Managing emergencies in primary care: does real-world simulation-based training have any lasting impact?

General Practitioners (GPs) have a responsibility to provide prompt and effective care when attending to life threatening emergencies in their GP surgeries. Primary care staff undertake mandatory, annual basic life support training. However, most emergencies are peri-arrest situations, and this is an area where GPs lack confidence and competence [1, 2]. The importance of effective, early intervention in peri-arrest scenarios was highlighted by the NCEPOD report “Time to Intervene (2012)” [3]. This report suggested that better early assessment and intervention may have prevented progression to cardiorespiratory arrest. GPs need to be equipped to manage ‘time critical’ emergencies, particularly as GP surgeries are deemed a place of safety and 999 ambulances can be redirected to other emergencies, thereby delaying transfer to secondary care for patients in GP settings. In previous work, we demonstrated that GPs’ confidence in managing time critical emergencies was initially low, and significantly improved immediately after attending ‘real-world’, simulation based workshops [1]. The value of real-world, in-house simulation based training has also been shown to increase “practical preparedness” in the context of resuscitation training (4). However, there is relatively little data regarding the long term value of simulation based training in primary care (5). In the current paper, we assessed whether our workshops had any longer-term benefit on participants’ confidence in managing emergencies and if it led to any changes in clinical practice

Colour terms in the interior design process

Colour is a very important topic that interior designers need to consider. Considerable research has been conducted in the area of colour application in interior design; in this study we are concerned with colour terms in interior design, mainly the terms designers use and know about. Fifteen interior designers with varied professional backgrounds, but based in the Middle East (Saudi Arabia, Dubai, Bahrain, Lebanon, Egypt, and Turkey), were interviewed. Previously we reported that fourteen out of fifteen designers stated that colour thinking and decision making take place at the early stages of their design processes; eight of them reported that colour takes place in the first step when meeting clients and starting the project (Attiah et al., 2014). This study documented 137 terms which the fifteen designers use whilst brainstorming and working on a design project; subsequent analysis of these terms could form a basis for understanding how interior designers communicate the abstract properties of colour as part of their design processes. In this paper we show how the 137 terms were categorised according to a framework of four categories of colour terms: emotional, descriptive, cultural and functional. In addition, seventeen words (scientists names and technical terms), which are widely used in colour science (such as: CIELAB, Saturation, Itten) were shown to the designers; their knowledge was shown to be incomplete

Counterparts: Clothing, value and the sites of otherness in Panapompom ethnographic encounters

This is an Author's Accepted Manuscript of an article published in Anthropological Forum, 18(1), 17-35, 2008 [copyright Taylor & Francis], available online at: http://www.tandfonline.com/10.1080/00664670701858927.Panapompom people living in the western Louisiade Archipelago of Milne Bay Province, Papua New Guinea, see their clothes as indices of their perceived poverty. ‘Development’ as a valued form of social life appears as images that attach only loosely to the people employing them. They nevertheless hold Panapompom people to account as subjects to a voice and gaze that is located in the imagery they strive to present: their clothes. This predicament strains anthropological approaches to the study of Melanesia that subsist on strict alterity, because native self‐judgments are located ‘at home’ for the ethnographer. In this article, I develop the notion of the counterpart as a means to explore these forms of postcolonial oppression and their implications for the ethnographic encounter

Scaling Behavior of Human Locomotor Activity Amplitude: Association with Bipolar Disorder

Scale invariance is a feature of complex biological systems, and abnormality of multi-scale behaviour may serve as an indicator of pathology. The hypothalamic suprachiasmatic nucleus (SCN) is a major node in central neural networks responsible for regulating multi-scale behaviour in measures of human locomotor activity. SCN also is implicated in the pathophysiology of bipolar disorder (BD) or manic-depressive illness, a severe, episodic disorder of mood, cognition and behaviour. Here, we investigated scaling behaviour in actigraphically recorded human motility data for potential indicators of BD, particularly its manic phase. A proposed index of scaling behaviour (Vulnerability Index [VI]) derived from such data distinguished between: [i] healthy subjects at high versus low risk of mood disorders; [ii] currently clinically stable BD patients versus matched controls; and [iii] among clinical states in BD patients

An Economic Evaluation of a Streamlined Day-Case Atrial Fibrillation Ablation Protocol and Conventional Cryoballoon Ablation versus Antiarrhythmic Drugs in a UK Paroxysmal Atrial Fibrillation Population

Background and Aims Symptom control for atrial fibrillation can be achieved by catheter ablation or drug therapy. We assessed the cost effectiveness of a novel streamlined atrial fibrillation cryoballoon ablation protocol (AVATAR) compared with optimised antiarrhythmic drug (AAD) therapy and a conventional catheter ablation protocol, from a UK National Health Service (NHS) perspective. Methods Data from the AVATAR study were assessed to determine the cost effectiveness of the three protocols in a two-step process. In the first stage, statistical analysis of clinical efficacy outcomes was conducted considering either a three-way comparison (AVATAR vs. conventional ablation vs. optimised AAD therapies) or a two-way comparison (pooled ablation protocol data vs. optimised AAD therapies). In the second stage, models assessed the cost effectiveness of the protocols. Costs and some of the clinical inputs in the models were derived from within-trial cost analysis and published literature. The remaining inputs were derived from clinical experts. Results No significant differences between the ablation protocols were found for any of the clinical outcomes used in the model. Results of a within-trial cost analysis show that AVATAR is cost-saving (£1279 per patient) compared with the conventional ablation protocol. When compared with optimised AAD therapies, AVATAR (pooled conventional and AVATAR ablation protocols efficacy) was found to be more costly while offering improved clinical benefits. Over a lifetime time horizon, the incremental cost-effectiveness ratio of AVATAR was estimated as £21,046 per quality-adjusted life-year gained (95% credible interval £7086–£71,718). Conclusions The AVATAR streamlined protocol is likely to be a cost-effective option versus both conventional ablation and optimised AAD therapy in the UK NHS healthcare setting

Bringing Darkness to Light: The Influence of Auditor Quality and Audit Committee Expertise on the Timeliness of Financial Statement Restatement Disclosures

This study investigates whether auditor quality and audit committee expertise are associated with improved financial reporting timeliness as measured by the duration of a financial statement restatement’s ‘‘dark period.’’ The restatement dark period represents the length of time between a company’s discovery that it will need to restate financial data and the subsequent disclosure of the restatement’s effect on earnings. For a sample of dark restatements disclosed between 2004 and 2009, we find that companies that engage Big 4 auditors have shorter dark periods than companies that do not engage Big 4 auditors. We also find that companies with more financial experts on the audit committee have shorter dark periods, but only when such financial expertise relates specifically to accounting. Finally, companies with audit committee chairs that have accounting financial expertise provide the most timely disclosures, as the dark periods for these firms are reduced by approximately 38 percent. Our results suggest that both auditor and audit committee expertise are associated with the timely disclosure of restatement details