Post-ROSC electrocardiogram timing in the management of out-of-hospital cardiac arrest: results of an international multicentric study (PEACE study)

Background Electrocardiogram (ECG) is a key tool to triage out-of-hospital cardiac arrest (OHCA) patients after achieving a sustained return of spontaneous circulation (ROSC). According to current guidelines, an immediate coronary angiography is indicated only when the post-ROSC ECG discloses a ST-elevation myocardial Infarction (STEMI). Moreover, the 12-lead ECG should be recorded as soon as possible after ROSC, although it is reasonable that in the early post-ROSC stages ECG could reflect the ischemia secondary to cardiac arrest besides that of coronary origin possibly causing an overdiagnosis of STEMI (false positive). Purpose To assess whether the time from ROSC to ECG acquisition could affect the percentage of false positive ECG for STEMI. Methods We performed a retrospective, international, multicenter study (PEACE Study - NCT04096079). We included all patients over 18 years of age hospitalized after an OHCA due to medical cause at one of the three participating high-volume hospitals of three different European countries between 2015, 1st January and 2018, 31st December. We considered for the present study only patients who underwent coronary angiography and in whom a post-ROSC ECG was available. For the electrocardiographic diagnosis of STEMI the criteria established by the ESC 2017 guidelines were used, while the execution of a percutaneous coronary angioplasty (PTCA) was evaluated as an angiographic endpoint. We used logistic regression to evaluate the association of time to acquisition and the endpoint. We computed odds ratios and 95% confidence intervals (OR, 95% CI). Results Population consisted of 370 patients (77.6% male, mean age 61±13 years, median ROSC-ECG time 15 minutes). Post-ROSC ECG was positive for STEMI in 198 patients and in 39 of them (10.5%) a PTCA was not performed during urgent coronary angiography, representing the false positive (FP) ECG. Dividing the population in three tertiles according to the time from ROSC to ECG (≤7 mins; 8–33 mins; >33 mins), the percentage of FP-ECG in the first tertile (18.5%) was statistically significantly higher than in the second (7.2%, OR 2.9 (95% CI 1.1–7.5) p=0.025) and third (5.8%, OR 3.7 (95% CI 2.2–6.5) p<0.001) as also shown in the Figure. These differences remained significant when adjusting for sex, age, number of segments involved at ECG (anterior, lateral, posterior, inferior and right), QRS duration >120 msec, ECG heart rate >100 bpm and adrenaline administered >1 mg. Conclusion Our study offers the first demonstration that the acquisition of the 12-leads ECG too early after ROSC can misleadingly lead to the diagnosis of STEMI. Despite further validation are required, our data suggest that it may be reasonable to delay the acquisition of the ECG at least 8 minutes after ROSC or to repeat the acquisition if the first ECG, resulting diagnostic for STEMI, was performed very early. Figure 1 Funding Acknowledgement Type of funding source: None

A Muslim Contribution to International Relations Theory: Aman (Peaceful Co-Existence and Mutual Respect) Theory

In the last ten years, the world has witnessed much debate on new forms of the global phenomena of fundamentalism and extremism. It is clear that many view Muslims as “the other” or outsider and vice-versa; an attitude of “us and them”, “our community and their community”. The concept of a ‘clash of civilisations’ has become part of our everyday vocabulary. The objective of this article is namely to develop the theory of Aman (peaceful co-existence and mutual respect) as a Muslim contribution to normative considerations in international relations theory. It is found that the main four components of this theory are: the methodology of Tadafu’ (counteraction), the concept of Adil (justice), the principle of not excluding others, and the constructive argumentation methodology. The theory has been tested and implemented by examining, in particular, Umar Assurance of Aman and the negotiations between Salah al-Din and King Richard I ‘the Lionheart’ of England over Islamicjerusalem in 1191. It is hoped that this theory could help place Muslim contributions in the epitome of global discourse of international relations theory, set the scene to advance the current research on the Muslim contributions to international relations theory including peace study and conflict resolution, and open up and promote intellectual and academic debate and understanding of this Muslim contributions to shed light on new lines of explanation. Although Islamicjerusalem is the most delicate issue of dispute between the current two conflicting parties, it is hoped that this theory will provide a better understanding for the world leaders who are trying to return peace to the region.

Exploring Sport and Intergroup Relations in Fiji: Guidance for Researchers Undertaking Short-Term Ethnography

There is a key tension associated with ethnographic explorations into the lives of people in the Global South – ‘outsider’ researchers from the Global North who lack experience of the environments they are seeking to understand. A considered response, therefore, is for scholars to seek physical immersion in a field—to live among those they are trying to understand. Such ethnographic inquiries are optimal when researchers have the capacity to engage over long periods of time. However, in some circumstances, this may not feasible. Thus, questions arise about the veracity of field work investigations that are not only temporally brief but undertaken by scholars who lack local experience. This paper reflects on the experiences of a researcher who was faced with those challenges. It provides guidance as to how scholars might prepare for short-term ethnography (STE) in field work, along with the limitations and constraints of such an approach. The research centered on a sport for development and peace study into intergroup relations and ethnic separatism in Fijian sport.

UNDERSTANDING PEACE FORMATION: A SOCIOLOGICAL PERSPECTIVE

Peace study is now one of the most debated discourses. In the discourse of peace study, the modes of peace which was based on the liberal western values have long gained supremacy. Three generations of peace study occurred from that liberal tradition. Along with the strengthening – and even the romanticizing- of locality, the liberal peace traditions began to be criticized. Post Liberal Peace presented around the searching for the modes of ideal peace by criticizing the liberal peace traditions that based on liberal values. Post liberal peace or, as Richmond conceptualized, peace formation, was the correction of liberal peace generation and the celebration of the strengthening of locality. Unfortunately, there is theoretical gap, as many theories of that post liberal generation can’t elaborate sociologically how locality involved in peace process and bound as social norms. To fill the gap, the literature study uses Giddens’s structuration to understand how locality becomes the base of peace formation. Based on structuration theory of Giddens, the study found that local actors could act as an agent with capacity to formulate the mode of peace by standing on the local attributes as the ground as well as cultures and social values-norms. In Addition, the local actors had the both reflexive and discursive consciousness in interpreting the purposes of local values conversion as a base of peace formation. Keywords: Agent; Liberal Peace; Local; Peace Formation; Post Liberal Peace; Structuration

IMPLEMENTASI PERATURAN DAERAH KABUPATEN PONOROGO NOMOR 5 TAHUN 2011 TENTANG KETERTIBAN UMUM DAN KETENTERAMAN MASYARAKAT (Studi Penertiban Pedagang Kaki Lima di Kawasan Aloon-Aloon Ponorogo)

Regional Regulation No. 5 of 2011 on Public Order and Communal Peace is one of the rules of Local Government which is a public policyin which the implementation of public order is necessary to assert the policy. Judging from the state of public places many street vendors still sell around the sidewalks, roads, road intersections, especially in the area of Aloon Aloon Ponorogo. The intended aims of this study are first, to find out how the implementation of Local Regulation Number 5 Year 2011 about Public Order and Communal Peace (Study on the Order of Traditional Foot Trader in Aloon-Aloon Ponorogo Area). Second, to determine the factors that affect the implementation of the Local Regulation on the Traditional Foot Trader in order to maintain the discipline in thearea of Aloon Aloon Ponorogo. The theory used in this research refers to Van Meter Theory and Van Horn. To support this study, the researcher used 8 people as informants by using qualitative data analysis as the data analysis in this study. Based on the result of this study, it can be concluded that the Implementation of Local Regulation Number 5 Year 2011 on Public Orderand Communal Peace on the Ordering ofTraditional Foot Trader in Aloon-Aloon Ponorogo Area until now has been running well in the disciplining but there is no arrangement of places for Traditional Foot Trader. Moreover, several factors that hamper the regulation of the Local Regulation are due to the lack of infrastructure and human resources in disciplining traditional foot trader. This happens because there is no special fund prepared for the arrangement of street traders. Keywords: Implementation, Regional Regulation, Traditional Foot Trader.