A new emergency procedure for cardiac arrests aims to save more lives – here’s how it works
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As of January this year, Aotearoa New Zealand became just the second country (after Canada) to adopt a groundbreaking new procedure for patients experiencing cardiac arrest.
Known as “double sequential external defibrillation” (DSED), it will change initial emergency response strategies and potentially improve survival rates for some patients.
Surviving cardiac arrest hinges crucially on effective resuscitation. When the heart is working normally, electrical pulses travel through its muscular walls creating regular, co-ordinated contractions.
But if normal electrical rhythms are disrupted, heartbeats can become unco-ordinated and ineffective, or cease entirely, leading to cardiac arrest.
Defibrillation is a cornerstone resuscitation method. It gives the heart a powerful electric shock to terminate the abnormal electrical activity. This allows the heart to re-establish its regular rhythm.
Its success hinges on the underlying dysfunctional heart rhythm and the proper positioning of the defibrillation pads that deliver the shock. The new procedure will provide a second option when standard positioning is not effective.
Using two defibrillators
During standard defibrillation, one pad is placed on the right side of the chest just below the collarbone. A second pad is placed below the left armpit. Shocks are given every two minutes.
Early defibrillation can dramatically improve the likelihood of surviving a cardiac arrest. However, around 20% of patients whose cardiac arrest is caused by “ventricular fibrillation” or “pulseless ventricular tachycardia” do not respond to the standard defibrillation approach. Both conditions are characterised by abnormal activity in the heart ventricles.
DSED is a novel method that provides rapid sequential shocks to the heart using two defibrillators. The pads are attached in two different locations: one on the front and side of the chest, the other on the front and back.
A single operator activates the defibrillators in sequence, with one hand moving from the first to the second. According to a recent randomised trial in Canada, this approach could more than double the chances of survival for patients with ventricular fibrillation or pulseless ventricular tachycardia who are not responding to standard shocks.
The second shock is thought to improve the chances of eliminating persistent abnormal electrical activity. It delivers more total energy to the heart, travelling along a different pathway closer to the heart’s left ventricle.
Evidence of success
New Zealand ambulance data from 2020 to 2023 identified about 1,390 people who could potentially benefit from novel defibrillation methods. This group has a current survival rate of only 14%.
Recognising the potential for DSED to dramatically improve survival for these patients, the National Ambulance Sector Clinical Working Group updated the clinical procedures and guidelines for emergency medical services personnel.
The guidelines now specify that if ventricular fibrillation or pulseless ventricular tachycardia persist after two shocks with standard defibrillation, the DSED method should be administered. Two defibrillators need to be available, and staff must be trained in the new approach.
Though the existing evidence for DSED is compelling, until recently it was based on theory and a small number of potentially biased observational studies. The Canadian trial was the first to directly compare DSED to standard treatment.
From a total of 261 patients, 30.4% treated with this strategy survived, compared to 13.3% when standard resuscitation protocols were followed.
The design of the trial minimised the risk of other factors confounding results. It provides confidence that survival improvements were due to the defibrillation approach and not regional differences in resources and training.
The study also corroborates and builds on existing theoretical and clinical scientific evidence. As the trial was stopped early due to the COVID-19 pandemic, however, the researchers could recruit fewer than half of the numbers planned for the study.
Despite these and other limitations, the international group of experts that advises on best practice for resuscitation updated its recommendations in 2023 in response to the trial results. It suggested (with caution) that emergency medical services consider DSED for patients with ventricular fibrillation or pulseless ventricular tachycardia who are not responding to standard treatment.
Training and implementation
Although the evidence is still emerging, implementation of DSED by emergency services in New Zealand has implications beyond the care of patients nationally. It is also a key step in advancing knowledge about optimal resuscitation strategies globally.
There are always concerns when translating an intervention from a controlled research environment to the relative disorder of the real world. But the balance of evidence was carefully considered before making the decision to change procedures for a group of patients who have a low likelihood of survival with current treatment.
Before using DSED, emergency medical personnel undergo mandatory education, simulation and training. Implementation is closely monitored to determine its impact.
Hospitals and emergency departments have been informed of the protocol changes and been given opportunities to ask questions and give feedback. As part of the implementation, the St John ambulance service will perform case reviews in addition to wider monitoring to ensure patient safety is prioritised.
Ultimately, those involved are optimistic this change to cardiac arrest management in New Zealand will have a positive impact on survival for affected patients.
Vinuli Withanarachchie, PhD candidate, College of Health, Massey University; Bridget Dicker, Associate Professor of Paramedicine, Auckland University of Technology, and Sarah Maessen, Research Associate, Auckland University of Technology
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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I’m So Effing Tired – by Dr. Amy Shah
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It’s easy sometimes to feel like we know more or less what we should be doing… If only we had the energy to get going!
- We know we want a better diet… But we don’t have the time/energy to cook so will go for the quickest option even when it’s not the best?
- We know we should exercise… But feel we just need to crash out on the couch for a bit first?
- We would dearly love to get better sleep… But our responsibilities aren’t facilitating that?
…and so on. Happily, Dr. Amy Shah is here with ways to cut through the Gordian Knot that is this otherwise self-perpetuating cycle of exhaustion.
Most of the book is based around tackling what Dr. Shah calls “the energy trifecta“:
- Hormone levels
- Immune system
- Gut health
You’ll note (perhaps with relief) that none of these things require an initial investment of energy that you don’t have… She’s not asking you to hit the gym at 5am, or magically bludgeon your sleep schedule into its proper place, say.
Instead, what she gives is practical, actionable, easy changes that don’t require much effort, to gently slide us back into the fast lane of actually having energy to do stuff!
In short: if you’ve ever felt like you’d like to implement a lot of very common “best practice” lifestyle advice, but just haven’t had the energy to get going, there’s more value in this handbook than in a thousand motivational pep talks.
Click here to check out “I’m So Effing Tired” and get on a better track of life!
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Wouldn’t It Be Nice To Have Regenerative Superpowers?
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The Best-Laid Schemes of Mice and Medical Researchers…
This is Dr. Ellen Heber-Katz. She’s an internationally-renowned immunologist and regeneration biologist, but her perhaps greatest discovery was accidental.
Unlike in Robert Burns’ famous poem, this one has a happy ending!
But it did involve the best-laid schemes of mice and medical researchers, and how they did indeed “gang gagly“ (or in the English translation, “go awry”).
How it started…
Back in 1995, she was conducting autoimmune research, and doing a mouse study. Her post-doc assistant was assigned to punch holes in the ears of mice that had received an experimental treatment, to distinguish them from the control group.
However, when the mice were later checked, none of them had holes (nor even any indication there ever had been holes punched)—the experiment was ruined, though the post-doc swore she did her job correctly.
So, they had to start from scratch in the new year, but again, a second batch of mice repeated the trick. No holes, no wounds, no scarring, not disruption to their fur, no damage to the cartilage that had been punched through.
In a turn of events worthy of a superhero origin story, they discovered that their laboratory-made autoimmune disease had accidentally given the mice super-healing powers of regeneration.
In the animal kingdom, this is akin to a salamander growing a new tail, but it’s not something usually found in mammals.
Read: A New Murine Model for Mammalian Wound Repair and Regeneration
How it’s going…
Dr. Heber-Katz and colleagues took another 20 years of work to isolate hypoxia-inducible factor-1a (HIF-1a) as a critical molecule that, if blocked, would eliminate the regenerative response.
Further, a drug (which they went on to patent), 1,4-dihydrophenonthrolin-4-one-3-carboxylic acid (1,4-DPCA), chemically induced this regenerative power:
See: Drug-induced regeneration in adult mice
Another 5 years later, they found that this same drug can be used to stimulate the regrowth of bones, too:
And now…
The research is continuing. Here’s the latest, a little over a month ago:
Epithelial–mesenchymal transition: an organizing principle of mammalian regeneration
Regrowing nerves has also been added into the list of things the drug can do.
What about humans?
Superpowered mice are all very well and good, but when can we expect this in humans?
The next step is testing the drug in larger animals, which she hopes to do next year, followed eventually by studies in humans.
Read the latest:
Regrowing nerves and healing without scars? A scientist’s career-long quest comes closer to fruition
Very promising!
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Black Beans vs Pinto Beans – Which is Healthier?
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Our Verdict
When comparing black beans to pinto beans, we picked the pinto beans.
Why?
Both of these beans have won all their previous comparisons, so it’s no surprise that this one was very close. Despite their different appearance, taste, and texture, their nutritional profiles are almost identical:
In terms of macros, pinto beans have a tiny bit more protein, carbs, and fiber. So, a nominal win for pinto beans, but again, the difference is very slight.
When it comes to vitamins, black beans have more of vitamins A, B1, B3, and B5, while pinto beans have more of vitamins B2, B6, B9, C, E, K and choline. Superficially, again this is nominally a win for pinto beans, but in most cases the differences are so slight as to be potentially the product of decimal place rounding.
In the category of minerals, black beans have more calcium, copper, iron, and phosphorus, while pinto beans have more magnesium, manganese, selenium, and zinc. That’s a 4:4 tie, but the only one with a meaningful margin of difference is selenium (of which pinto beans have 4x more), so we’re calling this one a very modest win for pinto beans.
All in all, adding these up makes for a “if we really are pressed to choose” win for pinto beans, but honestly, enjoy either in accordance with your preference (this writer prefers black beans!), or better yet, both.
Want to learn more?
You might like to read:
What’s Your Plant Diversity Score?
Take care!
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Burn! How To Boost Your Metabolism
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Let’s burn! Metabolic tweaks and hacks
Our metabolism is, for as long as we live, a constantly moving thing. And it’s not a monolith either; there are parts of our metabolism that can speed up or slow down independently of others.
If we talk about metabolism without clarifying context, though, this is usually about one’s “basal metabolic rate”, that is, how many calories we burn just by being alive.
Why do we want to speed it up? Might we ever want to slow it down?
We might want to slow our metabolism down in survival circumstances, but generally speaking, a faster metabolism is a better one.
Yes, even when it comes to aging. Because although metabolism comes with metabolizing oxygen (which, ironically, tends to kill us eventually, since this is a key part of cellular aging), it is still beneficial to replace cells sooner rather than later. The later we replace a given cell (ie, the longer the cell lives), the more damaged it gets, and then the copy is damaged from the start, because the damage was copied along with it. So, best to have a fast metabolism to replace cells quickly when they are young and healthy.
A quick metabolism helps the body to do this.
Most people, of course, are interested in a fast metabolism to burn off fat, but beware: if you increase your metabolism without consideration to how and when you consume calories, you will simply end up eating more to compensate.
One final quick note before we begin:
Limitations
There’s a lot we can do to change our metabolism, but there are some things that may be outside of our control. They include:
- Age—we can influence our biological age, but we cannot (yet!) halt aging, so this will happen
- Body size—and yes we can change this a bit, but we all have our own “basic frame” to work with. Someone who is 6’6” is never going to be able to have the same lower-end-of-scale body mass of someone who is 5’0”, say.
- Sex—this is about hormones, and HRT is a thing, but for example, broadly speaking, men will have faster metabolisms than women, because of hormonal differences.
- Medical conditions—often also related to other hormones, but for example someone with Type 1 Diabetes is going to have a very different relationship with their metabolism than someone without, and someone with a hypo- or hyperactive thyroid will again have a very different metabolism in a way that that lifestyle factors can’t completely compensate for.
The tips and tricks
Intermittent fasting
Intermittent fasting has been found to, amongst other things, promote healthy apoptosis and autophagy (in other words: early programmed cell death and recycling—these are good things).
It also has anti-inflammatory benefits and decreases the risk of insulin resistance. In other words, intermittent fasting boosts the metabolism while simultaneously guarding against some of the dangers of a faster metabolism (harms you’d get if you instead increased your metabolism by doing intense exercise and then eating a mountain of convenience food to compensate)
Read the science: Intermittent Fasting: Is the Wait Worth the Weight?
Read our prior article: Fasting Without Crashing? We Sort The Science From The Hype
Enjoy plenty of protein
This one won’t speed your metabolism up, so much as help it avoid slowing down as a result of fat loss.
Because of our body’s marvelous homeostatic system trying to keep our body from changing status at any given time, often when we lose fat, our body drops our metabolism to compensate, thinking we are in an ongoing survival situation and food is scarce so we’d better conserve energy (as fat). That’s a pain for would-be weight-loss dieters!
Eating protein can let our body know that we’re perfectly safe and not starving, so it will keep the metabolism ticking over nicely, without putting on fat.
Read the science: The role of protein in weight loss and maintenance
Stay hydrated
People think of drinking water as part of a weight loss program being just about filling oneself up, and that is a thing, but it also has a role to play in our metabolism. Specifically, lipolysis (the process of removing fat).
Because, we are mostly water. Not only is it the main content of our various body tissue cells, but also, of particular note, our blood (the means by which everything is transported around our body) is mostly water, too.
It’s hard for the body to keep everything ticking over like a well-oiled machine if its means of transportation is sluggish!
Check it out: Increased Hydration Can Be Associated with Weight Loss
Take a stand
That basal metabolic rate we talked about?
- If you’re lying down at rest, that’s what your metabolism will be like.
- If you’re sitting up, it’ll be a little quicker, but not much.
- If you’re standing, suddenly half your body is doing things, and you don’t even notice them because they’re just stabilizing muscles and the like, but on a cellular level, your body gets very busy.
Read all about it: Cardiometabolic impact of changing sitting, standing, and stepping in the workplace
Time to invest in a standing desk? Or a treadmill in front of the TV?
The spice of life
Capsaicin, the compound in many kinds of pepper that give them their spicy flavor, boosts the metabolism. In the words of Tremblay et al for the International Journal of Obesity:
❝[Capsaicin] stimulates the sympathoadrenal system that mediates the thermogenic and anorexigenic effects of capsaicinoids.
Capsaicinoids have been found to accentuate the impact of caloric restriction on body weight loss.
Some studies have also shown that capsinoids increase energy expenditure.
Capsaicin supplementation attenuates or even prevents the increase in hunger and decrease in fullness as well as the decrease in energy expenditure and fat oxidation, which normally result from energy restriction❞
Read for yourself: Capsaicinoids: a spicy solution to the management of obesity?
You snooze, you lose (fat)
While exercising is generally touted as the road to weight loss, and certainly regular exercise does have a part to play, doing so without good rest will have bad results.
In fact, even if you’re not exercising, if you don’t get enough sleep your metabolism will get sluggish to try to slow you down and encourage you to sleep.
So, be proactive, and make getting enough good quality sleep a priority.
Eat for metabolic health
Aside from the chilli peppers we mentioned, there are other foods associated with good metabolic health. We don’t have room to go into the science of each of them here, but here’s a well-researched, well-sourced standalone article listing some top choices:
The 12 Best Foods to Boost Your Metabolism
Enjoy!
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25 Healthy Habits That Will Change Your Life
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Cori Lefkowith, of “Redefining Strength” and “Strong At Every Age” fame, has compiled a list of the simple habits that make a big difference, and here they are!
The Tips
Her recommendations include…
- The healthy activities you’re most prone to skipping? Do those first
- Create staple meals… Consciously! This means: instead of getting into a rut of cooking the same few things in rotation because it’s what you have the ingredients in for, consciously and deliberately make a list of at least 7 meals that, between them, constitute a healthy balanced diet, and choose to make them your staples. That doesn’t mean don’t eat anything else (indeed, variety is good!) but having a robust collection of healthy staples to fall back on will help you avoid falling into unhealthy eating traps.
- Schedule time for healthy activities that you love. Instead of thinking “it would be nice to…”, actually figure out a timeslot, plan in advance, making it recurring, and do it!
- Have (healthy!) no-spoil food options always available. No-spoil doesn’t have to mean “won’t spoil ever”, but does mean at least that it has a long shelf-life. Nuts are a good example, assuming you’re not allergic. Sundried fruits are good too; not nearly as good as fresh fruit, but a lot better than some random processed snack because it’s what in. If you eat fish, then see if you can get dried fish in; it’s high in protein and keeps for a very long time indeed.
- Stock up on spices! Not only do they all have great health-giving properties (at least, we can’t think of a refutation by counterexample, Arrakis be damned), but also, they literally spice up our culinary repertoire, and bring joy to cooking and eating healthy food.
If you like these, check out the rest:
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Further reading
For more about actually making habits stick quickly and reliably,enjoy:
How To Really Pick Up (And Keep!) Those Habits
Take care!
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Nutritional Profiles to Recipes
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It’s Q&A Day at 10almonds!
Have a question or a request? We love to hear from you!
In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small
❝I like the recipes. Most don’t seem to include nutritional profile. would lilke to see that. Macro/micro world…. Thank you❞
We’re glad you’re enjoying them! There are a couple of reasons why we don’t, but the reasons can be aggregated into one (admittedly rare) concept: honesty
To even try to give you these figures, we’d first need to use the metric system (or at least, a strictly mass-based system) which would likely not go well with our largely American readership, because “half a bulb of garlic, or more if you like”, and “1 cucumber” or “1 cup chopped carrot” could easily way half or twice as much, depending on the sizes of the vegetables or the chopping involved, and in the case of chopped vegetables measured by the cup, even the shape of the cup (because of geometry and the spaces left; it’s like Tetris in there). We can say “4 cups low-sodium broth” but we can’t say how much sodium is in your broth. And so on.
And that’s without getting into the flexibility we offer with substitutions, often at a rate of several per recipe.
We’d also need to strictly regulate your portion sizes for you, because we (with few exceptions, such as when they are a given number of burger patties, or a dessert-in-a-glass, etc) give you a recipe for a meal and leave it to you how you divide it and whether there’s leftovers.
Same goes for things like “Extra virgin olive oil for frying”; a recipe could say to use “2 tbsp” but let’s face it, you’re going to use what you need to use, and that’s going to change based on the size of your pan, how quickly it’s absorbed into the specific ingredients that you got, which will change depending on how fresh they are, and things like that.
By the time we’ve factored in your different kitchen equipment, how big your vegetables are, the many factors effecting how much oil you need, substitutions per recipe per making something dairy-free, or gluten-free, or nut-free, etc, how big your portion size is (we all know that “serves 4” is meaningless in reality)… Even an estimated average would be wildly misleading.
So, in a sea of recipes saying “500 kcal per serving” from the same authors who say you can caramelize onions in 4–5 minutes “or until caramelized” and then use the 4–5 minutes figure for calculating the overall recipe time… We prefer to stay honest.
PS: for any wondering, caramelizing onions takes closer to 45 minutes than 4–5 minutes, and again will depend on many factors, including the onions, how finely you chopped them, the size and surface of your pan, the fat you’re using, whether you add sugar, what kind, how much you stir them, the mood of your hob,
and the phase of the moon. Under very favorable circumstances, it could conceivably be rushed in 20 minutes or so, but it could also take 60. Slow-cooking them (i.e. in a crock pot) over 3–4 hours is a surprisingly viable “cheat” option, by the way. It’ll take longer, obviously, but provided you plan in advance, they’ll be ready when you need them, and perfectly done (the same claim cannot be made if you budgeted 4–5 minutes because you trusted a wicked and deceitful author who wants to poop your party).Take care!
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