A simulation study of drone delivery of Automated External Defibrillator (AED) in Out of Hospital Cardiac Arrest (OHCA) in the UK

Background: Drones are increasingly used in healthcare, and feasibility studies of deployment of Automated External Defibrillators (AED) in Out-of-hospital cardiac arrest (OHCA) have been conducted. Despite the potential contribution of drones to healthcare, regulatory barriers exist, including limits on flights beyond visual line-of-sight (BVLOS). The aim of this project was to deliver an AED BVLOS in Wales. Methods: We developed of a Concept of Operations (CONOPS) to identify requirements, constraints, organisation and roles and responsibilities associated with deploying a drone to deliver an AED BVLOS. We equipped a Penguin B drone with satellite-enabled technology to enhance situational awareness and safety for the remote pilot. A BVLOS Operating Safety Case and three-week flight test programme was conducted with an AED attached directly to parachute for deployment to simulated OHCA. Results: We completed six flights totalling 92km, 1:02.5 hours of flight time and four successful parachute payload drops. We conducted a successful end-to-end flight demonstration of an AED delivered via BVLOS by drone to a simulated OHCA and resuscitation by lay responder’s in a remote location; the final delivery of 4.5km was completed in 2:50 minutes. Conclusion: We have delivered an AED by parachute, from fixed wing drone BVLOS in the UK in simulated OHCA. This project adds to the body of knowledge required for regulatory assurance on drone use BVLOS. Further research is needed before routine use of this technology

Joint angle affects volitional and magnetically-evoked neuromuscular performance differentially

This study examined the volitional and magnetically-evoked neuromuscular performance of the quadriceps femoris at functional knee joint angles adjacent to full extension. Indices of volitional and magnetically-evoked neuromuscular performance (N= 15 healthy males; 23.5 ± 2.9 years; 71.5 ± 5.4 kg; 176.5 ± 5.5 cm) were obtained at 25°; 35° and 45° of knee flexion. Results showed that volitional and magnetically-evoked peak force (PFV; PTFE, respectively) and electromechanical delay (EMDV; EMDE, respectively) were enhanced by increased knee flexion. However, greater relative improvements in volitional compared to evoked indices of neuromuscular performance were observed with increasing flexion from 25° to 45° (e.g. EMDV; EMDE: 36% vs. 11% improvement, respectively; F[2,14] = 6.8; p < 0.05). There were no significant correlations between EMDV and EMDE or PFV and PTFE, respectively at analogous joint positions. These findings suggest that the extent of the relative differential between volitional and evoked neuromuscular performance capabilities is joint angle-specific and not correlated with performance capabilities at adjacent angles, but tends to be smaller with increased flexion. As such, effective prediction of volitional from evoked performance capabilities at both analogous and adjacent knee joint positions would lack robustness

Repeated exercise stress impairs volitional but not magnetically evoked electromechanical delay of the knee flexors

The effects of serial episodes of fatigue and recovery on volitional and magnetically evoked neuromuscular performance of the knee flexors were assessed in twenty female soccer players during: (i) an intervention comprising 4x35s maximal static exercise; (ii) a control condition. Volitional peak force (PFV) was impaired progressively (-16 % vs. baseline: 235.3±54.7 to 198.1±38.5 N) by the fatiguing exercise and recovered to within -97 % of baseline values following six-minutes of rest. Evoked peak twitch force (PTFE) was diminished subsequent to the fourth episode of exercise (23.3 %: 21.4±13.8 vs. 16.4±14.6 N) and remained impaired at this level throughout the recovery. Impairment of volitional electromechanical delay performance (EMDV) following the first episode of exercise (25.5 % :55.3±11.9 vs. 69.5±24.5 ms) contrasted with concurrent improvement (10.0 %: 24.5±4.7 vs. 22.1±5.0 ms) in evoked electromechanical delay (EMDE) (p <0.05) and this increased disparity between EMDE and EMDV remained during subsequent periods of intervention and recovery. The fatiguing exercise provoked substantial impairments to volitional strength and EMDV that showed differential patterns of recovery. However, improved EMDE performance might identify a dormant capability for optimal muscle responses during acute stressful exercise and an improved capacity to maintain dynamic joint stabilty during critical episodes of loading

Magnetotelluric monitoring of unconventional resources

Extraction of unconventional gas involves the movement of fluids at depth. In the case of shale gas, hydraulic fracturing is performed, where fluids are injected into sequences at high pressures resulting in permeable pathways for the trapped gas to escape. Coal seam gas (CSG) extraction involves a process termed depressurisation, where large volumes of groundwater are extracted from coal measures causing a pressure reduction that allows trapped gas to desorb from the coal seams. One of the key questions the industry sector is facing is whether it can effectively monitor movement of fluids and changes in Earth as these unconventional energy resources are being developed. We present two MT monitoring surveys of unconventional energy resource development. The first survey involves an industrial field study conducted in Queensland, Australia, where MT responses indicated the orientation of fluid flow resulting from depressurisation, which can be mapped and directly attributed to spatial and temporal variations in permeability. The second survey involves monitoring deep hydraulic fracturing of a shale gas reservoir in the Cooper Basin, Australia. MT observations indicated increases in bulk conductivity of 20 – 40% in both the temporal and spatial domain, with these changes caused by a combination of both injected fluid permeability and an increase in wider-scale in-situ permeability. Finally the telluric sounding method is introduced as a potential tool for monitoring hydraulic fracturing at depth. The advantage of this method is that it is relatively easy to measure electric fields with many dipoles and multi-channel systems and therefore electric field arrays could be deployed and left out for continuous monitoring. Additionally, electric field transfer functions are essentially the identity matrix for a 1D Earth no matter what the vertical structure is and therefore monitoring involves plotting deviations relative to the identity matrix.Thesis (Ph.D.) (Research by Publication) -- University of Adelaide, School of Physical Sciences, 2016

Paramedic experiences of providing care in Wales (UK) during the 2020 COVID-19 pandemic (PECC-19): a qualitative study using evolved grounded theory

Objective: To explore paramedic experiences of providing care during the 2020 COVID-19 pandemic and develop theory in order to inform future policy and practice. Design: Qualitative study using constructivist evolved grounded theory (EGT) methodology. One-to-one semistructured interviews were conducted using a general interview guide. Voice over Internet Protocol was used through Skype. Setting: Conducted between March 2020 and November 2020 in the Welsh Ambulance Services National Health Services Trust UK which serves a population of three million. Participants: Paramedics were recruited through a poster circulated by email and social media. Following purposive sampling, 20 Paramedics were enrolled and interviewed. Results: Emergent categories included: Protect me to protect you, Rapid disruption and adaptation, Trust in communication and information and United in hardship. The Basic Social Process was recognised to involve Tragic Choices, conceptualised through an EGT including Tragic personal and professional choices including concerns over personnel protective equipment (PPE), protecting themselves and their families, impact on mental health and difficult clinical decisions, Tragic organisational choices including decision making support, communication, mental health and well-being and Tragic societal choices involving public shows of support, utilisation and resourcing of health services. Conclusions: Rich insights were revealed into paramedic care during the COVID-19 pandemic consistent with other research. This care was provided in the context of competing and conflicting decisions and resources, where Tragic Choices have to be made which may challenge life’s pricelessness. Well-being support, clinical decision making, appropriate PPE and healthcare resourcing are all influenced by choices made before and during the pandemic, and will continue as we recover and plan for future pandemics. The impact of COVID-19 may persist, especially if we fail to learn, if not we risk losing more lives in this and future pandemics and threatening the overwhelming collective effort which united society in hardship when responding to the COVID-19 Pandemic. Trial registration number: IRAS ID: 282 623.Peer reviewedFinal Published versio

Heroism and paramedic practice: A constructivist metasynthesis of qualitative research

© 2022 Rees, Williams, Hogan, Smyth and Archer. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). https://creativecommons.org/licenses/by/4.0/Objectives: We aimed to identify, appraise, and synthesise the qualitative literature to develop theory on heroism and paramedic practice. Hypothesis/research question: What does published literature tell us about heroism and paramedic practice? Setting: Paramedics and other healthcare workers (HCWs) faced an outpouring of public support for them early in the COVID-19 pandemic which brought into focus the relationship between them and society, where they are portrayed as heroes. Participants: We conducted a metasynthesis using Evolved Grounded Theory and procedural guidelines of Noblit and Hare to guide analysis. Preferred Reporting Items for Systematic Reviews and Meta-analysis Protocols (PRISMA-P) guidelines were also applied. Results: 151 papers were retrieved and eleven included in the final sample. Studies were moderate to very low quality, involving a wide range of methodologies and settings; none specifically explored heroism and paramedic practice. The following interrelated themes were constructed on heroism and paramedic practice: (a) Myth, Folk law, and storytelling in heroism and paramedic practice (b) The epic journey of heroism and paramedic practice (c) Heroes and Zeroes: The fluctuating Societal Value in heroism and paramedic practice (d) Politicisation, and objectification in Heroism and Paramedic practice. Conclusion: Paramedics have long been characterised as heroes, but this may not reflect their everyday experiences. Heroism in paramedic practice can provide scripts for prosocial action, inspiring others, and leading to more social heroic actions. Paramedics may however be ambivalent to such heroism narratives, due to politicisation, and objectification in the media and society. This metasynthesis is only one of many possible constructions of heroism and paramedic practice and is the first point in making sense of and developing theory on heroism and paramedic practice. Study registration: PROSPERO: CRD42021234851.Peer reviewe

First recorded occurrence of the parasitic barnacle (Anelasma squalicola) on a Greenland shark (Somniosus microcephalus) in the Canadian Arctic

A solitary Anelasma squalicola specimen was collected from the cloaca of a Greenland shark (Somniosus microcephalus), the first time this association has been recorded. The specimen's identity was confirmed through morphological and genetic assessment (mitochondrial markers: COI and control region). A. squalicola is a species typically associated with deep-sea lantern sharks (Etmopteridae) and, until the present observation, had never been observed at a sexually mature size in the absence of a mating partner. Given the reported negative effects of this parasite on its hosts, monitoring Greenland sharks for additional cases is recommended.publishedVersio

The proposal for a third medical school in New Zealand: A community-engaged graduate entry medical program

New Zealand has a maldistributed workforce that is heavily dependent on recruiting international medical graduates. Shortages are particularly apparent in high needs communities and in general scope specialties in provincial regions. The University of Waikato in partnership with the Waikato District Health Board has proposed a third medical school for New Zealand which will concentrate on addressing the workforce needs of disadvantaged rural and provincial communities. The proposed program is a community engaged, graduate entry medical course