Presence of a pre-hospital enhanced care team reduces on scene time and improves triage compliance for stab trauma

© The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.Background: A reduction in pre-hospital scene time for patients with penetrating trauma is associated with reduced mortality, when combined with appropriate hospital triage. This study investigated the relationship between presence of pre-hospital enhanced care teams (ECT) (Critical Care Paramedics (CCPS) or Helicopter Emergency Medical Service (HEMS)), on the scene time and triage compliance, of penetrating trauma patients in a UK ambulance service. The primary outcome was whether scene time reduces when an ECT is present. A secondary outcome was whether the presence of an ECT improved compliance with the trust's Major Trauma Decision Tree (MTDT). Methods: All suspected penetrating trauma incidents involving a patient's torso were identified from the Trust's computer-aided dispatch (CAD) system between 31st March 2017 and 1st April 2018. Only patients who sustained central penetrating trauma were included. Any incidents involving firearms were excluded due to the prolonged times that can be involved when waiting for specialist police units. Data relevant to scene time for each eligible incident were retrieved, along with the presence or absence of an ECT. The results were analysed to identify trends in the scene times and compliance with the MTDT. Results: One hundred seventy-one patients met the inclusion criteria, with 165 having complete data. The presence of an ECT improved the median on-scene time in central stabbing by 38% (29m50s vs. 19m0s, p = 0.03). The compliance with the trust's MTDT increased dramatically when an ECT is present (81% vs. 37%, odds ratio 7.59, 95% CI, 3.70-15.37, p < 0.0001). Conclusions: The presence of an ECT at a central stabbing incident significantly improved the scene time and triage compliance with a MTDT. Ambulance services should consider routine activation of ECTs to such incidents, with subsequent service evaluation to monitor patient outcomes. Ambulance services should continue to strive to reduce scene times in the context of central penetrating trauma.Peer reviewe

Lower Extremity Injury and Y-Balance Scores in Division I Women’s Soccer

The Y-Balance Test (YBT) is a functional, portable assessment used to examine stability and mobility in the lower extremities (LE). However descriptive YBT data and how scores may compare across healthy and previously injured women’s soccer players is scarce but in demand. PURPOSE: The purpose of this study was to explore the difference in YBT scores in female collegiate-level soccer athletes with and without a recent history of LE injury. METHODS: Twenty-two Division I female soccer players completed a YBT during pre-season. All of the subjects were cleared for testing by the head athletic trainer and the team physician and had no current LE injury precluding them from participating. Players were also asked to self-report if they had experienced a lower extremity injury or surgery in the prior twelve months, which divided the sample into two groups – those who did report having a LE injury in the past 12 months (LEI; n = 13, age = 19.9 ± 1.4 y, height = 166.9 ± 6.9 cm) and those who did not (LEI-N; n = 9, age = 19.8 ± 1.7 y, height = 169.2 ± 7.9 cm). Standardized approaches were used for the YBT to obtain scores for all three directions (anterior, posterior medial, posterior lateral) for both legs, along with the measurement of right and left leg length to determine a composite score for both legs. Descriptive statistics were calculated as mean ± standard deviation. RESULTS: The LEI group had a lower YBT composite score compared to the LEI-N group on the left side (86.0 ± 26.6 vs 90.04 ± 9.1 %) and the right side (85.2 ± 26.4 vs 87.2 ± 8.0 %). CONCLUSION: YBT screening during pre-season may help identify ongoing imbalances in soccer players with a prior LE injury, even after they have been cleared to practice or condition by the sports medicine team. However, ongoing research is needed comparing YBT scores prior to the injury to further support the use of the YBT in this manner

Strength and Mobility Measures in Division I Female Volleyball Student Athletes Across Different Positions

Shoulder internal and external rotation and hand grip measures are commonly used to evaluate upper extremity mobility and strength in college athletes. However, positional differences and their impact on these scores are rarely considered, therefore further research is needed in sports such as volleyball where information on these potential trends is lacking. PURPOSE: The purpose of this study was to identify possible differences between strength and mobility measures in female volleyball student-athletes whose responsibilities include hitting (predominantly overhead roles) versus those who are primarily passers and diggers (non-overhead roles). METHODS: Thirteen Division I volleyball student-athletes who volunteered to participate in this study were divided into two groups - hitters (H; age = 19.6 ± 1.5 y, height = 180.7 ± 6.7 cm) and passers (P; age = 19.3 ± 1.2 y, height = 172.0 ± 10.0 cm). Players were tested on their shoulder range of motion (ROM) for internal rotation (IR), external rotation (ER), and flexion using a goniometer. Total ROM was identified as a sum of IR and ER. Hand grip strength was measured in the dominant hand using a hand grip dynamometer. All testing was completed by certified healthcare professionals prior to preseason following clearance by the team physician. Descriptive statistics were calculated as mean ± standard deviations. RESULTS: H had higher total ROM than P in both the right arm (158.6 ± 65.8° vs 144.1 ± 65.8°) and left arm (165.0 ± 67.8° vs 155.7 ± 69.7°). H had higher flexion than P in the right, dominant arm (176.9 ± 7.9° vs 171.5 ± 18.7°), but similar flexion in the left, nondominant arm (180.1 ± 5.6° vs 180.7 ± 3.4°). H and P both had higher than average values for shoulder ROM compared to published normative data. Hand grip strength was also higher in H compared to P (31.6 ± 6.2 kg vs 26.1 ± 2.5 kg). CONCLUSIONS: H displayed greater total ROM in both arms, a higher flexion ROM in their dominant arm than P as well as greater strength in their dominant arm. This emphasizes the importance of mobility and strength in their positional demands, and the need for shoulder stability. This information provides strength and conditioning coaches preliminary information on possible foci for training and areas where further research is still needed

Differences in antiretroviral scale up in three South African provinces: the role of implementation management

BACKGROUND: South Africa's antiretroviral programme is governed by defined national plans, establishing treatment targets and providing funding through ring-fenced conditional grants. However, in terms of the country's quasi-federal constitution, provincial governments bear the main responsibility for provision of health care, and have a certain amount of autonomy and therefore choice in the way their HIV/AIDS programmes are implemented. METHODS: The paper is a comparative case study of the early management of ART scale up in three South African provincial governments--Western Cape, Gauteng and Free State--focusing on both operational and strategic dimensions. Drawing on surveys of models of ART care and analyses of the policy process conducted in the three provinces between 2005 and 2007, as well as a considerable body of grey and indexed literature on ART scale up in South Africa, it draws links between implementation processes and variations in provincial ART coverage (low, medium and high) achieved in the three provinces. RESULTS: While they adopted similar chronic disease care approaches, the provinces differed with respect to political and managerial leadership of the programme, programme design, the balance between central standardisation and local flexibility, the effectiveness of monitoring and evaluation systems, and the nature and extent of external support and programme partnerships. CONCLUSIONS: This case study points to the importance of sub-national programme processes and the influence of factors other than financing or human resource capacity, in understanding intervention scale up

The Panchromatic Afterglow of GW170817: The full uniform dataset, modeling, comparison with previous results and implications

We present the full panchromatic afterglow light curve data of GW170817, including new radio data as well as archival optical and X-ray data, between 0.5 and 940 days post-merger. By compiling all archival data, and reprocessing a subset of it, we have ensured that the panchromatic dataset is uniform and therefore immune to the differences in data processing or flux determination methods used by different groups. Simple power-law fits to the uniform afterglow light curve indicate a t^(0.86±0.04) rise, a t^(−1.90±0.12) decline, and a peak occurring at 155±4 days. The afterglow is optically thin throughout its evolution, consistent with a single spectral index (−0.569±0.002) across all epochs. This gives a precise and updated estimate of the electron power-law index, p=2.138±0.004. By studying the diffuse X-ray emission from the host galaxy, we place a conservative upper limit on the hot ionized ISM density, <0.01 cm⁻³, consistent with previous afterglow studies. Using the late-time afterglow data we rule out any long-lived neutron star remnant having magnetic field strength between 10^(10.4) G and 10¹⁶ G. Our fits to the afterglow data using an analytical model that includes VLBI proper motion from Mooley et al (2018), and a structured jet model that ignores the proper motion, indicates that the proper motion measurement needs to be considered while seeking an accurate estimate of the viewing angle

The Rapid ASKAP Continuum Survey I: Design and First Results

The Rapid ASKAP Continuum Survey (RACS) is the first large-area survey to be conducted with the full 36-antenna Australian Square Kilometre Array Pathfinder (ASKAP) telescope. RACS will provide a shallow model of the ASKAP sky that will aid the calibration of future deep ASKAP surveys. RACS will cover the whole sky visible from the ASKAP site in Western Australia, and will cover the full ASKAP band of $700-1800$ MHz. The RACS images are generally deeper than the existing NRAO VLA Sky Survey (NVSS) and Sydney University Molonglo Sky Survey (SUMSS) radio surveys and have better spatial resolution. All RACS survey products will be public, including radio images (with $\sim 15$ arcsecond resolution) and catalogues of about three million source components with spectral index and polarisation information. In this paper, we present a description of the RACS survey and the first data release of 903 images covering the sky south of declination $+41^\circ$ made over a 288 MHz band centred at 887.5 MHz.Comment: 24 pages, 17 figures, 4 tables. For associated data see https://data.csiro.au/collections/domain/casdaObservation/results/PRAS110%20-%20The%20Rapid%20ASKAP%20Continuu

Developing a core outcome set for fistulising perianal Crohn's disease

OBJECTIVE: Lack of standardised outcomes hampers effective analysis and comparison of data when comparing treatments in fistulising perianal Crohn's disease (pCD). Development of a standardised set of outcomes would resolve these issues. This study provides the definitive core outcome set (COS) for fistulising pCD. DESIGN: Candidate outcomes were generated through a systematic review and patient interviews. Consensus was established via a three-round Delphi process using a 9-point Likert scale based on how important they felt it was in determining treatment success culminating in a final consensus meeting. Stakeholders were recruited nationally and grouped into three panels (surgeons and radiologists, gastroenterologists and IBD specialist nurses, and patients). Participants received feedback fromtheir panel(in the second round) andall participants(in the third round) to allow refinement of their scores. RESULTS: A total of 295 outcomes were identified from systematic reviews and interviews that were categorised into 92 domains. 187 stakeholders (response rate 78.5%) prioritised 49 outcomes through a three-round Delphi study.The final consensus meeting of 41 experts and patients generated agreement on an eight domain COS. The COS comprised three patient-reported outcome domains (quality of life, incontinence and a combined score of patient priorities) and five clinician-reported outcome domains (perianal disease activity, development of new perianal abscess/sepsis, new/recurrent fistula, unplanned surgery and faecal diversion). CONCLUSION: A fistulising pCD COS has been produced by all key stakeholders. Application of the COS will reduce heterogeneity in outcome reporting, thereby facilitating more meaningful comparisons between treatments, data synthesis and ultimately benefit patient care

The development and validation of a scoring tool to predict the operative duration of elective laparoscopic cholecystectomy

Background: The ability to accurately predict operative duration has the potential to optimise theatre efficiency and utilisation, thus reducing costs and increasing staff and patient satisfaction. With laparoscopic cholecystectomy being one of the most commonly performed procedures worldwide, a tool to predict operative duration could be extremely beneficial to healthcare organisations. Methods: Data collected from the CholeS study on patients undergoing cholecystectomy in UK and Irish hospitals between 04/2014 and 05/2014 were used to study operative duration. A multivariable binary logistic regression model was produced in order to identify significant independent predictors of long (> 90 min) operations. The resulting model was converted to a risk score, which was subsequently validated on second cohort of patients using ROC curves. Results: After exclusions, data were available for 7227 patients in the derivation (CholeS) cohort. The median operative duration was 60 min (interquartile range 45–85), with 17.7% of operations lasting longer than 90 min. Ten factors were found to be significant independent predictors of operative durations > 90 min, including ASA, age, previous surgical admissions, BMI, gallbladder wall thickness and CBD diameter. A risk score was then produced from these factors, and applied to a cohort of 2405 patients from a tertiary centre for external validation. This returned an area under the ROC curve of 0.708 (SE = 0.013, p  90 min increasing more than eightfold from 5.1 to 41.8% in the extremes of the score. Conclusion: The scoring tool produced in this study was found to be significantly predictive of long operative durations on validation in an external cohort. As such, the tool may have the potential to enable organisations to better organise theatre lists and deliver greater efficiencies in care

Reproducibility of Molecular Phenotypes after Long-Term Differentiation to Human iPSC-Derived Neurons: A Multi-Site Omics Study.

Reproducibility in molecular and cellular studies is fundamental to scientific discovery. To establish the reproducibility of a well-defined long-term neuronal differentiation protocol, we repeated the cellular and molecular comparison of the same two iPSC lines across five distinct laboratories. Despite uncovering acceptable variability within individual laboratories, we detect poor cross-site reproducibility of the differential gene expression signature between these two lines. Factor analysis identifies the laboratory as the largest source of variation along with several variation-inflating confounders such as passaging effects and progenitor storage. Single-cell transcriptomics shows substantial cellular heterogeneity underlying inter-laboratory variability and being responsible for biases in differential gene expression inference. Factor analysis-based normalization of the combined dataset can remove the nuisance technical effects, enabling the execution of robust hypothesis-generating studies. Our study shows that multi-center collaborations can expose systematic biases and identify critical factors to be standardized when publishing novel protocols, contributing to increased cross-site reproducibility.Initiative Joint Undertaking under grant agreement no. 115439, resources of which are composed of financial contribution from the European Union's Seventh Framework Program (FP7/2007-2013) and EFPIA companies' in kind contribution. A.H., S.C., and M.Z.C. were also funded by the NIHR (Oxford BRC). K.M. and A.B. were also supported by the NIHR GOSH BRC