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The aim of this study is to identify the types of community paramedicine programs and the training for each.
A systematic review of MEDLINE, Embase, grey literature, and bibliographies followed a search strategy using common community paramedicine terms. All studies published in English up to January 22, 2018, were captured. Screening and extraction were completed in duplicate by two independent reviewers. The Mixed Methods Appraisal Tool (MMAT) was used to assess studies’ methodological quality (full methodology on PROSPERO: CRD42017051774).
From 3,004 papers, there were 64 papers identified (58 unique community paramedicine programs). Of the papers with an appraisable study design (40.6%), the median MMAT score was 3 of 4 criteria met, suggesting moderate quality. Programs most often served frequent 911 callers (48.3%) and individuals at risk for emergency department admission, readmission, or hospitalization (41.4%); and 70.7% of programs were preventive home visits. Common services provided were home assessment (29.5%), medication management (39.7%), and referral and/or transport to community services (37.9%); and 77.6% of programs involved interprofessional collaboration. Community paramedicine training was described by 57% of programs and expanded upon traditional paramedicine training and emphasized technical skills. Study heterogeneity prevented meta-analysis.
Community paramedicine programs and training were diverse and allowed community paramedics to address a spectrum of population health and social needs. Training was poorly described. Enabling more programs to assess and report on program and training outcomes would support community paramedicine growth and the development of formalized training or education frameworks.
Psychosocial disability affects a number of individuals with psychosis and often begins years before the formal onset of disorder. This suggests that for many, their psychosocial disability is enduring, and targeted interventions are therefore needed earlier in their developmental trajectories to ensure that psychosocial disability does not become entrenched. Poor psychosocial functioning also affects individuals with a range of different emerging mental health problems, putting these young people at risk of long-term social marginalisation and economic disadvantage; all of which are known risk factors for the development of psychosis. Identification of the markers of poor psychosocial functioning will help to inform effective treatments. This editorial will discern the early trajectories and markers of poor psychosocial outcome in psychosis, and highlight which individuals are most at risk of having a poor outcome. This editorial will also discuss whether early interventions are currently being targeted appropriately and will propose how intervention and preventative strategies can be implemented, to restore psychosocial trajectories in a way that enables young people to maximise their life chances.
To determine the impact of specialized treatments, relative to comparator treatments, upon the weight and psychological symptoms of anorexia nervosa (AN) at end-of-treatment (EOT) and follow-up.
Randomized controlled trials (RCTs) between January 1980 and December 2017 that reported the effects of at least two treatments on AN were screened. Weight and psychological symptoms were analyzed separately for each study. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed, and studies were assessed using the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) criteria and Cochrane risk of bias tool.
We identified 35 eligible RCTs, comprising data from 2524 patients. Meta-analyses revealed a significant treatment effect on weight outcomes at EOT [g = 0.16, 95% CI (0.05–0.28), p = 0.006], but not at follow-up [g = 0.11, 95% CI (−0.04 to 0.27), p = 0.15]. There was no significant treatment effect on psychological outcomes at either EOT [g = −0.03, 95% CI (−0.14 to 0.08), p = 0.63], or follow-up [g = −0.001, 95% CI (−0.11 to 0.11), p = 0.98]. There was no strong evidence of publication bias or significant moderator effects for illness duration, mean age, year of publication, comparator group category, or risk of bias (all p values > 0.05).
Current specialized treatments are more adept than comparator interventions at imparting change in weight-based AN symptoms at EOT, but not at follow-up. Specialized treatments confer no advantage over comparator interventions in terms of psychological symptoms. Future precision treatment efforts require a specific focus on the psychological symptoms of AN.
Gas production from the in vitro digestion of forage with buffered rumen fluid can be measured and used to determine forage digestibility and fermentation kinetics. Rumen micro-organisms ferment carbohydrate to gases (CO2 and CH4) and volatile fatty acids (VFA). The VFA produced also cause CO2 to be released from the C02-bicarbonate buffer. Theodorou et al. (1994) introduced the principle of measuring gas production by pressure increase using an electronic pressure transducer and sealed gas-tight culture bottles. Gases accumulate in the head space of the culture bottles as fermentation proceeds. The gas is measured and then released at regular intervals throughout the fermentation. This procedure was automated (Davies et al., 1995). The automated pressure evaluation system (APES) has advantages over the manual pressure transducer technique (Theodorou et al., 1994) in that it is less labour intensive and has been shown to be more sensitive to food characteristics (Davies et al., 1995). The APES, used in this work, has been improved to include new switches and a filtering system. It has been used here to determine the fermentation characteristics of various ruminant foods: ryegrass, wheat grain and ryegrass silage.
The n -alkane technique (Dove and Mayes, 1991; Mayes and Dove, 2000) has been developed as a method to determine the voluntary intake of herbivores grazing freely at pasture. The technique relies on the fact that each herbage species contain a unique profile of odd-chain n -alkane compounds within the cuticular waxes of each plant part. Whilst some n -alkane profiles for the major intensively managed herbage species are available, there is little comprehensive information on the n -alkane profiles of many of the herbage species found commonly in semi-natural vegetation communities (SNVC) in the hills and uplands of the UK. If the n -alkane technique is to be extended for use with herbivores grazing SNVC’s, it is necessary that such profiles be determined. This study details the n -alkane concentrations found in ten herbage species sampled from SNVC’s in the UK during late summer in 2000.
A numerical study of the flow-induced vibration of two elastically mounted cylinders in tandem and staggered arrangements at Reynolds number
is presented. The cylinder centres are set at a streamwise distance of 1.5 cylinder diameters, placing the rear cylinder in the near-wake region of the front cylinder for the tandem arrangement. The cross-stream or lateral offset is varied between 0 and 5 cylinder diameters. The two cylinders are identical, with the same elastic mounting, and constrained to oscillate only in the cross-flow direction. The variation of flow behaviours is examined for static cylinders and for elastic mountings of a range of spring stiffnesses, or reduced velocity. At least seven major modes of flow response are identified, delineated by whether the oscillation is effectively symmetric, and the strength of the influence of the flow through the gap between the two cylinders. Submodes of these are also identified based on whether or not the flow remains periodic. More subtle temporal behaviours, such as period doubling, quasi-periodicity and chaos, are also identified and mapped. Across all of these regimes, the amplitudes of vibration and the magnitude of the fluid forces are quantified. The modes identified span the parameter space between two important limiting cases: two static bodies at varying lateral offset; and two elastically mounted bodies in a tandem configuration at varying spring stiffnesses. Some similarity in the response of extremely stiff or static bodies and extremely slack bodies is shown. This is explained by the fact that the slack bodies are free to move to an equilibrium position and stop, effectively becoming a static system. However, the most complex behaviour appears between these limits, when the bodies are in reasonably close proximity, and the natural structural frequency is close to the vortex shedding frequency of a single cylinder. This appears to be driven by the interplay between a series of time scales, including the vortex formation time, the advection time across the gap between the cylinders and the oscillation period of both bodies. This points out an important difference between this multi-body system and the classic single-cylinder vortex-induced vibration: two bodies in close proximity will not oscillate in a synchronised, periodic manner when their natural structural frequencies are close to the nominal vortex shedding frequency of a single cylinder.
Limitations of access have long restricted exploration and investigation of the cavities beneath ice shelves to a small number of drillholes. Studies of sea-ice underwater morphology are limited largely to scientific utilization of submarines. Remotely operated vehicles, tethered to a mother ship by umbilical cable, have been deployed to investigate tidewater-glacier and ice-shelf margins, but their range is often restricted. The development of free-flying autonomous underwater vehicles (AUVs) with ranges of tens to hundreds of kilometres enables extensive missions to take place beneath sea ice and floating ice shelves. Autosub2 is a 3600 kg, 6.7 m long AUV, with a 1600 m operating depth and range of 400 km, based on the earlier Autosub1 which had a 500 m depth limit. A single direct-drive d.c. motor and five-bladed propeller produce speeds of 1–2 m s−1. Rear-mounted rudder and stern-plane control yaw, pitch and depth. The vehicle has three sections. The front and rear sections are free-flooding, built around aluminium extrusion space-frames covered with glass-fibre reinforced plastic panels. The central section has a set of carbon-fibre reinforced plastic pressure vessels. Four tubes contain batteries powering the vehicle. The other three house vehicle-control systems and sensors. The rear section houses subsystems for navigation, control actuation and propulsion and scientific sensors (e.g. digital camera, upward-looking 300 kHz acoustic Doppler current profiler, 200 kHz multibeam receiver). The front section contains forward-looking collision sensor, emergency abort, the homing systems, Argos satellite data and location transmitters and flashing lights for relocation as well as science sensors (e.g. twin conductivity–temperature–depth instruments, multibeam transmitter, sub-bottom profiler, AquaLab water sampler). Payload restrictions mean that a subset of scientific instruments is actually in place on any given dive. The scientific instruments carried on Autosub are described and examples of observational data collected from each sensor in Arctic or Antarctic waters are given (e.g. of roughness at the underside of floating ice shelves and sea ice).
We describe the performance of the Boolardy Engineering Test Array, the prototype for the Australian Square Kilometre Array Pathfinder telescope. Boolardy Engineering Test Array is the first aperture synthesis radio telescope to use phased array feed technology, giving it the ability to electronically form up to nine dual-polarisation beams. We report the methods developed for forming and measuring the beams, and the adaptations that have been made to the traditional calibration and imaging procedures in order to allow BETA to function as a multi-beam aperture synthesis telescope. We describe the commissioning of the instrument and present details of Boolardy Engineering Test Array’s performance: sensitivity, beam characteristics, polarimetric properties, and image quality. We summarise the astronomical science that it has produced and draw lessons from operating Boolardy Engineering Test Array that will be relevant to the commissioning and operation of the final Australian Square Kilometre Array Path telescope.
This study tested whether accurate dating by accelerator mass spectrometry (AMS) radiocarbon wiggle-matching of short tree-ring series (~30 annual rings) in the Medieval period could be achieved. Scientific dating plays a central role in the conservation of historic buildings in England. Precise dating helps assess the significance of particular buildings or elements of their fabric, thus allowing us to make informed decisions about their repair and protection. Consequently, considerable weight, both financial and legal, can be attached to the precision and accuracy of this dating. Dendrochronology is the method of choice, but in a proportion of cases this is unable to provide calendar dates. Hence, we would like to be able to use 14C wiggle-matching to provide a comparable level of precision and reliability, particularly on shorter tree-ring sequences (~30 annual growth rings) that up until now would not routinely be sampled. We present the results of AMS wiggle-matching five oak tree-ring sequences, spanning the period covered by the vast majority of surviving Medieval buildings in England (about AD 1180–1540) when currently we have only decadal and bidecadal calibration data.
We summarise the first year of operation of the Medium Deep Survey - a key project of the HST. Two fields in the LMC are discussed and some preliminary scientific results presented. We also comment on image deconvolution for the extragalactic fields observed as part of the Medium Deep Survey.
It came as a great surprise that many dwarf elliptical galaxies of very low surface brightness in the Virgo Cluster have conspicuous bright star-like nuclei (Reaves 1983, Binggeli, Sandage and Tammann 1985). These nuclei are at least a factor of 10 more luminous than the brightest globular clusters in the Local Group and comparable only to the very brightest globulars surrounding M87. They contain a considerable fraction (1 to 20%) of the total light of the parent galaxy (Binggeli, priv. commun.). Their physical nature and origin are a matter of debate (Zinnecker et al. 1985, van den Bergh 1985, Norman 1986, Zinnecker 1986) but optical spectroscopy for 3 objects indicates a stellar composition with a range similar to globular clusters (Bothun et al. 1985). It has been suggested that a central nucleus is formed when off-center bound star clusters migrate to the center as a consequence of dynamical friction (Norman 1986). Support for such a scenario comes from CCD observations of IC 3475 which reveal numerous knots near the center of this dwarf irregular galaxy (Vigroux et al. 1986). These knots have the same color as the parent galaxy and are interpreted as intermediate age star clusters.
Flowering and successful pollination in wheat are key determinants of both quantity and quality of grain. Bread wheat line ‘Paragon’, introgressed with single or multiple daylength insensitivity alleles was used to dissect the effects on the timing and duration of flowering within a hierarchical plant architecture. Flowering of wheat plants was observed in a series of pot-based and field experiments. Ppd-D1a was the most potent known allele affecting the timing of flowering, requiring the least thermal time to flowering across all experiments. The duration of flowering for individual lines was dominated by the shift in the start of flowering in later tillers and the number of tillers per plant, rather than variation in flowering duration of individual spikes. There was a strong relationship between flowering duration and the start of flowering with the earliest lines flowering for the longest. The greatest flowering overlap between tillers was recorded for the Ppd-1b. Across all lines, a warmer environment significantly reduced the duration of flowering and the influence of Ppd-1a alleles on the start of flowering. These findings provide evidence of pleiotropic effects of the Ppd-1a alleles, and have direct implications for breeding for increased stress resilient wheat varieties.
With HST and WFPC2, galaxies in the Medium Deep Survey can be reliably classified to magnitudes I814 ≲ 22.0 in the F814W band, at a mean redshift . The main result is the relatively high proportion (~40%) of objects which are in some way irregular or anomalous, and which are of relevance in understanding the origin of the familiar excess population of faint galaxies. These diverse objects include compact galaxies, apparently interacting pairs, galaxies with superluminous starforming regions and diffuse low surface brightness galaxies of various forms. The ‘irregulars’ and ‘peculiar’ galaxies contribute most of the excess counts in the I-band at our limiting magnitude, and may explain the ‘faint blue galaxy’ problem.
Introduction: The older adult population is growing. The consequences of minor trauma involving a head injury (MT-HI) in independent older adults are largely unknown. This study assessed the impact of a MT-HI on the functional and cognitive outcomes six months post injury of older adults who sustained a minor trauma. Methods: This multicenter prospective cohort study in eight sites included patients who were: aged 65 years or older, presenting to the emergency department (ED) within two weeks of injury with a chief complaint of a minor trauma, discharged within 48 hours, and independent for their basic activities of daily living prior to the ED visit. Participants underwent a baseline evaluation and a follow-up evaluation at six months post-injury. The main outcome was the functional decline measured with the Older Americans’ Resources and Services (OARS) scale six months after the trauma. Results: All 926 eligible patients were included in the analyses: 344 MT-HI patients and 582 without head injury. After six months, the functional decline was similar in both groups, 10.8% and 11.9% respectively (RR=0.79 [95% CI: 0.55-1.14]). The proportion of participants with mild cognitive disabilities was also similar, 21.7% and 22.8% respectively (RR=0.91 [95% CI: 0.71-1.18]). Furthermore, for the group of patients with a MT-HI, the functional outcome was not statistically different with or without the presence of a co-injury (RR= 1.35 [95% CI: 0.71-2.59]), or with or without the presence of a mTBI as defined by the WHO criteria (RR= 0.90 [95% CI: 0.59-1.13]). Conclusion: This study did not demonstrate that the occurrence of a MT-HI is associated with a worse functional or cognitive prognosis than other minor injuries without a head injury in an elderly population six months after injury.
During 1990 we surveyed the southern sky using a multi-beam receiver at frequencies of 4850 and 843 MHz. The half-power beamwidths were 4 and 25 arcmin respectively. The finished surveys cover the declination range between +10 and −90 degrees declination, essentially complete in right ascension, an area of 7.30 steradians. Preliminary analysis of the 4850 MHz data indicates that we will achieve a five sigma flux density limit of about 30 mJy. We estimate that we will find between 80 000 and 90 000 new sources above this limit. This is a revised version of the paper presented at the Regional Meeting by the first four authors; the surveys now have been completed.
Within the framework of shallow-water magnetohydrodynamics, we investigate the linear instability of horizontal shear flows, influenced by an aligned magnetic field and stratification. Various classical instability results, such as Høiland’s growth-rate bound and Howard’s semi-circle theorem, are extended to this shallow-water system for quite general flow and field profiles. In the limit of long-wavelength disturbances, a generalisation of the asymptotic analysis of Drazin & Howard (J. Fluid Mech., vol. 14, 1962, pp. 257–283) is performed, establishing that flows can be distinguished as either shear layers or jets. These possess contrasting instabilities, which are shown to be analogous to those of certain piecewise-constant velocity profiles (the vortex sheet and the rectangular jet). In both cases it is found that the magnetic field and stratification (as measured by the Froude number) are generally each stabilising, but weak instabilities can be found at arbitrarily large Froude number. With this distinction between shear layers and jets in mind, the results are extended numerically to finite wavenumber for two particular flows: the hyperbolic-tangent shear layer and the Bickley jet. For the shear layer, the instability mechanism is interpreted in terms of counter-propagating Rossby waves, thereby allowing an explication of the stabilising effects of the magnetic field and stratification. For the jet, the competition between even and odd modes is discussed, together with the existence at large Froude number of multiple modes of instability.
Early nutrition is critical for later health and sustainable development. We determined potential effectiveness of the Kenyan Community Health Strategy in promoting exclusive breastfeeding (EBF) in urban poor settings in Nairobi, Kenya. We used a quasi-experimental study design, based on three studies [Pre-intervention (2007–2011; n=5824), Intervention (2012–2015; n=1110) and Comparison (2012–2014; n=487)], which followed mother–child pairs longitudinally to establish EBF rates from 0 to 6 months. The Maternal, Infant and Young Child Nutrition (MIYCN) study was a cluster randomized trial; the control arm (MIYCN-Control) received standard care involving community health workers (CHWs) visits for counselling on antenatal and postnatal care. The intervention arm (MIYCN-Intervention) received standard care and regular MIYCN counselling by trained CHWs. Both groups received MIYCN information materials. We tested differences in EBF rates from 0 to 6 months among four study groups (Pre-intervention, MIYCN-Intervention, MIYCN-Control and Comparison) using a χ2 test and logistic regression. At 6 months, the prevalence of EBF was 2% in the Pre-intervention group compared with 55% in the MIYCN-Intervention group, 55% in the MIYCN-Control group and 3% in the Comparison group (P<0.05). After adjusting for baseline characteristics, the odds ratio for EBF from birth to 6 months was 66.9 (95% CI 45.4–96.4), 84.3 (95% CI 40.7–174.6) and 3.9 (95% CI 1.8–8.4) for the MIYCN-Intervention, MIYCN-Control and Comparison group, respectively, compared with the Pre-intervention group. There is potential effectiveness of the Kenya national Community Health Strategy in promoting EBF in urban poor settings where health care access is limited.