Epidemiology, prehospital care and outcomes of patients arriving by ambulance with dyspnoea: An observational study

Background: This study aimed to determine epidemiology and outcome for patients presenting to emergency departments (ED) with shortness of breath who were transported by ambulance. Methods: This was a planned sub-study of a prospective, interrupted time series cohort study conducted at three time points in 2014 and which included consecutive adult patients presenting to the ED with dyspnoea as a main symptom. For this sub-study, additional inclusion criteria were presentation to an ED in Australia or New Zealand and transport by ambulance. The primary outcomes of interest are the epidemiology and outcome of these patients. Analysis was by descriptive statistics and comparisons of proportions. Results: One thousand seven patients met inclusion criteria. Median age was 74 years (IQR 61-68) and 46.1 % were male. There was a high rate of co-morbidity and chronic medication use. The most common ED diagnoses were lower respiratory tract infection (including pneumonia, 22.7 %), cardiac failure (20.5%) and exacerbation of chronic obstructive pulmonary disease (19.7 %). ED disposition was hospital admission (including ICU) for 76.4 %, ICU admission for 5.6 % and death in ED in 0.9 %. Overall in-hospital mortality among admitted patients was 6.5 %. Discussion: Patients transported by ambulance with shortness of breath make up a significant proportion of ambulance caseload and have high comorbidity and high hospital admission rate. In this study, >60 % were accounted for by patients with heart failure, lower respiratory tract infection or COPD, but there were a wide range of diagnoses. This has implications for service planning, models of care and paramedic training. Conclusion: This study shows that patients transported to hospital by ambulance with shortness of breath are a complex and seriously ill group with a broad range of diagnoses. Understanding the characteristics of these patients, the range of diagnoses and their outcome can help inform training and planning of services

The second physical therapy summit on global health: developing an action plan to promote health in daily practice and reduce the burden of non-communicable diseases

Based on indicators that emerged from The First Physical Therapy Summit on Global Health (2007), the Second Summit (2011) identified themes to inform a global physical therapy action plan to integrate health promotion into practice across the World Confederation for Physical Therapy (WCPT) regions. Working questions were: (1) how well is health promotion implemented within physical therapy practice; and (2) how might this be improved across five target audiences (i.e. physical therapist practitioners, educators, researchers, professional body representatives, and government liaisons/consultants). In structured facilitated sessions, Summit representatives (n=32) discussed: (1) within WCPT regions, what is working and the challenges; and (2) across WCPT regions, what are potential directions using World CaféTM methodology. Commonalities outweighed differences with respect to strategies to advance health-focused physical therapy as a clinical competency across regions and within target audiences. Participants agreed that health-focused practice is a professional priority, and a strategic action plan was needed to develop it as a clinical competency. The action plan and recommendations largely paralleled the principles and objectives of the World Health Organization's non-communicable diseases action plan. A third Summit planned for 2015 will provide a mechanism for follow-up to evaluate progress in integrating health-focused physical therapy within the profession.info:eu-repo/semantics/acceptedVersio

A time-dependent logit-based taxi customer-search model

In this study, global positioning system data from 460 urban taxis are used to develop a time-dependent logit model. The rate of return (ROR, also known as profit per unit time) is used as a factor underlying taxi drivers' searching behaviour for customers. The data also reveal that the search behaviour across districts as well as the decisions towards a particular district in customer-search is strongly related to the daily profile of passenger demand, and that when the overall passenger demand is high, vacant taxi drivers tend to circulate within or wait at the area where their preceding customers got off to find their next customer. The results also show that the ROR is a significant factor that affects the customer-searching strategies of vacant taxi drivers over a day, and is inversely related to the percentage of taxi idling time. More importantly, this paper illustrates that there is a change in searching behaviour over time of day. © 2013 Copyright The Institute of Urban Sciences

Out-of-hospital cardiac arrest in Hong Kong

Objectives. To evaluate the effectiveness of the local emergency medical services system in resuscitation of out-of-hospital cardiac arrest and identify areas for improvement. Methods. This was a prospective descriptive study of adults with nontraumatic out-of-hospital cardiac arrest treated in the three accident & emergency departments that serve the whole of Hong Kong Island from March 15, 1999, to October 15, 1999. Patient characteristics, circumstances of cardiac arrest, final outcomes, and response times of the ambulance service were recorded according to the Utstein style. Results. Three hundred twenty patients were included. There was male predominance, and the mean age was 71.5 years. The majority of cardiac arrests occurred at patients' homes. In 57.5% of cases the arrest was not witnessed. The bystander cardiopulmonary resuscitation (CPR) rate was 15.6%. The most common electrocardiographic (ECG) rhythm at scene was asystole. Ventricular fibrillation or pulseless ventricular tachycardia constituted 14.1%. The average call to dispatch interval was 1.04 minutes. The average call to CPR interval was 9.82 minutes. The average total prehospital interval was 27.55 minutes. The overall immediate survival rate was 14.1% and the rate of survival to hospital discharge was 1.25%. Conclusion. The prognosis of out-of-hospital cardiac arrest in Hong Kong was dismal. Every link in the chain of survival has to be improved.Link_to_subscribed_fulltex

4D direct laser writing of photo-triggered liquid crystal elastomer microactuators with large actuation strain

4D printed photo-triggered liquid crystal elastomers (LCEs) microactuators by direct laser writing via two-photon polymerization (DLW-TPP) have attracted increasing attention due to their manipulation flexibility, reversible and rapid actuation capabilities. However, their development is hampered by the lack of room-temperature printable liquid crystal (LC) photoresists. Here, we developed new light-responsive LC photoresists by incorporating novel conjugated polymers (CPs) as photothermal agents for the DLW-TPP technology. The CPs displayed a remarkable photothermal effect and effectively avoided the aggregation problems that always happened for inorganic nanoparticles in photoresists. Moreover, the CPs incorporation lowered the nematic-to-isotropic temperature of the LC photoresists which is beneficial for room-temperature DLW-TPP. The printing parameters, including laser power and scanning speed, were investigated using the developed LC photoresists. It was found the range of printing parameters decreased with the increase of the CPs loading fraction from 0.1 to 0.5 wt%, which was attributed to the high photothermal conversion efficiency (52.7%). A well-defined CPs/LCEs microactuator with CPs as low as 0.3 wt% was printed, which could achieve a large 25.0% actuation strain in 5 s upon near-infrared (NIR) light stimulation. It could be used for thriving soft micro-robotics and micro-membranes with controllable separation capabilities

Non-invasive biomarkers for liver inflammation in non-alcoholic fatty liver disease: present and future

Inflammation is the key driver of liver fibrosis progression in non-alcoholic fatty liver disease (NAFLD). Unfortunately, it is often challenging to assess inflammation in NAFLD due to its dynamic nature and poor correlation with liver biochemical markers. Liver histology keeps its role as the standard tool, yet it is well-known for substantial sampling, intraobserver, and interobserver variability. Serum proinflammatory cytokines and apoptotic markers, namely cytokeratin-18, are well-studied with reasonable accuracy, whereas serum metabolomics and lipidomics have been adopted in some commercially available diagnostic models. Ultrasound and computed tomography imaging techniques are attractive due to their wide availability; yet their accuracies may not be comparable with magnetic resonance imaging-based tools. Machine learning and deep learning models, be they supervised or unsupervised learning, are promising tools to identify various subtypes of NAFLD, including those with dominating liver inflammation, contributing to sustainable care pathways for NAFLD