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Heart attacks (HAs) present clinically with varying symptoms, which are not always described by patients as chest pain (CP) or chest discomfort (CD). Emergency Medical Dispatchers (EMDs) select the CP/CD dispatch protocol for non-chest pain HA symptoms or classic HA complaint of CP/CD. Nevertheless, it is still unknown how often callers report HA symptoms other than CP/CD.
The objective of this study was to characterize the caller’s descriptions of the primary HA symptoms, descriptions of the other HA symptoms, and the use of a case entry (CE) question clarifier.
A retrospective descriptive study analyzed randomly selected EMD audios (where CD/CD protocol was used) from five accredited emergency communication centers in the United States. Several Quality Performance Review (QPR) experts reviewed the audios and recorded callers’ initial problem descriptions, the use of and responses to the CE question clarifier, including the EMD-assigned final determinant code.
A total of 1,261 audios were reviewed. The clarifier was used only 8.5% of the time. The CP/CD symptoms were mentioned alone or with other problems 87.0% of the time. Overall, CP symptom was mentioned alone 70.8%, HA alone 4.0%, and CD symptom alone 1.4% of the time.
9-1-1 callers report potential HA cases using a variety of terms and descriptions—most commonly CP. Other less-common symptoms associated with a HA may be mentioned. Therefore, EMDs must be well-trained to be prepared to probe the caller with a clarifying query to elicit more specific information when “having a heart attack” is the only complaint initially mentioned.
Outcomes Based Commissioning (OBC) – for example, Pay for Success (in the US) or Payment by Results (in the UK) – has been suggested as a way to provide ‘more’ social services for ‘less’ public resources. Such commissioning is often linked with an innovative financing tool called a Social Impact Bond (SIB). Using data from the Social Finance UK Database and focusing on SIBs in the US and UK, we evaluate whether the SIB approach aligns with the theoretical predictions of social innovation. The results provide limited evidence that SIBs facilitate capital injections from the private sector into the production of social goods as well as facilitate parts of the process of social innovation – namely, piloting and scaling. We conclude that there is significant variation, both between the US and UK and within the US, in social innovation ecosystems and the role played by SIBs.
Jane Manning's death, in March 2021, brought to an end a remarkable life and musical career, and it seems appropriate to celebrate that life with an extended tribute. TEMPO has always had a particularly close relationship with new music in Britain, where the journal is based, and Jane's work as a performer transformed the way in which musicians and audiences in Britain understood the technical and imaginative potential of new music. Her repertoire was enormous, and her interpretations of older music – Dallapiccola, Messiaen, Ravel, Webern – were wonderful, but it was as the creator of new work with living composers that she had such an extraordinary influence. What follows is an attempt to describe how that influence developed and to explain why it was so extraordinary.
Vessel strikes – collisions between ships and whales – occur throughout the world’s oceans (Figure 10.1) (Laist et al., 2001; Van Waerebeek et al., 2007). First reported in the late nineteenth century as ships reached speeds greater than 13–15 knots, lethal vessel strikes remained relatively infrequent until the mid-twentieth century (Laist et al., 2001). Since then, as the number, speed and size of vessels increased, reported vessel strikes have similarly grown (Figure 10.2) (Laist et al., 2001; Vanderlaan et al., 2009). Vessel strikes involving large whales have emerged as a global conservation concern, largely due to evidence that vessel traffic is increasing (Tournadre, 2014), vessel strikes are increasing (Laist et al., 2001; Vanderlaan et al., 2009), vessel strikes are hampering the recovery of certain endangered whale species (e.g., North Atlantic right whales; Knowlton & Kraus, 2001) and, where enacted, the success of mitigation efforts to reduce the threat of ship strikes may be mixed (e.g., Lagueux et al., 2011; Silber & Bettridge, 2012; Silber et al., 2012a, 2012b; Vanderlaan et al., 2008; van der Hoop et al., 2013).
This article explores aspects of the work of the composer Naomi Pinnock, focusing on six works written between 2012 and 2019: String Quartet No. 2 (2012), The Writings of Jakob Br. (2013), Lines and spaces (2015), Music for Europe (2016), The field is woven (2018) and I am, I am (2019). Each work is analysed and the analyses contextualised within a discussion of the works by other artists that form a creative hinterland to Pinnock's music: respectively art from the Sammlung Prinzhorn, paintings by Paul Klee and Agnes Martin, and the poetry of Rachael Boast.
We present the current status of a scalable computing framework to address the need of the multidisciplinary effort to study chemical dynamics. Specifically, we are enabling scientists to process and store experimental data, run large-scale computationally expensive high-fidelity physical simulations, and analyze these results using state-of-the-art data analytics, machine learning, and uncertainty quantification methods using heterogeneous computing resources. We present the results of this framework on a single metadata-driven workflow to accelerate an additive manufacturing use-case.