Critical care paramedics: Where is the evidence? A systematic review

© 2014, BMJ Publishing Group. All rights reserved. Objectives: Paramedic-delivered prehospital critical care is an established concept in a number of emergency medical services around the world and, more recently, has been introduced to the UK. This review identifies and describes the available evidence relating to paramedics who routinely provide prehospital critical care as primary scene response (critical care paramedics, or CCP). Methods: A systematic search of electronic databases was performed: CENTRAL, EMBASE, MEDLINE (through EMBASE and Web of Knowledge) and Web of Science (through Web of Knowledge). Results: The search identified 12 relevant publications, one of which was a randomised controlled trial. The remaining 11 were retrospective studies. Five studies compared CCPs with physician-led care. Three of these publications demonstrated improved outcomes with physician care, while two showed no difference. Four further publications examined CCPs versus non-physician-led care and found improved outcomes (two studies), mixed effects (one study) and no difference (one study) for CCPs. Finally, three publications addressed the addition of skills to CCP competencies. A randomised controlled trial of CCP rapid sequence induction (RSI) and tracheal intubation demonstrated improved neurologic outcomes. CCP tube thoracostomy was shown to have similar complication rates to the same procedure performed in the emergency department, while addition of a non-invasive ventilation protocol to CCP practice had no effect on long-term mortality. Conclusions: There is limited evidence to support the concept of paramedic-delivered prehospital critical care. The best available evidence suggests a benefit from prehospital RSI carried out by CCPs in patients with severe traumatic brain injury, but the impact of CCPs remains unclear for many conditions. Further high-quality research in this area would be welcome

Scanning X-ray nanodiffraction from ferroelectric domains in strained K0.75Na0.25NbO3 epitaxial films grown on (110) TbScO3

Scanning X-ray nanodiffraction on a highly periodic ferroelectric domain pattern of a strained K0.75Na0.25NbO3 epitaxial layer has been performed by using a focused X-ray beam of about 100 14;nm probe size. A 90°-rotated domain variant which is aligned along [1 2]TSO has been found in addition to the predominant domain variant where the domains are aligned along the [12]TSO direction of the underlying (110) TbScO3 (TSO) orthorhombic substrate. Owing to the larger elastic strain energy density, the 90°-rotated domains appear with significantly reduced probability. Furthermore, the 90°-rotated variant shows a larger vertical lattice spacing than the 0°-rotated domain variant. Calculations based on linear elasticity theory substantiate that this difference is caused by the elastic anisotropy of the K0.75Na0.25NbO3 epitaxial layer

The Lantern Vol. 18, No. 3, Spring 1950

• The Rise and Fall of Mr. Fluff • Thoughts by the Sea • Equality of Men • On Radio Comedians • After Hours • Rain • Morning • Escape from Fear • Book of Red • Poems by a Guy Named Mike • We are the People • Spirit Disrupted • Light • Sonnethttps://digitalcommons.ursinus.edu/lantern/1051/thumbnail.jp

The Lantern Vol. 21, No. 1, Fall 1952

• Dolly and Manny • The Man on the Stoop • Just a Plain, Simple Girl • If Damon Runyon Had Reviewed George Meredith\u27s Novel, The Ordeal of Richard Feverel • Two Before Dinner • A Treatise on the Noble Art of Warfare • My Neighbor, Zakeya • Elegy • What\u27s This Card For, Offisser? • Winter\u27s Loneliness • Birth • Of Thee I Sting • For Your Knowing • Beauty Defined • Daybreak at Home • Mood • Leaves • Love Recaptured • Awake Again • Silence • Sea-Song • The City • The Voice of Autumn Earthhttps://digitalcommons.ursinus.edu/lantern/1058/thumbnail.jp

The Materiality of Magic

The Materiality of Magic is an exciting new book about an aspect of magic that is usually neglected. In the last two decades we have had many books and proceedings of conferences on the concept of magic itself as well as its history, formulas and incantations in antiquity, both in East and West. Much less attention, however, has been paid to the material that was used by the magicians for their conjuring activities. This is the first book of its kind that focuses on the material aspects of magic, such as amulets, drawings, figurines, gems, grimoires, rings, and voodoo dolls. The practice of magic required a specialist expertise that knew how to handle material such as lead, gold, stones, papyrus and terra cotta – material that sometimes was used for specific genres of magic. That is why we present in this well illustrated collection of studies new insights on the materiality of magic in antiquity by studying both the materials used for magic as well as the books in which the expertise was preserved. The main focus of the book is on antiquity, but we complement and contrast our material with examples ranging from the Ancient Near East, via early modern Europe, to the present time

The Structure of Pre-transitional Protoplanetary Disks I: Radiative Transfer Modeling of the Disk+Cavity in the PDS 70 system

Through detailed radiative transfer modeling, we present a disk+cavity model to simultaneously explain both the SED and Subaru H-band polarized light imaging for the pre-transitional protoplanetary disk PDS 70. Particularly, we are able to match not only the radial dependence, but also the absolute scale, of the surface brightness of the scattered light. Our disk model has a cavity 65 AU in radius, which is heavily depleted of sub-micron-sized dust grains, and a small residual inner disk which produces a weak but still optically thick NIR excess in the SED. To explain the contrast of the cavity edge in the Subaru image, a factor of ~1000 depletion for the sub-micron-sized dust inside the cavity is required. The total dust mass of the disk may be on the order of 1e-4 M_sun, only weakly constrained due to the lack of long wavelength observations and the uncertainties in the dust model. The scale height of the sub-micron-sized dust is ~6 AU at the cavity edge, and the cavity wall is optically thick in the vertical direction at H-band. PDS 70 is not a member of the class of (pre-)transitional disks identified by Dong et al. (2012), whose members only show evidence of the cavity in the millimeter-sized dust but not the sub-micron-sized dust in resolved images. The two classes of (pre-)transitional disks may form through different mechanisms, or they may just be at different evolution stages in the disk clearing process.Comment: 28 pages (single column), 7 figures, 1 table, ApJ accepte