bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of Situated Game Teaching Through Set Plays on Soccer Tactical Knowledge Among Turkish Secondary School Students
Authors: Dervent Fatih , Xie Xiuye , Devrilmez Erhan , Nayır Nazım , Li Weidong
Published: August 2021

Purpose: This study was to examine the effects of a curricular model named Situated Game Teaching through Set Plays (SGTSP) on secondary students’ tactical knowledge in a 10-lesson soccer unit. Methods: A quasi-experimental design with a repeated measure was used to examine the effectiveness of the SGTSP model in comparison with a technique-focused approach. Participants’ perceptions of SGTSP were collected through reflection journals throughout the unit. A convenient sample of 27 sixth graders from two classes participated in this study. Data were collected from a tactical knowledge test and reflection journals. A 3 × 2 × 2 factorial analysis of variance with a repeated measure was conducted to analyze the data. Responses to reflection journals were analyzed by deductive analysis and constant comparison. Results: Participants’ tactical knowledge in the SGTSP condition improved significantly more than those in the comparison condition over time. Conclusions: The findings provided evidence supporting the effectiveness of the SGTSP model on developing students’ tactical knowledge as compared to a technique-focused approach.
Draft Genome Sequences of the Lipid-Degrading Bacteria
Moritella
sp. Strains F1 and F3, Isolated from Mesopelagic Seawater from the Sagami Trough, in Japan
Authors: Kagaya Kei , Kogure Rika , Okai Masahiko , Kawato Satoshi , Kondo Hidehiro , Hirono Ikuo , Ishida Masami
Published: August 2021

Moritella
sp. strains F1 and F3 are lipid-degrading bacteria that were isolated from intermediate water from the Sagami Trough, in Japan. We present the draft genome sequences of these two strains, which have 4,983,334 bp and 4,967,310 bp, respectively.
Draft Genome Sequence of Bacillus velezensis Strain Marseille-Q1230, Isolated from a Stool Sample from a Severely Malnourished Child
Authors: Konaté Salimata , Zgheib Rita , Camara Aminata , Doumbo Ogobara , Djimdé Abdoulaye , Koné Abdoulaye Kassoum , Théra Mahamadou Ali , Fournier Pierre-Edouard , Tidjani Alou Maryam , Raoult Didier , Million Matthieu
Published: August 2021

Bacillus velezensis
, a species first described in 2005, has been mostly associated with plants and the environment. To date, there is no genome available for this species from human samples.
Draft Genome Sequence of Hafnia paralvei Strain VBC_1714, Isolated from Frozen Cod Fillet Imported from Russia to Norway
Authors: Storesund Julia E. , Grevskott Didrik H. , Marathe Nachiket P. , Lunestad Bjørn Tore , Svanevik Cecilie Smith
Published: August 2021

Hafnia
spp. have the potential to cause opportunistic infections in humans and animals. This announcement describes the draft genome sequence of an H
2
S-positive
Hafnia paralvei
strain that was isolated as a presumptive
Salmonella
sp. from a frozen cod fillet.
Getting around the gut: a unique management challenge of thyroid storm precipitated by amphetamine-associated duodenal ischaemia leading to compromised enteric absorption
Authors: Lee Jin Sol Gene , Brown Ian Elliott , Semrad Alison M , Zeki Amir A
Published: August 2021

Thyroid storm is a rare, life-threatening endocrine emergency with a high mortality rate of up to 30%. We present a unique management challenge of a critically ill patient who developed thyroid storm in the setting of a duodenal perforation from amphetamine-associated non-occlusive mesenteric ischaemia. The diagnosis of ‘thyroid storm’ was made based on clinical criteria and a Burch-Wartofsky score of 100. During emergent exploratory laparotomy, a 1 cm duodenal perforation with surrounding friable tissue was found and repaired. Intraoperatively, a nasogastric tube was guided distal to the area of perforation to allow for enteric administration of medications, which was critical in the setting of thyroid storm. Therapeutic plasma exchange achieved biochemical control of our patient’s thyroid storm but ultimately did not prevent in-hospital mortality.
Experiences of early air travel with pneumothorax after anterior spinal surgery
Authors: Wong Amy Yoke Foong , Foo Choong Hoon , Wong Chung Chek , Ohn Khin Maung
Published: August 2021

Anterior thoracic or thoracolumbar spinal surgery by retropleural approach always carries a risk of pneumothorax as its consequence. Conventionally, the Aerospace Medicine Association and the British Thoracic Society recommend 2 weeks delay of air travel for a patient with resolved postoperative pneumothorax. They also label active pneumothorax as an absolute contraindication for commercial air travel. Such a delay always causes psychological and financial stress to patients and family who are far from home. Here, we report three patients with postoperative pneumothorax, who insisted on early air travel despite being informed of the possible consequences.
Adult Shigatoxin-mediated hemolytic uremic syndrome masked by alcohol use and inflammatory bowel disease
Authors: Thompson Rachel , Peng Lisa , Zarmbinski Breanna , Tierney David M
Published: August 2021

Diagnosing uncommon diseases in individuals with underlying medical conditions can be challenging. Cognitive bias can lead to delayed or missed disease management. We present a case of Shiga-toxin mediated hemolytic uremic syndrome (ST-HUS) in a 46-year-old man with ulcerative colitis and alcohol use disorder who presented with acute alcohol intoxication, non-bloody diarrhoea and coffee ground emesis. He was admitted to the hospital for alcoholic ketoacidosis, alcohol withdrawal and possible upper gastrointestinal bleed, but ultimately, he developed severe thrombocytopaenia, hemolytic anaemia, acute renal failure and prolonged altered mentation. Given that ST-HUS is uncommon in adults, his initial report of diarrhoea was attributed to alcohol use or underlying active ulcerative colitis and not connected to his haematologic abnormalities. He was initially started on plasmapheresis; however, thrombotic microangiopathy work up revealed Shiga-toxin in his stool and ADAMST13 levels within normal limits. Subsequently, he was transitioned to supportive care for management of ST-HUS.
Not all that is ‘full house’ is systemic lupus erythematosus: a case of membranous nephropathy due to syphilis infection
Authors: Scaperotti Moira Marie , Kwon DongHyang , Kallakury Bhaskar V , Steen Virginia
Published: August 2021

We describe an unusual case of membranous nephropathy precipitated by syphilis infection in a patient without systemic lupus erythematosus (SLE). A previously healthy 20-year-old man presented with leg and facial swelling. Laboratory investigation revealed nephrotic range proteinuria, acute kidney injury, hypocomplementaemia and a highly positive rapid plasma reagin. Kidney biopsy showed membranous nephropathy with ‘full-house’ immunofluorescence (IgG, IgA, IgM, C1q and C3), mimicking lupus nephritis class Vb. However, the patient had no features of SLE and had negative antinuclear and anti-double-stranded DNA antibodies. He was treated with high-dose methylprednisolone and mycophenolate mofetil for lupus nephritis and with penicillin for syphilis. After 2 months of therapy, his proteinuria resolved, and his renal function and C4 level normalised. This case illustrates that syphilis infection can be a mimicker of lupus nephritis. A literature review suggests that ful-house nephropathy may occur independently of lupus nephritis and may or may not develop into SLE.
Associations of network-derived metabolite clusters with prevalent type 2 diabetes among adults of Puerto Rican descent
Authors: Haslam Danielle E , Liang Liming , Wang Dong D , Kelly Rachel S , Wittenbecher Clemens , Pérez Cynthia M , Martínez Marijulie , Lee Chih-Hao , Clish Clary B , Wong David T W , Parnell Laurence D , Lai Chao-Qiang , Ordovás José M , Manson JoAnn E , Hu Frank B , Stampfer Meir J , Tucker Katherine L , Joshipura Kaumudi J , Bhupathiraju Shilpa N
Published: August 2021

Introduction

We investigated whether network analysis revealed clusters of coregulated metabolites associated with prevalent type 2 diabetes (T2D) among Puerto Rican adults.

Research design and methods

We used liquid chromatography-mass spectrometry to measure fasting plasma metabolites (>600) among participants aged 40–75 years in the Boston Puerto Rican Health Study (BPRHS; discovery) and San Juan Overweight Adult Longitudinal Study (SOALS; replication), with (n=357; n=77) and without (n=322; n=934) T2D, respectively. Among BPRHS participants, we used unsupervised partial correlation network-based methods to identify and calculate metabolite cluster scores. Logistic regression was used to assess cross-sectional associations between metabolite clusters and prevalent T2D at the baseline blood draw in the BPRHS, and significant associations were replicated in SOALS. Inverse-variance weighted random-effect meta-analysis was used to combine cohort-specific estimates.

Results

Six metabolite clusters were significantly associated with prevalent T2D in the BPRHS and replicated in SOALS (false discovery rate (FDR) <0.05). In a meta-analysis of the two cohorts, the OR and 95% CI (per 1 SD increase in cluster score) for prevalent T2D were as follows for clusters characterized primarily by glucose transport (0.21 (0.16 to 0.30); FDR <0.0001), sphingolipids (0.40 (0.29 to 0.53); FDR <0.0001), acyl cholines (0.35 (0.22 to 0.56); FDR <0.0001), sugar metabolism (2.28 (1.68 to 3.09); FDR <0.0001), branched-chain and aromatic amino acids (2.22 (1.60 to 3.08); FDR <0.0001), and fatty acid biosynthesis (1.54 (1.29 to 1.85); FDR <0.0001). Three additional clusters characterized by amino acid metabolism, cell membrane components, and aromatic amino acid metabolism displayed significant associations with prevalent T2D in the BPRHS, but these associations were not replicated in SOALS.

Conclusions

Among Puerto Rican adults, we identified several known and novel metabolite clusters that associated with prevalent T2D.
US Army basic combat training alters the relationship between body mass index and per cent body fat
Authors: Foulis Stephen A , Hughes J M , Spiering B A , Walker L A , Guerriere K I , Taylor K M , Proctor S P , Friedl K E
Published: August 2021

Introduction/background

As a proxy for adiposity, body mass index (BMI) provides a practical public health metric to counter obesity-related disease trends. On an individual basis, BMI cannot distinguish fat and lean components of body composition. Further, the relationship between BMI and body composition may be altered in response to physical training. We investigated this dynamic relationship by examining the effect of US Army basic combat training (BCT) on the association between BMI and per cent body fat (%BF).

Methods

BMI and %BF were measured at the beginning (week 1) and end (week 9) of BCT in female (n=504) and male (n=965) trainees. Height and weight were obtained for BMI, and body composition was obtained by dual X-ray absorptiometry. Sensitivity and specificity of BMI-based classification were determined at two BMI thresholds (25 kg/m2and 27.5 kg/m2).

Results

A progressive age-related increase in fat-free mass index (FFMI) was observed, with an inflection point at age 21 years. In soldiers aged 21+, BMI of 25.0 kg/m2predicted 33% and 29% BF in women and 23% and 20% BF in men and BMI of 27.5 kg/m2predicted 35% and 31% BF in women and 26% and 22% BF in men, at the start and end of BCT, respectively. Sensitivity and specificity of BMI-based classification of %BF were poor. Soldiers below BMI of 20 kg/m2had normal instead of markedly reduced %BF, reflecting especially low FFMI.

Conclusions

BCT alters the BMI–%BF relationship, with lower %BF at a given BMI by the end of BCT compared with the beginning, highlighting the unreliability of BMI to try to estimate body composition. The specific BMI threshold of 25.0 kg/m2, defined as‘overweight’, is an out-of-date metric for health and performance outcomes. To the extent that %BF reflects physical readiness, these data provide evidence of a fit and capable military force at BMI greater than 25.0 kg/m2.
Prevalence of sarcopenia in older Chinese adults: a systematic review and meta-analysis
Authors: Xin Caihong , Sun Xin , Lu Li , Shan Ling
Published: August 2021

Objective

This meta-analysis was conducted to estimate the overall prevalence of sarcopenia in older Chinese adults.

Design

Systematic review and meta-analysis.

Participants

A literature research was conducted using the PubMed, Web of Science, China National Knowledge Infrastructure, CQVIP and Wanfang databases. The following search terms in the abstract were used: “sarcopenia” in combination with the terms “prevalence,” “epidemiology” and “China.” All studies published from January 2010 to November 2020 were included. The random-effect model was used to estimate the prevalence of sarcopenia. The sex-specific prevalence of sarcopenia at a 95% CI was also calculated using different criteria for defining sarcopenia.

Primary outcome measures

The overall prevalence of sarcopenia in older Chinese adults.

Results

In total, 23 articles were included in this meta-analysis involving 21 564 participants. On the basis of the Asian Working Group for Sarcopenia criterion, the overall prevalence of sarcopenia among the elderly in China was 14% (95% CI 11% to 18%); the prevalence was higher in Chinese women than in men (15% vs 14%).

Conclusions

This systematic review is the first estimation of the pooled prevalence of sarcopenia in older Chinese adults. Our results suggest that China has a large number of patients with sarcopenia. These findings would be useful for sarcopenia prevention in China. There is a high degree of heterogeneity, and although there are a large number of cases and could be an emerging public health issue, more research is required to make these claims.

PROSPERO registration number

CRD42020223405.
The road to hell is paved with good intentions: the experience of applying for national data for linkage and suggestions for improvement
Authors: Taylor Julie A , Crowe Sonya , Espuny Pujol Ferran , Franklin Rodney C , Feltbower Richard G , Norman Lee J , Doidge James , Gould Doug William , Pagel Christina
Published: August 2021

Background

We can improve healthcare services by better understanding current provision. One way to understand this is by linking data sets from clinical and national audits, national registries and other National Health Service (NHS) encounter data. However, getting to the point of having linked national data sets is challenging.

Objective

We describe our experience of the data application and linkage process for our study ‘LAUNCHES QI’, and the time, processes and resource requirements involved. To help others planning similar projects, we highlight challenges encountered and advice for applications in the current system as well as suggestions for system improvements.

Findings

The study set up for LAUNCHES QI began in March 2018, and the process through to data acquisition took 2.5 years. Several challenges were encountered, including the amount of information required (often duplicate information in different formats across applications), lack of clarity on processes, resource constraints that limit an audit’s capacity to fulfil requests and the unexpected amount of time required from the study team. It is incredibly difficult to estimate the resources needed ahead of time, and yet necessary to do so as early on as funding applications. Early decisions can have a significant impact during latter stages and be hard to change, yet it is difficult to get specific information at the beginning of the process.

Conclusions

The current system is incredibly complex, arduous and slow, stifling innovation and delaying scientific progress. NHS data can inform and improve health services and we believe there is an ethical responsibility to use it to do so. Streamlining the number of applications required for accessing data for health services research and providing clarity to data controllers could facilitate the maintenance of stringent governance, while accelerating scientific studies and progress, leading to swifter application of findings and improvements in healthcare.
Utilisation of remote capillary blood testing in an outpatient clinic setting to improve shared decision making and patient and clinician experience: a validation and pilot study
Authors: Nwankwo Lisa , McLaren Kate , Donovan Jackie , Ni Zhifang , Vidal-Diaz Alberto , Loebinger Michael , Morrisey Alice , Igra Adam , Shah Anand
Published: August 2021

Background

In a tertiary respiratory centre, large cohorts of patients are managed in an outpatient setting and require blood tests to monitor disease activity and organ toxicity. This requires either visits to tertiary centres for phlebotomy and physician review or utilisation of primary care services.

Objectives

This study aims to validate remote capillary blood testing in an outpatient setting and analyse impact on clinical pathways.

Methods

A single-centre prospective cross-sectional validation and parallel observational study was performed. Remote finger prick capillary blood testing was validated compared with local standard venesection using comparative statistical analysis: paired t-test, correlation and Bland-Altman. Capillary was considered interchangeable with venous samples if all three criteria were met: non-significant paired t-test (ie, p>0.05), Pearson’s correlation coefficient (r)>0.8% and 95% of tests within 10% difference through Bland-Altman (limits of agreement). In parallel, current clinical pathways including phlebotomy practice were analysed over 4 weeks to review test predictability. A subsequent pilot cohort study analysed potential impact of remote capillary blood sampling on shared decision making. A final implementation phase ensued to embed the service into clinical pathways within the institution.

Results

117 paired capillary and venous blood samples were prospectively analysed. Interchangeability with venous blood was seen with glycated haemoglobin (%), total protein and C reactive protein. Further tests, although not interchangeable, are likely useful to enable longitudinal remote monitoring (eg, liver function and total IgE). 65% of outpatient clinic blood tests were predictable with 16% of patients requiring further follow-up. Patient and clinician-reported improvement in shared decision making given contemporaneous blood test results was observed.

Conclusions

Remote capillary blood sampling can be used accurately for specific tests to monitor chronic disease, and when incorporated into an outpatient clinical pathway can improve shared decision making and patient experience. Further research is required to determine health economic impact and applicability within telemedicine-based outpatient care.
Central catheter-associated deep vein thrombosis in cancer: clinical course, prophylaxis, treatment
Authors: Marin Arnaldo , Bull Leonardo , Kinzie Matthew , Andresen Max
Published: August 2021

The adequate handling of central venous catheters is a key element in the management of patients with cancer. Catheter-associated deep vein thrombosis is frequently observed in patients with malignant diseases; however, despite being a common complication among these patients, objective information concerning its epidemiology, clinical course, prophylaxis and treatment strategies is very limited. The reported incidence of catheter-related thrombosis (CRT) is highly variable, depending on symptomatic events, or if patients are screened for asymptomatic thrombosis. Several factors have been identified as potential predisposing factors for CRT, both technical and pathological aspects. The anticoagulant of choice is still unclear; while low-molecular-weight heparin is most commonly used, recent studies assessing the role of direct oral anticoagulants in the treatment of CRT show promise as an alternative, but the evidence remains insufficient and the decision must be made on a case-by-case basis.
EP13 Perceptions and experiences of residents and relatives of emergencies in care homes: systematic review and meta-synthesis
Authors: Laparidou Despina , Curtis Ffion , Udayangani Jayawickrama Withanage Iresha , Weligamage Dedunu , Ortega Marishona , Siriwardena Aloysius Niroshan
Published: August 2021

Background

Medical emergencies in care homes, both residential and nursing care homes, are common and costly, often resulting in calls to an out-of-hours general practitioner (GP) or Emergency Medical Services (EMS). Ambulance attendance frequently results in conveyance to hospital and the concomitant high costs and risks of, often prolonged, hospitalisation. Previous reviews have focussed on various stakeholder perceptions of transfer to hospital. The aim of this systematic review was to provide a comprehensive synthesis of the perceptions and experiences of care home residents and their family members, who have experienced medical emergencies in a care home setting.

Methods

We searched five electronic databases, supplemented with internet searches and forward and backward citation tracking from the included studies and review articles. Data were synthesised thematically following the Thomas and Harden approach. The CASP Qualitative Checklist was used to assess the quality of the included studies of this review.

Results

The search strategy identified 6,140 citations. After removing duplicates and excluding citations based on title and abstract, and full-text screening, ten studies from four countries (Australia, Canada, UK, and US) were included in the review and meta-synthesis. All included studies were considered of acceptable quality. Through an iterative approach, we developed six analytical themes. 1. Infrastructure and process requirements in care homes to prevent and address emergencies; 2. The decision to transfer to hospital – a perfect storm; 3. Challenges of transfer and hospitalisation for older patients; 4. Good communication vital for desirable outcomes; 5. Legal, regulatory and ethical concerns; and 6. Trusting relationships enabled residents to feel safe.

Conclusions

The emergency care experience for care home residents can be enhanced by ensuring resources, staff capacity and processes for high quality care. Building trusting relationships underpinned by good communication and attention to ethical practice were also identified as important factors.
PP14 An investigation of ambulance clinical recommendations for the management of obstetric emergencies in Australia and New Zealand
Authors: Flanagan Belinda , Pearce James , Barr Nigel , Eastwood Kathryn
Published: August 2021

Background

Various international studies have recognised that paramedics receive limited obstetric training and historically lack confidence in managing obstetric and neonatal emergencies. This lack of confidence, deficits in training and limited exposure to such cases may be sustained by absent, dated or insufficient clinical guidance provided by the employer. Clinical guidelines are an essential tool and cognitive aid to provide guidance when formulating an appropriate treatment plan, however paramedics have reported the use of varying and dated practices and procedures that have the potential to cause significant patient harm. The aim of this study was to conduct a qualitative textual/document analysis on five publicly available obstetric guidelines published by ambulance services in Australia and New Zealand.

Method

Publicly available electronic guidelines from Australian and New Zealand ambulance jurisdictions were imported into a custom designed data collection frame for comparison. This frame focused on five specific areas of obstetric presentations. Guideline quality was measured against a recognised national standard for the development and publication of clinical guidelines. Information and recommendations presented were compared against expert advice provided by the Royal Australian and New Zealand College of Obstetrics and Gynaecology (RANZCOG), Word Health Organization (WHO), state health clinical guidelines and systematic reviews.

Results

All ambulance service guidelines reviewed failed to meet the national standards for the development and publication of clinical guidelines in the area of transparency and grading of evidence. Some advice within the guidelines was found to be inconsistent, not supported by evidence, have the potential to cause harm or be absent. Some were found to be heavily reliant on hospital-based mnemonics that were either not ambulance specific or contained advice that was outside a paramedic scope of practice.

Conclusion

This study has identified inconsistent recommendations and highlighted conflicting and inadequate advice for paramedics when managing obstetric and neonatal emergencies.
PP19 Primary care streaming in emergency departments- contexts and mechanisms associated with perceived effectiveness outcomes: a realist evaluation
Authors: Edwards Michelle , Cooper Alison , Davies Freya , Stevens Andrew Carson , Edwards Adrian , Hughes Thomas , Snooks Helen , Anderson Pippa , Porter Alison , Evans Bridie , Dale Jeremy , Cooke Matthew , Hibbert Peter , Siriwardena Aloysius Niroshan
Published: August 2021

Background

Recent policy has encouraged emergency departments (EDs) to deploy nurses to stream patients from the ED front door to GPs working in a separate GP service operating within or alongside an ED. We aimed to describe mechanisms relating to effectiveness of streaming in different primary care service models identified in EDs. We explored perceptions of whether patients were perceived to be appropriately streamed to emergency care, primary care, other hospital services or community primary care services; and effects onpatient flow(waiting times and length of stay in the ED); andsafestreaming outcomes.

Methods

We used realist evaluation methodology to explore perceived streaming effectiveness. We visited 13 EDs with different primary care service models (purposively selected across England & Wales; 8 streamed primary care patients to a primary care clinician) and carried out observations of triage/streaming and patient flow and interviews with key members of staff (consultants, GPs, nurses). Field notes and audio-recorded interviews were transcribed and analysed by creating context, mechanism and outcome configurations to refine and develop theories relating to streaming effectiveness.

Results

We identified five contexts (nurses’ knowledge and experience, streaming guidance, teamwork and communication, operational management and strategic management) that facilitated mechanisms that influenced the effectiveness of streaming (streaming to an appropriate service, patient flow, delivering safe care). We integrated a middle range psychological theory (cognitive continuum theory) with our findings to recommend a focus for training nurses in streaming and service improvements.

Conclusions

We identified key mechanisms relating to the effectiveness of primary care streaming in different models of service. We recommend a collaborative approach to service development, guidance and training (including input from ED clinicians and primary care clinicians) and a range of training strategies that are suitable for less experienced junior nurses and more experienced senior nurses and nurse practitioners.
PP22 How do emergency staff communicate with patients during resuscitation?
Authors: Joss Karyn , Lloyd Adam , Clegg Gareth
Published: August 2021

Background

Clinical communication plays a key role in conveying compassion between individuals. Positive non-verbal communication (NVC) has been shown to encourage connectedness and improve patient outcomes – i.e. reducing pain and anxiety – in a range of conditions, including major trauma. Whilst little is understood about how staff utilise NVC in the resuscitation room, quality of interpersonal interactions has been shown to be the largest overall predictor of patient satisfaction within the Emergency Department (ED). Existing studies within the ED highlight patient experiences of feeling ‘isolated’, with their distress being ‘insensitively disregarded’ by staff, hence further research is required to improve patient experience.

Methods

This study utilised the video auditing system within the ED of Edinburgh’s Royal Infirmary to observe how emergency staff employed NVC with conscious patients across (n=15) resuscitation cases. Results were fed back to clinical staff, with suggestions for developing compassion awareness. Mixed method qualitative and quantitative analyses were employed to assess positive and negative staff NVC behaviours and evaluate how these appeared to influence patient experience. Several existing matrices for measuring staff non-technical performance informed design of a novel system for scoring five key aspects of clinical NVC: touch, eye contact, body language, proximity and patient exposure.

Results

This study highlights significant variation in how emergency staff convey compassion to patients during resuscitation. Staff members exhibited a range of positive and negative NVC behaviours, which were occasionally at odds with verbal cues given. Patterns of communication appeared related to members’ roles within the emergency team, with medical and nursing staff exhibiting different strengths.

Conclusions

Our findings are consistent with the idea that acts of compassion are ‘emotional labour’, underlining the need for staff education surrounding positive NVC, as well as increased workplace support. We suggest environmental level strategies including incorporation of a specifically designed ‘compassionate care’ toolkit into handover/pre-arrival checklists.
PP27 Features of emergency medical system calls that facilitate or inhibit call-taker recognition that a patient is in, or at risk of, cardiac arrest: a systematic mixed studies review
Authors: Kirby Kim , Voss Sarah , Bird Emma , Benger Jonathan
Published: August 2021

Aim

To identify and appraise evidence relating to the features of an Emergency Medicine System call interaction that enable, or inhibit, an Emergency Medical Dispatcher’s recognition that a patient is in out-of-hospital cardiac arrest, or at imminent risk of out-of-hospital cardiac arrest.

Methods

All study designs were eligible for inclusion. Data sources included Medline, BNI, CINAHL, EMBASE, PubMed, Cochrane Database of Systematic Reviews, AMED and OpenGrey. Stakeholder resources were screened and experts in resuscitation were asked to review the studies identified. Studies were appraised using the Mixed Methods Appraisal Tool. Synthesis was completed using a segregated mixed research synthesis approach.

Results

Twenty-five studies were included in the review. ‘Recognition studies’ involving patients already in out-of-hospital cardiac arrest dominated this SMSR and challenges associated with recognition of out-of-hospital cardiac arrest were apparent. Four main themes were identified: Recognising abnormal/agonal breathing during the emergency call, Managing the emergency call, Emotional distress, Patient’s colour.

Conclusion

A dominant finding is the difficulty in recognising abnormal/agonal breathing during the Emergency Medical Service call. The interaction between the caller and the Emergency Medical Dispatcher is critical in the recognition of patients who suffer an out-of-hospital cardiac arrest. Emergency Medical Dispatchers adapt their approach to the Emergency Medical Service call, and regular training for Emergency Medical Dispatchers is recommended to optimise out-of-hospital cardiac arrest recognition. Further research is required with a focus on the Emergency Medical Service call interaction of patients who are alive at the time of the Emergency Medical Service call and who later deteriorate into OHCA.
PP30 The Minnesota satisfaction questionnaire as a measure of advanced paramedic practitioner satisfaction with a three part rotational model of working
Authors: Wright Stella , Robertson Duncan , Nosworthy Gemma , Baines Bob , Thomas Wyn , Thomas Bryn , Timmins Mark , Watson Robyn
Published: August 2021

Background

Welsh Ambulance Service NHS Trust (WAST) and Betsi Cadwaladr University Health Board (BCUHB) were jointly awarded Welsh Government Pacesetter funding to assess the viability of a rotational approach to the delivery of care. The three part rotation incorporates the WAST Clinical Contact Centre, solo responding and shifts in BCUHB primary care settings. Nine WAST Advanced Paramedic Practitioners (APPs) started their rotation in north Wales in June 2019, a further eight joined in September 2020. The Minnesota Satisfaction Questionnaire (MSQ) was one of a number of data collection items undertaken as part of a service evaluation to evaluate the impact of this Pacesetter project.

Methods

APP Satisfaction was measured using the Minnesota Satisfaction Questionnaire (MSQ), a standardised tool designed to measure an employee’s satisfaction with work and aspects of the workplace environment. It comprises a 100-item questionnaire, with each question aligned to one of 20 scales. The MSQ was completed by the first cohort of APPs nine months into their rotation, and by the second Cohort in their third month. APPs were asked to consider all aspects of the rotation.

Results

Overall, both cohorts demonstrated a high level of satisfaction, in particular questions associated with intrinsic satisfaction scored better than ones linked to extrinsic satisfaction. For both Cohorts, Social Service, Working Conditions and Activity were all in the top five scoring scales. Whereas, Authority and Supervision (Human Relations) were lower scoring scales for both Cohorts.

The individual raw scores were slightly higher for Cohort II than I. Cohort II also demonstrated a wider range in standard deviation scores across the scales.

Conclusion

The MSQ is a simple yet effective measure of assessing workplace satisfaction. For the current Cohorts of Pacesetter APPs, scores indicated a high level of satisfaction across all aspects of the rotation.
PP31 Patterns of use of ambulance senior support during the COVID-19 pandemic: a service evaluation
Authors: Bell Fiona , Hodge Andrew , Pilbery Richard , Whiterod Sarah
Published: August 2021

Background

In early March 2020, a senior clinical support cell (SCSC) was established within Yorkshire Ambulance Service NHS Trust (YAS). The SCSC aimed to provide an additional layer of clinical leadership within the Emergency Operations Centre to support call centre and decision support for on-scene ambulance staff working in challenging circumstances. It was staffed by advanced practitioners, doctors and other senior paramedics with range of diverse skills from critical to urgent care. We aimed to understand the patterns of use of a SCSC for emergency 999 calls during the COVID-19 pandemic.

Methods

Routinely collected call data was retrospectively analysed to understand the patterns of use in the first three months of the service. The reason for the call, patient demographic and any regional differences were described. An anonymous survey was distributed to frontline ambulance crews to understand the reasons for contacting the SCSC, or not, and the outcomes of that contact for patient care.

Results

7296 patient care episodes received either a telephone triage by SCSC for 999 calls or 111 calls transferred for an emergency ambulance response (3160) or had telephone support provided to crews on scene (4136). Telephone triage accounted for 3160 calls where 642 cases (20.3%) resulted in a hear-and-treat outcome, and the findings suggest a low re-contact rate within 24 hours at 2.4%.

The primary reasons for crews seeking support/advice from the SCSC were discharge advice or permission (37%); support for pathways in their area (25%); or for cases where patients refused care or conveyance (11%).

Conclusions

SCSC was developed in response to the COVID-19 pandemic, and lessons can be learned to prepare for any future significant service challenges as a result of the rapid implementation of the SCSC and the clinical leadership required to support the pace of change and emerging clinical knowledge and practice.
PP34 The experiences and attitudes of ambulance staff towards the counter-terrorism ‘PREVENT’ training: a survey-based service evaluation
Authors: Mochrie Tessa , Foster Theresa , Prothero Larissa , South Nigel
Published: August 2021

Background

Understanding the views and opinions of ambulance clinicians about counter-terrorism is limited, as are the roles they have in identifying individuals vulnerable to radicalisation. The aim of this survey was to investigate ambulance clinician views and preparedness to identify individuals at risk of radicalisation and whether the current national PREVENT training offered is suitable for this clinical setting.

Methods

A purpose-designed, 18-question survey, was developed to understand staff attitudes and content knowledge of the national PREVENT training module. The survey was opened to all emergency ambulance clinicians in one UK ambulance service during August 2020, resulting in a sample of 123 responses which were analysed using descriptive and thematic approaches.

Results

Most respondents (87%; n=107) were aware of the PREVENT strategy, with almost three-quarters (73%; n=90) receiving training within the previous three years. Respondents were asked to score training received: the majority (89%; n=110) reported 5/10 or less. Whilst most (79%; n=97) identified the correct way to refer an individual, few had completed a PREVENT referral (9%; n=11). ‘Gut instinct’ was utilised by respondents to support their knowledge obtained via PREVENT training (70%, n=86). Respondents felt the national PREVENT training lacked relevance to their role and recommended ambulance-specific training packages be made available. They recognised their responsibility of identifying radicalisation and the opportunities their unique position offered to do so. Having a ‘duty of care’ and ‘moral responsibilities’ to make PREVENT referrals, and the importance of treating individuals as patients (not criminals), was also highlighted.

Conclusions

Ambulance staff have highlighted the importance of a clear and robust referral pathway for individuals vulnerable to radicalisation. Current training lacks specificity and effectiveness for the ambulance service setting. As this survey was limited to one ambulance service, future research is warranted to ensure PREVENT training is appropriate for all ambulance staff.
PP38 Rates of recording different aspects of patients’ social history on ambulance electronic patient records – a service evaluation
Authors: Barley Chloé R , Gunson Imogen M
Published: August 2021

Background

Understanding the impact of a patient’s social history forms part of medical assessments and wider NHS data collection. To date, there has been little work examining the extent of social history recording by ambulance clinicians. The aim of this service evaluation is to examine how frequently staff complete social history fields on electronic patient records and to identify patterns in completion rate when comparing categories of call, localities of crew, conveyance or non-conveyance, and individual fields of social history data.

Method

A retrospective review of one NHS ambulance trust’s electronic patient records (attended 01/01/2019 – 31/12/2019) was conducted. 10% of the records were analysed due to software limitations (n = 134434 adult cases).

Results

Very few cases (<0.05%) had every field completed, with 28.6% of all cases having no fields completed at all. In 45% of cases, between 8 and 11 fields were completed. The mean number of fields completed per case was 5.79 and the median number was 7.

‘Mobility’ and ‘Home circumstances’ were the most frequently completed and ‘Sexual Orientation’ and ‘Language’ were the least.

Category of call appears to have minimal impact on completion rates. Localities and specialists had more variation, ranging from 21.3% to 49.9% with no fields completed at all.

Conclusion

Social history documentation is very infrequently fully completed by frontline ambulance crews within this service. The majority of cases have a partially complete social history however, due to software limitations, it is unknown whether the same fields are consistently completed throughout these cases.

Further research, including qualitative work, is recommended to understand the low rate of recording of social history data and how this information is used by ambulance staff.
Phase I/II trial of a long peptide vaccine (LPV7) plus toll-like receptor (TLR) agonists with or without incomplete Freund’s adjuvant (IFA) for resected high-risk melanoma
Authors: Patel Sapna P , Petroni Gina R , Roszik Jason , Olson Walter C , Wages Nolan A , Chianese-Bullock Kimberly A , Smolkin Mark , Varhegyi Nikole , Gaughan Elizabeth , Smith Kelly T , Haden Kathleen , Hall Emily H , Gnjatic Sacha , Hwu Patrick , Slingluff Craig L
Published: August 2021

Background

We performed a clinical trial to evaluate safety and immunogenicity of a novel long peptide vaccine administered in combinations of incomplete Freund’s adjuvant (IFA) and agonists for TLR3 (polyICLC) and TLR7/8 (resiquimod). We hypothesized that T cell responses to minimal epitope peptides (MEPs) within the long peptides would be enhanced compared with prior vaccines with MEP themselves and that T cell responses would be enhanced with TLR agonists, compared with IFA alone.

Methods

Participants with resected stage IIB-IV melanoma were vaccinated with seven long melanoma peptides (LPV7) from tyrosinase, gp100, MAGE-A1, MAGE-A10, and NY-ESO-1, each containing a known MEP for CD8+T cells, plus a tetanus helper peptide (Tet) restricted by Class II MHC. Enrollment was guided by an adaptive design to one of seven adjuvant combinations. Vaccines were administered at weeks 1, 2, 3, 6, 9, 12 at rotating injection sites. T cell and IgG antibody (Ab) responses were measured with IFN-gamma ELIspot assay ex vivo and ELISA, respectively.

Results

Fifty eligible participants were assigned to seven study groups, with highest enrollment on arm E (LPV7+Tet+IFA+polyICLC). There was one dose-limiting toxicity (DLT) in Group E (grade 3 injection site reaction, 6% DLT rate). All other treatment-related adverse events were grades 1–2. The CD8+T cell immune response rate (IRR) to MEPs was 18%, less than in prior studies using MEP vaccines in IFA. The CD8+T cell IRR trended higher for IFA-containing adjuvants (24%) than adjuvants containing only TLR agonists (6%). Overall T cell IRR to full-length LPV7 was 30%; CD4+T cell IRR to Tet was 40%, and serum Ab IRR to LPV7 was 84%. These IRRs also trended higher for IFA-containing adjuvants (36% vs 18%, 48% vs 24%, and 97% vs 60%, respectively).

Conclusions

The LPV7 vaccine is safe with each of seven adjuvant strategies and induced T cell responses to CD8 MEPs ex vivo in a subset of patients but did not enhance IRRs compared with prior vaccines using short peptides. Immunogenicity was supported more by IFA than by TLR agonists alone and may be enhanced by polyICLC plus IFA.

Trial registration number

NCT02126579.
Evaluation of small-strain shear modulus of Fontainebleau sand based on innovative pressuremeter probe testing in a calibration chamber
Authors: Lopes dos Santos Alexandre , Dupla Jean-Claude , Canou Jean , Puech Alain , Cour Francis
Published: August 2021

This paper presents an experimental study aimed at evaluating the measuring capabilities of an innovative monocellular pressuremeter probe, the Monocell Francis Cour probe, based on calibration testing in the laboratory. The originality of the tested equipment is to allow evaluation of soil properties in both small- and large-strain domains, without the need of sophisticated point displacement measuring arms. This paper focuses on the evaluation of small-strain shear modulus G of Fontainebleau sand, NE34, based on tests carried out with this specific pressuremeter probe. Shear modulus values obtained with this probe are then compared with values resulting from more classical elementary tests, showing a fairly good consistency. It is shown, with satisfactory agreement, that it is possible to quantify the influence of the density index of the sand as well as the influence of the mean effective stress around the probe on the shear modulus, based on the analysis of specific unload−reload loops performed during the test. The experimental programme carried out under well-controlled laboratory conditions allows a validation to be proposed for a method of derivation of the shear modulus of sand at small strain levels using this prototype pressuremeter.
miR-193a as a potential mediator of WT-1/synaptopodin in the renoprotective effect of Losartan on diabetic kidney
Authors: Gao Dan , Yu Pei , Jing Sanhui , Yan Chengcheng , Ding Dandan , Qiao Yingjin , Wu Ge
Published: August 2021

Diabetic nephropathy (DN) is the most common complication of diabetic patients, and has become a global healthcare problem. In this study, we used diabetic mice to evaluate the effect of Losartan on DN, in which the experimental animals were divided into three groups: non-diabetic mice (db/m group), untreated-diabetic mice (db/db group), and Losartan-treated diabetic mice (db/db-losartan). Next, immunohistochemistry and immunofluorescence were used to detect Wilms tumor protein 1 (WT-1) and synaptopodin expression, respectively. Protein levels of WT-1, synaptopodin, claudin1, and Pax-2 were assessed by Western blotting and real-time PCR. The miR-193a mRNA levels were quantitated by real-time PCR. The results showed that albuminuria was increased in diabetic mice compared with control animals and was significantly ameliorated by treatment with Losartan. In addition, Losartan significantly upregulated the immunopositive cell numbers of WT-1, the expression of WT-1 and synaptopodin in renal tissue. By contrast, expression of claudin1 and Pax-2 in renal tissue were decreased in db/db-losartan group. Besides, expression of miR-193a was decreased significantly in db/db-losartan group compared with the untreated diabetic group. Thus, Losartan has renoprotective effects on the control of tissue damage possibly by inhibiting the expression of miR-193a, thereby promoting the repair of podocyte injury in mice with DN.
Caught in the currents: evaluating the evidence for common downstream police response interventions in calls involving persons with mental illness
Authors: Huey Laura , Andersen Judith , Bennell Craig , Ann Campbell Mary , Koziarski Jacek , Vaughan Adam D.
Published: August 2021

The origins of this report, and of the Mental Health and Policing Working Group, can be traced to the unique situation Canadians have faced as a result of the COVID-19 pandemic. The unique circumstances of this global outbreak, which have for many Canadians resulted in serious illness and death, intensified economic uncertainties, altered family and lifestyle dynamics, and generated or exacerbated feelings of loneliness and social dislocation, rightly led the Royal Society of Canada’s COVID-19 Taskforce to consider the strains and other negative impacts on individual, group, and community mental health. With the central role that police too often play in the lives of individuals in mental and (or) emotional crisis, we were tasked with exploring what can be reasonably said about the state of our current knowledge of police responses to persons with mental illness.