Retrospective Study of Midazolam Protocol for Prehospital Behavioral Emergencies

Introduction: Agitated patients in the prehospital setting pose challenges for both patient care and emergency medical services (EMS) provider safety. Midazolam is frequently used to control agitation in the emergency department setting; however, limited data exist in the prehospital setting. We describe our experience treating patients with midazolam for behavioral emergencies in a large urban EMS system. We hypothesized that using midazolam for acute agitation leads to improved clinical conditions without causing significant clinical deterioration.Methods: We performed a retrospective review of EMS patient care reports following implementation of a behavioral emergencies protocol in a large urban EMS system from February 2014–June 2016. For acute agitation, paramedics administered midazolam 1 milligram (mg) intravenous (IV), 5 mg intramuscular (IM), or 5 mg intranasal (IN). Results were analyzed using descriptive statistics, Levene’s test for assessing variance among study groups, and t-test to evaluate effectiveness based on route.Results: In total, midazolam was administered 294 times to 257 patients. Median age was 30 (interquartile range 24–42) years, and 66.5% were male. Doses administered were 1 mg (7.1%) and 5 mg (92.9%). Routes were IM (52.0%), IN (40.8%), and IV (7.1%). A second dose was administered to 37 patients. In the majority of administrations, midazolam improved the patient’s condition (73.5%) with infrequent adverse events (3.4%). There was no significant difference between the effectiveness of IM and IN midazolam (71.0% vs 75.4%; p = 0.24).Conclusion: A midazolam protocol for prehospital agitation was associated with reduced agitation and a low rate of adverse events

Gender-specific effects of COVID-19 lockdowns on scientific publishing productivity: Impact and resilience

Available online 3 February 2023Rationale: The SARS-CoV2 pandemic led to drastic social restrictions globally. Early data suggest that women in science have been more adversely affected by these lockdowns than men, with relatively fewer scientific articles authored by women. However, these observations test broad populations with many potential causes of disparity. Australia presents a natural experimental condition where several states of similar demographics and disease impact had differing approaches in their social isolation strategies. The state of Victoria experienced 280 days of lockdowns from 2020 to 2021, whereas the comparable state of New South Wales experienced 107 days, most of these in 2021, and other states even fewer restrictions. Objective and methods: To assess how the gender balance changed in Australian biomedical publishing with the lockdowns, we created a custom workflow to analyse PubMed data from more than 120,000 published articles submitted in 2019–2021 from Australian authors. Results: Broadly, Australian women have been incredibly resilient to the challenges faced by the lockdowns. There was an increase in the number of published articles submitted in 2020 that was equally due to women as men, including from Victoria. On the other hand, articles specifically addressing COVID-19 were significantly less likely to be authored by women than those on other topics, a finding not likely due to particular gender imbalance in virology or viral epidemiology, since publications on HIV followed similar patterns to previous years. By 2021, this imbalance had reversed, with more COVID-19-related papers authored by women than men. Conclusions: These data suggest women from Victoria were less able to rapidly transition to new research early in the pandemic but had accommodated to the new conditions by 2021. This work indicates we need strategies to support women in science as the pandemic continues and to continue to monitor the situation for its impact on vulnerable groups.M. Ryan, J. Tuke, M.R. Hutchinson, S.J. Spence

Changes in participant behaviour and attitudes are associated with knowledge and skills gained by using a turtle conservation citizen science app

1. Citizen science has become a popular way to collect biodiversity data and engage the wider public in scientific research. It has the potential to improve the knowledge and skills of participants, and positively change their behaviour and attitude towards the environment. Citizen science outcomes are particularly valuable for wildlife conservation, as they could help alleviate human impacts on the environment. 2. We used an online questionnaire to investigate the consequences of participating in an Australian turtle mapping app, TurtleSAT, on skills and knowledge gain, and test for any association between these gains and behavioural or attitudinal changes reported by the participants. 3. One hundred and forty-eight citizen scientists completed our questionnaire, mostly from the states of New South Wales and Victoria. TurtleSAT was the third most common source of correct answers about turtle ecology and conservation, after a talk about turtles and personal observations/research. Citizen scientists who participated more often were more knowledgeable about turtles than infrequent users. Self-reported gains in knowledge and skills were positively linked to attitudinal and behavioural changes, such as being more aware of turtles on roads. However, behaviour and attitude changes were not related to participation rate. Respondents also reported that after learning about the current decline in turtle populations, they adopted several turtle-friendly practices, such as habitat restoration or moving turtles out of harm's way, underlining the importance of increasing people's awareness on species declines. 4. The reported changes in attitudes and behaviours are likely to positively impact the conservation of Australian freshwater turtles. Engagement with citizen science projects like TurtleSAT may result in participants being more interested in the natural world, by learning more about it and being more exposed to it, and therefore contributing more actively to its protection

"An infinitude of Possible Worlds": towards a research method for hypertext fiction

While the investigation of creative writing as a research method is gathering apace, little work has been done into the specific case of hypertext fiction (fiction written through a digital medium). This paper argues that, while there remain certain similarities between paper-based and digital texts, fundamental differences in design and construction remain. If hypertext fictions are to be successfully understood, then the role and purpose of the digital writer needs to be more fully analysed as part of the creative process. This paper argues that Possible Worlds Theory offers a way forward. With its focus on the ontological structures created by hypertext fiction, Possible World Theory actively embraces narrative indeterminacy and ontological changeability. In this sense the method provides a structured means by which the creative manipulation of the unique affordances of a digital medium by a writer can be theorised

Rapid Exchange Cooling with Trapped Ions

The trapped-ion quantum charge-coupled device (QCCD) architecture is a leading candidate for advanced quantum information processing. In current QCCD implementations, imperfect ion transport and anomalous heating can excite ion motion during a calculation. To counteract this, intermediate cooling is necessary to maintain high-fidelity gate performance. Cooling the computational ions sympathetically with ions of another species, a commonly employed strategy, creates a significant runtime bottleneck. Here, we demonstrate a different approach we call exchange cooling. Unlike sympathetic cooling, exchange cooling does not require trapping two different atomic species. The protocol introduces a bank of $"$coolant$"$ ions which are repeatedly laser cooled. A computational ion can then be cooled by transporting a coolant ion into its proximity. We test this concept experimentally with two ions, executing the necessary transport in 107 $\mu s$, an order of magnitude faster than typical sympathetic cooling durations. We remove over 96%, and as many as 102(5) quanta, of axial motional energy from the computational ion. We verify that re-cooling the coolant ion does not decohere the computational ion. This approach validates the feasibility of a single-species QCCD processor, capable of fast quantum simulation and computation

The power of effective study design in animal Experimentation: Exploring the statistical and ethical implications of asking multiple questions of a data set

One of the chief advantages of using highly standardised biological models including model organisms is that multiple variables can be precisely controlled so that the variable of interest is more easily studied. However, such an approach often obscures effects in sub-populations resulting from natural population heterogeneity. Efforts to expand our fundamental understanding of multiple sub-populations are in progress. However, such stratified or personalised approaches require fundamental modifications of our usual study designs that should be implemented in Brain, Behavior and Immunity (BBI) research going forward. Here we explore the statistical feasibility of asking multiple questions (including incorporating sex) within the same experimental cohort using statistical simulations of real data. We illustrate and discuss the large explosion in sample numbers necessary to detect effects with appropriate power for every additional question posed using the same data set. This exploration highlights the strong likelihood of type II errors (false negatives) for standard data and type I errors when dealing with complex genomic data, where studies are too under-powered to appropriately test these interactions. We show this power may differ for males and females in high throughput data sets such as RNA sequencing. We offer a rationale for the use of alternative experimental and statistical strategies based on interdisciplinary insights and discuss the realworld implications of increasing the complexities of our experimental designs, and the implications of not attempting to alter our experimental designs going forward.R.A. Ankeny, A.L. Whittaker, M. Ryan, J. Boer, M. Plebanski, J. Tuke, S.J. Spence

Pleiotropic effects of simvastatin and losartan in preclinical models of post-traumatic elbow contracture

Elbow trauma can lead to post-traumatic joint contracture (PTJC), which is characterized by loss of motion associated with capsule/ligament fibrosis and cartilage damage. Unfortunately, current therapies are often unsuccessful or cause complications. This study aimed to determine the effects of prophylactically administered simvastatin (SV) and losartan (LS) in two preclinical models of elbow PTJC: a

Tectonic Transport Directions, Shear Senses and Deformation Temperatures Indicated by Quartz c‐Axis Fabrics and Microstructures in a NW‐SE Transect across the Moine and Sgurr Beag Thrust Sheets, Caledonian Orogen of Northern Scotland

Moine metasedimentary rocks of northern Scotland are characterized by arcuate map patterns of mineral lineations that swing progressively clockwise from orogen‐perpendicular E‐trend-ing lineations in greenschist facies mylonites above the Moine thrust on the foreland edge of the Caledonian Orogen, to S‐trending lineations at higher structural levels and metamorphic grades in the hinterland. Quartz c‐axis fabrics measured on a west to east coast transect demonstrate that the lineations developed parallel to the maximum principal extension direction and therefore track the local tectonic transport direction. Microstructures and c‐axis fabrics document a progressive change from top to the N shearing in the hinterland to top to the W shearing on the foreland edge. Field relationships indicate that the domain of top to the N shearing was at least 55 km wide before later horizontal shortening on km‐scale W‐vergent folds that detach on the underlying Moine thrust. Previously published data from the Moine thrust mylonites demonstrate that top to the W shearing had largely ceased by 430 Ma, while preliminary isotopic age data suggest top to the N shearing occurred at ~470–450 Ma. In addition, data from the east coast end of our transect indicate normal-sense top down‐SE shearing at close to peak temperatures at ~420 Ma that may be related to the closing stages of Scandian deformation, metamorphism and cooling/exhumation