The Concussion Recognition Tool 5th Edition (CRT5): Background and rationale

The Concussion Recognition Tool 5 (CRT5) is the most recent revision of the Pocket Sport Concussion Assessment Tool 2 that was initially introduced by the Concussion in Sport Group in 2005. The CRT5 is designed to assist non-medically trained individuals to recognise the signs and symptoms of possible sport-related concussion and provides guidance for removing an athlete from play/sport and to seek medical attention. This paper presents the development of the CRT5 and highlights the differences between the CRT5 and prior versions of the instrument

Hermes : global plasma edge fluid turbulence simulations

The transport of heat and particles in the relatively collisional edge regions of magnetically confined plasmas is a scientifically challenging and technologically important problem. Understanding and predicting this transport requires the self-consistent evolution of plasma fluctuations, global profiles and flows, but the numerical tools capable of doing this in realistic (diverted) geometry are only now being developed. Here a 5-field reduced 2-fluid plasma model for the study of instabilities and turbulence in magnetised plasmas is presented, built on the BOUT++ framework. This cold ion model allows the evolution of global profiles, electric fields and flows on transport timescales, with flux-driven cross-field transport determined self-consistently by electromagnetic turbulence. Developments in the model formulation and numerical implementation are described, and simulations are performed in poloidally limited and diverted tokamak configurations

Intrinsic suppression of turbulence in linear plasma devices

Plasma turbulence is the dominant transport mechanism for heat and particles in magnetized plasmas in linear devices and tokamaks, so the study of turbulence is important in limiting and controlling this transport. Linear devices provide an axial magnetic field that serves to confine a plasma in cylindrical geometry as it travels along the magnetic field from the source to the strike point. Due to perpendicular transport, the plasma density and temperature have a roughly Gaussian radial profile with gradients that drive instabilities, such as resistive drift-waves and Kelvin-Helmholtz. If unstable, these instabilities cause perturbations to grow resulting in saturated turbulence, increasing the cross-field transport of heat and particles. When the plasma emerges from the source, there is a time, τk, that describes the lifetime of the plasma based on parallel velocity and length of the device. As the plasma moves down the device, it also moves azimuthally according to E × B and diamagnetic velocities. There is a balance point in these parallel and perpendicular times that sets the stabilisation threshold. We simulate plasmas with a variety of parallel lengths and magnetic fields to vary the parallel and perpendicular lifetimes, respectively, and find that there is a clear correlation between the saturated RMS density perturbation level and the balance between these lifetimes. The threshold of marginal stability is seen to exist where τk ≈ 11τ⊥. This is also associated with the product τkγ∗, where γ∗ is the drift-wave linear growth rate, indicating that the instability must exist for roughly 100 times the growth time for the instability to enter the non-linear growth phase. We explore the root of this correlation and the implications for linear device design

Use of patient flow analysis to improve patient visit efficiency by decreasing wait time in a primary care-based disease management programs for anticoagulation and chronic pain: a quality improvement study

BACKGROUND: Patients with chronic conditions require frequent care visits. Problems can arise during several parts of the patient visit that decrease efficiency, making it difficult to effectively care for high volumes of patients. The purpose of the study is to test a method to improve patient visit efficiency. METHODS: We used Patient Flow Analysis to identify inefficiencies in the patient visit, suggest areas for improvement, and test the effectiveness of clinic interventions. RESULTS: At baseline, the mean visit time for 93 anticoagulation clinic patient visits was 84 minutes (+/- 50 minutes) and the mean visit time for 25 chronic pain clinic patient visits was 65 minutes (+/- 21 minutes). Based on these data, we identified specific areas of inefficiency and developed interventions to decrease the mean time of the patient visit. After interventions, follow-up data found the mean visit time was reduced to 59 minutes (+/-25 minutes) for the anticoagulation clinic, a time decrease of 25 minutes (t-test 39%; p < 0.001). Mean visit time for the chronic pain clinic was reduced to 43 minutes (+/- 14 minutes) a time decrease of 22 minutes (t-test 34 %; p < 0.001). CONCLUSION: Patient Flow Analysis is an effective technique to identify inefficiencies in the patient visit and efficiently collect patient flow data. Once inefficiencies are identified they can be improved through brief interventions

Inspiratory muscle training reduces blood lactate concentration during volitional hyperpnoea

Although reduced blood lactate concentrations ([lac−]B) have been observed during whole-body exercise following inspiratory muscle training (IMT), it remains unknown whether the inspiratory muscles are the source of at least part of this reduction. To investigate this, we tested the hypothesis that IMT would attenuate the increase in [lac−]B caused by mimicking, at rest, the breathing pattern observed during high-intensity exercise. Twenty-two physically active males were matched for 85% maximal exercise minute ventilation (V˙Emax) and divided equally into an IMT or a control group. Prior to and following a 6 week intervention, participants performed 10 min of volitional hyperpnoea at the breathing pattern commensurate with 85% V˙Emax

Recommendations for a core outcome set for measuring standing balance in adult populations: a consensus-based approach

Standing balance is imperative for mobility and avoiding falls. Use of an excessive number of standing balance measures has limited the synthesis of balance intervention data and hampered consistent clinical practice.To develop recommendations for a core outcome set (COS) of standing balance measures for research and practice among adults.A combination of scoping reviews, literature appraisal, anonymous voting and face-to-face meetings with fourteen invited experts from a range of disciplines with international recognition in balance measurement and falls prevention. Consensus was sought over three rounds using pre-established criteria.The scoping review identified 56 existing standing balance measures validated in adult populations with evidence of use in the past five years, and these were considered for inclusion in the COS.Fifteen measures were excluded after the first round of scoring and a further 36 after round two. Five measures were considered in round three. Two measures reached consensus for recommendation, and the expert panel recommended that at a minimum, either the Berg Balance Scale or Mini Balance Evaluation Systems Test be used when measuring standing balance in adult populations.Inclusion of two measures in the COS may increase the feasibility of potential uptake, but poses challenges for data synthesis. Adoption of the standing balance COS does not constitute a comprehensive balance assessment for any population, and users should include additional validated measures as appropriate.The absence of a gold standard for measuring standing balance has contributed to the proliferation of outcome measures. These recommendations represent an important first step towards greater standardization in the assessment and measurement of this critical skill and will inform clinical research and practice internationally

The development and application of a new tool to assess the adequacy of the content and timing of antenatal care

Abstract Background: Current measures of antenatal care use are limited to initiation of care and number of visits. This study aimed to describe the development and application of a tool to assess the adequacy of the content and timing of antenatal care. Methods: The Content and Timing of care in Pregnancy (CTP) tool was developed based on clinical relevance for ongoing antenatal care and recommendations in national and international guidelines. The tool reflects minimal care recommended in every pregnancy, regardless of parity or risk status. CTP measures timing of initiation of care, content of care (number of blood pressure readings, blood tests and ultrasound scans) and whether the interventions were received at an appropriate time. Antenatal care trajectories for 333 pregnant women were then described using a standard tool (the APNCU index), that measures the quantity of care only, and the new CTP tool. Both tools categorise care into 4 categories, from ‘Inadequate’ (both tools) to ‘Adequate plus’ (APNCU) or ‘Appropriate’ (CTP). Participants recorded the timing and content of their antenatal care prospectively using diaries. Analysis included an examination of similarities and differences in categorisation of care episodes between the tools. Results: According to the CTP tool, the care trajectory of 10,2% of the women was classified as inadequate, 8,4% as intermediate, 36% as sufficient and 45,3% as appropriate. The assessment of quality of care differed significantly between the two tools. Seventeen care trajectories classified as ‘Adequate’ or ‘Adequate plus’ by the APNCU were deemed ‘Inadequate’ by the CTP. This suggests that, despite a high number of visits, these women did not receive the minimal recommended content and timing of care. Conclusions: The CTP tool provides a more detailed assessment of the adequacy of antenatal care than the current standard index. However, guidelines for the content of antenatal care vary, and the tool does not at the moment grade over-use of interventions as ‘Inappropriate’. Further work needs to be done to refine the content items prior to larger scale testing of the impact of the new measure

Qualitative theory testing as mixed-method research

While the concept of mixed-methods research is more usually associated with combining quantitative and qualitative approaches, this paper outlines a study that mixed methods by undertaking qualitative theory testing and derivation when examining the relationship between health promotion theory and hospital nursing practice. Thus, it is concerned with relating the metatheoretical aspects of the debate and not with the pragmatic aspects of the research and concomitant methods. A deductive–inductive–deductive design, based on the theory–research–theory strategy of Meleis (1985), tested, revised and developed for nursing established health promotion theory using theory-testing criteria. To complement the methodological mix, the study also used the theory (i.e. a health-promotion taxonomy) as a framework to contextualise the findings rather than generate theory in the way associated with interpretative inquiry. While inconsistent with the traditional view linking theory testing with quantitative, objective epistemology, the process enabled a theoretically robust health-promotion taxonomy to be synthesised and advanced for use in nursing in relation to a paradigm of social thought

Influence of plasma turbulence on microwave propagation

It is not fully understood how electromagnetic waves propagate through plasma density fluctuations when the size of the fluctuations is comparable with the wavelength of the incident radiation. In this paper, the perturbing effect of a turbulent plasma density layer on a traversing microwave beam is simulated with full-wave simulations. The deterioration of the microwave beam is calculated as a function of the characteristic turbulence structure size, the turbulence amplitude, the depth of the interaction zone and the size of the waist of the incident beam. The maximum scattering is observed for a structure size on the order of half the vacuum wavelength. The scattering and beam broadening was found to increase linearly with the depth of the turbulence layer and quadratically with the fluctuation strength. Consequences for experiments and 3D effects are considered.Comment: 16 pages, 13 figures. This is an author-created, un-copyedited version of an article submitted for publication in Plasma Physics and Controlled Fusion. IoP Publishing Ltd is not responsible for any errors or omissions in this version of the manuscript or any version derived from i