Frailty Identification in Prehospital Care: A Scoping Review of the Literature

The proportion of older adults is increasing worldwide. Frailty assessment in prehospital care was suggested to improve triage decisions and paramedics’ judgment. This study aimed to assess the scope and nature of available evidence around frailty identification in prehospital care. A systematic search of the literature was performed using MEDLINE, SCOPUS, CINHAL, and Web of Science to identify relevant articles published from January 2022 downwards. A list of indexed terms and their associated alternatives were pre-determined. Of the 71 identified and reviewed articles after removing duplicates, six articles were included in the review. Due to the heterogeneity of the included articles, the findings were described narratively. The findings of this review showed that the available evidence is limited and heterogenic. Two themes emerged from the findings of the included articles: 1) Paramedics’ Perceptions about Frailty Assessment in Prehospital Care and 2) Frailty Scores for Application in Prehospital Care. Paramedics recognised frailty assessment in pre-hospital care to be feasible and important. They highlighted the need for a simple and clear frailty score that could be used and mentioned to other healthcare professionals when handing over patients. Six frailty scores were reported to be used in prehospital care. The evidence around each frailty score is very limited. Overall, frailty assessment in prehospital care was shown to be important and feasible. Different frailty scores have been assessed for use in prehospital care. Further research investigating frailty identification in prehospital care is needed

Under-triage of older trauma patients in prehospital care: a systematic review

Background: It is argued that many older trauma patients are under-triaged in prehospital care which may adversely affect their outcomes. This systematic review aimed to assess prehospital under-triage rates for older trauma patients, the accuracy of the triage criteria, and the impact of prehospital triage decisions on outcomes. Methods: A computerised literature search using MEDLINE, Scopus, and CINHAL databases was conducted for studies published between 1966 and 2021 using a list of predetermined index terms and their associated alternatives. Studies which met the inclusion criteria were included and critiqued using the Critical Appraisal Skills Programme tool. Due to the heterogeneity of the included studies, narrative synthesis was used in this systematic review. Results: Of the 280 identified studies, 23 met the inclusion criteria. Current trauma triage guidelines have poor sensitivity to identify major trauma and the need for TC care for older adults. Although modified triage tools for this population have improved sensitivity, they showed significantly decreased specificity or were not applied to all older people. The issue of low rates of TC transport for positively triaged older patients is not well understood. Furthermore, the benefits of TC treatment for older patients remain uncertain. Conclusions: This systematic review showed that under-triage is an ongoing issue for older trauma patients in prehospital care and its impact on their outcomes is still uncertain. Further high-quality prospective research is needed to assess the accuracy of prehospital triage criteria, the factors other than the triage criteria that affect transport decisions, and the impact of under-triage on outcomes

Modeling Luminosity-Dependent Galaxy Clustering Through Cosmic Time

We employ high-resolution dissipationless simulations of the concordance LCDM cosmology to model the observed luminosity dependence and evolution of galaxy clustering through most of the age of the universe, from z~5 to z~0. We use a simple, non-parametric model which monotonically relates galaxy luminosities to the maximum circular velocity of dark matter halos (V_max) by preserving the observed galaxy luminosity function in order to match the halos in simulations with observed galaxies. The novel feature of the model is the use of the maximum circular velocity at the time of accretion, V_max,acc, for subhalos, the halos located within virial regions of larger halos. We argue that for subhalos in dissipationless simulations, V_max,acc reflects the luminosity and stellar mass of the associated galaxies better than the circular velocity at the epoch of observation, V_max,now. The simulations and our model L-V_max relation predict the shape, amplitude, and luminosity dependence of the two-point correlation function in excellent agreement with the observed galaxy clustering in the SDSS data at z~0 and in the DEEP2 samples at z~1 over the entire probed range of projected separations, 0.1<r_p/(Mpc/h)<10.0. In particular, the small-scale upturn of the correlation function from the power-law form in the SDSS and DEEP2 luminosity-selected samples is reproduced very well. At z~3-5, our predictions also match the observed shape and amplitude of the angular two-point correlation function of Lyman-break galaxies (LBGs) on both large and small scales, including the small-scale upturn.Comment: 16 pages 11 figures, ApJ in pres

Diel Vertical Distribution Patterns of Zooplankton along the Western Antarctic Peninsula

The Western Antarctic Peninsula (WAP) is a region that has undergone significant change over the past several decades due to unprecedented increases sea surface temperature and decreases in sea ice cover. The ongoing Palmer Antarctica Long-Term Ecological Research (PAL LTER) study shows that these environmental changes are significantly affecting the marine pelagic ecosystem along the WAP. The goal of this study was to analyze diel vertical distribution patterns of zooplankton along the WAP

Energetic Materials at High Compression: First-Principles Density Functional Theory and Reactive Force Field Studies

We report the results of a comparative study of pentaerythritol tetranitrate (PETN) at high compression using classical reactive interatomic potential ReaxFF and first-principles density functional theory (DFT). Lattice parameters of PETN I, the ground state structure at ambient conditions, is obtained by ReaxFF and two different density functional methods (plane wave and LCAO pseudopotential methods) and compared with experiment. Calculated energetics and isothermal equation of state (EOS) upon hydrostatic compression obtained by DFT and ReaxFF are both in good agreement with available experimental data. Our calculations of the hydrostatic EOS at zero temperature are extended to high pressures up to 50 GPa. The anisotropic characteristics of PETN upon uniaxial compression were also calculated by both ReaxFF and DFT

Zooplankton diel vertical migration during Antarctic summer

Zooplankton diel vertical migration (DVM) during summer in the polar oceans is presumed to be dampened due to near continuous daylight. We analyzed zooplankton diel vertical distribution patterns in a wide range of taxa along the Western Antarctic Peninsula (WAP) to assess if DVM occurs, and if so, what environmental controls modulate DVM in the austral summer. Zooplankton were collected during January and February in paired day-night, depth-stratified tows through the mesopelagic zone along the WAP from 2009-2017, as well as in day and night epipelagic net tows from 1993-2017. The copepod Metridia gerlachei, salp Salpa thompsoni, pteropod Limacina helicina antarctica, and ostracods consistently conducted DVM between the mesopelagic and epipelagic zones. Migration distance for M. gerlachei and ostracods decreased as photoperiod increased from 17 to 22 h daylight. The copepods Calanoides acutus and Rhincalanus gigas, as well as euphausiids Thysanoessa macrura and Euphausia crystallorophias, conducted shallow (mostly within the epipelagic zone) DVMs into the upper 50 m at night. Rhincalanus gigas, T. macrura, and L. h. antarctica DVM behavior was modulated by chlorophyll a concentration, mixed layer depth, and depth of the subsurface chlorophyll a maximum, respectively. Carnivorous and detritivorous taxa – including the calanoid copepod Paraeuchaeta antarctica, ostracods, chaetognaths, and Tomopteris spp. polychaetes – as well as seasonally migrating copepods, were most abundant in the mesopelagic zone regardless of the diel cycle. Paraeuchaeta antarctica underwent reverse DVM within the top 100 m. The impacts of Antarctic zooplankton summer DVM and the resident mesopelagic assemblage on carbon export should be better quantified

Detecting the presence and concentration of nitrate in water using microwave spectroscopy

Nitrate is a common pollutant in surface waters which water companies must monitor for regulatory and safety reasons. The presence of nitrate in deionised water is detected and concentration estimated from microwave spectroscopy measurements in the range 9kHz-6GHz. Experimental results were obtained for 19 solutions (18 salt solutions in deionised water and 1 deionised water), each measured 10 times with 4001 points (total N=190). The resulting data was randomly assigned into equal parts training and test data (N=95 each). Both regression (for the estimation of nitrate concentration) and classification (for detecting the presence of nitrate) methods were considered, with a rigorous feature selection procedure used to identify two frequencies for each of the classification and regression problems. For detection classification models were applied with nitrate levels binned using 30mg/l as the threshold. A logistic regression model achieved AUROC of 0.9875 on test data and a multi-layer perceptron achieved AUROC of 0.9871. In each case the positive predictive value of the model could be optimised at 100% with sensitivity of 90% and specificity of 100%. For the concentration estimates, a linear regression model was able to explain 42% of the variance in the training data and 45% of the variance in the test data and an MLP model delivered similar performance, explaining 43% of variance in the training data and 47% of variance in the test data. A sensor based on this model would be appropriate for detecting the presence of nitrate above a given threshold but poor at estimating concentration

Psychosocial Characteristics and Obstetric Health of Women Attending a Specialist Substance Use Antenatal Clinic in a Large Metropolitan Hospital

Objective. This paper reports the findings comparing the obstetrical health, antenatal care, and psychosocial characteristics of pregnant women with a known history of substance dependence (n = 41) and a comparison group of pregnant women attending a general antenatal clinic (n = 47). Method. Face-to-face interviews were used to assess obstetrical health, antenatal care, physical and mental functioning, substance use, and exposure to violence. Results. The substance-dependent group had more difficulty accessing antenatal care and reported more obstetrical health complications during pregnancy. Women in the substance-dependent group were more likely to report not wanting to become pregnant and were less likely to report using birth control at the time of conception. Conclusions. The profile of pregnant women (in specialised antenatal care for substance dependence) is one of severe disadvantage and poor health. The challenge is to develop and resource innovative and effective multisectoral systems to educate women and provide effective care for both women and infants

Characterizing the gut microbiome in trauma: significant changes in microbial diversity occur early after severe injury.

Background:Recent studies have demonstrated the vital influence of commensal microbial communities on human health. The central role of the gut in the response to injury is well described; however, no prior studies have used culture-independent profiling techniques to characterize the gut microbiome after severe trauma. We hypothesized that in critically injured patients, the gut microbiome would undergo significant compositional changes in the first 72 hours after injury. Methods:Trauma stool samples were prospectively collected via digital rectal examination at the time of presentation (0 hour). Patients admitted to the intensive care unit (n=12) had additional stool samples collected at 24 hours and/or 72 hours. Uninjured patients served as controls (n=10). DNA was extracted from stool samples and 16S rRNA-targeted PCR amplification was performed; amplicons were sequenced and binned into operational taxonomic units (OTUs; 97% sequence similarity). Diversity was analyzed using principle coordinates analyses, and negative binomial regression was used to determine significantly enriched OTUs. Results:Critically injured patients had a median Injury Severity Score of 27 and suffered polytrauma. At baseline (0 hour), there were no detectable differences in gut microbial community diversity between injured and uninjured patients. Injured patients developed changes in gut microbiome composition within 72 hours, characterized by significant alterations in phylogenetic composition and taxon relative abundance. Members of the bacterial orders Bacteroidales, Fusobacteriales and Verrucomicrobiales were depleted during 72 hours, whereas Clostridiales and Enterococcus members enriched significantly. Discussion:In this initial study of the gut microbiome after trauma, we demonstrate that significant changes in phylogenetic composition and relative abundance occur in the first 72 hours after injury. This rapid change in intestinal microbiota represents a critical phenomenon that may influence outcomes after severe trauma. A better understanding of the nature of these postinjury changes may lead to the ability to intervene in otherwise pathological clinical trajectories. Level of evidence:III. Study type:Prognostic/epidemiological