Patient and clinician factors associated with prehospital pain treatment and outcomes: cross sectional study

Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.Objective: We aimed to identify how patient (age, sex, condition) and paramedic factors (sex, role) affected prehospital analgesic administration and pain alleviation. Methods: We used a cross-sectional design with a 7-day retrospective sample of adults aged 18 years or over requiring primary emergency transport to hospital, excluding patients with Glasgow Coma Scale below 13, in two UK ambulance services. Multivariate multilevel regression using Stata 14 analysed factors independently associated with analgesic administration and a clinically meaningful reduction in pain (≥2 points on 0–10 numerical verbal pain score [NVPS]). Results: We included data on 9574 patients. At least two pain scores were recorded in 4773 (49.9%) patients. For all models fitted there was no significant relationship between analgesic administration or pain reduction and sex of the patient or ambulance staff. Reduction in pain (NVPS ≥2) was associated with ambulance crews including at least one paramedic (odds ratio [OR] 1.52, 95% confidence interval [CI] 1.14 to 2.04, p < 0.01), with any recorded pain score and suspected cardiac pain (OR 2.2, 95% CI 1.02 to 4.75). Intravenous morphine administration was also more likely where crews included a paramedic (OR 2.82, 95% CI 1.93 to 4.13, P < 0.01), attending patients aged 51 to 64 years (OR 2.04, 95% CI 1.21 to 3.45, p = 0.01), in moderate to severe (NVPS 4–10) compared with lower levels of pain for any clinical condition group compared with the reference condition. Conclusion: There was no association between patient sex or ambulance staff sex or grade and analgesic administration or pain reduction.Peer reviewedFinal Accepted Versio

Focal plant observations as a standardised method for pollinator monitoring: opportunities and limitations for mass participation citizen science

Background: Recently there has been increasing focus on monitoring pollinating insects, due to concerns about their declines, and interest in the role of volunteers in monitoring pollinators, particularly bumblebees, via citizen science. Methodology/Principal Findings: The Big Bumblebee Discovery was a one-year citizen science project run by a partnership of EDF Energy, the British Science Association and the Centre for Ecology & Hydrology which sought to assess the influence of the landscape at multiple scales on the diversity and abundance of bumblebees. Timed counts of bumblebees ( Bombus spp.; identified to six colour groups) visiting focal plants of lavender (Lavendula spp.) were carried out by about 13 000 primary school children (7 – 11 years old) from over 400 schools across the UK. 3948 reports were received totalling 26 868 bumblebees. We found that while the wider landscape type had no significant effect on reported bumblebee abundance, the local proximity to flowers had a significant effect (fewer bumblebees where other flowers were reported to be > 5m away from the focal plant). However, the rate of mis-identifcation, revealed by photographs uploaded by participants and a photo-based quiz, was high. Conclusions/Significance: Our citizen science results support recent research on the importance of local floral resources on pollinator abundance. Timed counts of insects visiting a lure plant is potentially an effective approach for standardised pollinator monitoring, engaging a large number of participants with a simple protocol. However, the relatively high rate of mis-identifications (compared to reports from previous pollinator citizen science projects) highlights the importance of investing in resources to train volunteers. Also, to be a scientifically valid method for enquiry, citizen science data needs to be sufficiently high quality, so receiving supporting evidence (such as photographs) would allow this to be tested and for records to be verified

A strategic framework to support the implementation of citizen science for environmental monitoring. Final report to SEPA

In this report we provide a decision framework that can be used to guide whether and when to use a citizen science approach for environmental monitoring. Before using the decision framework we recommend that five precursors to a citizen science approach are considered

Choosing and using citizen science: a guide to when and how to use citizen science to monitor biodiversity and the environment

Here we aim to provide guidance to support people considering using a citizen science approach, especially (but not necessarily restricted to) monitoring biodiversity and the environment in the UK. It will help you decide whether citizen science is likely to be useful, and it will help you decide which broad approach to citizen science is most suitable for your question or activity. This guide does not cover the practical detail of developing a citizen science project. That information is provided in the ‘Guide to Citizen Science’ (Tweddle et al., 2012)

The diversity and evolution of ecological and environmental citizen science

Citizen science—the involvement of volunteers in data collection, analysis and interpretation—simultaneously supports research and public engagement with science, and its profile is rapidly rising. Citizen science represents a diverse range of approaches, but until now this diversity has not been quantitatively explored. We conducted a systematic internet search and discovered 509 environmental and ecological citizen science projects. We scored each project for 32 attributes based on publicly obtainable information and used multiple factor analysis to summarise this variation to assess citizen science approaches. We found that projects varied according to their methodological approach from ‘mass participation’ (e.g. easy participation by anyone anywhere) to ‘systematic monitoring’ (e.g. trained volunteers repeatedly sampling at specific locations). They also varied in complexity from approaches that are ‘simple’ to those that are ‘elaborate’ (e.g. provide lots of support to gather rich, detailed datasets). There was a separate cluster of entirely computer-based projects but, in general, we found that the range of citizen science projects in ecology and the environment showed continuous variation and cannot be neatly categorised into distinct types of activity. While the diversity of projects begun in each time period (pre 1990, 1990–99, 2000–09 and 2010–13) has not increased, we found that projects tended to have become increasingly different from each other as time progressed (possibly due to changing opportunities, including technological innovation). Most projects were still active so consequently we found that the overall diversity of active projects (available for participation) increased as time progressed. Overall, understanding the landscape of citizen science in ecology and the environment (and its change over time) is valuable because it informs the comparative evaluation of the ‘success’ of different citizen science approaches. Comparative evaluation provides an evidence-base to inform the future development of citizen science activities

Citizen science and invasive alien species: predicting the detection of the oak processionary moth Thaumetopoea processionea by moth recorders

Invasive alien species, including pests and diseases of plants and animals, are a major cause of biodiversity change and may impact upon human well-being and the economy. If new, potentially invasive, taxa arrive then it is most cost-effective to respond as early in their establishment as possible. Information to support this can be gained from volunteers, i.e. via citizen science. However, it is vital to develop ways of quantifying volunteer recorder effort to assess its contribution to the detection of rare events, such as the arrival of invasive alien species. We considered the potential to detect adult oak processionary moths (Thaumetopoea processionea) by amateur naturalists recording moths at light traps. We calculated detection rates from the Netherlands, where T. processionea is widely established and poses a risk to tree health and human health, and applied these to the spatial pattern of moth recording effort in the UK. The probability of recording T. processionea in the Netherlands varied across provinces from 0.05–2.4% per species of macro-moth recorded on a list of species (so equalling 1–52% for a list of 30 species). Applying these rates to the pattern of moth recording in the UK: T. processionea could be detected (detection > 0%), if it were present, in 69% and 4.7% of 10 km and 1 km squares, respectively. However, in most squares detection probability is low ( 10%). Our study provides a means to objectively assess the use of citizen science as a monitoring tool in the detection of rare events, e.g. the arrival of invasive alien species, occurrence of rare species and natural colonisation

Immunochemotherapy and Maintenance With Obinutuzumab or Rituximab in Patients With Previously Untreated Marginal Zone Lymphoma in the Randomized GALLIUM Trial

The aim of this study was to explore the efficacy and safety of obinutuzumab (G)- versus rituximab (R)-chemotherapy in a subgroup of patients with previously untreated marginal zone lymphoma (MZL) in the phase III GALLIUM trial (NCT01332968). Patients had stage III/IV (or stage II with bulky disease), splenic, nodal, or extranodal MZL requiring treatment. Patients were randomized 1:1 to receive G- or R-chemotherapy (cyclophosphamide, doxorubicin, vincristine, and prednisone; cyclophosphamide, vincristine, and prednisone; or bendamustine, allocated at patient level). Patients with complete/partial response at the end of induction (EOI) received G/R maintenance. Investigator-assessed progression-free survival (PFS), other time-to-event endpoints, response, and safety were assessed. Overall, 195 patients with MZL were included in this analysis: G-chemotherapy (n = 99), R-chemotherapy (n = 96). Median observation time: 59.3 months. No meaningful difference was observed between arms for PFS (4-y PFS rates: G-chemotherapy, 72.6%; R-chemotherapy, 64.1%), other time-to-event endpoints, or EOI response rates (by computed tomography [CT; G-chemotherapy, 81.8%; R-chemotherapy, 81.3%] and positron emission tomography CT [G-chemotherapy, 79.2%; R-chemotherapy, 87.5%]). All patients experienced ≥1 adverse event (AE). G-chemotherapy was associated with a higher incidence of grade 3–5 (86.1% versus 77.4%), grade 5 (14.9% versus 9.7%), and serious (66.3% versus 51.6%) AEs versus R-chemotherapy. Both arms had a higher incidence of grade 3–5 and serious AEs than patients with follicular lymphoma (GALLIUM), with G-chemotherapy being less tolerable than R-chemotherapy. Based on the observed tolerability of G-chemotherapy versus R-chemotherapy, and the comparable efficacy of G-chemotherapy and R-chemotherapy in this analysis, G-chemotherapy cannot be recommended as first-line treatment for MZL

The global reach of citizen science for monitoring insects [Primer]

Biodiversity is declining rapidly. The most important causes of biodiversity loss are climate change, land- and sea-use change, invasive alien species, pollution, and overexploitation of natural resources. This unprecedented deterioration of the biosphere has profound and far-reaching consequences for insects, who play many important roles within ecosystems, including pollination and decomposition. Declines in the abundance and distribution of insects threaten these essential ecosystem functions. While there is no doubt that urgent and immediate measures are needed to address biodiversity loss and climate change, monitoring of insects is a priority to underpin and inform ongoing conservation action. Citizen science has emerged as an important tool for monitoring insects. In this primer, we explain the application of citizen science for monitoring insects and emerging approaches using digital technologies

The effects of adrenaline in out of hospital cardiac arrest with shockable and non-shockable rhythms : findings from the PACA and PARAMEDIC-2 randomised controlled trials

Introduction Previous research suggests there may be differences in the effects of adrenaline related to the initial cardiac arrest rhythm. The aim of this study was to assess the effect of adrenaline compared with placebo according to whether the initial cardiac arrest rhythm was shockable or non-shockable. Methods Return of spontaneous circulation (ROSC), survival and neurological outcomes according to the initial arrest rhythm were compared amongst patients enrolled in the PARAMEDIC-2 randomised, placebo controlled trial. The results of the PARAMEDIC-2 and PACA out of hospital cardiac arrest trials were combined and meta-analysed. Results The initial rhythm was known for 3,929 (98.2%) in the placebo arm and 3,919 (97.6%) in the adrenaline arm. The effect on the rate of ROSC of adrenaline relative to placebo was greater in patients with non-shockable cardiac rhythms (1002/3003 (33.4%) versus 222/3005 (7.4%), adjusted OR: 6.5, (95% CI 5.6-7.6)) compared with shockable rhythms 349/716 (48.7%) versus (208/702 (29.6%), adjusted OR: 2.3, 95%CI: 1.9-2.9)). The adjusted odds ratio for survival at discharge for non-shockable rhythms was 2.5 (1.3, 4.8) and 1.3 (0.9, 1.8) for shockable rhythms (P value for interaction 0.065) and 1.8(0.8-4.1) and 1.1 (0.8-1.6) respectively for neurological outcome at discharge (P value for interaction 0.295). Meta-analysis found similar results. Conclusion Relative to placebo, the effects of adrenaline ROSC are greater for patients with an initially non-shockable rhythm than those with a shockable rhythms. Similar patterns are observed for longer term survival outcomes and favourable neurological outcomes, although the differences in effects are less pronounced

Weedy Life: Coloniality, Decoloniality, and Tropicality

Respect for any form of life entails nurturing all the potentialities proper to it, including those that might be unproductive from the human point of view. Are there lessons to be learnt about decolonisation of the tropics from a focus on ‘weeds’? The contributors to this photo-essay collectively consider here the lessons that can be learnt about the relationship between colonisation and decolonisation through a visual focus on life forms that have been defined as weeds and, consequently, subject to a contradictory politics of care, removal, and control – of germinating, blooming, and cutting. The essay demonstrates the continuing colonial tensions between aesthetic and practical evaluations of many plants and other lifeforms regarded as ‘invasive’ or ‘out of place’. It suggests a decolonial overcoming of oppositions. By celebrating alliances of endemics and ‘weeds’ regeneratively living together in patterns of complex diversity, we seek to transcend policies of differentiation, exclusion and even eradication rooted in colonial ontology