bluuebunny/crossref_metadata_2025_split huggingface dataset:
01  Major trauma triage tools study (MATTS) triage tools summary
Authors: Holt Christopher , Fuller Gordon , Keating Samuel , Turner Janette , Irving Andy , Herbert Esther 
Published: September 2020

IntroductionThe aim of this project is to identify major trauma triage tools currently in use by ambulance services in England, Wales and internationally and subsequently complete a detailed document analysis of these tools. The review will aim to detect the most commonly used predictors of major trauma whilst identifying the evidence behind them.MethodsA variety of triage tools used internationally were acquired through analysis of systematic reviews freely available on PubMed. The 46 identified tools included: 40 adult/general, 4 paediatric-specific and 2 geriatric-specific tools. Following the acquisition of all triage tools, they were analysed by diagnostic criteria and a detailed spreadsheet produced. Each row of the spreadsheet represented a different triage criterion and each cell was colour coded to suggest the correct course of action for patient management.ResultsIn total, 63 separate clinical features and triaging criteria were identified. These were categorised into five major groups (most common variables):Physiology (GCS, Low BP).Anatomy (Chest trauma, traumatic amputation).Mechanism of injury (Falls, high speed RTC).Modifiers for high risk groups (Age >55/65, pregnant)Time limit to the nearest MTC (>45 minutes).Additionally, crew concern is a potential predictor in 14 tools. Despite many tools using similar predictors, their respective predictor cut-points varied widely (e.g. from GCS ≤14 to <9).From the tools assessed, two basic tool structures were discerned:A flowchart style format (34 tools)A points-based scoring system (7 tools)ConclusionsThe various major trauma triaging tools currently in use in the NHS and worldwide are highly varied. Although there are commonly used domains variable cut-points often varied. Given this significant difference between services’ tools, and variability of clinician interpretation of those criteria, large variations in standards of major trauma triaging are likely.
PP10  How senior paramedics determine a futile resuscitation in pulseless electrical activity out of hospital cardiac arrest: a mixed methods study
Authors: Coppola Ali , Black Sarah , Endacott Ruth 
Published: September 2020

BackgroundPulseless electrical activity, a non-shockable cardiac arrest, is treated using advanced life support resuscitation. When resuscitation fails, evidenced-based guidelines are limited on when to stop resuscitation. This led to one UK Ambulance Service developing a local guideline for senior paramedics to cease resuscitation when considered futile. The aim of this study was to examine clinical, patient and system factors of a futile resuscitation for pulseless electrical activity and how senior paramedics apply these factors to the decision-making process.Design and MethodsAn explanatory sequential mixed method design conducted in a single UK Ambulance Service. Cessation of resuscitation data was retrieved for all adult patients suffering an Out of Hospital Cardiac Arrest from 1st December 2015 to 31st December 2018. Cases subject to a coronial or police investigation were excluded. Senior paramedics made decisions to cease resuscitation for 50 patients at the scene and these were reviewed in detail. Interviews were conducted with six senior paramedics, who provide telephone clinical support to on-scene paramedics.ResultsThe mean patient age was 78 years, the majority were male (n=30, 60%) had a witnessed collapse (n=37, 74%) and had a PEA rate below 50 (n=46, 92%). There were no significant associations between patient demographics and clinical or system factors. Themes arising from paramedic interviews included concepts that defined futility, the impact of decision-making, conflicting views and supportive clinical decision tools.ConclusionWhilst there were no significant associations between variables, senior paramedics balanced patient survival with resuscitation futility by interpreting key factors, such as patient demographics and clinical factors. This multifactorial approach questions termination of resuscitation based on clinical factors alone. It identifies a group of PEA patients, when resuscitation is not successful, may be considered for termination of resuscitation. Research using a larger sample is warranted to explore the validity of these criteria.AcknowledgementsThe authors would like to thank Professor Jonathan Benger for his valuable input and guidance as the educational supervisor for this study. J. Lynde and H. Trebilcock for quantitative data extraction. L. Tremayne and E. Freeman, qualitative data coding. Thank you to all the paramedics who participated.
PP17  Is weight just a number? The accuracy of UK ambulance paediatric weight guidance – findings from a cross sectional study
Authors: Charlton Karl , Capsey Matt , Moat Chris 
Published: September 2020

BackgroundThe weight of children is the cornerstone of their clinical management. It determines fluid quantities, drug dosages and defibrillation power, which are administered on a per kilogram basis. Gold standard care for all paediatric patients who attend hospital involves being weighed using scales. This is not possible in the out of hospital setting, where weight derives from a guidance table based upon age. No evidence exists to indicate if the page by age approach indicated in current ambulance guidelines meets the reference standard of 70% of estimations within 10% of actual weight and 95% within 20% of actual weight.MethodsWe used a cross sectional study design and collected data from a convenience sample of children who attended the outpatient’s department of a major hospital in England between July and September 2019. All children aged between one and eleven years who were weighed were eligible for inclusion. Outcomes were to determine if the page by age approach meets the reference standard and to determine any implications for care.ResultsThree hundred and forty-one children were included in this study. Each age group consisted of varying numbers of children. 50.5% (172/341) of the sample were female. Observed weights ranged from 8.28 to 82.70 kg (median 20.60 kg). The mean weight of girls versus boys was 24.69 kg and 23.39 kg respectively (95% CI -4.12–1.32, p=0.3123). Observed weights were greater than the page for age guidance in all age groups and the accuracy of this approach diminishes with age.ConclusionPage by age weight guidance does not meet the reference standard. Most paediatric prehospital care is administered by age and not weight. In the absence of an accurate weight, ambulance clinicians should continue to use the page for age system, although the gold standard remains to use an accurate weight measurement.
PP22  An exploration of the facilitators and barriers to paramedics’ assessment and treatment of pain in paediatric patients following trauma (EX-PAT)
Authors: Handyside Barry , Pocock Helen , Deakin Charles 
Published: September 2020

BackgroundA cross-sectional service evaluation within South Central Ambulance Service (SCAS) revealed deficiencies in the assessment and management of paediatric patients’ pain resulting from trauma. This suggested a need for further work to identify facilitators and barriers to pain assessment and management amongst this patient group. Studies looking into the barriers and facilitators to paramedics’ assessment and management of paediatrics in pain have been conducted internationally and not solely in traumatic events. These studies are not transferable to the UK setting due to prehospital emergency care differences within these countries.MethodsThis study will utilise qualitative research methods.The study population will be qualified paramedics. In-depth semi structured interviews will be conducted using a guide developed from previous studies and refined at patient and public involvement events. The expected numbers of participants will be 12–15 but will continue to the point of data saturation. Thematic analysis of data will be performed using an open coding technique guided by Braun and Clarke’s six step framework. Once complete member checking will take place with each participant.ResultsIt is anticipated that both positive and negative aspects of paramedics’ role during these incidents will be identified. Previous literature has identified support from colleagues, interaction with parents, and the ability to alleviate pain as facilitators. Barriers have included current educational practices, lack of exposure, guidelines, the prehospital environment, difficulty in assessing young children and difficulty in providing pain relief. It is therefore likely that these themes may emerge but identification of UK-specific barriers and facilitators is anticipated.ConclusionsWith no previous study of this nature conducted before in the UK this could valuably inform the education and teaching provision of ambulance services and universities as well as a platform for policy makers and guideline producers to enhance the tools available to paramedics.
PP27  What are emergency ambulance services doing to meet the needs of people who call frequently? A national survey of current practice in the united kingdom
Authors: Snooks Helen , Khanom Ashra , Cole Robert , Edwards Adrian , Edwards Bethan , Evans Bridie , Foster Theresa , Fothergill Rachael , Gripper Penny , Hampton Chelsey , John Ann , Petterson Robin , Porter Alison , Rosser Andy , Scott Jason 
Published: September 2020

BackgroundEmergency ambulance services are integral to providing a service for those with unplanned urgent and life-threatening health conditions. However, high use of the service by a small minority of patients is a concern.Aims and ObjectivesTo describe: service-wide and local policies or pathways for people classified as Frequent Caller; call volume; and results of any audit or evaluation.MethodsWe conducted a national survey of current practice in ambulance services in relation to the management of people who call the emergency ambulance service frequently using a structured questionnaire, for completion by email and telephone interview. We analysed responses using a descriptive and thematic approach.ResultsTwelve of 13 UK ambulance services responded. Most services used nationally agreed definitions for ‘Frequent Caller’, with 600 – 900 people meeting this classification each month. Service-wide policies were in place, with local variations. Models of care varied from within-service care where calls are flagged in the call centre, contact made with callers and their GP with an aim of discouraging further calls; to case management through cross-service, multi-disciplinary team meetings aiming to resolve callers’ needs. No formal audits or evaluations were reported.ConclusionsAmbulance services are under pressure to meet challenging response times for high acuity patients. Tensions are apparent in the provision of care to patients who have complex needs and call frequently. Within service care focused mainly on reducing calls whilst multi-disciplinary case management aimed to resolve clinical and emotional needs of patients. However, there is currently inadequate evidence to inform commissioning, policy or practice development.
Left ventricular longitudinal shortening: relation to stroke volume and ejection fraction in ageing, blood pressure, body size and gender in the HUNT3 study
Authors: Støylen Asbjørn , Dalen Håvard , Molmen Harald Edvard 
Published: September 2020

BackgroundAims of this cross-sectional study were to assess: the relative contribution of left ventricular (LV) systolic long-axis shortening (mean mitral annular plane systolic excursion, MAPSE) to stroke volume (SV), the mechanisms for preserved ejection fraction (EF) despite reduced MAPSE, the age dependency of myocardial volume and myocardial systolic compression.MethodsLinear dimensions and longitudinal and cross-sectional M-modes were acquired in 1266 individuals without history of heart disease, diabetes or known hypertension from the third wave of the Nord-Trøndelag Health Study. Measurements were entered into a half-ellipsoid LV model for volume calculations, and volumes were related to age, body size (body surface area, BSA), sex and blood pressure (BP).ResultsMean BP and proportion with hypertensive values increased with increasing age. MAPSE contributed to 75% of SV, with no relation to age or BSA as both MAPSE and SV decreased with increasing age. LV end-diastolic volume (LVEDV) and SV increased with BSA and decreased with higher age; EF was not related to age or BSA. Myocardial volume increased with higher age and BSA, with an additional gender dependency. The association of age with myocardial volume was not significant when corrected for BP, while both systolic and diastolic BP were significant associated with myocardial volume. Myocardial compression was less than 3%.ConclusionsMAPSE contributes approximately 75% and short axis shortening 25% to SV. Both decline with age, but their percentage contributions to SV are unchanged. EF is preserved by the simultaneous decrease in LVEDV and SV. Myocardial volume is positively associated with age, but this is only related to higher BP, which may have implications for BP treatment in ageing. The myocardium is near incompressible.
63,XX, SRY‐negative, pseudohermaphroditism in a Somali wild ass (Equus asinus somalicus)
Authors: Gillis James , Bercier Marjorie , Rattner Francine K , Citino Scott 
Published: September 2020

SUMMARYA six‐month‐old Somali wild ass (Equus asinus somalicus) scheduled for a routine health exam presented with masculinised external genitalia, which included an enlarged phallus‐like clitoris that was not connected to the urethra. A gonadectomy was conducted to sterilise the individual. Histological examination of the gonads revealed normal ovarian tissue with a recent corpus luteum, developing follicles and no testicular tissue. Karyotype analysis classified the individual as female, 63,XX, sex‐determining region Y‐negative, which is normal for a female Somali wild ass. Serum testosterone was analysed via enzyme immunoassay and was found to be below detectable concentrations. Although similar cases have been reported in domestic equids, this is the first case of intersex reported in a non‐domestic equid.
The analysis of electron scattering among multiplying layer in EBAPS using optimized Monte Carlo method
Authors: Bai Jinzhou , Bai Yonglin , Hou Xun , Cao Weiwei , Yang Yang , Wang Bo , Bai Xiaohong , Li Siqi 
Published: September 2020

Electron bombarded Active Pixel Sensor (EBAPS) is well known for its low noise in low-light level imaging, high mechanical integration, and a relatively low cost. It plays an important role in areas of the industrial process as well as the fundamental scientific research. However, the performance of EBAPS is intensively influenced by the structural parameters (i.e. the acceleration voltage between cathode and anode, thickness of the passivation layer, etc.). Due to the influence of these factors mentioned above, the performance of EBAPS is restricted to achieve its best condition. Herein, a model based on the optimized Monte Carlo method was proposed for effectively analyzing the scattering behavior of electrons within the electron multiplier layer. Unlike traditional simulation, which only deals with the electron scattering in longitudinal, in this paper, we simulate the electron scattering character not only in horizontal but also vertical among the multiplier layer, which would react to the influence induced by structural parameters more complete and more precise. Based on the proposed model, an experimental prototype of EBAPS is built and its detection sensitivity achieves [Formula: see text] lux under spectral response of ultraviolet (UV) spectroscopy, which improved a lot from our former design. The proposed model can be used for analyzing the influence induced by structural parameters, which exhibit enormous potential for exploring the high-gain EBAPS.
Addressing the geoethics skills gap through co-curricular approaches
Authors: Keane Christopher M. , Asher Pranoti 
Published: September 2020

Abstract
Geoethics as a broad and universal professional topic has become emergent over the last decade. Though the need of ethical conduct by geoscientists has always existed, the uneven professional licensing and standards for geoscientists as well as high-profile misconduct by geoscientists is driving employer demand for geoethical competency. Geoscience degree programmes in the USA are poorly equipped to teach geoethics beyond academic honesty and research integrity. One means to address the deficiency is through proactive engagement by the community and students in co-curricular activities to address specific needs. Co-curricular activities such as internships, mentoring, society and club activity, and professional development courses already exist, but are not well-coupled to the formal education process. For geoethics, the American Geosciences Institute (AGI) and the American Institute of Professional Geologists (AIPG) found that online on-demand professional development courses are a potentially effective co-curricular approach. The courses focus on the intentional learning framework, and experience shows that formal geoethics courses are in greater demand than other professional and technical topics in the on-demand course space. The challenge remains exposure of the opportunities to students and consistent acceptance by faculty and employers in the geosciences.
Dynamic Buffer Sizing for Out-of-order Event Compensation for Time-sensitive Applications
Authors: Weiss Wolfgang , Jiménez Víctor J. Expósito , Zeiner Herwig 
Published: September 2020

Today’s sensor network implementations often comprise various types of nodes connected with different types of networks. These and various other aspects influence the delay of transmitting data and therefore of out-of-order data occurrences. This turns into a crucial problem in time-sensitive applications where data must be processed promptly and decisions must be reliable.
In this article, we research dynamic buffer sizing algorithms for multiple, distributed, and independent sources, which reorder event streams, thus enabling subsequent time-sensitive applications to work correctly. To be able to evaluate such algorithms, we had to record datasets first. Five novel dynamic buffer sizing algorithms were implemented and compared to state-of-the-art approaches in this domain. The evaluation has shown that the use of a dynamic time-out buffering method is preferable over a static buffer. The higher the variation of the network or other influences in the environment, the more necessary it becomes to use an algorithm that dynamically adapts its buffer size. These algorithms are universally applicable, easy to integrate in existing architectures, and particularly interesting for time-sensitive applications. Dynamic time-out buffering is still a trade-off between reaction time and out-of-order event compensation.
Associations of Leisure-Time Physical Activity and Television Viewing with Life Expectancy Cancer-Free at Age 50: The ARIC Study
Authors: Cuthbertson Carmen C. , Nichols Hazel B. , Tan Xianming , Kucharska-Newton Anna , Heiss Gerardo , Joshu Corinne E. , Platz Elizabeth A. , Evenson Kelly R. 
Published: September 2020

Abstract

Background:
Physical activity has been associated with longer chronic disease–free life expectancy, but specific cancer types have not been investigated. We examined whether leisure-time moderate-to-vigorous physical activity (LTPA) and television (TV) viewing were associated with life expectancy cancer-free.

Methods:
We included 14,508 participants without a cancer history from the Atherosclerosis Risk in Communities (ARIC) study. We used multistate survival models to separately examine associations of LTPA (no LTPA, &lt;median, ≥median) and TV viewing (seldom/never, sometimes, often/very often) with life expectancy cancer-free at age 50 from invasive colorectal, lung, prostate, and postmenopausal breast cancer. Models were adjusted for age, gender, race, ARIC center, education, smoking, and alcohol intake.

Results:
Compared with no LTPA, participants who engaged in LTPA ≥median had a greater life expectancy cancer-free from colorectal [men-2.2 years (95% confidence interval (CI), 1.7–2.7), women-2.3 years (95% CI, 1.7–2.8)], lung [men-2.1 years (95% CI, 1.5–2.6), women-2.1 years (95% CI, 1.6–2.7)], prostate [1.5 years (95% CI, 0.8–2.2)], and postmenopausal breast cancer [2.4 years (95% CI, 1.4–3.3)]. Compared with watching TV often/very often, participants who seldom/never watched TV had a greater colorectal, lung, and postmenopausal breast cancer-free life expectancy of ∼1 year.

Conclusions:
Participating in LTPA was associated with longer life expectancy cancer-free from colorectal, lung, prostate, and postmenopausal breast cancer. Viewing less TV was associated with more years lived cancer-free from colorectal, lung, and postmenopausal breast cancer.

Impact:
Increasing physical activity and reducing TV viewing may extend the number of years lived cancer-free.
Effect of a Housing Intervention on Selected Cardiovascular Risk Factors Among Homeless Adults With Mental Illness: 24‐Month Follow‐Up of a Randomized Controlled Trial
Authors: Chum Antony , Wang Ri , Nisenbaum Rosane , O’Campo Patricia , Stergiopoulos Vicky , Hwang Stephen 
Published: September 2020

Background
Cardiovascular disease is a leading cause of mortality among people experiencing homelessness. This study investigated whether housing intervention affects cardiovascular disease risk factors among homeless adults with mental illnesses over a 24‐month period.

Methods and Results

We conducted a randomized controlled trial of a Housing First intervention that provided community‐based scattered‐site housing and support services. Five hundred seventy‐five participants were randomized to the intervention (n=301) or treatment as usual (TAU) (n=274). Analyses were performed according to the intention‐to‐treat principle using generalized estimating equations. There were no differences in change over 24 months between the 2 groups for blood pressure, tobacco, and cocaine/crack use. However, the intervention had an impact on reducing the number of days of alcohol intoxication by 1.58 days compared with TAU (95% CI, −2.88 to −0.27,
P
=0.0018). Over the 24‐month period, both the intervention and TAU groups had significant reductions in tobacco and cocaine use.

Conclusions
The intervention, compared with TAU, did not result in greater improvements in many of the selected cardiovascular risk factors. Since the study took place in a service‐rich city with a range of pre‐existing supportive services and universal health insurance, the high level of usual services available to the TAU group may have contributed to reductions in their cardiovascular disease risk factors. Further research is needed to develop interventions to reduce risk factors of cardiovascular disease among people experiencing homelessness and mental illness beyond existing treatments.

REGISTRATION

www.isrctn.com
URL:
www.isrctn.com
. Unique Identifier: ISRCTN42520374