Predictive performances of ALS and BLS termination of resuscitation rules in out-of-hospital cardiac arrest for different resuscitation protocols.

BACKGROUND: Resuscitation guidance has advanced; however, the predictive performance of the termination of resuscitation (TOR) rule has not been validated for different resuscitation protocols published by the American Heart Association (AHA). METHODS: A retrospective study validating the basic life support (BLS) and advanced life support (ALS) TOR rules was conducted using an Utstein-style database in Tainan city, Taiwan. Adult patients with nontraumatic out-of-hospital cardiac arrests from January 1, 2015, to December 31, 2015, (using the AHA 2010 resuscitation protocol) and from January 1, 2020, to December 31, 2020, (using the AHA 2015 resuscitation protocol) were included. The characteristics of rule performance were calculated, including sensitivity, specificity, positive predictive value (PPV) and negative predictive value. RESULTS: Among 1260 eligible OHCA patients in 2015, 757 met the BLS TOR rule and 124 met the ALS TOR rule. The specificity and PPV for predicting unfavorable neurological outcomes were 61.1% and 99.0%, respectively, for the BLS TOR rule and 93.8% and 99.2%, respectively, for the ALS TOR rule. A total of 970 OHCA patients were enrolled in 2020, of whom 438 met the BLS TOR rule and 104 met the ALS TOR rule. The specificity and PPV for predicting unfavorable neurological outcomes were 85.7% and 100%, respectively, for the BLS TOR rule and 99.5% and 100%, respectively, for the ALS TOR rule. CONCLUSIONS: Both the BLS and ALS TOR rules performed better when using the 2015 AHA resuscitation protocols compared to the 2010 protocols, with increased PPVs and decreased false-positive rates in predicting survival to discharge and good neurological outcomes at discharge. The BLS and ALS TOR rules can perform differently while the resuscitation protocols are updated. As the concepts and practices of resuscitation progress, the BLS and ALS TOR rules should be evaluated and validated accordingly.

Reducing regioisomers of fullerene-bisadducts by tether-directed remote functionalization: investigation of electronically and sterically isomeric effects on bulk-heterojunction solar cells.

C60 bis-adduct containing a mixture of regio-isomers with different LUMO energy levels and steric geometries could greatly affect the morphological and bulk properties. To investigate the regio-isomer effect on solar cell performance, we have successfully designed and synthesized a regio-selective 4-acetatephenyl-4'-methylphenylmethano C60 bis-adduct (S-APM-CBA) by "tether-directed remote functionalization" strategy and a random 4-acetatephenyl-4'-methylphenylmethano C60 bis-adduct denoted as R-APM-CBA by traditional cyclopropanation. The dramatic reduction in the number of regio-isomers in S-APM-CBA is confirmed by the (1)H NMR and HPLC measurements and theoretical calculation. Compared to the R-APM-CBA-based device with a Jsc of 6.63 mA/cm(2), an FF of 44.3% and a PCE of 2.46%, the device using S-APM-CBA yielded a much lower Jsc of 1.48 mA/cm(2), an FF of 32.2%, and a PCE of 0.38%. Consistently, the electron-only device using S-AMP-CBA exhibited lower electron mobility than the R-AMP-CBA-based device. These results imply that the electronic shallow-trap effect ascribed to the LUMO energy variations turned out to be insignificant in the AMP-CBA system. The lower efficiency and mobility of S-AMP-CBA might due to the assumption that the most probable trans-4-III isomer in S-AMP-CBA prevents the intermolecular facial contact of fullerenes, thereby hindering the electron transporting. Furthermore, the nanomorphology of S-AMP-CBA and R-AMP-CBA active layers could be different because of their different three-dimensional structures. This research demonstrated that steric effect of regio-isomers in a given C60 bis-adduct is more crucial than electronic shallow-trap effect.