Head injury evaluation and ambulance diagnosis (HOME) study protocol: a feasibility study assessing the implementation of the Canadian CT Head Rule in the prehospital setting

Introduction Traumatic brain injury (TBI) is a common presentation in the prehospital environment. At present, paramedics do not routinely use tools to identify low-risk patients who could be left at scene or taken to a local hospital rather than a major trauma centre. The Canadian CT Head Rule (CCHR) was developed to guide the use of CT imaging in hospital. It has not been evaluated in the prehospital setting. We aim to address this gap by evaluating the feasibility and acceptability of implementing the CCHR to patients and paramedics, and the feasibility of conducting a full-scale clinical trial of its use. Methods and analysis We will recruit adult patients who are being transported to an emergency department (ED) by ambulance after suffering a mild TBI. Paramedics will prospectively collect data for the CCHR. All patients will be transported to the ED, where deferred consent will be taken and the treating clinician will reassess the CCHR, blinded to paramedic interpretation. The primary clinical outcome will be neurosurgically significant TBI. Feasibility outcomes include recruitment and attrition rates. We will assess acceptability of the CCHR to paramedics using the Ottawa Acceptability of Decision Rules Instrument. Interobserver reliability of the CCHR will be assessed between paramedics and the treating clinician in the ED. Participating paramedics and patients will be invited to participate in semistructured interviews to explore the acceptability of trial processes and facilitators and barriers to the use of the CCHR in practice. Data will be analysed thematically. We anticipate recruiting approximately 100 patients over 6 months. Ethics and dissemination This study was approved by the Health Research Authority and the Research Ethics Committee (REC reference: 22/NW/0358). The results will be published in a peer-reviewed journal, presented at conferences and will be incorporated into a doctoral thesis. Trial registration number ISRCTN92566288

Towards exploring current challenges and future opportunities relating to the prehospital triage of patients with traumatic brain injury: a mixed-methods study protocol

Introduction Traumatic brain injury (TBI) is a major global health burden that results in disability and loss of health. Identifying those patients who require specialist neuroscience care can be challenging due to the low accuracy of existing prehospital trauma triage tools. Despite the widespread use of decision aids to ‘rule out’ TBI in hospitals, they are not widely used in the prehospital environment. We aim to provide a snapshot of current prehospital practices in the UK, and to explore facilitators and challenges that may be encountered when adopting new tools for decision support. Methods and analysis A mixed-methods study will be conducted using a convergent design approach. In the first phase, we will conduct a national survey of current practice in which every participating ambulance service in the UK will receive an online questionnaire, and only one response is required. In the second phase, semistructured interviews will be conducted to explore the perceptions of ambulance service personnel regarding the implementation of new triage methods that may enhance triage decisions. The survey questions and the interview topic guide were piloted and externally reviewed. Quantitative data will be summarised using descriptive statistics; qualitative data will be analysed thematically. Ethics and dissemination This study has been approved by the Health Research Authority (REC reference 22/HRA/2035). Our findings may inform the design of future care pathways and research as well as identify challenges and opportunities for future development of prehospital triage tools for patients with suspected TBI. Our findings will be published in peer-reviewed journals, relevant national and international conferences, and will be included in a PhD thesis

Dietary Supplementation with Different ω-6 to ω-3 Fatty Acid Ratios Affects the Sustainability of Performance, Egg Quality, Fatty Acid Profile, Immunity and Egg Health Indices of Laying Hens

The supplementation of different ω-6/ω-3 ratio to the diets of the laying hens has been studied to evaluate the effects on performance, egg quality, egg health indices, egg fatty acid profiles, and immune response. One-hundred and twenty, 50-weeks-old hens were divided into three groups fed diets with different ω-6/ω-3 polyunsaturated fatty acids (PUFA) at ratio: 16.7:1, 9.3:1, and 5.5:1, respectively. Each group contained eight replicates of five hens. Hens fed the diet with the highest ω-6/ω-3 ratio had significantly increased weight gain compared to those fed the 5.5:1 and 9.3:1 ω-6/ω-3 ratios. In contrast, hens fed the 9.3:1 ω-6/ω-3 ratios laid significantly more eggs, had increased egg mass, greater livability, and a better FCR than the control group. However, hens fed a ratio of 5.5:1 ω-6/ω-3 PUFA showed improved thrombogenic, atherogenic, hypocholesteremia, and hypocholesteremia/hypercholesteremia indices. In conclusion, laying hens of the 9.3:1 ω-6/ω-3 PUFA group showed improved laying performance, while a ratio of 5.5:1 enriched the ω-3 PUFA in eggs and boosted the immune response of hens

The Spinel LiCoMnO4: 5V cathode and conversion anode

LiCoMnO4 was made at 550 °C in 2 h using a novel biotemplating synthetic methodology. High temperature heat treatment under flowing N2 was then used to prepare the cation-disordered rock salt, LiCoMnO3. We demonstrate for the first time that both phases can operate as conversion anodes in lithium-ion batteries, operating at ~ 0.7 V with specific capacities of ~ 400 mAh g-1. We also demonstrate that 1,3-propane sultone can be used as an electrolytic additive to provide a modest boost to specific capacity in cells cycled at high potentials with LiCoMnO4 as the cathode

In vitro approaches to assess the effects of açai (Euterpe oleracea) digestion on polyphenol availability and the subsequent impact on the faecal microbiota

A considerable proportion of dietary plant-polyphenols reach the colon intact; determining the effects of these compounds on colon-health is of interest. We hypothesise that both fibre and plant polyphenols present in açai (Euterpe oleracea) provide prebiotic and anti-genotoxic benefits in the colon. We investigated this hypothesis using a simulated in vitro gastrointestinal digestion of açai pulp, and a subsequent pH-controlled, anaerobic, batch-culture fermentation model reflective of the distal region of the human large intestine. Following in vitro digestion, 49.8% of the total initial polyphenols were available. In mixed-culture fermentations with faecal inoculate, the digested açai pulp precipitated reductions in the numbers of both the Bacteroides-Prevotella spp. and the Clostridium-histolyticum groups, and increased the short-chain fatty acids produced compared to the negative control. The samples retained significant anti-oxidant and anti-genotoxic potential through digestion and fermentation. Dietary intervention studies are needed to prove that consuming açai is beneficial to gut health

Screening for cerebral vasculitis, role of physicians, nursing, pharmacists and clinical labratory

Vasculitides are distinguished by the presence of inflammation and necrosis in the wall of blood vessels. Giant-cell arteritis primarily affects large vessels such as the aorta, while classic polyarteritis nodosa primarily affects medium-sized arteries. The small-vessel vasculitides are classified into two groups: those with antineutrophil cytoplasm antibodies (ANCA) and those without. Primary angiitis of the central nervous system (PACNS) is an uncommon condition that impacts medium and small-sized blood vessels. The primary manifestations of cerebral vasculitis include stroke, headache, and encephalopathy. The diagnosis relies on laboratory and imaging results. Systemic vasculitis can lead to cerebral affection, which is characterized by an acute inflammatory response. This response is accompanied by elevated erythrocyte sedimentation rate and higher levels of C-reactive protein. In numerous cerebral vasculitides, such as primary angiitis of the central nervous system (PACNS), cerebrospinal fluid (CSF) analysis shows evidence of inflammation. Therefore, every healthcare provider such as, physcians, nursing, pharmacist and clinical laboratory have a crucial role in the screening and management of cerebral vasculitis

An integration of enhanced social force and crowd control models for high-density crowd simulation

Social force model is one of the well-known approaches that can successfully simulate pedestrians’ movements realistically. However, it is not suitable to simulate high-density crowd movement realistically due to the model having only three basic crowd characteristics which are goal, attraction, and repulsion. Therefore, it does not satisfy the high-density crowd condition which is complex yet unique, due to its capacity, density, and various demographic backgrounds of the agents. Thus, this research proposes a model that improves the social force model by introducing four new characteristics which are gender, walking speed, intention outlook, and grouping to make simulations more realistic. Besides, the high-density crowd introduces irregular behaviours in the crowd flow, which is stopping motion within the crowd. To handle these scenarios, another model has been proposed that controls each agent with two different states: walking and stopping. Furthermore, the stopping behaviour was categorized into a slow stop and sudden stop. Both of these proposed models were integrated to form a high-density crowd simulation framework. The framework has been validated by using the comparison method and fundamental diagram method. Based on the simulation of 45,000 agents, it shows that the proposed framework has a more accurate average walking speed (0.36 m/s) compared to the conventional social force model (0.61 m/s). Both of these results are compared to the real-world data which is 0.3267 m/s. The findings of this research will contribute to the simulation activities of pedestrians in a highly dense population

Large-scale unit commitment under uncertainty: an updated literature survey

The Unit Commitment problem in energy management aims at finding the optimal production schedule of a set of generation units, while meeting various system-wide constraints. It has always been a large-scale, non-convex, difficult problem, especially in view of the fact that, due to operational requirements, it has to be solved in an unreasonably small time for its size. Recently, growing renewable energy shares have strongly increased the level of uncertainty in the system, making the (ideal) Unit Commitment model a large-scale, non-convex and uncertain (stochastic, robust, chance-constrained) program. We provide a survey of the literature on methods for the Uncertain Unit Commitment problem, in all its variants. We start with a review of the main contributions on solution methods for the deterministic versions of the problem, focussing on those based on mathematical programming techniques that are more relevant for the uncertain versions of the problem. We then present and categorize the approaches to the latter, while providing entry points to the relevant literature on optimization under uncertainty. This is an updated version of the paper "Large-scale Unit Commitment under uncertainty: a literature survey" that appeared in 4OR 13(2), 115--171 (2015); this version has over 170 more citations, most of which appeared in the last three years, proving how fast the literature on uncertain Unit Commitment evolves, and therefore the interest in this subject