Focused ultrasound in out-of-hospital cardiac arrest by advanced paramedics

Background: This study describes and evaluates advanced paramedic practitioner (APP) use of focused cardiac ultrasound (FoCUS) in out-of-hospital cardiac arrest (OHCA), and relates ultrasound findings with decisions to terminate resuscitation. The authors report characteristics of patients who do/do not undergo a FoCUS examination by APPs, ultrasound probe positions used and whether FoCUS findings were associated with decisions to terminate resuscitation or to convey patients to an emergency department (ED) with ongoing resuscitation. Method: A retrospective, observational cohort study of all adult medical OHCA patients attended by APPs in Greater London during 2018 was carried out using data from EMS and APP databases. Results: Twenty-eight APPs attended 1444 OHCA patients in 2018, of whom 744 underwent FoCUS. The subcostal probe position was used most frequently (74%), followed by the parasternal long axis (19%), with significantly smaller use of the parasternal short axis and apical windows. Absence of spontaneous cardiac motion (SCM) was associated with resuscitation being terminated (333 out of 391; 85%) and the presence of SCM was associated with conveyance to the emergency department (213 out of 264 patients; 80%). All decisions to terminate resuscitation were within the APP scope of practice. Conclusion: The authors believe this is the largest prehospital study involving FoCUS in OHCA. An association between FoCUS findings and decisions made to either convey patients to hospital or terminate resuscitation was found. The SC window was most used and ROLE decisions were deemed to be in accordance with local guidance and practice

The possibility of absolute calibration of analog detectors by using parametric down-conversion: a systematical study

Accurate calibration of photodetectors both in analog and in photon-counting regime is fundamental for various scientific applications, which range from "traditional" quantum optics to the studies on foundations of quantum mechanics, quantum cryptography, quantum computation, etc. In this paper we systematically study the possibility of the absolute calibration of analog photo-detectors based on the properties of parametric amplifiers. Our results show that such a method can be effectively developed with interesting possible metrological applications

Program evaluation of an adapted PEERS® social skills program in young adults with autism spectrum disorder and/or mild intellectual impairment and social skills difficulties

Rationale, Aims and Objectives: Social challenges are common for young adults with autism spectrum disorder (ASD) and/or mild intellectual impairment, yet few evidence-based interventions exist to address these challenges. PEERS®, the Program for the Education and Enrichment of Relational Skills, has been shown to be effective in improving the social skills of young adults with ASD; however, it requires a significant time commitment for parents of young adults. As such, this mixed-methods study aimed to investigate the experiences of young adults, parents and PEERS® social coaches participating in an adapted PEERS® program, and to evaluate its acceptability and efficacy. Method: Young adults with ASD and/or mild intellectual impairment participated in a 16-week PEERS® program. Parents and PEERS® social coaches attended fewer, condensed sessions, where they learnt program content to support the young adults' social skill development at home and in the community. Focus groups were conducted post intervention. Quantitative pre−post assessment using the Social and Emotional Loneliness Scale for Adults, the Test of Young Adult Social Skills Knowledge, and Quality of Socialization Questionnaire-Young Adults was completed by young adults. The Social Responsiveness Scale Second Edition was completed by young adults and their parents. Result: Qualitative results revealed that, taken together, young adults, parents and PEERS® social coaches all felt that the adapted PEERS® program was ‘challenging, but worth it’. The program was acceptable with a 93% attendance rate across all sessions. Whilst young adults' perceptions of their own social functioning did not change post-intervention, their knowledge of social skills content improved significantly (p < 0.05). Parent perceptions of young adults' social responsiveness also improved (p < 0.05). Conclusions: Social skill knowledge, social responsiveness, and social engagement improved significantly following the completion of the adapted PEERS® program. It was deemed acceptable and worthwhile by young adults, their parents and PEERS® social coaches

Increased Population Prevalence of Low Pertussis Toxin Antibody Levels in Young Children Preceding a Record Pertussis Epidemic in Australia

Background: Cross-sectional serosurveys using IgG antibody to pertussis toxin (IgG-PT) are increasingly being used to estimate trends in recent infection independent of reporting biases. Methods/Principal Findings: We compared the age-specific seroprevalence of various levels of IgG-PT in cross-sectional surveys using systematic collections of residual sera from Australian diagnostic laboratories in 1997/8, 2002 and 2007 with reference to both changes in the pertussis vaccine schedule and the epidemic cycle, as measured by disease notifications. A progressive decline in high-level ($62.5 EU/ml) IgG-PT prevalence from 19 % (95 % CI 16–22%) in 1997/98 to 12 % (95 % CI 11–14%) in 2002 and 5 % (95 % CI 4–6%) in 2007 was consistent with patterns of pertussis notifications in the year prior to each collection. Concomitantly, the overall prevalence of undetectable (,5 EU/ml) levels increased from 17 % (95 % CI 14– 20%) in 1997/98 to 38 % (95 % CI 36–40%) in 2007 but among children aged 1–4 years, from 25 % (95 % CI 17–34%) in 1997/98 to 62 % (95 % CI 56–68%) in 2007. This change followed withdrawal of the 18-month booster dose in 2003 and preceded record pertussis notifications from 2008 onwards. Conclusions/Significance: Population seroprevalence of high levels of IgG-PT is accepted as a reliable indicator of pertussis disease activity over time within and between countries with varying diagnostic practices, especially in unimmunised age groups. Our novel findings suggest that increased prevalence of undetectable IgG-PT is an indicator of waning immunit

Laughing Hyena Distillery: Extracting Compact Recurrences From Convolutions

Recent advances in attention-free sequence models rely on convolutions as alternatives to the attention operator at the core of Transformers. In particular, long convolution sequence models have achieved state-of-the-art performance in many domains, but incur a significant cost during auto-regressive inference workloads -- naively requiring a full pass (or caching of activations) over the input sequence for each generated token -- similarly to attention-based models. In this paper, we seek to enable $\mathcal O(1)$ compute and memory cost per token in any pre-trained long convolution architecture to reduce memory footprint and increase throughput during generation. Concretely, our methods consist in extracting low-dimensional linear state-space models from each convolution layer, building upon rational interpolation and model-order reduction techniques. We further introduce architectural improvements to convolution-based layers such as Hyena: by weight-tying the filters across channels into heads, we achieve higher pre-training quality and reduce the number of filters to be distilled. The resulting model achieves 10x higher throughput than Transformers and 1.5x higher than Hyena at 1.3B parameters, without any loss in quality after distillation

TEARS: a longitudinal investigation of the prevalence, psychological associations and trajectory of poststroke emotionalism

Objective: There are few longitudinal studies of poststroke emotionalism (PSE) and our understanding of the psychological associations of PSE is limited, constraining assessment of existing interventions and the development of new therapies. This study aimed to assess the prevalence and course of PSE over the first year poststroke, and its psychological associations. Methods: Consenting stroke survivors who were physically and cognitively able to participate were assessed within 2 weeks, 6 and 12 months of stroke to determine PSE point prevalence using a diagnostic, semistructured PSE interview (Testing Emotionalism After Recent Stroke-Diagnostic Interview). At the same assessments, neuropsychological and disability status were determined using Hospital Anxiety and Depression Scale, Abbreviated Mental Test, National Institute of Health Stroke Scale, Barthel Index and Euro-Qol. Results: Two hundred and seventy seven stroke survivors were recruited between 1 October 2015 and 30 September 2018. Diagnostic data were available at baseline for 228 of 277 cohort participants. Point prevalence for PSE was 27.2% at 2 weeks; estimated prevalence at 6 months adjusted for baseline was 19.9% and at 12 months 22.3%. PSE was associated with symptoms of anxiety and event-related distress. Interpretation: PSE affects at least one in five stroke patients acutely following their stroke, and continues to affect one in eight longer term. PSE is associated with anxiety and event-related distress but is not simply a manifestation of mood disorder over time. Such psychological correlates may have implications for longer term social rehabilitation

Traffic noise drowns out great tit alarm calls

Anthropogenic noise is one of the fastest growing and most ubiquitous types of environmental pollution and can impair acoustic communication in a variety of animals [1]. Recent research has shown that birds can adjust acoustic parameters of their sexual signals (songs) in noisy environments 2, 3, yet we know little about other types of vocalizations. Anti-predator signals contain subtle information that is critical for avoiding predation 4, 5, and failure to detect these calls 6, 7 as a result of anthropogenic noise pollution could have large fitness consequences by negatively impacting survival. We investigated whether traffic noise impacts both the production and perception of avian alarm calls using a combination of lab and field experiments with great tits (Parus major), a songbird that frequently inhabits noise-polluted environments. In response to experimental noise manipulation in controlled laboratory conditions, great tits increased the amplitude, but not the frequency parameters, of their mobbing alarm calls (hereafter ‘alarm calls’). Playback experiments conducted in the wild indicate that current levels of road traffic noise mask alarm calls, impeding the ability of great tits to perceive these critical signals. These results show that, despite the vocal adjustments used to compensate for anthropogenic noise, great tits are not able to restore the active space of their calls in even moderately noisy environments. Consequently, birds are likely to suffer from increased predation risk under noise, with likely effects on their behaviour, populations, and community dynamics in noise-polluted areas

Recruitment and Retention of Patients into Emergency Medicine Clinical Trials

The emergency medicine (EM) and prehospital environments are unlike any other clinical environments and require special consideration to allow the successful implementation of clinical trials. This article reviews the specific issues involved in EM clinical trials and provides strategies from EM and non-EM trials to maximize recruitment and retention. While the evidence supporting some of these strategies is deficient, addressing recruitment and retention issues with specific strategies will help researchers deal with these issues in their funding applications and in turn develop the necessary infrastructure to participate in EM clinical trials.ACADEMIC EMERGENCY MEDICINE 2010; 17:1104–1112 © 2010 by the Society for Academic Emergency MedicinePeer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/79223/1/j.1553-2712.2010.00866.x.pd

Calcareous phytoplankton response to the half century of interannual climatic variability in Santa Barbara Basin (California)

A high-resolution study of calcareous phytoplankton in a box core from the Santa Barbara Basin (SBB) reveals floral assemblage fluctuations which can be related to climatic and paleoceanographic changes during the last half century (1940-1996). In particular, Gephyrocapsa oceanica production increased during El Niño periods, in response to high temperatures, silica depletion, and increased iron availability. Conversely, Helicosphaera carteri flux increases in conjunction with lower surface temperatures associated with La Niña episodes. Increasing abundances of Florisphaera profunda and Umbilicosphaera sibogae after 1970 reflect a warming trend and increased stratification within the basin associated with the warm phase of the Pacific Decadal Oscillation (PDO). Conversely, increased abundances of Coccolithus pelagicus and Calcidiscus leptoporus before 1970 mark the cold phase of PDO. These coccolithophore production rate data are consistent with instrumental records of surface and thermocline temperatures monitored since 1950. This is the first study to document the response of calcareous phytoplankton to surface water warming occurring in SBB since 197