The development of evidence-based guidelines to inform the extrication of casualties trapped in motor vehicles following a collision

Background Motor vehicle collisions (MVCs) are a common cause of injury and death throughout the world. Following an MVC some patients will remain in their vehicles due to injury, the potential for injury or physical obstruction. Extrication is the process of removing injured or potentially injured patients from vehicles following a motor-vehicle collision. Current extrication practices are based on the principles of 'movement minimisation' with the purpose of minimising the incidence of avoidable secondary spinal injury. Movement minimisation adds time to the process of extrication and may result in an excess morbidity and mortality for patients with time dependent injuries. The current extrication approach has evolved without the application of evidence-based medicine (EBM) principles. The principles of EBM; consideration of the relevant scientific evidence, patient values and preferences and expert clinical judgement are used as a framework for this thesis. Aims and Objectives To develop evidence-based guidance for the extrication of patients trapped in motor vehicles by applying EBM principles to this area of practice. This will be achieved through: - Describing the injury patterns, morbidity and mortality of patients involved in MVCs (trapped and not trapped). - To analyse the movement associated with and the time taken to deliver across a variety of extrication methods. - Determining the perceptions of patients who have undergone vehicle extrication and describe their experiences of extrication. - Developing consensus-based guidelines for extrication

Photosynthesis by the pericarp of developing cereal grain

Some photosynthetic properties of the chlorophyll containing layers of the immature cereal pericarp are described.The tissue was found to be capable of high rates of photosynthesis as determined by light dependent oxygen evolution. These rates were, however, reduced when isolated pericarps were used.The activity and kinetic properties of the enzyme phosphoenol pyruvate carboxylase (EC 4.1.1. 31) were investigated in some detail. In general enzyme activity followed chlorophyll content of the pericarp, although these results depended upon the exact conditions of plant growth. The dependence of enzyme activity on phosphoenol pyruvate and glucose 6 - phosphate concentration was investigated. The kinetic properties of the barley pericarp enzyme were found to be very similar to that from the maize leaf.The pericarp was found to contain high concentrations of phenols. These could be oxidised either in non-enzymic reactions by metal ions or enzymically by polyphenol oxidase. Thus extraction and reaction media were devised in which enzyme degradation by the products of phenol oxidation was minimised.The products of carbon dioxide fixation in isolated pericarps were in part identified, and resembled those reported for plants having the pathway. Further, the measured enzyme activities correlated with those found in plants with this pathway. The metabolic events leading to the synthesis of phosphoenol pyruvate remain unresolved

WHO Health Promotion Glossary: new terms

The WHO Health Promotion Glossary was written to facilitate understanding, communication and cooperation among those engaged in health promotion at the local, regional, national and global levels. Two editions of the Glossary have been released, the first in 1986 and the second in 1998, and continued revision of the document is necessary to promote consensus regarding meanings and to take account of developments in thinking and practice. In this update 10 new terms that are to be included in the Glossary are presented. Criteria for the inclusion of terms in the Glossary are that they differentiate health promotion from other health concepts, or have a specific application or meaning when used in relation to health promotion. The terms defined here are: burden of disease; capacity building; evidence-based health promotion; global health; health impact assessment; needs assessment; self-efficacy; social marketing; sustainable health promotion strategies, and; wellness. WHO will continue to periodically update the Health Promotion Glossary to ensure its relevance to the international health promotion communit

Addressing health literacy in patient decision aids

MethodsWe reviewed literature for evidence relevant to these two aims. When high-quality systematic reviews existed, we summarized their evidence. When reviews were unavailable, we conducted our own systematic reviews.ResultsAim 1: In an existing systematic review of PtDA trials, lower health literacy was associated with lower patient health knowledge (14 of 16 eligible studies). Fourteen studies reported practical design strategies to improve knowledge for lower health literacy patients. In our own systematic review, no studies reported on values clarity per se, but in 2 lower health literacy was related to higher decisional uncertainty and regret. Lower health literacy was associated with less desire for involvement in 3 studies, less question-asking in 2, and less patient-centered communication in 4 studies; its effects on other measures of patient involvement were mixed. Only one study assessed the effects of a health literacy intervention on outcomes; it showed that using video to improve the salience of health states reduced decisional uncertainty. Aim 2: In our review of 97 trials, only 3 PtDAs overtly addressed the needs of lower health literacy users. In 90% of trials, user health literacy and readability of the PtDA were not reported. However, increases in knowledge and informed choice were reported in those studies in which health literacy needs were addressed.ConclusionLower health literacy affects key decision-making outcomes, but few existing PtDAs have addressed the needs of lower health literacy users. The specific effects of PtDAs designed to mitigate the influence of low health literacy are unknown. More attention to the needs of patients with lower health literacy is indicated, to ensure that PtDAs are appropriate for lower as well as higher health literacy patients

Development Of Protocols For Determining Deleterious Material Content In Crushed Recycled Glass

Glass recycling appears to be a viable way to reduce waste; however, there are many challenges to ensuring the recycled product has an economically and environmentally sustainable end use. Cleaning recycled glass to a standard that allows it to be melted down into new glass is extremely difficult when single-stream recycling is in practice. The recycled glass that is not melted down is processed into different materials, such as processed glass aggregate (PGA). As states implement bans on landfilling recyclable materials (e.g., Act 148 in Vermont), additional uses for PGA are needed. In New England, there are diminishing sources of sand borrow that meet Vermont’s specifications, causing an increase in prices (Hedges, 2009). At the same time, recycling facilities can produce a sand-sized PGA that may be able to replace or supplement sand borrow as a construction material. One major concern for end users of PGA is the deleterious (i.e., non-glass) material present after separating and crushing glass at a recycling facility, which may have a negative effect on geotechnical properties or cause environmental harm. Despite the potential benefits of using PGA as a construction material, limited research has been conducted on how to accurately determine the amount of deleterious materials in PGA. The goal of this research is to develop a protocol for quantifying total deleterious material content of PGA. The specific objectives were to (1) research, develop, and evaluate a variety of processes to determine deleterious material content in PGA; (2) validate the effectiveness of individual processes using lab-manufactured PGA (LM-PGA) samples with known amounts and type of deleterious material; and (3) recommend a reliable and simple protocol (i.e., sequential processes) to determine deleterious material content for operational purposes. Four main mass removal processes were identified for determining deleterious material content in PGA: (1) magnet process, (2) float and skim process, (3) furnace process, and (4) acid washing process. The precision and accuracy of each process in determining deleterious material content was tested using LM-PGA containing known amounts of deleterious materials (i.e. plastics, papers, metals, ceramics, and food organics). Two protocols combining multiple processes were developed. Protocol 1 determined overall deleterious material content using a magnet process followed by a furnace process. Protocol 2 sought to estimate plastics content only using a magnet process and float and skim process. Protocol 1 and Protocol 2 were tested on LM-PGA containing multiple deleterious materials and recycling facility PGA (RF-PGA), provided by a local recycling facility. Protocol 1 was found to be precise and accurate for determining overall deleterious material content of PGA. While Protocol 2 provided a good estimate of plastic content in LM-PGA, it was unable to determine plastic content in recycling facility PGA due to the floated material containing large quantities of glass, organics, and plastics. Further work should focus on developing an improved method for determining the plastics content of PGA

Challenges and Opportunities: What Can We Learn from Patients Living with Chronic Musculoskeletal Conditions, Health Professionals and Carers about the Concept of Health Literacy Using Qualitative Methods of Inquiry?

The field of health literacy continues to evolve and concern public health researchers and yet remains a largely overlooked concept elsewhere in the healthcare system. We conducted focus group discussions in England UK, about the concept of health literacy with older patients with chronic musculoskeletal conditions (mean age = 73.4 years), carers and health professionals. Our research posed methodological, intellectual and practical challenges. Gaps in conceptualisation and expectations were revealed, reiterating deficiencies in predominant models for understanding health literacy and methodological shortcomings of using focus groups in qualitative research for this topic. Building on this unique insight into what the concept of health literacy meant to participants, we present analysis of our findings on factors perceived to foster and inhibit health literacy and on the issue of responsibility in health literacy. Patients saw health literacy as a result of an inconsistent interactive process and the implications as wide ranging; healthcare professionals had more heterogeneous views. All focus group discussants agreed that health literacy most benefited from good inter-personal communication and partnership. By proposing a needs-based approach to health literacy we offer an alternative way of conceptualising health literacy to help improve the health of older people with chronic conditions

49 Paediatric traumatic cardiac arrest - the development of a treatment algorithm

© 2017, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions. INTRODUCTION: Paediatric Traumatic Cardiac Arrest (TCA) is a high acuity, low frequency event with fewer than 15 cases reported per year to the Trauma Audit Research Network (TARN). Traditionally survival from TCA has been reported as low, with some believing resuscitation is futile. Within the adult population there is growing evidence to suggest that with early and aggressive correction of reversible causes, survival from TCA may be comparable to that seen from medical out-of-hospital cardiac arrests. Key to this survival has been the adoption of a standardised approach to resuscitation.The aim of this study was, by a process of consensus, to develop a national, standardised algorithm for the management of paediatric TCA.METHODS: A modified consensus development meeting was held. Statements discussed in the meeting were drawn from those that did not reach consensus (positive/negative) from a linked three round online Delphi study. Those participants completing the first round of the Delphi study were invited to attend.19 statements relating to the diagnosis, management and futility of paediatric TCA were discussed in small groups. After five minutes the key points from the small groups were presented to the whole audience. Subsequently, using electronic voting devices, each participant anonymously recorded their agreement with the statement using 'yes', 'no' or 'don't know'. In keeping with our Delphi study, consensus was set a priori at 70%. Statements reaching consensus were included in the proposed algorithm.RESULTS: 41 participants attended the consensus development meeting. Of the 19 statements discussed, 13 reached positive consensus and were included in the algorithm. A single statement regarding initial rescue breaths reached negative consensus and was excluded. Consensus was not reached for five statements, including the use of vasopressors and thoracotomy for haemorrhage control in blunt trauma. The proposed algorithm for the management of paediatric TCA is shown as Figures 1 and 2 for blunt and penetrating trauma respectively.emermed;34/12/A892-b/F1F1F1Figure 1emermed;34/12/A892-b/F2F2F2Figure 2 CONCLUSION: In attempt to standardise our approach to the management of paediatric TCA and to improve outcomes, we present the first algorithm specific to the paediatric population

Health Literacy in Context—Settings, Media, and Populations

To date, most published health literacy research has focused on assessing and improving personal skills and abilities. More recently, a better understanding has emerged of the extent to which these skills and abilities are mediated by environmental demands and situational complexities — the context in which health literacy is developed and applied. This has led to much greater attention being given to ways of reducing the situational demands and complexity in which an individual makes a health decision. This collection of papers examines current progress in understanding health literacy "in context", by improving our understanding of the mutual impact of a range of social, economic, environmental, and organisational influences on health literacy. These papers provide unique and original perspectives on the concept, distribution, and application of health literacy in very diverse populations, offering cultural insights and a clear indication of the impact of social and environmental context on health literacy. These perspectives include an examination of differing national policy responses to health literacy illustrating how policy and practice can (and should) respond to this more complete but complex understanding of health literacy. Other papers look at the application of new digital media and the creative harnessing of popular culture as routes to extend the reach and customisation of communications. These papers also illustrate good progress in the evolution of research in the contexts in which health literacy is developed and applied, as well as signaling some areas in which more research would be useful