bluuebunny/crossref_metadata_2025_split huggingface dataset:
MENTAL HEALTH CRISIS IN THE PRE-HOSPITAL SETTING
Authors: Prothero Larissa S , Cooke Philip 
Published: August 2016

BackgroundThe 2014 Mental Health Crisis Care Concordat is a national agreement to ensure people in crisis receive the help they need: integrated multi-agency schemes involving ambulance, police and mental health services are now being developed to provide urgent and emergency care pathways for these vulnerable patients. The aim of this study was to have improved understanding of mental health crisis (MHC) patients requiring ambulance care, to inform the development of new patient care pathways within the East of England.MethodsA retrospective pilot audit was performed using 291 ‘MHC’ patient care records generated following emergency ‘999’ ambulance and non-emergency ‘111’ calls in a distinct geographical area of the East of England Ambulance Service NHS Trust between 22–29 December 2014. Criteria for record inclusion were presence of the terms ‘mental health’, ‘anxiety’, ‘depression’, ‘self-harm’, ‘self-injury’, ‘abnormal behaviour’, ‘psychosis’, ‘paranoia’, ‘suicide’, ‘suicidal thoughts’, ‘overdose’, ‘dementia’, or ‘Section’.ResultsThe cohort age range was 13 to 98 years; 50.5% were male. MHC usually affected people under 65 years. The main reasons for ambulance care were deliberate drug/substance overdose (33.7%) and actions/behaviour associated with suicidal intention (19.2%) – attempted suicide was reported for 14 (4.8%) patients. Anxiety (including ‘panic attacks’/hyperventilation syndrome), depression and behavioural/emotional problems were prevalent. Alcohol consumption was reported for 36.8% patients and police attendance was required for aggressive/threatening behaviour in 22% of incidences. Approximately two-thirds (64.6%) of patients were conveyed to the emergency department; only 12 (4.1%) patients were directly admitted to a mental health facility. The majority of patient contacts occurred ‘out-of-hours’, in particular, between 20:00 and 22:00 hours.ConclusionsMental health crisis management is complex and challenging for ambulance clinicians with limited direct access to specialist services. Understanding the nature of crises and patient/public expectations of emergency services will facilitate the development of appropriate pre-hospital mental health pathways.
AMBULANCE RESPONSE TIMES AND MORTALITY IN ELDERLY FALLERS
Authors: Cannon Emily , Shaw Joanna , Fothergill Rachael , Lindridge Jaqualine 
Published: August 2016

BackgroundWorldwide, the number of people aged over 60 is growing faster than any other age group. Increased age is associated with a higher risk of falling and roughly a third of individuals aged 65 and over experience a fall each year. One way in which ambulance services may impact the outcome of patients is the time taken for a response to arrive on scene. Lying on the floor for a long time has been found to be strongly associated with serious injuries, admission to hospital, and mortality. However, previous research has not assessed the impact of ambulance response times on mortality.MethodsTo determine whether there is a relationship between the time elderly fallers (aged 65 and over) spend on the floor and mortality, an observational study was undertaken. A convenience sample of 503 ambulance response times, patient records detailing the amount of time spent on the floor, and patient outcomes at 90 days were analysed using logistic regression.ResultsEight percent of patients in the sample died within 90 days of their fall (n=38). Patients who were deceased at 90-day follow-up (n=38) did not wait significantly longer for an ambulance than patients who were still alive (n=464) (means= 34 min vs 37 min, p=.678).Of the patients who were still on the floor upon LAS arrival (n=178), those who had died within 90 days following their fall (n=14) spent less time in total on the floor than patients who were still alive at 90-day follow-up (n=164) (means= 59 min vs 98 min, p=.296).ConclusionsIncreased ambulance response time or prolonged time spent on the floor was not associated with 90-day mortality in elderly fallers who presented to the ambulance service. Whilst any delays in attending elderly fallers require monitoring, we can be reassured that long waits are not leading to mortality in this patient group.
PARAMEDIC ACUTE STROKE TREATMENT ASSESSMENT (PASTA) TRIAL
Authors: Shaw Lisa , Ford Gary A , Exley Catherine , Flynn Darren , McMeekin Peter , Rodgers Helen , Snooks Helen , Tyrell Pippa , Vale Luke , Price Christopher 
Published: August 2016

BackgroundRapid treatment of stroke can improve the chances of recovery. It is important that patients are assessed quickly to decide if it is appropriate to deliver thrombolysis treatment. This study is evaluating whether an enhanced assessment by paramedics could speed up treatment and improve stroke recovery.MethodStudy designMulticentre cluster randomised trial with cost-effectiveness analysis and parallel process evaluation.SettingNHS ambulance services, emergency departments and stroke units within three geographical regions of England and Wales.Study interventionA Paramedic Acute Stroke Treatment Assessment (PASTA) pathway initiated by paramedics and continued initially in hospital to facilitate the speed of brain imaging and delivery of thrombolysis when clinically appropriate.Study controlUsual care according to national and local guidelines for the pre-hospital and hospital assessment of suspected stroke.RandomisationAmbulance stations or paramedic teams within each region randomised to delivering the PASTA pathway or to continue with usual stroke care.ParticipantsIntervention paramedics will deliver the PASTA pathway to adults within 4 hours of suspected stroke onset. Participants enrolled in the study will be adults with confirmed stroke who were assessed by a study paramedic within 4 hours of onset.Primary outcomeDependency at 90 days after stroke (modified Rankin Scale)Process evaluationSemi-structured interviews with a subsample of participants and staff to gain insight into perceptions and experience of the PASTA pathway.Sample sizeAllowing for 3% attrition, 3640 participants are needed to provide 80% power to detect a 3% absolute difference in mRS 3–6 (poor outcome) to mRS 0–2 (good outcome).Current study statusOpened to recruitment in December 2015.
ADDRESSING THE CHALLENGES OF PARAMEDIC RECRUITMENT AND ENGAGEMENT IN AIRWAYS-2
Authors: Pilbery Richard , Green Jonathan , Hall Helen , Whitley Gregory 
Published: August 2016

AIRWAYS-2 is an NIHR-funded study to determine the best initial approach to advanced airway management during out of hospital cardiac arrest (OHCA). Four NHS ambulance trusts are taking part in AIRWAYS-2: East Midlands, South Western, Yorkshire and East of England. One of the key challenges has been the need to recruit approximately 1300 study paramedics for the trial.The three main challenges in engaging and recruiting paramedics to participate in AIRWAYS-2 have been:▸ Concerns relating to the potential results of the trial and what this will mean for the continuation of intubation for paramedics▸ Concerns relating to the restriction on paramedic choice of advanced airway in OHCA and potential skill erosion▸ Provision of training over large geographical areas at a time when morale is low and many ambulance trusts have recruitment and retention issues.How have these challenges been overcome?▸ Communication: Identifying the most appropriate communication methods in each Trust e.g. face to face, email, internal trust operational updates▸ Delivery of key messages: Emphasising why the trial is important and needed, and that its goal is not to remove intubation from paramedic practice. Obtaining the engagement of senior operational management to allay fears over impacts on service performance▸ Valuing study paramedics: Paying clinicians overtime to attend training sessions, which contributes to their own continuing professional development▸ Equity and opportunity: Delivery of multiple training sessions throughout each of the four ambulance trusts.Key achievementsBy November 2015, research paramedics had delivered nearly 350 training sessions and recruited in excess of 1300 paramedics to AIRWAYS-2.ConclusionThe research paramedics leading AIRWAYS-2 have collaboratively, and successfully, overcome the main challenges relating to recruiting and engaging the paramedics in their Trusts. This should contribute to achieving the target patient sample size for the trial.
UTILITY OF PRE-HOSPITAL LACTATE MEASUREMENT FOR TRAUMA PATIENTS: A SYSTEMATIC REVIEW
Authors: Lewis Christopher TM , Naumann David N , Midwinter Mark J , Crombie Nicholas 
Published: August 2016

BackgroundSerum lactate serves as a surrogate marker for tissue hypoxia following traumatic injury, and may be used to guide resuscitation. The portable, lightweight nature of handheld point-of-care monitoring devices enables lactate values to be readily available in the pre-hospital environment, whether in land or air based evacuation modalities. The current review evaluates the utility of pre-hospital lactate measurement in the management of trauma patients.MethodsThe published literature up to 06 August 2015 was searched using Medline and EMBASE using pre-defined criteria (English language, pre-hospital lactate measurement, trauma patients; excluding non-trauma/mixed patient groups). The Newcastle-Ottawa Scale was used to assess risk of bias of individual studies.ResultsOf 857 non-duplicate articles of interest, 5 articles met the inclusion criteria, and included four cohort studies and one cross-sectional study. There were 2049 patients included in all studies.Key findings▸ Pre-hospital lactate may be an independent prognostic marker of in-hospital mortality, multiple organ dysfunction, and requirement for transfusion or surgical intervention in trauma patients, particularly in blunt trauma.▸ Pre-hospital lactate measurement may be more sensitive than systolic blood pressure in determining need for resuscitative care.▸ Early lactate measurement may be particularly useful in the detection of occult hypotension, with elevated levels detectable within 30 minutes of injury.▸ All current studies that investigate pre-hospital lactate were assessed as being at risk of bias.ConclusionsThere is a paucity of evidence relating to pre-hospital lactate-guided management in trauma. From the limited literature, it seems that pre-hospital lactate may be a useful early tool in guiding the management of trauma patient resuscitation. Further prospective studies are required to elucidate the sensitivity and specificity of abnormal pre-hospital lactate values.
AN ANALYSIS OF THE IDENTIFICATION AND MANAGEMENT OF FREQUENT USERS OF URGENT AND EMERGENCY HEALTHCARE
Authors: Worrillow Nicola , Briggs Michelle , South Jane 
Published: August 2016

Abstracts selected through the 999 EMS Research Forum peer review process and presented orally and by poster at the ‘Making it Happen: Delivering Research in Pre-hospital Care’ Conference 2016.BackgroundThere is a dearth of literature available that examines the characteristics of frequent users of urgent and emergency healthcare. Most research and literature explores this population by focusing within one clinical service rather than throughout the whole urgent and emergency healthcare system in England.The aim was to examine how frequent users of: Out of Hours General Practitioners; NHS 111; Ambulance Services; and Emergency Departments are defined, what thresholds are used to categorise and what approaches are used to manage this population.MethodA systemic mapping exercise was undertaken to capture a wide range of data to gain a comprehensive understanding of how these services are currently working with regard to frequent users.The search provided 5094 articles which were screened against the inclusion criteria leaving 156 articles to be analysed. Data was extracted and thematic synthesis created four main themes: typology with regard to definitions assigned; threshold variance; separation of the main population into subgroups; and case management approaches.ResultsThe systematic mapping exercise revealed that diverse definitions and thresholds were being employed by all services. The language used to describe these individuals was often negative and subjective. A single definition of High Intensity User (HIUs) has been selected and advocated for the standardisation within all services. This transposable terminology and identification process will aid in supporting and managing patients within all these services.A taxonomy of HIUs has been developed from this research to sub-divide the main heterogeneous group into the 5 main classification groups. This meets a gap in current knowledge.ConclusionsThe standardised identification process and taxonomy will facilitate interoperability and clarity between clinicians thus benefitting patient and their outcome. The support and management of HIUs will be more comparable between all urgent and emergency services and within the research community.
The presence of fructosamine in human aortic valves is associated with valve stiffness
Authors: Kishabongo Antoine S , Katchunga Philippe , Cikomola Justin C , De Somer Filip M , De Buyzere Marc L , Speeckaert Marijn M , Delanghe Joris R 
Published: August 2016

AimsHuman heart valves are prone to glycation, a fundamental process of ageing. The aim of this study was to establish the relationship between fructosamine formation and the mechanical properties of human aortic valves.Methods67 patients (age: 76±8 years) diagnosed with an aortic valve stenosis, who underwent an aortic valve replacement were enrolled. Fructosamine and calcium concentrations in aortic valves were determined. Using a transthoracic Doppler echocardiography, aortic valve orifice area and transvalvular pressure gradients were measured. In a subgroup of 32 patients, the aortic valve orifice area was sufficient to carry out mechanical testing on a LFPlus Universal material tester. An in vitro removal of fructosamine of the valve was initiated using ATP-dependent fructosamine 3-kinase (FN3K).ResultsA significant correlation was found between the aortic valve fructosamine concentration and the calculated aortic valve orifice area: Y (aortic valve orifice area, mm2)=1.050−0.228X (aortic valve fructosamine concentration, µmol/g valve) (r=−0.38). A significantly higher calcium concentration was measured in the aortic valves of diabetics in comparison with those of non-diabetics. A multiple regression analysis revealed that the presence of diabetes mellitus and aortic valve fructosamine concentration were the main predictors of the extensibility of the aortic valves. In the in vitro deglycation study, a significant lower aortic valve fructosamine concentration was detected after treatment with FN3K. This resulted in an increased flexibility of the aortic valves.ConclusionsAlthough no direct causativeness is proven with the presented results, which just show an association between fructosamine, the effect of FN3K and aortic valve stiffness, the present study points for the first time towards a possible additional role of the Amadori products in the biomechanical properties of ageing aortic valves.
Synoptic-Scale Waves in Sheared Background Flow over the Western North Pacific
Authors: Feng Tao , Yang Xiu-Qun , Zhou Wen , Huang Ronghui , Wu Liang , Yang Dejian 
Published: August 2016

AbstractTropical depression (TD)-type waves are the dominant mode of synoptic-scale fluctuations over the western North Pacific. By applying spatiotemporal filters to the observed OLR data and the NCEP–DOE AMIP-II reanalysis data for 1979–2013, this study reveals the characteristics and energetics of convectively coupled TD-type waves under the effects of different circulation patterns in association with vertical wind shear. Results exhibit that different ambient sheared flows significantly affect the vertical structure of westward-propagating TD-type waves, with a lower-tropospheric mode in an easterly sheared background and an upper-tropospheric mode in a westerly sheared background. Energetic diagnoses demonstrate that when the disturbance is trapped in the lower (upper) level by easterly (westerly) shear, the horizontal mean flow in the lower (upper) level favors wave growth by converting energy from the shear of the zonal mean flow (from the convergence of the meridional mean flow). During the penetration of a westward-propagating synoptic-scale disturbance from a westerly sheared flow into an easterly sheared flow, the upper-level disturbance decays, and the lower-level disturbance intensifies. Meanwhile, the upper-level kinetic energy is transferred downward, but the effect induces the wave growth only confined to the midlevels. Consequently, the low-level growth of the westward-propagating upper-level synoptic-scale disturbance is mainly attributed to the barotropic conversion of horizontal mean flow in the lower troposphere.
Anthropogenic impacts on an oyster metapopulation: Pathogen introduction, climate change and responses to natural selection
Authors: Bushek David , Ford Susan E. 
Published: August 2016

Abstract
Humans rely on marine ecosystems for a variety of services but often impact these ecosystems directly or indirectly limiting their capacity to provide such services. One growing impact is the emergence of marine disease. We present results from a unique case study examining how oysters, a dominant organism in many coastal bays and estuaries that is often harvested for food, have responded to pathogens influenced by human activities, namely the introduction of novel pathogens. Climate change has enabled a northward spread and establishment of Dermo disease in oysters along the eastern seaboard of North America and human activities inadvertently introduced MSX disease along this same coast. Oysters in Delaware Bay have responded differently to each pathogen, and uniquely to MSX disease by developing a highly resistant baywide population not documented in any other bay. Offspring were produced using parents collected from low or high disease (MSX and Dermo) regions of Delaware Bay and exposed in a common garden experiment along with a naïve population from Maine. Results indicated widespread resistance to MSX disease, but not to Dermo disease, across Delaware Bay. One striking result was the demonstration of resilience in the population through its capacity to spread, presumably through larval transport, resistance to MSX disease into portions of the population that have experienced little to no MSX disease pressure themselves. Related studies indicated that larval transport mechanisms allowed widespread dispersal such that the entire metapopulation could acquire a high level of resistance over time if disease resistance is sufficiently heritable. The findings have implications for restoration, management and recovery of diseased populations. Namely, that if left to their own devices, natural selection may find a solution that enables populations to recover from introduced pathogens.
A new ceramics approach for contact lens
Authors: Carpena DDS, MS, PhD Guilherme , Balaron DDS Andressa , Aguiar José 
Published: August 2016

Nowadays the field of dentistry is focusing into a new aesthetic area in the light of an minimal invasive dentistry approach. Aesthetic treatments with dental porcelain veneers without any preparation (ceramic contact lenses) have gained popularity in recent years. Thus, the need for constant improvement and knowledge of innovative techniques and ceramics is fundamental. This article point out about the essential criteria to promote a clinical succeed of the technique over the years.
Fístula extraoral asociada a sialolitiasis en el conducto de Wharton. Reporte de un caso
Authors: Obando DDS Danny , Fernández DDS José 
Published: August 2016

Sialolithiasis is one of the frecuent pathologies that affect the salivary glands, and the submandibular gland is the most commonly affected due to it´s anatomy. There are many theories that try to explain the etiology, but is not yet fully determined. The most common symptom is the presence of pain, especially when eating because of the salivary stimulation produced by food. Other symptoms seen are the inflammation of the floor of mouth and infection associated with chronic sialadenitis processes; the formation of cutaneous fistulas is rare. This case report presents a 31-year-old male patient with an extra-oral fistula located on the left side of his neck subzone Ib (submandibular); with chronic sialadenitis associated with sialolithiasis in the left Wharton's duct with a four-year progress. The surgical management is described and a review of the literature is performed.
Análisis espectroscópico del precipitado formado por la mezcla de hipoclorito de sodio y clorhexidina utilizando resonancia magnética nuclear
Authors: Benavides DDS Marianella , Hernández DDS Erick , Soto Víctor 
Published: August 2016

The aim of this study was to determine the presence of para-chloroaniline (PCA) obtained by the mixture of 5,25% sodium hypochlorite (NaOCl) and 2% chlorhexidine (CHX), evaluated by nuclear magnetic resonance spectroscopy (NMR-H-1) at 600MHz. Initially a commercial sample of 98% PCA (group 1: GPCA) was analyzed by NMRH-1 combining it with dimethylsulfoxide perdeuterated as solvent, in order to obtain the basal spectra. Ten samples were then prepared by combining equal amounts of 5,25%NaOCl and 2%CHX (group 2:GHC) (PROPORTION 1:1 v/v) by manual stirring. Each sample was then spinned for 10 minutes at 25Cº, in order to eliminate the supernatant and to obtain the precipitate, which was prepared at dry vacuum to finally isolate the solid precipitate. The precipitate was again dissolved in d6-DMSO to perform the NMR.H-1 analysis. Commercial PCA showed a distinctive spectra, with a characteristic double sign at 7.02-7.03 ppm and 6.58-6.59 ppm. Experimental samples lack of this distinctive spectra, instead, they all showed a complex combination of signs, which none correspond to pure PCA.
Impacto emocional y en calidad de vida de individuos afectados por amelogénesis imperfecta
Authors: Murillo DDS, MSc Gina , Morales DDS Fabián , Gamboa DDS Luis , Meza DDS Ana Maria , López DDS Ana Cristina 
Published: August 2016

“Amelogenesis imperfecta” (AI) (prevalence up to 1 in 700) describes largely Mendelian enamel defects arising from gene mutations that present as structural abnormalities of the temporary and permanent teeth as a result of defective enamel formation. AI has a wide range of clinical presentations and phenotypes and affects both sexes. Despite increasing knowledge of the genetic mutations underlying AI there has been little research focussing on the effect of AI on the quality of life of AI patients. This study aimed to investigate the effects of AI on patient quality of life in a Costa Rican AI cohort. Affected family members were interviewed and their experiences used to develop an instrument (questionnaire) that was subsequently used to evaluate the impact of AI on their quality of life. 18 AI patients from 17 families were included in the study. Our findings showed that 100% had been teased and had suffered social rejection; 77.8% were concerned about their children´s inheritance and 66.7 % were concerned by the cost of treatment; 89% placed a high importance on their teeth. Results were not statistically significant when sorted by sex (p = 0.732). The results of this study indicate that dental professionals need to understand AI not only as defective tooth enamel structure demanding specialist clinical management but also the negative impacts of the condition on the lives of their patients. This should be taken in to account when communicating with those affected.