Why do ambulance employees (not) seek organisational help for mental health support? A mixed-methods systematic review protocol of organisational support available and barriers/facilitators to uptake

Introduction: The COVID-19 pandemic is exacerbating a wide range of symptoms of poor mental health among emergency medical service (EMS) ambulance populations. Evidence suggests that using organisational support can improve employee outcomes and in turn, patient outcomes. Understanding why EMS staff do and do not use support services is therefore critical to improving uptake, ensuring equitable access, and potentially influencing workforce well-being, organisational sustainability and patient care delivery. This systematic review aims to identify what support is available and any perceived barriers and facilitators to accessing and utilising organisational support. Methods and analysis: Searches performed between 18 February 2022 and 23 February 2022 will be used to identify studies that report barriers and facilitators to EMS employee support among all government/state commissioned EMS ambulance systems. Electronic databases, AMED, CINAHL, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, EMBASE, EMCARE, HMIC, Medline and PsycINFO will be searched. All relevant English-language studies of adult employees of government/state commissioned EMS ambulance organisations published since December 2004 will be screened and relevant data extracted by two independent reviewers. A third reviewer will resolve any disagreements. The primary outcome is the identification of perceived barriers or facilitators to EMS staff using organisational support for mental health. The secondary outcome is the identification of supportive interventions offered through or by ambulance trusts. Study selection will follow Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and the methodological quality of included studies will be appraised by administering rating checklists. A narrative synthesis will be conducted to report qualitative and quantitative data and will include population characteristics, methodological approach and information about barriers and facilitators. Ethics and dissemination: Ethical approval is not required because only available published data will be analysed. Findings will be disseminated through peer-reviewed publication and conference presentation

Take-home naloxone administered in emergency settings: feasibility of intervention implementation in a cluster randomized trial

Background: Opioids kill more people than any other class of drug. Naloxone is an opioid antagonist which can be distributed in kits for peer administration. We assessed the feasibility of implementing a Take-home Naloxone (THN) intervention in emergency settings, as part of designing a definitive randomised controlled trial (RCT). Methods: We undertook a clustered RCT on sites pairing UK Emergency Departments (ED) and ambulance services. At intervention sites, we recruited emergency healthcare practitioners to supply THN to patients presenting with opioid overdose or related condition, with recruitment across 2019–2021. We assessed feasibility of intervention implementation against four predetermined progression criteria covering site sign up and staff training; identification of eligible patients; issue of THN kits and Serious Adverse Events. Results: At two intervention sites, randomly selected from 4, 299/687 (43.5%) clinical staff were trained (ED1 = 107, AS1 = 121, ED2 = 25, AS2 = 46). Sixty THN kits were supplied to eligible patients (21.7%) (n: ED1 = 36, AS1 = 4, ED2 = 16, AS2 = 4). Across sites, kits were not issued to eligible patients on a further 164 occasions, with reasons reported including: staff forgot (n = 136), staff too busy (n = 15), and suspected intentional overdose (n = 3), no kit available (n = 2), already given by drugs nurse (n = 4), other (n = 4). Staff recorded 626 other patients as ineligible but considered for inclusion, with reasons listed as: patient admitted to hospital (n = 194), patient absconded (n = 161) already recruited (n = 64), uncooperative or abusive (n = 55), staff not trained (n = 43), reduced consciousness level (n = 41), lack of capacity (n = 35), patient in custody (n = 21), other (n = 12). No adverse events were reported. Conclusion: Staff and patient recruitment were low and varied widely by site. This feasibility study did not meet progression criteria; a fully powered RCT is not planned. Trial Registration: ISRCTN13232859 (Registered 16/02/2018)

Large expert-curated database for benchmarking document similarity detection in biomedical literature search

Document recommendation systems for locating relevant literature have mostly relied on methods developed a decade ago. This is largely due to the lack of a large offline gold-standard benchmark of relevant documents that cover a variety of research fields such that newly developed literature search techniques can be compared, improved and translated into practice. To overcome this bottleneck, we have established the RElevant LIterature SearcH consortium consisting of more than 1500 scientists from 84 countries, who have collectively annotated the relevance of over 180 000 PubMed-listed articles with regard to their respective seed (input) article/s. The majority of annotations were contributed by highly experienced, original authors of the seed articles. The collected data cover 76% of all unique PubMed Medical Subject Headings descriptors. No systematic biases were observed across different experience levels, research fields or time spent on annotations. More importantly, annotations of the same document pairs contributed by different scientists were highly concordant. We further show that the three representative baseline methods used to generate recommended articles for evaluation (Okapi Best Matching 25, Term Frequency-Inverse Document Frequency and PubMed Related Articles) had similar overall performances. Additionally, we found that these methods each tend to produce distinct collections of recommended articles, suggesting that a hybrid method may be required to completely capture all relevant articles. The established database server located at https://relishdb.ict.griffith.edu.au is freely available for the downloading of annotation data and the blind testing of new methods. We expect that this benchmark will be useful for stimulating the development of new powerful techniques for title and title/abstract-based search engines for relevant articles in biomedical research.Peer reviewe

Slavery, abolition and the myth of white benevolence

This thesis interrogates gestures of remembrance in British culture, specifically as they serve to construct and maintain a collective memory of Britain’s involvement in Atlantic slavery and abolitionism. I am particularly interested in what representations of slavery and abolitionism tell us about the permissible limits of Britain’s historical narratives, and the relationship of those narratives to contemporary ideals of national identity. The achievement of abolition in the nineteenth century – or “the emancipation moment,” as David Brion Davis so appropriately describes it – enabled a form of strategic denial, wherein the self-congratulatory celebration of abolition was used to elide important moral and ethical questions engendered by Britain’s participation in Atlantic slavery. As a result, Britain was not required to contend with its paradoxical position as champion of both slavery and abolition. Through an examination of various public debates initiated by the 2007 bicentennial of abolition in Britain, and an analysis of “Breaking the Chains” – an exhibit in Bristol’s British Empire and Commonwealth Museum – I seek to demonstrate that the discursive formation of slavery and abolition in contemporary Britain continues to both inform and invoke what I am calling the myth of white British benevolence. This allows many Britons to cling to a national identity that is grounded in assumptions about racial whiteness, and to avoid having to confront the ways in which the legacy of slavery (and its abolition) informs racial/ethnic tensions in Britain, putting future policies and practices of multiculturalism into question.Graduate Studies, College of (Okanagan)Graduat

Perceptions and experiences of mental health support for ambulance employees

Background: Mental ill health among ambulance staff is widespread. Evidence suggests that, with the right support, employees experiencing mental ill health can continue to work, symptom severity can be reduced and suicide prevented. Aims: To investigate ambulance staff perceptions and experiences of organisational mental health support. Methods: A cross-sectional online survey investigated work-related stressful life events and their potential psychological impact. The survey also examined staff perceptions and experiences of organisational support and acceptability of a proposed wellbeing intervention offering mandatory time to talk at work. Findings: A total of 540 ambulance staff responded. The majority reported having experienced work-related stressful life events (n=444; 82%). Associated psychological symptoms appeared to persist for years. Perceptions about organisational support related to support uptake. Stigma, fear and embarrassment were reported as barriers to disclosure and help-seeking. Mandatory time to talk at work would be acceptable (n=400; 74%). Conclusion: The association between work-related stressful events and psychological symptoms underscores the need for interventions supported at an organisation level

UK ambulance service resuscitation management of pulseless electrical activity: a systematic review protocol of text and opinion

Abstract published with permission. Background: Out-of-hospital cardiac arrest patients with pulseless electrical activity are treated by paramedics using basic and advanced life support resuscitation. When resuscitation fails to achieve return of spontaneous circulation, there are limited evidence and national guidelines on when to continue or stop resuscitation. This has led to ambulance services in the United Kingdom developing local guidelines to support paramedics in the resuscitative management of pulseless electrical activity. The content of each guideline is unknown, as is any association between guideline implementation and patient survival. We aim to identify and synthesise local ambulance service guidelines to help improve the consistency of paramedic-led decision-making for the resuscitation of pulseless electrical activity in out-of-hospital cardiac arrest. Methods: A systematic review of text and opinion will be conducted on ambulance service guidelines for resuscitating adult cardiac arrest patients with pulseless electrical activity. Data will be gathered direct from the ambulance service website. The review will be guided by the methods of the Joanna Briggs Institute (JBI). The search strategy will be conducted in three stages: 1) a website search of the 14 ambulance services; 2) a search of the evidence listed in support of the guideline; and 3) an examination of the reference list of documents found in the first and second stages and reported using the Preferred Reporting Items for Systematic Reviews and Meta-analyses. Each document will be assessed against the inclusion criteria, and quality of evidence will be assessed using the JBI Critical Appraisal Checklist for Text and Opinion. Data will be extracted using the JBI methods of textual data extraction and a three-stage data synthesis process: 1) extraction of opinion statements; 2) categorisation of statements according to similarity of meaning; and 3) meta-synthesis of statements to create a new collection of findings. Confidence of findings will be assessed using the graded ConQual approach

How property title impacts urban consolidation:a life cycle examination of multi-title developments

Continuing urbanisation is triggering an increase in multi-titled housing internationally. This trend has given rise to a substantial research interest in the social consequences of higher density living. Fewer enquiries have been directed to examining how property title subdivisions generate social issues in multi-titled housing. This is a significant gap in the literature, as the tensions inherent in multi-title developments have significant implications for individuals, developments and entire metropolitan areas. This article employs a life cycle framework to examine the profound operational and governance challenges that are associated with the fusion of private lot ownership with common property ownership. The article calls for a more explicit recognition of these challenges by academics, policymakers, practitioners and the broader community

Relationship between photolysis frequencies derived from spectroscopic measurements of actinic fluxes and irradiances during the IPMMI campaign

[1] The relationship between photolysis frequencies derived from spectroscopic measurements of actinic fluxes and irradiances was determined during a coordinated measurement campaign (International Photolysis Frequency Measurement and Modeling Intercomparison campaign (IPMMI)). When differences in viewing geometries are taken into account, the measurements are in close agreement. An empirical relationship, which is useful for high sun (noon) conditions or for daily integrals, was found to convert irradiance data to photolysis frequencies. For low-sun conditions (large solar zenith angle), model calculations were shown to improve the accuracy. However, the input parameters to the model are site specific and the conversion depends on diffuse/direct ratios. During cloudy conditions, significant improvements in the conversion can be achieved by assuming the radiation field to comprise entirely diffuse isotropic radiation when the UVA transmission by cloud is less than 0.8. Changing cloud conditions remain the greatest limitation, but they tend to bias the results away from the clear-sky case in a systematic way. Furthermore, although the cloud effects on the photolysis rates of nitrogen dioxide (J(NO2)) are rather large, they are much smaller for ozone photolysis (J(O-3 --> O(D-1))), which is of prime importance in tropospheric chemistry. The study shows the potential for deriving historical and geographical differences in actinic fluxes from the extensive records of ground-based measurements of spectral irradiance