Toscano' and 'Red Russian' kale, and Amara mustard had the highest mineral and vitamin content. [ABSTRACT FROM AUTHOR]

Introduction: The incidence of thrombocytopenia in neonates receiving extracorporeal membrane oxygenation (ECMO) with and without concurrent continuous renal replacement therapy (CRRT) and associated complications have not been well described. The primary aims of the current study were to (1) characterize thrombocytopenia in neonates receiving ECMO (including those treated concurrently with CRRT) and (2) evaluate risk factors (including CRRT utilization) associated with severe thrombocytopenia. In a planned exploratory secondary aim, we explored the association of severe thrombocytopenia with outcomes in neonates receiving ECMO. Methods: We conducted a retrospective single-center chart review of neonates who received ECMO 07/01/14–03/01/20 and evaluated associations between CRRT, severe thrombocytopenia (platelet count <50,000/mm3), and outcomes (ECMO duration, length of stay, and survival). Results: Fifty-two neonates received ECMO; 35 (67%) received concurrent CRRT. Severe thrombocytopenia occurred in 27 (52%) neonates overall and in 21 (60%) neonates who received concurrent CRRT. Underlying diagnosis, ECMO mode, care unit, and moderate/severe hemolysis differed between those who did and did not receive CRRT. CRRT receivers experienced shorter hospital stays than CRRT non-receivers, but ECMO duration, length of intensive care unit (ICU) stay, and survival did not differ between groups. CRRT receipt was associated with severe thrombocytopenia. Exploratory classification and regression tree (CART) analysis suggests CRRT use, birthweight, and ICU location are all predictors of interest for severe thrombocytopenia. Conclusions: In our cohort, CRRT use during ECMO was associated with severe thrombocytopenia, and patients who received ECMO with CRRT experienced shorter hospital stays than those who did not receive CRRT. Exploratory CART analysis suggests CRRT use, birthweight, and ICU location are all predictors for severe thrombocytopenia and warrant further investigations in larger studies. Plain Language Summary: Heart and lung life support, or extracorporeal membrane oxygenation (ECMO), is a form of life support that can be utilized in critically ill neonates. Continuous dialysis, or continuous renal replacement therapy (CRRT), can be used in conjunction with ECMO to help support and supplement kidney function. The frequency of low platelet counts in neonates receiving ECMO with and without concurrent CRRT and associated outcomes have not been well described in the literature. The primary aims of the current study were to (1) characterize low platelet counts in neonates receiving ECMO (including those treated concurrently with CRRT) and (2) evaluate risk factors (including CRRT utilization) associated with low platelets. In our study, CRRT use during ECMO was associated with severely low platelet counts. Exploratory analysis suggests CRRT use, birthweight, and intensive care unit location are all predictors of interest for low platelet counts and worthy of further investigations in larger studies. [ABSTRACT FROM AUTHOR]

Aim: Pediatric out-of-hospital cardiac arrest has an unfavorable prognosis; therefore, making accurate predictions of outcomes is crucial for tailoring treatment plans. The termination of resuscitation rules must accurately predict unfavorable outcomes. In this study, we aimed to assess if the current termination of resuscitation rules for adults can predict factors associated with unfavorable outcomes in pediatric out-of-hospital cardiac arrest and examine the relationship between these factors and unfavorable outcomes. Methods: A retrospective nationwide cohort study of pediatric cases registered in the Japanese Association for Acute Medicine Multicenter Out-of-Hospital Cardiac Arrest Registry from June 1, 2014, to December 31, 2020, was conducted. The association between the current termination of resuscitation rules and outcomes, such as 30-day mortality and unfavorable 30-day neurological outcomes following out-of-hospital cardiac arrest, was evaluated. Results: A total of 1,216 participants were included. The positive predictive value for predicting 30-day mortality for each termination of resuscitation rule exceeded 0.9. The specificity and positive predictive value for predicting unfavorable 30-day neurological outcomes were 1.00, indicating that no rules identified favorable outcomes. Factors such as no bystander witness, no return of spontaneous circulation before hospital arrival, no automated external defibrillator or defibrillator use, and no bystander cardiopulmonary resuscitation were associated with poor 30-day mortality and neurological outcomes. Conclusion: Adult termination of resuscitation rules had a high positive predictive value for predicting pediatric out-of-hospital cardiac arrest. However, surviving cases make it challenging to use these rules for end-of-resuscitation decisions, indicating the need for identifying new rules to help predict neurological outcomes.

Left ventricular assistance devices (LVADs) are one type of life support with the unique quality of allowing recipients to live outside the hospital. This case report explores the decision by a patient and their family to withdraw LVAD therapy in the setting of dementia and consultant team recommendations at odds with one another due to the patient's simultaneous alertness and lack of decisional capacity. It then discusses the guiding principles that led to the withdrawal of LVAD therapy and lessons drawn from the experience by the care team. [ABSTRACT FROM AUTHOR]

ABSTRACTSpace habitats typically have elevated CO2 and NASA is considering growing leafy greens in space to supplement astronauts’ diets. Dragoon’ and ‘Outredgeous’ lettuce, ‘Amara’ mustard, ‘Extra Dwarf’ pak choi, shungiku, ‘Red Russian’ kale, ‘Toscano’ kale, and ‘Barese’ Swiss chard were grown for 4 weeks at 400, 1500, 3000, and 6000 ppm CO2. Shoot fresh mass at 28 days was greater for one of more elevated CO2 levels for all species/cultivars except ‘Toscano’ kale. Fresh mass varied by species/cultivar, with pak choi and ‘Dragoon’ lettuce showing the greatest yields. Super-elevated CO2 (6000 ppm) reduced shoot mass for both lettuce cvs. compared to 3000 ppm. Elevated CO2 increased K levels for most species/cultivars but decreased Mg for some species/cultivars. CO2 affected Vitamin B1 and Vitamin C content but had no effect on Vitamin K. ‘Toscano’ and ‘Red Russian’ kale, and Amara mustard had the highest mineral and vitamin content.

Introduction: The organization of primary Extracorporeal membrane oxygenation (ECMO) transport is highly variable. Methods: To present the experience of the first mobile pediatric ECMO program in Spain, we designed a prospective descriptive study of all primary neonatal and pediatric (0–16 years) ECMO transports carried out over 10 years. The main variables recorded include demographic information, patient background, clinical data, ECMO indications, adverse events, and main outcomes. Results: 39 primary ECMO transports were carried out with a 66.7% survival to hospital discharge. The median age was 1.24 months[IQR: 0.09–96]. Cannulation was mostly peripheral venoarterial (33/39). The mean response time from the call from the sending center to the departure of the ECMO team was 4 h[2.2–8]. The median inotropic score at the time of cannulation was 70[17.2–206.5], with a median oxygenation index of 40.5[29–65]. In 10% of the cases, ECMO-CPR was performed. Adverse events occurred in 56.4%, mostly related to the means of transport (40% overall). On arrival at the ECMO center, 44% of the patients underwent interventions. The median PICU stay was 20.5 days[11–32]. 5 patients developed neurological sequels. Statistically significant differences between survivors and deceased patients were not found. Conclusions: A good survival rate, with a low prevalence of serious adverse events, suggests a clear benefit of primary ECMO transport when conventional therapeutic measures are exhausted and the patient is too unstable to undergo conventional transport. A nationwide primary ECMO-transport program must therefore be offered to all patients regardless of their location. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the effectiveness of augmented reality (AR) and virtual reality (VR), compared with other instructional methods, for basic and advanced life support training. Methods: This systematic review was part of the continuous evidence evaluation process of the International Liaison Committee on Resuscitation (ILCOR) and reported based on the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) guidelines and registered with PROSPERO (CRD42023376751). MEDLINE, EMBASE, and SCOPUS were searched from inception to January 16, 2024. We included all published studies comparing virtual or augmented reality to other methods of resuscitation training evaluating knowledge acquisition and retention, skills acquisition and retention, skill performance in real resuscitation, willingness to help, bystander CPR rate, and patients’ survival. Results: Our initial literature search identified 1807 citations. After removing duplicates, reviewing the titles and abstracts of the remaining 1301 articles, full text review of 74 articles and searching references lists of relevant articles, 19 studies were identified for analysis. AR was used in 4 studies to provide real-time feedback during CPR, demonstrating improved CPR performance compared to groups trained with no feedback, but no difference when compared to other sources of CPR feedback. VR use in resuscitation training was explored in 15 studies, with the majority of studies that assessed CPR skills favoring other interventions over VR, or showing no difference between groups. Conclusion: Augmented and virtual reality can be used to support resuscitation training of lay people and healthcare professionals, however current evidence does not clearly demonstrate a consistent benefit when compared to other methods of training.

Introduction: Despite high vulnerability to infection, hand disinfection compliance in emergencies is low. This is regularly justified as the disinfection procedure delays life support, and instead, wearing disposable gloves is preferred. Simulation studies showed higher achievable compliance than detected in real-life situations. This study aimed to explore healthcare providers’ attitudes toward hand disinfection and using gloves in emergencies. Methods: We conducted an anonymous online survey in Germany on the attitude and subjective behavior in the five moments of hand hygiene in a closed environment and an open convenience sampling survey. Statistics included paired student's t-tests corrected for multiple testing. For qualitative analysis, we employed a single-coder approach. Results: In 400 participants, we detected low priority of WHO-1 (before touching a patient) and WHO-2 (before clean/aseptic procedure) hand hygiene moments, despite knowing the risks of omission of hand disinfection. For all moments, self-assessment exceeded the assessment of colleagues (p < 0.001). For WHO-3, we detected a lower disinfection priority for wearing gloves compared to contaminated bare hands. Qualitative analyses revealed five themes: basic conditions, didactic implementations, cognitive load, and uncertainty about feasibility and efficacy. Discussion: Considering bias, the study's subjective nature, the unknown role of emergency-related infections contributing to hospital-acquired infections, and different experiences of healthcare providers, we conclude that hand disinfection before emergencies is de-prioritized and justified by the emergency situation regardless of the objective feasibility. Conclusion: This study reveals subjective and objective barriers to implementation of WHO-1 and WHO-2 moments of hand disinfection to be further evaluated and addressed in educational programs.

The paper presents the results of archaeological and archaeozoological study of the 2021excavation material from the Shiroky Buerak settlement which is a part of the Golden Horde city of Ukek. The purpose of the study is to reconstruct a part of the economic functions of this settlement in the life support system of a larger town. The excavations revealed three stratigraphic horizons, remains of several service amenities outbuildings and pits. The ceramic complex is mainly represented by fragments of local production vessels: unglazed red-clay, red-brown, and ancient Russian gray-clay. Fragments of tandoors, coatings, as well as the production of unglazed red clay ceramics were found. However, no special buildings were identified. Other finds include iron, bronze, bone items typical material culture of an “ordinary” rural settlement remains. The coins allow dating the monument to the early 14th century. The archaeozoological collection included 444 fragments of bone remains of mammals, birds, fish, and reptiles which is typical for the rural settlements of this area according to the taxonomic set. The remains of sturgeons found in the cultural layers testify to the specialized fishing industry of the Volga region. The collection is dominated by domestic ungulates bones, among which the remains of cattle are of the highest proportion up to 70%. The proportions of the remains of small ruminants and horses are close to each other 15%and 13% respectively, while about 1% is presented by pig bones. Beef decisively dominates in the meat consumption of the settlement making up to 81%, which suggests that specialized breeding of cattle was one of the important aspects of economic activity to the detriment of other types of domestic ungulates breeding. A comprehensive archaeological and archaeozoological study revealed that the studied monument – Shiroky Buerak is a rural-type settlement with finds typical of the Ukek district, according to its industries, ceramic complex, and the residents` economic activities. The hypothesis about the important role of such settlements in supplying cities with meat products and provision of animal skins for processing by urban artisans has been confirmed, since such industries were found previously in the Ukek excavations.

Background Few prediction models for individuals with early‐stage out‐of‐hospital cardiac arrest (OHCA) have undergone external validation. This study aimed to externally validate updated prediction models for OHCA outcomes using a large nationwide dataset. Methods and Results We performed a secondary analysis of the JAAM‐OHCA (Comprehensive Registry of In‐Hospital Intensive Care for Out‐of‐Hospital Cardiac Arrest Survival and the Japanese Association for Acute Medicine Out‐of‐Hospital Cardiac Arrest) registry. Previously developed prediction models for patients with cardiac arrest who achieved the return of spontaneous circulation were updated. External validation was conducted using data from 56 institutions from the JAAM–OHCA registry. The primary outcome was a dichotomized 90‐day cerebral performance category score. Two models were updated using the derivation set (n=3337). Model 1 included patient demographics, prehospital information, and the initial rhythm upon hospital admission; Model 2 included information obtained in the hospital immediately after the return of spontaneous circulation. In the validation set (n=4250), Models 1 and 2 exhibited a C‐statistic of 0.945 (95% CI, 0.935–0.955) and 0.958 (95% CI, 0.951–0.960), respectively. Both models were well‐calibrated to the observed outcomes. The decision curve analysis showed that Model 2 demonstrated higher net benefits at all risk thresholds than Model 1. A web‐based calculator was developed to estimate the probability of poor outcomes (https://pcas‐prediction.shinyapps.io/90d_lasso/). Conclusions The updated models offer valuable information to medical professionals in the prediction of long‐term neurological outcomes for patients with OHCA, potentially playing a vital role in clinical decision‐making processes.

Advances in neonatal medicine have allowed us to rescue extremely preterm infants. However, both long-term vulnerability and the burden of treatment in the neonatal period increase with decreasing gestational age. This raises questions about the justification of life support when a baby is born at the border of viability, and has led to a so-called “grey zone”, where many professionals are unsure whether provision of life support is in the child's best interest. Despite cultural, political and economic similarities, the Scandinavian countries differ in their approach to periviable infants, as seen in their respective national guidelines and practices. In Sweden, guidelines and practice are more rescue-focused at the lower end of the border of viability, Danish guidelines emphasizes the need to involve parental views in the decision-making process, whereas Norway appears to be somewhere in between. In this paper, I will give an overview of national consensus documents and practices in Norway, Sweden and Denmark, and reflect on the ethical justification for the different approaches.

Abstract Background Many physicians use point-of-care ultrasound (PoCUS) in their clinical practice to improve their diagnostic capabilities, accuracy, and timeliness. Over the last two decades, the use of PoCUS in the emergency room has dramatically increased. This study aimed to determine emergency physicians’ retention of knowledge and skills after a brief training workshop on a focused ultrasound-guided approach to a patient presenting with undifferentiated shock, shortness of breath, and cardiac arrest in the emergency department of a tertiary care hospital. The secondary aim was to deliver the PoCUS-guided algorithmic approach to manage a patient presenting with undifferentiated shock, respiratory distress, and cardiac arrest in the emergency department. Methods A quasi-experimental study was conducted with a single-day Point of Care Ultrasonographic Life Support in Emergency (PULSE) training workshop in October 2021 at the Aga Khan University Hospital, Karachi, Pakistan. A total of 32 participants attended the course, including twenty-one junior residents (PGY 1 and 2) and medical officers with experience of fewer than two years working in different emergency departments of urban tertiary care hospitals across Karachi, Pakistan. Pre- and post-assessment tools comprised a written examination, evaluating participants' knowledge and skills in ultrasound image acquisition and interpretation. Cronbach's alpha was used to calculate the validity of the tool. Results obtained before and after the training session were compared by the McNemar’s test. A p value of ≤ 0.05 was considered significant. Results There was a significant improvement in response to each question pre to post-test after completion of the course (Table 1). The significant change can be seen in questions 7, 8, 13, and 15, with a percentage change of 33.3, 80.9, 42.9, and 47.7. There was a significant improvement in the understanding and knowledge of participants after the training. The scores in the post-test were high compared to the pre-test in each category, i.e., respiratory distress (p

In this study, we have developed an IoT-based plant growing system to address the pressing issue of supporting individuals with developmental disabilities and other challenges in their daily and social lives. The primary objective of the system is to facilitate environmental adaptation by monitoring the user's daily routine and indoor environment, while also providing assistance in plant cultivation. The flowerpot system we have developed is equipped with various sensors, including temperature, humidity, light, and moisture sensors. These sensors enable the comprehensive monitoring of both the plant growing process and the indoor environment. Additionally, the system features a built-in display and speaker, serving as a user interface that facilitates communication between the user and the anthropomorphic flowerpot character. The objective evaluation of the system was conducted through electroencephalography (EEG) measurements, whereas subjective evaluation involved the use of questionnaires and interviews. The results confirmed that the system has a relaxation effect on the users. [ABSTRACT FROM AUTHOR]

Key points: Extra corporeal membrane oxygenation (ECMO) is an advanced life support technique used in cases of respiratory and cardiovascular failure when conventional intensive care supportive therapies have been exhausted.ECMO has been used to support pregnant and postpartum women and people presenting with several cardiac and respiratory pathologies; it has gained wider recognition among the obstetric community owing to the COVID‐19 pandemic.It is important for clinicians to understand the difference between veno‐venous and veno‐arterial ECMO and the different purposes of these configurations.It is important to consider such dilemmas in the provision of care as when to deliver and monitoring the fetus.Management of pregnant women on ECMO is complex and requires MDT discussions, repeated regularly when the clinical situation, including when gestation crosses stages of viability, changes. Learning objectives: To learn about the different types, aim and risks of ECMO.To understand the benefit and risks of delivery of the fetus.To be aware of the management of critically ill antenatal and post‐partum patients being considered for ECMO or whilst receiving ECMO support. [ABSTRACT FROM AUTHOR]

Introduction: The management of polytraumatized patients is set in a stressful environment with numerous critical decisions in a brief amount of time. Working along a standardised procedure can improve the outcome for these patients and reduce mortality. To help clinical practitioners, we developed "TraumaFlow", a workflow management system for the primary care of polytrauma patients based on the current treatment guidelines. This study sought to validate the system and investigate its effect on user performance and perceived workload. Methods: The computer-assisted decision support system was tested in two scenarios in a trauma room of a level 1 trauma centre by 11 final-year medical students and 3 residents. In simulated polytrauma scenarios, the participants functioned as a trauma leader. The first scenario was performed without decision support and the second with support by "TraumaFlow" via tablet. During each scenario, the performance was evaluated in a standardized assessment. After each scenario, the participants answered a questionnaire on workload [NASA Raw Task Load Index (NASA RTLX)]. Results: In total, 14 participants (mean 28 ± 4 years, 43% female) managed 28 scenarios. During the first scenario without computer-assisted support, the participants achieved a mean of 6.6 out of 12 points (SD 1.2, range 5 to 9). With the support of TraumaFlow, the mean performance score was significantly higher with 11.6 out of 12 points (SD 0.5, range 11 to 12, p < 0.001). In the 14 scenarios performed without support, there was no run in which no errors were made. In comparison, ten of the 14 scenarios performed with TraumaFlow ran free of relevant errors. The mean improvement in the performance score was 42%. There was a significant decrease in the mean self-reported mental stress level in scenarios with support of TraumaFlow (55, SD 24) as compared to scenarios without support (72, SD 13, p = 0.041). Conclusion: In a simulated environment, computer-assisted decision-making improved the performance of the trauma leader, helped to adhere to clinical guidelines, and reduced stress in a fast-acting environment. In reality, this may improve the treatment outcome for the patient. [ABSTRACT FROM AUTHOR]

As presently conceptualised, the artificial placenta (AP) is an experimental life support platform for extremely preterm infants (i.e. 400-600 g; 21–23+6 weeks of gestation) born at the border of viability. It is based around the oxygenation of the periviable fetus using gas-exchangers connected to the fetal vasculature. In this system, the lung remains fluid-filled and the fetus remains in a quiescent state. The AP has been in development for some sixty years. Over this time, animal experimental models have evolved iteratively from employing external pump-driven systems used to support comparatively mature fetuses (generally goats or sheep) to platforms driven by the fetal heart and used successfully to maintain extremely premature fetuses weighing around 600 g. Simultaneously, sizable advances in neonatal and obstetric care mean that the nature of a potential candidate patient for this therapy, and thus the threshold success level for justifying its adoption, have both changed markedly since this approach was first conceived. Five landmark breakthroughs have occurred over the developmental history of the AP: i) the first human studies reported in the 1950's; ii) foundation animal studies reported in the 1960's; iii) the first extended use of AP technology combined with fetal pulmonary resuscitation reported in the 1990s; iv) the development of AP systems powered by the fetal heart reported in the 2000's; and v) the adaption of this technology to maintain extremely preterm fetuses (i.e. 500-600 g body weight) reported in the 2010's. Using this framework, the present paper will provide a review of the developmental history of this long-running experimental system and up-to-date assessment of the published field today. With the apparent acceleration of AP technology towards clinical application, there has been an increase in the attention paid to the field, along with some inaccurate commentary regarding its potential application and merits. Additionally, this paper will address several misrepresentations regarding the potential application of AP technology that serve to distract from the significant potential of this approach to greatly improve outcomes for extremely preterm infants born at or close to the present border of viability. • The artificial placenta is an experimental life support platform for extremely preterm infants. • The artificial placenta concept has been in development for over 60 years. • Significant improvements have been made in hardware performance. • Significant challenges remain to be overcome before clinical use can occur. [ABSTRACT FROM AUTHOR]

Future long-duration human spaceflights require developments to limit biocontamination of surface habitats. The three MATISS (Microbial Aerosol Tethering on Innovative Surfaces in the International Space Station) campaigns exposed surface treatments over several months in the ISS. To this end, eight sample holders designed were mounted with lamella-bearing FDTS ((1H, 1H, 2H, 2H)-perfluorodecyltrichlorosilane), SiOCH, and parylene hydrophobic coatings, at two different locations, for several months, during three distinct periods from 2016 to 2020. Tile scanning optical microscopy (×3 and ×30 magnifications) detected several thousand particles, indicating a relatively clean environment (a few particles per mm2). In previous studies, exposure rates were analyzed for all the coarse and fine particles detected on the largest total area of the integrated FDTS area exposed in the ISS (several cm2). Here, the contamination rates observed for a smaller constant area unit (the 0.66-cm2 window area of the holder) were statistically analyzed. Therefore, a statistical difference in rate distributions between RGSH (Return Grid Sensor House) and EDR (European Drawer Rack) and between FDTS and either SiOCH or parylene was shown for the coarse particles but not for the fine particles. The contamination rates were found to be low, confirming the efficiency of the long-term air purification system. The rates tend to vary with the astronaut occupancy rates. Surfaces of spacecraft for long-duration exploration left unmanned during dormancy periods can be considered safe from biocontamination.

Background: Many physicians use point-of-care ultrasound (PoCUS) in their clinical practice to improve their diagnostic capabilities, accuracy, and timeliness. Over the last two decades, the use of PoCUS in the emergency room has dramatically increased. This study aimed to determine emergency physicians' retention of knowledge and skills after a brief training workshop on a focused ultrasound-guided approach to a patient presenting with undifferentiated shock, shortness of breath, and cardiac arrest in the emergency department of a tertiary care hospital. The secondary aim was to deliver the PoCUS-guided algorithmic approach to manage a patient presenting with undifferentiated shock, respiratory distress, and cardiac arrest in the emergency department. Methods: A quasi-experimental study was conducted with a single-day Point of Care Ultrasonographic Life Support in Emergency (PULSE) training workshop in October 2021 at the Aga Khan University Hospital, Karachi, Pakistan. A total of 32 participants attended the course, including twenty-one junior residents (PGY 1 and 2) and medical officers with experience of fewer than two years working in different emergency departments of urban tertiary care hospitals across Karachi, Pakistan. Pre- and post-assessment tools comprised a written examination, evaluating participants' knowledge and skills in ultrasound image acquisition and interpretation. Cronbach's alpha was used to calculate the validity of the tool. Results obtained before and after the training session were compared by the McNemar's test. A p value of ≤ 0.05 was considered significant. Results: There was a significant improvement in response to each question pre to post-test after completion of the course (Table 1). The significant change can be seen in questions 7, 8, 13, and 15, with a percentage change of 33.3, 80.9, 42.9, and 47.7. There was a significant improvement in the understanding and knowledge of participants after the training. The scores in the post-test were high compared to the pre-test in each category, i.e., respiratory distress (p < 0.017), cardiac arrest (p < 0.041), basic ultrasound knowledge (p < 0.001), and undifferentiated shock (p < 0.001). Conclusion: All participants showed improvement in their knowledge and confidence regarding using PoCUS in life-threatening conditions. Through this study, we have also developed an algorithmic approach to managing undifferentiated shock, respiratory failure, and cardiac arrest. Future studies must assess the effectiveness and feasibility of incorporating these algorithms into clinical practice. [ABSTRACT FROM AUTHOR]

Introduction: Hyperbaric chamber ventilation (HCV) refers to the intentional introduction of fresh gas, whether air, oxygen, or heliox, into a pressurised hyperbaric chamber in order to remove stale or otherwise compromised gas. The minimum required continuous HCV rate is usually determined by mathematical models derived from the contaminant mass balance within a well-stirred compartment. Non-uniform contaminant distribution patterns inside a hyperbaric chamber could emerge and invalidate the predictions of well-stirred models. Methods: Contaminant distribution was investigated inside a clinical hyperbaric chamber with the aim of comparing wellstirred model predictions with the actual contaminant concentration measurements. Results: Local ventilation effectiveness inside a clinical hyperbaric chamber may be compromised, leading to higher contaminant concentration values compared to the predictions of a mathematical model with a well-stirred assumption. Conclusions: A well-stirred assumption in mathematical models is a useful simplification that allows reasonably accurate estimates of HCV requirements. However, local ventilation effectiveness values in a particular hyperbaric chamber might vary, with the potential for hazardous contaminant accumulation in under-ventilated zones. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Despite all our dreams and enthusiasm, the essential question of whether our species can ever live permanently in space remains unanswered. the 1975 NASA Ames Design Study on Space Settlements demonstrated how human physiology constrains and determines human habitat design in space. Our scientific understanding about the risks of and standards for microgravity (and rotation rate if centrifugally generated), ionizing radiation, and atmosphere pressure and composition, remains inadequate a half century later. In addition, there are newly recognized physiological challenges to living safely in space, including spaceflight-associated neuro-ocular syndrome (SANS), extravascular hemolytic anemia, and other factors that affect every human cell and organ system. A comprehensive review was conducted to establish what we have learned and what is still required to know about the pathophysiology of long-term space travel and living in space since my first report in 1978. The results determine not only how, but if we can realistically plan to inhabit the cosmos that surrounds us. [ABSTRACT FROM AUTHOR]

Background: Acute kidney injury (AKI) and fluid overload (FO) are associated with poor outcomes in children receiving extracorporeal membrane oxygenation (ECMO). Our objective is to evaluate the impact of AKI and FO on pediatric patients receiving ECMO for cardiac pathology. Methods: We performed a secondary analysis of the six-center Kidney Interventions During Extracorporeal Membrane Oxygenation (KIDMO) database, including only children who underwent ECMO for cardiac pathology. AKI was defined using Kidney Disease: Improving Global Outcomes (KDIGO) creatinine criteria. FO was defined as < 10% (FO–) vs. ≥ 10% (FO +) and was evaluated at ECMO initiation, peak during ECMO, and ECMO discontinuation. Primary outcomes were mortality and length of stay (LOS). Results: Data from 191 patients were included. Non-survivors (56%) were more likely to be FO + than survivors at peak ECMO fluid status and ECMO discontinuation. There was a significant interaction between AKI and FO. In the presence of AKI, the adjusted odds of mortality for FO + was 4.79 times greater than FO– (95% CI: 1.52–15.12, p = 0.01). In the presence of FO + , the adjusted odds of mortality for AKI + was 2.7 times higher than AKI– [95%CI: 1.10–6.60; p = 0.03]. Peak FO + was associated with a 55% adjusted relative increase in LOS [95%CI: 1.07–2.26, p = 0.02]. Conclusions: The association of peak FO + with mortality is present only in the presence of AKI +. Similarly, AKI + is associated with mortality only in the presence of peak FO +. FO + was associated with LOS. Studies targeting fluid management have the potential to improve LOS and mortality outcomes. A higher resolution version of the Graphical abstract is available as Supplementary information. [ABSTRACT FROM AUTHOR]

Exploring austere environments required a reimagining of resource acquisition and utilization. Cyanobacterial in situ resources utilization (ISRU) and biological life support system (BLSS) bioreactors have been proposed to allow crewed space missions to extend beyond the temporal boundaries that current vehicle mass capacities allow. Many cyanobacteria and other microscopic organisms evolved during a period of Earth's history that was marked by very harsh conditions, requiring robust biochemical systems to ensure survival. Some species work wonderfully in a bioweathering capacity (siderophilic), and others are widely used for their nutritional power (non-siderophilic). Playing to each of their strengths and having them grow and feed off of each other is the basis for the proposed idea for a series of three bioreactors, starting from regolith processing and proceeding to nutritional products, gaseous liberation, and biofuel production. In this paper, we discuss what that three reactor system will look like, with the main emphasis on the nutritional stage. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate hemodynamic effects and resuscitation outcomes of simultaneous sternothoracic cardiopulmonary resuscitation (SST-CPR) with a prototype of a motor-driven automatic device, comparing to manual standard CPR (SCPR), in an animal model of ventricular fibrillation (VF). 20 male pigs were randomized to receive standard CPR (S-CPR group) or CPR with an automatic SST-CPR device (A-CPR group) after 5 minutes of VF. Five minutes of basic life support CPR was performed, followed by 10 minutes of advanced life support CPR. Hemodynamic variables including systolic blood pressure (SBP), diastolic blood pressure (DBP), coronary perfusion pressure (CPP), and end-tidal carbon dioxide tension (ETCO2), and resuscitation outcomes including rate of restoration of spontaneous circulation (ROSC) and 2-hour survival were compared between two groups. Ten animals among the A-CPR group and 8 animals among the S-CPR group were included in the final analysis. SBP was higher in the A-CPR group than in the S-CPR group during CPR (p = 0.046). The DBP, CPP and ETCO2 were not different between two groups (p = 0.412, 0.585, and 0.243, respectively). ROSC rate was 38% in the S-CPR group and 10% in the A-CPR group (p = 0.275). The 2-hour survival rate was 25% in the S-CPR group and 0% in the A-CPR group (p = 0.183). In a swine model of cardiac arrest, CPR with a prototype of a motor-driven automatic SST-CPR device, compared with standard CPR, produced higher systolic blood pressure, but there was no difference in diastolic pressure, coronary perfusion pressure, ROSC rate and 2-hour survival rate. [ABSTRACT FROM AUTHOR]

Copyright of China Journal of Oral & Maxillofacial Surgery is the property of Shanghai Jiao Tong University, College of Stomatology and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Textual is the property of Universidad Autonoma Chapingo and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Turkiye Klinikleri Journal of Medical Ethics-Law & History / Türkiye klinikleri tıp Etiği, Hukuku ve Tarihi Dergisi is the property of Turkiye Klinikleri and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Emergency Medical Service (EMS) systems have been well established and designed largely to cater to the needs of the cardiac and trauma related emergencies in adult patients. Paediatric emergencies are different; the benefits and outcomes of paediatric EMS have been assumed but without much evidence. With the emergence of paediatric and neonatal Advanced Life Support (ALS); it is imperative to have data that define the problems encountered in the prehospital care setting and also their outcome. This analysis may also provide insights into any modifications that may be required in the EMS system that exists to transport sick children. Aim: To characterise the paediatric prehospital care with emphasis on demography, presenting symptoms, treatment given, prehospital times, vitals monitoring and interventions done during EMS transport affiliated to Emergency Medical Service Agency. Materials and Methods: This descriptive cross-sectional study was conducted from July 2018 to June 2019 in Cheluvamba Hospital, a tertiary care referral teaching hospital attached to Mysore Medical College and Research Institute, Mysuru, India. The study included 147 children who were provided EMS by the 108 ambulance affiliated to the state/central government. Data pertaining to demography, presenting symptoms, vital sign monitoring, treatment given, various prehospital times, and interventions done during transport was obtained and analysed. Inpatient diagnosis with the duration of hospital stay and outcome in these childrens were also described. Results: Among the 147 children included; 3 were brought dead, hence the studied population comprised of 144 children. Amongst them, 42 were neonates and the remaining 102 belonged to the general paediatric population (older children). Overall, 61.8% were males and 57.64% hailed from a rural background. Mean ‘onscene’ time was 12.12±2.34 minutes and 5.50±5.01 minutes, and ‘transport time’ was 33.79±16.78 minutes, and 26.11±14.2 minutes for neonates and older children, respectively. Respiratory distress was the most common presenting symptom. The mean Heart Rate (HR, beats/min), Respiratory Rate (RR, cycles/min) and temperature (°C) in neonates was 129.86±27.91, 59.90±15.40 and 36.14±0.84 whereas in older children it was 112.81±28.39, 34.87±14.86, and 37.40±0.96, respectively. Mean systolic blood pressure (SBP mmHg) in children aged more than 10 years was 116.67±8.61. Of the 39 children aged more than 6 years, 36 (92.30%) had a Glasgow Coma Scale (GCS) between 13-15. The most common intervention done was administering oxygen in 84.02% (121/144) of children; 34.02% (49/144) of children were unstable at admission; 127 (88.2%) were discharged; remaining 17 (11.8%) succumbed to their illness. Onscene time of more than 15 minutes, transport time of more than 30 minutes and factors such as hypoxia, respiratory failure and shock at admission were significantly associated with mortality (p

Objective Extracorporeal membrane oxygenation (ECMO) is a relatively new technology used for life support in patients with cardiopulmonary failure from various causes. The objective of this study is to review the first 5-year experience in adopting this technology in a teaching hospital in southern Thailand. Methods The data of ECMO-supported patients in Songklanagarind Hospital, from the years 2014 to 2018, were retrospectively reviewed. Data sources were from electronic medical records and the database of the perfusion service. Parameters in focus included prior conditions and indications of ECMO, type of ECMO and cannulation method, complications during and after the treatment, and discharge statuses. Results A total of 83 patients received ECMO life support during the 5-year period and the number of cases per year increased. The proportion of venovenous: venoarterial ECMO in our institute was 49:34 cases and there were three cases who used ECMO as a part of cardiopulmonary resuscitation. Moreover, there were 57 cases who used ECMO for cardiac failure and 26 cases were for respiratory causes, while premature withdrawal was decided in 26 cases (31.3%). Overall survival from ECMO was 35/83 cases (42.2%) and survival to discharge was 32/83 (38.6%). During therapy, ECMO could restore serum pH to the normal range in all cases. Furthermore, those who used ECMO for respiratory failure had significantly higher survival probability (57.7%) when compared to the cardiac counterpart (29.8%, p-value = 0.03). Patients with younger ages also had significantly better survival outcomes. The most common complications were cardiac (75 cases, 85.5%), followed by renal (45 cases, 54.2%), and hematologic systems (38 cases, 45.8%). In those who survived to discharge, average ECMO duration was 9.7 days. Conclusion Extracorporeal life support is a technology that bridges the patients with cardiopulmonary failure to their recovery or definitive surgery. Despite the high complication rate, survival can be expected, especially in respiratory failure cases and relatively young patients.

Background and aimThere are no investigations on hand hygiene during cardiopulmonary resuscitation (CPR), even though these patients are at high risk for healthcare-associated infections. We aimed to evaluate the number of indicated hand hygiene per CPR case in general and the fraction that could be accomplished without delay for other life-saving techniques through standardized observations.Materials and methodsIn 2022, we conducted Advanced Cardiovascular Life Support (ACLS) courses over 4 days, practicing 33 ACLS case vignettes with standard measurements of chest compression fractions and hand hygiene indications. A total of nine healthcare workers (six nurses and three physicians) participated.ResultsA total of 33 training scenarios resulted in 613 indications for hand disinfection. Of these, 150 (24%) occurred before patient contact and 310 (51%) before aseptic activities. In 282 out of 310 (91%) indications, which have the highest impact on patient safety, the medication administrator was responsible; in 28 out of 310 (9%) indications, the airway manager was responsible. Depending on the scenario and assuming 15 s to be sufficient for alcoholic disinfection, 56–100% (mean 84.1%, SD ± 13.1%) of all indications could have been accomplished without delaying patient resuscitation. Percentages were lower for 30-s of exposure time.ConclusionTo the best of our knowledge, this is the first study investigating the feasibility of hand hygiene in a manikin CPR study. Even if the feasibility is overestimated due to the study setup, the fundamental conclusion is that a relevant part of the WHO indications for hand disinfection can be implemented without compromising quality in acute care, thus increasing the overall quality of patient care.

Background: Due to the COVID-19 pandemic, Basic Life Support (BLS) training has been limited to compression-only or bag–mask ventilation. The most breathable nanofiber respirators carry the technical possibility for inflation of the mannequin. The aim of this study was to assess the efficacy of mouth-to-mouth breathing through a FFP2 respirator during BLS. Methods: In the cross-over simulation-based study, the medical students performed BLS using a breathable nanofiber respirator for 2 min on three mannequins. The quantitative and qualitative efficacy of mouth-to-mouth ventilation through the respirator in BLS training was analyzed. The primary aim was the effectivity of mouth-to-mouth ventilation through a breathable respirator. The secondary aims were mean pause, longest pause, success in achieving the optimal breath volume, technique of ventilation, and incidence of adverse events. Results: In 104 students, effective breath was reached in 951 of 981 (96.9%) attempts in Adult BLS mannequin (Prestan), 822 of 906 (90.7%) in Resusci Anne, and 1777 of 1857 (95.7%) in Resusci Baby. In Resusci Anne and Resusci Baby, 28.9%/15.9% of visible chest rises were evaluated as low-, 33.0%/44.0% as optimal-, and 28.8%/35.8% as high-volume breaths. Conclusions: Mouth-to-mouth ventilation through a breathable respirator had an effectivity greater than 90%. [ABSTRACT FROM AUTHOR]

Background: Extracorporeal membrane oxygenation (ECMO) has been widely used as a life support for different kinds of acute cardiopulmonary dysfunction. The present study aimed at presenting the global trend of the top 100 cited original studies related to ECMO., Methods: Bibliometric analysis was the primary methodology for this study. Literature data were collected from Web of Science Core Collection (WoSCC). Indicators were analyzed and visualized by Excel and VOSviewer, the study design, study population, study topic, journal impact factor (IF), Category Rank and Category Quartile, author, country, journal and keywords were included., Results: The top 100 cited articles were published between 1979 and 2021. With 19 publications, 2020 was the most prolific year. High-income countries or regions, such as the United States of America (USA), France and Canada owned a majority of the articles. Seventeen studies were randomized trials, 52 were finished in single center, and 53 focused on adults. The 100 articles were documented by 31 different journals. The journals were well recognized, with a mean IF 2022 of 28.77, a median of 8.8, and a range of 1.6-168.9. The major diseases were viral infection of respiratory system, acute respiratory distress syndrome (ARDS) or respiratory failure, pulmonary hypertension of infants, heart failure/cardiogenic shock, diaphragmatic hernia and cardiac arrest. Specifically, coronavirus disease 2019 (COVID-19) accounted for 72.7% of viral infections. The disease spectrum changed from congenital cardiopulmonary dysfunction to cardiac arrest, ARDS and cardiopulmonary failure, and to severe COVID infection cases. Another fresh hotspot is immune dysfunction., Conclusions: This bibliometric analysis identified 100 most frequently cited original studies on ECMO and described their characteristics, which may help with further investigations., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jtd.amegroups.com/article/view/10.21037/jtd-24-597/coif). The authors have no conflicts of interest to declare., (2024 AME Publishing Company. All rights reserved.)

Background Despite clear definitions of brain death, students and medical professionals may have varying understandings. This study investigated the knowledge and attitudes of medical students regarding brain death. Methods A cross-sectional survey was administered to 142 fourth-year medical students at Umm Al-Qura University. The survey used single-choice and Likert scale questions to assess knowledge of brain death definition, diagnosis procedures, and student attitudes. Prior to administration, the questionnaire underwent content validation by experts in medicine, ethics, and public health. Results A significant proportion of students lacked knowledge of the legal definition of brain death in Saudi Arabia (26.1%), brain death diagnostic procedures (43.7%), and prerequisites for declaring brain death (38%). While some students expressed confidence in diagnosing brain death, concerns about misdiagnosis were also present. Conclusion Fourth-year medical students in this study demonstrated significant knowledge gaps regarding brain death. Medical education programs may need to be revised to provide more comprehensive training on brain death and its implications. Additionally, public awareness campaigns could improve understanding and facilitate informed decision-making about organ donation. Further research, including multicenter studies, is warranted to confirm these findings and guide educational interventions., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Umm Al-Qura University Biomedical Research Ethics Committee issued approval HAPO-02-K-012-2024-06-2182. The committee reviewed and approved the research protocol in accordance with the ethical standards set forth by the university and the guidelines of the National Committee for Medical and Biological Ethics. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Basubrain et al.)

Exploration of space has always held a certain fascination for humankind. Stepping foot on the Moon may have been the achievement of the century, and sending humans to Mars will be even more challenging and exciting. To achieve self-sufficiency off the Earth, humans will need a steady supply of food while also maintaining adequate mental health. We propose here a closed-loop ecosystem that accomplishes both while being feasible to transport, construct, and maintain on Mars. The resulting design, MarsGarden, is capable of providing a crew of four astronauts with all their dietary needs and also acting as a place of relaxation and restoration. MarsGarden is a scalable architecture that can be adapted to many deep space environments, or can be implemented on Earth as an agricultural solution for areas with land scarcity or extreme environments. • Sustained life on Mars will require the ability to grow food. • A hydroponics-based greenhouse offers a viable option for food production on Mars. • MarsGarden is designed to maximize food production in a constrained space. • MarsGarden improves the psychological wellbeing of astronauts on Mars. [ABSTRACT FROM AUTHOR]

Critical infrastructure services determine where people can survive and what they can do with their survival. This fact conditions political possibilities at a fundamental level but remains underexplored in the literature. Those who wish to extend the boundaries of political action, or to win protections and the possibility of a new political community for themselves and others, should focus a substantial part of their energies and attention on developing alternative infrastructure systems for supporting human life. Without such systems, political action – no matter how revolutionary or ingenious – will ultimately find itself constrained by its position within the zones of survivability established by existing forms of infrastructure and by the hierarchies and configurations of power linked with those forms of infrastructure. As a result, those who wish to change current political and economic conditions should think of the capacity to take care of everyone as a condition for such change rather than its result. [ABSTRACT FROM AUTHOR]

AimHuman factors are essential for high-quality resuscitation team collaboration and are, therefore, taught in international advanced life support courses, but their assessment differs widely. In Europe, the summative life support course assessment tests mainly adhere to guidelines but few human factors. This randomized controlled simulation trial investigated instructors’ and course participants’ perceptions of human factors assessment after two different summative assessments.MethodsAll 5th/6th-year medical students who attended 19 advanced life support courses according to the 2015 European Resuscitation Council guidelines during one study year were invited to participate. Each course was randomized to either: (1) Simulated team assessment (one instructor simulates a team, and the assessed person leads this “team” through a cardiac-arrest scenario test); (2) Real team assessment (4 students form a team, one of them is assessed as the team leader; team members are not assessed and act only on team leader’s commands). After the summative assessments, instructors, and students rated the tests’ ability to assess human factors using a visual analog scale (VAS, 0 = no agreement, 10 = total agreement).ResultsA total of 227 students participated in the 1-day Immediate Life Support courses, 196 students in the 2-day Advanced Life Support courses, additionally 54 instructors were included. Instructors judged all human factors significantly better in real team assessments; students rated leadership and situational awareness comparable between both assessments. Assessment pass rates were comparable between groups.ConclusionSummative assessment in real teams was perceived significantly better to assess human factors. These results might influence current summative assessment practices in advanced life support courses.