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Noninvasive in situ monitoring of viscoelastic characteristics of corneal tissue at elevated temperatures is pivotal for mechanical property-informed refractive surgery techniques, including thermokeratoplasty and photorefractive keratectomy, requiring precise thermal modifications of the corneal structure during these surgical procedures. This study harnesses Brillouin light scattering spectroscopy as a biosensing platform to noninvasively probe the viscoelastic properties of ovine corneas across a temperature range of 25-64 °C. By submerging the tissue samples in silicone oil, consistent hydration and immiscibility are maintained, allowing for their accurate sensing of temperature-dependent mechanical behaviors. We identify significant phase transitions in the corneal tissue, particularly beyond 40 °C, likely due to collagen unfolding, marking the beginning of thermal destabilization. A subsequent transition, observed beyond 60 °C, correlates with collagen denaturation. These phase transformations highlight the cornea's sensitivity to both physiologically reversible and irreversible viscoelastic changes induced by mild to high temperatures. Our findings underscore the potential of the Brillouin biosensing technique for real-time diagnostics of corneal biomechanics during refractive surgeries to attain optimized therapeutic outcomes.

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BACKGROUND: Effective education is considered by the American Heart Association (AHA) as a vital variable in improving outcomes of cardiac arrest. Studies have shown that the level of knowledge and attitude of non-healthcare providers towards resuscitation training varies widely across the globe. While some training methods and barriers to training have been discussed, the literature is still quite vague and unclear regarding resuscitation training, particularly in the Middle East. This study's focus on the efficacy of resuscitation training in this region of the world may help dictate how to better implement education initiatives aimed towards non-healthcare providers in developing countries. METHODOLOGY: A systematic review and meta-analysis were conducted on studies published from inception until March 2023. Observational studies assessing CPR knowledge and skills among non-healthcare workers in Arab countries were included. Data were extracted from PubMed, Cochrane Library, EMBASE, Web of Science, and Scopus. Data analysis was performed using Rstudio with a random effects model. RESULTS: 50 studies were included in this review and meta-analysis, revealing that 55% of participants had prior knowledge of CPR, while only 28% considered their knowledge sufficient. The majority (76%) supported mandatory CPR training, and 86% were willing to attend training if offered. This study found that prior knowledge of cardiopulmonary resuscitation (CPR) varied among populations. This meta-analysis also compiled results regarding CPR technique defined by correct compression to ventilation ratio, compression depth, compression rate, location of chest compression, and correct sequence. The overall results from this meta-analysis showed that, of these factors, compression rate and depth were the two factors that were most often administered incorrectly. In all, the results from this study demonstrated that CPR training in Arab countries was favorably viewed overall, with the majority of participants indicating both support for mandatory CPR training and general willingness to attend training if offered the opportunity. CONCLUSION: Given the overall positive view and willingness to learn CPR skills, healthcare policy makers should adopt a more comprehensive focus on strategies that enhance the accessibility and opportunity for CPR training for non-healthcare populations in Arab countries. Future training programs should implement strategies to highlight the ideal combination of compression rates and depth to learners to ensure correct and efficacious delivery of CPR with increased focus on the practical portion during refresher courses to promote retention.

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The aim of this study was to develop and evaluate bilosomes loaded with Celecoxib (CXB) for the efficient treatment of Alzheimer. The thin-film hydration approach was utilized in the formulation of CXB bilosomes (CXB-BLs). The study used a 23-factorial design to investigate the impact of several formulation variables. Three separate parameters were investigated: bile salt type (X1), medication amount (X2), and lipid-bile salt ratio (X3). The dependent responses included entrapment efficiency (Y1: EE %), particle size (Y2: PS), and zeta potential (Y3: ZP). The formulation factors were statistically optimized using the Design-Expert® program. The vesicles demonstrated remarkable CXB encapsulation efficiency, ranging from 94.16 ± 1.91 to 98.38 ± 0.85%. The vesicle sizes ranged from 241.8 ± 6.74 to 352 ± 2.34 nm. The produced formulations have high negative zeta potential values, indicating strong stability. Transmission electron microscopy (TEM) revealed that the optimized vesicles had a spherical form. CXB release from BLs was biphasic, with the release pattern following Higuchi's model. In vivo studies confirmed the efficiency of CXB-BLs in management of lipopolysaccharide-induced Alzheimer as CXB-BLs ameliorated cognitive dysfunction, decreased acetylcholinesterase (AChE), and inhibited neuro-inflammation and neuro-degeneration through reducing Toll-like receptor (TLR4), and Interleukin-1ß (IL-1ß) levels. The findings suggested that the created CXB-BLs could be a potential drug delivery strategy for Alzheimer's treatment.

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Background: Education for the lay public in basic life support (BLS) is critical for increasing bystander cardiopulmonary resuscitation (CPR) rates and improving survival from out-of-hospital cardiac arrest (OHCA). Despite years of implementation, the BLS training rate in China has remained modest. The aim of this study was to investigate the factors influencing the implementation of BLS training programs in emergency medical service (EMS) centers in China and to identify specific barriers and enablers. Methods: Qualitative interviews were conducted with key informants from 40 EMS centers in Chinese cities. The participants included 11 directors/deputy directors, 24 training department leaders, and 5 senior trainers. The interview guide was based on the Exploration, Preparation, Implementation, Sustainment (EPIS) framework. Thematic content analysis was used to identify themes and patterns across the interviews. Results: We identified 16 factors influencing the implementation of BLS training programs encompassing the outer content, inner context, innovation and bridging factors. Some factors acted as either barriers or enablers at different EPIS stages. The main implementation barriers included limited external leadership, insufficient government investment, low public awareness, a shortage of trainers, an absence of incentives, an absence of authoritative courses and guidelines, a lack of qualification to issue certificates, limited academic involvement, and insufficient publicity. The main enablers were found to be supportive government leaders, strong public demand, adequate resources, program champions, available high-quality courses of high fitness within the local context, the involvement of diverse institutions, and effective publicity and promotion. Conclusion: Our findings emphasize the diversity of stakeholders, the complexity of implementation, and the need for localization and co-construction when conducting BLS training for lay public in city EMS centers. Improvements can be made at the national level, city level, and EMS institutional level to boost priority and awareness, promote legislation and policies, raise sustainable resources, and enhance the technology of BLS courses.

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Background: Basic life support (BLS) is a life-saving link in the out-of-hospital cardiac arrest chain of survival. Most members of the public are capable of providing BLS but are more likely to do so confidently and effectively if they undertake BLS training. Lay members of the public comprise diverse and specific populations and may benefit from tailored BLS training. Data on this topic are scarce, and it is completely unknown if there are any benefits arising from tailored courses or for whom course adaptations should be developed. Methods: The primary objective of this scoping review was to identify and describe differences in patient, clinical, and educational outcomes when comparing tailored versus standard BLS courses for specific layperson populations. This review was undertaken as part of the continuous evidence evaluation process of the International Liaison Committee on Resuscitation. Results: A primary search identified 1307 studies and after title, abstract, and full-text screening, we included eight publications reporting on tailored courses for specific populations. There were no studies reporting direct comparisons between tailored and standardized training. Seven (88%) studies investigated courses tailored for individuals with a disability, and only one study covered another specific population group (refugees). Overall, the quality of evidence was low as the studies did not compare tailored vs. non-tailored approaches or consisted of observational or pre-post-designed investigations. Conclusions: Tailored BLS education for specific populations is likely feasible and can include such groups into the pool of potential bystander resuscitation providers. Research into comparing tailored vs. standard courses, their cost-to-benefit ratio, how to best adapt courses, and how to involve members of the respective communities should be conducted. Additionally, tailored courses for first responders with and without a duty to respond could be explored.

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Introduction The 2020 American Heart Association's (AHA) Basic Life Support (BLS) curriculum focuses on cardiac arrest resuscitation with one or two rescuers, providing only limited opportunities to develop higher-level skills such as leadership, communication, and debriefing. This mixed-methods pilot study evaluated whether supplementing the traditional Heartcode BLS course with a high-fidelity teamwork simulation session improved mastery of these higher-level skills. Methods Twenty-four first-year medical students completed the pilot training during sessions offered in February and May of 2023. The program included the traditional AHA Heartcode BLS course, which ranges from two to four hours, and includes both online and in-person skills components. This was followed by a 90-minute high-fidelity simulation session consisting of two simulated resuscitations separated by a student-led plus/delta debriefing. Facilitators then debriefed the entire activity. Students completed an anonymous online survey that used a 0-10 slider scale to attribute their perceived proficiency for specific skills to the initial BLS course or the teamwork simulations and provided qualitative feedback. Results Twenty-one students (87.5%) completed the follow-up survey. Students credited their proficiency in technical skills (e.g., "Chest Compressions") to both sessions equally, but proficiency in higher-level skills, such as leadership, communication, and teamwork, was predominantly credited to the simulation. Additionally, students reported that the teamwork simulation promoted realism and increased self-efficacy. Conclusion Team-based resuscitation simulations using high-fidelity equipment augmented the AHA BLS course by promoting perceived competence in team dynamics domains and increasing students' self-efficacy for participating in real hospital-based resuscitations. Studies with larger sample sizes and objective data should be performed, and the use of similar resuscitation simulations or the development of a formal team-based BLS certification course should be considered.

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AIM: To quantify the associations of foreign body airway obstruction (FBAO) basic life support (BLS) interventions with FBAO relief and survival to discharge. METHODS: We identified prehospital FBAO patient encounters in Alberta, Canada between Jan 1, 2018 and Dec 31,2021 using the provincial emergency medical services' medical records, deterministically linked to hospital data. Two physicians reviewed encounters to determine cases and extract data. Multivariable logistic regression determined the adjusted odds ratio of FBAO relief (primary outcome) and survival to discharge for the exposure of BLS interventions (abdominal thrusts [AT], chest compressions/thrusts [CC], or combinations) relative to back blows [BB]. Intervention-associated injuries were identified using International Classification of Diseases codes, followed by health records review. RESULTS: We identified 3,677 patient encounters, including 709 FBAOs requiring intervention. Bystanders performed the initial BLS intervention in 488 cases (77.4%). Bystanders and paramedics did not relieve the FBAO in 151 (23.5%) and 11 (16.7%) cases, respectively. FBAOs not relieved before paramedic arrival had a higher proportion of deaths (n = 4[0.4%] versus n = 92[42.4%], p < 0.001). AT and CC were associated with decreased odds of FBAO relief relative to BB (adjusted odds ratio [aOR] 0.49 [95%CI 0.30-0.80] and 0.14 [95%CI 0.07-0.28], respectively). CC were associated with decreased odds of survival to discharge (aOR 0.04 [95%CI 0.01-0.32]). AT, CC, and BB were implicated in intervention-associated injuries in four, nine, and zero cases, respectively. CONCLUSIONS: Back blows are associated with improved outcomes compared to abdominal thrusts and chest compressions. These data can inform prospective studies aimed at improving response to choking emergencies.

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INTRODUCTION: Management of trauma involves both in-hospital and prehospital care. The level of prehospital care plays a vital role in trauma management. Low- and middle-income countries are still in the nascent stages of development of their emergency medical services (EMS) systems. Also, there have been insufficient studies assessing the availability and level of prehospital care in developing nations such as India. Therefore, we decided to study the level of awareness and prehospital care given to severe trauma patients. MATERIALS AND METHODS: We conducted this prospective observational study at the emergency department of Fortis Hospital, Noida, Uttar Pradesh, in Northern India. All adults between ages 18 and 85 years presenting with severe trauma (immediate life- or limb-threatening conditions requiring emergent intervention) were included. We measured the primary outcome in terms of why people did not avail EMS. We measured secondary outcomes in terms of intervention done in patients coming to us via EMS. RESULTS: Out of 101 patients, 89 (88.12%) were transported to Fortis Hospital through non-EMS, whereas only 12 (11.88%) patients were transported by EMS. We found the difference to be statistically significant. The major reason given for not summoning advanced trauma care services in patients was a lack of awareness about the potential benefits of EMS (n = 64 [72%]), followed by a lack of availability (n = 24 [27%]), and financial reasons (n = 1 [1.1%]). CONCLUSION: We conclude that the level of awareness about EMS for severe trauma patients was found to be low in our study. There is a need for an awareness-creation program across the nation to fill this gap.

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To deal with the highly nonlinear and time-varying characteristics of Batch Process, a model named adaptive stacking approximate kernel based broad learning system is proposed in this paper. This model innovatively introduces the approximate kernel based broad learning system (AKBLS) algorithm and the Adaptive Stacking framework, giving it strong nonlinear fitting ability, excellent generalization ability, and adaptive ability. The Broad Learning System (BLS) is known for its shorter training time for effective nonlinear processing, but the uncertainty brought by its double random mapping results in poor resistance to noisy data and unpredictable impact on performance. To address this issue, this paper proposes an AKBLS algorithm that reduces uncertainty, eliminates redundant features, and improves prediction accuracy by projecting feature nodes into the kernel space. It also significantly reduces the computation time of the kernel matrix by searching for approximate kernels to enhance its ability in industrial online applications. Extensive comparative experiments on various public datasets of different sizes validate this. The Adaptive Stacking framework utilizes the Stacking ensemble learning method, which integrates predictions from multiple AKBLS models using a meta-learner to improve generalization. Additionally, by employing the moving window method-where a fixed-length window slides through the database over time-the model gains adaptive ability, allowing it to better respond to gradual changes in industrial Batch Process. Experiments on a substantial dataset of penicillin simulations demonstrate that the proposed model significantly improves predictive accuracy compared to other common algorithms.

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This qualitative study aims to analyse the personal qualification, attitudes and the pedagogical concepts of German teachers as experts in their profession regarding basic life support (BLS) education in secondary schools. Thirteen (n = 13) secondary school teachers participated in semi-structured expert interviews and were interviewed for at least 20 to 60 min regarding BLS student education. Interviews were semi-structured with guiding questions addressing (1) personal experience, (2) teacher qualification for BLS and (3) implementation factors (e.g., personal, material and organisational). Audio-recorded interviews were analysed by content analysis, generating a coding system. School teachers provided a heterogeneous view on implementation-related processes in BLS education. Many teachers were educated in first aid, acknowledge its importance, but had no experience in teaching BLS. They want to assure being competent for teaching BLS and need tailored trainings, materials, pedagogical information and the incorporation into the curriculum. Also, the management of time constraints, unwilling colleagues, or young students being overwhelmed were commonly mentioned considerations. Concluding, teachers reported to be willing to teach BLS but a stepwise implementation framework incorporating practice-oriented qualification and educational goals is missing.

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How to cite this article: Sinha S. Cardiopulmonary Resuscitation Training and Reinforcement: A Bulwark against Death. Indian J Crit Care Med 2024;28(4):317-319.

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Background: App-linked real-time feedback-devices for cardiopulmonary resuscitation (CPR) aim to improve laypersons' resuscitation quality. Resuscitation guidelines recommend these technologies in training settings. This is the first study comparing resuscitation quality of all App-linked feedback-devices currently on market. Methods: A prospective randomised simulation study was performed. After standardised instructions, participants performed 2-minutes compression-only CPR on a manikin without feedback (baseline). Afterwards, participants performed 4 × 2 min CPR with four different feedback devices in randomised order (CorPatch® Trainer, CPRBAND AIO Training, SimCPR®ProTrainer, Relay Response™) (intervention). CPR metrics (chest compression depth (CD), chest compression rate (CR), percentage of correct CD/CR (%), correct hand position, correct chest recoil, and technical preparation-time) were assessed. Devices data were compared to the baseline group using Wilcoxon testing with IBM SPSS (primary outcome). Differences between devices were analysed with ANOVA testing (secondary outcome). Normally distributed data were described as mean ± standard deviation (SD) and non-normally distributed data as Median [Interquartile range (IQR). CPR self-confidence was measured by means of questionnaire before and after feedback devices' use. Comparison was performed by students t-test. Results: Forty participants were involved. SimCPR®ProTrainer was the only device, which resulted in guideline-compliant chest compressions (Mean ± SD:5.37 ± 0.76) with improved chest compression depth (p < 0.001), and percentage of correct chest compression depth (p < 0.001) compared to unassisted CPR (baseline). CorPatch® Trainer as the only device with audio-visual recoil instructions resulted in improved chest recoil (Mean ± SD:72.25 ± 24.89) compared to baseline (Mean ± SD:49.00 ± 42.20; p < 0.01), while the other three devices resulted in significantly lower chest recoil rates (CPRBAND AIO Training: 37.03 ± 39.90; p < 0.01, SimCPR®ProTrainer: Mean ± SD:39.88 ± 36.50; p = 0.03, Relay Response™: Mean ± SD:36.88 ± 37.73; p = 0.02). CPR quality when using the different feedback devices differ in chest compression depth (p = 0.02), chest compression rate (p < 0.001), percentage of correct chest compression depth/rate (p = 0.03/p = 0.04), and technical preparation-time (p < 0.001). Feedback-devices' use increased participant's CPR self-confidence (p < 0.001). Conclusion: Although, CPR feedback devices show improved CPR performance in layperson in some metrics, none of the tested CPR feedback devices supported layperson in overall adequate CPR performance. More and better technical functionality is necessary, to fully utilise the potential of CPR feedback devices and to prevent a worsening of CPR performance when layperson use this technology.

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BLS-type diffuse large B-cell lymphoma (DLBCL) denotes an uncommon, aggressive variant of DLBCL presenting initially in bone marrow, liver and spleen without lymphadenopathy or mass lesion. Patients with BLS-type DLBCL present frequently with haemophagocytic syndrome which often leads to early patient demise. Programmed death ligand 1 (PD-L1) plays a negative regulatory role on effector T cells and is an important target of immunotherapy. Assessment of PD-L1 expression in BLS-type DLBCL may carry therapeutic implications and provide mechanistic insights. Standard immunohistochemical analysis for PD-L1 was performed in seven cohorts for this study: (1) DLBCL-not otherwise specified (NOS) (n=201); (2) Epstein-Barr virus (EBV)-positive DLBCL (n=26); (3) thymic (primary mediastinal) DLBCL (n=12); (4) intravascular LBCL (n=3); (5) high-grade B-cell lymphoma, NOS (n=12); (6) BLS-type DLBCL (n=37); and (7) systemic DLBCL involving bone marrow (n=28). We found that PD-L1 was positive in 12.9% of DLBCL-NOS cases, 46.2% of EBV-positive DLBCL, 91.7% of thymic LBCL, none of intravascular LBCL, 8.3% of high-grade B-cell lymphoma-NOS, and 56.8% of BLS-type DLBCL. By comparison, only 14.3% of bone marrow cases involved by systemic DLBCL were positive for PD-L1 (p<0.001). Interestingly, BLS-type DLBCL more frequently showed activated B-cell phenotype (86.5% vs 65.2%, p=0.010), a high Ki-67 proliferative index (97.1% vs 63.3%, p<0.001), MYC overexpression (90.9% vs 56.2%, p=0.023), presence of haemophagocytic syndrome (86.5% vs 4.0%, p<0.001), and poorer overall survival (p<0.001) than DLBCL-NOS. These data suggest that the poor prognosis of BLS-type DLBCL may be explained by both extrinsic tumour microenvironment factors and intrinsic genetic factors of tumour cells, such as PD-L1-associated inactivation of anti-tumour immunity for the former, and MYC pathway activation-related aggressiveness for the latter.

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BACKGROUND: Cardiac arrest is a critical medical emergency that can strike individuals of any age or background, often occurring suddenly and unpredictably. The administration of Basic Life Support (BLS) techniques by laypersons in the first few crucial minutes following a cardiac arrest can substantially increase the chances of survival and minimize potential neurological damage. Despite the vital role of BLS in saving lives, there remains a gap in public awareness, knowledge, and attitudes regarding BLS among the general population in many regions worldwide, including Saudi Arabia. In recent years, there has been a growing emphasis on the importance of community-based interventions to enhance cardiac arrest survival rates. Public involvement in the early stages of cardiac arrest management is a key component of the chain of survival, and improving BLS awareness and knowledge among the general population is central to this effort. OBJECTIVE: This study aimed to assess the awareness, knowledge, and attitudes with regard to BLS among the general population in the Al-Majma'ah region, Saudi Arabia. METHODS: This is a descriptive cross-sectional study adopted among the population living in the Al-Majma'ah region of Saudi Arabia. The data was collected by a pre-tested and self-administered questionnaire. Data was analyzed by using IBM SPSS Statistics for Windows, Version 26.0 (Released 2019; IBM Corp., Armonk, New York, United States). The questions included information on social demographic information, awareness and knowledge, and attitudes related to BLS. RESULTS: More than half the participants (n=352; 52.5%) understand that during cardiac arrest, the heart is still beating and pumping blood, but the person is not breathing normally. This is an important understanding for providing proper care during a cardiac arrest situation. On the other hand, the study found that 384 (57.2%) had various reasons for their lack of knowledge about cardiopulmonary resuscitation (CPR). The biggest reason was lack of interest (n=98; 14.6%). This highlights a need for increased awareness and education about the importance of CPR. The findings from the Pearson correlation conducted in this study show that age has a significant influence on the level of awareness and knowledge of cardiac arrest BLS. The p-value obtained for the test was 0.014, indicating that there is a significant relationship between age and awareness and knowledge of BLS. Similarly, the study findings also show that gender has a significant influence on the attitude of cardiac arrest BLS. CONCLUSION: The participants had a decent understanding of BLS, particularly regarding concepts like cardiac arrest and the role of automated external defibrillators (AEDs). However, they showed confusion or gaps in awareness, especially concerning the correct initial steps when encountering a collapsed person. Many participants felt uncomfortable performing Hands-Only CPR in a real-life situation due to a lack of knowledge and skills, which acted as a significant barrier to public CPR performance.

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Background: Since antiquity, alternative herbal remedies, such as S. africana caerulea/Blue Sage (BLS) water infusion extract (WIE) has been used by traditional healers, for the effective treatment of various chronic inflammatory disorders associated with reduced cellular antioxidant defense mechanisms and free radical cellular damage. In the heart, ischaemia-reperfusion (I/R) induced oxidative stress becomes an early crucial event in the pathogenesis of ischaemia-reperfusion injury (I/RI) and subsequent heart failure. Purpose/Aim: To investigate whether BLS WIE treatment during ischaemia and/or reperfusion may be cardioprotective. Study design: Isolated perfused rat hearts were exposed to 35 min regional ischaemia (RI) and 60 min reperfusion. The BLS WIE was applied: i) for the last 10 min of RI (PerT) or ii) from onset of reperfusion (PostT) or iii) both (PerT) + (PostT). Methods: Endpoints were functional recovery and infarct size (IS). In another set of experiments, left ventricles were freeze-clamped after RI and 10 min reperfusion for detection of total and phosphorylated p-ERK p44/p42, p-Akt, p-p38-MAPK, p-JNK, Nrf-2, NF-kB, Bax, Bcl-2, Caspase-3, and PGC-1α by Western blot analysis. Results: BLS (PostT) significantly increased ERK p44, p-Akt, Nrf-2, and Bcl-2 levels; significantly decreased p-p38-MAPK as well as p-JNK p46 phosphorylation; did not affect Bax levels and significantly decreased Bax/Bcl-2 ratios. This was associated with significantly reduced Caspase-3 levels and increased PGC-1α phosphorylation, particlarly when BLS WIE was administered as PostT. Conclusion: The administration of polyphenol-rich BLS WIE at different stages of ischaemia and/or reperfusion, activate/inhibit several signaling events simultaneously and mediate cardioprotection in a multitarget manner.

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BACKGROUND: Basic Life Support (BLS) plays an important role in increasing the survival rate of hospitalized heart attack patients. There are no previous studies on the effect of BLS training among Palestinian nurses. This study aimed to evaluate the effect of simulation-based BLS training program on nurses' knowledge Palestinian nurses at governmental hospitals. METHODS: A quasi-experimental, pre & post-test design was used. 700 nurses were recruited proportionally using a simple random sampling method among 2980 nurses from 13 public hospitals in the Gaza Strip. This study was conducted from June to August 2022. A practical BLS test consisting of 10 multiple-choice questions according to American Heart Association guidelines (2020) was collected and sociodemographic characteristics. SPSS software, version 24 was used for the statistical analysis. Descriptive statistics and weighted mean were used. T-Test and One-way analysis of variance (ANOVA) were applied to determine differences in means among groups. RESULTS: Most of the participating nurses (55.7%) were male, while (44.3%) were female. The majority of nurses (84.4%) are under 40 years of age. The weighted mean scores in the pre-test ranged from 52.2 to 75.1% and the mean scores was (6.16 ± 1.97). After applying conventional BLS training, the weighted mean scores ranged from 85.6 to 97.3% and the mean scores was (9.19 ± 1.04). The study revealed that the nurses' knowledge increased after applying simulation-based training program. The mean of knowledge scores was statistically significant between the pre and post-test on the basis of the current work hospital (P-value < 0.001). CONCLUSION: This study affords significant evidence of the positive effects of the BLS training program in improving nurses' knowledge; we recommend advanced BLS training for all healthcare providers, doctors, and nurses working in hospitals and healthcare centers. Nursing managers can implement systematic strategies to enhance nurses' knowledge and practice in BLS to target low-scoring Governorates.

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OBJECTIVE: This study aims to address the knowledge gap in first aid and basic life support (BLS) among teachers, expand the targeted schools to elementary and intermediate schools for boys and girls, and develop clear, focused recommendations. Furthermore, to assess the knowledge, skills, and attitude of BLS among schoolteachers in Qassim, Saudi Arabia. METHODS: This cross-sectional study was conducted in the school year of 2022 to 2023. In Buraidah city and the Uyun AlJiwa and Asyah governorates of Qassim, there are a total of 906 elementary and intermediate schools employing 12,057 teachers (5447 males and 6610 females). A stratified random sampling method was used with a self-administered Arabic questionnaire. This questionnaire included multiple parts (sociodemographic data, previous training status, knowledge and skill of BLS, and assessment of the following: attitude to learn and practice CPR; barriers to performing CPR; the presence or lack of previous resuscitation experience in BLS). Data were analyzed using SPSS Statistics version 25 (IBM Corp., Armonk, NY, USA). Categorical variables were described by frequency and percentage, while continuous variables were described by mean ± SD. A normality test showed that the total knowledge and skills scale was not normally distributed. The Mann-Whitney and Kruskal-Wallis tests were used to compare the mean knowledge and skills scale across variables. The accepted level of significance was below 0.05 (p <0.05). RESULTS: Our study included 482 participants. Only 19.5% (94) had previous CPR training, and 80.9% (76) were trained more than two years prior to this study's data collection. The main reason for participants' fears of applying BLS was the lack of proper knowledge and skills (48.1%). The majority of the teachers, i.e., 71.0% (342), wanted more training in CPR, and 41.1% (198) thought CPR training should be mandatory at school. We found no statistical relationship between attitude toward training and the city or differences in knowledge and skills scores due to the difference in sociodemographic characteristics. Also, we found no statistical relationship between the question 'Did you observe CPR on a collapsed patient?' and the city, meaning that the observation of CPR on collapsed patients is independent of the respondent's school location. Significant differences in skills scores were found between those who had CPR observation and those who did not (p = 0.014), in knowledge scores between those who had previous CPR training and those who did not (p = 0.034), and in skills scores between those who had previous CPR training and those who did not (p <0.001). We found no significant differences in knowledge and skills scores according to the place of previous CPR training (p = 0.163 and p = 0.695, respectively). CONCLUSION: This study reveals that knowledge and skills in BLS among schoolteachers need to be improved. For this reason, we emphasize the inclusion of International Liaison Committee on Resuscitation (ILCOR) recommendations in the curriculum and that they are made periodic and mandatory for teachers. Especially as we found teachers to have a positive attitude and were willing to train and help.

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Peptide presentation by MHC class I and MHC class II molecules plays important roles in the regulation of the immune response. One factor in these displays is the density of antigen, which must exceed a critical threshold for the effective activation of T cells. Nonrandom distribution of MHC class I and class II has already been detected at the nanometer level and at higher hierarchical levels. It is not clear how the absence and reappearance of some protein molecules can influence the nonrandom distribution. Therefore, we performed experiments on HLA II-deficient bare lymphocyte syndrome (BLS1) cells: we created a stable transfected cell line, tDQ6-BLS-1, and were able to detect the effect of the appearance of HLA-DQ6 molecules on the homo and heteroassociation of different cell surface molecules by comparing Förster resonance energy transfer (FRET) efficiency on transfected cells to that on nontransfected BLS-1 and JY human B-cell lines. Our FRET results show a decrease in homoassociation FRET between HLA I chains in HLA-DQ6-transfected tDQ6-BLS-1 cells compared with the parent BLS-1 cell line and an increase in heteroassociation FRET between HLA I and HLA II (compared with JY cells), suggesting a similar pattern of antigen presentation by the HLA-DQ6 allele. Transmission electron microscopy (TEM) revealed that both HLA class I and class II molecules formed clusters at higher hierarchical levels on the tDQ6-BLS-1 cells, and the de novo synthesized HLA DQ molecules did not intersperse with HLA class I islands. These observations could be important in understanding the fine tuning of the immune response.

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INTRODUCTION: Although very crucial in medicine, mastery of cardiopulmonary resuscitation remains poor in many low and-medium income countries (LMICs) due mainly to the lack of readily accessible training facilities and expertise. SUBJECTS AND METHODS: The current study was aimed at evaluating the knowledge of Basic Life Support (BLS) among senior-level medical students and doctors in Nigeria, as well as to evaluate the value of a video teaching method in improving the knowledge base of BLS. It was a two-cohort prospective study carried out over a duration of one month. Each group of participants had an initial assessment of their knowledge of Basic Life Support using a questionnaire. Thereafter, the 45-minute CHEMPIONS-BLS video was projected. On completion of the video session, the same questionnaire was again administered to each group of participants. This was followed by a practical, hands-on workshop at the skills laboratory. Data was collected using the questionnaires and comparisons were made between the pre and post-test responses. RESULTS: Seventy-five medical students and 41 doctors were enrolled into this study. Overall, their knowledge of BLS and their exposure to previous BLS training were poor, but there was a significant improvement in the mean scores, and the overall performance after viewing the video just one time; t = 27.30, p = .000 and χ² = 116.01; p = .000 respectively. CONCLUSION: This study reveals poor knowledge and exposure to basic life support training among both medical students and practicing doctors. It further reveals the value of a novel training method in improving BLS knowledge.

INTRODUCTION: Bien que cruciale en médecine, la maîtrise de la réanimation cardio-pulmonaire reste faible dans de nombreux pays à revenu faible et moyen (PRFM), principalement en raison du manque d'infrastructures de formation et d'expertise facilement accessibles. SUJETS ET MÉTHODES: La présente étude visait à évaluer les connaissances en matière de réanimation cardio-pulmonaire de base (Basic Life Support - BLS) parmi les étudiants en médecine et les médecins au Nigeria, ainsi qu'à évaluer la valeur d'une méthode d'enseignement par vidéo pour améliorer la base de connaissances en BLS. Il s'agissait d'une étude prospective à deux cohortes menée sur une durée d'un mois. Chaque groupe de participants a fait l'objet d'une évaluation initiale de ses connaissances en matière de réanimation cardio-pulmonaire à l'aide d'un questionnaire. Ensuite, la vidéo CHEMPIONS-BLS de 45 minutes a été projetée. À l'issue de la séance vidéo, le même questionnaire a été administré à chaque groupe de participants. Cette séance a été suivie d'un atelier pratique au laboratoire de compétences. Les données ont été collectées à l'aide des questionnaires et des comparaisons ont été faites entre les réponses avant et après le test. RÉSULTATS: Soixante-quinze étudiants en médecine et 41 médecins ont participé à cette étude. Dans l'ensemble, leur connaissance du BLS et leur exposition à une formation BLS antérieure étaient faibles, mais il y a eu une amélioration significative des scores moyens et de la performance globale après avoir visionné la vidéo une seule fois ; t = 27,30, p = .000 et χ² = 116,01 ; p = .000 respectivement. CONCLUSION: Cette étude révèle que les étudiants en médecine et les médecins en exercice ont une connaissance et une exposition insuffisantes à la formation aux soins de base en réanimation. Elle révèle également l'intérêt d'une nouvelle méthode de formation pour améliorer les connaissances en matière de BLS. Mots clés: Soins de base en réanimation (BLS), Réanimation cardiopulmonaire (RCP), Éducation médicale, Arrêt cardiaque extrahospitalier (OHCA), Formation post-COVID, Formation médicale continue (FMC), Hôpital universitaire spécialisé d'Irrua (ISTH), Le Nigeria.

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