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Background/Aims: Limited bystander assistance and delayed emergency medical service arrival reduce the chances of survival in cardiac arrest victims. Early basic life support through trained first responders (FR) and automatic external defibrillation both improve the outcome. Well-organized FR networks have shown promise, but guidance on effective implementation is lacking. This study evaluates two FR networks, in Belgium and in Switzerland, to identify main advancements in the development of such systems. Method: Direct comparison is made of the barriers and facilitators in the development of both FR systems from 2006 up until December 2022, and summarized within a roadmap. Results: The Roadmap comprises four integral steps: exploration, installation, initiation, and implementation. Exploration involves understanding the national legislation, engaging with advisory bodies, and establishing local steering committees. The installation phase focuses on FR recruitment, engaging specific professional groups such as firemen, registering public Automated External Defibrillators (AEDs), and requesting feedback. The initiation step includes implementing improvement cycles and fidelity measures. Finally, implementation expands the network, leading to increased survival rates and the integration of these practices into legislation. A significant focus is placed on FR's psychological wellbeing. Moreover, the roadmap highlights the use of efficient geo-mapping to simplify optimal AED placement and automatically assign FRs to tasks. Conclusion: The importance of FR networks for early resuscitation is increasingly recognized and various systems are being developed. Key developmental strategies of the EVapp and Ticino Cuore app system may serve as a roadmap for other systems and implementations within Europe and beyond.
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BACKGROUND: EVapp (Emergency Volunteer Application) is a Belgian smartphone application that mobilizes volunteers to perform cardiopulmonary resuscitation (CPR) and defibrillation with publicly available automatic external defibrillators (AED) after an emergency call for suspected out of hospital cardiac arrest (OHCA). The aim is to bridge the time before the arrival of the emergency services. METHODS: An accessible model was developed, using literature data, to simulate survival and cost-effectiveness of nation-wide EVapp implementation. Initial validation was performed using field data from a first pilot study of EVapp implementation in a city in Flanders, covering 2.5 years of implementation. RESULTS: Simulation of nation-wide EVapp implementation resulted in an additional yearly 910 QALY gained over the current baseline case scenario (worst case 632; best case 3204). The cost per QALY associated with EVapp implementation was comparable to the baseline scenario, i.e., 17 vs 18 k QALY-1. CONCLUSIONS: EVapp implementation was associated with a positive balance on amount of QALY gained and cost of QALY. This was a consequence of both the lower healthcare costs for patients with good neurological outcome and the more efficient use of yet available resources, which did not outweigh the costs of operation.
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Hops is an almost unique source of the potent phytoestrogen 8-prenylnaringenin (8-PN). As hops contain only low levels of 8-PN, synthesis may be more attractive than extraction. A strain of the Gram-positive Eubacterium limosum was isolated previously for 8-PN production from more abundant precursor isoxanthohumol (IX) from hops. In this study, spent hops, an industrial side stream from the beer industry, was identified as interesting source of IX. Yet, hop-derived compounds are well-known antibacterial agents and the traces of a large variety of different compounds in spent hops interfered with growth and IX conversion. Critical factors to finally enable bacterial 8-PN production from spent hops, using a food and feed grade medium, were evaluated in this research. The use of bacterial resting cells and complex medium at a pH of 7.8-8 best fulfilled the requirements for 8-PN production and generated a solid basis for development of an economic process.
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Micro-organisms are often subjected to stressful conditions. Owing to their capacity to adapt, they try to rapidly cope with the unfavorable conditions by lowering their growth rate, changing their morphology, and developing altered metabolite production and other stress-related metabolism. The stress-related metabolism of the cells which interrupted their growth is often referred to as resting metabolism and can be exploit for specific and high rate production of secondary metabolites. Although the bacterial resting cell process has been described decades ago, we find it worthwhile to bring the process under renewed attention and refer to this type of processes as non-growing metabolically active (NGMA) cell processes. Despite their use may sound counterproductive, NGMA cells can be of interest to increase substrate conversion rates or enable conversion of certain substrates, not accessible to growing cells due to their bacteriostatic nature or requirement of resistance to a multitude of different stress mechanisms. Biomass reuse is an interesting feature to improve the economics of NGMA cell processes. Yet, for lipophilic compounds or compounds with low solubility, biomass separation can be delicate. This review draws the attention on existing examples of NGMA cell processes, summarizing some developmental tools and highlighting drawbacks and opportunities, to answer the research question if NGMA cells can have a distinct added value in industry. Particular elaboration is made on a novel and more broadly applicable strategy to enable biomass reuse for conversions of compounds with low solubility.