Retrospective Analysis of Emergency Medical Services (EMS) Physician Medical Control Calls

INTRODUCTION: Although emergency medical services (EMS) standing-order protocols provide more efficient and accurate on-scene management by paramedics, online medical direction (OLMD) has not been eliminated from practice. In this modern era of OLMD, no studies exist to describe the prevalence of reasons for contacting OLMD. OBJECTIVES: The primary goal of this study was to describe the quantity of and reasons for calls for medical direction. We also sought to determine time diverted from emergency physicians due to OLMD. Finally, we hoped to identify any areas for potential improvement or additional training opportunities for EMS providers. METHODS: This was a descriptive study with retrospective data analysis of recorded OLMD calls from January 1, 2016, to December 31, 2016. Data were extracted by research personnel listening to audio recordings and were entered into a database for descriptive analysis. We abstracted the date and length of call, patient demographic information (age and gender), category of call (trauma, medical, cardiac, or obstetrics), reason for call, and origin of call (prehospital, interhospital, nursing home, or discharge). RESULTS: The total number of recordings analyzed was 519. Calls were divided into four categories pertaining to their nature: 353 (68.5%) medical; 70 (13.6%) trauma; 83 (16.1%) cardiac; and 9 (8%) were obstetrics related. Repeat calls regarding the same patient encounter comprised 48 (9.4%) of the calls. Patient refusal of transport was the most common reason for a call medical direction (32.3% of calls). The total time for medical direction calls for the year was 26.6 hours. The maximum number of calls in a single day was seven, with a mean of 2.04 calls per day (standard deviation [SD] +/- 1.18). The mean call length was 3.06 minutes (SD +/- 2.51). CONCLUSION: Our analysis shows that the use of OLMD frequently involves complex decision-making such as determination of the medical decision-making capacity of patients to refuse treatment and transport, and evaluation of the appropriate level of care for interfacility transfers. Further investigation into the effect of EMS physician-driven medical direction on both the quality and time required for OLMD could allow for better identification of areas of potential improvement and training

The Gender Pain Gap: gender inequalities in pain across 19 European countries

Aims: Chronic pain is increasingly considered to be an international public health issue – but gender differences in chronic pain in Europe are under-examined. This work aimed to examine gender inequalities in pain across Europe. Methods: Data for 27,552 men and women aged 25-74 years in 19 European countries were taken from the social determinants of health module of the European Social Survey (2014). Inequalities in reporting pain were measured by means of adjusted rate differences (ARD) and relative adjusted rate risks (ARR). Results: At the pooled pan-European level, a greater proportion of women (62.3%) reported pain than men (55.5%) (ARD 5.5% [95% CI 4.1%, 6.9%], ARR 1.10 [95% CI 1.08, 1.13]). These inequalities were greatest for back/neck pain (ARD 5.8% [95% CI 4.4%, 7.1%], ARR 1.15 [95% CI 1.12, 1.19]), but were also significant for hand/arm pain (ARD 4.6% [95% CI 3.5%, 5.7%], ARR 1.24 [95% CI 1.17, 1.30]), and foot/leg pain (ARD 2.6% [95% CI 1.5%, 3.8%], ARR 1.12 [95% CI 1.07, 1.18]). There was considerable cross‐national variation in gender pain inequalities across European countries. Conclusions: Significant gender pain inequalities exist across Europe whereby women experience more pain than men; this was most pronounced for back/neck pain. The extent of the gender pain gap varies by country. The gender pain gap is a public health concern, and should be considered in future prevention and management strategies

Ion–molecule reactions of CoAr₆⁺ with nitrogen oxides N₂O, NO, and NO₂: measuring absolute pressure by shock-freezing of the collision complex

A new method to determine the absolute pressure in an ultra-high vacuum apparatus is tested using ion molecule reactions with CoAr₆⁺. In a collision with a neutral reactant, the complex between Co⁺ and the collision partner is stabilized by evaporation of argon atoms. If CoAr₆⁺ reacts with collision rate, the absolute pressure can be determined by comparing the experimental collision rate with the collision rate calculated from average dipole orientation theory. The experimental results with N₂O, NO, and NO₂ indeed show that the collision complex is frozen out. Comparison of the rates of primary, secondary and tertiary reaction products, however, suggests that not all collisions of CoAr₆⁺ are reactive

Photodissociation and photochemistry of V⁺ (H₂O)n, n = 1–4, in the 360–680 nm region

The photodissociation and photochemistry of V⁺ (H₂O)n, n = 1–4, was studied in the 360–680 nm region in a Fourier transform ion cyclotron resonance mass spectrometer. The light of a high pressure mercury arc lamp was filtered with band pass filters, with center wavelengths from 360 to 680 nm in steps of 20 nm. The bandwidth of the filters, defined as full width at half maximum, was 10 nm. Photodissociation channels are loss of water molecules, as well as loss of atomic or molecular hydrogen, which may be accompanied by loss of water molecules. The most intense absorptions are red shifted with increasing hydration. Theoretical spectra are calculated with time dependent density functional theory. Calculations reproduce all features of the experimental spectra, including the red shift with increasing hydration shell and the overall pattern of strong and weak absorptions

Native-valve tricuspid endocarditis due to Neisseria Sicca with bilateral pulmonary embolism

International audienceNo abstract availabl

Meeting report: discussions and preliminary findings on extracellular RNA measurement methods from laboratories in the NIH Extracellular RNA Communication Consortium

Extracellular RNAs (exRNAs) have been identified in all tested biofluids and have been associated with a variety of extracellular vesicles, ribonucleoprotein complexes and lipoprotein complexes. Much of the interest in exRNAs lies in the fact that they may serve as signalling molecules between cells, their potential to serve as biomarkers for prediction and diagnosis of disease and the possibility that exRNAs or the extracellular particles that carry them might be used for therapeutic purposes. Among the most significant bottlenecks to progress in this field is the lack of robust and standardized methods for collection and processing of biofluids, separation of different types of exRNA-containing particles and isolation and analysis of exRNAs. The Sample and Assay Standards Working Group of the Extracellular RNA Communication Consortium is a group of laboratories funded by the U.S. National Institutes of Health to develop such methods. In our first joint endeavour, we held a series of conference calls and in-person meetings to survey the methods used among our members, placed them in the context of the current literature and used our findings to identify areas in which the identification of robust methodologies would promote rapid advancements in the exRNA field

RNA expression patterns in serum microvesicles from patients with glioblastoma multiforme and controls

<p>Abstract</p> <p>Background</p> <p>RNA from exosomes and other microvesicles contain transcripts of tumour origin. In this study we sought to identify biomarkers of glioblastoma multiforme in microvesicle RNA from serum of affected patients.</p> <p>Methods</p> <p>Microvesicle RNA from serum from patients with de-novo primary glioblastoma multiforme (N = 9) and normal controls (N = 7) were analyzed by microarray analysis. Samples were collected according to protocols approved by the Institutional Review Board. Differential expressions were validated by qRT-PCR in a separate set of samples (N = 10 in both groups).</p> <p>Results</p> <p>Expression profiles of microvesicle RNA correctly separated individuals in two groups by unsupervised clustering. The most significant differences pertained to down-regulated genes (121 genes > 2-fold down) in the glioblastoma multiforme patient microvesicle RNA, validated by qRT-PCR on several genes. Overall, yields of microvesicle RNA from patients was higher than from normal controls, but the additional RNA was primarily of size < 500 nt. Gene ontology of the down-regulated genes indicated these are coding for ribosomal proteins and genes related to ribosome production.</p> <p>Conclusions</p> <p>Serum microvesicle RNA from patients with glioblastoma multiforme has significantly down-regulated levels of RNAs coding for ribosome production, compared to normal healthy controls, but a large overabundance of RNA of unknown origin with size < 500 nt.</p

Health Educ Behav

UL1 TR000433/TR/NCATS NIH HHS/United States5U01CE001957-02/CE/NCIPC CDC HHS/United StatesDA07484/DA/NIDA NIH HHS/United StatesUL1TR000433/TR/NCATS NIH HHS/United StatesR01 DA007484/DA/NIDA NIH HHS/United StatesU01 CE001957/CE/NCIPC CDC HHS/United States2014-03-26T00:00:00Z23863911PMC396656

Probing the competition among different coordination motifs in metal-ciprofloxacin complexes through IRMPD spectroscopy and DFT calculations

The vibrational spectra of ciprofloxacin complexes with monovalent (Li+, Na+, K+, Ag+) and polyvalent (Mg2+, Al3+) metal ions are recorded in the range 1000-1900 cm(-1) by means of infrared multiple-photon dissociation (IRMPD) spectroscopy. The IRMPD spectra are analyzed and interpreted in the light of density functional theory (DFT)-based quantum chemical calculations in order to identify the possible structures present under our experimental conditions. For each metal-ciprofloxacin complex, four isomers are predicted, considering different chelation patterns. A good agreement is found between the measured IRMPD spectrum and the calculated absorption spectrum of the most stable isomer for each complex. Metal ion size and charge are found to drive the competition among the different coordination motifs: small size and high charge density metal ions prefer to coordinate the quinolone between the two carbonyl oxygen atoms, whereas large-size metal ions prefer the carboxylate group as a coordination site. In the latter case, an intramolecular hydrogen bond compensates the weaker interaction established by these cations. The role of the metal cation on the stabilization of ionic and nonionic structures of ciprofloxacin is also investigated. It is found that large-size metal ions preferentially stabilize charge separated motifs and that the increase of metal ion charge has a stabilizing effect on the zwitterionic form of ciprofloxacin