***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background —Early defibrillation is considered the most important factor for restoring spontaneous circulation in cardiac arrest patients with ventricular fibrillation . Recent studies have shown that , after prolonged ventricular fibrillation , the rates of return of spontaneous circulation ( ROSC ) and survival are improved if defibrillation is delayed so that CPR can be given first . To examine whether CPR improves myocardial readiness for defibrillation , we analyzed whether CPR causes changes in predictors of defibrillation success calculated from the ventricular fibrillation waveform . Methods and Results —ECG recordings were retrieved for 105 patients from an original study of 200 patients receiving CPR or defibrillation first . Altogether , 267 CPR sequences from 77 patients were identified on which the effect of CPR could be evaluated . Five predictors of ROSC ( spectral flatness measure , energy , centroid frequency , amplitude spectrum relationship , and estimated probability of ROSC ) were determined from a spectral analysis of the ventricular fibrillation waveform immediately before and immediately after each of the 267 sequences . CPR  increased spectral flatness measure , centroid frequency , and amplitude spectrum relationship ( P < 0.05 , P < 0.001 , P < 0.01 ) . In an analysis of the effect of the duration of CPR , the probability of ROSC and amplitude spectrum relationship showed a positive change for CPR sequences lasting > 3 minutes ( P < 0.001 , P < 0.05 ) . Conclusions —During resuscitation from ventricular fibrillation , changes in the predictors calculated from the ventricular fibrillation waveform indicated a positive effect of CPR on the myocardium This pilot aims to better underst and the market for childcare in Saudi Arabia – both the supply and dem and sides – and to design a r and omized controlled experiment to test whether access to affordable day care ( in the form of subsidies , for example ) would incentivize Saudi mothers to search actively for employment and to remain employed once they are hired . In addition , the study seeks to underst and the degree to which employment early on in one ’s life impacts employment in later stages . The pilot will provide information on the groups of women the experiment should target , appropriate levels for the childcare subsidy , and the quality and current geographic locations of daycare sites . Expected Impact Determine the effects of facilitating childcare access on Saudi women ’s employment . PRINCIPAL INVESTIGATORS  Boston University Patricia Cortes  Harvard University Claudia Goldin  Swarthmore College Jennifer Background When airway management is difficult , various measures can be taken to facilitate tracheal intubation . The Bullard and Airtraq laryngoscopes were developed for this purpose . We hypothesised that the Bullard and Airtraq laryngoscopes would perform better than a conventional laryngoscope in the management of a simulated difficult airway . We also hypothesised that the indirect laryngoscopes would perform comparably . Methods In a r and omised controlled study , 60 anaesthetists ( 30 with no or little experience and 30 with broader experience in the use of the Bullard laryngoscope , referred to as beginners and experts , respectively ) performed three successive intubation attempts using conventional , Bullard and Airtraq laryngoscopes in two simulated difficult airway scenarios : neck immobilisation ( scenario A ) and neck immobilisation with additional tongue oedema ( scenario B ) . The primary endpoint was overall intubation success rate . Secondary endpoints were time required for successful intubation , the amount of dental stress exerted during laryngoscopy and satisfaction with each airway device . Results In scenario A , intubation success rates were 97–100 % with all devices . In scenario B , all participants failed to intubate the trachea using the conventional laryngoscope . When using the Bullard laryngoscope , intubation success rates of 87–97 % did not differ significantly ( P > 0.05 ) from those during scenario A and between groups ( beginners vs. experts ) . In contrast , when using the Airtraq laryngoscope , the overall intubation success rate was significantly lower ( P < 0.05 ) compared with scenario A and compared with use of the Bullard laryngoscope , and differed between beginners and experts ( 20 and 50 % , respectively ) . In cases of successful intubation , intubation times were comparable between devices and groups . Intubation times were longer during scenario B. Dental stress was always lower ( P < 0.05 ) during use of the Bullard and Airtraq laryngoscopes compared with the conventional laryngoscope , lowest ( P < 0.05 ) during use of the Bullard laryngoscope and ( with the exception of use of the conventional laryngoscope by the experts ) higher during scenario B than during scenario A. In scenario A , participants preferred both video laryngoscopes to the conventional laryngoscope . Conclusion In a moderately difficult airway scenario , all laryngoscopes performed equally well . However , in a more difficult airway scenario , the Bullard and Airtraq laryngoscopes performed better than the conventional laryngoscope , with the Bullard device performing better than the Airtraq . This may be in part related to differing prior experiences of operators with the respective airway devices Objective . To investigate the effectiveness of the Karl Storz BERCI DCI Macintosh video laryngoscope ( MVL ) via the TELE PACK system for facilitating intubation by novice paramedic students in a simulation environment . We assessed the laryngeal view , measured by percentage of glottic opening ( POGO ) , when intubating the SimMan manikin airway in different setting s. The primary endpoint was the best POGO achieved by the student . Secondary endpoints included intubation times and success rate . Method . We enrolled 25 novice paramedic students to intubate SimMan manikins . Students were r and omized to use either a conventional Macintosh 3 ( Mac3 ) blade alone or the MVL with a Mac3 blade . Students attempted their first intubation with the manikin on a stretcher in a normal neck position and reattempted intubation with the manikin 's neck stiffened . The groups then crossed over using the alternate device to repeat the attempts in the manikin with a normal neck and with a stiffened neck . The students then attempted the same sequence of four intubations with the manikin on the floor . Results . The MVL  significantly improved POGO in all scenarios ( p < 0.05 ) . The MVL  improved mean POGO 16 % ± 6 % in the manikin with a normal neck position on a stretcher and 33 % ± 7 % in the manikin with a stiff neck on the floor . The improvement was significantly greater in simulated difficult scenarios . The intubation success rate ( 94 % ) was equal in the two groups , and the POGO was significantly worse in the failures . In some subgroups , intubation times were longer with the MVL . Conclusion . The MVL improves the laryngeal view for novice laryngoscopists in a simulated setting , and this improvement is greatest in simulated difficult Objective Emergency airway situations are relatively rare events in pediatrics with most graduating residents having little exposure to intubate . Newer video technology offers the promise of reducing complications associated with intubation . This study proposes that video laryngoscopy ( VL ) should aid less skilled residents to intubate an infant mannequin with greater success and speed as compared with traditional direct laryngoscopy ( DL ) . Methods Pediatric ( PED ) and emergency medicine ( EM ) residents were r and omized in a prospect i ve controlled study . A st and ard respiratory failure scenario was conducted using SimBaby with an uncomplicated airway . Residents who inadvertently performed esophageal intubation were made aware as part of the scenario and allowed to reattempt until successful . Results Sixty-nine residents voluntarily participated , 49 % EM and 51 % PED . Seven subjects in the DL group required multiple attempts ( 21 % ) , compared with 6 subjects in the VL group ( 17 % ) ( P = 0.718 ) . Median time to intubation was 30 seconds ( 95 % confidence interval [ CI ] , 19–41 seconds ) for DL and 39 seconds ( 95 % CI , 36–42 seconds ) for VL ( P = 0.111 ) . Comparison of programs revealed a 77 % PED success rate versus 85 % EM success rate ( P = 0.578 ) and median time to intubation of 38 seconds ( 95 % CI , 31–45 seconds ) for PED compared with 32 seconds ( 95 % CI , 23–41 seconds ) for EM residents ( P = 0.316 ) . In a sub analysis , subjects successful at first attempt revealed a 13-second median difference ( DL , 23 seconds [ 95 % CI , 18–28 seconds ] vs. VL , 36 seconds [ 95 % CI , 29–43 seconds ; P = 0.01 ) . Conclusions In a simulated respiratory failure scenario involving residents , VL provided no additional success over DL with slightly longer time to intubation OBJECTIVES This study assesses intubation times and potential trauma with two new portable video laryngoscopes , the GlideScope Ranger ( GSR ) and the Venner A.P. Advance ( APA ) , in a simulated difficult prehospital airway . The GSR has a hockey stick shape and is inserted by a different ( midline ) technique compared with direct laryngoscopy and requires the use of a stylet . The APA has a h and le similar to a direct laryngoscope , but with an angulated difficult airway blade . The APA is design ed to have an intuitive insertion technique somewhat similar to that of direct laryngoscopy ( lateral tongue displacement ) and has a guiding mechanism that foregoes the need for a stylet . METHODS Thirty qualified paramedics received a short demonstration of each device and were asked to intubate a modified Grade III difficult laryngoscopy mannequin in a r and om order ( closed envelope technique ) . Optimal view and tracheal intubation times were recorded , and potential trauma assessed by the number of additional discrete forward advances and by visual analog scale ( VAS ) . Direct laryngoscopy was used as a comparator . The Wilcoxon rank sum test was used for intubation times , optimal view times , percentage of glottis opening ( POGO ) seen , and objective trauma assessment . Student 's paired t-test was used for subjective trauma assessment and a Bonferroni correction was used for the primary outcome measures . RESULTS Participants declared a median of 60 ( range 20 to 300 ) previous intubations .  Time to achieve optimal view between APA and GSR was not different ( 20 seconds vs. 19 seconds ; p = 0.19 ) , but tracheal intubation was significantly faster with the APA ( 25 seconds vs. 46 seconds ; p < 0.0001 ) . Intubation success was ultimately 97 % in both groups . Participants judged subjective trauma to be less for the APA than GSR on a VAS ( 1.6 cm vs. 3.3 cm ; p < 0.001 ) . More than three additional forward advances were required in 43 % of GSR and 0 % of APA intubations . CONCLUSIONS Following a brief demonstration to paramedics naïve to video laryngoscopy , the APA demonstrated earlier intubation , fewer additional discrete forward advances of the tube , and less participant-judged subjective trauma when compared to the GSR in this simulation model Background The National Confidential Enquiry into Patient Outcome and Death ( NCEPOD ) report on trauma management , published in 2007 , defined st and ards for United Kingdom ( UK ) hospitals dealing with trauma . This study compared the NCEPOD st and ards with the performance of a UK military field hospital in Afghanistan . Setting UK military field hospital , Camp Bastion , Helm and Province , Afghanistan . Material s and methods Data were collected prospect ively for all patients fulfilling the trauma team activation criteria during the 3 months of Operation Herrick IXa ( from mid October 2008 to mid January 2009 ) and combined with a retrospective review of prehospital documentation , trauma resuscitation notes , operations notes and transfer notes for these patients . Results During the study period , there were 226 trauma team activations . Of those patients brought to the medical facility at Camp Bastion by UK assets , 93.7 % were accompanied by a doctor with advanced airway skills , although only 6.2 % of the patients required such an intervention . Consultants in emergency medicine and anaesthesia were present in 100 % of cases and were directly involved ( in either leading the team or performing airway management ) in 63.5 % and 77.6 % of cases respectively . Of those patients requiring operative intervention , 98.1 % had this performed by a consultant surgeon . Of those patients requiring CT , 93.6 % of cases had this performed within 1 h of arrival . Conclusions Trauma patients presenting to the medical facility at Camp Bastion during Operation Herrick IXa , irrespective of their nationality or background , received a high st and ard of medical care when compared with the NCEPOD st and ards Background Many healthcare professionals are trained in direct laryngoscopic tracheal intubation ( LEI ) , which is a potentially lifesaving procedure . This study attempts to determine the number of successful LEI exposures required during training to assure competent performance , with special emphasis on defining competence itself . Methods Analyses were based on a longitudinal study of novices under training conditions in the operating room . The progress of 438 LEIs performed by the 20 nonanesthesia trainees was monitored by observation and videotape analysis .  Eighteen additional LEIs were performed by experienced anesthesiologists to define the st and ard . A generalized linear , mixed-modelling approach was used to identify key aspects of effective training and performance . The number of tracheal intubations  that the tra 
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Conclusion This review suggests that simulation-based training is one effective way to teach VL skills .