Which intravenous bronchodilators are being administered to children presenting with acute severe wheeze in the UK and Ireland?

During a prospective 10-week assessment period, 3238 children aged 1-16 years presented with acute wheeze to Paediatric Emergency Research in the UK and Ireland centres. 110 (3.3%) received intravenous bronchodilators. Intravenous magnesium sulfate (MgSO4) was used in 67 (60.9%), salbutamol in 61 (55.5%) and aminophylline in 52 (47.3%) of cases. In 35 cases (31.8%), two drugs were used together, and in 18 cases (16.4%), all three drugs were administered. When used sequentially the most common order was salbutamol, then MgSO4, then aminophylline. Overall, 30 different intravenous treatment regimens were used varying in drugs, dose, rate and duration

Spatial linear global instability analysis of the HIFiRE-5 elliptic cone model flow

The linear instability of the three-dimensional boundary-layer over the HIFiRE-5 flight test geometry, i.e. a rounded-tip 2:1 elliptic cone, at Mach 7, has been analyzed through spatial BiGlobal analysis, in a effort to understand transition and accurately predict local heat loads on next-generation ight vehicles. The results at an intermediate axial section of the cone, Re x = 8x10 5, show three different families of spatially amplied linear global modes, the attachment-line and cross- ow modes known from earlier analyses, and a new global mode, peaking in the vicinity of the minor axis of the cone, termed \center-line mode". We discover that a sequence of symmetric and anti-symmetric centerline modes exist and, for the basic ow at hand, are maximally amplied around F* = 130kHz. The wavenumbers and spatial distribution of amplitude functions of the centerline modes are documente

G12 what are the research priorities of paediatric emergency medicine clinicians in the United Kingdom and Ireland? An international survey

Objective Paediatric Emergency Research in the UK and Ireland (PERUKI) is a collaborative clinical studies group established in August 2012. It consists of a network of 43 centres from England, Ireland, Northern Ireland, Scotland and Wales, and aims to improve the emergency care of children through the performance of robust collaborative multicentre research within emergency departments. A study was conducted regarding the research priorities of PERUKI, to establish the research agenda for paediatric emergency medicine in the UK and Ireland. Methods A two-stage modified Delphi survey was conducted of PERUKI members via an online survey platform. Stage 1 allowed each member to submit up to 12 individual questions that they identified as priorities for future research. In stage 2, the shortlisted questions were each rated on a seven-point Likert scale of relative importance. Participants Members of PERUKI, including clinical specialists, academics, trainees and research nurses. Results Stage 1 surveys were submitted by 46/91 PERUKI members (51%). A total of 249 research questions were generated and, following the removal of duplicate questions and shortlisting, 60 questions were carried forward for stage 2 ranking. Stage 2 survey responses were submitted by 58/95 members (61%). For the 60 research questions that were rated, the mean score of ‘relative degree of importance’ was 4.70 (range 3.36–5.62, SD 0.55). After ranking, the top 10 research priorities included questions on biomarkers for serious bacterial illness, major trauma, intravenous bronchodilators for asthma and decision rules for fever with petechiae, head injury and atraumatic limp. Conclusions Research priorities of PERUKI members have been identified. By sharing these results with clinicians, academics and funding bodies, future research efforts can be focused to the areas of greatest need

Socially sensitive lactation: Exploring the social context of breastfeeding

Many women report difficulties with breastfeeding and do not maintain the practice for as long as intended. Although psychologists and other researchers have explored some of the difficulties they experience, fuller exploration of the relational contexts in which breastfeeding takes place is warranted to enable more in-depth analysis of the challenges these pose for breastfeeding women. This article is based on qualitative data collected from 22 first-time breastfeeding mothers through two phases of interviews and audio-diaries which explored how the participants experienced their relationships with significant others and the wider social context of breastfeeding in the first five weeks postpartum. Using a thematic analysis informed by symbolic interactionism, we develop the overarching theme of 'Practising socially sensitive lactation' which captures how participants felt the need to manage tensions between breastfeeding and their perceptions of the needs, expectations and comfort of others. We argue that breastfeeding remains a problematic social act, despite its agreed importance for child health. While acknowledging the limitations of our sample and analytic approach, we suggest ways in which perinatal and public health interventions can take more effective account of the social challenges of breastfeeding in order to facilitate the health and psychological well-being of mothers and their infants

Evaluating the audio-diary method in qualitative research.

noPurpose – Audio-diary methods are under-utilised in contemporary qualitative research. The purpose of this paper is to discuss participants and researchers’ experiences of using audio-diaries alongside semi-structured interviews to explore breastfeeding experiences in a short-term longitudinal study with 22 first-time mothers. Design/methodology/approach – The authors provide a qualitative content analysis of the participants’ feedback about their experiences of the audio-diary method and supplement this with the perspectives of the research team based on fieldwork notes, memos and team discussions. The authors pay particular attention to the ways in which the data attained from diaries compared with those from the interviews. Findings – The diaries produced were highly heterogeneous in terms of data length and quality. Participants’ experiences with the method were varied. Some found the process therapeutic and useful for reflecting upon the development of breastfeeding skills whilst negative aspects related to lack of mobility, self-consciousness and concerns about confidentiality. Researchers were positive about the audio-diary method but raised certain ethical, epistemological and methodological concerns. These include debates around the use of prompts, appropriate support for participants and the potential of the method to influence the behaviour under scrutiny. Interview and diary accounts contrasted and complemented in ways which typically enriched data analysis. Practical implications – The authors conclude that audio-diaries are a flexible and useful tool for qualitative research especially within critical realist and phenomenological paradigms. Originality/value – This appears to be the first paper to evaluate both participants and researchers’ experiences of using audio-diaries in a detailed and systematic fashion

Making use of expertise: A qualitative analysis of the experience of breastfeeding support for first-time mothers

There is now a body of research evaluating breastfeeding interventions and exploring mothers’ and health professionals’ views on effective and ineffective breastfeeding support. However, this literature leaves relatively unexplored a number of questions about how breastfeeding women experience and make sense of their relationships with those trained to provide breastfeeding support. The present study collected qualitative data from 22 breastfeeding first-time mothers in the UK on their experiences of, and orientation towards, relationships with maternity care professionals and other breastfeeding advisors. The data were obtained from interviews and audio-diaries at two time points during the first five weeks post-partum. We discuss a key theme within the data of ‘Making use of expertise’ and three subthemes which capture the way in which the women’s orientation towards those assumed to have breastfeeding expertise varied according to whether the women (i) adopted a position of consulting experts versus one of deferring to feeding authorities (ii) experienced difficulty interpreting their own and their baby’s bodies and (iii) experienced the expertise of health workers as empowering or disempowering. Although sometimes mothers felt empowered by aligning themselves with the scientific approach and ‘normalising gaze’ of healthcare professionals, at other times this gaze could be experienced as objectifying and diminishing. The merits and limitations of a person-centred approach to breastfeeding support are discussed in relation to using breastfeeding expertise in an empowering rather than disempowering way

Understanding the Effects of Training on Underwater Undulatory Swimming Performance and Kinematics

In swimming, the underwater phase after the start and turn comprises gliding and dolphin kicking, with the latter also known as underwater undulatory swimming (UUS). Swimming performance is highly dependent on the underwater phase; therefore, understanding the training effects in UUS and underwater gliding can be critical for swimmers and coaches. Further, the development of technique in young swimmers can lead to exponential benefits in an athlete’s career. This study aimed to evaluate the effects of a training protocol on UUS and underwater gliding performance and kinematics in young swimmers. Seventeen age group swimmers (boys = 10, girls = 7) performed maximal UUS and underwater gliding efforts before and after a seven-week training protocol. Time to reach 10 m; intra-cyclic mean, peak, and minimum velocities; and gliding performance improved significantly after the training protocol. The UUS performance improvement was mostly produced by an improvement of the upbeat execution, together with a likely reduction of swimmers’ hydrodynamic drag. Despite the changes in UUS and gliding, performance was also likely influenced by growth. The findings from this study highlight kinematic variables that can be used to understand and quantify changes in UUS and gliding performance

Paediatric traumatic cardiac arrest– A Delphi study to establish consensus on management. A PERUKI study

Background Paediatric traumatic cardiac arrest (TCA) is associated with low survival and poor outcomes. The mechanisms that underlie TCA are different from medical cardiac arrest; the approach to treatment of TCA may therefore also need to differ to optimise outcomes. The aim of this study was to explore the opinion of subject matter experts (SMEs) regarding the diagnosis and treatment of paediatric TCA, and to reach consensus on how best to manage this group of patients.Methods Following topic-specific literature reviews which demonstrated a lack of evidence, an online Delphi study was conducted over three rounds, with the aim of achieving consensus (defined as 70% agreement) on statements related to the diagnosis and management of paediatric TCA. SMEs were invited from PERUKI, (Paediatric Emergency Research in the UK and Ireland), paediatric major trauma centre leads, paediatric anaesthetists, paediatric ICU clinicians, paediatric surgeons, and representatives from the Resuscitation Council UK. Statements were informed by the literature reviews and were based on elements of Advanced Paediatric Life Support resuscitation algorithms as well as some concepts used in the management of adult TCA; they ranged from confirmation of cardiac arrest to the indications for thoracotomy.Results 73 SMEs completed all three rounds between June and November 2016. Consensus has been reached on 14 statements regarding the diagnosis and management of paediatric TCA.Conclusion Paediatric TCA is one of the most challenging presentations that we face in paediatric emergency medicine. This study has given a consensus-based framework to guide protocol development in the management of paediatric TCA, though further work is required in other key areas including its acceptability to clinicians. A consensus dissemination meeting will be held in March 2017 where those statements which came close to consensus will also be discussed

Psychological responses after a major fatal earthquake: The effect of preitraumatic dissociation and posttraumatic stress symptoms on anxiety and depression.

Following trauma, most people with initial symptoms of stress recover, but it is important to identify those at risk for continuing difficulties so resources are allocated appropriately. There has been limited investigation of predictors of posttraumatic stress disorder following natural disasters. This study assessed psychological difficulties experienced in 101 adult treatment seekers following exposure to a significant earthquake. Peritraumatic dissociation, posttraumatic stress symptoms, anxiety, depression, and emotional support were assessed. Path analysis was used to determine whether the experience of some psychological difficulties predicted the experience of other difficulties. As hypothesized, peritraumatic dissociation was found to predict posttraumatic stress symptoms and anxiety. Posttraumatic stress symptoms then predicted anxiety and depression. Depression and anxiety were highly correlated. Contrary to expectations, emotional support was not significantly related to other psychological variables. These findings justify the provision of psychological support following a natural disaster and suggest the benefit of assessing peritraumatic dissociation and posttraumatic stress symptoms soon after the event to identify people in need of monitoring and intervention

Selfish genes and sexual selection: the impact of genomic parasites on host reproduction

This is the author accepted manuscript. The final version is available from Wiley via the DOI in this record.Selfish genetic elements (SGEs) such as replicating mobile elements, segregation distorters, and maternally inherited endosymbionts, bias their transmission success relative to the rest of the genome to increase in representation in subsequent generations. As such they generate conflict with the rest of the genome. Such intra-genomic conflict is also a hallmark of sexually antagonistic (SA) alleles, which are shared genes between the sexes but that have opposing fitness effects when expressed in males and females. However, while both SGEs and SA alleles are recognised as common and potent sources of genomic conflict, the realisation that SGEs can also generate sexually antagonistic selection and contribute to sexual conflict in addition to generate sexual selection is largely overlooked. Here I show that SGEs frequently generate sex-specific selection and outline how SGEs that are associated with compromised male fertility can shape female mating patterns, play a key role in the dynamics of sex determination systems, and likely be an important source of sexually antagonistic genetic variation. Given the prevalence of SGEs their contribution to sexual conflict is likely to be greatly overlooked.Royal Societ