bluuebunny/crossref_metadata_2025 huggingface dataset:
PP18 Implementation of electronic patient clinical records in ambulances in the UK: a national survey
Authors: Williams Victoria , LaFlamme-Williams Yvette , McNee Katie , Morgan Heather , Morrison Zoe , WW Potts Henry , Shaw Debbie , Siriwardena Niro , Snook Helen , Spaight Rob , Porter Alison
Published: April 2019

Background

The roll-out of electronic Patient Clinical Records (ePCR) across UK ambulance services has been an important aspect of modernisation. Electronic Records in Ambulances (ERA) is a two-year study which aims to describe the opportunities and challenges of implementing ePCR and associated technology in emergency ambulances.

Our study includes a baseline survey of progress implementing ePCR in all UK ambulance services providing a snapshot of current usage.

Methods

We carried out semi-structured telephone interviews with information managers in each ambulance service in the UK. We asked them about the systems in use, the process and current stage of implementation and explored the perceived value of using ePCR. If services did not use ePCR we asked about plans for future introduction.

The interviews were transcribed and thematically analysed, by three members of the research team.

Results

We completed interviews with 22 managers from 13 services. Implementation varied across the UK. Seven services were using electronic records. Four services had adopted electronic records but, at the time of interview, had reverted to paper with the intention of implementing a new ePCR. Two services still used paper but hoped to move to ePCR in the future. Those who had fully implemented ePCR reported mixed success in terms of staff compliance, and in realising the potential benefits offered by ePCR to link with primary and secondary care.

Reported benefits of ePCR were largely associated with improved data management for audit and record keeping. Potential improvements to patient care were discussed, but tended to be associated with future planned developments.

Implications

Implementation of ePCR has proved challenging with wide variation in use between ambulance services. Progress has been erratic, rather than linear, demonstrated by difficulties that services experienced putting ePCR into practice. There is potential for ambulance services in the earlier stages of implementation to learn from the experiences of others.
02 Women’s experience of unplanned out-of-hospital birth in paramedic care
Authors: Flanagan Belinda , Lord Bill , Reed Rachel , Crimmins Gail
Published: April 2019

Background

Paramedics assess, treat and transport labouring women who require intrapartum care in the out-of-hospital setting, yet very little is known about the experiences of mothers who birth whilst being supported by paramedics. Internationally, the healthcare literature describes predisposing factors, clinical risk and maternal and neonatal clinical outcome. However, there is little quality research available that explores the care provided by paramedics or that describes the views of women with recent experience of birth involving paramedic care.

Methods

Through narrative inquiry this study utilised a feminist approach to explore the experiences of women who birth in paramedic care, their care needs, and the physical, emotional and psychosocial issues surrounding these cases.

Results

22 narrative interviews with women who birthed in paramedic care in Australia within the last 5 years were undertaken. This identified a series of factors that contributed to the planned hospital birth occurring in the out-of-hospital setting. The Results identified the themes: Birth Knowledge, The Birth Experience and Reflections on Birth. Women in this study began their story by discussing previous birth experience and their knowledge and personal beliefs concerning the birth process. Women described their previous interactions with maternity care providers and issues that caused them to delay attending hospital. Specific to the birth event, women reported feeling empowered, confident and exhilarated during the birth. However, they also identified concerns with paramedics not providing privacy, having poor interpersonal skills, a lack of consent for procedures, feeling judged and issues related to bonding.

Conclusion

This study identified a series of factors that contribute to the planned hospital birth occurring in the out-of-hospital setting. Women described various deficiencies in the antenatal and intrapartum care received by maternity services in Australia. Women also described opportunities for improvement in the care provided by paramedics, specifically deficiencies in technical and non-technical skills.
PP20 Exploring the knowledge, attitudes, and behaviour of the general public to responding to out-of-hospital cardiac arrest
Authors: Dobbie Fiona , Clegg Gareth , Marie MacKintosh Anne , Bauld Linda
Published: April 2019

Background

Bystander Cardio-Pulmonary Resuscitation (CPR) is a key determinant of survival after Out-of-Hospital Cardiac Arrest (OHCA) but is performed at only around half of OHCA in UK. This study collected data to inform a social marketing strategy to address the barriers to responding to OHCA.

Methods

A representative sample (n=1027) of Scottish adults aged 16 and over were included in a general population face-to-face omnibus survey in 2015.

Results

We identified three factors associated with knowledge, experience, and attitudes toward bystander CPR.Age –the older a person is, the less likely they were to be CPR trained and show willingness to be CPR trained. They were also more likely to have had CPR training more than five years previously and be the least confident to administer bystander CPR. These findings are particularly relevant considering that most OHCA happen in the homes of older people.Social grade– people in professional managerial and non-manual occupations were more likely than those in manual, unskilled occupations and long-term unemployed people to be CPR trained and be more confident to administer CPR if talked through by a call handler.Working status –people who were working were more likely to be CPR trained, be trained more recently and show higher levels of confidence to administer CPR. Barriers cited for not administering CPR were not having the skills or confidence to give CPR, fear of making things worse or of being sued.

Conclusions

Future social marketing strategies to improve bystander CPR should address the barriers to administering CPR by building confidence and addressing myths/fears.
PP22 Sandpiper wildcat project – saving lives after out-of-hospital cardiac arrest in rural grampian
Authors: Fickling Keri , Clegg Gareth , Jensen Keith , Donaldson Lorna , Laird Colville , Bywater Dave
Published: April 2019

Background

Recent analysis shows a higher risk of death after Out of Hospital Cardiac Arrest (OHCA) for patients who lived in rural areas of UK in casemix adjusted comparison with urban areas. Sandpiper Wildcat is an action research project aiming to increase survival rates through the implementation of a novel network of trained responders in rural Grampian.

Methods

After using historic data to identify 50 locations with poor response times but significant numbers of OHCA we established teams of trained volunteer responders equipped with automatic external defibrillators (AED 3, Zoll) and Vehicle Locator Systems. Responders were trained and made available for dispatch to OHCA by ambulance control. In addition to real time CPR quality feedback the AED 3 also records ECG, compression metrics and audio of the incident for analysis and debrief.

Results

Around 500 responders were successfully trained and deployed in 53 rural locations during the first 6 months. They were mobilised to 109 OHCA, arriving on scene an average of 7 min (−15 to 48 mins) before Scottish ambulance service resources. Analysis of metrics from defibrillator downloads showed high quality resuscitation. In addition there were many reports of significant ‘added value’ to patients, families and Scottish Ambulance Service staff as a result of Sandpiper Wildcat responders’ attendance. Responders replied overwhelmingly positively to debrief questions ‘did you feel of value at scene’ and ‘do you feel you made a difference’, all indicated that they would be willing to respond again.

Conclusions

Sandpiper Wildcat project has reduced the response time to OHCA in rural Grampian and increased the number of responders at each OHCA. Responders have delivered high quality BLS and provided assistance to SAS personnel. Further analysis will examine the spread and sustainability of this approach in rural UK and the longer term impact on clinical outcomes.
PP23 Linking pre-hospital out-of-hospital cardiac arrest data to in-hospital outcomes in order to improve the ‘chain of survival’
Authors: Halbesma Nynke , Clegg Gareth , Bijman Laura , Lynch Ellen , Clarke Scott , Bywater David
Published: April 2019

Background

A first step to improving outcomes after Out-of-hospital cardiac arrest is to measure the performance of the local ‘Chain of Survival’. Ambulance services routinely report the number of OHCA where resuscitation is attempted, but lack access to outcome data such as survival to hospital discharge. Our novel data linkage project has been developed to inform the implementation of UK’s strategy for OHCA and provide insight into both short- and long-term patient outcomes.

Methods

Scottish Ambulance Service data was used to identify OHCA incidents where resuscitation was attempted between 2011–2015. OHCA incidents were then probabilistically matched to a range of administrative datasets based on Community Health Index (CHI) linkage. The data were stored and accessed through a Safe Haven where it was used to determine baseline characteristics of the ‘Chain of Survival’ in UK.

Results

Around 3,000 OHCA cases per year were identified with around 6.2% survival to hospital discharge. Of all cases 73.2% could be linked with other datasets such as hospital data (SMR01 and intensive care data), deaths data and SPARRA (comorbidities). This resulted in a rich dataset including a range of demographics, survival and clinical performance measures. Logistic regression models showed that a higher age, male gender and living in a socially deprived area are associated with a higher risk of an OHCA. Higher age and living in a rural or socially deprived area are also associated with an increased mortality risk.

Conclusions

Our data set the scene for the implementation of UK’s Strategy for OHCA providing insight into the performance of whole ‘Chain of Survival’. It offers the opportunity to identify priority areas for improvement and track impact of strategy implementation.
PP29 Paramedics’ experiences of administering fascia iliaca compartment block to patients with suspected hip fracture
Authors: Evans Bridie , Brown Alan , Bulger Jenna , Fegan Greg , Ford Simon , Guy Katy , Jones Sian , Keen Leigh , Khanom Ashrafunnesa , Pallister Ian , Rees Nigel , Russell Ian , Seagrove Anne , Snooks Helen
Published: April 2019

Background

Routine pre-hospital pain management for hip fracture is inadequate, with risk of potentially fatal complications, particularly from morphine. Fascia Iliaca Compartment Block (FICB) is used in Emergency Department and orthopaedic wards. The RAPID trial tested feasibility of paramedics administering FICB to patients with suspected hip fracture at the scene of injury.

Objective

To explore paramedics’ experience of delivering FICB pre-hospitally.

Methods

We held three focus groups with 11 paramedics serving one district hospital, audio-recorded with participants’ consent. We conducted thematic analysis of interview transcripts. Two researchers, one paramedic and one lay member were in the analysis team.

Results

Respondents believed FICB was a suitable intervention for paramedics to deliver. It aligned with their routine practice and was within people’s capabilities to administer, they reported. They said it took up to 10 min longer than usual care to prepare and deliver, in part due to nervousness and unfamiliarity with a new procedure. They praised the training provided but said they were anxious about causing harm by injecting into the wrong location. Confidence increased after one paramedic team successfully treated a patient for toxic reaction. Reported challenges related to the emergency context: patients often waited many hours for ambulance arrival; they sometimes needed to be moved from awkward locations which exacerbated pain; family and neighbours were present as paramedics administered treatment. Most respondents treated few or just one patient with FICB. Although uncertain whether FICB reduced patients’ pain more effectively than other pain relief options, respondents believed it was safer for elderly people at risk of pneumonia.

Conclusions

Paramedics are willing and able to administer FICB to patients with suspected hip fracture before ambulance transport to hospital. Feasibility study findings will inform a research proposal for a definitive multi-centre trial of paramedic administered prehospital FICB.
03 The use of scratchcards for allocation concealment and treatment allocation in a prehospital randomised controlled trial
Authors: Keen Leigh , Bulger Jenna , Rees Nigel , Snooks Helen , Fegan Greg , Ford Simon , Evans Bridie , Longo Mirella
Published: April 2019

Background

RAPID (Rapid Analgesia for Prehospital Hip Disruption) study was a small study to determine the feasibility of undertaking a randomised controlled trial to test the clinical and cost-effectiveness of paramedics administering Fascia Iliaca Compartment Block (FICB) as early pain relief to patients who have fractured a hip at the scene of their injury.

Objectives

To devise a simple and effective method of random allocation concealment suitable for use by Paramedics whilst in the mobile emergency prehospital setting.

Methods

Traditional Methods of randomly allocating patients were considered, however none were suitable for paramedics to use during their shift. Scratchcards have been used successfully in other studies, though not prehospitally to our knowledge. Scratchcards were produced using scratch-off silver stickers which concealed the trial arm allocation. Paramedics were each allocated a unique range of consecutive numbers, used as both the scratchcard number and patient’s study ID. The cards were designed to allow the paramedic to write on the incident number, date and signature. A small envelope holding the cards was prepared for each paramedic.

Results

Nineteen trial paramedics used 71 scratchcards throughout the study and reported no problems randomly allocating patients using the scratchcards. Five protocol deviations reported in relation to scratchcard use. On auditing the scratchcards, all unused cards were located and no evidence of tampering with the silver panel was found.

Conclusion

Paramedics can use scratchcards as a method of randomly allocating patients in trials in prehospital care. In future a method that allows only the top card to be selected should be sought. Also a more protective method of storing the cards should be used. Scratchcards can be considered for wider use in randomised controlled trials in the emergency prehospital setting.
PP31 Data awareness for sending help (DASH): policy opportunities & challenges
Authors: Drake Archie , Pollitt Alex , Smith Leanne , Sklar Elizabeth
Published: April 2019

Background

The DASH project is a collaboration between King’s College London and the London Ambulance Service (LAS). Its goal is to explore the potential impact of integrating new and emerging data sources and technologies on emergency response, using technical and policy approaches in tandem. Computer science and public health both emphasise dynamic systems thinking in which elements should be connected to others, e.g. ‘data linkage’, ‘health in all policies’. EMS research has started to demonstrate the value of connecting LAS information systems to transport and environmental as well as emergency department data. Policy research question: what are the opportunities and challenges for EMS, wider healthcare providers and the public in the integration of new and emergent data sources and technologies in ambulance dispatch?

Methods

Mixed Methods study, including literature review, framework analysis, stakeholder and process mapping, open policy development and interviews. Primary data collection (thematic analysis) entails approximately: 15 semi-structured interviews with LAS staff and 60 unstructured interviews with a variety of stakeholders. Secondary data analysis of LAS incident and response datasets over calendar year 2016 with other publicly available administrative data.

Results

A wide range of new and emergent data sources have a potential impact on ambulance dispatch decision-making. The opportunities extend beyond the operational level into tactical and strategic dimensions. But the challenges are significant across a range of perspectives, impeding efforts to realise the benefits in practice. The study suggests a prioritisation of new and emergent data sources and technologies for LAS based on a utility/feasibility matrix which is presented to provoke discussion.

Conclusions

More effective, dynamic ‘data aware’ dispatch systems are likely to improve patient outcomes. Ambulance services can usefully raise awareness to seek the necessary data and support – simultaneously furthering health system integration and wider public health goals. See https://dash.kcl.ac.uk/reports/ for project outputs.
OP6 An investigation into suicide amongst ambulance service staff
Authors: Hird Kelly , Bell Fiona , Mars Becky , James Catheryn , Gunnell David
Published: April 2019

Background

In 2015, Ambulance Service Medical Directors raised concerns regarding a perceived increase in suicide deaths among ambulance service staff. The Association of Ambulance Chief Executives (AACE) then commissioned a research study to investigate these concerns and provide recommendations towards a suicide prevention strategy. The aim of this study was to determine whether staff who work in the UK ambulance services (AS) are at higher risk of suicide than staff who work in other professions.

Methods

Data was requested from the Office for National Statistics (ONS) regarding AS staff suicide. Eighteen AS were invited to return data on Occupational Health (OH). AS in England and Wales (n=11) were also asked to return data on staff suicides. Coroners were contacted to request permission to review the records of the deaths.

Results

The ONS analysis of occupational suicide risk between 2011 and 2015 indicated that there were 20 suicide deaths amongst paramedics in England during that period. The risk of suicide amongst male paramedics was 75% higher than the national average.

Over a 2 year period, 8 AS trusts identified 15 staff suicides (11 male, 4 female). The mean age of those dying by suicide was 42 years. Findings from coroners’ records indicated that the predominant suicide method used was hanging (66.7%).

Conclusions

The following recommendations have been accepted by the AACE: a) Develop a mental health strategy for all staff which includes specific emphasis on suicide prevention b) Review and assess suicide risk at times of increased vulnerability c) Collect and monitor data on AS suicides d) Review occupational health, counselling and support services e) Training for staff in identifying and responding to a colleague in distress f) Return to work discussions should consider and establish the status of an individual’s mental health and wellbeing.
PP8 Paramedic views and experiences of the ethical considerations in ambulance based clinical trials: an interview study
Authors: Armstrong Stephanie , Langlois Adele , Siriwardena Niroshan
Published: April 2019

Background

Prehospital ambulance based research has unique ethical considerations due to urgency, time-limitations and the locations (home, ambulance) involved. We sought to explore these issues through interviews with paramedics that have research experience.

Methods

We undertook semi-structured interviews with paramedics, seeking their views and experiences of undertaking research in ambulance based clinical trials. Participants were purposively chosen because they were actively involved research and had enrolled one or more patients into a clinical trial. Participants were questioned regarding their experiences of the enrolment and consent process, and their opinions regarding the facilitators and barriers to ambulance based research. Transcripts were digitally recorded, transcribed verbatim, and analysed thematically.

Results

We interviewed 15 paramedics. They ranged from newly qualified to experienced advanced paramedics. Mental capacity and consent were discussed and the time and complexity for undertaking these processes were highlighted. Participants discussed problems with completing paperwork due to the complexity of recording systems. Most highlighted paramedic training and experience as a potential barrier to research, stating that those that had gone through a university education in general seemed more open to research than those that had ‘learnt on the job’. It was also felt that more information on the benefits of a trial to both patients and practice were needed from the outset to allow paramedics to make an informed decision about whether to take part in research or not. Several stated that they did additional reading around the subject before signing up. All stated that the training given prior to commencing the research was good and appropriate to each trial.

Conclusions

We identified patient capacity and consent, paramedic training and experience and complexity of processes as important potential barriers to prehospital research. There is scope to improve guidance for prehospital research studies in future.
PP9 A systematic review and meta-analysis of pre-hospital diagnostic accuracy studies
Authors: Wilson Caitlin , Harley Clare , Steels Stephanie
Published: April 2019

Background

Pre-hospital clinicians are involved in examining, treating and diagnosing patients. The accuracy of pre-hospital diagnoses is evaluated using diagnostic accuracy studies. We undertook a systematic review of published literature to provide an overview of how accurately pre-hospital clinicians diagnose patients compared to hospital doctors. A bivariate meta-analysis was incorporated to examine the range of diagnostic sensitivity and specificity.

Methods

We searched MEDLINE, CINAHL, Embase, AMED and the Cochrane Database of Systematic Reviews from 1946 to 7th May 2016 for studies where patients had been given a diagnosis by pre-hospital clinicians and hospital doctors. Key words focused on study type (‘diagnostic accuracy’), outcomes (sensitivity, specificity, likelihood ratio?, predictive value?) and setting (paramedic*, pre-hospital, ambulance, ‘emergency service?’, ‘emergency medical service?’, ‘emergency technician?’). The sole researcher screened titles and abstracts to ensure eligibility criteria were met, as well as assessing methodological quality using QUADAS-2.

Results

2941 references were screened by title and/or abstract. Eleven studies encompassing 3 84 985 patients were included after full-text review. The types of diagnoses in one of the studies encompassed all possible diagnoses and in the other studies focused on sepsis, stroke and myocardial infarction. Sensitivity estimates ranged from 32%–100% and specificity estimates from 14%–100%. Eight of the studies were deemed to have a low risk of bias and were incorporated into a meta-analysis, which showed a pooled sensitivity of 0.74 (0.62, 0.82) and a pooled specificity of 0.94 (0.87, 0.97).

Conclusions

Current published research suggests that diagnoses made by pre-hospital clinicians have high sensitivity and even higher specificity. However, the paucity and varying quality of eligible studies indicates that further pre-hospital diagnostic accuracy studies are warranted especially in the field of non-life-threatening conditions and trauma.
Five-year costs from a randomised comparison of bilateral and single internal thoracic artery grafts
Authors: Little Matthew , Gray Alastair , Altman Doug , Benedetto Umberto , Flather Marcus , Gerry Stephen , Lees Belinda , Murphy Jacqueline , Campbell Helen , Taggart David
Published: April 2019

Background

The use of bilateral internal thoracic arteries (BITA) for coronary artery bypass grafting (CABG) may improve survival compared with CABG using single internal thoracic arteries (SITA). We assessed the long-term costs of BITA compared with SITA.

Methods

Between June 2004 and December 2007, 3102 patients from 28 hospitals in seven countries were randomised to CABG surgery using BITA (n=1548) or SITA (n=1554). Detailed resource use data were collected from the initial hospital episode and annually up to 5 years. The associated costs of this resource use were assessed from a UK perspective with 5 year totals calculated for each trial arm and pre-selected patient subgroups.

Results

Total costs increased by approximately £1000 annually in each arm, with no significant annual difference between trial arms. Cumulative costs per patient at 5-year follow-up remained significantly higher in the BITA group (£18 629) compared with the SITA group (£17 480; mean cost difference £1149, 95% CI £330 to £1968, p=0.006) due to the higher costs of the initial procedure. There were no significant differences between the trial arms in the cost associated with healthcare contacts, medication use or serious adverse events.

Conclusions

Higher index costs for BITA were still present at 5-year follow-up mainly driven by the higher initial cost with no subsequent difference emerging between 1 year and 5 years of follow-up. The overall cost-effectiveness of the two procedures, to be assessed at the primary endpoint of the 10-year follow-up, will depend on composite differences in costs and quality-adjusted survival.

Trial registration number

ISRCTN46552265
Pericardial diseases in patients with hypothyroidism
Authors: Chahine Johnny , Ala Chandra K , Gentry James L , Pantalone Kevin M , Klein Allan L
Published: April 2019

Hypothyroidism is a well-known cause of pericardial effusion (with an incidence of 3%–37%) and can cause cardiac tamponade in severe cases. In this review, we present the current knowledge on the epidemiology of hypothyroid-induced pericardial diseases, the mechanism through which low thyroid hormone levels affect the pericardium, the associated clinical manifestations, diagnostic tests and management options. Hypothyroidism causes pericardial effusion through increased permeability of the epicardial vessels and decreased lymphatic drainage of albumin, resulting in accumulation of fluid in the pericardial space. Interestingly, autoimmunity does not seem to play a major role in the pathophysiology, and a majority of effusions are asymptomatic due to slow fluid accumulation. The diagnosis is generally made when the pericardial disease is associated with an elevated thyroid-stimulating hormone level, and other secondary causes are excluded. Management consists of thyroid replacement therapy, along with pericardial drainage in case of tamponade.

In conclusion, hypothyroidism-induced pericardial diseases are underdiagnosed. Initiating treatment early in the disease process and preventing complications relies on early diagnosis through systematic screening per guidelines.
Paediatric window falls and interannual temperature variability in the Seattle metro area
Authors: Sellers Samuel P , Johnston Brian D , Hess Jeremy J
Published: April 2019

We explore whether the timing and burden of paediatric window fall injuries in the Seattle area have changed with higher temperatures and increased air conditioning (AC) prevalence. Using hospital trauma registry records from 2005 to 2017, along with population estimates from the National Center for Health Statistics, we calculate trauma incidence rates from paediatric window falls. Using local temperature data, we explore the relationship between temperature increases over time and the seasonality and rate of incidents. Window falls are a substantial cause of injury among children, with an annual trauma incidence rate among children age 0–8 of 10.4 per 100 000 boys and 5.9 per 100 000 girls in our sample. We find a mildly positive trend in the crude rate of window falls over the study period, increasing further when a population-level adjustment for AC prevalence is included. We do not find evidence of earlier injury timing during the calendar year.
Iron deficiency in heart failure with preserved ejection fraction: a systematic review and meta-analysis
Authors: Beale Anna L , Warren Josephine Lillian , Roberts Nia , Meyer Philippe , Townsend Nick P , Kaye David
Published: April 2019

Objective

Iron deficiency (ID) has an established impact on outcomes in patients with heart failure with reduced ejection fraction; however, there is a lack of conclusive evidence in patients with heart failure with preserved ejection fraction (HFpEF). We sought to clarify the prevalence and impact of ID in patients with HFpEF.

Methods

A systematic search of Cohcrane, MEDLINE, EMBASE, Web of Science and CINAHL electronic databases was performed to identify relevant studies. Included studies defined HFpEF as heart failure with an ejection fraction ≥50%. We used a random-effects meta-analysis to determine the composite prevalence of ID in patients with HFpEF across the included studies. Other outcomes were assessed with qualitative analysis due to a paucity of studies with comparable outcome measures.

Results

The prevalence of ID in the included studies was 59% (95% CI 52% to 65%). ID was associated with lower VO2max in three of four studies reporting VO2max as an outcome measure, lower functional status as determined by dyspnoea class or 6 min walk test in two of three studies, and worse health-related quality of life in both studies reporting on this outcome. Conversely, ID had no impact on death or hospitalisation in three of the four studies investigating this.

Conclusions

ID is highly prevalent in patients with HFpEF and is associated with worse exercise capacity and functional outcomes, but not hospitalisation or mortality. Our study establishes that ID may play an important a role in HFpEF.
A performance evaluation of surplus production models with time-varying intrinsic growth in dynamic ecosystems
Authors: Nesslage Geneviève M. , Wilberg Michael J.
Published: April 2019

We conducted a simulation study to evaluate performance of surplus production models (SPMs) with a time-varying intrinsic growth rate (SPMTVr) for stocks with predation-driven changes in productivity. Data sets were simulated using an age-structured, linked, predator–prey model of Atlantic menhaden (Brevoortia tyrannus), a forage fish native to the Northwest Atlantic, and Atlantic striped bass (Morone saxatilis), its primary predator, with differing time series of fishing mortality on both predator and prey. Simulations generated test data sets for Atlantic menhaden SPMs that included either a static or time-varying intrinsic growth rate parameter. The SPMTVr largely produced more accurate, less variable estimates of exploitation rate and biomass than models with static intrinsic growth. We also applied SPMTVr to empirical Atlantic menhaden catch and survey data for 1964–2016. The SPMTVr fit the survey data well, estimated an intrinsic growth rate time series that mirrored long-term juvenile survey trends, and produced biomass and exploitation rate trends that mirrored a statistical catch-at-age model. The SPMTVr estimated dynamic, maximum sustainable yield (MSY)-based reference points that reflected changing stock productivity.
A Short Introduction to Procedural Content Generation Algorithms for Videogames
Authors: Barriga Nicolas A.
Published: April 2019

One of the main costs of developing a videogame is content creation. Procedural Content Generation (PCG) can help alleviate that cost by algorithmically generating some of the content a human would normally produce. We first describe and classify the different types of content that can be automatically generated for a videogame. Then, we review the most prominent PCG algorithms, focusing on current research on search-based and machine learning based methods. Finally, we close with our take on the most important open problems and the potential impact solving them will have on the videogame industry.
INTERFACIAL AND TENSILE PROPERTIES OF HYBRID FRP COMPOSITES USING DNN STRUCTURE WITH OPTIMIZATION MODEL
Authors: BASEER AHMED ABDUL , RAVI SHANKAR D. V. , HUSSAIN M. MANZOOR
Published: April 2019

Fiber reinforced polymer (FRP) composites are appealing for use in structural building applications because of their high strength-to-weight and stiffness-to-weight proportions, corrosion resistance, lightweight, possibly high durability, along with free design characteristics. The aim of this research work was to develop high strength natural fiber-based composite plates for the possible application in the shear strengthening of the reinforced concrete structure. In the experimental modeling, the composites were fabricated using glass, flax and kenaf fibers in treated and untreated conditions. This paper studied and analyzed the interfacial and tensile properties of fiber reinforced hybrid composites such as flax/glass and kenaf/glass by using the simulation approach, i.e. Deep Neural Network (DNN) with weight optimization. For optimizing the weights in DNN, Oppositional based FireFly Optimization (OFFO) is proposed. All the optimal results exhibit in the way that the accomplished error values between the output of the experimental values and the predicted qualities are firmly equivalent to zero in the designed system.
BIOMECHANICAL ANALYSIS TO VERIFY THE BUTTRESS THEORY WHEN USING THE ANATOMICAL THIN TITANIUM MESH PLATE FOR ZYGOMATICOMAXILLARY COMPLEX BONE FRACTURE
Authors: WANG YU-TZU , WANG PO-FANG , CHEN CHIEN-TZUNG , CHEN CHIH-HAO , LIN CHUN-LI
Published: April 2019

Objective: The aim of this study was to investigate the biomechanics of the facial skeletal for understanding the buttress after fixation with standard and modified anatomical thin titanium mesh (ATTM) plates by finite element (FE) analysis. Methods: Standard ATTM (SATTM) plate designed as the “L”-shape anticipated to be fixed in the ZMC anterior maxilla and lateral buttress to increase the fixation screw anchoring strength and another modified ATTM (MATTM) plate with a protrusion in the medial side and a slot and barb design in the lateral side to enhance the zygomaticomaxillary/nasomaxillary buttresses and provide precise positioning to the ZMC segments were studied by the FE analysis under masticatory forces with 250[Formula: see text]N. Result: The FE simulation results indicated that the total displacement distribution of the maxillary for ZMC fracture fixation with MATTM plate was smaller than that of SATTM plate. Stress concentration was found at the frontal and alveolar processes of the maxillary bone for SATTM plate fixation. Local vector plots of the first principal stress near the frontal process of the maxillary and zygomaticofacial formen of the zygomatic indicated that the stress flow for MATTM plate fixation was relatively close to nasomaxillary buttress, and the zygomaticomaxillary buttress, respectively. Conclusions: This study concluded that “L”-shape ATTM plate designed with a protrusion in the medial side and a slot and barb design in the lateral side can enhance the zygomaticomaxillary/nasomaxillary buttresses under uniform occlusal condition.
A Task Learning Mechanism for the Telerobots
Authors: Luo Jing , Yang Chenguang , Li Qiang , Wang Min
Published: April 2019

Telerobotic systems have attracted growing attention because of their superiority in the dangerous or unknown interaction tasks. It is very challenging to exploit such systems to implement complex tasks in an autonomous way. In this paper, we propose a task learning framework to represent the manipulation skill demonstrated by a remotely controlled robot. Gaussian mixture model is utilized to encode and parametrize the smooth task trajectory according to the observations from the demonstrations. After encoding the demonstrated trajectory, a new task trajectory is generated based on the variability information of the learned model. Experimental results have demonstrated the feasibility of the proposed method.
The impact of former mining activity on soils and plants in the vicinity of an old mercury mine (Vallalta, Belluno, NE Italy)
Authors: Wahsha Mohammad , Maleci Laura , Bini Claudio
Published: April 2019

Exploitation of ore minerals (cinnabar, chalcopyrite, sphalerite) from the old mine in Vallalta (Belluno, NE Italy) has resulted in serious environmental impacts, including the acidification of water, and the contamination of soils and plants. Forty-eight soil samples and four wild plants were examined at four sites in the vicinity of the mine (<100 m), where mine waste was discharged. After digestion with aqua regia, chemical analyses were carried out on both soils and plants by inductively coupled plasma-optical emission spectroscopy (ICP-OES) for potentially harmful elements (Cr, Cu, Ni, Pb, Zn, Fe, Mn); the mercury concentration was directly ascertained by atomic absorption spectrometry (AAS). The levels of Ni, Cr, Mn and Zn in the soils were generally below the ‘normal’ levels for uncontaminated sites. Conversely, more than 50% of the examined samples presented Cu and Pb concentrations higher than the phytotoxic level (10 mg kg
−1
). Iron concentrations exceeded normal values (<300 mg kg
−1
) in 65% of the examined samples. The mercury concentration was high (6–21 mg kg
−1
) in all soil samples, mostly above the phytotoxicity limit (10 mg kg
−1
).
Chaerophyllum hirsutum
presented the highest Hg levels in roots, up to the phytotoxicity level (10 mg kg
−1
).

Micronutrients Cu, Zn, Fe and Mn showed translocation factors (TFs) of between 0.5 and 1, suggesting that these elements are taken up to a critical concentration and are then arrested in the roots. Iron is less mobile, particularly in
C. hirsutum
, with the lowest TF of 0.38
.
The TF for Mn and Hg is >1 in
S. nemorum
and
C. hirsutum
; a TF of <0.5 in
P. braunii
, and particularly in
T. officinale
, suggests that these metals are most likely to be arrested in their roots.

Soil contamination is confined to the proximity (<100 m) of the mine waste. Among the investigated plants,
Chaerophyllum
seems to be most suitable for phytoremediation of Hg-contaminated sites.
Bi-Level Thresholding
Authors: Katsuragawa Keiko , Kamal Ankit , Liu Qi Feng , Negulescu Matei , Lank Edward
Published: April 2019

In gesture recognition, one challenge that researchers and developers face is the need for recognition strategies that mediate between false positives and false negatives. In this article, we examine bi-level thresholding, a recognition strategy that uses two thresholds: a tighter threshold limits false positives and recognition errors, and a looser threshold prevents repeated errors (false negatives) by analyzing movements in sequence. We first describe early observations that led to the development of the bi-level thresholding algorithm. Next, using a Wizard-of-Oz recognizer, we hold recognition rates constant and adjust for fixed versus bi-level thresholding; we show that systems using bi-level thresholding result in significantly lower workload scores on the NASA-TLX and significantly lower accelerometer variance when performing gesture input. Finally, we examine the effect that bi-level thresholding has on a real-world dataset of wrist and finger gestures, showing an ability to significantly improve measures of precision and recall. Overall, these results argue for the viability of bi-level thresholding as an effective technique for balancing between false positives, recognition errors, and false negatives.
A Lightweight and Secure Data Collection Serverless Protocol Demonstrated in an Active RFIDs Scenario
Authors: Cherif Amina , Belkadi Malika , Sauveron Damien
Published: April 2019

In the growing Internet of Things context, thousands of computing devices with various functionalities are producing data (from environmental sensors or other sources). However, they are also collecting, storing, processing and transmitting data to eventually communicate them securely to third parties (e.g., owners of devices or cloud data storage). The deployed devices are often battery-powered mobile or static nodes equipped with sensors and/or actuators, and they communicate using wireless technologies. Examples include unmanned aerial vehicles, wireless sensor nodes, smart beacons, and wearable health objects. Such resource-constrained devices include Active Radio Frequency IDentification (RFID) nodes, and these are used to illustrate our proposal. In most scenarios, these nodes are unattended in an adverse environment, so data confidentiality must be ensured from the sensing phase through to delivery to authorized entities: in other words, data must be securely stored and transmitted to prevent attack by active adversaries even if the nodes are captured. However, due to the scarce resources available to nodes in terms of energy, storage, and/or computation, the proposed security solution has to be lightweight. In this article, we propose a serverless protocol to enable Mobile Data Collectors (MDCs), such as drones, to securely collect data from mobile and static Active RFID nodes and then deliver them later to an authorized third party. The whole solution ensures data confidentiality at each step (from the sensing phase, before data collection by the MDC, once data have been collected by MDC, and during final delivery), while fulfilling the lightweight requirements for the resource-limited entities involved. To assess the suitability of the protocol against the performance requirements, it was implemented on the most resource-constrained devices to get the worst possible results. In addition, to prove the protocol fulfills the security requirements, it was analyzed using security games and also formally verified using the AVISPA and ProVerif tools.
Exposing Inter-process Information for Efficient PDES of Spatial Stochastic Systems on Multicores
Authors: Lindén Jonatan , Bauer Pavol , Engblom Stefan , Jonsson Bengt
Published: April 2019

We present a new approach for efficient process synchronization in parallel discrete event simulation on multicore computers. We aim specifically at simulation of spatially extended stochastic system models where time intervals between successive inter-process events are highly variable and without lower bounds: This includes models governed by the mesoscopic Reaction-Diffusion Master Equation (RDME). A central part of our approach is a mechanism for optimism control, in which each process disseminates accurate information about timestamps of its future outgoing interprocess events to its neighbours. This information gives each process a precise basis for deciding when to pause local processing to reduce the risk of expensive rollbacks caused by future “delayed” incoming events. We apply our approach to a natural parallelization of the Next Subvolume Method (NSM) for simulating systems obeying RDME. Since this natural parallelization does not expose accurate timestamps of future interprocess events, we restructure it to expose such information, resulting in a simulation algorithm called
Refined Parallel NSM
(Refined PNSM). We have implemented Refined PNSM in a parallel simulator for spatial extended Markovian processes. On 32 cores, it achieves an efficiency ranging between 43--95% for large models, and on average 37% for small models, compared to an efficient sequential simulation without any code for parallelization. It is shown that the gain of restructuring the naive parallelization into Refined PNSM more than outweighs its overhead. We also show that our resulting simulator is superior in performance to existing simulators on multicores for comparable models.
Insight Into Insiders and IT
Authors: Homoliak Ivan , Toffalini Flavio , Guarnizo Juan , Elovici Yuval , Ochoa Martín
Published: April 2019

Insider threats are one of today’s most challenging cybersecurity issues that are not well addressed by commonly employed security solutions. In this work, we propose structural taxonomy and novel categorization of research that contribute to the organization and disambiguation of insider threat incidents and the defense solutions used against them. The objective of our categorization is to systematize knowledge in insider threat research while using an existing grounded theory method for rigorous literature review. The proposed categorization depicts the workflow among particular categories that include incidents and datasets, analysis of incidents, simulations, and defense solutions. Special attention is paid to the definitions and taxonomies of the insider threat; we present a structural taxonomy of insider threat incidents that is based on existing taxonomies and the 5W1H questions of the information gathering problem. Our survey will enhance researchers’ efforts in the domain of insider threat because it provides (1) a novel structural taxonomy that contributes to orthogonal classification of incidents and defining the scope of defense solutions employed against them, (2) an overview on publicly available datasets that can be used to test new detection solutions against other works, (3) references of existing case studies and frameworks modeling insiders’ behaviors for the purpose of reviewing defense solutions or extending their coverage, and (4) a discussion of existing trends and further research directions that can be used for reasoning in the insider threat domain.
Chimp
Authors: Arghavani Abbas , Zhang Haibo , Huang Zhiyi , Chen Yawen
Published: April 2019

Radio links in wireless body area networks (WBANs) commonly experience highly time-varying attenuation due to the dynamic network topology and frequent occlusions caused by body movements, making it challenging to design a reliable, energy-efficient, and real-time communication protocol for WBANs. In this article, we present Chimp, a learning-based power-aware communication protocol in which each sending node can self-learn the channel quality and choose the best transmission power level to reduce energy consumption and interference range while still guaranteeing high communication reliability. Chimp is designed based on learning automata that uses only the acknowledgment packets and motion data from a local gyroscope sensor to infer the real-time channel status. We design a new cost function that takes into account the energy consumption, communication reliability and interference and develop a new learning function that can guarantee to select the optimal transmission power level to minimize the cost function for any given channel quality. For highly dynamic postures such as walking and running, we exploit the correlation between channel quality and motion data generated by a gyroscope sensor to fastly estimate channel quality, eliminating the need to use expensive channel sampling procedures. We evaluate the performance of Chimp through experiments using TelosB motes equipped with the MPU-9250 motion sensor chip and compare it with the state-of-the-art protocols in different body postures. Experimental results demonstrate that Chimp outperforms existing schemes and works efficiently in most common body postures. In high-date-rate scenarios, it achieves almost the same performance as the optimal power assignment scheme in which the optimal power level for each transmission is calculated based on the collected channel measurements in an off-line manner.