Abstract only Background: The cardiac arrest hospital prognosis (CAHP) score has been shown in French studies to predict neurologic outcomes in patients who suffer an out-of-hospital cardiac arrest ...(OHCA), but this score has not been studied in an American cohort. We aimed to validate the CAHP score in an independent, single center, large cardiac arrest registry. Methods: Between January 2015 to June 2020 there were 925 patients who suffered OHCA and were transferred to Northeast Georgia Medical Center out of whom 450 patients survived to hospital admission. Cerebral Performance Category (CPC) score was used for assessment of neurologic outcome at discharge ranging from 1-5. The primary endpoint was poor neurologic outcome defined as CPC 3-5. Logistic regression was performed to identify independent predictors of poor neurologic outcome. Results: Included patients were mostly male 57% (256 of 450) with a mean age of 52±15. STEMI was present on 11% (51 of 450) and a shockable rhythm on 35% (150 of 450) of patients. Targeted temperature management (TTM) and a mechanical compression device (MCD) were used in 72% (327 of 450) and 74% (336 of 450) respectively. 76% (344 of 450) had a CPC of 3-5 at discharge. After adjusting for covariates, including gender, BMI, serum lactate level, witnessed arrest status, STEMI on ECG, and use of MCD and TTM, the only independent predictors of a CPC of 3-5 were CAHP score (p<0.001), witnessed cardiac arrest, (p=0.039, OR: 0.45) and STEMI on admission ECG (P=0.001, OR: 0.22). Compared with CAHP< 150, CAHP 150-200 and CAHP>200 were associated with a 12-fold (p<0.00001) and 79-fold (p<0.00001) increased risk of poor neurologic outcome. Area under ROC curve for CAHP score predicting neurologic outcome was 0.92 (95% CI: 0.89-0.94). Conclusion: Here we show, for the first time, in an independent, large American cardiac arrest registry that CAHP score predicts neurologic outcomes in patients with OHCA. Further research is needed to assess how this prognostication tool would help clinicians decide on early vs. delayed invasive strategy in patients with OHCA admitted to hospitals across the U.S.
To examine the predictive utility of psychological correlates of alcohol consumption identified in previous (US-dominated) research for a UK student sample and construct an integrative model ...predictive of alcohol dependency in a sample of first-year undergraduate students.
A self-report questionnaire completed by 230 students measured stable and modifiable correlates of alcohol dependence. Stable correlates included age when first regularly drinking (age of onset), personality traits and religiosity. Modifiable measures included drinking motives, self-efficacy, alcohol-related expectancies, prototype perceptions and normative beliefs.
The final multivariate model highlighted the importance of age of onset, sensation-seeking and a series of social cognitive measures including: social drinking motives, confidence in the ability to drink within government guidelines (self-efficacy) and the perceived quantity and frequency of alcohol consumed by university friends. Beta-coefficients indicated that self-efficacy and social drinking motives were particularly important predictors. A significant interaction was observed between age of onset and self-efficacy. Earlier onset was associated with higher levels of alcohol dependence for low and moderate, but not high levels of self-efficacy.
The model presented here could be used to identify students at risk of alcohol dependence and inform the design of campus-based interventions.
Aims: To examine the predictive utility of psychological correlates of alcohol consumption identified in previous (US-dominated) research for a UK student sample and construct an integrative model ...predictive of alcohol dependency in a sample of first-year undergraduate students, Methods: A self-report questionnaire completed by 230 students measured stable and modifiable correlates of alcohol dependence. Stable correlates included age when first regularly drinking (age of onset), personality traits and religiosity. Modifiable measures included drinking motives, self-efficacy, alcohol-related expectancies, prototype perceptions and normative beliefs. Results: The final multivariate model highlighted the importance of age of onset, sensation-seeking and a series of social cognitive measures including: social drinking motives, confidence in the ability to drink within government guidelines (self-efficacy) and the perceived quantity and frequency of alcohol consumed by university friends. Beta-coefficients indicated that self-efficacy and social drinking motives were particularly important predictors. A significant interaction was observed between age of onset and self-efficacy. Earlier onset was associated with higher levels of alcohol dependence for low and moderate, but not high levels of self-efficacy. Conclusion: The model presented here could be used to identify students at risk of alcohol dependence and inform the design of campus-based interventions. Adapted from the source document.
Excessive alcohol consumption among UK university students is well documented. Although alcohol use reduces over the time spent at university, drinking patterns of undergraduates have been associated ...with risk of alcohol dependence and abuse a decade following graduation. Consequently, UK universities should endeavour to promote responsible drinking among their drinking student population. This thesis presents four studies that aim to inform the development of feasible and effective alcohol-related interventions targeting the student population. The first two studies examined the effect of an alcohol-related outcome expectancy manipulation on alcohol-related cognitions and consumption. Study one showed that a manipulation aiming to bolster negative expectancies and contradict positive expectancies was associated with immediate reductions in mild desires for alcohol. Study two provided limited support for study one, and indicated that repeated exposure to the manipulation was not associated with significantly greater effects. Neither study showed significant reductions in alcohol consumption. Study three used a survey to examine the predictive utility of a broader range of correlates of alcohol consumption, and provided an integrative model of risky drinking behaviour. The model highlighted the importance of age when first regularly drinking, the sensation-seeking personality trait, social drinking motives, confidence in ability to drink within government guidelines, and the perceived quantity and frequency of alcohol consumed by university friends. Study four consisted of a systematic review and meta-analysis examining the effectiveness of computer-delivered interventions (CDIs) across different study design features and identified the characteristics of CDIs associated with the largest effects. CDI efficacy was greater for primary than secondary outcomes, and varied according to the control condition and outcomes used. CDIs with the largest effects utilised personalised normative feedback among US heavy/binge drinking students. The results of these studies contribute to the current intervention literature and can be used to inform intervention development in UK universities.
Excessive alcohol consumption among UK university students is well documented. Although alcohol use reduces over the time spent at university, drinking patterns of undergraduates have been associated ...with risk of alcohol dependence and abuse a decade following graduation. Consequently, UK universities should endeavour to promote responsible drinking among their drinking student population. This thesis presents four studies that aim to inform the development of feasible and effective alcohol-related interventions targeting the student population. The first two studies examined the effect of an alcohol-related outcome expectancy manipulation on alcohol-related cognitions and consumption. Study one showed that a manipulation aiming to bolster negative expectancies and contradict positive expectancies was associated with immediate reductions in mild desires for alcohol. Study two provided limited support for study one, and indicated that repeated exposure to the manipulation was not associated with significantly greater effects. Neither study showed significant reductions in alcohol consumption. Study three used a survey to examine the predictive utility of a broader range of correlates of alcohol consumption, and provided an integrative model of risky drinking behaviour. The model highlighted the importance of age when first regularly drinking, the sensation-seeking personality trait, social drinking motives, confidence in ability to drink within government guidelines, and the perceived quantity and frequency of alcohol consumed by university friends. Study four consisted of a systematic review and meta-analysis examining the effectiveness of computer-delivered interventions (CDIs) across different study design features and identified the characteristics of CDIs associated with the largest effects. CDI efficacy was greater for primary than secondary outcomes, and varied according to the control condition and outcomes used. CDIs with the largest effects utilised personalised normative feedback among US heavy/binge drinking students. The results of these studies contribute to the current intervention literature and can be used to inform intervention development in UK universities.
A growing number of endurance athletes have considered switching from a traditional high-carbohydrate/low-fat (HCLF) to a low-carbohydrate/high-fat (LCHF) eating pattern for health and performance ...reasons. However, few studies have examined how LCHF diets affect blood lipid profiles in highly-trained runners. In a randomized and counterbalanced, cross-over design, athletes (n = 7 men; VO2max: 61.9 ± 6.1 mL/kg/min) completed six weeks of two, ad libitum, LCHF (6/69/25% en carbohydrate/fat/protein) and HCLF (57/28/15% en carbohydrate/fat/protein) diets, separated by a two-week washout. Plasma was collected on days 4, 14, 28, and 42 during each condition and analyzed for: triglycerides (TG), LDL-C, HDL-C, total cholesterol (TC), VLDL, fasting glucose, and glycated hemoglobin (HbA1c). Capillary blood beta-hydroxybutyrate (BHB) was monitored during LCHF as a measure of ketosis. LCHF lowered plasma TG, VLDL, and TG/HDL-C (all p < 0.01). LCHF increased plasma TC, LDL-C, HDL-C, and TC/HDL-C (all p < 0.05). Plasma glucose and HbA1c were unaffected. Capillary BHB was modestly elevated throughout the LCHF condition (0.5 ± 0.05 mmol/L). Healthy, well-trained, normocholesterolemic runners consuming a LCHF diet demonstrated elevated circulating LDL-C and HDL-C concentrations, while concomitantly decreasing TG, VLDL, and TG/HDL-C ratio. The underlying mechanisms and implications of these adaptive responses in cholesterol should be explored.
Black and Latinx youth are disproportionately affected by violence in the United States. Hospital‐based violence intervention programs (HVIPs) have emerged as an effective response to this epidemic; ...however, participation rates remain low. This study aimed to identify facilitators and barriers to recruitment and engagement amongst black and Latinx youth from the perspective of HVIP staff. Employing a phenomenological approach, a purposive sample of key informants was recruited. Focus groups and semi‐structured interviews lasting approximately 90 min were conducted with representatives (N = 12) from five HVIPs in U.S. cities across the Midwest and Northeast, making up 15% of all HVIPs in the United States. Each interview was recorded and transcribed verbatim. The research team employed rigorous content analysis of the data. Three themes and subsequent categories resulted from the analysis: (1) Interpersonal/Relational Facilitators (building rapport; connecting with youth; enhancing the teachable moment; building relational health); (2) Structural/Systemic Barriers (lack of reinforcement; difficulties connecting after discharge from the hospital; hospital workflow; institutional challenges); (3) Structural/Systemic Facilitators (embedding the HVIP; trauma‐informed practices and policies). Given the limited research on black and Latinx youth and the disproportionate rate of violent injuries amongst these groups, an evidence‐based systematic approach to engage youth is essential to promote health equity. The findings from this study suggest that there are several steps that HVIPs and hospitals can take to enhance their recruitment and engagement of youth and their families.
A common belief is that high intensity exercise (>60%VO
) is best sustained by high rates of carbohydrate oxidation. The belief is based, in part, on an idea developed by Krogh and Lindhard in 1920. ...In the 100 years since, few studies have tested its validity. We tested the null hypothesis that performance in competitive recreational athletes exercising at >80% VO
, during simulated 5-km running time trials (5KTT) would be impaired during a 6-week period of adaption to a low-carbohydrate, high-fat (LCHF) diet, compared to their performances when they ate a diet higher in carbohydrate and lower in fat (HCLF). Seven male athletes (age 35.6 ± 8.4 years, height 178.7 ± 4.1 cm, weight 68.6 ± 1.6 kg) completed two maximal exercise (VO
) tests (Day 1 and 39) and four 5KTT (Day 4, 14, 28, and 42) in a fasted state during two 6-week periods when they ate either a HCLF or a LCHF diet, in a randomized counterbalanced, crossover design. Exercise performance during the VO
tests was unchanged on either diet (p = 0.251). Performance in the initial 5KTT was significantly slower on the LCHF diet (p = 0.011). There were no diet-related performance differences in the remaining three 5KTT (p > 0.22). Subjects exercised at ~82%VO
. Carbohydrate oxidation provided 94% of energy on the HCLF diet, but only 65% on the LCHF diet. 5KTT performance at ~82%VO
was independent of the runners' habitual diet. The HCLF diet offered no advantage over a diet with a high-fat content. Since these athletes run faster than 88% of recreational distance runners in the United States (U.S.), this finding may have wide general application.
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