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Background: Extracorporeal cardiopulmonary resuscitation (ECPR) improves the prognosis of in-hospital cardiac arrest (IHCA). The six-factor RESCUE-IHCA score (resuscitation using ECPR during IHCA) was developed to predict outcomes of post-IHCA ECPR-treated adult patients. Our goal was to validate the score in an Asian medical center with a high volume and experience of ECPR performance and to compare the differences in patient characteristics between the current study and the original cohort in a 2022 observational study. Method: For this single-center, retrospective cohort study we enrolled 324 ECPR-treated adult IHCA patients. The primary outcome was in-hospital mortality. We used the area under the receiver operating curve (AUROC) to externally validate the RESCUE-IHCA score. The calibration of the model was tested by the decile calibration plot as well as Hosmer–Lemeshow goodness-of-fit with an associated P-value. Results: Of the 324 participants, 231 (71%) died before hospital discharge. The discriminative performance of the RESCUE-IHCA score was comparable with the originally validated cohort, with an AUC of 0.63. A prolonged duration of cardiac arrest was associated with an increased risk of mortality (odds ratio [OR] 1.02, 95% confidence interval [CI] 1.01–1.03, P = .006). An initial rhythm of ventricular tachycardia (OR 0.14, 95% CI 0.04–0.51, P = .003), ventricular fibrillation (OR 0.11, 95% CI 0.03–0.46, P = .003), and palpable pulse (OR 0.26, 95% CI 0.07–0.92, P = 0.04) were associated with a reduced mortality risk compared to asystole or pulseless electrical activity. In contrast to the original study, age (P = 0.28), resuscitation timing (P = 0.14), disease category (P = 0.18), and pre-existing renal insufficiency (P = 0.12) were not associated with in-hospital death. Conclusion: In external validation, the RESCUE-IHCA score exhibited performance comparable to its original validation within the single-center population. Further investigation on hospital experience, time-of-day effect, and specific disease categories is warranted to improve the selection criteria for ECPR candidates during IHCA.

Objective The overall objective of this study was to elicit understandings of community health among Inuit youth aged 12–18 in the region of Nunavik, northern Quebec, through identifying community conditions supporting health from their perspective and exploring how they conceptualize a healthy community. Methods In January and February 2020, 51 secondary students from three communities participated in a 1-week participatory photovoice activity during regular class time. Youth participated in three different sessions dedicated to the ethics of taking photographs, taking photos in the community, and group discussions of photographs. Discussions were analyzed via thematic analysis and validated with the youth in the fall of 2020. Results Twelve key community conditions supporting health were identified: family, food, culture, language, sense of community belonging, land, housing, services, community, connection, caring and somewhere to go. The youth understood a healthy community to be a place where “nothing was broken” and where community conditions supporting health could be visualized like the rocks in an inuksuk, a stone cairn used by Inuit for wayfinding on the tundra landscape. Participants chose the human form of inuksuk which has become widespread in northern and southern Canadian popular culture. Conclusion Findings from this study serve to confirm and strengthen existing models of Inuit health while also raising fresh perspectives and concepts relevant to the younger generation. Images and words of the youth identified in this study may be important in designing effective health promotion strategies that are accessible and relevant to younger generations, thus responding to an important research, programmatic and policy gap.

Since the late 1970s, special education in the People’s Republic of China has experienced significant reform and fast development. However, education for children with severe developmental disabilities, especially autism spectrum disorders (ASDs), is still the greatest challenge in the field. This paper aims to give readers an overview of what is happening to children with ASDs in China. We first address the issue of prevalence of ASDs, and then offer an introduction to the diagnostic process. After that, a review of disability-related legislation is provided, followed by a description of current treatment options and available educational services. Finally we introduce all extent service providers and their roles.

Introduction: Eye emergencies make up nearly 3% of US emergency department (ED) visits. While emergency physicians (EP) should diagnose and treat these ophthalmologic emergencies, many trainees report limited ocular exposure and insufficient training throughout their residency to confidently conduct a thorough slit-lamp exam. Methods: We created an interdisciplinary, simulation-based mastery learning (SBML) curriculum to teach emergency attending physicians how to operate the slit lamp with multimodal learning methodology at a tertiary academic center. The EPs first demonstrate their initial slit-lamp competency with a 20-item checklist, and they then review the necessary curricular content to pass their independent readiness test before completing their in-person teaching and demonstration session with an ophthalmology attending to demonstrate procedural mastery (minimal passing score >90%). Results: Fifteen EPs were enrolled; all completed the final exam of the curriculum. The pre- and post-curriculum checklist scores increased by an average of seven points (P = .002); 86.7% of EPs felt confident in completing a slit-lamp exam after the curriculum, compared to 20% at the beginning. Five of 15 reported teaching learners within the two-month post-curricular period, ranging from 5–30 students. The hands-on teaching was the most positively reviewed element of the curriculum. Conclusion: The SBML program successfully trained EPs on performing a comprehensive slit-lamp exam with promising results of downstream education to junior learners. We encourage other institutions to leverage SBML as a teaching modality for procedural-based training and advocate cross-discipline education initiatives.

BackgroundThe number of out-of-school children and adolescents has been increasing globally. In sub-Saharan Africa, an estimated 23 million adolescents leave school due to poverty, teenage pregnancy, and unspecified illnesses. The reasons for absenteeism are well-known but the factors involved in the decision to return to school have not been analyzed. This study aimed to identify the factors that promote primary school re-entry among chronic adolescent absentees in rural sub-Saharan Africa.MethodsQualitative data were gathered through participant observation, in-depth interviews, and focus group discussions involving nine pupils who returned to school after chronic absenteeism and 140 adult stakeholders in Mbita sub-county, Kenya. Data were analyzed using thematic analysis.ResultsThe thematic analysis results showed that four factors promoted school re-entry, namely: (1) social norms: “school for a better life”; (2) linkage of community and school; (3) supportive environment; and (4) using discipline to make adolescents serious about their education.ConclusionsSchool re-entry among chronic absentees in Mbita sub-county is promoted by both community and school factors. It was observed that social norms regarded an education as a “passport to a better life.” Adolescents, teachers, and community leaders view education as a means of improving one’s socio-economic status. Two essential elements of health-promoting schools, a supportive environment and a linkage with community, effectively promoted returning to the school among adolescents. The introduction of health-promoting schools was recommended to implement a school re-entry policy in Kenya effectively.

BackgroundAdapted Physical Education (APE) focuses on tailoring school Physical Education (PE) to the needs of learners with special educational needs (LSEN), promoting their optimal physical and psychosocial development, which is also one of the priorities of the Brazil, Russia, India, China and South Africa (BRICS) organisation in addressing the health issues of its people. In view of limited available literature, more research is needed on the state and status of APE in BRICS.ObjectiveTo explore the current state and status of APE in the BRICS countries.MethodEmploying the qualitative document analysis methodology, school curriculum documents and education policies in the BRICS countries were analysed inductively within an interpretivist perspective, based on the frameworks of Bronfenbrenner’s Ecological Systems Theory and the Cultural-Historical Activity Theory.ResultsAlthough BRICS policies mandate the inclusion of LSEN in PE in mainstream and special schools, specific guidelines for adapting activities in PE could only be found in governmental documents of Russia, India and China. Teachers of LSEN are required to be qualified in special or inclusive education, but specialised undergraduate and professional APE teacher training is not equally available in all BRICS countries. Specific requirements regarding the assessment of LSEN within APE are also lacking.ConclusionMore comprehensive guidelines are needed regarding teaching strategies, curriculum content, assessment and professional development in APE to address challenges in APE implementation across BRICS countries.ContributionImplementing the recommendations of this study would enhance the physical and psychosocial development of LSEN in BRICS countries.

The relationship between educational outcomes and the use of web-based clinical knowledge support systems in teaching hospitals remains unknown in Japan. A previous study on this topic could have been affected by recall bias because of the use of a self-reported questionnaire. We aimed to explore the relationship between the use of the Wolters Kluwer UpToDate clinical knowledge support system in teaching hospitals and residents' General Medicine In-Training Examination (GM-ITE) scores. In this study, we objectively evaluated the relationship between the total number of UpToDate hospital use logs and the GM-ITE scores. This nationwide cross-sectional study included postgraduate year-1 and -2 residents who had taken the examination in the 2020 academic year. Hospital-level information was obtained from published web pages, and UpToDate hospital use logs were provided by Wolters Kluwer. We evaluated the relationship between the total number of UpToDate hospital use logs and residents' GM-ITE scores. We analyzed 215 teaching hospitals with at least 5 GM-ITE examinees and hospital use logs from 2017 to 2019. The study population consisted of 3013 residents from 215 teaching hospitals with at least 5 GM-ITE examinees and web-based resource use log data from 2017 to 2019. High-use hospital residents had significantly higher GM-ITE scores than low-use hospital residents (mean 26.9, SD 2.0 vs mean 26.2, SD 2.3; P=.009; Cohen d=0.35, 95% CI 0.08-0.62). The GM-ITE scores were significantly correlated with the total number of hospital use logs (Pearson r=0.28; P<.001). The multilevel analysis revealed a positive association between the total number of logs divided by the number of hospital physicians and the GM-ITE scores (estimated coefficient=0.36, 95% CI 0.14-0.59; P=.001). The findings suggest that the development of residents' clinical reasoning abilities through UpToDate is associated with high GM-ITE scores. Thus, higher use of UpToDate may lead physicians and residents in high-use hospitals to increase the implementation of evidence-based medicine, leading to high educational outcomes.

Seclusion of students for challenging behavior is a dangerous and illogical practice. It is a discriminatory practice that is disproportionately used with students with disabilities, especially students with intensive emotional and behavioral needs. Furthermore, there is widespread misuse and under-reporting of the practice in schools. The authors describe the inherent risks with using seclusion in schools and offer alternatives for addressing risk behaviors. The authors propose the cessation of seclusion practices and recommend the use of therapeutic evidence-based prevention and interventions strategies to support students involved in crisis situations.

Basic life support improves survival prognosis after out-of-hospital cardiac arrest, but is too rarely provided before the arrival of professional rescue services. First responder networks have been developed in many regions of the world to decrease the delay between collapse and initiation of resuscitation maneuvers. Their efficiency depends on the number of first responders available and many networks lack potential rescuers. Medical, dental, and biomedical students represent an almost untapped source of potential first responders, and a first study, carried out during the COVID-19 pandemic, led to the recruitment of many of these future professionals even though many restrictions were still in effect. The objective of this study was to determine the impact of an enhanced strategy on the recruitment of medical, dental, and biomedical students as first responders in the immediate aftermath of the COVID-19 pandemic. This was a prospective follow-up study, conducted between November 2021 and March 2022 at the University of Geneva Faculty of Medicine, Geneva, Switzerland. A web-based study platform was used to manage consent, registrations, and certificates. A first motivational intervention was held early in the academic year and targeted all first-year medical, dental, and biomedical students. Participants first answered a questionnaire designed to assess their initial basic life support knowledge before following an e-learning module. Those who completed the module were able to register for a face-to-face training session held by senior medical students. A course certificate was awarded to those who completed these sessions, enabling them to register as first responders on the Save a Life first responder network. Since the number of students who had enlisted as first responders 2 months after the motivational intervention was markedly lower than expected, a second, unplanned motivational intervention was held in an attempt to recruit more students. Out of a total of 674 first-year students, 19 (2.5%) students had registered as first responders after the first motivational intervention. This was significantly less than the proportion achieved through the initial study (48/529, 9.1%; P<.001). The second motivational intervention led to the enrollment of 7 more students (26/674, 3.9%), a figure still significantly lower than that of the original study (P<.001). At the end of the study, 76 (11.3%) students had been awarded a certificate of competence. Contrary to expectations, an earlier presentation during the academic year outside the COVID restriction period did not increase the recruitment of medical, dental, and biomedical students as first responders in the immediate aftermath of the COVID-19 pandemic. The reasons underlying this drop in motivation should be explored to enable the design of focused motivational interventions.

In 2011, the United States Congress amended and passed laws requiring states to monitor and decrease psychotropic medication use in child welfare systems. In addition to prescribers, Luna et al. Behavior and Social Issues , 27 , AA16-AA20, ( 2018 ) identified case managers, caregivers, and teachers as potential contributors to the prescribing process. For example, due to the lower response effort, teachers may recommend caregivers seek a medical evaluation, which may give rise to pharmacological interventions for behavioral problems as opposed to behavioral interventions. To date, no study has evaluated the extent to which teachers display positive or negative bias for either behavioral or pharmacological intervention as treatment for behavior problems displayed by students. As a step toward addressing this issue, the current study randomly assigned 119 certified teachers to one of four groups: Medication information (Med info), Behavioral information (Beh info), No change (control), and Reverse video (also no change control). Teachers watched two 5-min videos of a child engaging in low to moderate levels of problem behavior. After watching each video, teachers rated seven questions on a 5-point Likert scale. Although teachers in the Med info and Beh info groups observed worsening of behavior in the second video, only the Beh info group provided more negative ratings than the control group regarding the child’s ability to follow directions. In addition, Pre-K/elementary school teachers rated the child’s behavior as “more normal” than did other teachers. Overall, findings suggest that teachers displayed (1) a slight negative bias toward the behavioral intervention; and (2) neither positive nor negative bias toward psychotropic medication.