Qualitative Research of Violent Incidents Toward Young Paramedics in the Czech Republic

Introduction: Prehospital and emergency medical services (EMS) providers are usually the first to respond to an individual’s urgent health needs, sometimes in emotionally charged circumstances. Because violence toward EMS providers in the Czech Republic is often overlooked and under-reported, we do not have a complete understanding of the extent of such violence, nor do we have recommendations from EMS professional organizations on how to resolve this problem in prehospital emergency medicine.Methods: We conducted this study to explore the process of violence against EMS providers, using the Strauss/Corbin systematic approach of grounded theory to create a paradigm model. The participants in this research included personnel who had at least two years experience in the EMS systems of the city of Prague and the Central Bohemian Region, and who had been victims of violence. Our sample included 10 registered paramedics and 10 emergency medical technicians ages 23–33 (mean ± standard deviation: 27.7). The impact of communication during EMS delivery, in the context of violence from patients or their relatives, emerged as the core category and the main focus of our study. The five main groups of the paradigm model of violence against EMS personnel included causal, contextual and intervening conditions, strategies, and consequences.Results: Of the 20 study participants, 18 reported experiencing an attack during the night shift. Ten participants experienced violence on the street, and 10 inside an ambulance. The perpetrators in all 18 cases were men. The behavior of EMS personnel plays a crucial role in how violent confrontations play out: nonprofessional behavior with drunken or addict patients increases the possibility of violence in 70% of cases.Conclusion: We found that paramedics and EMTs were exposed to verbal abuse and physical violence. However, in 10 of the violent encounters reported by our 20 participants, the attack was perpetrated by otherwise-ordinary people (ie, individuals with strong family support and good jobs) who found themselves in a very stressful situation. Thanks to grounded theory we learned that for all 20 participants there was a potential opportunity to prevent the conflict

Bioavailable Trace Metals in Neurological Diseases

Medical treatment in Wilson’s disease includes chelators (d-penicillamine and trientine) or zinc salts that have to be maintain all the lifelong. This pharmacological treatment is categorised into two phases; the first being a de-coppering phase and the second a maintenance one. The best therapeutic approach remains controversial, as only a few non-controlled trials have compared these treatments. During the initial phase, progressive increase of chelators’ doses adjusted to exchangeable copper and urinary copper might help to avoid neurological deterioration. Liver transplantation is indicated in acute fulminant liver failure and decompensated cirrhosis; in cases of neurologic deterioration, it must be individually discussed. During the maintenance phase, the most important challenge is to obtain a good adherence to lifelong medical therapy. Neurodegenerative diseases that lead to a mislocalisation of iron can be caused by a culmination of localised overload (pro-oxidant siderosis) and localised deficiency (metabolic distress). A new therapeutic concept with conservative iron chelation rescues iron-overloaded neurons by scavenging labile iron and, by delivering this chelated metal to endogenous apo-transferrin, allows iron redistribution to avoid systemic loss of iron

Neurofilament light levels predict clinical progression and death in multiple system atrophy

Disease-modifying treatments are currently being trialed in multiple system atrophy (MSA). Approaches based solely on clinical measures are challenged by heterogeneity of phenotype and pathogenic complexity. Neurofilament light chain protein has been explored as a reliable biomarker in several neurodegenerative disorders but data in multiple system atrophy have been limited. Therefore, neurofilament light chain is not yet routinely used as an outcome measure in MSA. We aimed to comprehensively investigate the role and dynamics of neurofilament light chain in multiple system atrophy combined with cross-sectional and longitudinal clinical and imaging scales and for subject trial selection. In this cohort study we recruited cross-sectional and longitudinal cases in multicentre European set-up. Plasma and cerebrospinal fluid neurofilament light chain concentrations were measured at baseline from 212 multiple system atrophy cases, annually for a mean period of 2 years in 44 multiple system atrophy patients in conjunction with clinical, neuropsychological and MRI brain assessments. Baseline neurofilament light chain characteristics were compared between groups. Cox regression was used to assess survival; ROC analysis to assess the ability of neurofilament light chain to distinguish between multiple system atrophy patients and healthy controls. Multivariate linear mixed effects models were used to analyse longitudinal neurofilament light chain changes and correlated with clinical and imaging parameters. Polynomial models were used to determine the differential trajectories of neurofilament light chain in multiple system atrophy. We estimated sample sizes for trials aiming to decrease NfL levels. We show that in multiple system atrophy, baseline plasma neurofilament light chain levels were better predictors of clinical progression, survival, and degree of brain atrophy than the NfL rate of change. Comparative analysis of multiple system atrophy progression over the course of disease, using plasma neurofilament light chain and clinical rating scales, indicated that neurofilament light chain levels rise as the motor symptoms progress, followed by deceleration in advanced stages. Sample size prediction suggested that significantly lower trial participant numbers would be needed to demonstrate treatment effects when incorporating plasma neurofilament light chain values into multiple system atrophy clinical trials in comparison to clinical measures alone. In conclusion, neurofilament light chain correlates with clinical disease severity, progression, and prognosis in multiple system atrophy. Combined with clinical and imaging analysis, neurofilament light chain can inform patient stratification and serve as a reliable biomarker of treatment response in future multiple system atrophy trials of putative disease-modifying agents.European Union’s Horizon 2020 research and innovation programm

Qualitative Research of Violent Incidents Toward Young Paramedics in the Czech Republic

Introduction: Prehospital and emergency medical services (EMS) providers are usually the first to respond to an individual’s urgent health needs, sometimes in emotionally charged circumstances. Because violence toward EMS providers in the Czech Republic is often overlooked and under-reported, we do not have a complete understanding of the extent of such violence, nor do we have recommendations from EMS professional organizations on how to resolve this problem in prehospital emergency medicine.Methods: We conducted this study to explore the process of violence against EMS providers, using the Strauss/Corbin systematic approach of grounded theory to create a paradigm model. The participants in this research included personnel who had at least two years experience in the EMS systems of the city of Prague and the Central Bohemian Region, and who had been victims of violence. Our sample included 10 registered paramedics and 10 emergency medical technicians ages 23–33 (mean ± standard deviation: 27.7). The impact of communication during EMS delivery, in the context of violence from patients or their relatives, emerged as the core category and the main focus of our study. The five main groups of the paradigm model of violence against EMS personnel included causal, contextual and intervening conditions, strategies, and consequences.Results: Of the 20 study participants, 18 reported experiencing an attack during the night shift. Ten participants experienced violence on the street, and 10 inside an ambulance. The perpetrators in all 18 cases were men. The behavior of EMS personnel plays a crucial role in how violent confrontations play out: nonprofessional behavior with drunken or addict patients increases the possibility of violence in 70% of cases.Conclusion: We found that paramedics and EMTs were exposed to verbal abuse and physical violence. However, in 10 of the violent encounters reported by our 20 participants, the attack was perpetrated by otherwise-ordinary people (ie, individuals with strong family support and good jobs) who found themselves in a very stressful situation. Thanks to grounded theory we learned that for all 20 participants there was a potential opportunity to prevent the conflict

Three‐dimensional conservation planning of fish biodiversity metrics to achieve the deep‐sea 30×30 conservation target

International audienceAccelerating rate of human impact and environmental change severely affects marine biodiversity and increases the urgency to implement the Convention on Biological Diversity (CBD) 30×30 plan for conserving 30% of sea areas by 2030. However, area‐based conservation targets are complex to identify in a 3‐dimensional (3D) ocean where deep‐sea features such as seamounts have been seldom studied mostly due to challenging methodologies to implement at great depths. Yet, the use of emerging technologies, such as environmental DNA combined with modern modeling frameworks, could help address the problem. We collected environmental DNA, echosounder acoustic, and video data at 15 seamounts and deep island slopes across the Coral Sea. We modeled 7 fish community metrics and the abundances of 45 individual species and molecular operational taxonomic units (MOTUs) in benthic and pelagic waters (down to 600‐m deep) with boosted regression trees and generalized joint attribute models to describe biodiversity on seamounts and deep slopes and identify 3D protection solutions for achieving the CBD area target in New Caledonia (1.4 million km 2 ). We prioritized the identified conservation units in a 3D space, based on various biodiversity targets, to meet the goal of protecting at least 30% of the spatial domain, with a focus on areas with high biodiversity. The relationship between biodiversity protection targets and the spatial area protected by the solution was linear. The scenario protecting 30% of each biodiversity metric preserved almost 30% of the considered spatial domain and accounted for the 3D distribution of biodiversity. Our study paves the way for the use of combined data collection methodologies to improve biodiversity estimates in 3D structured marine environments for the selection of conservation areas and for the use of biodiversity targets to achieve area‐based international targets.Planeación tridimensional de la conservación de las medidas de biodiversidad de peces para lograr el objetivo de conservación 30x30 de mar profundo Resumen El impacto antropogénico y el cambio ambiental acelerados afectan gravemente a la biodiversidad marina y aumentan la urgencia de aplicar el plan 30x30 del Convenio sobre la Diversidad Biológica (CDB) para conservar el 30% de las zonas marinas para el 2030. Sin embargo, la identificación de objetivos de conservación basados en zonas es compleja en un océano tridimensional (3D) en el que rara vez se han estudiado las características de las profundidades marinas, como los montes marinos, sobre todo por la dificultad de aplicar metodologías a grandes profundidades. No obstante, el uso de tecnologías emergentes, como el ADN ambiental combinado con marcos actuales de modelación, podría ayudar a resolver el problema. Recopilamos datos de ADN ambiental, acústica de ecosonda y video en 15 montes marinos y taludes de islas profundas del mar del Coral. Modelamos siete medidas de comunidades de peces y 45 abundancias de especies individuales y unidades taxonómicas moleculares (UTOM) en aguas bentónicas y pelágicas (hasta 600 m de profundidad) con árboles de regresión reforzada (ARR) y modelos de atributos conjuntos generalizados (MACJ) para describir la biodiversidad en los montes marinos y taludes profundos e identificar soluciones de protección en 3D para alcanzar el objetivo de área del CDB en Nueva Caledonia (1.4 millones de km 2 ). Priorizamos las unidades de conservación identificadas en un espacio 3D con base en varios objetivos de biodiversidad para cumplir el objetivo de proteger al menos el 30% del dominio espacial con un enfoque en las zonas con una gran biodiversidad. La relación entre los objetivos de protección de la biodiversidad y el área espacial protegida por la solución fue lineal. El escenario que protegía el 30% de cada medida de biodiversidad preservó casi el 30% del dominio espacial considerado y consideró la distribución tridimensional de la biodiversidad. Nuestro estudio prepara el camino para el uso de metodologías combinadas de recopilación de datos con el fin de mejorar las estimaciones de biodiversidad en entornos marinos estructurados en 3D para la selección de áreas de conservación y para el uso de objetivos de biodiversidad con el fin de alcanzar objetivos internacionales basados en áreas

Three‐dimensional conservation planning of fish biodiversity metrics to achieve the deep‐sea 30×30 conservation target

International audienceAccelerating rate of human impact and environmental change severely affects marine biodiversity and increases the urgency to implement the Convention on Biological Diversity (CBD) 30×30 plan for conserving 30% of sea areas by 2030. However, area‐based conservation targets are complex to identify in a 3‐dimensional (3D) ocean where deep‐sea features such as seamounts have been seldom studied mostly due to challenging methodologies to implement at great depths. Yet, the use of emerging technologies, such as environmental DNA combined with modern modeling frameworks, could help address the problem. We collected environmental DNA, echosounder acoustic, and video data at 15 seamounts and deep island slopes across the Coral Sea. We modeled 7 fish community metrics and the abundances of 45 individual species and molecular operational taxonomic units (MOTUs) in benthic and pelagic waters (down to 600‐m deep) with boosted regression trees and generalized joint attribute models to describe biodiversity on seamounts and deep slopes and identify 3D protection solutions for achieving the CBD area target in New Caledonia (1.4 million km 2 ). We prioritized the identified conservation units in a 3D space, based on various biodiversity targets, to meet the goal of protecting at least 30% of the spatial domain, with a focus on areas with high biodiversity. The relationship between biodiversity protection targets and the spatial area protected by the solution was linear. The scenario protecting 30% of each biodiversity metric preserved almost 30% of the considered spatial domain and accounted for the 3D distribution of biodiversity. Our study paves the way for the use of combined data collection methodologies to improve biodiversity estimates in 3D structured marine environments for the selection of conservation areas and for the use of biodiversity targets to achieve area‐based international targets.Planeación tridimensional de la conservación de las medidas de biodiversidad de peces para lograr el objetivo de conservación 30x30 de mar profundo Resumen El impacto antropogénico y el cambio ambiental acelerados afectan gravemente a la biodiversidad marina y aumentan la urgencia de aplicar el plan 30x30 del Convenio sobre la Diversidad Biológica (CDB) para conservar el 30% de las zonas marinas para el 2030. Sin embargo, la identificación de objetivos de conservación basados en zonas es compleja en un océano tridimensional (3D) en el que rara vez se han estudiado las características de las profundidades marinas, como los montes marinos, sobre todo por la dificultad de aplicar metodologías a grandes profundidades. No obstante, el uso de tecnologías emergentes, como el ADN ambiental combinado con marcos actuales de modelación, podría ayudar a resolver el problema. Recopilamos datos de ADN ambiental, acústica de ecosonda y video en 15 montes marinos y taludes de islas profundas del mar del Coral. Modelamos siete medidas de comunidades de peces y 45 abundancias de especies individuales y unidades taxonómicas moleculares (UTOM) en aguas bentónicas y pelágicas (hasta 600 m de profundidad) con árboles de regresión reforzada (ARR) y modelos de atributos conjuntos generalizados (MACJ) para describir la biodiversidad en los montes marinos y taludes profundos e identificar soluciones de protección en 3D para alcanzar el objetivo de área del CDB en Nueva Caledonia (1.4 millones de km 2 ). Priorizamos las unidades de conservación identificadas en un espacio 3D con base en varios objetivos de biodiversidad para cumplir el objetivo de proteger al menos el 30% del dominio espacial con un enfoque en las zonas con una gran biodiversidad. La relación entre los objetivos de protección de la biodiversidad y el área espacial protegida por la solución fue lineal. El escenario que protegía el 30% de cada medida de biodiversidad preservó casi el 30% del dominio espacial considerado y consideró la distribución tridimensional de la biodiversidad. Nuestro estudio prepara el camino para el uso de metodologías combinadas de recopilación de datos con el fin de mejorar las estimaciones de biodiversidad en entornos marinos estructurados en 3D para la selección de áreas de conservación y para el uso de objetivos de biodiversidad con el fin de alcanzar objetivos internacionales basados en áreas

Parkinsonian central pain is linked to the connectivity of the nucleus accumbens and the anterior insula

International audiencePain is a frequent and disabling non-motor symptom of Parkinson’s Disease (PD). Yet, no treatment to date can efficiently reduce this pain. This article investigates the brain functional connectivity of PD patients with central pain and the effects of levodopa and oxycodone on this connectivity.Thirty-eight PD patients received either levodopa, oxycodone, or a placebo during an eight-week period. Pain intensity was evaluated using the Visual Analogue Scale and resting-state functional connectivity was measured before and after treatments. PD patients were also separated into two groups: responders and non-responders.At baseline, the intensity of pain was correlated with the connectivity between the anterior insula and the posterior cingulate cortex and between the nucleus accumbens, the brainstem, and the hippocampus. Levodopa and oxycodone had no specific effects on functional connectivity. Responders had a decrease in connectivity between the anterior insula and the posterior cingulate cortex, while non-responders showed an increase in connectivity.The correlation between pain intensity and specific brain connectivity may represent a “hyper-awareness” of pain and a distortion of learning and memory systems in PD patients with central pain, leading to a state of chronic pain. The placebo effect could explain the changes in connectivity that are associated with a potential reduction in pain awareness