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

Synthesis and electrochemical study of CoNi2S4 as a novel cathode material in a primary Li thermal battery

The authors acknowledge support and contribution from AWE Plc for this work, and thank the STFC for neutron diffraction beam-time.In this work CoNi2S4 was investigated as a candidate cathode material for Li thermal batteries. The CoNi2S4 was synthesized by a solid state reaction at 550◦C in a sealed quartz tube. Neutron powder diffraction was utilized to confirm normal spinel structure up to 200◦C, however, there was cation disorder above this temperature. The electrochemical properties of the batteries were investigated at 500◦C by galvanostatic discharge to elucidate the mechanism and the products NiS, Co3S4 and Co9S8 of the discharge mechanism were confirmed using powder X-ray diffraction. CoNi2S4 exhibits two voltage plateaus vs Li13Si4 at 500◦C, one at 1.75 V and the second at 1.50 V. CoNi2S4 has an overall capacity of 318 mA h g−1 from OCV 2.58 V to 1.25 V vs Li13Si4 which is comparable to that of the well-known metal disulfidesPublisher PDFPeer reviewe

Purposeful Interventions for Older Adults Post-Joint Replacement Surgery: An Evidence-Based Project

The overall focus of each of case scenarios are related to assessment or interventions that are related to Choosing Wisely Campaign items 1, 2, 3, 5, 8, 10. Case scenarios were developed related to each initiative with clientele and conditions across the lifespan in various practice settings. Practice settings included school district, outpatient pediatric, primary care, skilled nursing facility, work rehabilitation, and acute care

Zirconium trisulfide as a promising cathode material for Li primary thermal batteries

In this work ZrS3 has been synthesized by solid state reaction in a sealed quartz tube and investigated as a candidate cathode material in Li thermal batteries. The structure of ZrS3 before and after cell testing has been studied using powder X-ray diffraction. A new spinel related material, LiZr2S4, has been identified as the product of the electrochemical process, which can be indexed to a = 10.452(8) Å cubic unit cell. The electrochemical properties of the batteries were investigated at 500 °C against Li13Si4 by galvanostatic discharge and galvanostatic intermittent titration technique (GITT). In a thermal Li cell at 500 °C a single voltage plateau of 1.70 V at a current density of 11 mA/cm2 was achieved with capacity of 357 mA h g-1. Therefore ZrS3 material has some promise as a cathode for Li thermal batteries.Publisher PDFPeer reviewe

In-situ studies of high temperature thermal batteries : a perspective

Funding: UK Engineering and Physical Sciences Research Council (EP/P007821/1).Here we present a perspective on in-situ studies of high temperature batteries. We focus on a primary battery technology- the thermal battery- which possesses a molten salt electrolyte. We discuss aspects of sample environment design, data collection and will briefly look at some case studies. We aim to highlight the importance of using in-situ techniques in studying electrochemical devices such as high temperature batteries.Publisher PDFPeer reviewe

In situ thermal battery discharge using CoS2 as a cathode material

Authors thank AWE and the EPSRC (EP/K015540/1) for funding. JTSI acknowledges a Royal Society Wolfson Research Merit award. We thank the STFC for beam-time.Thermal batteries are an established primary battery technology and the most commonly used cathodes in these batteries are transition metal disulfides MS2 (where M = Co, Ni and Fe). However, understanding the evolution of crystalline phases upon battery discharge has been hindered due to the high temperature operation of these batteries. Here we report an experiment that simultaneously collects powder neutron diffraction and electrochemical data as the battery is discharged. Four regions are observed in the diffraction data and four different cobalt containing phases are observed. Multi-phase Rietveld refinement has been used to monitor the evolution of phases during discharge and this is linked to the battery discharge profile. A new discharge mechanism has been proposed which involves hexagonal CoS instead of Co3S4, and the increase in unit cell parameters on discharge suggests the formation of a sulfur deficient solid solution before transformation to Co9S8. This behavior seems reminiscent of that of NiS2 suggesting that the discharge mechanisms of transition metal disulfides may have more similarities than originally thought.Publisher PDFPeer reviewe

Transition metal chlorides NiCl2, KNiCl3, Li6VCl8 and Li2MnCl4 as alternative cathode materials in primary Li thermal batteries

Special thanks to AWE Plc for their support and funding for this work. The authors would also like to acknowledge the EPSRC Platform Grant EP/K015540/1 and the Royal Society Wolfson Merit Award WRMA 2012/R2.Transition metal chlorides KNiCl3, Li6VCl8 and Li2MnCl4 were synthesized by solid state reaction in sealed quartz tubes and investigated as candidate cathode materials along with NiCl2 in Li thermal batteries. The structure and morphology were studied and electrochemical properties probed at high temperatures (400°C–500°C) against Li13Si4 by galvanostatic discharge and galvanostatic intermittent titration technique (GITT). All the transition metal chlorides reduced to metal and the products of the discharge mechanism were confirmed by powder X-ray diffraction. NiCl2 was tested at 500°C and a capacity of 360 mAhg−1 was achieved. KNiCl3 was tested at different current densities from 15 mA/cm2 to 75 mA/cm2 and a high voltage profile 2.30V was achieved at 425°C with a capacity of 262 mAhg−1. Li6VCl8 was tested at 500°C and a 1.80V voltage plateau at a current density of 7.5 mA/cm2 was achieved with a capacity of 145 mAhg−1. Li2MnCl4 was tested at the same current density at 400°C and a capacity of 254 mAhg−1 was achieved. These transition metal chlorides exhibit higher voltage against Li13Si4 and, hence, provide more specific power compared to the well-known metal disulfides MS2 (M = Fe, Co, Ni) and may be promising cathode materials for Li thermal batteries.Publisher PDFPeer reviewe

Reckoning up: sexual harassment and violence in the neoliberal university

This paper situates sexual harassment and violence in the neoliberal university. Using data from a ‘composite ethnography’ representing twelve years of research, I argue that institutional inaction on these issues reflects how they are ‘reckoned up’ in the context of gender and other structures. The impact of disclosure is projected in market terms: this produces institutional airbrushing which protects both the institution and those (usually privileged men) whose welfare is bound up with its success. Staff and students are differentiated by power/value relations, which interact with gender and intersecting categories. Survivors are often left with few alternatives to speaking out in the ‘outrage economy’ of the corporate media: however, this can support institutional airbrushing and bolster punitive technologies. I propose the method of Grounded Action Inquiry, implemented with attention to Lorde’s work on anger, as a parrhesiastic practice of ‘speaking in’ to the neoliberal institution

Research Participants' Perspectives on Genotype-Driven Research Recruitment

Genotype-Driven Recruitment is a potentially powerful approach for studying human genetic variation but presents ethical challenges. We conducted in-depth interviews with research participants in six studies where such recruitment occurred. Nearly all responded favorably to the acceptability of recontact for research recruitment, and genotype-driven recruitment was viewed as a positive sign of scientific advancement. Reactions to questions about the disclosure of individual genetic research results varied. Common themes included explaining the purpose of recontact, informing decisions about further participation, reciprocity, “information is valuable,” and the possibility of benefit, as well as concerns about undue distress and misunderstanding. Our findings suggest contact about additional research may be least concerning if it involves a known element (e.g., trusted researchers). Also, for genotype-driven recruitment, it may be appropriate to set a lower bar for disclosure of individual results than the clinical utility threshold recommended more generally

P-wave excited baryons from pion- and photo-induced hyperon production

We report evidence for $N(1710)P_{11}$, $N(1875)P_{11}$, $N(1900)P_{13}$, $\Delta(1600)P_{33}$, $\Delta(1910)P_{31}$, and $\Delta(1920)P_{33}$, and find indications that $N(1900)P_{13}$ might have a companion state at 1970\,MeV. The controversial $\Delta(1750)P_{31}$ is not seen. The evidence is derived from a study of data on pion- and photo-induced hyperon production, but other data are included as well. Most of the resonances reported here were found in the Karlsruhe-Helsinki (KH84) and the Carnegie-Mellon (CM) analyses but were challenged recently by the Data Analysis Center at GWU. Our analysis is constrained by the energy independent $\pi N$ scattering amplitudes from either KH84 or GWU. The two $\pi N$ amplitudes from KH84 or GWU, respectively, lead to slightly different $\pi N$ branching ratios of contributing resonances but the debated resonances are required in both series of fits.Comment: 22 pages, 28 figures. Some additional sets of data are adde