The effect of the emergency medical services vehicle location and response strategy on response times

Response time is currently considered to be an important performance indicator in Emergency Medical Services (EMS) systems. A number of factors may affect response times, including the location of emergency vehicles and the type of response system design used. This study aimed to assess the effects of emergency vehicle location and response system design on response time performance in a model of a large South African urban EMS system, using discrete-event simulation. Results indicated that both the emergency vehicle location and response system design factors had a significant effect on response time performance, with more decentralised vehicle location having a greater effect

Pilot of ‘Families for Health’ : community-based family intervention for obesity

Objective - To develop and evaluate ‘Families for Health’ - a new community based family intervention for childhood obesity. Design – Programme development, pilot study and evaluation using intention-to-treat analysis. Setting – Coventry, England Participants – 27 overweight or obese children aged 7-13 years (18 girls, 9 boys) and their parents, from 21 families. Intervention – ‘Families for Health’ is a 12 week programme with parallel groups for parents and children, addressing parenting, lifestyle change and social & emotional development. Main Outcome Measures – Primary: change in baseline BMI z-score at end of programme (3 months) and 9 month follow-up. Attendance, drop-out, parents’ perception of programme, child’s quality of life and self esteem, parental mental health, parent-child relationships and lifestyle changes were also measured. Results: Attendance rate was 62%, with 18 of the 27 (67%) children completing the programme. For the 22 children with follow-up data (including 4 drop-outs), BMI z-score was reduced by -0.18 (95%CI -0.30 to -0.05) at end of programme and by -0.21 (-0.35 to -0.07) at 9 months. Statistically significant improvements were observed in children’s quality of life and lifestyle (reduced sedentary behaviour, increased steps and reduced exposure to unhealthy foods), child-parent relationships and parents’ mental health. Fruit and vegetable consumption, participation in moderate/vigorous exercise and children’s self-esteem did not change significantly. Topics on parenting skills, activity and food were rated as helpful and were used with confidence by the majority of parents. Conclusions Families for Health is a promising new childhood obesity intervention. Definitive evaluation of its clinical effectiveness by randomised controlled trial is now required

Photograph-based diagnosis of burns in patients with dark-skin types: The importance of case and assessor characteristics

AbstractAimThis study assessed whether photographs of burns on patients with dark-skin types could be used for accurate diagnosing and if the accuracy was affected by physicians’ clinical background or case characteristics.Method21 South-African cases (Fitzpatrick grades 4–6) of varying complexity were photographed using a camera phone and uploaded on a web-survey. Respondents were asked to assess wound depth (3 categories) and size (in percentage). A sample of 24 burn surgeons and emergency physicians was recruited in South-Africa, USA and Sweden. Measurements of accuracy (using percentage agreement with bedside diagnosis), inter- (n=24), and intra-rater (n=6) reliability (using percentage agreement and kappa) were computed for all cases aggregated and by case characteristic.ResultsOverall diagnostic accuracy was 67.5% and 66.0% for burn size and depth, respectively. It was comparable between burn surgeons and emergency physicians and between countries of practice. However, the standard deviations were smaller, showing higher similarities in diagnoses for burn surgeons and South-African clinicians compared to emergency physicians and clinicians from other countries. Case characteristics (child/adult, simple/complex wound, partial/full thickness) affected the results for burn size but not for depth. Inter- and intra-rater reliability for burn depth was 55% and 77%.ConclusionSize and depth of burns on patients with dark-skin types could be assessed at least as well using photographs as at bedside with 67.5% and 66.0% average accuracy rates. Case characteristics significantly affected the accuracy for burn size, but medical specialty and country of practice seldom did in a statistically significant manner

Temporal Foraging Patterns of Nonnative Frogs (Eleutherodactylus Coqui) in Hawaii

The Puerto Rican Coqui Frog (Eleutherodactylus coqui) is a nocturnal, invasive species that was introduced into Hawaii in the 1980s. Because they reach extremely high densities (up to 90,000 frogs/ha), they have the potential to affect invertebrate prey communities. Previously, researchers used frogs collected only at night to characterize their prey. Because Coquis use retreat sites near the forest floor during the day and understory perch sites at night, frogs collected at night might show different amounts and types of prey than would frogs collected in the morning. We analyzed stomach contents of 435 frogs collected in the morning (0300–0600 h) and at night (1900–2200 h) from five sites on the island of Hawaii. Frogs collected in the morning had 1.7 times more prey items and 2.1 times greater prey volume than those collected at night; however, prey composition did not differ between morning- and evening-collected frogs. Across sites, Formicidae (ants) and Amphipoda (amphipods) were the dominant prey, and at least 61.6% of their prey items were nonnative species. Across sites, morning- and evening-collected stomach contents were not different from environmental samples of leaflitter invertebrates but were different from environmental samples of foliage and flying invertebrates, suggesting that Coquis forage primarily in the leaf litter throughout the night. Previous research that investigated stomach contents of frogs collected only at night greatly underestimated the number and volume of prey items that Coquis consume during the entire foraging period but accurately described their primary prey: nonnative, leaf-litter invertebrates

Charge transfer complexes and radical cation salts of chiral methylated organosulfur donors

The single crystal X-ray structure of the all-axial conformer of the (R,R,R,R) enantiomer of the chiral donor tetramethyl-BEDT-TTF (TM-BEDT-TTF) was described and compared to the all-equatorial conformer. (S,S,S,S)-Tetramethyl-BEDT-TTF formed crystalline 1 : 1 complexes with TCNQ and TCNQ-F4, as well as a THF solvate of the TCNQ complex. Donors bis((2S,4S)-pentane-2,4-dithio)tetrathiafulvalene and (ethylenedithio)((2S,4S)-pentane-2,4-dithio)tetrathiafulvalene, which contain seven-membered rings bearing chirally oriented methyl groups, only formed complexes with TCNQ-F4. The TCNQ-F4 complexes contain planar organosulfur systems, in contrast to the TCNQ complexes in which there is minimal charge transfer. A variety of crystal packing modes were observed. Electrocrystallization experiments with both enantiomers and the racemic form of tetramethyl-BEDT-TTF afforded mixed valence radical cation salts with the AsF6 and SbF6 anions formulated as (TM-BEDT-TTF)2XF6 (X = As, Sb). Electrical conductivity was only found in one charge transfer complex, while the radical cation salts are all semiconducting

Double Arrays, Triple Arrays and Balanced Grids

Triple arrays are a class of designs introduced by Agrawal in 1966 for two-way elimination of heterogeneity in experiments. In this paper we investigate their existence and their connection to other classes of designs, including balanced incomplete block designs and balanced grids

Cohort profile: the avon longitudinal study of parents and children: ALSPAC mothers cohort

The Avon Longitudinal Study of Children and Parents (ALSPAC) was established to understand how genetic and environmental characteristics influence health and development in parents and children. All pregnant women resident in a defined area in the South West of England, with an expected date of delivery between 1st April 1991 and 31st December 1992, were eligible and 13 761 women (contributing 13 867 pregnancies) were recruited. These women have been followed over the last 19–22 years and have completed up to 20 questionnaires, have had detailed data abstracted from their medical records and have information on any cancer diagnoses and deaths through record linkage. A follow-up assessment was completed 17–18 years postnatal at which anthropometry, blood pressure, fat, lean and bone mass and carotid intima media thickness were assessed, and a fasting blood sample taken. The second follow-up clinic, which additionally measures cognitive function, physical capability, physical activity (with accelerometer) and wrist bone architecture, is underway and two further assessments with similar measurements will take place over the next 5 years. There is a detailed biobank that includes DNA, with genome-wide data available on >10 000, stored serum and plasma taken repeatedly since pregnancy and other samples; a wide range of data on completed biospecimen assays are available. Details of how to access these data are provided in this cohort profile

Development and evaluation of deep learning algorithms for assessment of acute burns and the need for surgery

Assessment of burn extent and depth are critical and require very specialized diagnosis. Automated image-based algorithms could assist in performing wound detection and classification. We aimed to develop two deep-learning algorithms that respectively identify burns, and classify whether they require surgery. An additional aim assessed the performances in different Fitzpatrick skin types. Annotated burn (n = 1105) and background (n = 536) images were collected. Using a commercially available platform for deep learning algorithms, two models were trained and validated on 70% of the images and tested on the remaining 30%. Accuracy was measured for each image using the percentage of wound area correctly identified and F1 scores for the wound identifier; and area under the receiver operating characteristic (AUC) curve, sensitivity, and specificity for the wound classifier. The wound identifier algorithm detected an average of 87.2% of the wound areas accurately in the test set. For the wound classifier algorithm, the AUC was 0.885. The wound identifier algorithm was more accurate in patients with darker skin types; the wound classifier was more accurate in patients with lighter skin types. To conclude, image-based algorithms can support the assessment of acute burns with relatively good accuracy although larger and different datasets are needed.Peer reviewe

The IT framework of the European Archive of Historical Earthquake Data (AHEAD)

The European Archive of Historical EArthquake Data (AHEAD) has been developed in the frame of the EC project NERIES and maintained in the frame of the EC project SHARE.AHEAD makes available on the web the result of a networked historical earthquake data research, formalised in terms of studies (papers, reports, macroseismic data points, etc). It provides an updated wealth of data that are unique for many European events in the time-window 1000-1963.A series of IT solutions have been developed in order to support both the research and the networking activities carried out within the building process of AHEAD. The resulting framework is an equally balanced effort in both the back-end and front-end design and implementation, a key feature in a research approach very much human-centred, where the quantity of data is small if compared to terabytes of instrumental data.AHEAD is composed of five mutually dependent data-components: 1) the “Digital Library”, where all the historical earthquake studies are stored and described by bibliographical metadata, 2) the “Consensus Earthquake Inventory”, where the relevant macroseismic data (event date, epicentral area, number of macroseismic data-point, maximum observed intensity) are extrapolated, the best available information are selected and fake earthquakes are highlighted, 3) the “European Macroseismic Database”, where all the available macroseismic data-points (MDPs) are stored, 4) the “Parameters Laboratory”, where earthquakes parameterisation methods are applied to MDPs in order to obtain epicentral locations and magnitudes and 5) the “European Earthquake Catalogue”.The presentation will demonstrate the adopted IT solutions separately for the back-end and the front-end, both for the access-restricted website and the general-purpose implementation designed to be included in the “Earthquake Data Portal”, developed within the EC project NERIES, which targets a much broader scientific community

What's the point of knowing how?

Why is it useful to talk and think about knowledge-how? Using Edward Craig’s discussion of the function of the concepts of knowledge and knowledge-how as a jumping off point, this paper argues that considering this question can offer us new angles on the debate about knowledge-how. We consider two candidate functions for the concept of knowledge-how: pooling capacities, and mutual reliance. Craig makes the case for pooling capacities, which connects knowledge-how to our need to pool practical capacities. I argue that the evidence is much more equivocal. My suggested diagnosis is that the concept of knowledge-how plays both functions, meaning that the concept of knowledge-how is inconsistent, and that the debate about knowledge-how is at least partly a metalinguistic negotiation. In closing, I suggest a way to revise the philosophical concept of knowledge how