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INTRODUCTION: Survival from refractory out of hospital cardiac arrest (OHCA) without timely return of spontaneous circulation (ROSC) utilising conventional advanced cardiac life support (ACLS) therapies is dismal. CHEER3 was a safety and feasibility study of pre-hospital deployed extracorporeal membrane oxygenation (ECMO) during cardiopulmonary resuscitation (ECPR) for refractory OHCA in metropolitan Australia. METHODS: This was a single jurisdiction, single-arm feasibility study. Physicians, with pre-existing ECMO expertise, responded to witnessed OHCA, age < 65 yrs, within 30 min driving-time, using an ECMO equipped rapid response vehicle. If pre-hospital ECPR was undertaken, patients were transported to hospital for investigations and therapies including emergent coronary catheterisation, and standard intensive care (ICU) therapy until either cardiac and neurological recovery or palliation occurred. Analyses were descriptive. RESULTS: From February 2020 to May 2023, over 117 days, the team responded to 709 "potential cardiac arrest" emergency calls. 358 were confirmed OHCA. Time from emergency call to scene arrival was 27 min (15-37 min). 10 patients fulfilled the pre-defined inclusion criteria and all were successfully cannulated on scene. Time from emergency call to ECMO initiation was 50 min (35-62 min). Time from decision to ECMO support was 16 min (11-26 min). CPR duration was 46 min (32-62 min). All 10 patients were transferred to hospital for investigations and therapy. 4 patients (40%) survived to hospital discharge neurologically intact (CPC 1/2). CONCLUSION: Pre-hospital ECPR was feasible, using an experienced ECMO team from a single-centre. Overall survival was promising in this highly selected group. Further prospective studies are now warranted.

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The subjects of this study were 22-year-old adults who had attended a special school for children with mental handicap. Since leaving school, they had dropped out of the mental handicap services. The subjects' leisure activities were compared with peers who had always attended regular classes as children. The subjects engaged in fewer types of activities than the comparisons and had fewer activities that involved interpersonal relations, especially with non-family peers. The size of these differences was influenced by marital status.

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To evaluate the involvement of the mesolimbic and nigrostriatal dopaminergic systems in hyperactivity in offspring of nicotine-treated dams, timed-pregnant Sprague-Dawley rats were implanted SC on gestational day 4 with osmotic minipumps to receive saline or nicotine (3 or 6 mg/kg/day) for 16 days. Hyperactive and nonhyperactive male offspring of nicotine-treated dams as well as nonhyperactive offspring of saline-treated dams were selected and sacrificed at day 22 postnatally. Discrete brain areas (the nucleus accumbens [NAcc], striatum [STR], frontal cortex [FC], ventral tegmental area [VTA], and substantia nigra [SN]) were microdissected for the evaluation of dopamine (DA) concentration and/or the D2 receptor subtype. Dopamine concentration was decreased in the VTA and STR but was increased in the SN of the hyperactive offspring. The reduction in striatal DA level was associated with a reduction in the number of D2 receptors in that area. The data suggest a role for the VTA and striatal dopaminergic system in offspring hyperactivity.

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Leisure activities were examined for young adults with mild mental retardation. Some had disappeared from mental retardation services after leaving school; others were in adult day services. Peers without mental retardation (comparison subjects) were also included. Various leisure activities were combined using cluster analysis. Some adults with mental retardation and some comparison subjects were found in each of the 13 clusters obtained but proportions varied. Leisure patterns were strongly influenced by gender and marital status as well as mental retardation, except for one cluster, Socially Isolated, Impoverished, where there were more adults with mental retardation, irrespective of gender and marital status.

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Data covering a 15-year period on the health, behavior, and functioning of a representative population of families of children with mental retardation and comparison children were used in cluster analysis to obtain relatively homogeneous groupings of families. Only a small minority of families of children with mental retardation did not cluster together with comparison families. More than a third functioned well and had a middle-class orientation; less than a third functioned poorly. A few clusters had ambiguous configurations, but most were easily understood and conformed generally to expectations in validation analyses.

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A wide range of DNA damage is known to be caused by reactive oxygen species (ROS). Defence against the effects of such damage include damage prevention (e.g. antioxidant activity) and the removal of damaged moieties from DNA (DNA repair). Radiation (X-ray) sensitive murine lymphoma (LY) cells were seen to be more susceptible to ROS-induced damage than were radiation resistant cells. This difference was unlikely to be due to the marginally decreased DNA excision repair capacity of the sensitive cells. Radiation sensitive cells did, however, have lower endogenous antioxidant enzyme levels. Thus, the importance of assessing all levels of a cell's response to ROS, in determining the major factors leading to increased mutagen sensitivity, is emphasised.

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The cumulative risk of seizures and epilepsy was investigated in a prospectively identified cohort of 221 children with mental retardation (MR) born between 1951 and 1955 in Aberdeen, Scotland. By age 22 years, 33 (15%) had epilepsy. An additional 16 (7%) had had at least one seizure, but did not meet the criteria for epilepsy. The cumulative risk of epilepsy was 9, 11, 13, and 15% at 5, 10, 15, and 22 years, respectively. In children with MR and no associated disabilities, the cumulative risk of epilepsy was only 2.6, 3.2, 3.9, and 5.2% at 5, 10, 15, and 22 years. In children with MR and cerebral palsy (CP), the cumulative risk was 28, 31, and 38% at 5, 10, and 22 years. Children with a postnatal injury associated with MR had a cumulative risk of epilepsy of 53, 66, and 66% at 5, 10, and 15 years after the injury. By age 22 years, 39% had achieved 5-year seizure-free remission, including 56% of children with MR without associated disability, 47% of children with MR and CP, and 11% of children with a postnatal injury. We conclude that, in the absence of associated disability or postnatal injury, the risk of epilepsy in the retarded population is low. Epilepsy in this population also will frequently enter remission in later life.

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The lack of a clear definition of mental retardation in many studies and the lack of a description of the methods used in selecting subjects make it difficult to determine to whom the results apply. A review of prevalence studies of MR in childhood shows that over the past 30 years there has been a trend of decreasing rates. Reasons are suggested to explain these falling prevalence rates. Adult prevalence rates were lower than childhood rates and reasons are suggested for this drop. Factors needing consideration in future studies are suggested.

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The South Carolina Department of Health and Environmental Control has developed and tested several quality assessment tools over the last 7 years to assess both the administration and direct delivery of patient education services. The most recent system covers three aspects of patient education: environment, materials and personal interaction. Practical assessment tools, methods of introducing them into clinic settings, and areas of possible resistance are discussed.

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Socializing with peers and opposite-sex relationships were examined in two subsets of a mildly mentally retarded (MMR) young adult population living in the community: those who were no longer receiving MR services and those who were attending day centres for MR adults. The MMR young people not receiving services had fewer best friends and socialized significantly less often than a nonretarded comparison population. The MMR males not receiving services also had fewer opposite-sex relationships than comparisons but this difference was not significant for the females. At age 22, these MMR young people continued to see friends from school significantly less often than comparisons, indicating a possible detrimental effect of special schooling on later socializing with peers. The MMR young people at the day centres socialized more often but this was done almost wholly with others who were MR. Within the MMR study population, the young women not receiving services socialized with peers the least, less than the young women at the day centres and less than the young men not receiving services, but they were married most often.

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Job histories were obtained for a population of young adults with mental retardation. No one with IQ less than 50 had been in open employment. Persons with mild mental retardation (n = 100) who received no adult services were compared to peers who were not retarded (n = 52) who left school without academic qualifications on a variety of job measures (e.g., unemployment, time out of the labor force, job turnover, level of job skill, and take-home pay). Among the 54 subjects with IQs of 50 or more who received adult services, approximately half had some open employment. Our results provide a less optimistic picture than that given by reviewers of previous research.

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Marriage was examined in a total population of mentally retarded young adults born in a 5-year period. No one with severe retardation had married. Among the mildly retarded, significantly fewer young people had married by age 22 than in a nonretarded comparison population, and the retarded young people who had married had significantly higher IQs than the remainder of the mildly retarded population. The retarded females had significantly more problems in their marriages than nonretarded comparisons. Nevertheless, the marriages of almost half the mildly retarded young women appeared to be working out well. The retarded young men were not significantly different from nonretarded comparisons. Marriages in which both partners were retarded had many problems.

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A consistent finding in epidemiological studies of mild mental retardation (MMR) is a somewhat higher prevalence of boys than girls. Our own study in Aberdeen agreed with these findings. Examination of the numbers of boys and girls at different levels of retardation within our study population revealed the greatest excess at the highest IQ levels of greater than or equal to 75. This was found to be true in other studies as well. Since this IQ range is above the generally agreed upon cut-off point used to classify children as MMR, these findings suggest that boys remaining in regular classes may be having more difficulty in school performance than girls. Possible reasons for this are examined.

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Behavior disturbance was found to be more frequent among mildly retarded (MMR) than a group of young adults matched during childhood for age, sex and social class. Reasons for this were examined. An unstable environment in childhood was found to be significantly related to behavior disturbance in both MMR and controls. The greater frequency of behavior disturbance among the MMR was due to their more frequently experiencing unstable environments in childhood than comparisons. Further, when stability of upbringing was held constant, differences in behaviour disturbance between the two groups were no longer found. Central nervous system damage was found not to be a contributory factor.

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Many epidemiological studies of mental retardation have shown a higher prevalence of boys than girls. Data were reviewed from various studies consistently showing that the highest male/female ratios are found at the upper end of the IQ range for children classified as mentally retarded. One reason for this may be that boys with IQs at the upper end of this range have greater difficulty than girls in meeting the requirements of school performance. Factors that may cause boys to experience more difficulties than girls in the early school years were reviewed.

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A year-by-year analysis up to age 22 was carried out of the numbers of males and females in a birth cohort receiving mental retardation services in a British city. A slight excess of males was found during childhood, with the largest excess occurring at the upper end of the IQ range, the borderline area for classifying children as mentally retarded. There was also a large male excess found in residential care at each age. During the young adult years, this predominance of males in residential care was offset by an excess of females attending day care centres, leading to almost equality of numbers of males and females receiving some sort of services during this period. Possible explanations for the findings were discussed.

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