搜索结果：arrive

Rheumatic heart disease (RHD) remains a preventable cause of cardiovascular morbidity/mortality, disproportionately affecting socioeconomically disadvantaged populations. While largely controlled in high-income countries, RHD persists in low- and middle-income countries and may remain underrecognized among migrants from endemic regions in Europe, where systematic surveillance data are lacking. This study aimed to explore the implementation and diagnostic yield of echocardiographic screening in a migrant population and to contextualize these findings through a scoping review of European RHD research. We conducted a single-center pilot study in Munich, Germany, screening 150 recently-arrived migrants (aged 5-26 years) from RHD-endemic regions using 2023 World Heart Federation (WHF) echocardiographic criteria. Medical history was documented. Furthermore, we conducted a scoping literature review of European studies reporting RHD published since 2000, in accordance with Cochrane and PRISMA guidelines (PROSPERO ID: CRD42024538000). Among screened participants (mean age 20.0 ± 5.9 years), ten (6.8%) showed abnormalities warranting confirmatory echocardiography according to the WHF protocol for RHD diagnosis, with mitral regurgitation being the most frequent finding. No participant had a prior diagnosis of RHD. Screening was integrated into routine health examinations without any obvious disruption of routine workflows. The scoping review identified 86 publications, predominantly from Turkey and Italy, highlighting fragmented research, methodological heterogeneity, limited prevalence data, and a focus on surgical management rather than early detection. No multicenter screening studies in asymptomatic at-risk populations were identified, limiting a more accurate assessment of disease burden. This study suggests that systematic echocardiographic screening for RHD in high-risk migrant populations in Europe may facilitate the identification of individuals with echocardiographic abnormalities requiring confirmatory evaluation. Combined with the fragmented European literature, these findings underscore the need for harmonized surveillance, larger multicenter studies, and careful evaluation of targeted screening approaches into migrant health programs to inform future epidemiologic and implementation research. What question did this study address, and why does it matter?: This study asked whether echocardiographic screening for rheumatic heart disease (RHD) can be implemented in migrant health assessments in Europe, and whether such screening could contribute to a better understanding of RHD in a potentially high-risk population. In addition, we sought to explore whether existing research suggests that RHD may be under-recognized in selected high-risk populations in Europe, particularly in the context of migration from endemic regions. To address this, we reviewed the current European literature to assess the extent of research activity and available evidence on RHD.Where was the study done, and what were the main results?: The study was conducted in Munich, Germany, where 150 recently-arrived migrants aged 5-26 years underwent echocardiographic screening as part of a pilot program. Approximately 7% of participants showed cardiac abnormalities that may require further evaluation, although these findings do not represent confirmed diagnoses. In addition, a scoping review of 86 publications from across Europe was performed to contextualize the pilot findings within the broader European RHD literature. The literature was highly fragmented, with most studies originating from a small number of countries. Many focused on hospital-based management rather than early detection, and only a few addressed screening in at-risk populations such as migrants.What do these findings mean in practice?: Given that early identification of RHD could help prevent long-term cardiac complications, echocardiographic screening may be a relevant component of routine migrant health assessments to identify individuals requiring further diagnostic evaluation. RHD may still be present in select high-risk groups in Europe, but appears to be insufficiently systematically monitored. Since current European evidence remains limited and fragmented, we recommend that larger studies be conducted to determine whether targeted screening should be implemented more widely.

Reaction optimization is a very time- and resource-intensive process, as optimal reaction conditions depend highly on specific electronic and steric properties of the substrate identity and require extensive fine-tuning of synthetic conditions to arrive at the highest-yielding conversions. Amide couplings, which comprise nearly 40% of synthetic transformations performed in a medicinal chemistry setting, present a particularly challenging context for predictive modeling given the diversity of coupling agents and reaction parameters that must be matched to substrate reactivity. Amide coupling reaction data is particularly well-suited for machine-learning approaches that predict optimal reaction conditions given a particular substrate feature set. Herein, we report a platform for standardizing and filtering open-source reaction data from the ORD (Open Reaction Database) and using this machine-readable data set of 3800 amide coupling reactions to evaluate 13 machine learning models. These include linear, tree-based, kernel method, instance-based, neural network, and ensemble architectures in the yield prediction and classification of coupling agents in amide coupling reactions. Yield prediction remained a difficult task because of the complexity of our reaction data, achieving R 2 scores of only 0.61. However, the models were largely successful in classifying reactions to their ideal coupling agent category (carbodiimide-based, uronium salts, or phosphonium salts) with ensemble- and kernel-based models achieving up to 87% accuracy. To further validate this approach, we deployed the classification models on literature-reported data not in the ORD database, achieving similarly high predictive performance. Our results demonstrate that kernel methods and ensemble-based architectures perform significantly better than other models such as linear or single-tree. Additionally, molecular environment features, captured by XYZ coordinates, three-dimensional features, and Morgan fingerprints around reactive functional groups, boosted model predictivity more than bulk material properties derived from SMILES such as molecular weight and log P.

Nucleotide excision repair (NER) is a crucial DNA repair pathway that is orchestrated by transcription factor IIH (TFIIH) in eukaryotic cells. TFIIH is a multifunctional complex that contains two DNA helicase/DNA translocase subunits and a kinase module, different subsets of which act in NER, transcription initiation, and cell cycle control. To ensure fidelity despite multifunctionality, the DNA helicase activity of TFIIH is autoinhibited in its free form or when the factor engages in transcription initiation. While the release of the kinase module has been identified as a key step in TFIIH activation, the molecular mechanisms controlling this step and concomitant structural changes in TFIIH are incompletely understood. Here, we determine high-resolution structures of three NER intermediates that visualize how TFIIH arrives at sites of DNA damage in an autoinhibited state and how autoinhibition is released via previously undescribed intermediates. These findings contribute to a mechanistic understanding of human DNA repair.

Paediatric refugees face heightened health risks. At the same time, lack of real-world data hampers the development of evidence-based guidelines for their health care providers. The aim of the study was to assess health-care data and guideline adherence regarding paediatric Ukrainian refugees. Demographic and health-related data were collected from paediatric Ukrainian refugees who arrived in Switzerland between 24 February and 31 October 2022. Data was obtained from five participating centres. Information on infectious disease screening tests and vaccination status was extracted from a REDCap database. Adherence to national guidelines for the care of Ukrainian paediatric refugees was assessed. Of 517 children enrolled, test positivity rates were 2.7% (2/74) for HIV, 1.6% (2/125) for hepatitis B, 0.7% (2/307) for hepatitis C, and 1.0% (3/308) for tuberculosis screening. A high rate of refusal of HIV screening was observed, substantially reducing the intention-to-test rate (0.38-1.25%). Age-appropriate vaccination status was documented in 71-82% of children for measles-mumps-rubella, diphtheria-tetanus-pertussis, poliomyelitis, and Haemophilus influenzae type b. Main reason for incomplete vaccination status was vaccine hesitancy. Following arrival in Switzerland, 98% (509/517) of participants completed catch-up vaccination programmes.Conclusion: Our findings highlight challenges in the uptake of recommended infectious disease screening among paediatric refugees, underscoring the need for targeted and culturally sensitive screening strategies. The observed positivity rates provide important data to refine current screening recommendations. Moreover, the marked improvement in vaccination coverage after counselling highlights the effectiveness of addressing vaccine hesitancy in refugee populations.

IntroductionIn Quebec, the P-38.001 Act (P-38) allows police officers or crisis workers, under exceptional circumstances, to bring individuals at risk of harming themselves or others to the Emergency Department (ED) against their will. Data on the application of this Act remains limited.ObjectivesWe aimed to determine the prevalence of P-38 use among ED patients with mental health presentations and to compare their characteristics, clinical course, and outcomes with those who sought care voluntarily.MethodsWe conducted a retrospective cohort study using a Public Health Agency of Canada-approved mental health database. Patients aged ≥14 years presenting to 5 EDs for mental health reasons in 2020-2021 were included. The main outcome, enforcement of P-38, was abstracted from medical charts. Information on care trajectory and management was also collected. Relative risks (RR) were estimated using modified Poisson regression with robust variance.ResultsAmong 15,021 mental health-related ED visits, 860 (5.7% [95% CI: 5.4-6.1]) involved enforcement of the P-38 Act. Mean age was 41.1 ± 16.5 years, with 46.1% aged 25-44, and 54.4% being male. Most lived independently (85.4%), arrived by ambulance (80.5%), and had a documented mental health history (92.2%). A higher proportion were materially deprived (P = 0.020). Compared with patients who voluntarily consulted in the ED, those under P-38 were more likely to be restrained (RR: 1.68 [95% CI: 1.45-1.94]), placed under preventive confinement (RR 3.41 [95% CI: 2.96-3.93]), receive multidisciplinary assessment (RR: 1.70 [95% CI: 1.59-1.80]), and be hospitalized (RR: 1.36 [95% CI: 1.24-1.48]).ConclusionEnforcement of P-38 accounted for nearly 6% of mental health-related ED visits, disproportionately affecting materially deprived individuals in early to mid-adulthood with prior mental health disorders. Our findings suggest a reliance on coercive and short-term measures, underscoring the need for targeted policy efforts to expand community-based crisis intervention alternatives for this vulnerable population.

Universal screening tools can help detect child physical abuse. Epic released an electronic health record-embedded universal child physical abuse screening tool (U-CAST) that can quickly be implemented by any institution that uses Epic. We evaluated the first year of implementation of an adapted U-CAST in the pediatric emergency department at an academic hospital. All patients less than four years of age who arrived in the pediatric emergency department were screened using a four-question tool embedded into the electronic health record. A screen was positive if at least one question was answered "yes". For positive screens, a Best Practice Advisory prompted the attending to document low risk, order specialty consultation, or indicate they were not the responsible physician. The Suspected Child Abuse and Neglect (SCAN) team reviewed all positive screens. From May 28, 2024 to May 27, 2025, 11,326 screenings were initiated; 10,634 (93.9%) were completed and 198 (1.7%) were positive. Thirty-eight positive screens were associated with Child Protective Services (CPS) reports for concern of child physical abuse (true positives). Eight CPS reports for concern of child physical abuse occurred after negative or incomplete screens. Demographic proportions were similar across screening stages. Implementation achieved a 97% corrected completion rate and an 83% sensitivity for CPS reports for concern for child physical abuse. The successful implementation in the first year is promising evidence for the adoption of U-CAST among pediatric emergency departments. We will continue to monitor sustainability beyond the first year.

This mini-review examines how molecular dynamics simulations reshape the view of annexin-mediated plasma membrane repair from simple recruitment to coupled protein-membrane states. Molecular dynamics simulations show that annexin-induced curvature is shaped by oligomerization, cholesterol, and anionic lipid chemistry, while engineering normally non-trimerizing annexin A3 into a trimer-forming state demonstrates that curvature generation alone does not ensure repair competence. Membrane-active perturbants such as trifluoperazine further suppress repair by altering bilayer thickness, lipid packing, phosphatidylserine mobility, and annexin binding. These findings shift the question from whether annexins arrive to how protein-membrane states generate repair-relevant remodeling.

Tamsulosin, an α1-adrenergic receptor antagonist, has been proposed as a potential therapeutic agent against urolithiasis-induced renal damage. However, limited in vivo evidence exists regarding its renoprotective mechanisms. Forty male Wistar rats were randomly allocated into four groups (n=10/group): positive control, negative control (ethylene glycol-induced urolithiasis), prevention (tamsulosin administered simultaneously with ethylene glycol), and treatment (tamsulosin administered after model induction). Biochemical parameters including serum creatinine, urea, uric acid, calcium, and phosphorus were measured using rat-validated commercial kits (Pars Azmun, Iran). Normal ranges were defined based on published reference values. Gene expression was analyzed by qPCR using the 2^-ΔΔCt method. Study design and reporting followed the ARRIVE checklist. At day 30, the prevention group exhibited significantly lower serum creatinine (0.60 ± 0.08 mg/dL) compared to the negative control (0.98 ± 0.12 mg/dL, P0.01). Although urea levels were slightly higher in the prevention group (4.0 ± 0.7 mg/dL) versus the negative control (3.22 ± 0.6 mg/dL), the calculated BUN/creatinine ratio was significantly improved (46.7 vs. 33.0, P0.05). No significant changes were observed in serum calcium or phosphorus. Gene expression analysis showed upregulation of protective markers in the prevention group. In vivo findings on the beneficial effects of tamsulosin on the renal profile in ethylene glycol-induced urolithiasis illustrate its protective effects on the renal system through improvement of creatinine clearance and BUN/creatinine balance. This underscores its probable use as a protective therapeutic agent against renal injury of crystallization origin.

Shock-augmented ignition (SAI) [R. H. H. Scott et al., Phys. Rev. Lett. 129, 195001 (2022)0031-900710.1103/PhysRevLett.129.195001] is an alternative inertial confinement fusion concept that is designed to achieve high energy gain by combining improved resilience to instabilities with enhanced fuel compression. In SAI, lower implosion velocities can improve hydrodynamic stability and limited laser intensities reduce the excitation of detrimental laser-plasma instabilities, enabling greater areal density accumulation. Here we report an experimental investigation of SAI using a series of warm D_{2} implosions. By timing the augmenting shock to arrive at the implosion center immediately prior to peak compression, the areal density and hot-spot pressure increase by 50% and 112%, respectively, relative to unoptimized designs. Ignition-scale simulations reproduce the observed timing dependence and demonstrate the potential of SAI for inertial fusion energy.

The accurate documentation of medical treatments for combat-injured personnel has historically posed significant challenges for prehospital medical teams. During recent US Army conflicts in Afghanistan and Iraq, only 18%-25% of casualties had any form of prehospital documentation. In the Israel Defense Forces (IDF), traditional manual and paper-based documentation has proven inefficient. During the 2014 Israel-Hamas conflict in Gaza, the completion rate for full documentation was notably low; only 11% (82/704) of casualties had casualty cards from the field. The sudden outbreak of the 2023-2024 Israel-Hamas war required an immediate re-evaluation of battlefield medical documentation practices. The IDF identified an urgent need for an innovative documentation approach to address the challenges of managing and tracking casualties in high-pressure scenarios. The integration of this system underscores the importance of real-time, robust documentation in improving continuity of care, minimizing medical error, and enhancing operational efficiency. This study outlines the rapid development and deployment of the Digital Casualty Card System (DCCS), designed to enhance the accuracy and efficiency of field documentation by medical teams during the 2023-2024 Israel-Hamas war. The DCCS was designed to streamline real-time medical data capture, enhance information transfer along the evacuation chain, and improve battlefield casualty care. A strategic decision was made to prioritize rapid deployment by focusing on a user-friendly, digital application, deliberately excluding advanced features such as sensor integration and real-time data transfer between echelons. This system became operational within 2 weeks of the project's initiation and comprises military-grade tablets embedded with a dedicated software application for documenting casualty status and plastic memory cards worn around the casualty's neck for data transfer between medical teams. This study uses patient data from the IDF Trauma Registry, relying on data from point of injury casualty cards (DCCS), after-action reports, and data entry by on scene and en route providers. Overall, since the beginning of the distribution, over 700 DCCS kits were embedded in combat units, medical evacuation units, and training units. During the ground operation in Gaza, out of 2984 casualties, 1175 (39%) arrived with DCCS documentation. The rapid development and deployment of DCCS during the ongoing war proved to be feasible and contributed to the substantial improvements in both documentation rates and the quality of data collected in the field compared to traditional paper-based casualty cards.

The inauguration of the Australian Association of Neurologists 75 years ago in October 1950 was a major event in the history of Australasian neurology. Already behind many of the world centers in terms of professional organization and leadership, Australian neurology arrived rather late on the international scene, firmly establishing its professional roots a full half-century after many global counterparts. Yet from the vantage point of today, this lapse in professional formation is hardly noticeable. An important reason for this discrepancy is the determination and vision of the founding generation of Australian neurologists. Two central players in particular-Leonard Bell Cox (1894-1976) and Edward Graeme Robertson (1903-1975), both Melbournian neurologists-are frequently credited with first forming the Association. By reviewing primary sources recording their individual influences and important contributions to the Association, we come to find some of the earliest indicators of its future prosperity and success.

Congressional legislation mandated research on intimate partner violence (IPV) among veterans. We convened a panel addressing veteran-related IPV to arrive at evidence-based recommendations. A panel composed of community, decision-maker, health service provider, and research representatives addressed veteran-related IPV prevalence, risk factors, consequences, and interventions. The panel process followed a modified Delphi approach centered around 2 days of virtual moderated discussions and pre- and post-panel surveys. Panelists stressed that definitions must include examples beyond physical violence to adequately communicate the scope of IPV for veterans. They highlighted that prevalence varies due to sampling strategies that should be communicated together with estimates. Panelists identified additional risk factors particularly salient to and sometimes unique to veterans such as post-traumatic stress disorder and suicidality, and deployment-related stress on relationships due to prolonged separation. There was no strong agreement on the consequences of IPV unique to veterans. However, there was universal agreement that the guiding principles of VA's National IPV Assistance Program (emphasizing a person-centered, veteran-centric, recovery-oriented, and trauma-informed approach) are critical for program integrity and growth. Recommendations included providing screening skills training and education for all health care staff; establishing a "no wrong door" policy for veterans seeking help; screening for IPV among veterans who are expressing suicidality, post-traumatic stress disorder symptoms, substance abuse, or sleeping problems; engaging in safety planning around homicide risk; and reinforcing the need for screening, staffing, clinical services, staff education, and training. Panel results can help clinicians, policy makers, and researchers better address IPV in veterans.

I came to the United States as a refugee at age eleven, fleeing religious persecution in Iran. Decades later, as a family physician, I found myself caring for newly arrived refugees during the Afghan humanitarian crisis of 2021. Launching and leading a refugee clinic forced a convergence of my personal history and professional identity that I had long avoided. Each patient encounter echoed my own experiences of displacement, fear, and hope, transforming clinical care into an act of witnessing, healing, and shared humanity. Through caring for refugees, I confronted unresolved trauma, discovered unexpected healing, and reaffirmed medicine's moral and spiritual dimensions. As refugee arrivals slowed and policy shifts led me to step away from this work, I carried forward its lessons: that family medicine is uniquely positioned to hold vulnerability and resilience together, and that caring for others whose stories mirror our own can deepen both professional purpose and personal healing.Abstract also available in عربي (Arabic); Deutsch (German); Español (Spanish); Francais (French); हिन्दी (Hindi); Indonesia (Indonesian); (Chinese); (Japanese); Portuguese (Portugese).

This systematic review aimed to evaluate the effects of biomimetic surface engineering strategies applied to dental implants on osseointegration and peri-implant bone regeneration compared with conventional implant surfaces. A comprehensive literature search was conducted in the Web of Science, PubMed, and Scopus databases in accordance with the PRISMA guidelines, covering the period from January 2021 to January 2026. A total of 12 studies, including in vivo animal experiments and in vitro investigations, that met the inclusion criteria were analyzed. Risk of bias assessment was performed using the SYR-CLE tool and the ARRIVE guidelines. Biomimetic strategies, including laser texturing, sulfonation, bioactive coatings, and growth factor/peptide functionalization (e.g., BMP-2, FGF-2, and PRF), significantly increased bone-implant contact (BIC), new bone volume (BV/TV), and biomechanical stability (pullout strength and reverse torque) compared to conventional surfaces. These surfaces enhance fixation under conditions of low bone density, such as osteoporosis, and improve infection resistance through antibacterial activity. In addition, these modifications enhance cellular adhesion, osteogenic differentiation, angiogenesis, and immune modulation. Current experimental evidence suggests that biomimetic implant surface engineering transforms dental implants from passive biomaterials into multifunctional bioactive interfaces capable of simultaneously regulating osteogenesis, immune response, angiogenesis, and antibacterial activity. Although promising outcomes have been demonstrated in preclinical studies, standardized long-term human clinical studies are still required to validate translational potential and long-term clinical efficacy.

BackgroundAdolescent psychiatric hospitalisation is often organised as if one patient had entered the ward while the family remained outside. This may stabilise acute symptoms but can intensify relational rupture, institutional dependency and weakened parental agency.ObjectiveThis paper presents the Admitted Family Model, hereafter referred to as the AFM, as a clinical-conceptual framework for adolescent inpatient care.ApproachThe AFM is developed from sustained clinical observation, multidisciplinary reflection, supervision, teaching and iterative comparison with family systems, mentalisation, psychoanalytic, dialogic, child- and family-centred and service literatures; the clinical vignettes are composite and substantially disguised.Clinical contributionThe framework identifies five linked functions: the family within the admission field; restoration of parental function; calmamiento, a deliberate slowing of the ward's relational tempo through which urgency, shame and overpressure are reduced, allowing reflective, regulatory and relational capacities to emerge, return or be restored; team vitality; and discharge as sustainable reorganisation, with auxiliary family space and attractor-informed discharge planning specified as additional mechanisms.ConclusionsAcute admission can be understood not only as symptom stabilisation but as a relational intervention that may lessen institutional dependency, blame and shame, and create conditions for adolescents, families and teams to think and relate more safely. When a young person is admitted to a psychiatric ward, the crisis usually affects the whole family. Parents and carers may arrive frightened, guilty, exhausted or unsure how to help. The ward can quickly become the place that feels safest and most organised, while the family can feel pushed aside or blamed. This paper presents the Admitted Family Model (AFM), a way of organising hospital care so that the family is included from the beginning, when this is safe and clinically appropriate. The aim is not to blame parents or to make the family responsible for everything. The aim is to help young people, parents and staff slow down enough to think, listen and respond more safely. The AFM focuses on helping parents recover a useful caring role, protecting the ability of the ward team to stay thoughtful and connected, and planning discharge around the old family patterns that are most likely to return under stress. It also describes how carefully planned shared meetings or groups can help young people and adults practise safer ways of relating. The model is offered as a clinical framework, not as proof that these outcomes have already been demonstrated.

With the arrival of direct-acting antivirals, the implementation of universal hepatitis C virus screening, and simplified treatment protocols, the landscape for managing hepatitis C has become less complicated and more adaptable to primary care settings. In 2019, Washington State created and implemented a statewide comprehensive plan aimed at eliminating hepatitis C by 2030. This study aims to understand provider-based perceptions about screening and treating hepatitis C, and how these perceptions influence care across Washington State. This is a qualitative study using semi-structured in-depth interviews exploring screening and treatment practices of health providers across Washington State. Qualitative data collection was guided by the Updated Consolidated Framework for Implementation Research. Data was analyzed using thematic analysis to identify key factors. Fourteen providers participated in interviews. Most providers (86%) treated hepatitis C, and (71%) of those providers also treated substance use disorders. Emerging themes included organizational barriers, patient barriers, provider barriers, and stigma. Healthcare provider shortages, high turnover in rural parts of the state, lack of provider knowledge about current guidelines and access to information, patient competing priorities, and lack of updated screening and treatment care models were identified as strong barriers to treatment implementation.

The behavior and fate of carbon during oxidation of iron-based materials remain poorly understood at the atomic scale, largely because these processes are difficult to probe experimentally under reactive conditions. Yet this knowledge gap is scientifically and technologically important, as carbon redistribution during oxidation can strongly influence catalyst stability, surface evolution, and high-temperature corrosion. An atomic-level understanding of carbon behavior is therefore essential for predicting material performance and degradation in reactive environments. Here, using a structurally well-defined iron carbide (Fe2C) thin film on Cu(100), we track carbon through the complete oxidation sequence with scanning tunnelling microscopy and X-ray photoelectron spectroscopy, temperature-programmed desorption and density functional theory. Carbon does not desorb as CO or CO2 during oxidation, as the total C 1s intensity is conserved while the speciation changes entirely. Oxygen arriving at the surface displaces surface carbide carbon into the subsurface iron layers; continued oxidation ultimately expels it to the buried Fe/Cu interface, where graphitic C-C bonding develops. DFT shows that coadsorbed oxygen lowers the surface-to-subsurface carbon migration barrier from 1.65 to 0.9 eV, a roughly 7-order-of-magnitude rate enhancement at 550 K. These results connect oxide formation, carbon expulsion, and interfacial carbon accumulation in a single mechanistic framework for iron carbide oxidation.

While advanced airway management (AAM) is commonly performed for children with out-of-hospital cardiac arrest (OHCA), the benefit and optimal timing of AAM remains unclear. To determine whether earlier prehospital AAM is associated with patient outcomes compared with later or no AAM in children with OHCA. Retrospective cohort study of pediatric patients (aged <18&#xa0;years) with nontraumatic OHCA treated by emergency medical services (EMS), using the Resuscitation Outcomes Consortium Epidemiologic Registry-Cardiac Arrest at 10 sites in the United States and Canada from April 2011 to June 2015. The exposures are early prehospital AAM (defined as successful AAM within 10 minutes of EMS arrival) and any successful prehospital AAM (endotracheal intubation or supraglottic airway placement). The primary outcome was survival to hospital discharge. Children who received successful prehospital AAM at each minute after EMS arrival were matched, using time-dependent propensity scores, to children at risk of AAM in the same minute. Among 954 eligible pediatric patients (median [IQR] age, 1 [0 to 11] years), 521 (54.6%) received prehospital AAM, and 433 (45.4%) did not. Overall, 91 (9.5%) survived to discharge. In the propensity score-matched cohort (922 matched cases), successful AAM &#x2264;10 minutes was associated with higher likelihood of survival to hospital discharge (risk ratio [RR], 1.93; 95% CI, 1.01-3.70) compared with children at risk of receiving AAM. In contrast, when successful prehospital AAM was considered regardless of timing, any successful AAM was not associated with survival (RR, 1.35; 95% CI, 0.75-2.43). In this North American cohort of pediatric OHCA, earlier AAM (successful AAM within 10&#xa0;minutes) was associated with survival to hospital discharge. However, successful prehospital AAM at any time was not associated with survival to hospital discharge. These findings suggest that performing AAM earlier in the resuscitation may have a potential benefit for children with OHCA.