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In many low-income countries, basic prehospital Emergency Medical Services (EMS) remain under-developed, resulting in significant delays or the complete inability to access care.
The purpose of this study was to analyze the effectiveness of a layperson EMS training targeting motorcycle taxi (boda) drivers in a rural region of Uganda.
Fifty (50) adult boda drivers from Masindi, Uganda were selected for a one-day training course including lectures and simulation. Course content covered basic prehospital skills and transport. Participants were given a first responder kit at completion of the course. Understanding of material was assessed prior to training, immediately after course completion, and four months from the initial course using the same ten question test. Test means were analyzed using a standard linear regression model. At the four-month follow up, all 50 boda drivers participated in semi-structured small group qualitative interviews regarding their perception of the course and experiences implementing course skills in the community. Boda drivers were asked to complete a brief form on each patient transported during the study period. For patients transported to Masindi Kitara Medical Center (MKMC), hospital trauma registry data were analyzed.
Trainees showed both knowledge acquisition and retention with pre-test scores of 21.8% improving to 48.0% at course completion and 57.7% at the four-month follow up. Overall, participant’s scores increased by an average of 35% from the pre-test to the second post-test (P <.001). A total of 69 patient forms were completed on transported patients over the initial four-month period. Ninety-five percent (95%) of these were injured patients, and motorcycle crash was the predominant mechanism of injury (48% of injuries). Eight patients were transported to MKMC, but none of these patients were recorded in the hospital trauma registry. Major barriers identified through semi-structured interviews included harassment by police, poor road conditions, and lack of basic resources for transport. Ninety-four percent (94%) of trainees strongly agreed that the training was useful. Total costs were estimated at $3,489 USD, or $69 per trainee.
Motorcycle taxi drivers can be trained to provide basic prehospital care in a short time and at a low cost. While there is much enthusiasm for additional training and skill acquisition from this cohort, the sustainability and scalability of such programs is still in question.
Measurement of subjective animal welfare creates a special problem in validating the measurement indicators used. Validation is required to ensure indicators are measuring the intended target state, and not some other object. While indicators can usually be validated through looking for correlation between target and indicator under controlled manipulations, this is not possible when the target state is not directly accessible. In this paper, I outline a four-step approach using the concept of robustness, that can help with validating indicators of subjective animal welfare.
Heintz & Scott-Phillips provide a useful synthesis for constructing a bridge between work by both cognitive scientists and evolutionary biologists studying the diversity of human communication. Here, we aim to strengthen their bridge from the side of evolutionary biology, to argue that we can best understand ostensive communication as a scaffold for more complex forms of intentional expressions.
Dubourg and Baumard mention a potential role for the human drive to systemise as a factor motivating interest in imaginary worlds. Given that hyperexpression of this trait has been linked with autism (Baron-Cohen, 2002, 2006), we think this raises interesting implications for how those on the autism spectrum may differ from the neurotypical population in their engagement with imaginary worlds.
In this commentary we advance Jagiello et al.'s proposal by zooming in on the possible evolutionary origins of the “bifocal stance” that may have enabled a major transition in human cultural evolution, arguing that the evolution of the bifocal stance was driven by an explosion in cultural complexity arising from cooperative foraging, which led to a feedback loop between the ritual and instrumental stances.
There has been much criticism of the idea that Friston's free-energy principle can unite the life and mind sciences. Here, we argue that perhaps the greatest problem for the totalizing ambitions of its proponents is a failure to recognize the importance of evolutionary dynamics and to provide a convincing adaptive story relating free-energy minimization to organismal fitness.
In March 2018, the US Food and Drug Administration (FDA), US Centers for Disease Control and Prevention, California Department of Public Health, Los Angeles County Department of Public Health and Pennsylvania Department of Health initiated an investigation of an outbreak of Burkholderia cepacia complex (Bcc) infections. Sixty infections were identified in California, New Jersey, Pennsylvania, Maine, Nevada and Ohio. The infections were linked to a no-rinse cleansing foam product (NRCFP), produced by Manufacturer A, used for skin care of patients in healthcare settings. FDA inspected Manufacturer A's production facility (manufacturing site of over-the-counter drugs and cosmetics), reviewed production records and collected product and environmental samples for analysis. FDA's inspection found poor manufacturing practices. Analysis by pulsed-field gel electrophoresis confirmed a match between NRCFP samples and clinical isolates. Manufacturer A conducted extensive recalls, FDA issued a warning letter citing the manufacturer's inadequate manufacturing practices, and federal, state and local partners issued public communications to advise patients, pharmacies, other healthcare providers and healthcare facilities to stop using the recalled NRCFP. This investigation highlighted the importance of following appropriate manufacturing practices to minimize microbial contamination of cosmetic products, especially if intended for use in healthcare settings.
Benenson et al. provide a compelling case for treating greater investment into self-protection among females as an adaptive strategy. Here, we wish to expand their proposed adaptive explanation by placing it squarely in modern state-based and behavioural life-history theory, drawing on Veit's pathological complexity framework. This allows us to make sense of alternative “lifestyle” strategies, rather than pathologizing them.
Parents who receive a diagnosis of a severe, life-threatening CHD for their foetus or neonate face a complex and stressful decision between termination, palliative care, or surgery. Understanding how parents make this initial treatment decision is critical for developing interventions to improve counselling for these families.
We conducted focus groups in four academic medical centres across the United States of America with a purposive sample of parents who chose termination, palliative care, or surgery for their foetus or neonate diagnosed with severe CHD.
Ten focus groups were conducted with 56 parents (Mage = 34 years; 80% female; 89% White). Results were constructed around three domains: decision-making approaches; values and beliefs; and decision-making challenges. Parents discussed varying approaches to making the decision, ranging from relying on their “gut feeling” to desiring statistics and probabilities. Religious and spiritual beliefs often guided the decision to not terminate the pregnancy. Quality of life was an important consideration, including how each option would impact the child (e.g., pain or discomfort, cognitive and physical abilities) and their family (e.g., care for other children, marriage, and career). Parents reported inconsistent communication of options by clinicians and challenges related to time constraints for making a decision and difficulty in processing information when distressed.
This study offers important insights that can be used to design interventions to improve decision support and family-centred care in clinical practice.
Coronavirus disease (COVID-19) has been identified as an acute respiratory illness leading to severe acute respiratory distress syndrome. As the disease spread, demands on health care systems increased, specifically the need to expand hospital capacity. Alternative care hospitals (ACHs) have been used to mitigate these issues; however, establishing an ACH has many challenges. The goal of this session was to perform systems testing, using a simulation-based evaluation to identify areas in need of improvement.
Four simulation cases were designed to depict common and high acuity situations encountered in the ACH, using a high technology simulator and standardized patient. A multidisciplinary observer group was given debriefing forms listing the objectives, critical actions, and specific areas to focus their attention. These forms were compiled for data collection.
Logistical, operational, and patient safety issues were identified during the simulation and compiled into a simulation event report. Proposed solutions and protocol changes were made in response to the identified issues.
Simulation was successfully used for systems testing, supporting efforts to maximize patient care and provider safety in a rapidly developed ACH. The simulation event report identified operational deficiencies and safety concerns directly resulting in equipment modifications and protocol changes.
Introduction to Education provides pre-service teachers with an overview of the context, craft and practice of teaching in Australian schools as they commence the journey from learner to classroom teacher. Each chapter poses questions about the nature of teaching students, and guides readers though the Australian Professional Standards for Teachers. Incorporating recent research and theoretical literature, Introduction to Education presents a critical consideration of the professional, policy and curriculum contexts of teaching in Australia. The book covers theoretical topics in chapters addressing assessment, planning, safe learning environments, and working with colleagues, families, carers and communities. More practical chapters discuss professional experience and building a career after graduation. Rigorous in conception and practical in scope, Introduction to Education welcomes new educators to the theory and practical elements of teaching, learning, and professional practice.