Survival following out-of-hospital cardiac arrest (OHCA) remains low, typically less than 10%. Bystander cardiopulmonary resuscitation (CPR) and bystander-AED use have been shown to improve survival ...by up to fourfold in individual studies. Numerous community-based interventions have been implemented worldwide in an effort to enhance rates of bystander-CPR, bystander-AED use, and improve OHCA survival. This systematic review and meta-analysis aims to evaluate the effect of such interventions on OHCA outcomes. Medline and Embase were systematically searched from inception through July 2021 for studies describing the implementation and effect of one or more community-based interventions targeting OHCA outcomes. Two reviewers screened articles, extracted data, and evaluated study quality using the Newcastle-Ottawa Scale. For each outcome, data were pooled using random-effects meta-analysis. Of the 2481 studies identified, 16 met inclusion criteria. All included studies were observational. They reported a total of 1,081,040 OHCAs across 11 countries. The most common interventions included community-based CPR training (n = 12), community-based AED training (n = 9), and dispatcher-assisted CPR (n = 8). Health system interventions (hospital or paramedical services) were also described in 11 of the included studies. Evidence certainty among all outcomes was low or very low according to GRADE criteria. On meta-analysis, community-based interventions with and without health system interventions were consistently associated with improved OCHA outcomes: rates of bystander-CPR, bystander-AED use, survival, and survival with a favorable neurological outcome. Bystander CPR-14 studies showed a significant increase in post-intervention bystander-CPR rates (n = 285 752; OR 2.26 1.74, 2.94; I
= 99%, and bystander AED use (n = 37 882; OR 2.08 1.44, 3.01; I
= 54%) and durvival-10 studies, pooling survival to hospital discharge and survival to 30 days (n = 79 206; OR 1.59 1.20, 2.10; I
= 95%. The results provide foundational support for the efficacy of community-based interventions in enhancing OHCA outcomes. These findings inform our recommendation that communities, regions, and countries should implement community-based interventions in their pre-hospital strategy for OHCA. Further research is needed to identify which specific intervention types are most effective.
Background and aims
Cannabis and alcohol are frequently detected in fatal and injury motor vehicle crashes. While epidemiological meta‐analyses of cannabis and alcohol have found associations with an ...increase in crash risk, convergent evidence from driving performance measures is insufficiently quantitatively characterized. Our objectives were to quantify the magnitude of the effect of cannabis and alcohol—alone and in combination—on driving performance and behaviour.
Methods
Systematic review and meta‐analysis. We systematically searched Academic Search Complete, CINAHL, Embase, Scopus, Google Scholar, MEDLINE, PsycINFO, SPORTDiscus and TRID. Of the 616 studies that underwent full‐text review, this meta‐analysis represents 57 studies and 1725 participants. We extracted data for hazard response time, lateral position variability, lane deviations or excursions, time out of lane, driving speed, driving speed variability, speed violations, time speeding, headway, headway variability and crashes from experimental driving studies (i.e. driving simulator, closed‐course, on‐road) involving cannabis and/or alcohol administration. We reported meta‐analyses of effect sizes using Hedges’ g and r.
Results
Cannabis alone was associated with impaired lateral control e.g. g = 0.331, 95% confidence interval (CI) = 0.212–0.451 for lateral position variability; g = 0.198, 95% CI = 0.001–0.395 for lane excursions) and decreased driving speed (g = –0.176, 95% CI = –0.298 to –0.053. The combination of cannabis and alcohol was associated with greater driving performance decrements than either drug in isolation e.g. g = 0.480, 95% CI = 0.096–0.865 for lateral position variability (combination versus alcohol); g = 0.525, 95% CI = 0.049–1.002 for time out of lane (versus alcohol); g = 0.336, 95% CI = 0.036–0.636 for lateral position variability (combination versus cannabis; g = 0.475, 95% CI = 0.002–0.949 for time out of lane (combination versus cannabis). Subgroup analyses indicated that the effects of cannabis on driving performance measures were similar to low blood alcohol concentrations. A scarcity of data and study heterogeneity limited the interpretation of some measures.
Conclusions
This meta‐analysis indicates that cannabis, like alcohol, impairs driving, and the combination of the two drugs is more detrimental to driving performance than either in isolation.
•SCE risk is greatest for tasks that require drivers to look away from the roadway.•More research needed to validate SCEs against real-world crash risk.•Limitations and potential biases within NDS ...designs are identified and addressed.
A systematic review and meta-analysis of naturalistic driving studies involving estimates of safety-critical event risk associated with handheld device use while driving is described. Fifty-seven studies identified from targeted databases, journals and websites were reviewed in depth, and six were ultimately included. These six studies, published between 2006 and 2014, encompass seven sets of naturalistic driver data and describe original research that utilized naturalistic methods to assess the effects of distracting behaviors. Four studies involved non-commercial drivers of light vehicles and two studies involved commercial drivers of trucks and buses. Odds ratios quantifying safety-critical event (SCE) risk associated with talking, dialing, locating or answering, and texting or browsing were extracted. Stratified meta-analysis of pooled odds ratios was used to estimate SCE risk by distraction type; meta-regression was used to test for sources of heterogeneity. The results indicate that tasks that require drivers to take their eyes off the road, such as dialing, locating a phone and texting, increase SCE risk to a greater extent than tasks that do not require eyes off the road such as talking. Although talking on a handheld device did not increase SCE risk, further research is required to determine whether it indirectly influences SCE risk (e.g., by encouraging other cell phone activities). In addition, a number of study biases and quality issues of naturalistic driving studies are discussed.
Objective
An up-to-date meta-analysis of experimental research on talking and driving is needed to provide a comprehensive, empirical, and credible basis for policy, legislation, countermeasures, and ...future research.
Background
The effects of cell, mobile, and smart phone use on driving safety continues to be a contentious societal issue.
Method
All available studies that measured the effects of cell phone use on driving were identified through a variety of search methods and databases. A total of 93 studies containing 106 experiments met the inclusion criteria. Coded independent variables included conversation target (handheld, hands-free, and passenger), setting (laboratory, simulation, or on road), and conversation type (natural, cognitive task, and dialing). Coded dependent variables included reaction time, stimulus detection, lane positioning, speed, headway, eye movements, and collisions.
Results
The overall sample had 4,382 participants, with driver ages ranging from 14 to 84 years (M = 25.5, SD = 5.2). Conversation on a handheld or hands-free phone resulted in performance costs when compared with baseline driving for reaction time, stimulus detection, and collisions. Passenger conversation had a similar pattern of effect sizes. Dialing while driving had large performance costs for many variables.
Conclusion
This meta-analysis found that cell phone and passenger conversation produced moderate performance costs. Drivers minimally compensated while conversing on a cell phone by increasing headway or reducing speed. A number of additional meta-analytic questions are discussed.
Application
The results can be used to guide legislation, policy, countermeasures, and future research.
•Meta-analysis of voice-recognition system interaction on driving performance.•Voice-recognition system interaction while driving has a distraction cost.•Some improved performance relative to ...visual-manual systems.
Driver distraction is a growing and pervasive issue that requires multiple solutions. Voice-recognition (V-R) systems may decrease the visual-manual (V-M) demands of a wide range of in-vehicle system and smartphone interactions. However, the degree that V-R systems integrated into vehicles or available in mobile phone applications affect driver distraction is incompletely understood. A comprehensive meta-analysis of experimental studies was conducted to address this knowledge gap. To meet study inclusion criteria, drivers had to interact with a V-R system while driving and doing everyday V-R tasks such as dialing, initiating a call, texting, emailing, destination entry or music selection. Coded dependent variables included detection, reaction time, lateral position, speed and headway. Comparisons of V-R systems with baseline driving and/or a V-M condition were also coded. Of 817 identified citations, 43 studies involving 2000 drivers and 183 effect sizes (r) were analyzed in the meta-analysis. Compared to baseline, driving while interacting with a V-R system is associated with increases in reaction time and lane positioning, and decreases in detection. When V-M systems were compared to V-R systems, drivers had slightly better performance with the latter system on reaction time, lane positioning and headway. Although V-R systems have some driving performance advantages over V-M systems, they have a distraction cost relative to driving without any system at all. The pattern of results indicates that V-R systems impose moderate distraction costs on driving. In addition, drivers minimally engage in compensatory performance adjustments such as reducing speed and increasing headway while using V-R systems. Implications of the results for theory, design guidelines and future research are discussed.
Pedestrians are commonly involved in vehicle collisions that result in injuries and fatalities. Pedestrian distraction has become an emerging safety issue as more pedestrians use their mobile phones ...while walking and crossing the street.
The purpose of this research synthesis and meta-analysis is to determine the extent to which cell phone conversation, text messaging or browsing, and listening to music affect a number of common pedestrian behavioural measures.
A keyword search was developed with a subject librarian that used MeSH terms from selected databases including PsycINFO, SPORTDiscus, Medline and TRID. Supplemental searches were also conducted with Google Scholar and Mendeley.
Thirty-three studies met inclusion criteria and were subjected to data extraction. Statistical information (ie,
) was extracted to generate standardised mean difference effect sizes (ie, Cohen's d) and
effect sizes.
Fourteen experimental studies were ultimately included in an N-weighted meta-analysis (
=81 effect sizes), and eight observational studies were included in a qualitative overview. Both mobile phone conversation and text messaging increased rates of hits and close calls. Texting decreased rates of looking left and right prior to and/or during street crossing. As might be expected, text messaging was generally found to have the most detrimental effect on multiple behavioural measures.
A variety of study quality issues limit the interpretation and generalisation of the results, which are described, as are future study measurement and methods improvements.
Post-COVID-19 condition (also known as long COVID) is an emerging chronic illness potentially affecting millions of people. We aimed to evaluate whether outpatient COVID-19 treatment with metformin, ...ivermectin, or fluvoxamine soon after SARS-CoV-2 infection could reduce the risk of long COVID.
We conducted a decentralised, randomised, quadruple-blind, parallel-group, phase 3 trial (COVID-OUT) at six sites in the USA. We included adults aged 30–85 years with overweight or obesity who had COVID-19 symptoms for fewer than 7 days and a documented SARS-CoV-2 positive PCR or antigen test within 3 days before enrolment. Participants were randomly assigned via 2 × 3 parallel factorial randomisation (1:1:1:1:1:1) to receive metformin plus ivermectin, metformin plus fluvoxamine, metformin plus placebo, ivermectin plus placebo, fluvoxamine plus placebo, or placebo plus placebo. Participants, investigators, care providers, and outcomes assessors were masked to study group assignment. The primary outcome was severe COVID-19 by day 14, and those data have been published previously. Because the trial was delivered remotely nationwide, the a priori primary sample was a modified intention-to-treat sample, meaning that participants who did not receive any dose of study treatment were excluded. Long COVID diagnosis by a medical provider was a prespecified, long-term secondary outcome. This trial is complete and is registered with ClinicalTrials.gov, NCT04510194.
Between Dec 30, 2020, and Jan 28, 2022, 6602 people were assessed for eligibility and 1431 were enrolled and randomly assigned. Of 1323 participants who received a dose of study treatment and were included in the modified intention-to-treat population, 1126 consented for long-term follow-up and completed at least one survey after the assessment for long COVID at day 180 (564 received metformin and 562 received matched placebo; a subset of participants in the metformin vs placebo trial were also randomly assigned to receive ivermectin or fluvoxamine). 1074 (95%) of 1126 participants completed at least 9 months of follow-up. 632 (56·1%) of 1126 participants were female and 494 (43·9%) were male; 44 (7·0%) of 632 women were pregnant. The median age was 45 years (IQR 37–54) and median BMI was 29·8 kg/m2 (IQR 27·0–34·2). Overall, 93 (8·3%) of 1126 participants reported receipt of a long COVID diagnosis by day 300. The cumulative incidence of long COVID by day 300 was 6·3% (95% CI 4·2–8·2) in participants who received metformin and 10·4% (7·8–12·9) in those who received identical metformin placebo (hazard ratio HR 0·59, 95% CI 0·39–0·89; p=0·012). The metformin beneficial effect was consistent across prespecified subgroups. When metformin was started within 3 days of symptom onset, the HR was 0·37 (95% CI 0·15–0·95). There was no effect on cumulative incidence of long COVID with ivermectin (HR 0·99, 95% CI 0·59–1·64) or fluvoxamine (1·36, 0·78–2·34) compared with placebo.
Outpatient treatment with metformin reduced long COVID incidence by about 41%, with an absolute reduction of 4·1%, compared with placebo. Metformin has clinical benefits when used as outpatient treatment for COVID-19 and is globally available, low-cost, and safe.
Parsemus Foundation; Rainwater Charitable Foundation; Fast Grants; UnitedHealth Group Foundation; National Institute of Diabetes, Digestive and Kidney Diseases; National Institutes of Health; and National Center for Advancing Translational Sciences.
Xerostomia (dry mouth) is the most common side effect of radiation therapy in patients with head and neck cancer and causes difficulty speaking and swallowing. Since aldehyde dehydrogenase 3A1 ...(ALDH3A1) is highly expressed in mouse salivary stem/progenitor cells (SSPCs), we sought to determine the role of ALDH3A1 in SSPCs using genetic loss-of-function and pharmacologic gain-of-function studies. Using DarkZone dye to measure intracellular aldehydes, we observed higher aldehyde accumulation in irradiated Aldh3a1
−/− adult murine salisphere cells and in situ in whole murine embryonic salivary glands enriched in SSPCs compared with wild-type glands. To identify a safe ALDH3A1 activator for potential clinical testing, we screened a traditional Chinese medicine library and isolated D-limonene, commonly used as a food-flavoring agent, as a single constituent activator. ALDH3A1 activation by D-limonene significantly reduced aldehyde accumulation in SSPCs and whole embryonic glands, increased sphere-forming ability, decreased apoptosis, and improved submandibular gland structure and function in vivo after radiation. A phase 0 study in patients with salivary gland tumors showed effective delivery of D-limonene into human salivary glands following daily oral dosing. Given its safety and bioavailability, D-limonene may be a good clinical candidate for mitigating xerostomia in patients with head and neck cancer receiving radiation therapy.
The COVID-19 pandemic offers both challenges and opportunities for those who provide and receive psychological services. For training clinics tasked with educating the next generation of health ...service psychologists, providing vital mental health care to the community, and conducting clinical research, the pandemic offers an opportunity to consider how best to fulfill these crucial missions during a time of global uncertainty. The present paper reviews the recent, rapid move to telepsychology among North American university training clinics in response to the COVID-19 pandemic and offers relevant suggestions for mental health service providers rapidly transitioning to telepsychology moving forward. Data summarizing the response of university training clinics in health service psychology in the United States and Canada to physical distancing guidelines are presented, and considerations regarding best practices in service delivery and supervision via telepsychology are provided. While the present data focus on North American training clinics, the suggestions offered are relevant to any clinic tasked with providing high quality services and training mental health providers via telepsychology, particularly during the COVID-19 pandemic. Given the growing emphasis within health service psychology on increasing access to mental health services via telepsychology prior to the pandemic, as well as the benefits to psychology trainees in gaining competence in this valuable form of service delivery, this paper aims to provide timely guidance around the benefits, risks, and practical considerations regarding the maintenance of effective clinical care in training settings when rapidly implementing telepsychology.
Navegando aguas desconocidas: Consideraciones para clínicas de capacitación el la transición rápida a la telepsicología y telesupervisión durante COVID-19
La pandemia COVID-19 ofrece a la vez retos y oportunidades para aquellos que proporcionan y reciben servicios psicológicos. Para las clínicas de capacitación encargadas de educar a la próxima generación de psicólogos de servicio de salud, proporcionando cuidado de salud mental vital a la comunidad, y llevando a cabo investigaciones clínicas, la pandemia ofrece una oportunidad para considerar la mejor manera de cumplir con estas misiones cruciales durante un tiempo de incertidumbre mundial. El articulo presente repasa el reciente traslado rápido a la telepsicología entre las clínicas de capacitación en universidades Norte Americanas en respuesta a la pandemia COVID-19 y ofrece sugerencias pertinentes para los proveedores de salud mental en transición rápida a la telepsicología en el futuro. Los datos resumiendo la respuesta de las clínicas de capacitación universitarias en la psicología de servicio de salud en los Estados Unidos y Canadá a las pautas de distanciamiento físico son presentados, y las consideraciones con respecto a las mejores prácticas en la entrega de servicios y supervisión a través de la telepsicología son proporcionadas. Mientras los datos actuales se enfocan en las clínicas de capacitación Norte Americanas, las sugerencias ofrecidas son pertinentes a cualquier clínica encargada con proveer servicios de alta calidad y capacitación de la salud mental a proveedores a través de la telepsicología, particularmente durante la pandemia COVID-19. Dado al énfasis cada vez mayor dentro de la psicología de servicio de salud en incrementar acceso a servicios de salud mental antes de la pandemia a través de la telepsicología y los beneficios para los aprendices en obtener habilidad en esta forma valiosa de entrega de servicios, este articulo tiene como objetivo proporcionar orientación oportuna en torno a los beneficio, riesgos, y consideraciones practicas con respecto el mantenimiento de el cuidado clínico efectivo en entornos de capacitación implementando rápidamente la telepsicología.
探索未知水域：在COVID-19中对训练诊所向远程心理治疗和远程督导转换中的一些思考
COVID-19全球大流行对提供和接受心理服务的人群提供了挑战和机遇。对于训练诊所来说，既有教育下一代健康服务心理学家的任务，又要对社区提供关键的心理健康服务，还要进行临床研究；这次大流行提供了很好地机会，让其考虑怎样在全球性的不确定性时期中最好地完成这些关键任务。本文回顾了最近北美大学的训练诊所为应对COVID-19进行的快速转换到远程心理治疗的举动，并像心理健康服务提供者们提供未来快速转向远程心理治疗的一些建议。展示了总结出的在美国和加拿大的高校为应对物理距离指导意见而做出的回应的数据，并且提供了通过远程心理方式提供服务和督导的最佳实务方式。尽管本文数据集中在北美训练诊所上，所提供的建议对任何需要通过远程心理提供高质量的心理服务和培训心理健康工作者的诊所都适用，特别是在COVID-19大流行期间。鉴于大流行前就有的在健康服务心理学中越来越多的对使远程心理来提高心理健康服务可及性的强调，以及心理学受训者对这种宝贵的服务提供方式提高能力的好处，本文旨在提供及时的指导，关于在快速转换为远程心理时保持训练背景下有效临床关怀的益处、风险和实际考虑。
There is growing evidence of abnormal epigenetic processes playing a role in the neurobiology of psychiatric disorders, although the precise nature of these anomalies remains largely unknown. To ...study neurobiological (including epigenetic) factors that influence emotionality, we use rats bred for distinct behavioral responses to novelty. Rats bred for low novelty response (low responder LR) exhibit high levels of anxiety- and depressive-like behavior compared with high novelty responder (HR) rats. Prior work revealed distinct limbic brain development in HR versus LR rats, including altered expression of genes involved in DNA methylation. This led us to hypothesize that DNA methylation differences in the developing brain drive the disparate HR/LR neurobehavioral phenotypes. Here we report altered DNA methylation markers (altered DNA methyltransferase protein levels and increased global DNA methylation levels) in the early postnatal amygdala of LR versus HR male rats. Next-generation sequencing methylome profiling identified numerous differentially methylated regions across the genome in the early postnatal HR/LR amygdala. We also contrasted methylation profiles of male HRs and LRs with a control rat strain that displays an intermediate behavioral phenotype relative to the HR/LR extremes; this revealed that the LR amygdalar methylome was abnormal, with the HR profile more closely resembling that of the control group. Finally, through two methylation manipulations in early life, we found that decreasing DNA methylation in the developing male and female amygdala improves adult anxiety- and depression-like behavior. These findings suggest that inborn DNA methylation differences play important roles in shaping brain development and lifelong emotional behavior.
Epigenetic changes are biological mechanisms that regulate the expression and function of genes throughout the brain and body. DNA methylation, one type of epigenetic mechanism, is known to be altered in brains of psychiatric patients, which suggests a role for DNA methylation in the pathogenesis of psychiatric disorders, such as depression and anxiety. The present study examines brains of rats that display high versus low levels of anxiety- and depression-like behavior to investigate how neural DNA methylation levels differ in these animals and how such differences shape their emotional behavioral differences. Studying how epigenetic processes affect emotional behavior may improve our understanding of the neurobiology of psychiatric disorders and lead to improved treatments.
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