bluuebunny/crossref_metadata_2025_split huggingface dataset:
PP31  Ambulance handover: a thematic review of delays in 2018/19
Authors: Lindridge Jaqualine , Reynard Kevin , Kemp Rob , Brownhill Richard , Penn-Ashman Jerry 
Published: September 2020

BackgroundAmbulance handover delays are an important indicator of an emergency care system under pressure. Delayed handovers compromise patient safety in the Emergency Department (ED). As a direct consequence patients wait longer for an emergency ambulance response, and as a result patient safety in the community is also compromised. We explored factors perceived to contribute to ambulance handover delays at EDs in an urban area of England, in order to inform delay reduction strategies.MethodsFifteen EDs were visited as part of a regional improvement programme. Ambulance handover processes were observed, and staff involved in the process were informally interviewed. A data corpus of twenty-nine written reports was generated. These reports were anonymised and thematic analysis was used inductively to explore the phenomenon of ambulance handover delay. Pattern coding was used to identify and cluster common themes, with magnitude coding added to identify the most prevalent themes.ResultsPerceived reasons for ambulance handover delay arose from a number of factors. A mismatch was frequently seen between handover capacity and demand. This occurred alongside, but was also frequently observed to be independent of, ED exit block. Approaches to escalation were often sub-optimal. This was observed both before and after an ambulance queue developed. Processes were often uneconomical by design, and pathways were frequently inefficient. Inter-professional culture was identified as an important, cross-cutting theme, with a lack of urgency to release ambulances frequently observed.ConclusionsOur results suggest several factors influence ambulance handover delays. Programmes which aim to improve overall hospital flow, streamline pathways and processes, and improve escalation are needed. Programmes should also seek to improve the inter-professional culture relating to ambulance handover. Limitations to this enquiry include an opportunistic, retrospective approach and use of a convenience sample. There are few empirical studies which address the causes of ambulance handover delay. More research is needed on this important patient safety issue.
PP34  Collecting experience-based expertise when planning prehospital care research: a stakeholder event about evaluating paramedics working in care homes
Authors: Evans Bridie , Kingston Mark , Porter Alison , Keen Leigh , Griffiths Lesley , James Mari , Green Stephanie 
Published: September 2020

BackgroundDue to medical advances, the population of care homes is becoming increasingly frail, often with co-morbidities. Recent innovations have seen paramedics take on non-emergency roles within or supporting care homes. This workforce innovation requires urgent evaluation, taking account of the multiple perspectives at stake. Research is more relevant, feasible and accountable if those who commission, deliver and use healthcare services are able to input their professional and personal insights.MethodWe conducted a stakeholder event as part of research development work for paramedics working in care homes (PERCH: Preliminary Exploration of paramedic Roles in Care Homes). We invited representatives from care homes, including Enabling Research in Care Homes (ENRICH) network members, ambulance services, primary and secondary care, patient/resident and public members, and the research community. To inform discussion, we presented examples of paramedics working in care homes. We then facilitated small-group discussions about how to evaluate such innovations and recorded views on sticky notes and flipcharts.Results23 people attended the event. Clarity of roles and communication processes were considered important to implement the pilot project. Attendees agreed that research outcome measures should include changes in avoidable hospital admissions, emergency department attendances and 999 calls plus staff, patient and family satisfaction. They identified some potential benefits to ambulance services and general practice, such as time saved for other patients, but believed these could be difficult to measure.DiscussionGaining the insights of a wide range of stakeholders prior to research being designed is an important, but under-utilised approach in research development. People who deliver and receive community-based care have insight derived from personal and professional experience which complements research expertise. Research in care home settings is challenging, and insights from stakeholders were significant in the development of a research proposal about the role of paramedics in care homes (PERCH study). We submitted this to the Health and Care Research Wales Research for Public and Patient Benefit funding scheme in 2019.
OP8  What factors do ems clinicians report as influencing their decision to perform a prehospital 12 lead ECG in acute coronary syndromes?: A qualitative study
Authors: Halter Mary , Calovski Vid , Davies Glenn , Driscoll Timothy , Gale Christopher , Gavalova Lucia , Hampton Chelsey , Quinn Tom , Snooks Helen , Watkins Alan , Weston Clive 
Published: September 2020

BackgroundInternational guidelines for the management of acute coronary syndromes (ACS) recommend use of the prehospital 12-lead electrocardiogram (PHECG). Research conducted before the primary PCI era suggested that PHECG is not always performed for those receiving a hospital diagnosis of ACS, with the patient’s gender and ethnicity speculated as influential.AimAs part of a mixed methods study investigating the use and impact of the PHECG in the primary PCI era, we explored the factors emergency medical services (EMS) clinicians report as influencing their decision to perform a PHECG.MethodsWe conducted a qualitative phenomenological study, in six focus groups with a semi structured topic guide, in three UK regions involving 47 EMS clinicians with experience ranging from nine months to 31 years. We recorded, transcribed and anonymised each focus group; familiarised ourselves with the data including notes and reflections; formed and iterated a coding framework; and constructed themes with the study team, including patient and public representatives.ResultsAll participants expressed a desire to perform a prehospital ECG in patients suspected with ACS but described a setting characterised by uncertainty and ‘messy’ context. We drew out three themes of influence on the decision to perform an ECG: surface characteristics (age, sex, ethnicity, privacy, presenting condition of the patient); pattern recognition (training, experience of atypical presentations, equipment availability, confidence in interpretation); and tensions/external pressures (distance to PCI, guidelines, organisational pressures). These were interwoven by the concept of clinical autonomy.ConclusionFactors identified as influencing clinicians’ decision to perform a PHECG ranged from straightforward to complex and were difficult to unpick. Whilst qualitatively clinicians reported performing 12 lead PHECG wherever possible in suspected ACS, the reported multifaceted influences on the decision reinforce the need for the quantitative arm of this study to examine this nationally, alongside its association with patient outcomes.
OP9  Perch – preliminary exploration of the role of paramedics in care homes
Authors: Kingston Mark , Keen Leigh , Green Stephanie , Griffiths Lesley 
Published: September 2020

BackgroundHalf a million people live in UK care homes. General practices struggle to deliver primary care for residents due to high demand and staff shortages. Meanwhile, ambulance services are seeing an increase in 999 calls from care homes. In response, some areas are involving paramedics in proactive support to care homes, part of a shift towards paramedics undertaking non-emergency community care. Yet such workforce changes require urgent evaluation to understand implications for residents, staff and health services. We aimed to explore the role of non-emergency paramedics in care homes to support the design of portfolio research.MethodsWe convened a Research Development Group of care home, ambulance service, health board, primary care, public and academic representatives. We:Conducted fact-finding visits to sitesAnalysed 999 call data from care homesSurveyed ENRICH (Enabling Research in Care Homes) care home managers in England and WalesHeld a stakeholder workshop to explore the issuesResultsWe identified sites in England and Wales where paramedics provide non-emergency care in care homes. Operating models varied with paramedics employed by ambulance services, health boards and practices. Monthly 999 data from 300 homes confirmed high call and hospital conveyance rates. Survey respondents thought paramedics were well suited to assessing residents, identifying issues, improving care and avoiding admissions. They foresaw benefits to inter-professional working, clinical support and person-centred care, but raised concerns over professional boundaries and role clarity. These messages were reinforced in our workshop, where the value of timely assessment was highlighted, alongside challenges of funding and governance.ConclusionsThe role of paramedics is shifting into dedicated primary and community work, including care homes. It is imperative that research is aligned and informs evidence based practice. We are developing PERCH2, a feasibility study evaluating the impact of paramedics working in this way.
Unexpected cancellation on a catatonic patient’s electroconvulsive therapy due to the coronavirus pandemic
Authors: Casano Kelsey , Capone Erin 
Published: September 2020

We report a case of a 39-year-old woman with a psychiatric history of schizoaffective disorder with catatonia, dependent personality disorder and substance use disorder whose symptoms have been very difficult to control. During her most recent inpatient admission, she was treated with electroconvulsive therapy (ECT) for catatonia. Our treatment team was hopeful that ECT was making a difference for this patient. However, she was only able to receive two sessions of treatment due to new hospital protocols related to the coronavirus pandemic. Although the patient was not suspected to have the coronavirus, she could no longer undergo ventilation with a bag and mask during the procedure. Bag–mask ventilation is known to aerosolise the coronavirus and other diseases and potentially put healthcare workers at risk. Although orotracheal intubation also aerosolises the coronavirus, this was the only means of airway management still allowed by anaesthesia providers at this time. Our psychiatry team estimated that the risks of intubation outweighed the benefits of treatment, and ECT was cancelled.Without additional ECT treatments, the patient again decompensated for several weeks before being stabilised on clozapine, haloperidol and lorazepam. Although she eventually had a positive treatment outcome, her hospital course was likely prolonged due to unforeseen events related to the novel coronavirus. We feel that the current medical climate is unprecedented and is interfering with necessary psychiatric treatment in an unanticipated way. Anaesthesiologists will need to be flexible while working with psychiatrists and identify safe ways to provide this necessary psychiatric treatment for patients.
Impact of a streamlined trauma management approach and determinants of mortality among hemodynamically unstable patients with severe multiple injuries: a before-and-after retrospective cohort study
Authors: Otsuka Hiroyuki , Uehata Atsushi , Sakoda Naoki , Sato Toshiki , Sakurai Keiji , Aoki Hiromichi , Yamagiwa Takeshi , Iizuka Shinichi , Inokuchi Sadaki 
Published: September 2020

BackgroundTrauma management requires a multidisciplinary approach, but coordination of staff and procedures is challenging in patients with severe trauma. In October 2014, we implemented a streamlined trauma management system involving emergency physicians trained in severe trauma management, surgical techniques, and interventional radiology. We evaluated the impact of streamlined trauma management on patient management and outcomes (study 1) and evaluated determinants of mortality in patients with severe trauma (study 2).MethodsWe conducted a retrospective cohort study of 125 patients admitted between January 2011 and 2019 with severe trauma (Injury Severity Score ≥16) and persistent hypotension (≥2 systolic blood pressure measurements <90 mm Hg). Patients were divided into a Before cohort (January 2011 to September 2014) and an After cohort (October 2014 to January 2019) according to whether they were admitted before or after the new approach was implemented. The primary outcome was in-hospital mortality.ResultsCompared with the Before cohort (n=59), the After cohort (n=66) had a significantly lower in-hospital mortality (36.4% vs. 64.4%); required less time from hospital arrival to initiation of surgery/interventional radiology (median, 41.0 vs. 71.5 minutes); and was more likely to undergo resuscitative endovascular balloon occlusion of the aorta (24.2% vs. 6.8%). Plasma administration before initiating hemostasis (adjusted OR 1.49 (95% CI 1.04 to 2.14)), resuscitative endovascular balloon occlusion of the aorta (9.48 (95% CI 1.25 to 71.96)), and shorter time to initiation of surgery/interventional radiology (0.97 (95% CI 0.96 to 0.99)) were associated with significantly lower mortality.DiscussionImplementing a streamlined trauma management protocol improved outcomes among hemodynamically unstable patients with severe multiple trauma.Level of evidenceLevel III.
Effect of a high‐intensity one‐week training programme and student‐level variables on the bovine transrectal palpation and pregnancy diagnosis skills of final‐year veterinary students
Authors: Annandale Annett , May Catherine E , van der Leek Martin L , Fosgate Geoffrey T , Kremer Wim DJ , Bok Harold GJ , Holm Dietmar E 
Published: September 2020

BackgroundTo improve bovine transrectal palpation (TRP) and pregnancy diagnosis (PD) training, the effect of a high‐intensity one‐week training programme for veterinary elective students (N=59) with an interest in production animal practice was evaluated.MethodsTraining consisted of exposure to rectal examination simulators, abattoir organs, theory materials and live cow PDs supervised by experienced large animal practitioners. Palpation skills were assessed before and after training using a validated TRP Objective Structured Clinical Examination (OSCE) in non‐pregnant cows. Each student then performed PDs (n=12) on cows of known pregnancy status. Students’ PD accuracy was measured as sensitivity and specificity, being respectively defined as the proportion of pregnant and non‐pregnant cows correctly identified.ResultsStudents’ scores improved from the first to the second OSCE (P=0.03), mostly as a result of improved ability to identify uterine symmetry/asymmetry and the presence/absence of a corpus luteum on the right ovary (P<0.01 and P=0.03, respectively). Overall student sensitivity and specificity of PD were 89.1 per cent (95 per cent CI 78.1–92.2 per cent) and 67.7 per cent (95 per cent CI 60.1–74.5 per cent), respectively.ConclusionThis prospective cohort study describes a strategy to improve students’ TRP skills with the potential to reduce training time and animal use at teaching institutions by outsourcing student training to private practitioners.
New gedanken experiment on higher-dimensional asymptotically AdS Reissner–Nordström black hole
Authors: Zhang Ming , Jiang Jie 
Published: September 2020

AbstractViewing the negative cosmological constant as a dynamical quantity derived from the matter field, we study the weak cosmic censorship conjecture for the higher-dimensional asymptotically AdS Reissner–Nordström black hole. To this end, using the stability assumption of the matter field perturbation and the null energy condition of the matter field, we first derive the first-order and second-order perturbation inequalities containing the variable cosmological constant and its conjugate quantity for the black hole. We prove that the higher-dimensional RN-AdS black hole cannot be destroyed under a second-order approximation of the matter field perturbation process.
A Novel Energy-Efficient Clustering Protocol Using Two-Stage Genetic Algorithm for Improving the Lifetime of Wireless Sensor Networks
Authors: Mahani Ali , Farahmand Ebrahim , Sheikhpour Saeide , Taheri-Chatrudi Nooshin 
Published: September 2020

Wireless sensor networks (WSNs) are beginning to be deployed at an accelerated pace, and they have attracted significant attention in a broad spectrum of applications. WSNs encompass a large number of sensor nodes enabling a base station (BS) to sense and transmit data over the area where WSN is spread. As most sensor nodes have a limited energy capacity and at the same time transmit critical information, enhancing the lifetime and the reliability of WSNs are essential factors in designing these networks. Among many approaches, clustering of sensor nodes has proved to be an effective method of reducing energy consumption and increasing lifetime of WSNs. In this paper, a new energy-efficient clustering protocol is implemented using a two-step Genetic Algorithm (GA). In the first step of GA, cluster heads (CHs) are selected, and in the second step, cluster members are chosen based on their distance to the selected CHs. Compared to other clustering protocols, the lifetime of WSNs in the proposed clustering is improved. This improvement is the consequence of the fact that this clustering considers energy efficient parameters in clustering protocol.
Manganese occurrence in the Mankwadzi Area, southern Kibi–Winneba metavolcanic belt, Ghana: typical or atypical palaeoproterozoic Birimian Mn mineralization?
Authors: Nyame Frank K. , Armah Thomas K. E. , Ibrahim Kwabina , Baah-Acheamfour Jeff , Manu Johnson , Tigme Jacob 
Published: September 2020

Abstract
Previous work on the manganese occurrence in the Mankwadzi area, Ghana, suggested that it resulted from localized hydrothermal or pyrometasomatic activity genetically related to dyke formation. This observation means that the Mankwadzi Mn occurrence could be genetically different from typical Birimian Mn mineralization which dominantly displays sedimentary protore and overlying, supergene-derived manganese oxides. We recently conducted field sampling, geophysical survey and petrographic analyses of the Mankwadzi Mn-bearing rocks. Our results suggest that the NNE-trending manganiferous zone, about 20–30 m wide and over 200 m long, is conformable with immediately enclosing hornblende schist. Samples of Mn rock from the manganiferous zone are generally massive to variably banded and occasionally show centimetre-scale macro-folding. Scanning electron microscope analyses revealed that bands dominated by Mn garnet often distinctly alternate with silica (chert) or siliciclastic layers. These converging lines of evidence, i.e. conformability of the manganiferous zone with enclosing rock, occurrence of distinct banding, inter-folding of manganese and silica (chert) or siliciclastic layers and alternating Mn garnet-rich and garnet-poor layers strongly suggest the Mankwadzi manganese occurrence is genetically similar to the stratiform Nsuta manganese deposit in Ghana and, more likely, to other Mn deposits in the Birimian of West Africa.
Scientists, collectors and illustrators: the roles of women in the Palaeontographical Society
Authors: Panciroli Elsa , Wyse Jackson Patrick N. , Crowther Peter R. 
Published: September 2020

Abstract
Women have taken on a range of roles in scientific societies since the early twentieth century. The oldest society dedicated to palaeontology, the Palaeontographical Society, was established in 1847 principally for the publication of monographs on British fossils. Since its foundation, women have been involved, initially as collectors and illustrators, then authors and latterly as elected members of council. Early contributors include well-known female scientists such as Gertrude Lilian Elles (1872–1960) and Ethel Mary Reader Wood (1871–1946), and the enigmatic ‘Miss Pike’. Although there have been female monograph authors and council members since 1901, their number has not risen significantly since the early twentieth century. The increased female presence on the Society's Council since 2009 is promising but, to date, there have been only four female vice-presidents and no female presidents in almost 175 years. Although things have undoubtedly improved since its founding, the Palaeontographical Society – like similar geosciences societies – still has some distance to travel to reach gender parity. This paper contributes to that process by recognizing the many talented women who have played formative roles in the development, and continued success, of this organization.
International geoscience cooperation – fair and equitable?
Authors: Ovadia David C. , O'Connor Eugene A. 
Published: September 2020

Abstract
This chapter looks at some of the ethical issues associated with international cooperation in the geosciences, which face students, researchers, academics, practitioners and others who work in this sector. It notes that the geosciences are fundamentally trans-national activities and traces the history of international cooperation from ancient times, through the era of European colonialism to the present. The drivers for international cooperation are the desire to find and extract natural resources, ways of avoiding and mitigating natural hazards through to curiosity-driven research. It identifies how altruism co-exists and sometimes competes with politics and enterprise in implementing international cooperation, and the various roles of international bodies and agencies.
Reaching out from Earth to the stars
Authors: McLean Margaret R. 
Published: September 2020

Abstract

Over a decade ago, Stephen Hawking cautioned, ‘I don't think that the human race will survive the next thousand years unless we spread into space. There are too many accidents that befall life on a single planet. But I'm an optimist. We will reach out to the stars’ (in Highfield 2001,
https://www.theguardian.com/commentisfree/2016/dec/01/stephen-hawking-dangerous-time-planet-inequality
). With plans afoot to pack our bags for life on the red planet in the 2030s, we should expand our ethical thinking from the Earth deep into space. This chapter proposes the development of a set of reasoning tools in the form of principles and virtue to guide scientists, the public and policy-makers in creating an ethical framework to steer and constrain our reaching out from Earth to the stars.