Psychological Debriefing of Hospital Emergency Personnel: Review of Critical Incident Stress Debriefing

Emergency department providers are subjected to cumulative exposure to critical incidents, which may predispose them to Post-Traumatic Stress Disorder (PTSD). Critical Incident Stress Debriefing (CISD) is aimed at remediating the effects of a critical incident. Defusing and CISD are two components of the Critical Incident Stress Debriefing (CISM) model. A literature review was performed to include published, peer-reviewed, English-language articles. Ten publications were identified and included in this review. Findings suggest hospital emergency personnel view psychological debriefing to be important and valuable; however, training and education in psychological debriefing is insufficient. There are mixed results regarding the efficacy of psychological debriefing in reducing PTSD on hospital emergency personnel. Studies indicate that poor adherence to the debriefing process, lack of training and education for hospital nurses and other personnel, and unsubstantiated fears that CISD will exacerbate PTSD symptoms may explain low utilization of the CISM model. Although the effect of critical incidents on urban emergency personnel is available, there is only limited data concerning the impact on those in rural communities

The impact of hop bitter acid and polyphenol profiles on the perceived bitterness of beer

Thirty-four commercial lager beers were analysed for their hop bitter acid, phenolic acid and polyphenol contents. Based on analytical data, it was evident that the beers had been produced using a range of different raw materials and hopping practices. Principal Components Analysis was used to select a sub-set of 10 beers that contained diverse concentrations of the analysed bitter compounds. These beers were appraised sensorially to determine the impacts of varying hop acid and polyphenolic profiles on perceived bitterness character. Beers high in polyphenol and hop acid contents were perceived as having ‘harsh’ and ‘progressive’ bitterness, whilst beers that had evidently been conventionally hopped were ‘sharp’ and ‘instant' in their bitterness. Beers containing light-stable hop products (tetrahydro-iso-α-acids) were perceived as ‘diminishing’, ‘rounded’ and ‘acidic’ in bitterness. The hopping strategy adopted by brewers impacts on the nature, temporal profile and intensity of bitterness perception in beer

The effect of consumption context on consumer hedonics, emotional response and beer choice

The context of a consumer test affects participant response. Data collected in a sensory laboratory is likely to have little predictive value of consumer experience in real-life situations. This study determined the effects of context on consumer response to two commercial beers. Regular beer consumers (n=100) rated liking and emotional response using ten beer-specific emotion categories for two beers (Lager and Ale) under three different conditions: (1) a sensory testing facility (Lab), (2) a natural consumption environment (Bar) and (3) using an evoked context (Evoked). Their choice of product to take home was also recorded. Overall results showed significant product differentiation for liking (F (99, 2, 1) = 8.46, p = 0.004) and product choice (Q (1, N = 100) = 4.85, p = 0.028) in the Bar but not in the Lab or Evoked context. Emotional variables highlighted significant product differentiation (p < 0.05) but more so in the Bar than in the Lab or Evoked context. However, clustering participants on liking revealed three distinct clusters differing in sensitivity to context. Two clusters showed opposing but consistent preference for one of the two products regardless of context. The third cluster was more influenced by context, showing a more discriminating response in the Bar. These findings showed that consumers differ in their degree of context-sensitivity and the extent to which evoking a context gives similar results to a real environment. They also highlighted the importance of segmentation and confirmed the added insights gained by measuring emotional response compared to liking

Perceived bitterness character of beer in relation to hop variety and the impact of hop aroma

The impact of hop variety and hop aroma on perceived beer bitterness intensity and character was investigated using analytical and sensory methods. Beers made from malt extract were hopped with 3 distinctive hop varieties (Hersbrucker, East Kent Goldings, Zeus) to achieve equi-bitter levels. A trained sensory panel determined the bitterness character profile of each singly-hopped beer using a novel lexicon. Results showed different bitterness character profiles for each beer, with hop aroma also found to change the hop variety-derived bitterness character profiles of the beer. Rank-rating evaluations further showed the significant effect of hop aroma on selected key bitterness character attributes, by increasing perceived harsh and lingering bitterness, astringency, and bitterness intensity via cross-modal flavour interactions. This study advances understanding of the complexity of beer bitterness perception by demonstrating that hop variety selection and hop aroma both impact significantly on the perceived intensity and character of this key sensory attribute

Improving HIV Surveillance Data for Public Health Action in Washington, DC: A Novel Multiorganizational Data-Sharing Method

Background: The National HIV/AIDS Strategy calls for active surveillance programs for human immunodeficiency virus (HIV) to more accurately measure access to and retention in care across the HIV care continuum for persons living with HIV within their jurisdictions and to identify persons who may need public health services. However, traditional public health surveillance methods face substantial technological and privacy-related barriers to data sharing. Objective: This study developed a novel data-sharing approach to improve the timeliness and quality of HIV surveillance data in three jurisdictions where persons may often travel across the borders of the District of Columbia, Maryland, and Virginia. Methods: A deterministic algorithm of approximately 1000 lines was developed, including a person-matching system with Enhanced HIV/AIDS Reporting System (eHARS) variables. Person matching was defined in categories (from strongest to weakest): exact, very high, high, medium high, medium, medium low, low, and very low. The algorithm was verified using conventional component testing methods, manual code inspection, and comprehensive output file examination. Results were validated by jurisdictions using internal review processes. Results: Of 161,343 uploaded eHARS records from District of Columbia (N=49,326), Maryland (N=66,200), and Virginia (N=45,817), a total of 21,472 persons were matched across jurisdictions over various strengths in a matching process totaling 21 minutes and 58 seconds in the privacy device, leaving 139,871 uniquely identified with only one jurisdiction. No records matched as medium low or low. Over 80% of the matches were identified as either exact or very high matches. Three separate validation methods were conducted for this study, and they all found ≥90% accuracy between records matched by this novel method and traditional matching methods. Conclusions: This study illustrated a novel data-sharing approach that may facilitate timelier and better quality HIV surveillance data for public health action by reducing the effort needed for traditional person-matching reviews without compromising matching accuracy. Future analyses will examine the generalizability of these findings to other applications

Uncertainty about cellulitis and unmet patient information needs: a mixed methods study in primary and secondary care

Background: Cellulitis is a painful infection of the skin and underlying tissues, commonly affecting the lower leg: approximately a third of people experience recurrence. Patients’ ability to recover from cellulitis or prevent recurrence is likely to be influenced by their understanding of the condition.Aim: To explore patients’ perceptions of cellulitis and their information needs.Design and Setting: Mixed methods study comprising semi‐structured, face‐to‐face interviews and a cross‐sectional survey, recruiting through primary care, secondary care and advertising.Methods: Adults aged 18 or over with a history of cellulitis were invited to take part in a survey, qualitative interview, or both.Results: Thirty interviews were conducted between August 2016 and July 2017. Qualitative data highlighted: (1) low awareness of cellulitis prior to first episode, 2) uncertainty around the time of diagnosis, 3) concern/surprise at the severity of cellulitis, 4) perceived insufficient information provision. People were surprised they had never heard of cellulitis and that they had not received advice or leaflets giving self‐care information. Some sought information from the internet and found this confusing. Two hundred and forty surveys were completed (response rate 17%). These showed that, while many participants had received information on the treatment of cellulitis (60.0%, n=144), they often reported receiving no information about causes (60.8%, n=146) or prevention of recurrence (73.3%, n=176).Conclusions: There is a need to provide information for people with cellulitis, particularly around (1) the name of their condition, (2) managing acute episodes and (3) reducing risk of recurrences

Mapping the developing human cardiac endothelium at single cell resolution identifies MECOM as a regulator of arteriovenous gene expression

AIMS: Coronary vasculature formation is a critical event during cardiac development, essential for heart function throughout perinatal and adult life. However, current understanding of coronary vascular development has largely been derived from transgenic mouse models. The aim of this study was to characterize the transcriptome of the human foetal cardiac endothelium using single-cell RNA sequencing (scRNA-seq) to provide critical new insights into the cellular heterogeneity and transcriptional dynamics that underpin endothelial specification within the vasculature of the developing heart. METHODS AND RESULTS: We acquired scRNA-seq data of over 10 000 foetal cardiac endothelial cells (ECs), revealing divergent EC subtypes including endocardial, capillary, venous, arterial, and lymphatic populations. Gene regulatory network analyses predicted roles for SMAD1 and MECOM in determining the identity of capillary and arterial populations, respectively. Trajectory inference analysis suggested an endocardial contribution to the coronary vasculature and subsequent arterialization of capillary endothelium accompanied by increasing MECOM expression. Comparative analysis of equivalent data from murine cardiac development demonstrated that transcriptional signatures defining endothelial subpopulations are largely conserved between human and mouse. Comprehensive characterization of the transcriptional response to MECOM knockdown in human embryonic stem cell-derived EC (hESC-EC) demonstrated an increase in the expression of non-arterial markers, including those enriched in venous EC. CONCLUSIONS: scRNA-seq of the human foetal cardiac endothelium identified distinct EC populations. A predicted endocardial contribution to the developing coronary vasculature was identified, as well as subsequent arterial specification of capillary EC. Loss of MECOM in hESC-EC increased expression of non-arterial markers, suggesting a role in maintaining arterial EC identity

Functional Antibody Responses Following Allogeneic Stem Cell Transplantation for TP53 Mutant pre-B-ALL in a Patient With X-Linked Agammaglobulinemia

Patients with X-linked agammaglobulinemia (XLA) have failure of B-cell development with lack of immunoglobulin (Ig) production. While immunoglobulin replacement therapy (IgRT) is beneficial, XLA patients remain at risk for infections, structural lung damage, and rarely, neoplasia. Allogeneic stem cell transplantation (alloSCT) may offer a potential cure, but is associated with significant life-threatening complications. Here, we present a 25-year old XLA patient who developed pre-B acute lymphocytic leukemia (ALL) with somatic TP53 mutation, and treatment for this high-risk malignancy involved full myeloablative conditioning and a HLA-matched sibling alloSCT. Full donor chimerism was achieved for CD3+ and CD3- cell fractions. The patient remains in morphological and flow cytometric remission 14 months post-transplant, with late-onset oral GvHD requiring low dose prednisolone and cyclosporin. Following IgRT discontinuation at 4 months post-transplantation, humoral immunity was established within 14 months as reflected by normal numbers of total B cells, memory B cells, serum IgG, IgM, and IgA, and production of specific IgG responses to Prevenar-13 vaccination. This is only the second reported case of an XLA patient with pre-B-ALL, and the most detailed report of engraftment following alloSCT in XLA. Together with the two previous XLA cases treated with alloSCT, our report provides evidence for the potential for successful humoral reconstitution with alloSCT in patients with B-cell intrinsic antibody deficiency. These observations may be relevant given IgRT, while beneficial, remains an imperfect solution to long-term infectious complications

What should be included in case report forms? Development and application of novel methods to inform surgical study design:a mixed methods case study in parastomal hernia prevention

OBJECTIVES: To describe the development and application of methods to optimise the design of case report forms (CRFs) for clinical studies evaluating surgical procedures, illustrated with an example of abdominal stoma formation. DESIGN: (1) Literature reviews, to identify reported variations in surgical components of stoma formation, were supplemented by (2) intraoperative qualitative research (observations, videos and interviews), to identify unreported variations used in practice to generate (3) a ‘long list’ of items, which were rationalised using (4) consensus methods, providing a pragmatic list of CRF items to be captured in the Cohort study to Investigate the Prevention of parastomal HERnias (CIPHER) study. SETTING: Two secondary care surgical centres in England. PARTICIPANTS: Patients undergoing stoma formation, surgeons undertaking stoma formation and stoma nurses. OUTCOME MEASURES: Successful identification of key CRF items to be captured in the CIPHER study. RESULTS: 59 data items relating to stoma formation were identified and categorised within six themes: (1) surgical approach to stoma formation; (2) trephine formation; (3) reinforcing the stoma trephine with mesh; (4) use of the stoma as a specimen extraction site; (5) closure of other wounds during the procedure; and (6) spouting the stoma. CONCLUSIONS: This study used multimodal data collection to understand and capture the technical variations in stoma formation and design bespoke CRFs for a multicentre cohort study. The CIPHER study will use the CRFs to examine associations between the technical variations in stoma formation and risks of developing a parastomal hernia. TRIAL REGISTRATION NUMBER: ISRCTN17573805

Modification of perceived beer bitterness intensity, character and temporal profile by hop aroma extract

The effect of hop aroma on perceived bitterness intensity, character and temporal profile of beer was investigated. A hop aroma extract was added at 3 levels (0, 245, 490 mg/L) to beers at low, medium and high bitterness. Beers were evaluated for perceived bitterness intensity, harshness, roundedness and linger by a trained panel using a rank-rating technique at each bitterness level, with and without nose clips. The use of nose clips enabled the olfactory aspect to be decoupled from taste and mouthfeel aspects of bitterness perception. Results showed significant modification of perceived bitterness in beer by hop aroma depending on the inherent level of bitter-ness. These modifications were mainly driven by olfaction – in an example of taste-aroma interactions, as well as certain tactile sensations elicited by the hop aroma extract in the oral cavity. At low bitterness, beers with hop aroma added were perceived as more bitter, and of ‘rounded’ bitterness character relative to those without hop aroma. When judges used nose clips, this effect was completely eliminated but the sample was perceived to have a ‘harsh’ bitterness character. Conversely, at high bitterness, even when nose clips were used, judges still perceived beers containing hop aroma to be more bitter. These increases in bitterness perception with nose clips indicates the stimulating of other receptors, e.g. trigeminal receptors by hop aroma extract, which in tandem with the high bitterness, cause perceptual interactions enhancing bitterness intensity and also affecting bitterness character. Bitterness character attributes such as ‘round’ and ‘harsh’ were found to significantly depend on bitterness and aroma levels, with the second level of aroma addition (245 mg/L) giving a ‘rounded’ bitterness in low bitterness beers but ‘harsh’ bitterness in high bitterness beers. The impact of aroma on temporal bitterness was also confirmed with time-intensity measurements, and found to be mostly significant at the highest level of hop aroma addition (490 mg/L) in low bitterness beers. These findings represent a significant step forward in terms of understanding bitterness flavour perception and the wider impact of hop compounds on sensory perception