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

The development of corporate real estate practices in India : a survey of CRE professionals

Business process outsourcing (BPO) is transforming Western companies? corporate real estate (CRE) requirements. When business processes move to a developing country there are consequences for that country?s CRE practice. This paper considers the effects of western BPO on Indian CRE. Qualitative and quantitative analysis was used to analyze data from a survey of professionals operating in Indian CRE. Location issues, quality of workspace, and the availability of human resources were identified as important in establishing BPO activities in India. Suburban, and campus or built-to-suit facilities, were increasingly preferred locations and styles of workplace that were transforming Indian CRE practice. Also, the effect of western BPO was impacting on the types of CRE services being offered. With the continuing growth in BPO to ?secondary cities? the transformational effects on local CRE practice are likely to spread and further transform CRE practice in India

British Kierkegaard Research: A Historical Survey

British Kierkegaard Research: A Historical Surve

Structure, Morphology and Growth of Biogenic Greigite (Fe\u3csub\u3e3\u3c/sub\u3eS\u3csub\u3e4\u3c/sub\u3e)

Several species of aquatic bacteria are known to exploit the earth\u27s geomagnetic field as a means of directing their motion towards suitable habitats. A feature common to these bacteria is the presence of discrete intracellular magnetic inclusions, magnetosomes, aligned in chains along the long axis of the organism. The size and orientation of the individual magnetic particles imparts a permanent magnetic dipole moment to the cell which is, in turn, responsible for the magnetotactic response. In all species examined to date the magnetic particles have been found to be well-ordered, single domain, membrane-bounded crystals with reproducible, species-specific morphologies. Until recently, however, only crystals of the mixed valence iron oxide, magnetite (Fe3O4), were identified in these magnetotactic bacteria. We have now identified three species of bacteria from sulphidic environments which contain crystals of the mixed valence ferrimagnetic iron sulphide, greigite (Fe3S4). High resolution electron microscopical studies of the biogenic greigite crystals showed that they also exhibit the narrow size range (50-90nm) and unique crystallographic habits (e.g. cubo-octahedral, rectangular prismatic) which characterized and distinguished the inclusions in other magnetotactic species. Thus, it would appear that the bio-precipitation of iron sulphides in magnetotactic bacteria is a highly regulated process which is directed and controlled at the molecular level. These findings are not only important to our understanding of biomineralization in unicellular organisms but may also be significant to studies of paleomagnetism. Furthermore, the controlled synthesis of greigite presents an interesting challenge to material scientists and solid state chemists

Hidden Markov models identify major movement modes in accelerometer and magnetometer data from four albatross species

Funding was provided by an NSF CAREER award to L. Thorne under award number 79804, and by a Minghua Zhang Early Career Faculty Innovation award to L Thorne.Background : Inertial measurement units (IMUs) with high-resolution sensors such as accelerometers are now used extensively to study fine-scale behavior in a wide range of marine and terrestrial animals. Robust and practical methods are required for the computationally-demanding analysis of the resulting large datasets, particularly for automating classification routines that construct behavioral time series and time-activity budgets. Magnetometers are used increasingly to study behavior, but it is not clear how these sensors contribute to the accuracy of behavioral classification methods. Development of effective classification methodology is key to understanding energetic and life-history implications of foraging and other behaviors.  Methods : We deployed accelerometers and magnetometers on four species of free-ranging albatrosses and evaluated the ability of unsupervised hidden Markov models (HMMs) to identify three major modalities in their behavior: ‘flapping flight’, ‘soaring flight’, and ‘on-water’. The relative contribution of each sensor to classification accuracy was measured by comparing HMM-inferred states with expert classifications identified from stereotypic patterns observed in sensor data.  Results : HMMs provided a flexible and easily interpretable means of classifying behavior from sensor data. Model accuracy was high overall (92%), but varied across behavioral states (87.6, 93.1 and 91.7% for ‘flapping flight’, ‘soaring flight’ and ‘on-water’, respectively). Models built on accelerometer data alone were as accurate as those that also included magnetometer data; however, the latter were useful for investigating slow and periodic behaviors such as dynamic soaring at a fine scale.  Conclusions : The use of IMUs in behavioral studies produces large data sets, necessitating the development of computationally-efficient methods to automate behavioral classification in order to synthesize and interpret underlying patterns. HMMs provide an accessible and robust framework for analyzing complex IMU datasets and comparing behavioral variation among taxa across habitats, time and space.Publisher PDFPeer reviewe

Imports, unionization and racial age discrimination in the US

Past studies of the relationship between competition and racial wages find that domestic competition reduces racial wage discrimination of nonunion workers. This article examines the effects of foreign competition on racial wages of union and nonunion workers utilizing an empirical model which allows for cluster-adjusted SEs by industry. Such a procedure allows independence of observations across industries but not within industries, thereby not overstating the significance of industry invariant controls. In this analysis, clustered SEs prevent the overstatement of the significance of imports as a means to reduce earnings discrimination. We find evidence of a wage premium for nonunion white workers in concentrated industries; however, imports cause the wages of nonunion whites to converge towards market rates. In contrast, for union workers in concentrated industries, wage standardization provides a sanctuary from market power initiated discrimination such that imports play a limited role in reducing discrimination

Sub-cortical and brainstem sites associated with chemo-stimulated increases in ventilation in humans

We investigated the neural basis for spontaneous chemo-stimulated increases in ventilation in awake, healthy humans. Blood oxygen level dependent (BOLD) functional MRI was performed in nine healthy subjects using T2weighted echo planar imaging. Brain volumes (52 transverse slices, cortex to high spinal cord) were acquired every 3.9 s. The 30 min paradigm consisted of six, 5-min cycles, each cycle comprising 45 s of hypoxic-isocapnia, 45 s of isooxic-hypercapnia and 45 s of hypoxic-hypercapnia, with 55 s of non-stimulatory hyperoxic-isocapnia (control) separating each stimulus period. Ventilation was significantly (p &#60; 0.001) increased during hypoxic-isocapnia, isooxic-hypercapnia and hypoxic-hypercapnia (17.0, 13.8, 24.9 L/min respectively) vs. control (8.4 L/min) and was associated with significant (p &#60; 0.05, corrected for multiple comparisons) signal increases within a bilateral network that included the basal ganglia, thalamus, red nucleus, cerebellum, parietal cortex, cingulate and superior mid pons. The neuroanatomical structures identified provide evidence for the spontaneous control of breathing to be mediated by higher brain centres, as well as respiratory nuclei in the brainstem

Between the Devil and the Deep Blue Sea: The Role of the Amundsen Sea Continental Shelf in Exchanges Between Ocean and Ice Shelves

The Amundsen Sea is a key region of Antarctica where ocean, atmosphere, sea ice, and ice sheet interact. For much of Antarctica, the relatively warm water of the open Southern Ocean (a few degrees above freezing) does not reach the Antarctic continental shelf in large volumes under current climate conditions. However, in the Amundsen Sea, warm water penetrates onto the continental shelf and provides heat that can melt the underside of the area’s floating ice shelves, thinning them. Here, we discuss how the ocean’s role in melting has come under increased scrutiny, present 2014 observations from the Amundsen Sea, and discuss their implications, highlighting aspects where understanding is still incomplete

How surgical Trainee Research Collaboratives achieve success: a mixed methods study to develop trainee engagement strategies

OBJECTIVES: This study aimed to understand the role of surgical Trainee Research Collaboratives (TRCs) in conducting randomised controlled trials and identify strategies to enhance trainee engagement in trials. DESIGN: This is a mixed methods study. We used observation of TRC meetings, semi-structured interviews and an online survey to explore trainees' motivations for engagement in trials and TRCs, including barriers and facilitators. Interviews were analysed thematically, alongside observation field notes. Survey responses were analysed using descriptive statistics. Strategies to enhance TRCs were developed at a workshop by 13 trial methodologists, surgical trainees, consultants and research nurses. SETTING: This study was conducted within a secondary care setting in the UK. PARTICIPANTS: The survey was sent to registered UK surgical trainees. TRC members and linked stakeholders across surgical specialties and UK regions were purposefully sampled for interviews. RESULTS: We observed 5 TRC meetings, conducted 32 semi-structured interviews and analysed 73 survey responses. TRCs can mobilise trainees thus gaining wider access to patients. Trainees engaged with TRCs to improve patient care, surgical evidence and to help progress their careers. Trainees valued the TRC infrastructure, research expertise and mentoring. Challenges for trainees included clinical and other priorities, limited time and confidence, and recognition, especially by authorship. Key TRC strategies were consultant support, initial simple rapid studies, transparency of involvement and recognition for trainees (including authorship policies) and working with Clinical Trials Units and research nurses. A 6 min digital story on YouTube disseminated these strategies. CONCLUSION: Trainee surgeons are mostly motivated to engage with trials and TRCs. Trainee engagement in TRCs can be enhanced through building relationships with key stakeholders, maximising multi-disciplinary working and offering training and career development opportunities