The shock of the new: ethics, law and the introduction of public access defibrillation

There have been recent moves to include Public Access Defibrillation (PAD) in emergency response strategies. The value of this development is explored in this article. The benefits and limitations of extending AutomaticExternal Defibrillator (AED) use to non-traditional first responders, minimally trained witnesses and citizens are examined and the cost-effectiveness of such developments is discussed. The authors contend that, at the present time, enthusiasm for PAD would seem misplaced and that there is a series of economic, ethical and legal uncertainties that need to be addressed before widespread distribution of AED technology should be pursued

Single-shooting homotopy method for parameter identification in dynamical systems

An algorithm for identifying parameters in dynamical systems is developed in this work using homotopy transformations and the single-shooting method. The equations governing the dynamics of the mathematical model are augmented with observer-like homotopy terms that smooth the objective function. As a result, premature convergence to a local minimum is avoided and the obtained parameter estimates are globally optimal. Numerical examples are presented to demonstrate the application of the proposed approach to chaotic systems

Epidemiology of Injury in Women’s Super League Football: A Cohort Study

Introduction: The epidemiology of injury in male professional football has been well documented (Ekstrand, Hägglund, & Waldén, 2011) and used as a basis to understand injury trends for a number of years. The prevalence and incidence of injuries occurring in women’s super league football is unknown. The aim of this study is to estimate the prevalence and incidence of injury in an English Super League Women’s Football squad. Methods: Following ethical approval from Leeds Beckett University, players (n = 25) signed to a Women’s Super League Football club provided written informed consent to complete a self-administered injury survey. Measures of exposure, injury and performance over a 12-month period was gathered

The Costs of an Outreach Intervention for Low-Income Women With Abnormal Pap Smears

INTRODUCTION: Follow-up among women who have had an abnormal Papanicolaou (Pap) smear is often poor in public hospitals that serve women at increased risk for cervical cancer. This randomized controlled trial evaluated and compared the total cost and cost per follow-up of a tailored outreach intervention plus usual care with the total cost and cost per follow-up of usual care alone. METHODS: Women with an abnormal Pap smear (n = 348) receiving care at Alameda County Medical Center (Alameda County, California) were randomized to intervention or usual care. The intervention used trained community health advisors to complement the clinic's protocol for usual care. We assessed the costs of the intervention and the cost per follow-up within 6 months of the abnormal Pap smear test result. RESULTS: The intervention increased the rate of 6-month follow-up by 29 percentage points, and the incremental cost per follow-up was $959 (2005 dollars). The cost per follow-up varied by the severity of the abnormality. The cost per follow-up for the most severe abnormality (high-grade squamous intraepithelial lesion) was$681, while the cost per follow-up for less severe abnormalities was higher. CONCLUSION: In a health care system in which many women fail to get follow-up care for an abnormal Pap smear, outreach workers were more effective than usual care (mail or telephone reminders) at increasing follow-up rates. The results suggest that outreach workers should manage their effort based on the degree of abnormality; most effort should be placed on women with the most severe abnormality (high-grade squamous intraepithelial lesion)

The Subduction experiment : cruise report R/V Oceanus cruise number 250 legs 1 and 2 subduction 2 mooring deployment and recovery cruise, 25 January-26 February 1992

Subduction is the mechanism by which water masses formed in the mixed layer and near the surface of the ocean find their way into the upper thermocline. The subduction process and its underlying mechanisms were studied through a combination of Eulerian and Langrangian measurements of velocity, measurements of tracer distrbutions and hydrographic propertes and modeling. An array of five surface moorings carrying meteorological and oceanographic instrumentation were deployed for a period of two years beginning in June 1991 as part of an Office of Naval Research (ONR) funded Subduction experiment. Three eight month deployments were planned. The initial deployment of five surface moorings took place during the third leg of R/V Oceanus cruise number 240. The moorings were deployed at 18°N 34°W, 18°N 22°W, 25.5°N 29°W, 33°N 22°W and 33°N 34°W. A Vector Averaging Wind Recorder (VAWR) and an Improved Meteorological Recorder (IMET) collected wind speed and wind direction, sea surface temperature, air temperature, short wave radiation, barometric pressure and relative humidity. The IMET also measured precipitation. The moorings were heavily instrumented below the surface with Vector Measuring Current Meters (VMCM) and single point temperature recorders. Expendable bathythermograph (XBT) data were collected and meteorological observations were made while transitting between mooring locations. This report describes the work that took place during R/V Oceanus cruise 250 which was the second scheduled Subduction mooring cruise. During this cruise the first setting of the moorings were recovered and redeployed for a second eight month period. This report includes a description of the instrumentation that was deployed and recovered, has information about the underway measurements (XBT and meteorological observations) that were made including plots of the data and presents a chronology of the cruise events.Funding was provided by the Office of Naval Research under contract N00014-90-J-1490

Vaginal progesterone pessaries for pregnant women with a previous preterm birth to prevent neonatal respiratory distress syndrome (the PROGRESS Study): A multicentre, randomised, placebo-controlled trial

Published: September 26, 2017Background: Neonatal respiratory distress syndrome, as a consequence of preterm birth, is a major cause of early mortality and morbidity. The withdrawal of progesterone, either actual or functional, is thought to be an antecedent to the onset of labour. There remains limited information on clinically relevant health outcomes as to whether vaginal progesterone may be of benefit for pregnant women with a history of a previous preterm birth, who are at high risk of a recurrence. Our primary aim was to assess whether the use of vaginal progesterone pessaries in women with a history of previous spontaneous preterm birth reduced the risk and severity of respiratory distress syndrome in their infants, with secondary aims of examining the effects on other neonatal morbidities and maternal health and assessing the adverse effects of treatment. Methods: Women with a live singleton or twin pregnancy between 18 to <24 weeks' gestation and a history of prior preterm birth at less than 37 weeks' gestation in the preceding pregnancy, where labour occurred spontaneously or in association with cervical incompetence or following preterm prelabour rupture of the membranes, were eligible. Women were recruited from 39 Australian, New Zealand, and Canadian maternity hospitals and assigned by randomisation to vaginal progesterone pessaries (equivalent to 100 mg vaginal progesterone) (n = 398) or placebo (n = 389). Participants and investigators were masked to the treatment allocation. The primary outcome was respiratory distress syndrome and severity. Secondary outcomes were other respiratory morbidities; other adverse neonatal outcomes; adverse outcomes for the woman, especially related to preterm birth; and side effects of progesterone treatment. Data were analysed for all the 787 women (100%) randomised and their 799 infants. Findings: Most women used their allocated study treatment (740 women, 94.0%), with median use similar for both study groups (51.0 days, interquartile range [IQR] 28.0-69.0, in the progesterone group versus 52.0 days, IQR 27.0-76.0, in the placebo group). The incidence of respiratory distress syndrome was similar in both study groups-10.5% (42/402) in the progesterone group and 10.6% (41/388) in the placebo group (adjusted relative risk [RR] 0.98, 95% confidence interval [CI] 0.64-1.49, p = 0.912)-as was the severity of any neonatal respiratory disease (adjusted treatment effect 1.02, 95% CI 0.69-1.53, p = 0.905). No differences were seen between study groups for other respiratory morbidities and adverse infant outcomes, including serious infant composite outcome (155/406 [38.2%] in the progesterone group and 152/393 [38.7%] in the placebo group, adjusted RR 0.98, 95% CI 0.82-1.17, p = 0.798). The proportion of infants born before 37 weeks' gestation was similar in both study groups (148/406 [36.5%] in the progesterone group and 146/393 [37.2%] in the placebo group, adjusted RR 0.97, 95% CI 0.81-1.17, p = 0.765). A similar proportion of women in both study groups had maternal morbidities, especially those related to preterm birth, or experienced side effects of treatment. In 9.9% (39/394) of the women in the progesterone group and 7.3% (28/382) of the women in the placebo group, treatment was stopped because of side effects (adjusted RR 1.35, 95% CI 0.85-2.15, p = 0.204). The main limitation of the study was that almost 9% of the women did not start the medication or forgot to use it 3 or more times a week. Conclusions: Our results do not support the use of vaginal progesterone pessaries in women with a history of a previous spontaneous preterm birth to reduce the risk of neonatal respiratory distress syndrome or other neonatal and maternal morbidities related to preterm birth. Individual participant data meta-analysis of the relevant trials may identify specific women for whom vaginal progesterone might be of benefit. Current Clinical Trials ISRCTN20269066.Caroline A. Crowther, Pat Ashwood, Andrew J. McPhee, Vicki Flenady, Thach Tran, Jodie M. Dodd, Jeffrey S. Robinson, for the PROGRESS Study Grou

The Wow Factor? A Comparative Study of the Development of Student Music Teachers' Talents in Scotland and Australia

For some time there has been debate about differing perspectives on musical gift and musical intelligence. One view is that musical gift is innate: that it is present in certain individuals from birth and that the task of the teacher is to develop the potential which is there. A second view is that musical gift is a complex concept which includes responses from individuals to different environments and communities (Howe and Sloboda, 1997). This then raises the possibility that musical excellence can be taught. We have already explored this idea with practising musicians (Stollery and McPhee, 2002). Our research has now expanded to include music teachers in formation, and, in this paper, we look at the influences in their musical development which have either 'crystallised' or 'paralysed' the musical talent which they possess. Our research has a comparative dimension, being carried out in Scotland and in Australia. We conclude that there are several key influences in the musical development of the individual, including home and community support, school opportunities and teaching styles and that there may be education and culture-specific elements to these influences

Does n-3 LCPUFA supplementation during pregnancy increase the IQ of children at school age? Follow-up of a randomised controlled trial

Introduction Despite recommendations that pregnant women increase their docosahexaenoic acid (DHA) intake to support fetal brain development, a recent systematic review found a lack of high-quality data to support the long-term effects of DHA supplementation on children's neurodevelopment. Methods and analysis We will assess child neurodevelopment at 7 years of age in follow-up of a multicentre double-blind randomised controlled trial of DHA supplementation in pregnancy. In 2010–2012, n=2399 Australian women with a singleton pregnancy <21 weeks’ gestation were randomised to receive 3 capsules daily containing a total dose of 800 mg DHA/day or a vegetable oil placebo until birth. N=726 children from Adelaide (all n=97 born preterm, random sample of n=630 born at term) were selected for neurodevelopmental follow-up and n=638 (preterm n=85) are still enrolled at 7 years of age. At the 7-year follow-up, a psychologist will assess the primary outcome, IQ, with the Wechsler Abbreviated Scale of Intelligence, Second Edition. Specific measures of executive functioning (Fruit Stroop and the Rey Complex Figure), attention (Test of Everyday Attention for Children), memory and learning (Rey Auditory Verbal Learning Test), language (Clinical Evaluation of Language Fundamentals, Fourth Edition) and basic educational skills (Wide Range Achievement Test, Fourth Edition) will also be administered. Caregivers will be asked to complete questionnaires measuring behaviour and executive functioning. Families, clinicians and research personnel are blinded to group assignment with the exception of families who requested unblinding prior to the follow-up. All analyses will be conducted according to the intention-to-treat principal. Ethics and dissemination All procedures will be approved by the relevant institutional ethics committees prior to start of the study. The results of this study will be disseminated in peer-reviewed journal publications and academic presentations. Trial registration numbers ACTRN12605000569606 and ACTRN12614000770662.Jacqueline F Gould, Karli Treyvaud, Lisa N Yelland, Peter J Anderson, Lisa G Smithers, Robert A Gibson, Andrew J McPhee, Maria Makride

A Systematic Review and Meta-Analysis of the Incidence of Injury in Professional Female Soccer

The epidemiology of injury in male professional football is well documented and has been used as a basis to monitor injury trends and implement injury prevention strategies. There are no systematic reviews that have investigated injury incidence in women’s professional football. Therefore, the extent of injury burden in women’s professional football remains unknown. PURPOSE: The primary aim of this study was to calculate an overall incidence rate of injury in senior female professional soccer. The secondary aims were to provide an incidence rate for training and match play. METHODS: PubMed, Discover, EBSCO, Embase and ScienceDirect electronic databases were searched from inception to September 2018. Two reviewers independently assessed study quality using the Strengthening the Reporting of Observational Studies in Epidemiology statement using a 22-item STROBE checklist. Seven prospective studies (n=1137 professional players) were combined in a pooled analysis of injury incidence using a mixed effects model. Heterogeneity was evaluated using the Cochrane Q statistic and I2. RESULTS: The epidemiological incidence proportion over one season was 0.62 (95% CI 0.59 - 0.64). Mean total incidence of injury was 3.15 (95% CI 1.54 - 4.75) injuries per 1000 hours. The mean incidence of injury during match play was 10.72 (95% CI 9.11 - 12.33) and during training was 2.21 (95% CI 0.96 - 3.45). Data analysis found a significant level of heterogeneity (total Incidence, X2 = 16.57 P < 0.05; I2 = 63.8%) and during subsequent sub group analyses in those studies reviewed (match incidence, X2 = 76.4 (d.f. = 7), P <0.05; I2 = 90.8%, training incidence, X2 = 16.97 (d.f. = 7), P < 0.05; I2 = 58.8%). Appraisal of the study methodologies revealed inconsistency in the use of injury terminology, data collection procedures and calculation of exposure by researchers. Such inconsistencies likely contribute to the large variance in the incidence and prevalence of injury reported. CONCLUSIONS: The estimated risk of sustaining at least one injury over one football season is 62%. Continued reporting of heterogeneous results in population samples limits meaningful comparison of studies. Standardising the criteria used to attribute injury and activity coupled with more accurate methods of calculating exposure will overcome such limitations

The Subduction experiment : cruise report RRS Charles Darwin cruise number 73 subduction 3 mooring deployment and recovery cruise, 30 September-26 October 1992

Subduction is the mechanism by which water masses formed in the mixed layer and near the surface of the ocean find their way into the upper thermocline. The subduction process and its underlying mechanisms were studied through a combination of Eulerian and Langrangian measurements of velocity, measurements of tracer distrbutions and hydrographic properties and modeling. An array of five surface moorings carrying meteorological and oceanographic instrumentation were deployed for a period of two years beginning in June 1991 as part of an Office of Naval Research (ONR) funded Subduction experiment. Three eight month deployments were planned. The moorings were deployed at 18°N 34°W, 18°N 22°W, 25.5°N 29°W, 33°N 22°W and 33°N 34°W. A Vector Averaging Wind Recorder (VAWR) and an Improved Meteorological Recorder (IMET) collected wind speed and wind direction, sea surface temperature, air temperature, short wave radiation, barometric pressure and relative humidity. The IMET also measured precipitation. The moorings were heavily instrumented below the surface with Vector Measuring Current Meters (VMCM), and single point temperature recorders. Expendable bathythermograph (XBT) data were collected and meteorological observations were made while transitting between mooring locations. In addition a series of 59 cm stations were made and water samples taken to be analyzed for tritium levels, salinity and dissolved oxygen content. This report describes the work that took place during RRS Charles Darwin cruise number 73 which was the third scheduled Subduction mooring cruise. During this cruise the second setting of the moorings were recovered and redeployed for a third eight month period. This report includes a description of the instrumentation that was deployed and recovered, has information about the underway measurements (XBT and meteorological observations) that were made including plots of the data, includes a description of the work conducted in conjunction with the tracer/hydrography program and presents a chronology of the cruise events.Funding was provided by the Office of Naval Research under contract N00014-90-J-1490