An Evaluation of early stage development of rotating paramedic model pilot sites

This report, commissioned by Health Education England, aims to evaluate the development of a rotating paramedic model of care delivery designed to address both the career aspirations of specialist paramedics and the combined workforce issues in ambulance services and primary care so that all, not just some, of the healthcare sectors can benefit. The fundamental principle of this model is that, rather than working within a single environment, a specialist or advanced paramedic can “rotate” through different sectors of the healthcare system whilst remaining employed by one employer

The Christian Faith Factor and the African American Child During the Early Childhood Years

The purpose of this research was to determine if African American children progressed through developmental faith stages in the same manner as the subjects described by Fowler in his seminal work on faith development (1981). In Developmental Psychology, many theories with stages have been developed and many studies conducted in the areas of cognitive, psychosocial, creative, and moral development. These studies have explored Erickson\u27s stages of psychosocial development, (1963); Kohlberg\u27s stages of moral development, (1969); and Piaget\u27s stages of cognitive development (1967). There remains, however, limited research examining faith development and faith experiences with African American children during the early childhood years. This investigation sought to explore how African American children understand and express their concept of faith, and to determine if they were congruent with the first two faith stages in the construct developed by Fowler (1981). The use of case study and ethnography as a qualitative research methodology was used to investigate these questions. The case study method provided a rich context in which to view the lives of four urban African American children, two boys 7 and 10 years of age and two girls, 5 and 8 years of age. The method used also provided a voice for the participants and the researcher to explore their unique understanding of their faith development. Also, in order to understand the role of inter-generational faith transmission, an interview was conducted with four African American women related to two of the participants. The four children selected attended an urban public school in a mid-size northeastern city. All of the subjects attended and participated in activities at the same church. The interviews with the children and their parents were tape recorded for further analysis. Each of the recorded interviews was analyzed using a construct derived from the indicators of Stage One and Stage Two faith development described in the original Fowler study. In addition, the children were asked to create a pictorial representation of their faith. These drawings were also analyzed using a construct derived from the works of Coles, (1990); Deleon, (1983); Eng, (1959); Kellogg, (1967); Levick, (1988); and Lowenfeld, (1982). A finding of the study is that the African American culture and world view seem to have a significant impact on faith stage development in these children. Although the children were in varying stages of cognitive development all of them responded to the age/stage of faith development at a higher level than the stages described by Fowler (1981). All of the children provided a rich pictorial representation of their faith that is unique to the African American culture. Furthermore, all of the children described God anthropomorphically and assigned other attributes of a friend or parent which differed from the Fowler study. These findings suggest that stages of faith development are specific to the African American culture and could be used to further investigate the phenomenon of childhood faith/spirituality within the constructs of the African American culture and world view. Furthermore, early childhood educators can improve classroom environments for these children by recognizing the significance of the faith factor as an integral cultural component. African American children operate within the construct of being connected to others and they are guided by the principal of community . These children probably thrive better in classrooms that provide opportunities for collaboration, working in small groups, discussing social justice issues as well as having generational experiences. These opportunities help the children develop a feeling of oneness which can have significant impact on their self esteem and ultimately have an impact on school achievement

The Impact of Interior Design on Hospital Cleaning: Can Good Design Decisions Help Cleaning Staff Achieve Better Outcomes?

Evidence- based design is commonly recognized as the best practice for the interior design of healthcare facilities. Research indicates that careful planning and design can have a positive effect on hospital staff and patient outcome. However, there is a lack of existing research on how interior design effects the cleaning of healthcare facilities. More research is needed to determine the impact of interior design specifically on the cleaning and maintenance personnel of our hospitals and clinics. If designers can make the important job of cleaning and disinfecting healthcare facilities easier then healthcare acquired infections can be reduced saving lives and billions of dollars per year. Advisor: Betsy S. Gab

Modern American Federalism: Defending a Dualist Approach to State-Federal Government Relations

One of the greatest tenets of what American founders called this experiment in democracy is the Constitutional standard of federalism. Those in the Continental Congress labored over the proper relationship of a people to its government and, thus, the proper size of government that this relationship implies. The tyranny from which the young republic sought independence just thirteen years before the drafting of the Constitution was a pervasive and seemingly omniscient one. The hand of the British Crown into the affairs of the common man was an instrument of autocratic control, rather than that of guiding protection. According to Constitutional scholar Craig R. Ducat, The centralization of governmental power breeds tyranny, where tyranny is essentially defined as the systematic exploitation of most of the populace by a narrow, self-serving few. It was this struggle that fostered the ideas of a limited and distant government. Quite plainly, the role of the American government was to protect the free exercise of liberty of its people, while keeping a safe distance. As long as taxes were collected by April 15, then there should be no cause for interference. Because of these founding sentiments of limited government, congressmen of the day felt it necessary to create a Constitutional standard for smaller institutions such as municipal and state-level government. These smaller institutions were to be left to the discretion of popularly elected state representatives in each geographically bound state, allowed to enforce its own laws and standards of social behavior. All the while, these states were to be subservient to the supremacy of the federal American Government. While exercising the freedom of self-government, states must also recognize the over-arching national supremacy. Some scholars note shifts between different eras of American jurisprudence, mostly seen in the differences of the Warren, Burger, and Rehnquist Courts from those of decades past. Specifically, constitutional academics note the distinction between two primary, competing practices of federalism. The first is dual federalism. More the Jeffersonian model, this layercake practice would consist of two equally powerful, mutually exclusive levels of government, the state and the national level. Using the textualist approach to Constitutional interpretation, many would argue in favor of a stronger reading of the Tenth Amendment. The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people. A stricter application of this text would imply very little use of the elastic clause (i.e. necessary and proper clause) to expand powers of the national government. As some would say, If, in the exercise of its enumerated powers, the national government happened to touch upon the functions reserved to the states, then the action of the national government was unconstitutional. Furthermore, the diffusion of power into lower-level systems allows the citizen greater opportunity for participation, and thus, a greater adherence to the republican ideal of self-government. The competing view - and what many would consider the dominant view of the last 70 to 80 years- is cooperative federalism. Focusing more on the urbanized, industrial society of the Hamiltonian model, cooperative federalism features more of a partnership between the national and state levels of government, which finds its strength in the supreme power of the centralized national government. In Ducat\u27s estimation, the nation\u27s growth out of Jefferson\u27s agrarian society necessitated a stronger national government to regulate a vast and trade-centered economy. Taking a nationalist approach, scholars argue that federalism in this sense is not a contract among states, but rather a means in which to form a more perfect union, composed of only one- the ultimate sovereign- the people. Comparable to the dualist\u27s limited use of the elastic clause, cooperative federalists tend to enlist a looser application of Article I, Section 8, in conjunction with a heavy reliance upon the supremacy clause (i.e. Article VI, Paragraph 2). Ducat asserts that a sort of pendular swing characterizes the last several decades of Court rulings on federalism, but he further asserts that while there have been recent dualist stirrings, he finds the dual-federalism argument to be obsolete and inappropriate. At issue in this analysis is the current standing of the notion of federalism in the American government. Research compiled here will use historical views of federalism decisions to determine what the modem context entails. Evaluating two recent cases, we can make an assumption about the future of American federalism. In essence, with the recent changes to those seated on the bench and shifts to domestic politics, what is to be expected of the current relationship of states\u27 rights versus federal supremacy? Could we expect a shift back toward more trust in the state system during this new era of the Roberts Court

Consider Collateral Consequences: The Inherent Hypocrisy of Veterans Treatment Courts’ Failure to Dismiss Criminal Charges

American veterans are often plagued by psychological and physical injuries, among other hardships, which, when unaddressed, can lead to substance abuse, criminal behavior, and suicide. As public awareness of the difficulties that American veterans face was growing, the problem-solving court movement was also gaining momentum. Largely inspired by therapeutic jurisprudence, an interdisciplinary framework that sees the law as a way to reach therapeutic outcomes, problem-solving courts seek to identify the root causes of criminal behavior and address those causes in ways that promote rehabilitation and reduce recidivism. Veterans Treatment Courts (“VTCs”) emerged when veterans advocacy intersected with the problem-solving court movement. This Note explores the origins, growth, and general structure of VTCs. Focusing on the legal implications for veterans who graduate from VTCs, this Note argues that leaving veterans with a criminal conviction directly contradicts the reasons the programs were created and exposes veterans to collateral consequences, only adding additional barriers to reintegration into American civil society

The Impact of Interior Design on Hospital Cleaning: Can Good Design Decisions Help Cleaning Staff Achieve Better Outcomes?

Evidence- based design is commonly recognized as the best practice for the interior design of healthcare facilities. Research indicates that careful planning and design can have a positive effect on hospital staff and patient outcome. However, there is a lack of existing research on how interior design effects the cleaning of healthcare facilities. More research is needed to determine the impact of interior design specifically on the cleaning and maintenance personnel of our hospitals and clinics. If designers can make the important job of cleaning and disinfecting healthcare facilities easier then healthcare acquired infections can be reduced saving lives and billions of dollars per year. Advisor: Betsy S. Gab

Emergency medical dispatch recognition, clinical intervention and outcome of patients in traumatic cardiac arrest from major trauma : an observational study

© Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.OBJECTIVES: The aim of this study is to describe the demographics of reported traumatic cardiac arrest (TCA) victims, prehospital resuscitation and survival to hospital rate. SETTING: Helicopter Emergency Medical Service (HEMS) in south-east England, covering a resident population of 4.5 million and a transient population of up to 8 million people. PARTICIPANTS: Patients reported on the initial 999 call to be in suspected traumatic cardiac arrest between 1 July 2016 and 31 December 2016 within the trust's geographical region were identified. The inclusion criteria were all cases of reported TCA on receipt of the initial emergency call. Patients were subsequently excluded if a medical cause of cardiac arrest was suspected. OUTCOME MEASURES: Patient records were analysed for actual presence of cardiac arrest, prehospital resuscitation procedures undertaken and for survival to hospital rates. RESULTS: 112 patients were reported to be in TCA on receipt of the 999/112 call. 51 (46%) were found not to be in TCA on arrival of emergency medical services. Of the 'not in TCA cohort', 34 (67%) received at least one advanced prehospital medical intervention (defined as emergency anaesthesia, thoracostomy, blood product transfusion or resuscitative thoracotomy). Of the 61 patients in actual TCA, 10 (16%) achieved return-of-spontaneous circulation. In 45 (88%) patients, the HEMS team escorted the patient to hospital. CONCLUSION: A significant proportion of patients reported to be in TCA on receipt of the emergency call are not in actual cardiac arrest but are critically unwell requiring advanced prehospital medical intervention. Early activation of an enhanced care team to a reported TCA call allows appropriate advanced resuscitation. Further research is warranted to determine which interventions contribute to improved TCA survival.Peer reviewedFinal Published versio

A novel method of non-clinical dispatch is associated with a higher rate of critical Helicopter Emergency Medical Service intervention

Background - Helicopter Emergency Medical Services (HEMS) are a scarce resource that can provide advanced emergency medical care to unwell or injured patients. Accurate tasking of HEMS is required to incidents where advanced pre-hospital clinical care is needed. We sought to evaluate any association between non-clinically trained dispatchers, following a bespoke algorithm, compared with HEMS paramedic dispatchers with respect to incidents requiring a critical HEMS intervention. Methods - Retrospective analysis of prospectively collected data from two 12-month periods was performed (Period one: 1st April 2014 – 1st April 2015; Period two: 1st April 2016 – 1st April 2017). Period 1 was a Paramedic-led dispatch process. Period 2 was a non-clinical HEMS dispatcher assisted by a bespoke algorithm. Kent, Surrey & Sussex HEMS (KSS HEMS) is tasked to approximately 2500 cases annually and operates 24/7 across south-east England. The primary outcome measure was incidence of a HEMS intervention.Results - A total of 4703 incidents were included; 2510 in period one and 2184 in period two. Variation in tasking was reduced by introducing non-clinical dispatchers. There was no difference in median time from 999 call to HEMS activation between period one and two (period one; median 7 min (IQR 4–17) vs period two; median 7 min (IQR 4–18). Non-clinical dispatch improved accuracy of HEMS tasking to a mission where a critical care intervention was required (OR 1.25, 95% CI 1.04–1.51, p = 0.02).Conclusion - The introduction of non-clinical, HEMS-specific dispatch, aided by a bespoke algorithm improved accuracy of HEMS tasking. Further research is warranted to explore where this model could be effective in other HEMS services.Peer reviewedFinal Published versio

¡Acierta con la metáfora! Las metáforas de los tratamientos contra el cáncer en la prensa inglesa y española

ABSTRACT: This study explores the use of metaphor in the presentation of cancer therapies in a corpus of 300 popularisation articles in four quality newspapers, The Guardian, The Times, El País and El Mundo, in the English and Spanish press. More specifically, it seeks to investigate the ways in which currently available cancer treatments are portrayed as opposed to those still under development. Metaphorically used words were identified primarily according to the "Metaphor Identification Procedure" MIP developed by the Pragglejaz Group (2007) but also taking into account the developments presented by the more elaborated procedure MIPVU. The analysis revealed three major source domains that conceptualise cancer treatment: WEAPON, GARMENT and FOOD AND COCKTAILS. Contextual analysis showed that these metaphors are often used by both journalists and scientists with persuasive and evaluative functions in the text.RESUMEN: Este estudio explora el uso de la metáfora en la presentación de terapias contra el cáncer en un corpus de 300 artículos de divulgación publicados en cuatro periódicos, The Guardian, The Times, El País y El Mundo, de la prensa inglesa y española. En concreto, se investiga la forma en la que los tratamientos actuales se presentan frente a los que siguen en desarrollo. Los términos empleados de forma metafórica se identificaron según el "Metaphor Identification Procedure" MIP desarrollado por el Grupo Pragglejaz (2007), teniendo en cuenta también las mejoras presentadas por el procedimiento más elaborado del MIPVU. El análisis muestra que se emplean tres dominios fuente en la conceptualización de los tratamientos contra el cáncer: ARMAS, ROPA y COMIDA Y CÓCTELES. Del análisis contextual se desprende que las metáforas son empleadas frecuentemente con una función persuasiva y evaluativa en los textos tanto por periodistas como científicos.This work was funded by the Spanish Ministerio de Economía y Competitividad, under the project Evidencialidad y epistemicidad en textos de géneros discursivos evaluativos. Análisis contrastivo y traduccion [ModevigTrad] (Evidentiality and epistemicity in texts of evaluative discourse genres. Contrastive analysis and translation), with reference number FFI2014-57313-P