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Objective The "Trial of Continuous (CCC) or Interrupted Chest Compressions (ICC) during Cardiopulmonary Resuscitation (CPR)" compared two CPR strategies for out-of-hospital cardiac arrest (OHCA). Although results were neutral, there was suggestion of benefit for ICC. However, nearly 50% of study patients had a protocol violation; regional variations may have played a role in protocol adherence and outcomes. We analyzed our British Colombia (BC) cohort to decide whether a protocol change from CCC to ICC was justified. Methods This was a post-hoc analysis of BC-enrolled study patients. The primary between-group comparison was favorable neurological outcome (modified Rankin scale ≤ 3) using intention-to-treat. Secondary analyses compared those treated per-protocol (adjusted) and the top compliant clusters (unadjusted). We classified protocol violations using a structured algorithm. We used logistic regression and computed the difference in probabilities using the marginal standardization method with bootstrapping to calculate confidence intervals. Results There were 3769 patients included, with a median age of 69 years (IQR: 56-80). There were protocol violations in 3.2% of those in the CCC group and 27% of those in the ICC group. In patients randomized to CCC or ICC, 11.2% and 10.8% (risk difference 0.42%; 95% CI -1.58, 2.41) had favorable neurological outcomes, respectively. In the per-protocol and top compliant clusters comparisons, risk differences were 0.25% (95% CI -1.70, 2.25) and 2.95% (95% CI -0.68, 6.58). Conclusion Our comparisons suggest that CCC may be the preferred strategy in our region and is likely not resulting in worse outcomes. Based on the original study and our local analysis, we found no compelling reasons to change our local strategy from CCC to ICC.

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BACKGROUND: British Columbia (BC) Emergency Health Services implemented a strategy to improve outcomes for out-of-hospital cardiac arrest (OHCA), focusing on paramedic-led high-quality on-scene resuscitation. We measured changes in care metrics and survival trends. METHODS: This was a post-hoc study of prospectively identified consecutive non-traumatic ambulance-treated adult OHCAs from 2006 to 2016 within BC's four metropolitan areas. The primary outcome was survival to hospital discharge; we also described available favourable neurological outcomes (mRS ≤3). We tested the significance of year-by-year trends in baseline characteristics, and calculated risk-adjusted survival rates using multivariable Poisson regression. RESULTS: We included 15 145 patients. In univariate analyses there were significant increases in bystander CPR, chest compression fraction, advanced life support attendance, duration of resuscitation until advanced airway placement, duration of resuscitation until termination, and overall scene time. There was a significant decrease in initial shockable rhythms, bystander witnessed arrests, and transports initiated prior to ROSC. Survival and the proportion of survivors with favourable neurological outcomes increased significantly. In adjusted analyses, there was an improvement in return of spontaneous circulation (risk-adjusted rate 41% in 2006 to 51% in 2016; adjusted rate ratio per year 1.02, 95% CI 1.01-1.02, p < 0.01 for trend) and survival at hospital discharge (risk-adjusted rate 8.6% in 2006 to 16% in 2016; adjusted rate ratio per year 1.05, 95% CI 1.04-1.06, p < 0.01 for trend). CONCLUSION: From 2006 to 2016 BC's provincial ambulance system prioritized paramedic-led on-scene resuscitation, during which time there were significant improvements in patient outcomes. Our data may assist other systems, providing a model for prehospital resuscitation quality improvement.

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Over the last decade, international donors, technical specialists, and governments have come to recognize the potential of community-based organizations (CBOs) in the fight against HIV/AIDS. Recent empirical studies suggest that community engagement, including the involvement of CBOs, adds value to the national response to HIV/AIDS. With the emerging evidence of the effectiveness of engaging communities in the fight against AIDS, it is crucial to understand the economic dimension of community engagement. This article provides an analysis of funding and expenditure data collected from CBOs in three African countries: Kenya, Nigeria, and Zimbabwe. It presents descriptive information regarding CBO funding and expenditure and examines the factors associated with the total amount of funds received and with the proportions of the funds allocated to programmatic activities and program management and administration. An average CBO in the sample received US$29,800 annually or about US$2480 per month. The highest percentage of CBO funding (37%) came from multilateral organizations. CBOs in the sample spent most of their funds (71%) on programmatic activities including provision of treatment, support, care, impact mitigation, and treatment services.

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OBJECTIVE: Social isolation is a common problem in older people who move into care that has negative consequences for well-being. This is of particular concern for men, who are marginalised in long-term care settings as a result of their reduced numbers and greater difficulty in accessing effective social support, relative to women. However, researchers in the social identity tradition argue that developing social group memberships can counteract the effects of isolation. We test this account in this study by examining whether increased socialisation with others of the same gender enhances social identification, well-being (e.g. life satisfaction, mood), and cognitive ability. METHOD: Care home residents were invited to join gender-based groups (i.e. Ladies and Gentlemen's Clubs). Nine groups were examined (five male groups, four female groups) comprising 26 participants (12 male, 14 female), who took part in fortnightly social activities. Social identification, personal identity strength, cognitive ability and well-being were measured at the commencement of the intervention and 12 weeks later. RESULTS: A clear gender effect was found. For women, there was evidence of maintained well-being and identification over time. For men, there was a significant reduction in depression and anxiety, and an increased sense of social identification with others. CONCLUSION: While decreasing well-being tends to be the norm in long-term residential care, building new social group memberships in the form of gender clubs can counteract this decline, particularly among men.

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The combined use of electrokinetic remediation and phytoremediation to decontaminate soil polluted with heavy metals has been demonstrated in a laboratory-scale experiment. The plants species selected were rapeseed and tobacco. Three kinds of soil were used: un-contaminated soil from forest area (S1), artificially contaminated soil with 15mgkg(-1) Cd (S2) and multi-contaminated soil with Cd, Zn and Pb from an industrial area (S3). Three treatment conditions were applied to the plants growing in the experimental vessels: control (no electrical field), alternating current electrical field (AC, 1Vcm(-1)) and direct current electrical field (DC, 1Vcm(-1)) with switching polarity every 3h. The electrical fields were applied for 30d for rapeseed and 90d for tobacco, each experiment had three replicates. After a total of 90d growth for rapeseed and of 180d for tobacco, the plants were harvested. The pH variation from anode to cathode was eliminated by switching the polarity of the DC field. The plants reacted differently under the applied electrical field. Rapeseed biomass was enhanced under the AC field and no negative effect was found under DC field. However, no enhancement of the tobacco biomass under the AC treatment was found. The DC field had a negative influence on biomass production on tobacco plants. In general, Cd content was higher in both species growing in S2 treated with AC field compared to the control. Metal uptake (Cd, Cu, Zn and Pb) per rapeseed plant shoot was enhanced by the application of AC field in all soils.

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Concepts and constructions of resilience have assumed a significant position in contributing to understandings of the psychosocial development of children and young people. This paper examines how concepts of resilience are constructed within the literature, and then explores social workers' perceptions and use of resilience with young people who were 'looked after' or at risk of becoming 'looked after'. It addresses the interface between social workers' views and understandings of the emotional health needs of their clients, and the responsiveness of accompanying service interventions. Using the Framework for Assessment as a platform for discussion, 32 semistructured interviews were conducted with 19 social workers relating to a purposive sample of 52 children and young people (31 boys and 21 girls). Social workers experienced difficulty in conceptualizing resilience, often providing cursory, general or non-expert explanations. Furthermore, social workers described all children and young people within the sample as being resilient, drawing only upon face-value observations to evidence this. Related to this was the low frequency of social workers' reports of children and young people's mental health difficulties and the concomitant low referral rate to secondary tier services. The authors argue that social workers' optimistic perceptions of the resilience of children and young people within this sample, alongside their positive appraisal of their emotional needs, impact on the interventions that are put in place. The paper concludes that the tendency of social workers to project optimism onto their client base calls our attention to a possible transference of the collective need for the social work department itself to be resilient within that local authority.

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