bluuebunny/crossref_metadata_2025_split huggingface dataset:
PP17 Verbalisation of plans during out-of-hospital cardiac arrest resuscitation
Authors: Marzuki Ernisa , Crawford Anna , Cummins Chris , Rohde Hannah , Branigan Holly , Clegg Gareth 
Published: April 2019

BackgroundPlanning and communication are pivotal in achieving team goals. Studies have shown that teams with effective planning and sharing of mental models display better performance in resuscitation. The Advanced Life Support (ALS) algorithm serves as an overall script regarding specific stages during resuscitation, but it does not explicitly specify how tasks should be delegated or synchronised. Team members therefore need to rely on ongoing, context-specific shared plans for effective team coordination.MethodsIn our research, we explore paramedic resuscitation teams’ verbal communication from a discourse-analytic perspective. We analysed out-of-hospital cardiac arrest (OHCA) resuscitation videos, recorded using body cameras in the field, for plan verbalisation patterns and possible association with successful or unsuccessful outcomes. For the current study, the first five minutes of 10 OHCA resuscitations were transcribed and annotated using a bespoke coding scheme. We focused on how paramedics use language to coordinate their goals and manage the transitions between stages of the OHCA treatment process, and whether this is associated with the deployment of the mechanical compression device, AutoPulse.ResultsAll 10 videos showed similar patterns of plan verbalisation in the first five minutes. The amount of verbalised plans took up nearly half the spoken utterances of all teams, suggesting that paramedics actively shared plans with their team members. Early in the resuscitation, paramedics tended to concentrate on immediate, single-task goals (e.g. moving patient to ideal position) rather than long-term, multi-task goals (e.g. accessing airway). We found little communication of the team leader’s overall mental model or script. Instead, plans were shared moment by moment. Based on the 10 videos, the timing of AutoPulse deployment seemed unaffected by the way plans were shared.ConclusionThis study enriches our understanding of real-life planning and sharing of mental models during resuscitation. Through these, we can contribute to the betterment of professional interaction in this critical domain.
PP24 Time: take-home naloxone in multicentre emergency settings: protocol for a feasibility study
Authors: Jones Matthew , Snooks Helen , Bulger Jenna , Watkins Alan , Moore Chris , Edwards Adrian , Evans Bridie , Fuller Gordon , John Ann , Benger Jonathan , Buykx Penny , Hoskins Rebecca , Dixon Simon , Goodacre Steve , Black Sarah , Parry Emma , Lawrence Barbara , Bell Fiona 
Published: April 2019

BackgroundOpioids such as heroin kill more people worldwide than any other drug. Death rates associated with opioid poisoning in the UK are at record levels. Naloxone is an opioid agonist which can be distributed in take home ‘kits’. This intervention is known as Take Home Naloxone (THN).MethodsWe propose to carry out a randomised controlled feasibility trial (RCT) of THN distributed in emergency settings clustered by Emergency Department (ED) catchment area, and local ambulance service; with anonymised linked data outcomes. This will include distribution of THN by paramedics and ED staff to patients at risk of opioid overdose. Existing linked data will be used to develop a discriminant function to retrospectively identify people at high risk of overdose death based on observable predictors of overdose to include in outcome follow up.ResultsWe will gather outcomes up to one year including; deaths (and drug related); emergency admissions; intensive care admissions; ED attendances (and overdose related); 999 attendances (and for overdose); THN kits issued; and NHS resource usage. We will agree progression criteria following consultation with research team members related to sign up of sites; successful identification and provision of THN to eligible participants; successful follow up of eligible participants and opioid decedents; adverse event rate; successful data matching and data linkage; and retrieval of outcomes within three months of projected timeline.ConclusionsTHN programmes are currently run by some drug services in the UK. However, saturation is low. There has been a lack of experimental research in to THN, and so questions remain: Does THN reduce deaths? Are there unforeseen harms associated with THN? Is THN cost effective? This feasibility study will establish whether a fully powered cluster RCT can be used to answer these questions.
PP26 Convey or not convey? Does crew skill level predict hospital conveyance rate in a UK regional NHS ambulance service trust?
Authors: Black Sarah , Frampton Ian 
Published: April 2019

BackgroundThis study aimed to explore how demographic, temporal and patient characteristics influenced the decision to convey in a large dataset of nearly half a million consecutive calls to an NHS Ambulance Service Trust in the course of a single year.MethodsThe retrospective dataset combined information from patient clinical records and Control system data. Thirty variables were examined using a variety of techniques, including Pearson χ2, Mantel-Haenszel test for trend and Binomial logistic regression. Challenges and benefits to combining large datasets from different sources were explored.ResultsThe binomial logistic regression model was statistically significant, χ2(21)=90409, p<0.0005, and showed that crew skill level independently predicted decision to convey. The model explained 24.3% (NagelkerkeR2) of the variance in conveyance and correctly classified 68.2% of cases. Sensitivity was 86.4%, specificity was 44.4%, positive predictive value was 33.1% and negative predictive value was 71.6%. All five predictor variables were statistically significant. Controlling for all the other variables; increasing crew skill level was independently associated with a significantly reduced likelihood of being conveyed.ConclusionsThe potential implications of this finding for ambulance services, Emergency Departments and the wider NHS are profound. Investment in community services in more rural areas may reduce ambulance conveyance, resulting in fewer avoidable admissions and easing pressure on the system. A striking difference in conveyance rates due to the time of day the 999 call was made is evident. During the ‘in hours’ period ambulance clinicians were able to discharge more patients at scene without the requirement for an ED conveyance. Conversely access to alternative health and social care providers is limited ‘out of hours’; making these services available over a longer operating period may similarly reduce ambulance conveyance rates during the evening and overnight.
PP28 Tia prehospital referral feasibility trial (TIER): recruitment and intervention usage
Authors: Rees Nigel , Hampton Chelsey , Bulger Jenna , Ali Khalid , Quinn Tom , Ford Gary , Akbari Ashley , Ward Matthew , Porter Alison , Jones Charlene , Snooks Helen 
Published: April 2019

BackgroundEarly specialist assessment of Transient Ischaemic Attack (TIA) can reduce the risk of stroke and death. This study assessed feasibility of undertaking a multi-centre randomised trial to evaluate clinical and cost effectiveness of referral of patients attended by emergency ambulance paramedic with low-risk TIA directly to specialist TIA clinic for early review.MethodsWe developed a protocol and referral pathway for paramedics to assess and refer patients directly to TIA clinic, including provision of aspirin. We randomly allocated volunteer paramedics to intervention or control group. Intervention paramedics were trained to deliver the intervention during the patient recruitment period. Control paramedics continued to deliver care as usual. Patients with TIA were identified from hospital records. We aimed to recruit 86 patients and pre-defined progression criteria related to feasibility of intervention delivery and trial methods.ResultsDevelopment and recruitment phases are complete, with outcome follow up ongoing. Eighty nine of 134 (66%) paramedics participated in TIER. Of 1377 patients attended by trial paramedics during the patient recruitment period, 53 (3.8%) were identified as eligible for trial inclusion. Three of 36 (8%) patients attended by intervention paramedics were referred to the TIA clinic. Of the others, only one appeared to be a missed referral; in one case there was no prehospital record of TIA; one was attended by a paramedic who was not TIER trained; one patient record was missing; all others were recorded with contraindications: FAST positive (n=13); ABCD2 score >3 (n=5); already taking warfarin (n=2); crescendo TIA (n=1) other clinical factors (n=8).ConclusionsPreliminary Results indicate challenges in recruitment and low referral rates. The low-risk 999 TIA population suitable for Emergency Department avoidance may be smaller than previously thought. Further analyses will focus on whether progression criteria for a definitive trial were met, and clinical outcomes from this feasibility trial.
PP7 Perceptions and experiences of being a community first responder: interview study
Authors: Phung Viet-Hai , Trueman Ian , Togher Fiona , Ørner Roderick , Siriwardena Niroshan 
Published: April 2019

BackgroundCommunity First Responder (CFR) schemes work with ambulance services, supporting volunteers to respond to medical emergencies. The CFR’s primary role is to stabilise a patient’s condition and perform basic clinical procedures before handing over to statutory ambulance service staff. By early 2014, there were 2,431 CFR schemes, with over 12 000 volunteers in the UK. Despite expansion in numbers and role, little is known about perspectives of CFRs. We aimed to explore the perceptions and experiences of CFRs about their role.MethodsWe used a qualitative design conducting semi-structured interviews with a purposive sample of CFRs from one scheme in one English county. Interviews were transcribed verbatim and coded thematically in NVivo 10 using the Framework approach.ResultsWe interviewed four female and 12 male adult CFRs between June and July 2016. The interviews identified five overarching themes,: ‘getting started and keeping going’; ‘the reality of being a CFR’; ‘recognition and relationships’; ‘learning to be a CFR’; and ‘the way forward’ for CFRs and schemes. Participants were keen to enhance their skills and progress. CFRs felt that the public confused them with ambulance staff, although patients felt reassured by the presence of someone who could help them regardless of who they were. CFRs were keen to raise their profile within the communities they served and to establish a distinct identity. The relationship between CFRs and ambulance staff was ambivalent: sometimes they worked well together while at other times they perceived a poor relationship with ambulance staff.ConclusionThe complex relationship between CFRs, patients and the ambulance service has implications for how such schemes develop in the future. As such, further research is required on public and ambulance staff perceptions of what they do to see how these complex relationships can be harnessed effectively to benefit the communities they serve.
ContextAiDe
Authors: Pore Madhurima , Chakati Vinaya , Banerjee Ayan , Gupta Sandeep K. S. 
Published: April 2019

Mobile crowd-sensing (MCS) enables development of context-aware applications by mining relevant information from a large set of devices selected in an ad hoc manner. For example, MCS has been used for real-time monitoring such as Vehicle ad hoc Networks-based traffic updates as well as offline data mining and tagging for future use in applications with location-based services. However, MCS could be potentially used for much more demanding applications such as real-time perpetrator tracking by online mining of images from nearby mobile users. A recent example is tracking the miscreant responsible for the Boston bombing. We present a new design approach for tracking using MCS for such complex processing in real time. Since MCS applications assume an unreliable underlying computational platform, most typically sample size for recruited devices is guided by concerns such as fault tolerance and reliability of information. As the real-time requirements get stricter coupled with increasing complexity of data-mining approaches, the communication and computation overheads can impose a very tight constraint on the sample size of devices needed for realizing real-time operation. This results in trade-off in acquiring context-relevant data and resource usage incurred while the real-time operation requirements get updated dynamically. Such effects have not been properly studied and optimized to enable real-time MCS applications such as perpetrator tracking. In this article, we propose ContextAiDe architecture, a combination of API, middleware, and optimization engine. The key innovation in ContextAiDe is context-optimized recruitment for execution of computation- and communication-heavy MCS applications in edge environment.
ContextAiDe uses a notion of two types of contexts, exact (hard constraints), which have to be satisfied, and preferred (soft constraints), which may be satisfied to a certain degree. By adjusting the preferred contexts, ContextAiDe can optimize the operational overheads to enable real-time operation. ContextAiDe provides an API to specify contexts requirements and the code of MCS app, offload execution environment, a middleware that enables context-optimized and a fault-tolerant distributed execution. ContextAiDe evaluation using a real-time perpetrator tracking application shows reduced energy consumption of 37.8%, decrease in data transfer of 24.8%, and 43% less time compared to existing strategy. In spite of a small increase in the minimum distance from the perpetrator, iterations of optimization tracks the perpetrator successfully. Pro-actively learning the context and using stochastic optimization strategy minimizes the performance degradation caused due to uncertainty (<20%) in usage-dependent contexts.
Adventitial Cell Atlas of wt (Wild Type) and ApoE (Apolipoprotein E)-Deficient Mice Defined by Single-Cell RNA Sequencing
Authors: Gu Wenduo , Ni Zhichao , Tan Yuan-Qing , Deng Jiacheng , Zhang Si-Jin , Lv Zi-Chao , Wang Xiao-Jian , Chen Ting , Zhang Zhongyi , Hu Yanhua , Jing Zhi-Cheng , Xu Qingbo 
Published: April 2019

Objective—
Vascular adventitia encompasses progenitors and is getting recognized as the major site of inflammation in early stage of atherosclerosis. However, the cellular atlas of the heterogeneous adventitial cells, the intercellular communication, the cellular response of adventitia to hyperlipidemia, and its contribution to atherosclerosis have been elusive.

Approach and Results—

Single-cell RNA sequencing was applied to wt (wild type) and ApoE (apolipoprotein E)-deficient aortic adventitia from 12-week-old C57BL/6J mice fed on normal laboratory diet with early stage of atherosclerosis. Unbiased clustering analysis revealed that the landscape of adventitial cells encompassed adventitial mesenchyme cells, immune cells (macrophages, T cells, and B cells), and some types of rare cells, for example, neuron, lymphatic endothelial cells, and innate lymphoid cells. Seurat clustering analysis singled out 6 nonimmune clusters with distinct transcriptomic profiles, in which there predominantly were stem/progenitor cell–like and proinflammatory population (Mesen II). In ApoE-deficient adventitia, resident macrophages were activated and related to increased myeloid cell infiltration in the adventitia. Cell communication analysis further elucidated enhanced interaction between a mesenchyme cluster and inflammatory macrophages in ApoE-deficient adventitia. In vitro transwell assay confirmed the proinflammatory role of SCA1
+
(stem cell antigen 1 positive) Mesen II population with increased CCL2 (chemokine [C-C motif] ligand 2) secretion and thus increased capacity to attract immune cells in ApoE-deficient adventitia.

Conclusions—
Cell atlas defined by single-cell RNA sequencing depicted the heterogeneous cellular landscape of the adventitia and uncovered several types of cell populations. Furthermore, resident cell interaction with immune cells appears crucial at the early stage of atherosclerosis.
Predictors of Clinical Evolution in Prehypertrophic Fabry Disease
Authors: Camporeale Antonia , Pieroni Maurizio , Pieruzzi Federico , Lusardi Paola , Pica Silvia , Spada Marco , Mignani Renzo , Burlina Alessandro , Bandera Francesco , Guazzi Marco , Graziani Francesca , Crea Filippo , Greiser Adreas , Boveri Sara , Ambrogi Federico , Lombardi Massimo 
Published: April 2019

Background:
In prehypertrophic Fabry disease, low myocardial T1 values, reflecting sphingolipid storage, are associated with early structural and ECG changes. The correlations between T1 values and functional parameters have not been explored. Furthermore, the potential prognostic role of T1 in predicting disease worsening is still unknown.

Methods:
ECG, 2D echocardiography, cardiopulmonary test, and cardiac magnetic resonance were performed in 44 Fabry patients without left ventricular hypertrophy (35.7±14.5 years, 68.2% females). After a 12-month follow-up, clinical stability was evaluated using Fabry Stabilization Index.

Results:

At baseline, T1 values showed a negative correlation with left ventricular mass (
r
=−0.79;
P
<0.0001), maximum wall thickness (
r
=−0.79;
P
<0.0001), Sokolow-Lyon Index (
r
=−0.54;
P
<0.0001), left atrial volume (
r
=−0.49;
P
<0.0002), and Mainz Severity Score Index (
r
=−0.61;
P
<0.0001). No significant differences in systo-diastolic function and exercise capacity were observed comparing normal and low T1 Fabry patients. Arrhythmias were reported in 2 females with low T1 and late gadolinium enhancement. Five patients (40.0±12.4 years, 2 females) showed clinical worsening (Fabry Stabilization Index >20%) at follow-up. Higher left ventricular wall thickness (odds ratio, 2.61; CI, 1.04–6.57;
P
=0.04), left atrial volume (odds ratio, 1.24; CI, 1.02–1.51;
P
=0.03), and lower T1 values (odds ratio, 0.98; CI, 0.96–0.99;
P
=0.03) at baseline were independently associated with clinical worsening at follow-up.

Conclusions:
In prehypertrophic Fabry disease, low T1 values correlate with early electrocardiographic, morphological cardiac changes, and worsening of global disease severity but are not associated with functional abnormalities. The presence of low T1 values is a risk factor for disease worsening, thus representing a potential new tool in prognostic stratification and therapeutic approach.
Somatosensory Deficits After Ischemic Stroke
Authors: Kessner Simon S. , Schlemm Eckhard , Cheng Bastian , Bingel Ulrike , Fiehler Jens , Gerloff Christian , Thomalla Götz 
Published: April 2019

Background and Purpose—
About 50% to 80% of stroke survivors present with somatosensory deficits. Somatosensory deficits because of an ischemic stroke are determined by the infarct location. However, a detailed understanding of the long-term effect of lesions on somatosensory performance is lacking.

Methods—
This prospective observational study enrolled 101 ischemic stroke patients. For voxel-based lesion-symptom mapping, magnetic resonance imaging fluid-attenuated inversion recovery imaging infarct lesions were segmented within 5 days after stroke. Standardized tests such as the National Institutes of Health Stroke Scale and the Rivermead Assessment of Somatosensory Performance were performed during acute stage, after 3 and 12 months. This included bilateral testing for multiple tactile and proprioceptive somatosensory modalities (pressure, light touch, sharp-dull discrimination, temperature discrimination, sensory extinction, 2-point discrimination, and joint position and movement sense). We further study the association of acute somatosensory deficit with functional outcome 12 months after stroke assessed by the modified Rankin Scale using univariate and multiple linear regression analysis also including acute motor deficit assessed by the arm research action test.

Results—
Sixty patients (59.4%) showed impairment in at least one somatosensory modality. Light touch was most frequently affected (38.7%), whereas temperature was least frequently affected (21.8%). After 3 months, significant recovery was observed in all somatosensory modalities, with only minor additional improvements after 12 months. Voxel-based lesion-symptom mapping revealed significant associations of lesions in the primary and secondary somatosensory and insular cortex with somatosensory deficits. Acute somatosensory deficit was associated with functional outcome at 12 months. However, including the acute motor deficit, somatosensory deficit was no longer an independent predictor of functional outcome.

Conclusions—
Our study confirms that somatosensory deficits are frequent in acute ischemic stroke but largely recover over time. Infarct lesions in the primary and secondary somatosensory cortex and insula show a robust association with somatosensory impairment. Long-term disability is influenced by somatosensory deficits but driven by motor symptoms.
Evaluation of the Performance Characteristics of the Lightning Imaging Sensor
Authors: Zhang Daile , Cummins Kenneth L. , Bitzer Phillip , Koshak William J. 
Published: April 2019

AbstractThe Lightning Imaging Sensor (LIS) that was on board the Tropical Rainfall Measuring Mission (TRMM) satellite captured optical emissions produced by lightning. In this work, we quantify and evaluate the LIS performance characteristics at both the pixel level of LIS events and contiguous clusters of events known as groups during a recent 2-yr period. Differences in the detection threshold among the four quadrants in the LIS pixel array produce small but meaningful differences in their optical characteristics. In particular, one LIS quadrant (Q1, X ≥ 64; Y ≥ 64) detects 15%–20% more lightning events than the others because of a lower detection threshold. Sensitivity decreases radially from the center of the LIS array to the edges because of sensor optics. The observed falloff behavior is larger on orbit than was measured during the prelaunch laboratory calibration and is likely linked to changes in cloud scattering pathlength with instrument viewing angle. Also, a two-season comparison with the U.S. National Lightning Detection Network (NLDN) has uncovered a 5–7-km north–south LIS location offset that changes sign because of periodic TRMM yaw maneuvers. LIS groups and flashes that had any temporally and spatially corresponding NLDN reports (i.e., NLDN reported the radio signals from the same group and/or from other groups in the same flash) tended to be spatially larger and last longer (only for flashes) than the overall population of groups/flashes.