bluuebunny/crossref_metadata_2025 huggingface dataset:
Medium-frequency electromagnetic device to measure electric conductivity and dielectric permittivity of soils
Authors: Kessouri Pauline , Flageul Sébastien , Vitale Quentin , Buvat Solène , Rejiba Fayçal , Tabbagh Alain
Published: November 2015

An electromagnetic (EM) tool working in the medium-frequency range allows the determination of the electric conductivity and dielectric permittivity of soils with a single measurement. It brings information about different state parameters of soils, especially their water and clay contents for a significant volume of investigation. To investigate these properties, a medium-frequency-range EM prototype, the CE120, was built using a perpendicular coil Slingram configuration with a working frequency of 1.56 MHz and a fixed coil spacing of 1.2 m. This configuration was chosen using modeling with the purpose of measuring electric resistivities up to a few thousands of ohm-meters and relative dielectric permittivities as low as two. These thresholds match the expected parameters values in the medium frequency range. Moreover, the CE120 characteristics allowed for an investigation depth between 2 and 2.5 m, depending on the nature of the soil. The prototype was tested on two different soils with water variations: sandy alluvia and clay-loam soil. The electric resistivities of the sandy alluvia can reach [Formula: see text], which is higher than the detection threshold of the CE120. Only the measured dielectric permittivity can be interpreted in terms of water contrasts. Four different zones corresponding to four different water contents were detected. For the clay-loam soil, the electric conductivity and dielectric permittivity measure the water content variations created by the wheat roots. At 1.56 MHz, the high-frequency equations linking the dielectric permittivity to the volumetric water content have a limited validity. Laboratory measurements for each different soil type are necessary to deduce empirical relations. In both cases, the results are coherent with the measured mass water content variations.
Understanding Eliot: Mass Media and Literary Modernism in the American Century
Authors: Harris Donal
Published: November 2015

T. S. Eliot’s extraordinary popularity in the United States during the late 1940s and the 1950s rests in part on how mass-market magazines like Time and Life reinterpreted his poetry from the 1920s as transparent, realistic, and, most strikingly, American. These magazines widely circulated Eliot’s prewar poetry, especially The Waste Land, as an allegory of the crisis in national and nationalist culture during the “American Century,” a term coined by Henry Luce in 1941. The articles about and reproductions of Eliot’s work leading up to his Nobel Prize in 1948 not only figure literary modernism as part of the “vital center” of Cold War politics but, improbably, position postwar nationalist anxiety as a version of modernist ennui. This unlikely picture of an American Eliot exposes a momentary reinterpretation of modernism as inherently nationalist in postwar periodical culture, while it also suggests the possible critical payoff of taking failed readings seriously.
Moving Transgender Histories
Authors: Crandall Maxe , Schwartz Selby Wynn
Published: November 2015

This article explores the performance practices of Sean Dorsey, modern dance's first out transgender choreographer, in order to consider one embodied strategy for staging transgender histories. Utilizing extant LGBTQ archives, and then collecting oral histories himself, Dorsey develops a trans archival practice founded in collaboration, an ethic of care, and grassroots activism that he extends into live performance. Tracing the arc of Dorsey's practice in generating choreography from the archive, the authors ask how embodied artists move with history and consider his dance performance as a site of historical production.
The Emergence of a Grassroots African Trans Archive
Authors: Theron Liesl , Kgositau Tshepo Ricki
Published: November 2015

This paper demonstrates the enthusiasm of the young trans movement in sub-Saharan Africa. The rich history of the struggles and successes of various trans-related events and work in the African continent has not been documented. With this first publication, which forms part of the larger collection of an African trans archive, the authors provide a credible reference source to those doing research on, working with, or interested in knowing some of the history of African trans and gender-nonconforming persons, communities, and movements. A brief reflection into apartheid South Africa and the lives of trans people before democracy leads to a short description how Gender DynamiX, while only in its emerging stage, embarked in archiving and documenting material and history of trans people throughout the country. This placed Gender DynamiX as the key witness of the emergence of the first trans movement in sub-Saharan Africa.
Trans* Collecting at the Schlesinger Library
Authors: Peimer Laura
Published: November 2015

This article discusses how the Schlesinger Library on the History of Women in America has addressed issues related to privacy, access, and description with three of its trans* collections: The Ari Kane Papers, the International Foundation for Gender Education (IFGE) Records, and the Mark Ethan Smith Papers. The Kane Papers and the IFGE Records contain extensive materials with potentially sensitive third party content. While legally most personal third party content can be made available to users, librarians and archivists have an ethical responsibility to take personal privacy into consideration when determining how open a collection should be to users. This article also touches upon the limitations of the Library of Congress subject headings for the Smith Papers, acknowledging the challenges of applying these subject headings to describe an individual whose identity falls outside their limited scope.
Using Archives to Identify the Trans* Women of Casa Susanna
Authors: Davis Bob
Published: November 2015

The publication in 2005 of a book of found photographs focused attention on a rural cross-dressers' resort in New York's Catskill Mountains named “Casa Susanna.” At the time of publication, the editors knew very little about the people in the photographs, and no one was identified. Interest in these anonymous trans* women intensified when playwright Harvey Fierstein's play, Casa Valentina, based on Casa Susanna, opened on Broadway nine years later. This article discusses how magazines, photographs, newsletters, private correspondence, and personal ads in private and institutional trans* archives can be used to identify these trans* women and other members of the early MtF cross-dressing community. It proposes a research methodology that uses aliases and identification codes, originally intended for protection and anonymity, to connect archival holdings to individuals, deepening our understanding of the lived experience of early community members.
Anxiety at the Archive
Authors: Joynt Chase , Schilt Kristen
Published: November 2015

This article is a piece of experimental writing by Chase Joynt, a moving-image artist and writer, and Kristen Schilt, a professor of sociology. In this short piece, the authors track their affective and experiential engagements with objects found in the archives of Robert J. Stoller, a psychiatrist who helmed the Gender Identity Clinic at the University of California, Los Angeles, in the 1950s–70s and who was a key figure in the medicalization of transsexuality. Through daily free-write sessions in the archives, Joynt and Schilt managed the emotional tensions that emerged from their political, personal, and disciplinary investments as scholars and as individuals. These writings seek to consider various pieces of the Stoller archive through highlighting historical and political fissures, missing pieces, and affective responses.
“This Is Not a Girl”
Authors: Edwards Rebekah
Published: November 2015

In 1917 San Francisco Police Chief Jesse Brown Cook pasted a photograph of Garaldine Portica into his personal scrapbook, annotating it as a document of arrest, deportation, and gender transgression. This essay situates that document within the coconstitutive forces of personal and public narrations of embodiment, identity, and nation in the United States in the early twentieth century. While Cook's annotation is concerned with narrating the gender transgression of a body that did not yet exist under the sign of “trans*,” this essay's counterarchival methodology treats that body, or at least the Portica/Cook document, as an object for inclusion in a future trans* archive and as an appropriate object of study for an exploration of trans* archival praxis. It suggests that trans* archival methodologies that seek to recuperate or resignify documents produced in the service of regulatory/judicial/medical archives are engaged with reading the negation animating these artifacts as the very sign of their (now) trans* signification.
In Herzog's Hands
Authors: Mathiason Jessica Lee
Published: November 2015

In her critical review of Katie Herzog's art installation Transtextuality (Senate Bill 48), Jessica Lee Mathiason argues that the artist's collection of forty-eight portraits transforms the archive into an artwork while questioning institutional boundaries and disrupting its previous stability, position, and purpose. A reimagining of Gerhard Richter's 1972 installation of 48 Portraits of men of letters, Herzog's piece sets itself apart from the original through its commitment to materiality. While Richter removed all brushstrokes from his portraits, making them closely resemble the encyclopedia photographs he used as models, Herzog instead embraces the hand with her long, sweeping, and visible strokes. Using her unmistakable indentations, daring lines, and stylized portraiture to foreground the contractedness of art and the archive, Herzog challenges Richter's methodology and disciplinary modes of historiography, which have systematically excluded LGBT persons from our encyclopedias, textbooks, and collective memory.
Metabarcoding-based fungal diversity on coarse and fine particulate organic matter in a first-order stream in Nova Scotia, Canada
Authors: Wurzbacher Christian , Grimmett Ivan J. , Bärlocher Felix
Published: November 2015

Most streams receive substantial inputs of allochthonous organic material in the form of leaves and twigs (CPOM, coarse particulate organic matter). Mechanical and biological processing converts this into fine particulate organic matter (FPOM). Other sources of particles include flocculated dissolved matter and soil particles. Fungi are known to play a role in the CPOM conversion process, but the taxonomic affiliations of these fungi remain poorly studied. The present study seeks to shed light on the composition of fungal communities on FPOM and CPOM as assessed in a natural stream in Nova Scotia, Canada. Maple leaves were exposed in a stream for four weeks and their fungal community evaluated through pyrosequencing. Over the same period, four FPOM size fractions were collected by filtration and assessed. Particles had much lower ergosterol contents than leaves, suggesting major differences in the extent of fungal colonization. Pyrosequencing documented a total of 821 fungal operational taxonomic units (OTU), of which 726 were exclusive to particles and 47 to leaf samples. Characterizing fungal communities may shed some light on the origins and processing pathways of fine particles in streams and broadens our view of the phylogenetic composition of fungi in freshwater ecosystems.
Practice-oriented studying and education of law faculty junior students in the university
Authors: Алексеенко Александр , Alekseenko Aleksandr
Published: November 2015

The article is the analysis of effectiveness of active methods of studying of law. The experience of organizing visiting session of courts and their conduct in the university is analyzed here. The work of the student’s group of promoting the rule of law as a means of legal education is studied in the paper.
IMPROVING THE REPORTING FORMS ON THE DISCLOSURE OF GOVERNMENT SUBSIDIES
Authors: Нуриева  , Nurieva Regina
Published: November 2015

The article is devoted to the examine the peculiarities of information disclosure of government subsidies in the accounting (financial) statements of the agricultural organizations. On the basis of the study we offer main directions of improving the reporting forms for government grants in order to form an objective idea about the expected changes in financial position and operating results of the organization.
DNA-GENOTYPING OF SPRING BARLEY TO LOOSE SMUT RESISTANCE BY PCR METHOD
Authors: Блохин  , Blokhin Vasiliy , Вильданова  , Vildanova Gulusa , Нижегородцева  , Nizhegorodtseva Lyubov , Ланочкина  , Lanochkina Marina
Published: November 2015

The most economical and environmentally safe way to control the disease is to use resistant barley varieties of plants. The use of molecular markers, associated with disease resistance genes, predetermine great possibilities, being used as a tool for the selection of breeders. The study aim is to identify varietal specimen, carrying genes, which are encoding resistance to loose smut of barley. A method of DNA-genotyping by PCR markers was used in the study. During the process of the research 83 varietal specimen have been tested, which were selected in the nursery Tatar Research Institute of Agriculture. The following two SCAR-markers, resistant to loose smut: Un8-700R and Un8-700 were used to identify the U8 gene. The studies found, that 36.2% have the gene, encoding the susceptibility to loose smut, in the genome alleles. 5.3% of the total number of varietal specimen was characterized by the presence of the resistance gene Un8 in the genome allele. The other specimen was observed no resistance gene to loose smut. The comparison with accounting data of loose smut spread, provided by the Barley breeding Department, showed no infestation of barley lines with resistance gene of loose smut in natural infectious background. As a result of molecular and genetic evaluation, the five specimen of nursery of Tatar Research Institute of Agriculture were identified with resistance genes in the genome alleles, which had been recommended, as a valuable genotypes for selection according to the loose smut resistance of barley.
SOWING AND PRODUCTIVE QUALITY OF SEEDS, DEPENDING ON THE NUTRITION BACKGROUND IN THE KAMA AREA OF THE REPUBLIC OF TATARSTAN
Authors: Гараев  , Garaev Razil , Шайхразиев  , Shaykhraziev Shamil , Зубарев  , Zubarev Sergey , Ганиев  , Ganiev Azat , Шайхутдинов  , Shaykhutdinov Farit , Сержанов  , Serzhanov Igor
Published: November 2015

The article presents an analyzes of high quality seeds production of spring wheat in the Kama area of the Republic of Tatarstan. The questions of influence of nutrition background on productive and sowing quality of this variety.
NUTRITINOAL, BIOLOGICAL VALUE OF NEW TYPES OF MEAT-AND-CEREAL PRESERVES FOR DIETARY PREVENTIVE HUMAN NUTRITION
Authors: Патиева  , Patieva Svetlana , Прищепова  , Prishchepova Tatyana
Published: November 2015

The article was dedicated to the creation of a new generation of meat-and-cereal products with functional characteristics, intended for the preventive nutrition of people, living under the harmful effects of the environment and professional activity.
Nurturing a patient's dignity: small gestures can have a big impact
Authors: Mendes Aysha
Published: November 2015

In this monthly column, Aysha Mendes discusses the role of the nurse in facilitating the aspects of care that contribute to nurturing a patient's dignity and argues that the small things, as well as the big things, can have a valuable impact on a person's self-worth and quality of life
The health and care of older people in England
Authors: Tingle John
Published: November 2015

John Tingle discusses two reports that look at the care of older people in England
The duty of candour: what it means for practising nurses
Authors: Griffith Richard
Published: November 2015

Nurses now have a statutory and professional duty to be open and candid with patients about any errors in their care and treatment. A professional duty of candour is a key requirement of the revised Code from the Nursing and Midwifery Council ( NMC, 2015 ). Nurses are also subject to a statutory duty of candour imposed on their employer. In this article, the author considers the statutory and professional duties of candour and their impact on nurses.
Smoking cessation—what is involved?
Authors: Wadia Reena
Published: November 2015

Reena Wadia gives a brief overview of the five As approach to help patients stop smoking
Whistleblowing: putting patients first
Authors: Hancock Dave
Published: November 2015

Attitudes to whistleblowing are changing in all businesses, including dentistry. Dental nurses need to know when to metaphorically put the whistle to their lips and blow, as Dave Hancock explains
Professional behaviour outside of the practice
Authors: Talati Shilla
Published: November 2015

Shilla Talati discusses how dental nurses' conduct, both at work and in personal life, justifies patients' trust in you and the public's trust in the dental profession
The characteristics and experiences of anticipatory mourning in caregivers of teenagers and young adults
Authors: Griffith Rachel , Davies Kerry , Lavender Verna
Published: November 2015

This article reports a systematic review of literature undertaken to identify characteristics and experiences of anticipatory mourning in caregivers of teenagers and young adults with life-limiting or life-threatening conditions. A comprehensive literature search was conducted using the key words ‘anticipatory’, ‘mourning’, ‘grief’, and synonyms. This review focused on six studies that met inclusion criteria and reported characteristics of anticipatory mourning in caregivers of teenagers and young adults. Characteristics and experiences were sorted into four main themes: symptoms; a sense of loss; caregiver behaviour; and the unique experience of caring for, or losing, a teenager or young adult. The review suggests that there are characteristics and experiences of anticipatory mourning that are unique to caregivers of this age group. The review also suggests that consideration of anticipatory mourning is important in offering holistic care to young adults and their caregivers, and points to the need for further research in this area.
‘Fighting for care’: parents' perspectives of children's palliative care in South Tyrol, Italy
Authors: Darbyshire Philip , Mischo-Kelling Maria , Lochner Lukas , Messerschmidt-Grandi Caterina
Published: November 2015

Background:

Children's palliative care in Italy develops comparatively slowly. Recent legislation is enabling, but foundational research exploring parental experiences and perceptions is lacking.

Aim:

To investigate the experiences and perceptions of parents in South Tyrol, Italy regarding caring for a child with a life-threatening or life-limiting illness.

Design:

A mixed qualitative design incorporated both an online survey and parent interviews. Using purposive sampling, 13 parents undertook 9 interviews and 7 parents completed the survey.

Results:

The authors highlight a major parental theme describing difficult relationships with health services requiring them to ‘fight the system’ for services.

Discussion:

The authors raise a disturbing possibility that such ‘fighting the system’ is now so widely recognised worldwide that it cannot be considered to be accidental.

Conclusion:

The authors recommend the establishment of a specialist, dedicated paediatric palliative care service in South Tyrol with the international recognised values and operating standards that would render such parental ‘fighting’ unnecessary.
Can a community of practice enhance a palliative approach for people drawing close to death with dementia?
Authors: Toye Christine , Jiwa Moyez , Holloway Kristi , Horner Barbara J , Andrews Sharon , McInerney Fran , Robinson Andrew L
Published: November 2015

This action research study was conducted to trial a strategy intended to support a consistent, high-quality, palliative approach for people with dementia drawing close to death—the implementation of a community of practice. Professionals from community/residential care and hospitals formed this community of practice, which took on the role of an action research group. The group was supported to identify and address practice problems. Four action plans were implemented; outcomes from two are reported. When actioning the plan ‘providing education and information for the staff’, the staff's ratings of sessions and resources were positive but impacts upon knowledge, views, or confidence were small. When actioning ‘supporting families’, families providing care in non-hospital settings received information about severe dementia from suitably prepared staff, plus contact details to access support. Family feedback was primarily positive. Reference to additional practice change frameworks and inclusion of specialist palliative care professionals are recommendations for future initiatives; also focusing on targeted, achievable goals over longer timeframes.
Communication differences when patients and caregivers are seen separately or together
Authors: Swetenham Kate , Tieman Jennifer , Butow Phyllis , Currow David
Published: November 2015

Background:

Southern Adelaide Palliative Care Services introduced a nurse-led early introduction to a palliative care clinic in 2011. The clinic offers a thorough psychosocial assessment and the provision of information and an introduction to future care planning. The patients and their caregivers are seen together by the nurse practitioner initially for a physical assessment. They are then seen by a social worker to focus on advanced care planning and assessment of social and emotional factors. After the social work visit, the patient and caregiver are separated, and the patient sees the psychosocial nurse for coping and adjustment to illness and the carer sees the caregiver network facilitator to assess their informal supports to assist in the role of community-based caregiving. The pilot study looks at the nature of communication in the clinic where patient and carer are together and compares that to when they are separated.

Methods:

A total of 33 patients and their caregivers agreed for their coversations to be tape recorded between May and November of 2013. All tape recordings were transcribed verbatim. Ten patient transcripts (n=40) have been coded for quantitative analysis. The codes identify content and function of speech, cues for information and emotion and whether they are responded to by clinicians.

Results:

Pilot results reveal that caregivers contribute little in the combined clinics and dominate the conversation in the private clinic. Patients, when seen alone, predominantly express emotion related cues, opposed to cues for information. The clinicians focus on their area of specialty, which results in little duplication in this clinic setting.

Conclusion:

An earlier evaluation of this clinic found that patients and their caregivers appreciate being separated in the clinic setting to have time and privacy to reveal fears and feelings related to end-of-life care. This current study quantifies the patient and caregiver experience and confirms those earlier findings.
Politics and palliative care: Guadeloupe
Authors: Smyth Dion
Published: November 2015

Dion Smyth's review of the internet for palliative nursing
Exploring an evolving therapy for resistant hypertension
Authors: Hough Maxine
Published: November 2015

With hypertension becoming more prevalent throughout the adult population, many studies are being undertaken. Maxine Hough aims to give kidney care professionals a better understanding of renal denervation and how it can be used to combat high blood pressure. She also considers the nurse's role in monitoring and offering treatment options, while exploring the existing research.
Oral nutritional supplements: what is suitable for renal patients?
Authors: Kariyawasam Deepa
Published: November 2015

With the prevalence of chronic kidney disease rising and an increasingly ageing population, there is a risk of malnutrition. Oral nutrition supplements (ONS) can provide renal patients with key nutrients, which may have been lost during dialysis. Deepa Kariyawasam outlines different types of ONS and discusses key factors to consider when choosing a supplement.
Developing a patient-centred approach to end-of-life care
Authors: Banks Ann
Published: November 2015

Charity funding for the role of a kidney supportive care nurse has enabled the development of tools for patient assessment and screening. Advance care planning has also been offered to suitable patients. Ann Banks explores the impact of this specialist role on end-of-life care in a regional renal department.
Tolvaptan approved, but is NICE fit for purpose in these challenging times?
Authors: Finnigan Robert
Published: November 2015

After the National Institute for Health and Care Excellence reversed its decision to approve tolvaptan, a potentially life-altering drug for autosomal dominant polycystic kidney disease, Robert Finnigan questions the process responsible for not approving the drug in the first place.
Prioritising dignity at the end of life for patients with end-stage renal disease
Authors: Mendes Aysha
Published: November 2015

Those with chronic kidney disease are increasingly choosing to stop their dialysis treatment in order to enhance their quality of life. Subsequently, many patients have supportive and palliative care needs. Aysha Mendes describes what considerations should be made during this time.
Preparing for CQC inspection: getting the most from the process
Authors: Ellis Peter , Abbott Jane
Published: November 2015

The Care Quality Commission (CQC) has the power to inspect any provider and decide on the quality of the care provided. In the first article of this series, Peter Ellis and Jane Abbott consider how renal managers can prepare themselves and their staff for an impending inspection. They also describe the fundamental standards below which care must never fall.
Experiences of two paramedics deployed to the Phillipines in response to Typhoon Haiyan
Authors: Watts Peta , Byrom Tim
Published: November 2015

This article describes the experiences of two paramedics from the UK International Emergency Trauma Register (UKIETR) who deployed as part of the UK-Med response to Typhoon Haiyan in 2013. Each had a key role in the deployed teams, both targeting distinct but differing health needs following the Typhoon. Tim Byrom was a member of the first team activated on 13 November 2013. He formed part of a surgical, anaesthetic and rehabilitation team that assisted the Australian Medical Assistance Team (AUSMAT) at their field hospital in Tacloban. Peta Watts was in the second team, deployed two weeks after the Typhoon following invitation to continue assessments and health provision on outlying islands. Her experience involved being part of a unique and effective collaboration between the Department for International Development (DfID), UK-Med, and the British Military in the delivery of an integrated humanitarian aid package.
Allied health professionals’ contribution to the quality of care and service delivery
Authors: Peate Ian
Published: November 2015

A report has been produced by QualityWatch exploring the quality of care and the services that are delivered by allied health professionals (AHPs) in the UK. Ian Peate looks at the comparative data between the various professional AHP groups, before exploring the section of the report that focused on paramedics.
Is it time to change? The use of intranasal fentanyl for severe pain in the pre-hospital setting
Authors: Parkinson Martin
Published: November 2015

The treatment of pain is a commonplace issue for today's paramedics, where the need for new analgesics to overcome cannulation barriers is gathering momentum. Intranasal fentanyl has proven itself to be a very safe and effective form of analgesia that overcomes those barriers and can help paramedics provide a higher standard of care. Although research into its use in the pre-hospital environment is still limited, evidence of its effectiveness in the accident and emergency department has highlighted its potential for helping paramedics treat severe pain where venous access is compromised. Studies have shown that intranasal fentanyl compares with the analgesic standard set by intravenous morphine and is rapidly becoming the drug of choice in the paediatric accident and emergency department.
Why evaluation is important to you, me and everybody
Authors: Simpson Karen
Published: November 2015

The Health and Care Professionals Council (HCPC) suggest that the use of operational evaluation and monitoring contributes to the creation of correct and current assessment standards ( HCPC, 2009 ).

This short article is aimed at anyone who attends training courses including mandatory, induction, CPD, management and clinical skills, and explores the theory of evaluation and its benefit in adding depth and value to all training purposes.
Ambulance leaders discuss future of urgent and emergency care services at ALF
Authors: Parry Anna
Published: November 2015

Anna Parry, national programme manager, Association of Ambulance Chief Executives, gives an overview of the key themes from the Ambulance Leadership Forum 2014, held on 18–19 November at the Queens Hotel, Leeds.
The expanding scope of EMS: decreasing emergency department overcrowding in the United States
Authors: Randall Williams Gordon , Hertelendy Attila J
Published: November 2015

The ageing population has been on the rise in the United States (US) and is expected to significantly increase over the next few decades. Additionally, with the Affordable Care Act (ACA) now in full effect, there's a significant increase in the amount of persons with health insurance. In turn, this is expected to cause an influx of patients seeking emergency care through our nation's emergency medical service (EMS) system and emergency departments (EDs), which is already overcrowded on a frequent basis in many areas. Experts believe this is going to significantly increase the amount of strain on an already burdened US EMS and ED system. To prevent detrimental effects from ensuing, we have to be proactive in combating this issue. Therefore, there are three options presented to overcome any adverse reactions: i) Increase the use of preventative measures in our existing EMS system; ii) Implementing the use of telemedicine into our existing EMS system; and iii) expanding the scope of practice in our EMS systems by implementing the paramedic practitioner. Of these options, we believe the paramedic practitioner will best serve the role of alleviating an already strained EMS and ED system in the US.
Dr Mark Bloch obituary
Authors: Newton Andy
Published: November 2015

The Journal of Paramedic Practice was saddened to learn of the death of editorial board member Dr Mark Bloch. Prof Andy Newton, chair of the College of Paramedics, reflects on a great clinician, educator and proponant of the paramedic profession.
Minister for Civil Society assures air ambulances his ‘door is always open’
Authors: Quaile Alistair
Published: November 2015

Minister for Civil Society, Nick Hurd MP, extends open door policy to air ambulances at annual reception held by the All Party Parliamentary Group for Air Ambulances on 9 June on the House of Commons Terrace, Westminster.
Preparing for the future, protecting lives today
Authors: Prior Keith
Published: November 2015

The National Ambulance Resilience Unit (NARU) has just completed its third full year as an operational organisation. Now is a good time to pause, take a breath and contemplate the huge progress it has made during the past three years, says Keith Prior, director, NARU.
A brief history of analgesia in paramedic practice
Authors: Lord Bill , Nicholls Tracy
Published: November 2015

Paramedics and ambulance clinicians have an important role in alleviating pain. However, clinician-initiated analgesia has a relatively short history when compared with the field of medicine. Several barriers to the introduction of pharmacological options for the management of pain appear to have delayed the introduction of options for managing severe pain. These include legislative restrictions as well as concerns about the adverse effects of analgesics.

This report describes the history of analgesia in paramedic or ambulance practice in the United Kingdom (UK) and Australia in order to add to the knowledge base for this profession, and to inform the development of strategies to advance pain management practice.
Intranasal and buccal midazolam in the pre-hospital management of epileptic tonic-clonic seizures
Authors: Thom David
Published: November 2015

Epilepsy is a common neurological condition causing seizures or convulsions. This article looks to analyse the treatment and management of a patient suffering from a prolonged epileptic tonic-clonic seizure by the administration of two common benzodiazepines: midazolam and diazepam. Epileptic seizures carry high risks of secondary injury and the potential for long-term neurological damage; therefore, it is imperative that paramedics can provide swift and effective treatment for these patients. With current advances in pre-hospital care, paramedics should be aware of the latest advances in techniques, management and the associated legal issues. This article will look specifically at the administration of benzodiazepines and in particular the comparison between midazolam and diazepam and the routes of administration available.
A critical appraisal of the impact of Section 3 of the Mental Capacity Act (2005)
Authors: Amblum Jeshni
Published: November 2015

Paramedic's have verbalised uncertainty on how to proceed when treating unwell patients who refuse treatment, stating that they feel ill-equipped to interpret situations when patients refuse treatment. They expressed a need to be formally trained in how to systematically, yet quickly, assess a patient's capacity, rather than relying on intuition or opting out with the ‘take them to hospital’ approach, as they report it is better to face the accusation of assault or battery, than allegations of negligence.

This article will explore the appropriate mechanisms and approach for the assessment of capacity in emergency situations. Capacity will be defined according to the Mental Capacity Act 2005 (c.9), with an explanation of consent and the particular difficulties faced by paramedics in the assessment of capacity in an emergency will be identified and analysed.
Continuing Professional Development: Managing anaphylaxis in the out-of-hospital setting
Authors: Rice Alan
Published: November 2015

Overview

This Continuing Professional Development (CPD) module will explore the most severe form of allergic reactions, anaphylaxis. This will include outlining the definition, prevalence, pathophysiology and paramedic management of the disease. There are a number of self-directed activities to complete as you move through the article together with a list of further resources to expand your research. This article requires the reader to have a basic appreciation of normal physiology associated with the immune system and an appreciation of the general approach to assessing and managing patients in the out-of-hospital, emergency setting before completion.

Learning Outcomes

After completing this module you will be able to: • Outline the definition, pathophysiology and epidemiology of anaphylaxis • Identify the key diagnostic features of anaphylaxis, including the causes and physical presentation • Outline how anaphylaxis is managed by paramedics
Recipe for success: baking in Boston strong-observations on Boston's success
Authors: Lord Gregg
Published: November 2015

On 15 April 2013 at 14:29 hours, two improvised explosive devices (IED) exploded within 15 seconds of each other in Boston. The explosions occurred approximately 200 yards apart at the Boston Marathon finish line.

In the follow on to the event it became quickly apparent that Boston EMS, in collaboration with the health community had achieved, by any standard, an effective response. One determining factor was the survival of victims; in Boston no victims died who survived the initial blast. This success did not happen by chance. In the wake and review of the events it became apparent that the successful response during the Boston Marathon was the result of decades of preparedness.

This article will not dwell on the actual response events as other reports and articles have done that well. The intent is to discuss the underlying principles that led to a successful response by Boston EMS and the other parts of the community response system. As will be discussed, the whole community of Boston participated in not only the response that day, but was integral parts of the recipe that created such a successful response.
Documentation: are we writing it right?
Authors: Eaton Georgette
Published: November 2015

While the need to keep accurate patient records is acknowledged by the bodies that govern healthcare practice, there is currently little evidence to support a specific standard of record keeping, with advice on following one of several recognised models. For many ambulance Trusts, documentation guidelines are based on expert opinion of what should constitute good medical records and documentation, but this can vary from region to region. However, whichever model is used, there are several core principles that should be used when writing medical documentation.

This article aims to provide ambulance staff with general information on documentation in an attempt to enable readers to understand why records are kept, the standard to which records should be kept, and the legal and regulatory issues relating to record-keeping for paramedics.
Election fever and the football: a game of rhetoric
Authors: Peate Ian
Published: November 2015

With the general election looming ever closer and political parties doing all they can to secure votes, Ian Peate argues that Governments should stop game playing with the NHS and engage in meaningful and open debate with key stakeholders about its future, the level of funding available and the quality and scope of services that they can realistically deliver through the staff they have.
Does adrenaline improve long-term outcomes after out-of-hospital cardiac arrest?
Authors: Nolan Jerry P
Published: November 2015

Adrenaline has been an integral component of advanced life support from the birth of modern cardiopulmonary resuscitation (CPR) in the early 1960s.

The findings from randomised trials and observational studies indicate that giving adrenaline in out-of-hospital cardiac arrest (OHCA) increases the rate of return of spontaneous circulation (ROSC) but that longer-term outcomes (survival to hospital discharge and neurologically favourable survival) are either worse or, at best, neutral.

PARAMEDIC2: The Adrenaline Trial should answer once and for all the question of whether giving doses of adrenaline 1 mg during CPR improves long-term outcome from OHCA. As such, it is the most important cardiac arrest research study ever to be undertaken in the United Kingdom.
Essex and Herts Air Ambulance: a focused case series for pre-hospital practice
Authors: Ferris John D , Ley Erica , Chesters Adam
Published: November 2015

Pelvic fractures cause significant mortality and morbidity in major trauma patients and contribute to early deaths both pre-hospital and in-hospital. Traditional teaching that few pre-hospital interventions benefit patients with major pelvic fractures has been challenged in recent years and a number of key early interventions are now seeing many such patients survive to reach a surgeon or interventional radiologist for definitive care. We outline the case of a 38-year-old male who sustained a crush injury resulting in a severe lateral compression fracture of his pelvis with associated haemodynamic instability. Fundamental principles of pre-hospital pelvic fracture management are explained including core techniques of patient handling, splinting and packaging along with analgesic strategies and triage principles. Novel theories and interventions for haemostasis are described. The additional care that can be provided by an enhanced care team is also discussed.
Equal value of physical and mental health: transforming outcomes by 2021
Authors: Mendes Aysha
Published: November 2015

In March 2015, NHS England launched a Taskforce to develop a five-year strategy to improve mental health outcomes across the NHS. Aysha Mendes looks at a report produced by the Taskforce in September, considering its key priorities and themes, as well as the role of ambulance services in this equation.
Exploring trends in demand for urgent care
Authors: Jones Rodney
Published: November 2015

Last year, Rod Jones, statistical advisor, Healthcare Analysis and Forecasting, published an article considering factors affecting bed occupancy and capacity at A&E departments. In this article, he provides further justification for why trends in demand for urgent care may be as a result of a persistent infectious agent, as opposed to the more usual ‘spike’ infectious events observed for influenza and other non-persistent infections.
The NHS Constitution lacks clout
Authors: Peate Ian
Published: November 2015

The NHS Constitution for England brings together the principles, values, rights and responsibilities underpinning the NHS. However, Ian Peate argues that for it to be valued, supported and used by patients and staff, carers and the public, and for it to have more significant impact, then awareness must be raised.
Single–dose activated charcoal—a feasibility study in an ambulance setting
Authors: Walker Richard , Black Sarah
Published: November 2015

Following a previous article published in the Journal of Paramedic Practice ( Walker, 2013 ) this article summarises the findings of a study conducted by South Western Ambulance Service NHS Foundation Trust (SWASFT). As a result of the literature review detailed in the previous article, approval was given to run a 6-month study examining the feasibility of paramedic crews carrying and administering single-dose activated charcoal (SDAC) to patients of self-poisoning attended within 1 hour of ingestion of a suitable toxin. Sixty nine patients were offered SDAC, with an acceptance rate of 94%. Fears of adverse incidents such as vomiting, aspiration and increased time on scene appeared almost entirely unfounded and crews found the medication easy to use and popular with patients. Paracetamol, usually at hepatotoxic levels accounted for 57% of all overdoses encountered, most of these receiving SDAC within 1 hour, with 81.5% of all patients receiving the medication in that time frame. SWASFT has now adopted SDAC as a treatment for patients of overdose.
Training versus education: the terminology
Authors: Mortimer Craig
Published: November 2015

Learning for pre-hospital clinicians is often defined by the terms ‘education’ and ‘training’. However, there are constrasting views on what constitutes each. Craig Mortimer looks at the difference between these two terms, and considers whether the way they are used impacts upon the individual learner and their development.
Mass-gathering medical care: a retrospective analysis
Authors: Sami Amtul Salam , Ahmed Nida , Ahmad Syed Muzaffer
Published: November 2015

Background:

Patient care at mass-gathering events presents a unique challenge both in terms of organisation and the delivery of care.

Methods:

We carried out a retrospective analysis of women and children attending the designated first aid area of a large-scale international annual religious event in Alton, Hampshire in the United Kingdom (UK). Data analysis was done for the years 2011–2013, inclusive.

Results:

There was a consistent increase in attendees with an associated rise in the total number of patients. The top 10 medical conditions encountered remained similar throughout the years 2011–2013. There was a significant burden of chronic conditions in our cohort.

Conclusions:

This study adds to the body of knowledge by providing conditions that are commonly seen in a large-scale mass gathering setting. The patient demographic highlighted in the results can be used to plan and prepare for future mass gatherings in many different contexts.
Teaching to encourage deep learning in paramedic science students: a case study
Authors: Phillips Peter
Published: November 2015

The needs of the modern NHS requires a paramedic who can analyse complex data, make increasingly complex decisions and use evidence to inform treatment plans to ensure quality in patient care. The student paramedic will not simply acquire these qualities, rather higher education should be focused on teaching that encourages deep learning. If successful, the design of teaching and learning will ensure that, upon graduation, a paramedic has the skills of critical thinking, autonomous practice and lifelong learning that will enable them to provide the best care for patients. This article is a case study examining the design of a series of lectures about history taking. The lectures were designed specifically to encourage deep learning in paramedic students. The design of teaching and learning activities is explored alongside current evidence, to assess the extent to which deep learning was achieved among the students. Throughout the article it is evident that a deep approach to learning in higher education is crucial if the profession is to meet the needs of patients and the NHS.
Emergency medical services (EMS) and waste: a review of the literature on sustainable EMS waste management
Authors: Nichols Andrew , Allum Pete
Published: November 2015

Waste management contributes significantly to the financial costs and carbon footprints of healthcare organisations, thus contributing to climate change and subsequent harm to health. Increasing efficiencies and the introduction of sustainable waste management practice within healthcare organisations, including emergency medical services (EMS), could reduce associated CO2 and other greenhouse gas emissions while reducing costs, enabling funding to be reinvested in patient care.

This article aims to contribute to the discussion of sustainable healthcare waste management, particularly within EMS, and provides a review of the literature on this topic. The literature suggests there is a growing interest among EMS in the efficient use of resources and there has been some gradual change in practice, including the introduction of sustainable waste management practices. The literature also reveals that empirical research discussing greenhouse gas emissions associated with EMS is limited, particularly in regard to waste management. The evidence indicates that there is scope for further research investigating the environmental impacts of EMS. Such research could specifically investigate the CO2 emissions associated with EMS waste management and interventions that might reduce these emissions, with the potential sequelae of cost savings or income generation.
The perceived concerns of newly qualified paramedics commencing their careers: a pilot study
Authors: Thompson Sally
Published: November 2015

Objective:

To identify the perceived concerns of newly qualified paramedics commencing their careers and how they may be subsequently supported both in university and practice.

Methods:

A pilot study using a focus group approach to collect qualitative data from a selection of newly qualified paramedics regarding their perceived concerns when first becoming clinical lead. Transcripts were analysed and themes generated.

Results:

Four paramedics attended the session. Themes emerged around confidence, defensive practice and theory to practice application. Confidence appeared to be a key topic and linked into all the other themes.

Conclusions:

Newly qualified paramedics have the clinical knowledge and application but lack confidence in their own abilities due to lack of exposure and experience. They rely on support given to them by colleagues, peers and preceptors in the early stage of their careers.