Emergency medical dispatch recognition, clinical intervention and outcome of patients in traumatic cardiac arrest from major trauma : an observational study

© Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.OBJECTIVES: The aim of this study is to describe the demographics of reported traumatic cardiac arrest (TCA) victims, prehospital resuscitation and survival to hospital rate. SETTING: Helicopter Emergency Medical Service (HEMS) in south-east England, covering a resident population of 4.5 million and a transient population of up to 8 million people. PARTICIPANTS: Patients reported on the initial 999 call to be in suspected traumatic cardiac arrest between 1 July 2016 and 31 December 2016 within the trust's geographical region were identified. The inclusion criteria were all cases of reported TCA on receipt of the initial emergency call. Patients were subsequently excluded if a medical cause of cardiac arrest was suspected. OUTCOME MEASURES: Patient records were analysed for actual presence of cardiac arrest, prehospital resuscitation procedures undertaken and for survival to hospital rates. RESULTS: 112 patients were reported to be in TCA on receipt of the 999/112 call. 51 (46%) were found not to be in TCA on arrival of emergency medical services. Of the 'not in TCA cohort', 34 (67%) received at least one advanced prehospital medical intervention (defined as emergency anaesthesia, thoracostomy, blood product transfusion or resuscitative thoracotomy). Of the 61 patients in actual TCA, 10 (16%) achieved return-of-spontaneous circulation. In 45 (88%) patients, the HEMS team escorted the patient to hospital. CONCLUSION: A significant proportion of patients reported to be in TCA on receipt of the emergency call are not in actual cardiac arrest but are critically unwell requiring advanced prehospital medical intervention. Early activation of an enhanced care team to a reported TCA call allows appropriate advanced resuscitation. Further research is warranted to determine which interventions contribute to improved TCA survival.Peer reviewedFinal Published versio

Accumulating experience in a child abuse clinic

No Abstract

The PML-RAR alpha transcript in long-term follow-up of acute promyelocytic leukemia patients

Background and Objectives. Detection of PML-RAR alpha transcripts by RT-PCR is now established as a rapid and sensitive method for diagnosis of acute promyelocytic leukemia (APL), Although the majority of patients in longterm clinical remission are negative by consecutive reverse transcription polymerase chain reaction (RT-PCR) assays, negative tests are still observed in patients who ultimately relapse. Conversion from negative to positive PCR has been observed after consolidation and found to be a much stronger predictor of relapse. This study reports on 47 APL patients to determine the correlation between minimal residual disease (MRD) status and clinical outcome in our cohort of patients. Design and Methods. The presence of PML-RAR alpha t transcripts was investigated in 47 APL patients (37 adults and 10 children) using a semi-nested reverse transcriptase-polymerase chain reaction to evaluate the prognostic value of RT-PCR tests. Results. All patients achieved complete clinical remission (CCR) following induction treatment with all-trans retinoic acid (ATRA) and chemotherapy (CHT) or ATRA alone. Patients were followed up between 2 and 117.6 months (median: 37 months). Relapses occurred in 11 patients (9 adults and 2 children) between 11.4 and 19 months after diagnosis (median: 15.1 months) while 36 patients (28 adults and 8 children) remained in CCR, Seventy-five percent of patients carried the PML-RARa long isoform (bcr 1/2) which also predominated among the relapsed cases (9 of 11) but did not associate with any adverse outcome (p = 0.37), For the purpose of this analysis, minimal residual disease tests were clustered into four time-intervals: 0-2 months, 3-5 months, 5-9 months and 10-24 months. Interpretation and Conclusions. Children showed persisting disease for longer than adults during the first 2 months of treatment, At 2 months, 10 (50%) of 20 patients who remained in CCR and 4 (80%) of 5 patients who subsequently relapsed were positive. Patients who remained in CCR had repeatedly negative results beyond 5.5 months from diagnosis. A positive MRD test preceded relapse in 3 of 4 tested patients. The ability of a negative test to predict CCR (predictive negative value, PNV) was greater after 6 months (> 83%), while the ability of a positive test to predict relapse (predictive positive value, PPV) was most valuable only beyond 10 months (100%). This study (i) highlights the prognostic value of RT-PCR monitoring after treatment of APL patients but only from the end of treatment, (ii) shows an association between conversion to a positive test and relapse and (iii) suggests that PCR assessments should be carried out at 3-month intervals to provide a more accurate prediction of hematologic relapses but only after the end of treatment, (C) 2001, Ferrata Storti Foundatio

Health and safety in garment workers’ lives: setting a new research agenda

Amidst new global initiatives to promote garment workers’ health and safety following a spate of deadly factory disasters across the Global South, this critical review calls for an expanded research agenda that looks beyond the workplace to examine the complex politics, spatialities, and temporalities of garment workers’ health and wellbeing. Drawing on ethnographic research on garment workers across South Asia, we argue against a narrow, technocratic, and depoliticised emphasis on physical infrastructures and building safety, and advocate instead a more holistic and politically-engaged research approach to the everyday health and wellbeing of workers. A conceptual focus on health and wellbeing offers a window onto workers’ employment experiences and reveals how routine work pressures, exhaustion and ill health are shaped by the dynamics of global supply chains, even well after workers have disengaged from these global circuits. Understanding how garment work affects workers’ wellbeing and their prospects for a fulfilling life requires research that moves beyond the workplace and covers the entire life course

Views and practice of abortion among Queensland midwives and sexual health nurses

Background: A significant barrier to the access of safe abortion is the lack of trained abortion providers. Recent studies show that with appropriate education, nurses and midwives can provide abortions as safely as medical practitioners. Aims: To examine the attitudes and practices of registered midwives (RMs) and sexual health nurses (SHNs) in Queensland toward abortion. Materials and Methods: A cross-sectional mixed-methods questionnaire was distributed to RMs and SHNs from the Queensland Nursing and Midwifery Union. Data were described and analysed both quantitatively and qualitatively. Results: There was a 20% response rate (n = 624) to the survey from the overall study population. There were 53.5% who reported they would support the provision of abortion in any situation at all; 7.4% held views based on religion or conscience that would make them completely opposed to abortion. There were 92.9% who felt that education surrounding abortion should be part of the core curriculum for midwifery and/or nursing students in Australia. The qualitative responses demonstrated a variety of views and suggestions regarding the practice of abortion. Conclusions: There was a wide variation in views toward induced abortion from RMs and SHNs in Queensland. While a proportion of respondents opposed abortion in most circumstances, a significant group was in support of abortion in any situation and felt involvement in initiating and/or performing abortion would be within the scope of RMs and SHNs

The distance to the Vela pulsar gauged with HST parallax oservations

The distance to the Vela pulsar (PSR B0833-45) has been traditionally assumed to be 500 pc. Although affected by a significant uncertainty, this value stuck to both the pulsar and the SNR. In an effort to obtain a model free distance measurement, we have applied high resolution astrometry to the pulsar V~23.6 optical counterpart. Using a set of five HST/WFPC2 observations, we have obtained the first optical measurement of the annual parallax of the Vela pulsar. The parallax turns out to be 3.4 +/- 0.7 mas, implying a distance of 294(-50;+76) pc, i.e. a value significantly lower than previously believed. This affects the estimate of the pulsar absolute luminosity and of its emission efficiency at various wavelengths and confirms the exceptionally high value of the N_e towards the Vela pulsar. Finally, the complete parallax data base allows for a better measurement of the Vela pulsar proper motion (mu_alpha(cos(delta))=-37.2 +/- 1.2 mas/yr; mu_delta=28.2 +/- 1.3 mas/yr after correcting for the peculiar motion of the Sun) which, at the parallax distance, implies a transverse velocity of ~65 km/s. Moreover, the proper motion position angle appears specially well aligned with the axis of symmetry of the X-ray nebula as seen by Chandra. Such an alignment allows to assess the space velocity of the Vela pulsar to be ~81 km/s.Comment: LaTeX, 21 pages, 5 figures. Accepted for publication in Ap

Objectively measured physical activity and fat mass in a large cohort of children

Background Previous studies have been unable to characterise the association between physical activity and obesity, possibly because most relied on inaccurate measures of physical activity and obesity. Methods and Findings We carried out a cross sectional analysis on 5,500 12-year-old children enrolled in the Avon Longitudinal Study of Parents and Children. Total physical activity and minutes of moderate and vigorous physical activity (MVPA) were measured using the Actigraph accelerometer. Fat mass and obesity (defined as the top decile of fat mass) were measured using the Lunar Prodigy dual x-ray emission absorptiometry scanner. We found strong negative associations between MVPA and fat mass that were unaltered after adjustment for total physical activity. We found a strong negative dose-response association between MVPA and obesity. The odds ratio for obesity in adjusted models between top and the bottom quintiles of minutes of MVPA was 0.03 (95% confidence interval [CI] 0.01-0.13, p-value for trend < 0.0001) in boys and 0.36 (95% CI 0.17-0.74, p-value for trend = 0.006) in girls. Conclusions We demonstrated a strong graded inverse association between physical activity and obesity that was stronger in boys. Our data suggest that higher intensity physical activity may be more important than total activity

Scottish theme towns: have new identities enhanced development?

Three small towns in southwest Scotland have recently been branded as distinct theme towns, based on books, artists and food. This is an attempt to make them more attractive to visitors and thereby improve their economy. The objective of this research is to establish whether the new identities possessed by the towns have enhanced their development. It is argued, using data reviewing the past decade, that they have all developed, albeit at different rates, in terms of the economy and culture. Moreover, it is maintained that social capital has been enhanced and is a factor whose importance has been under-appreciated by planners and observers of this type of process. The relevance of the new identity to the pre-branding identity is also seen as a factor in successful development and ideas of authenticity and heritage are brought to bear on the relationship

AVALIAÇÃO EXPERIMENTAL E NUMÉRICA DA CINÉTICA DO CONGELAMENTO DO MÚSCULO DE ABRÓTEA (Urophycis brasiliensis)

This work carried out an experimental and numerical study of the kinetics of freezing of the Brazilian codling (Urophycis brasiliensis) muscle in air blast freezer, with air temperature set at 253.15 K and the average convective heat transfer coefficient at 25.4 W m-2 K-1. The initial temperature of the fish muscle was 277.15 K and the final temperature 255.15 K. The objective of this work was verify the best agreement between the experimental temperature profile and the numerical temperature profile to Brazilian codling muscle, using the CFD (Computational Fluid Dynamics) as numerical tool. In relation to the obtained results, it was verified that a good agreement between the experimental and numerical temperature profiles for the Brazilian codling muscle. The experimental freezing time found was 6618 s, and the freezing time through the numerical simulation was 6246 s. The error percentage found was 5.6%.Este trabalho realizou um estudo experimental e numérico da cinética de congelamento do músculo de abrótea (Urophycis brasiliensis) em uma câmara fria de convecção a ar forçado, com a temperatura do ar fixada em 253,15 K e o coeficiente convectivo médio de transferência de calor de 25,4 W m-2 K-1. A temperatura inicial do músculo do pescado foi de 277,15 K e a temperatura final de 255,15 K. O objetivo deste trabalho foi verificar a melhor concordância entre o perfil de temperatura experimental e o perfil de temperatura numérico para o músculo de abrótea, utilizando o CFD (Computational Fluid Dynamics) como ferramenta numérica. Em relação aos resultados obtidos, verificou-se uma boa concordância entre os perfis experimentais e numéricos de temperatura para o músculo de abrótea. O tempo de congelamento experimental encontrado foi de 6618 s, e o tempo de congelamento pela simulação numérica foi de 6246 s. O percentual de erro encontrado foi de 5,6%