The Heroic Imagination Project (HIP) aims to redefine heroism as a set of habits that anyone can achieve. Research findings on the psychological foundations of negative forms of social influence that can lead to bystander behavior are translated into tools that individuals can use in their daily lives. Habits of wise and effective helping behavior are learned, modeled, and encouraged through the training of the \"heroic imagination.\" According to the literature, practicing mindfulness can increase empathy, compassion, and prosocial behaviors. There is empirical evidence that compassion can act as a mediator between mindfulness and prosocial helping behaviors toward strangers, suggesting that mindfulness promotes this behavior and thus helps to overcome the bystander effect. With this hypothesis in mind, we created a program that combined mindfulness and HIP sessions. Five participants volunteered to participate in the \"Creating Mindful Heroes\" 9-week program. Throughout the sessions, they filled in a diary, and at the end of the program, they answered two feedback questionnaires. They were then invited to participate in individual interviews. The participants reported a positive overall perspective regarding the program, mentioning several improvements in their relationships with their family, peers, and others in society. Moreover, participants reported that the program promoted prosocial behaviors and aided them in developing empathy.

UNASSIGNED: To measure medium borne bystander effects, to study the influence of radioadaptive response (RAR) on bystander response, and to discover reliable radioresponsive biomarkers in radio-adapting frogs from Duke Swamp contaminated with an above-background radiation level and in naïve frogs from Twin Lake as the background control site.
UNASSIGNED: Frogs were captured at Duke Swamp and Twin Lake and brought to the lab at the Canadian Nuclear Laboratories facility. Half of the frogs from each site were irradiated with 4 Gy while the other half of the frogs were left with no further radiation treatment. Frog bladders were removed and placed in sterile culture media. Upon arrival at McMaster University, the bladders were processed for tissue cultures. After 48 h, the culture media conditioned by the bladder explants were harvested for clonogenic reporter survival assay and calcium flux measurements for assessing bystander effects. HPV-G cells were used as bystander reporter cells in all radiation-induced bystander effect (RIBE) assays. The frog bladder cultures were incubated for another 10-12 days followed by immunochemical staining for bcl-2 and c-myc expressions to analyze cellular anti-apoptotic (pro-survival) and pro-apoptotic (pro-death) responses, respectively.
UNASSIGNED: Only culture media conditioned by bladders from 4-Gy-irradiated naïve frogs from Twin Lake induced bystander effects (reduction of HPV-G reporter cells\' clonogenic survival and presence of strong calcium flux activities). The 4 Gy irradiation dose increased pro-apoptotic c-myc expression in naïve frogs\' bladder explants. Culture media conditioned by bladders from radio-adapting frogs from Duke Swamp enhanced HPV-G\'s clonogenic survival and a 4 Gy irradiation challenge did not change the enhanced clonogenic survival nature nor induce calcium flux. In bladder explants from both control and 4-Gy-irradiated radio-adapting frogs, anti-apoptotic bcl-2 expression for pro-survival responses was ubiquitous while c-myc expression for pro-death responses was limited to a small fraction of cells.
UNASSIGNED: The clonogenic RIBE reporter assay using HPV-G and calcium flux measurements are useful diagnostic tools for RIBE assessment of field biological samples, specifically those from frogs. RAR induced by environmentally relevant low-dose radiation induces protective bystander response. Bcl-2 and c-myc are reliable biomarkers for evaluating low dose radiation responses in wild populations of amphibians. Overall, this pilot study emphasizes the importance of looking at non-targeted effects (NTEs) in natural populations of non-human biota that could be vulnerable to chronic low-dose radiation exposures.

Besides the direct effects of radiations, indirect effects are observed within the surrounding non-irradiated area; irradiated cells relay stress signals in this close proximity, inducing the so-called radiation-induced bystander effect. These signals received by neighboring unirradiated cells induce specific responses similar with those of direct irradiated cells. To understand the cellular response of bystander cells, we performed a 2D gel-based proteomic study of the chondrocytes receiving the conditioned medium of low-dose irradiated chondrosarcoma cells. The conditioned medium was directly analyzed by mass spectrometry in order to identify candidate bystander factors involved in the signal transmission. The proteomic analysis of the bystander chondrocytes highlighted 20 proteins spots that were significantly modified at low dose, implicating several cellular mechanisms, such as oxidative stress responses, cellular motility, and exosomes pathways. In addition, the secretomic analysis revealed that the abundance of 40 proteins in the conditioned medium of 0.1 Gy irradiated chondrosarcoma cells was significantly modified, as compared with the conditioned medium of non-irradiated cells. A large cluster of proteins involved in stress granules and several proteins involved in the cellular response to DNA damage stimuli were increased in the 0.1 Gy condition. Several of these candidates and cellular mechanisms were confirmed by functional analysis, such as 8-oxodG quantification, western blot, and wound-healing migration tests. Taken together, these results shed new lights on the complexity of the radiation-induced bystander effects and the large variety of the cellular and molecular mechanisms involved, including the identification of a new potential actor, namely the stress granules.

Early bystander cardiopulmonary resuscitation (CPR) improves the chances of successful resuscitation and survival. However, few data are available regarding the willingness to perform CPR among First Aid Attendants on the Workplace (FAAWs) in Italy. The present study was performed in order to identify current attitudes of Italian FAAWs towards CPR.
Between February and June 2017, FAAWs from the Autonomous Province of Trento were asked about their willingness to perform CPR through a structured questionnaire assessing their knowledge about CPR, and the reasons for hesitancy. A cumulative knowledge score (KS) was eventually calculated.
A total of 123 FAAWs (male 57.7%, mean age 45.2 years ± 10.1) completed the questionnaire. About 1/3 of participants (32.5%) had previously performed First Aid procedures. Overall, 77.2% exhibited willingness to perform CPR, and such attitude was more frequently reported by subjects younger than 40 years (29.5% vs. 10.7% in older subjects; p = 0.045), perceiving First Aid training as useful (98.9% vs. 84.7%, p = 0.002), and exhibiting a better knowledge of CPR (KS ≥ 75%: 47.4% vs. 15.3%). The reasons for the unwillingness were inadequate knowledge and doubt regarding whether they could perform the techniques effectively. Eventually, KS was identified as the main predictor for willingness to perform CPR (OR 4.450, 95%CI 1.442 - 14.350).
Willingness to perform CPR was seemingly high, and knowledge of CPR techniques was its main predictor. These findings emphasize the importance for an accurate CPR training, as well as for the surveillance of the quality of qualification courses.

OBJECTIVE: to determine the impact of the irradiated in vitro blood cells from patients with B-cell chronic lymphocytic leukemia (CLL) on the level of chromosomal instability in peripheral blood lymphocytes (PBL) from healthy persons during the development of tumor-induced bystander effect.
METHODS: Separate and joint cultivation of PBL from healthy persons (cells-bystanders) together withblood cells from CLL patients irradiated in vitro at the G0 stage of the mitotic cycle by γ-quanta 137Cs in a dose of0.5 Gy 137Cs (cells-inductors) was used. For joint cultivation our own model system for co-cultivation of PBL fromindividuals of different sex, designed by us to investigate the bystander effects at the cytogenetic level was used.Traditional cytogenetic analysis of uniformly painted chromosomes with group karyotyping was performed. The frequency of chromosome aberrations in cells-inductors and cells-bystanders as the markers of chromosome instability were determined.
RESULTS: Found that at co-cultivation of PBL from healthy individuals with irradiated blood cells from CLL patientsthe middle group frequency of chromosome aberrations in the bystander cells (5.18 ± 0.51 per 100 metaphases,p < 0.001) was statistically significant higher than its background level determined at a separate cultivaton (1.52± 0.30 per 100 metaphases), and at co-cultivation with non-irradiated blood cells from CLL patients (3.31 ± 0.50 per100 metaphases, p < 0.01).
CONCLUSIONS: Co-cultivation of in vitro irradiated blood cells from CLL patients with PBL from healthy persons leadsto an increase in the level of chromosome instability in the bystander cells due to synergism between tumor-inducedand radiation-induced bystander effects.
Meta: vyznachyty vplyv oprominenykh in vitro klityn krovi patsiientiv z V-klitynnoiu khronichnoiu limfotsytarnoiu leĭkemiieiu (KhLL) na riven\' khromosomnoï nestabil\'nosti v limfotsytakh peryferychnoï krovi (LPK) zdorovykh osib pryrozvytku pukhlyno-indukovanogo efektu svidka.Materialy i metody. Zastosovuvaly okreme ta spil\'ne kul\'tyvuvannia LPK zdorovykh osib (klityny-svidky) z klitynamy krovi patsiientiv z KhLL, oprominenymy in vitro na G0 stadiï klitynnogo tsyklu γ-kvantamy 137Cs v dozi 0,5 Gr(klityny-induktory). Dlia sumisnogo kul\'tyvuvannia klityn vykorystovuvaly vlasnu model\'nu systemu spil\'nogokul\'tyvuvannia LPK riznostatevykh osib, rozroblenu dlia doslidzhennia efektu svidka na tsytogenetychnomu rivni.Provodyly analiz rivnomirno zabarvlenykh khromosom z grupovym kariotypuvanniam. Vyznachaly chastotu khromosomnykh aberatsiĭ v klitynakh-induktorakh ta klitynakh-svidkakh.Rezul\'taty. Vstanovyly, shcho pry sumisnomu kul\'tyvuvanni LPK zdorovykh osib z oprominenymy klitynamy krovipatsiientiv z KhLL seredn\'ogrupova chastota aberatsiĭ khromosom v klitynakh-svidkakh (5,18 ± 0,51 na 100 metafaz)statystychno znachushche perevyshchyla iak ïkh fonovyĭ riven\', vyznachenyĭ pry okremomu kul\'tyvuvanni (1,52 ± 0,30 na100 metafaz, p < 0,001)), tak i tseĭ pokaznyk pry ko-kul\'tyvuvanni klityn-svidkiv z neoprominenymy klitynamykrovi patsiientiv z KhLL (3,31 ± 0,50 na 100 metafaz, p < 0,01).Vysnovky. Sumisne kul\'tyvuvannia oprominenykh in vitro klityn krovi patsiientiv z V-klitynnoiu KhLL z limfotsytamyperyferychnoï krovi umovno zdorovykh osib pryzvodyt\' do pidvyshchennia rivnia khromosomnoï nestabil\'nosti vklitynakh-svidkakh vnaslidok synergizmu mizh pukhlyno-indukovanym ta radiatsiĭno- indukovanym efektamy svidka.

Background Mathematical optimization of automated external defibrillator (AED) placement may improve AED accessibility and out-of-hospital cardiac arrest (OHCA) outcomes compared with American Heart Association (AHA) and European Resuscitation Council (ERC) placement guidelines. We conducted an in silico trial (simulated prospective cohort study) comparing mathematically optimized placements with placements derived from current AHA and ERC guidelines, which recommend placement in locations where OHCAs are usually witnessed. Methods and Results We identified all public OHCAs of presumed cardiac cause from 2008 to 2016 in Copenhagen, Denmark. For the control, we computationally simulated placing 24/7-accessible AEDs at every unique, public, witnessed OHCA location at monthly intervals over the study period. The intervention consisted of an equal number of simulated AEDs placements, deployed monthly, at mathematically optimized locations, using a model that analyzed historical OHCAs before that month. For each approach, we calculated the number of OHCAs in the study period that occurred within a 100-m route distance based on Copenhagen\'s road network of an available AED after it was placed (\"OHCA coverage\"). Estimated impact on bystander defibrillation and 30-day survival was calculated by multivariate logistic regression. The control scenario involved 393 AEDs at historical, public, witnessed OHCA locations, covering 15.8% of the 653 public OHCAs from 2008 to 2016. The optimized locations provided significantly higher coverage (24.2%; P<0.001). Estimated bystander defibrillation and 30-day survival rates increased from 15.6% to 18.2% (P<0.05) and from 32.6% to 34.0% (P<0.05), respectively. As a baseline, the 1573 real AEDs in Copenhagen covered 14.4% of the OHCAs. Conclusions Mathematical optimization can significantly improve OHCA coverage and estimated clinical outcomes compared with a guidelines-based approach to AED placement.

BACKGROUND: High-quality cardiopulmonary resuscitation (CPR) could improve survival of drowning victims. The purpose of the study is to assess the impact of fatigue caused by water rescue on subsequent CPR quality and the influence of a bystander\'s participation on CPR quality in a lifeguard rescue.
METHODS: This was a simulated quasi-experimental study with a sample of 14 lifeguards and 13 laypersons. Each lifeguard performed 2 min single-rescuer CPR as baseline measurement. In three separate trials, a single lifeguard swam 50 m to perform a water rescue in a pool and returned with the manikin another 50 m. After each rescue, 10 min of CPR was performed by a single lifeguard, two lifeguards or a lifeguard with a layperson with no CPR training. Paired t-test and repeated analysis of variance were used to analyse CPR quality variables.
RESULTS: Baseline CPR quality was adequate for most measures except compression depth and re-expansion. After water rescue, the single lifeguard trial showed no significant differences compared with baseline. CPR score and ventilation score of the single-lifeguard trial was higher than that of the lifeguard-bystander trial (p=0.027, p<0.001). Both the two-lifeguard trial (p=0.025), and lifeguard-bystander trial (p=0.010) had a lower percentage of breaths with correct ventilation volume and higher percentage of breaths with excessive ventilation volume (p=0.007, p=0.011, respectively) than the single-lifeguard trial. No-flow time of the lifeguard-bystander trial was longer than other trials (p<0.001).
CONCLUSIONS: Although CPR given by the lifeguard was not optimal, fatigue generated by a water rescue has no impact on the quality of subsequent CPR performed by a trained lifeguard for 10 min. Untrained bystanders assisting in CPR in a drowning event is unlikely to be helpful.

OBJECTIVE: To explore the influences of clinical nurses\' workplace violence and bystander behaviour on patient safety.
BACKGROUND: Bystanders\' role in social violence affects the consequences of said violence; however, few studies have explored the relationship between workplace violence and patient safety among nurses working in clinical settings.
METHODS: A cross-sectional survey design was conducted using a structured questionnaire pertaining to workplace violence, bystander behaviour, patient safety culture and nurse-assessed patient safety outcomes. The questionnaire was administered to 185 bedside nurses at a university hospital in a metropolitan city in Korea.
RESULTS: A regression model with department, patient safety culture, workplace bullying, incivility and bystander behaviour explained approximately 34.0% of patient safety. Further, defending bystander behaviour, facilitating bystander behaviour, work-related bullying and co-worker incivility influenced the patient safety.
CONCLUSIONS: Being a facilitating bystander was a threat to patient safety, while being a defending bystander enhanced patient safety.
CONCLUSIONS: The negative consequences of workplace violence on patient safety may be mitigated by colleagues\' reaction to violence; therefore, nursing policymakers should emphasize the role of positive bystanders as an organisational strategy against workplace violence.

BACKGROUND: Radiotherapy-induced lymphopenia may be limiting the success of therapy and could also negatively affect the ability of immune system in mediating the bystander (BE) and abscopal effects (AE). A novel SBRT-based PArtial Tumor irradiation of HYpoxic clonogenic cells (SBRT-PATHY) for induction of the tumoricidal BE and AE by sparing the peritumoral immune microenvironment and regional circulating lymphocytes has been developed to enhance the radiotherapy therapeutic ratio of advanced lung cancer. The aim of this retrospective review of prospectively collected mono-institutional phase 2 study was to compare the outcomes between unconventional SBRT-PATHY and standard of care in unresectable stage IIIB/IV bulky NSCLC.
METHODS: Sixty patients considered inoperable or unsuitable for radical radio-chemotherapy were enrolled and treated using the following 3 regimens: SBRT-PATHY (group I, n = 20 patients), recommended standard of care chemotherapy (group II, n = 20 patients), and institutional conventional palliative radiotherapy (group III, n = 20 patients).
RESULTS: Median follow-up was 13 months. The 1-year overall survival was 75, 60, and 20% in groups 1, 2 and 3, respectively (p = 0.099). The 1-year cancer specific survival was 90, 60, and 20% in groups 1, 2, and 3, respectively (p = 0.049). Bulky tumor control rate was 95% for SBRT-PATHY compared with 20% in the other two groups. BE and AE were seen by SBRT-PATHY in 95 and 45% of patients, respectively. Multi-variate analysis for cancer specific survival was significant for treatment effect with SBRT-PATHY (p < 0.001) independent of age, sex, performance status, histology, stage, treated bulky site and tumor diameter. SBRT-PATHY resulted in lower toxicity (p = 0.026), and improved symptom control (p = 0.018) when compared to other two treatment options.
CONCLUSIONS: SBRT-PATHY improved treatment outcomes in unresectable NSCLC and should be investigated in larger trials. Present study has been retrospectively registered on 8th of August 2019 by the ethic committee for Austrian region \"Kärnten \"in Klagenfurt (AUT), under study number A 31/19.

Mesenchymal stem cells (MSCs) have surfaced as ideal candidates for treatment of different therapeutically challenging diseases however their effect on cancer cells is not well determined. In this study, we investigated the effect of MSCs derived from human bone marrow (BM), adipose tissue (AT), and umbilical cord derived MSCs (UC-MSCs) on ovarian cancer.Measurements of ovarian tumor marker proteins were computed by ELISA. Proliferative, apoptosis and anti-inflammatory effects of the MSCs were measured by Flow cytometry (FCM). MMPs expression was measured by RT-PCR.The co-culture of cancer cell lines OVCAR3, CAOV3, IGROV3 and SKOV3 with the conditioned media of MSCs (CM-MSC) and MSCs showed an increase in cellular apoptosis, along with a reduction in the level of CA-125 and a decline of LDH and beta-hCG. A decrease in CD24 of the cancer cell lines in co-culture with the CM-MSCs showed a reduction of the cancer tumorigenicity. In addition, the invasion and aggressiveness of cancer cell lines was significantly decreased by CM-MSC; this was translated by a decrease in MMP-2, MMP-9, and CA-125 mRNA expression, and an increase in TIMP 1, 2, and 3 mRNA expression. An increase in IL-4 and IL-10 cytokines, and a decrease in GM-CSF, IL-6, and IL-9, were also noted.In conclusion, mesenchymal stem cells derived from different sources and their conditioned media appear to have a major role in inhibition of cancer aggressiveness and might be considered as a potential therapeutic tool in ovarian cancer.