Pre-pandemic Executive Function Protects Against Pandemic Anxiety in Children with and Without Autism Spectrum Disorder

The COVID-19 pandemic may have exacerbated depression, anxiety, and executive function (EF) difficulties in children with autism spectrum disorder (ASD). EF skills have been positively associated with mental health outcomes. Here, we probed the psychosocial impacts of pandemic responses in children with and without ASD by relating pre-pandemic EF assessments with anxiety and depression symptoms several months into the pandemic. We found that pre-pandemic inhibition and shifting difficulties, measured by the Behavior Rating Inventory of Executive Function, predicted higher risk of anxiety symptoms. These findings are critical for promoting community recovery and maximizing clinical preparedness to support children at increased risk for adverse psychosocial outcomes.

Brain Dynamics Underlying Cognitive Flexibility Across the Lifespan

The neural mechanisms contributing to flexible cognition and behavior and how they change with development and aging are incompletely understood. The current study explored intrinsic brain dynamics across the lifespan using resting-state fMRI data (n = 601, 6-85 years) and examined the interactions between age and brain dynamics among three neurocognitive networks (midcingulo-insular network, M-CIN; medial frontoparietal network, M-FPN; and lateral frontoparietal network, L-FPN) in relation to behavioral measures of cognitive flexibility. Hierarchical multiple regression analysis revealed brain dynamics among a brain state characterized by co-activation of the L-FPN and M-FPN, and brain state transitions, moderated the relationship between quadratic effects of age and cognitive flexibility as measured by scores on the Delis-Kaplan Executive Function System (D-KEFS) test. Furthermore, simple slope analyses of significant interactions revealed children and older adults were more likely to exhibit brain dynamic patterns associated with poorer cognitive flexibility compared with younger adults. Our findings link changes in cognitive flexibility observed with age with the underlying brain dynamics supporting these changes. Preventative and intervention measures should prioritize targeting these networks with cognitive flexibility training to promote optimal outcomes across the lifespan.

Altered patterns of brain dynamics linked with body mass index in youth with autism

Children with autism spectrum disorder (ASD) have higher rates of overweight and obesity (OWOB) compared with typically developing (TD) children. Brain functional connectivity differences have been shown in both ASD and OWOB. However, only one study to date has examined ASD and OWOB concurrently, so little is known regarding the neural mechanisms associated with the higher prevalence of OWOB and its behavioral impacts in ASD. We investigated co-activation patterns (CAPs) of brain regions identified by independent component analysis in 129 children and adolescents between 6 and 18 years of age (n = 68 ASD). We examined the interaction between body mass index (BMI) and diagnosis in predicting dynamic brain metrics (dwell time, DT; frequency of occurrence, and transitions between states) as well as dimensional brain-behavior relationships. The relationship between BMI and brain dynamics was moderated by diagnosis (ASD, TD), particularly among the frequency of CAP 4, characterized by co-activation of lateral frontoparietal, temporal, and frontal networks. This pattern was negatively associated with parent-reported inhibition skills. Children with ASD had shorter CAP 1, characterized by co-activation of the subcortical, temporal, sensorimotor, and frontal networks, and CAP 4 DTs compared with TD children. CAP 1 DT was negatively associated with cognitive flexibility, inhibition, social functioning, and BMI. Cognitive flexibility moderated the relationship between BMI and brain dynamics in the visual network. Our findings provide novel evidence of neural mechanisms associated with OWOB in children with ASD. Further, poorer cognitive flexibility may result in increased vulnerability for children with ASD and co-occurring OWOB. LAY SUMMARY: Obesity is a societal epidemic and is common in autism, however, little is known about the neural mechanisms associated with the higher rates of obesity in autism. Here, we find unique patterns of brain dynamics associated with obesity in autism that were not observed in typically developing children. Further, the relationship between body mass index and brain dynamics depended on cognitive flexibility. These findings suggest that individuals with autism may be more vulnerable to the effects of obesity on brain function. Autism Res 2021, 14: 873-886. © 2021 International Society for Autism Research, Wiley Periodicals LLC.

Neural Substrates of Food Valuation and Its Relationship With BMI and Healthy Eating in Higher BMI Individuals

Considerable evidence points to a link between body mass index (BMI), eating behavior, and the brain's reward system. However, much of this research focuses on food cue reactivity without examining the subjective valuation process as a potential mechanism driving individual differences in BMI and eating behavior. The current pre-registered study (https://osf.io/n4c95/) examined the relationship between BMI, healthy eating, and subjective valuation of healthy and unhealthy foods in a community sample of individuals with higher BMI who intended to eat more healthily. Particularly, we examined: (1) alterations in neurocognitive measures of subjective valuation related to BMI and healthy eating; (2) differences in the neurocognitive valuation for healthy and unhealthy foods and their relation to BMI and healthy eating; (3) and whether we could conceptually replicate prior findings demonstrating differences in neural reactivity to palatable vs. plain foods. To this end, we scanned 105 participants with BMIs ranging from 23 to 42 using fMRI during a willingness-to-pay task that quantifies trial-by-trial valuation of 30 healthy and 30 unhealthy food items. We measured out of lab eating behavior via the Automated Self-Administered 24 H Dietary Assessment Tool, which allowed us to calculate a Healthy Eating Index (HEI). We found that our sample exhibited robust, positive linear relationships between self-reported value and neural responses in regions previously implicated in studies of subjective value, suggesting an intact valuation system. However, we found no relationship between valuation and BMI nor HEI, with Bayes Factor indicating moderate evidence for a null relationship. Separating the food types revealed that healthy eating, as measured by the HEI, was inversely related to subjective valuation of unhealthy foods. Imaging data further revealed a stronger linkage between valuation of healthy (compared to unhealthy) foods and corresponding response in the ventromedial prefrontal cortex (vmPFC), and that the interaction between healthy and unhealthy food valuation in this region is related to HEI. Finally, our results did not replicate reactivity differences demonstrated in prior work, likely due to differences in the mapping between food healthiness and palatability. Together, our findings point to disruptions in the valuation of unhealthy foods in the vmPFC as a potential mechanism influencing healthy eating.

Coactivation pattern analysis reveals altered salience network dynamics in children with autism spectrum disorder

Brain connectivity studies of autism spectrum disorder (ASD) have historically relied on static measures of functional connectivity. Recent work has focused on identifying transient configurations of brain activity, yet several open questions remain regarding the nature of specific brain network dynamics in ASD. We used a dynamic coactivation pattern (CAP) approach to investigate the salience/midcingulo-insular (M-CIN) network, a locus of dysfunction in ASD, in a large multisite resting-state fMRI dataset collected from 172 children (ages 6–13 years; n = 75 ASD; n = 138 male). Following brain parcellation by using independent component analysis, dynamic CAP analyses were conducted and k-means clustering was used to determine transient activation patterns of the M-CIN. The frequency of occurrence of different dynamic CAP brain states was then compared between children with ASD and typically developing (TD) children. Dynamic brain configurations characterized by coactivation of the M-CIN with central executive/lateral fronto-parietal and default mode/medial fronto-parietal networks appeared less frequently in children with ASD compared with TD children. This study highlights the utility of time-varying approaches for studying altered M-CIN function in prevalent neurodevelopmental disorders. We speculate that altered M-CIN dynamics in ASD may underlie the inflexible behaviors commonly observed in children with the disorder.

Autism spectrum disorder (ASD) is a neurodevelopmental disorder associated with altered patterns of functional brain connectivity. Little is currently known about how moment-to-moment brain dynamics differ in children with ASD and typically developing (TD) children. Altered functional integrity of the midcingulo-insular network (M-CIN) has been implicated in the neurobiology of ASD. Here we use a novel coactivation analysis approach applied to a large sample of resting-state fMRI data collected from children with ASD and TD children to demonstrate altered patterns of M-CIN dynamics in children with the disorder. We speculate that these atypical patterns of brain dynamics may underlie behavioral inflexibility in ASD.

Brain Activity Associated With Regulating Food Cravings Predicts Changes in Self-Reported Food Craving and Consumption Over Time

Neural patterns associated with viewing energy-dense foods can predict changes in eating-related outcomes. However, most research on this topic is limited to one follow-up time point, and single outcome measures. The present study seeks to add to that literature by employing a more refined assessment of food craving and consumption outcomes along with a more detailed neurobiological model of behavior change over several time points. Here, a community sample of 88 individuals (age: M = 39.17, SD = 3.47; baseline BMI: M = 31.5, SD = 3.9, range 24–42) with higher body mass index (BMI) performed a food craving reactivity and regulation task while undergoing functional magnetic resonance imaging. At that time—and 1, 3, and 6 months later—participants reported craving for and consumption of healthy and unhealthy foods via the Food Craving Inventory (FCI) and ASA24 (N at 6 months = 52–55 depending on the measure). A priori hypotheses that brain activity associated with both viewing and regulating personally desired unhealthy, energy-dense foods would be associated with self-reported craving for and consumption of unhealthy foods at baseline were not supported by the data. Instead, regression models controlling for age, sex, and BMI demonstrated that brain activity across several regions measured while individuals were regulating their desires for unhealthy food was associated with the self-reported craving for and consumption of healthy food. The hypothesis that vmPFC activity would predict patterns of healthier eating was also not supported. Instead, linear mixed models controlling for baseline age and sex, as well as changes in BMI, revealed that more regulation-related activity in the dlPFC, dACC, IFG, and vmPFC at baseline predicted decreases in the craving for and consumption of healthy foods over the course of 6 months.

Neural Responses to a Putative Set-shifting Task in Children with Autism Spectrum Disorder

While much progress has been made toward understanding the neurobiology of social and communication deficits associated with autism spectrum disorder (ASD), less is known regarding the neurobiological basis of restricted and repetitive behaviors (RRBs) central to the ASD diagnosis. Symptom severity for RRBs in ASD is associated with cognitive inflexibility. Thus, understanding the neural mechanisms underlying cognitive inflexibility in ASD is critical for tailoring therapies to treat this understudied yet pervasive symptom. Here we used a set-shifting paradigm adopted from the developmental cognitive neuroscience literature involving flexible switching between stimulus categories to examine task performance and neural responses in children with ASD. Behaviorally, we found little evidence for group differences in performance on the set-shifting task. Compared with typically developing children, children with ASD exhibited greater activation of the parahippocampal gyrus during performance on trials requiring switching. These findings suggest that children with ASD may need to recruit memory-based neural systems to a greater degree when learning to flexibly associate stimuli with responses. LAY SUMMARY: Children with autism often struggle to behave in a flexible way when faced with unexpected challenges. We examined brain responses during a task thought to involve flexible thinking and found that compared with typically developing children, those with autism relied more on brain areas involved in learning and memory to complete the task. This study helps us to understand what types of cognitive tasks are best suited for exploring the neural basis of cognitive flexibility in children with autism. Autism Res 2020, 13: 1501-1515. © 2020 International Society for Autism Research, Wiley Periodicals, Inc.

Evoked and intrinsic brain network dynamics in children with autism spectrum disorder

OBJECTIVE

Brain dynamics underlie flexible cognition and behavior, yet little is known regarding this relationship in autism spectrum disorder (ASD). We examined time-varying changes in functional co-activation patterns (CAPs) across rest and task-evoked brain states to characterize differences between children with ASD and typically developing (TD) children and identify relationships with severity of social behaviors and restricted and repetitive behaviors.

METHOD

17 children with ASD and 27 TD children ages 7-12 completed a resting-state fMRI scan and four runs of a non-cued attention switching task. Metrics indexing brain dynamics were generated from dynamic CAPs computed across three major large-scale brain networks: midcingulo-insular (M-CIN), medial frontoparietal (M-FPN), and lateral frontoparietal (L-FPN).

RESULTS

Five time-varying CAPs representing dynamic co-activations among network nodes were identified across rest and task fMRI datasets. Significant Diagnosis × Condition interactions were observed for the dwell time of CAP 3, representing co-activation between nodes of the M-CIN and L-FPN, and the frequency of CAP 1, representing co-activation between nodes of the L-FPN. A significant brain-behavior association between dwell time of CAP 5, representing co-activation between nodes of the M-FPN, and social abilities was also observed across both groups of children.

CONCLUSION

Analysis of brain co-activation patterns reveals altered dynamics among three core networks in children with ASD, particularly evident during later stages of an attention task. Dimensional analyses demonstrating relationships between M-FPN dwell time and social abilities suggest that metrics of brain dynamics may index individual differences in social cognition and behavior.

Prevalence of nosocomial pathogens in German ambulances: the SEKURE study

OBJECTIVE

The increasing prevalence of multidrug resistant bacteria is a problem in the inpatient care setting, and in the emergency care system. The aim of this observational, cross-sectional study was to evaluate the prevalence of pathogens on well-defined surfaces in German ambulances that have been designated as 'ready for service'.

METHODS

After informed consent was obtained, ambulance surfaces were sampled with agar plates for microbiological examination during an unannounced visit. A standardised questionnaire was used to obtain information regarding the disinfection protocols used at each rescue station.

RESULTS

Methicillin resistant staphylococcus aureus contamination was present in 18 sampling surfaces from 11 out of 150 ambulance vehicles (7%) that were designated as ready for service. Contact surfaces directly surrounding patients or staff were most frequently contaminated with pathogens. However, bacterial contamination was not related to annual missions, methods or frequency of disinfection.

CONCLUSIONS

In accordance with previous studies, disinfection and cleaning of areas with direct contact to patients or staff seem to be the most challenging. This should also be reflected in disinfection guidelines and the related continuing education.

[Comments on the 2010 guidelines on cardiopulmonary resuscitation of the European Resuscitation Council]

ADULTS

Administer chest compressions (minimum 100/min, minimum 5 cm depth) at a ratio of 30:2 with ventilation (tidal volume 500-600 ml, inspiration time 1 s, F(I)O₂ if possible 1.0). Avoid any interruptions in chest compressions. After every single defibrillation attempt (initially biphasic 120-200 J, monophasic 360 J, subsequently with the respective highest energy), chest compressions are initiated again immediately for 2 min independent of the ECG rhythm. Tracheal intubation is the optimal method for securing the airway during resuscitation but should be performed only by experienced airway management providers. Laryngoscopy is performed during ongoing chest compressions; interruption of chest compressions for a maximum of 10 s to pass the tube through the vocal cords. Supraglottic airway devices are alternatives to tracheal intubation. Drug administration routes for adults and children: first choice i.v., second choice intraosseous (i.o.). Vasopressors: 1 mg epinephrine every 3-5 min i.v. After the third unsuccessful defibrillation amiodarone (300 mg i.v.), repetition (150 mg) possible. Sodium bicarbonate (50 ml 8.4%) only for excessive hyperkaliemia, metabolic acidosis, or intoxication with tricyclic antidepressants. Consider aminophylline (5 mg/kgBW). Thrombolysis during spontaneous circulation only for myocardial infarction or massive pulmonary embolism; during on-going cardiopulmonary resuscitation (CPR) only when indications of massive pulmonary embolism. Active compression-decompression (ACD-CPR) and inspiratory threshold valve (ITV-CPR) are not superior to good standard CPR.

CHILDREN

Most effective improvement of outcome by prevention of full cardiorespiratory arrest. Basic life support: initially five rescue breaths, followed by chest compressions (100-120/min depth about one third of chest diameter), compression-ventilation ratio 15:2. Foreign body airway obstruction with insufficient cough: alternate back blows and chest compressions (infants), or abdominal compressions (children >1 year). Treatment of potentially reversible causes: ("4 Hs and 4 Ts") hypoxia and hypovolaemia, hypokalaemia and hyperkalaemia, hypothermia, and tension pneumothorax, tamponade, toxic/therapeutic disturbances, thrombosis (coronary/pulmonary). Advanced life support: adrenaline (epinephrine) 10 µg/kgBW i.v. or i.o. every 3-5 min. Defibrillation (4 J/kgBW; monophasic or biphasic) followed by 2 min CPR, then ECG and pulse check. NEWBORNS: Initially inflate the lungs with bag-valve mask ventilation (p(AW) 20-40 cmH₂O). If heart rate remains <60/min, start chest compressions (120 chest compressions/min) and ventilation with a ratio 3:1. Maintain normothermia in preterm babies by covering them with foodgrade plastic wrap or similar. POSTRESUSCITATION PHASE: Early protocol-based intensive care stabilization; initiate mild hypothermia early regardless of initial cardiac rhythm [32-34°C for 12-24 h (adults) or 24 h (children); slow rewarming (<0.5°C/h)]. Consider percutaneous coronary intervention (PCI) in patients with presumed cardiac ischemia. Prediction of CPR outcome is not possible at the scene, determine neurological outcome <72 h after cardiac arrest with somatosensory evoked potentials, biochemical tests and neurological examination. ACUTE CORONARY SYNDROME: Even if only a weak suspicion of an acute coronary syndrome is present, record a prehospital 12-lead ECG. In parallel to pain therapy, administer aspirin (160-325 mg p.o. or i.v.) and clopidogrel (75-600 mg depending on strategy); in ST-elevation myocardial infarction (STEMI) and planned PCI also prasugrel (60 mg p.o.). Antithrombins, such as heparin (60 IU/kgBW, max. 4000 IU), enoxaparin, bivalirudin or fondaparinux depending on the diagnosis (STEMI or non-STEMI-ACS) and the planned therapeutic strategy. In STEMI define reperfusion strategy depending on duration of symptoms until PCI, age and location of infarction. TRAUMA: In severe hemorrhagic shock, definitive control of bleeding is the most important goal. For successful CPR of trauma patients a minimal intravascular volume status and management of hypoxia are essential. Aggressive fluid resuscitation, hyperventilation and excessive ventilation pressure may impair outcome in patients with severe hemorrhagic shock.

TRAINING

Any CPR training is better than nothing; simplification of contents and processes is the main aim.

Detection and enumeration of Dekkera anomala in beer, cola, and cider using real-time PCR

AIMS

In this article, a quantitative real-time PCR assay for detection and enumeration of the spoilage yeast Dekkera anomala in beer, cola, apple cider, and brewing wort is presented as an improvement upon existing detection methods, which are very time-consuming and not always accurate.

METHODS AND RESULTS

  Primers were designed to exclude other organisms common in these beverages, and the assay was linear over 6 log units of cell concentrations. The addition of large amounts of non-target yeast DNA did not affect the efficiency of this assay. A standard curve of known DNA was established by plotting the C(t) values obtained from the QPCR against the log of plate counts on yeast peptone dextrose medium and unknowns showed exceptional correlation when tested against this standard curve. The assay was found to detect D. anomala at levels of 10-14 CFU ml⁻¹ in either cola or beer and at levels of 9·4-25·0 CFU ml⁻¹ in apple cider. The assay was also used to follow the growth of D. anomala in brewing wort.

CONCLUSIONS

The results indicate that real-time PCR is an effective tool for rapid, accurate detection and quantitation of D. anomala in beer, cola and apple cider.

SIGNIFICANCE AND IMPACT OF THE STUDY

This method gives a faster and more efficient technique to screen beer, cola, and cider samples and reduce spoilage by D. anomala. Faster screening may allow for significant reduction in economic loss because of reduced spoilage.

[The new 2005 resuscitation guidelines of the European Resuscitation Council: comments and supplements]

The new CPR guidelines are based on a scientific consensus which was reached by 281 international experts. Chest compressions (100/min, 4-5 cm deep) should be performed in a ratio of 30:2 with ventilation (tidal volume 500 ml, Ti 1 s, FIO2 if possible 1.0). After a single defibrillation attempt (initially biphasic 150-200 J, monophasic 360 J, subsequently with the respective highest energy), chest compressions are initiated again immediately for 2 min. Endotracheal intubation is the gold standard; other airway devices may be employed as well depending on individual skills. Drug administration routes for adults and children: first choice IV, second choice intraosseous, third choice endobronchial [epinephrine dose 2-3x (adults) or 10x (pediatric patients) higher than IV]. Vasopressors: 1 mg epinephrine every 3-5 min IV. After the third unsuccessful defibrillation attempt amiodarone IV (300 mg); repetition (150 mg) possible. Sodium bicarbonate (1 ml/kg 8.4%) only in excessive hyperkalemia, metabolic acidosis, or intoxication with tricyclic antidepressants. Consider atropine (3 mg) and aminophylline (5 mg/kg). Thrombolysis during spontaneous circulation only in myocardial infarction or massive pulmonary embolism; during CPR only during massive pulmonary embolism. Cardiopulmonary bypass only after cardiac surgery, hypothermia or intoxication. Pediatrics: best improvement in outcome by preventing cardiocirculatory collapse. Alternate chest thumps and chest compression (infants), or abdominal compressions (>1-year-old) in foreign body airway obstruction. Initially five breaths, followed by chest compressions (100/min; approximately 1/3 of chest diameter): ventilation ratio 15:2. Treatment of potentially reversible causes (4 "Hs", "HITS": hypoxia, hypovolemia, hypo- and hyperkaliemia, hypothermia, cardiac tamponade, intoxication, thrombo-embolism, tension pneumothorax). Epinephrine 10 microg/kg IV or intraosseously, or 100 microg (endobronchially) every 3-5 min. Defibrillation (4 J/kg; monophasic oder biphasic) followed by 2 min CPR, then ECG and pulse check. Newborns: inflate the lungs with bag-valve mask ventilation. If heart rate<60/min chest compressions:ventilation ratio 3:1 (120 chest compressions/min). Postresuscitation phase: initiate mild hypothermia [32-34 degrees C for 12-24 h; slow rewarming (<0.5 degrees C/h)]. Prediction of CPR outcome is not possible at the scene; determining neurological outcome within 72 h after cardiac arrest with evoked potentials, biochemical tests and physical examination. Even during low suspicion for an acute coronary syndrome, record a prehospital 12-lead ECG. In parallel to pain therapy, aspirin (160-325 mg PO or IV) and in addition clopidogrel (300 mg PO). As antithrombin, heparin (60 IU/kg, max. 4000 IU) or enoxaparine. In ST-segment elevation myocardial infarction, define reperfusion strategy depending on duration of symptoms until PCI (prevent delay>90 min until PCI). Stroke is an emergency and needs to be treated in a stroke unit. A CT scan is the most important evaluation, MRT may replace a CT scan. After hemorrhage exclusion, thrombolysis within 3 h of symptom onset (0.9 mg/kg rt-PA IV; max 90 mg within 60 min, 10% of the entire dosage as initial bolus, no aspirin, no heparin within the first 24 h). In severe hemorrhagic shock, definite control of bleeding is the most important goal. For successful CPR of trauma patients, a minimal intravascular volume status and management of hypoxia are essential. Aggressive fluid resuscitation, hyperventilation, and excessive ventilation pressure may impair outcome in severe hemorrhagic shock. Despite bad prognosis, CPR in trauma patients may be successful in select cases. Any CPR training is better than nothing; simplification of contents and processes remains important.

The genome of black cottonwood, Populus trichocarpa (Torr. & Gray)

We report the draft genome of the black cottonwood tree, Populus trichocarpa. Integration of shotgun sequence assembly with genetic mapping enabled chromosome-scale reconstruction of the genome. More than 45,000 putative protein-coding genes were identified. Analysis of the assembled genome revealed a whole-genome duplication event; about 8000 pairs of duplicated genes from that event survived in the Populus genome. A second, older duplication event is indistinguishably coincident with the divergence of the Populus and Arabidopsis lineages. Nucleotide substitution, tandem gene duplication, and gross chromosomal rearrangement appear to proceed substantially more slowly in Populus than in Arabidopsis. Populus has more protein-coding genes than Arabidopsis, ranging on average from 1.4 to 1.6 putative Populus homologs for each Arabidopsis gene. However, the relative frequency of protein domains in the two genomes is similar. Overrepresented exceptions in Populus include genes associated with lignocellulosic wall biosynthesis, meristem development, disease resistance, and metabolite transport.

Randomised comparison of epinephrine and vasopressin in patients with out-of-hospital ventricular fibrillation

BACKGROUND

Studies in animals have suggested that intravenous vasopressin is associated with better vital-organ perfusion and resuscitation rates than is epinephrine in the treatment of cardiac arrest. We did a randomised comparison of vasopressin with epinephrine in patients with ventricular fibrillation in out-of-hospital cardiac arrest.

METHODS

40 patients in ventricular fibrillation resistant to electrical defibrillation were prospectively and randomly assigned epinephrine (1 mg intravenously; n = 20) or vasopressin (40 U intravenously; n = 20) as primary drug therapy for cardiac arrest. The endpoints of this double blind study were successful resuscitation (hospital admission), survival for 24 h, survival to hospital discharge and neurological outcome (Glasgow coma scale). Analyses were by intention to treat.

FINDINGS

Seven (35%) patients in the epinephrine group and 14 (70%) in the vasopressin group survived to hospital admission (p = 0.06). At 24 h, four (20%) epinephrine-treated patients and 12 (60%) vasopressin-treated patients were alive (p = 0.02). Three (15%) patients in the epinephrine group and eight (40%) in the vasopressin group survived to hospital discharge (p = 0.16). Neurological outcomes were similar (mean Glasgow coma score at hospital discharge 10.7 [SE 3.8] vs 11.7 [1.6], p = 0.78).

INTERPRETATION

In this preliminary study, a significantly larger proportion of patients created with vasopressin than of those treated with epinephrine were resuscitated successfully from out-of-hospital ventricular fibrillation and survived for 24 h. Based upon these findings, larger multicentre studies of vasopressin in the treatment of cardiac arrest are needed.

Active compression-decompression cardiopulmonary resuscitation--instructor and student manual for teaching and training. Part I: The workshop

In an attempt to standardize the teaching and training of active compression-decompression cardiopulmonary resuscitation (ACD-CPR), a group of leading emergency physicians, cardiologists, anesthesiologists, paramedics and nurses with practical, theoretical, educational, and scientific experience in the subject met in June 1995. The group was called The International Working Group of Teaching and Training Active Compression-Decompression CPR. The group was 'born' as a result of the first International Conference of Active Compression-Decompression CPR held in Copenhagen in March 1995. The following paper describes the background, development and text of and ACD-CPR course manual for both students and instructors.