Survey of hospital practitioners: common understanding of cardiopulmonary resuscitation definition and outcomes.

BACKGROUND: Cardiopulmonary resuscitation (CPR) is internationally defined as chest compressions and rescue breaths, and is a subset of resuscitation. First used for out-of-hospital cardiac arrest, CPR is now frequently used for in-hospital cardiac arrest (IHCA) with different causes and outcomes. AIMS: This paper aims to describe clinical understanding of the role of in-hospital CPR and perceived outcomes for IHCA. METHODS: An online survey of a secondary care staff involved in resuscitation was conducted, focussing on definitions of CPR, features of do-not-attempt-CPR conversations with patients and clinical case scenarios. Data were analysed using a simple descriptive approach. RESULTS: Of 652 responses, 500 were complete and used for analysis. Two hundred eleven respondents were senior medical staff covering acute medical disciplines. Ninety-one percent of respondents agreed or strongly agreed that defibrillation is part of CPR, and 96% believed CPR for IHCA included defibrillation. Responses to clinical scenarios were dissonant, with nearly half of respondents demonstrating a pattern of underestimating survival and subsequently showing a desire to offer CPR in similar scenarios with poor outcomes. This was unaffected by seniority and level of resuscitation training. CONCLUSIONS: The common use of CPR in hospital reflects the broader definition of resuscitation. Recapturing the CPR definition for clinicians and patients as only chest compressions and rescue breaths may allow clinicians to better discuss individualised resuscitation care to aide meaningful shared decision-making around patient deterioration. This may involve reframing current in-hospital algorithms and uncoupling CPR from wider resuscitative measures.

Effective fisheries management instrumental in improving fish stock status.

Marine fish stocks are an important part of the world food system and are particularly important for many of the poorest people of the world. Most existing analyses suggest overfishing is increasing, and there is widespread concern that fish stocks are decreasing throughout most of the world. We assembled trends in abundance and harvest rate of stocks that are scientifically assessed, constituting half of the reported global marine fish catch. For these stocks, on average, abundance is increasing and is at proposed target levels. Compared with regions that are intensively managed, regions with less-developed fisheries management have, on average, 3-fold greater harvest rates and half the abundance as assessed stocks. Available evidence suggests that the regions without assessments of abundance have little fisheries management, and stocks are in poor shape. Increased application of area-appropriate fisheries science recommendations and management tools are still needed for sustaining fisheries in places where they are lacking.

A first-principles prediction on the "healing effect" of graphene preventing carrier trapping near the surface of metal halide perovskites.

We herein report that surface modification of metal halide perovskites using graphene would be beneficial to improving the energy conversion efficiencies of perovskite solar cells. The present first-principles calculations on MAPbI3 with a single vacancy created by removing either I, Pb or MA show that the I and Pb vacancies near the surface result in the formation of Pb-Pb and I-I dimers, respectively. They are predicted to yield mid-gap levels, and would degrade the energy conversion efficiency of perovskite solar cells through carrier trapping. The present calculations suggest that when the surface of MAPbI3 is covered with a graphene sheet, the formation of the carrier trapping dimers would be suppressed. The origin of the "healing effect" of graphene on the lattice defect is ascribed to electronic interactions on the surface, which prevent charge localization at the lattice defects beneath the surface.

Collaborative assessment of California spiny lobster population and fishery responses to a marine reserve network.

Assessments of the conservation and fisheries effects of marine reserves typically focus on single reserves where sampling occurs over narrow spatiotemporal scales. A strategy for broadening the collection and interpretation of data is collaborative fisheries research (CFR). Here we report results of a CFR program formed in part to test whether reserves at the Santa Barbara Channel Islands, USA, influenced lobster size and trap yield, and whether abundance changes in reserves led to spillover that influenced trap yield and effort distribution near reserve borders. Industry training of scientists allowed us to sample reserves with fishery relevant metrics that we compared with pre-reserve fishing records, a concurrent port sampling program, fishery effort patterns, the local ecological knowledge (LEK) of fishermen, and fishery-independent visual surveys of lobster abundance. After six years of reserve protection, there was a four- to eightfold increase in trap yield, a 5-10% increase in the mean size (carapace length) of legal sized lobsters, and larger size structure of lobsters trapped inside vs. outside of three replicate reserves. Patterns in trap data were corroborated by visual scuba surveys that indicated a four- to sixfold increase in lobster density inside reserves. Population increases within reserves did not lead to increased trap yields or effort concentrations (fishing the line) immediately outside reserve borders. The absence of these catch and effort trends, which are indicative of spillover, may be due to moderate total mortality (Z = 0.59 for legal sized lobsters outside reserves), which was estimated from analysis of growth and length frequency data collected as part of our CFR program. Spillover at the Channel Islands reserves may be occurring but at levels that are insufficient to influence the fishery dynamics that we measured. Future increases in fishing effort (outside reserves) and lobster biomass (inside reserves) are likely and may lead to increased spillover, and CFR provides an ideal platform for continued assessment of fishery-reserve interactions.

Small-scale spatial variation in population dynamics and fishermen response in a coastal marine fishery.

A major challenge for small-scale fisheries management is high spatial variability in the demography and life history characteristics of target species. Implementation of local management actions that can reduce overfishing and maximize yields requires quantifying ecological heterogeneity at small spatial scales and is therefore limited by available resources and data. Collaborative fisheries research (CFR) is an effective means to collect essential fishery information at local scales, and to develop the social, technical, and logistical framework for fisheries management innovation. We used a CFR approach with fishing partners to collect and analyze geographically precise demographic information for grass rockfish (Sebastes rastrelliger), a sedentary, nearshore species harvested in the live fish fishery on the West Coast of the USA. Data were used to estimate geographically distinct growth rates, ages, mortality, and length frequency distributions in two environmental subregions of the Santa Barbara Channel, CA, USA. Results indicated the existence of two subpopulations; one located in the relatively cold, high productivity western Channel, and another in the relatively warm, low productivity eastern Channel. We parameterized yield per recruit models, the results of which suggested nearly twice as much yield per recruit in the high productivity subregion relative to the low productivity subregion. The spatial distribution of fishing in the two environmental subregions demonstrated a similar pattern to the yield per recruit outputs with greater landings, effort, and catch per unit effort in the high productivity subregion relative to the low productivity subregion. Understanding how spatial variability in stock dynamics translates to variability in fishery yield and distribution of effort is important to developing management plans that maximize fishing opportunities and conservation benefits at local scales.

Utilizing spatial demographic and life history variation to optimize sustainable yield of a temperate sex-changing fish.

Fish populations vary geographically in demography and life history due to environmental and ecological processes and in response to exploitation. However, population dynamic models and stock assessments, used to manage fisheries, rarely explicitly incorporate spatial variation to inform management decisions. Here, we describe extensive geographic variation in several demographic and life history characteristics (e.g., size structure, growth, survivorship, maturation, and sex change) of California sheephead (Semicossyphus pulcher), a temperate rocky reef fish targeted by recreational and commercial fisheries. Fish were sampled from nine locations throughout southern California in 2007-2008. We developed a dynamic size and age-structured model, parameterized separately for each location, to assess the potential cost or benefit in terms of fisheries yield and conservation objectives of changing minimum size limits and/or fishing mortality rates (compared to the status quo). Results indicate that managing populations individually, with location-specific regulations, could increase yield by over 26% while maintaining conservative levels of spawning biomass. While this local management approach would be challenging to implement in practice, we found statistically similar increases in yield could be achieved by dividing southern California into two separate management regions, reflecting geographic similarities in demography. To maximize yield, size limits should be increased by 90 mm in the northern region and held at current levels in the south. We also found that managing the fishery as one single stock (the status quo), but with a size limit 50 mm greater than the current regulations, could increase overall fishery yield by 15%. Increases in size limits are predicted to enhance fishery yield and may also have important ecological consequences for the predatory role of sheephead in kelp forests. This framework for incorporating demographic variation into fisheries models can be exported generally to other species and may aid in identifying the appropriate spatial scales for fisheries management.

Predicting completeness of symptom relief after major heart surgery.

The authors hypothesized that the same biopsychosocial factors that raise the risk of illness incidence would influence the speed and completeness of relief from physical symptoms during recovery following cardiac surgery. This multicenter prospective study involved 463 patients aged 35 to 69 years who underwent coronary artery bypass graft or cardiac valve surgery. Predictor data were gathered 1 to 3 days before surgery, and outcome measures were collected 6 months postoperatively. The following predictors were associated with postoperative freedom from cardiac symptoms: fewer preoperative cardiac hospitalizations; low levels of angina, dyspnea, fatigue, and sleep problems; low levels of anxiety, depression, hostility, and life-change events; and high levels of psychosocial well-being, hopefulness, overall satisfaction, and social support. The predictors of not requiring daytime bed rest because of cardiac symptoms during the 6th postoperative month were male gender, higher education, less cardiac disability preoperatively, low levels of angina, dyspnea, sleep problems, depression and fatigue, and absence of Type A behavior and of intraoperative hypotension. By using separate multiple logistic regression equations, the authors identified the variables printed in bold face as independent significant contributors to prediction. Many of the predictors are strong enough and simple enough to be used in clinical practice. Many of them may also predict recovery after acute illnesses and injuries involving other organ systems.

Quantifying and predicting recovery after heart surgery.

The validity of the biopsychosocial approach to the study of health and illness is reaffirmed by the prospective findings of the Recovery Study. This is a multidisciplinary examination, conducted in four teaching hospitals, of the predictors of symptoms of cardiac illness in 463 patients 6 months after coronary artery bypass or cardiac valve surgery. We found that the following preoperative measures predict freedom from cardiac symptoms 6 months after surgery: low levels of all of the following: angina pain, shortness of breath, fatigue and sleep problems, lifetime cigarette usage, and preoperative hospitalization for cardiac treatment; low levels of anxiety, depression, and hostility, and few life change events; high levels of all of the following: self-esteem, well-being, vigor; prevalence of activities and hobbies, social participation, and social support. The six variables in bold print contributed independently in a multiple regression equation that accounted for 21% of the variance of the symptoms score and was associated with an estimated 45% difference in success of recovery. The statistical strength and general nature of many of the predictors indicate that the predictors may also be important in recovery from other health crises. Psychosocial and biomedical factors correlate across time (predictively), as well as cross-sectionally, indicating that psychological, social, and biological mechanisms may be parts of a single general multifaceted process influencing recovery of health. A clinical trial could determine if psychological, social, or behavioral interventions will hasten and improve recovery from physical illness or trauma.

Violence and psychiatric disorder in the community: evidence from the Epidemiologic Catchment Area surveys.

Data from the Epidemiologic Catchment Area survey were used to examine the relationship between violence and psychiatric disorders among adults living in the community. Psychiatric assessment of survey respondents was based on the Diagnostic Interview Schedule, which also provided self-report information about violent behavior. Those who reported violent behavior within the preceding year tended to be young, male, and of low socioeconomic status, and more than half met DSM-III criteria for one or more psychiatric disorders. Subjects with alcohol or drug use disorders were more than twice as likely as those with schizophrenia to report violent behavior. In a multivariate model of the predictors of violence, a significant interaction effect was found between major mental illness and substance abuse. The risk of violent behavior increased with the number of psychiatric diagnoses for which respondents met DSM-III criteria.

The measurement of health-related quality of life: major dimensions identified by factor analysis.

The measurement of quality of life is becoming more important in the evaluation of medical technologies and pharmaceuticals. Particularly when the several available therapies have similar effects on survival, quality of life measures may help decide which should be the therapy of choice. The Recovery Study utilized a multidisciplinary array of indicators of health-related quality of life and recovery. This paper reports factor analyses of 58 outcome measures on a study group of 469 persons who had undergone coronary artery bypass or cardiac valve surgery 6-months previously. The factor analyses revealed 5 orthogonal dimensions. We have named them: low morale, symptoms of illness, neuropsychological function, interpersonal relationships, and economic-employment. The data argue that health-related quality of life is a multidimensional construct, and that these dimensions can be measured quantitatively with relatively simple interview and questionnaire approaches. The next research step is to determine whether the five dimensions of post-operative quality of life have different pre-operative predictors, and whether intervention on these predictors can improve the recovery and rehabilitation process.

The association between marital adjustment and compliance with antihypertension regimens.

The purpose of this cross-sectional survey was to determine relations between marital adjustment as measured by the Dyadic Adjustment Scale and antihypertension compliance. From seven dependent measures, we found high marital adjustment scores to be significantly correlated with less obesity, lower frequency of forgetting blood pressure medications, and less cessation of blood pressure medicine. These effects were much larger in a younger subsample of respondents who were 28 to 50 years old. The Dyadic Adjustment Scale measures the respondent's perception of the degree of affection and consensus, cohesion, and satisfaction in marriage. We conclude that the perception of positive marital interaction and communication ultimately contributes to controlled blood pressure by helping the patient to maintain healthy weight and to remember and continue taking blood pressure medication.