Non-theatre emergency airway management: a multicentre prospective observational study.

Emergency airway management events are common, unpredictable and associated with high complication rates. This multicentre prospective observational study across eight acute NHS hospitals in southeast England reports the incidence and nature of non-theatre emergency airway management events. Data were collected from non-theatre emergency airway management, including adverse events, over a continuous 28-day window, and recorded on an electronic case report form. Events were classified according to type (advanced airway; simple airway; and cardiac arrest). A total of 166 events were recorded, with 111 advanced airway events involving tracheal intubation or tracheostomy management. Senior personnel with three or more years of airway management experience were present for 105/111 (95%) advanced airway management episodes. There was a significant reduction in consultant or equivalent presence out-of-hours (21/64, 33%) vs. in-hours (34/47, 72%) (p < 0.001). We found high utilisation of videolaryngoscopy (95/106, 90%) and universal use of capnography for all advanced airway management events. This was lower during cardiac arrest when videolaryngoscopy was used in 11/16 (69%) of tracheal intubations and capnography in 21/32 (66%) of all cardiac arrest episodes. Adverse outcomes during advanced airway management (excluding during cardiac arrest) occurred in 53/111 (48%) episodes, including hypoxia (desaturation to Sp O2 < 80% in 14/111, 13%) and hypotension (systolic blood pressure < 80 mmHg in 27/111, 25%). Adverse outcomes were not associated with time of day or experience level of airway practitioners. We conclude that there is a disparity between consultant presence for advanced airway interventions in- and out-of-hours; high utilisation of videolaryngoscopy and capnography, especially for advanced airway interventions; and a high incidence of hypotension and hypoxaemia, including critical values, during non-theatre airway management.

Patient-reported health outcomes of SARS-CoV-2-tested patients presenting to emergency departments: a propensity score-matched prospective cohort study.

OBJECTIVE: This study aimed to compare the long-term physical and mental health outcomes of matched severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-positive and SARS-CoV-2-negative patients controlling for seasonal effects. STUDY DESIGN: This was a retrospective cohort study. METHODS: This study enrolled patients presenting to emergency departments participating in the Canadian COVID-19 Emergency Department Rapid Response Network. We enrolled consecutive eligible consenting patients who presented between March 1, 2020, and July 14, 2021, and were tested for SARS-CoV-2. Research assistants randomly selected four site and date-matched SARS-CoV-2-negative controls for every SARS-CoV-2-positive patient and interviewed them at least 30 days after discharge. We used propensity scores to match patients by baseline characteristics and used linear regression to compare Veterans RAND 12-item physical health component score (PCS) and mental health component scores (MCS), with higher scores indicating better self-reported health. RESULTS: We included 1170 SARS-CoV-2-positive patients and 3716 test-negative controls. The adjusted mean difference for PCS was 0.50 (95% confidence interval [CI]: -0.36, 1.36) and -1.01 (95% CI: -1.91, -0.11) for MCS. Severe disease was strongly associated with worse PCS (ß = -7.4; 95% CI: -9.8, -5.1), whereas prior mental health illness was strongly associated with worse MCS (ß = -5.4; 95% CI: -6.3, -4.5). CONCLUSION: Physical health, assessed by PCS, was similar between matched SARS-CoV-2-positive and SARS-CoV-2-negative patients, whereas mental health, assessed by MCS, was worse during a time when the public experienced barriers to care. These results may inform the development and prioritization of support programs for patients.

Deafness in Australian Cattle Dogs associated to QTL on chromosome 20 in genome-wide association study analyses.

Pigment-associated deafness is a common hereditary condition in a range of dog breeds. The aim of this study was to perform a genome-wide association analysis to investigate the genetic architecture of deafness in Australian Cattle Dogs. Genotypes for 104 757 polymorphisms in 216 dogs were available for analyses after quality control. A genomic relationship matrix was used in the mixed model analyses to account for polygenic effects, as we tested each polymorphism for its association with deafness, in a case/control experimental design. Three approaches were used to code the genotypes and test for additive, recessive and dominant SNP effects. The genome-wide association study analyses identified a clear association peak on CFA20, with the most significant SNPs on this chromosome (1.29 × 10-4 ) in the vicinity of MITF. Variants in MITF have been associated with white pigmentation in dogs and with deafness in humans and other species, supporting the premise that canine deafness is associated with variants in or near this gene. A recessive inheritance for the peak in CFA20 is possible given the significant results in the recessive model; however, the estimated heritability was low (4.54 × 10-5 ). Further validation, identification of variants and testing in other dog breeds are needed.

What is the relationship between fear of self, self-ambivalence, and obsessive-compulsive symptomatology? A systematic literature review.

Obsessive-compulsive disorder (OCD) is one of the most debilitating health conditions in the world. There has been a vast amount of research into factors that increase the likelihood of developing OCD, and there are several explanatory models. Current cognitive models of OCD can be split into appraisal-based and self-doubt models. To date, cognitive-behavioural therapy for OCD (grounded in appraisal-based models) is the recommended treatment approach, and research into the importance of self-doubt beliefs has been somewhat neglected. This paper therefore aims to consolidate current research, utilizing a systematic review approach, to establish the relationship between fear of self, self-ambivalence, and obsessive-compulsive symptomatology. A systematic search was conducted based on inclusion criteria identified for this review. Papers were then individually appraised for quality and key data extracted from each paper. A total of 11 studies were included in the final sample. Fear of self and self-ambivalence were both consistently found to be significant predictors of obsessive-compulsive symptomatology. In particular, research suggests that there is a strong link between self-doubt beliefs and obsessions and obsessional beliefs related to OCD. Limitations of the review and suggestions for future research are made and applications to clinical practice discussed.

Long-term evaluation of the impact of urbanization on chloride levels in lakes in a temperate region.

The application of road salts for winter de-icing of roadways in cold regions has been demonstrated to increase chloride (Cl) concentrations in nearby surface waters and have a negative impact on aquatic organisms and processes. In addition to toxicity to aquatic organisms, high concentrations of Cl in lakes can alter mixing processes, resulting in prolonged anoxic conditions and associated water quality degradation. Elevated concentrations of Cl in freshwater environments in cold regions is a well-documented phenomenon, but few studies have undertaken a long-term evaluation of the impact of urbanization on lakes. In this paper, nine lakes in the Halifax region of Nova Scotia, Canada, were monitored over 35 years to observe Cl concentrations prior to, during, and after urbanizing development. Cl concentrations were observed to increase in most study lakes over the monitoring period and all nine exhibited seasonal trending in response to winter de-icing activities. Six of the lakes achieved a steady-state Cl level after an initial increase in response to development activities, two are potentially still in transition, and one was unaffected by development activities. Watershed land use was found to be a good predictor of the springtime concentration of Cl and can help to inform decision-making surrounding development activities. When the percent of developed land was 25% or more, the Cl concentrations tended to exceed Canadian freshwater quality guidelines for the protection of aquatic life.

Primary Ciliary Dyskinesia Due to Microtubular Defects is Associated with Worse Lung Clearance Index.

PURPOSE: Primary ciliary dyskinesia (PCD) is characterised by repeated upper and lower respiratory tract infections, neutrophilic airway inflammation and obstructive airway disease. Different ultrastructural ciliary defects may affect lung function decline to different degrees. Lung clearance index (LCI) is a marker of ventilation inhomogeneity that is raised in some but not all patients with PCD. We hypothesised that PCD patients with microtubular defects would have worse (higher) LCI than other PCD patients. METHODS: Spirometry and LCI were measured in 69 stable patients with PCD. Age at testing, age at diagnosis, ethnicity, ciliary ultrastructure, genetic screening result and any growth of Pseudomonas aeruginosa was recorded. RESULTS: Lung clearance index was more abnormal in PCD patients with microtubular defects (median 10.24) than those with dynein arm defects (median 8.3, p = 0.004) or normal ultrastructure (median 7.63, p = 0.0004). Age is correlated with LCI, with older patients having worse LCI values (p = 0.03, r = 0.3). CONCLUSION: This study shows that cilia microtubular defects are associated with worse LCI in PCD than dynein arm defects or normal ultrastructure. The patient's age at testing is also associated with a higher LCI. Patients at greater risk of obstructive lung disease should be considered for more aggressive management. Differences between patient groups may potentially open avenues for novel treatments.

PdZn catalysts for CO2 hydrogenation to methanol using chemical vapour impregnation (CVI).

The formation of PdZn bimetallic alloys on ZnO, TiO2 and Al2O3 supports was investigated, together with the effect of alloy formation on the CO2 hydrogenation reaction. The chemical vapour impregnation (CVI) method produced PdZn nanoparticles with diameters of 3-6 nm. X-ray photoelectron spectroscopy and X-ray diffraction revealed the changes in the structure of the PdZn alloy that help stabilise formate intermediates during methanol synthesis. PdZn supported on TiO2 exhibits high methanol productivity of 1730 mmol kgcat-1 h-1 that is associated with the high dispersion of the supported PdZn alloy.

The FVF framework and target prevalence effects.

The Functional Visual Field (FVF) offers explanatory power. To us, it relates to existing literature on the flexibility of attentional focus in visual search and reading (Eriksen & St. James 1986; McConkie & Rayner 1975). The target article promotes reflection on existing findings. Here we consider the FVF as a mechanism in the Prevalence Effect (PE) in visual search.

The influence of smoking on radiation-induced bystander signal production in esophageal cancer patients.

The relevance of radiation-induced bystander effects in humans is unclear. Much of the existing data relate to cell lines but the effect of bystander signals in complex human tissues is unclear. A phase II clinical study was untaken, where blood sera from 60 patients along with 15 cancer-free volunteers were used to detect whether measurable bystander factor(s) could be found in the blood following high dose rate (HDR) brachytherapy. Overall, there was no significant change in bystander signal production (measured in a human keratinocyte reporter system) before and after one treatment fraction of HDR brachytherapy (p>0.05). Further assessment of patient characteristics and environmental modifiable factors including smoking were also analyzed. Similar to previously published data, samples taken from smokers produced weaker signals compared to non-smokers (p<0.05). Although the number of non-smoking subjects was low, there was a clear decrease in cloning efficiency observed in keratinocyte cultures for these patients that requires further study. This study found that samples taken from smokers do not produce bystander signals, whereas samples taken from non-smokers can produce such signals following HDR brachytherapy. These findings highlight the importance of studying the interactions of multiple stressors including environmental modifiers with radiation, since some factors such as smoking may elicit protection in tumor cells which could counteract the effectiveness of radiation therapy.

Intrapartum epidural fixation methods: a randomised controlled trial of three different epidural catheter securement devices.

This randomised controlled trial investigated the efficacy of Epi-Fix(™) , LockIt Plus(®) and Tegaderm(™) as fixation devices for intrapartum epidural catheters. One hundred and sixty-five women requesting intrapartum epidural analgesia were randomised to receive different fixation devices to secure their epidural catheter. The amount of epidural catheter migration (measured to the nearest 0.5 cm) was analysed for three devices: Epi-Fix (n = 55); LockIt Plus (n = 54); and Tegaderm dressing (n = 51). Median (IQR [range]) catheter migration for Epi-Fix was 1.0 cm (0.0-2.0 [-2.0 to 9.5]), vs 0.0 cm (0.0-0.5 [-1.0 to 5.5]) for LockIt Plus and 0.5 cm (0.0-1.8 [-1.5 to 8.0]) for Tegaderm (p = 0.003). Thirty-eight (69.1%) epidural catheters secured with Epi-Fix migrated < 2.0 cm, compared with 49 (90.7%) with LockIt Plus and 40 (78.4%) with Tegaderm. Sixteen epidural catheters required resiting due to failure of analgesia of which 12 (75.0%) occurred in patients with epidural catheters that had migrated ≥ 2.0 cm. This study shows that intrapartum epidural catheters secured with the LockIt Plus device exhibit less catheter migration compared with fixation with Epi-Fix and Tegaderm.

When ignorance is bliss: weight perception, body mass index and quality of life in adolescents.

BACKGROUND/OBJECTIVES: Body weight is negatively associated with adolescent Health-Related Quality of Life (HRQoL). Despite this well-established relationship, some adolescents with obesity do not display the expected HRQoL decreases. This study hypothesised weight perception as a moderator of the association between weight status and adolescent HRQoL. SUBJECTS/METHODS: Subjects were secondary school students from an obesity prevention project in the Barwon South-West region of Victoria, Australia, entitled It's Your Move (N=3040). Measures included standardised body mass index (BMI-z; World Health Organization growth standards), weight perception and HRQoL, measured by the Paediatric Quality of Life Inventory. Linear regression and average marginal effect analyses were conducted on cross-sectional baseline data to determine the significance of any interaction between weight perception and measured weight status in shaping adolescent HRQoL. RESULTS: The BMI-z/perceived weight status interaction was significantly associated with adolescent HRQoL outcomes. Adolescents with BMI z-scores in the overweight/obesity range who perceived themselves as overweight had lower HRQoL than those who perceived themselves as 'about right.' Conversely, adolescents with BMI scores in the lower end of the normal range or in the thinness range who perceived themselves as underweight had lower HRQoL than those with 'about right' perceptions. CONCLUSIONS: This was the first study to report third-variable impacts of a body-perception variable on the relationship between adolescent weight status and HRQoL. Adolescents' weight perceptions significantly moderated the relationship between overweight/obesity and reduced HRQoL. Adolescents who were outside the normal weight range and misperceived their objectively measured weight status enjoyed a higher HRQoL than adolescents whose weight perception was concordant with their actual weight status. These findings suggest that practitioners may need to exercise caution when educating adolescents about their weight status, as such 'reality checks' may negatively impact on adolescent HRQoL. It is suggested that more research be conducted to examine this potential effect.

The jingle fallacy in comprehension tests for reading.

The Jingle fallacy is the false assumption that instruments which share the same name measure the same underlying construct. In this experiment, we focus on the comprehension subtests of the Nelson Denny Reading Test (NDRT) and the Wechsler Individual Achievement Test (WIAT-II). 91 university students read passages for comprehension whilst their eye movements were recorded. Participants took part in two experimental blocks of which the order was counterbalanced, one with higher comprehension demands and one with lower comprehension demands. We assumed that tests measuring comprehension would be able to predict differences observed in eye movement patterns as a function of varying comprehension demands. Overall, readers were able to adapt their reading strategy to read more slowly, making more and longer fixations, coupled with shorter saccades when comprehension demands were higher. Within an experimental block, high scorers on the NDRT were able to consistently increase their pace of reading over time for both higher and lower comprehension demands, whereas low scorers approached a threshold where they could not continue to increase their reading speed or further reduce the number of fixations to read a text, even when comprehension demands were low. Individual differences based on the WIAT-II did not explain similar patterns. The NDRT comprehension test was therefore more predictive of differences in the reading patterns of skilled adult readers in response to comprehension demands than the WIAT-II (which also suffered from low reliability). Our results revealed that these different comprehension measures should not be used interchangeably, and researchers should be cautious when choosing reading comprehension tests for research.

Individual differences and the transposed letter effect during reading.

When a preview contains substituted letters (SL; markey) word identification is more disrupted for a target word (monkey), compared to when the preview contains transposed letters (TL; mnokey). The transposed letter effect demonstrates that letter positions are encoded more flexibly than letter identities, and is a robust finding in adults. However, letter position encoding has been shown to gradually become more flexible as reading skills develop. It is unclear whether letter position encoding flexibility reaches maturation in skilled adult readers, or whether some differences in the magnitude of the TL effect remain in relation to individual differences in cognitive skills. We examined 100 skilled adult readers who read sentences containing a correct, TL or SL preview. Previews were replaced by the correct target word when the reader's gaze triggered an invisible boundary. Cognitive skills were assessed and grouped based on overlapping variance via Principal Components Analysis (PCA) and subsequently used to predict eye movement measures for each condition. Consistent with previous literature, adult readers were found to generally encode letter position more flexibly than letter identity. Very few differences were found in the magnitude of TL effects between adults based on individual differences in cognitive skills. The flexibility of letter position encoding appears to reach maturation (or near maturation) in skilled adult readers.

No evidence of attentional prioritization for threatening targets in visual search.

Throughout human evolutionary history, snakes have been associated with danger and threat. Research has shown that snakes are prioritized by our attentional system, despite many of us rarely encountering them in our daily lives. We conducted two high-powered, pre-registered experiments (total N = 224) manipulating target prevalence to understand this heightened prioritization of threatening targets. Target prevalence refers to the proportion of trials wherein a target is presented; reductions in prevalence consistently reduce the likelihood that targets will be found. We reasoned that snake targets in visual search should experience weaker effects of low target prevalence compared to non-threatening targets (rabbits) because they should be prioritized by searchers despite appearing rarely. In both experiments, we found evidence of classic prevalence effects but (contrasting prior work) we also found that search for threatening targets was slower and less accurate than for nonthreatening targets. This surprising result is possibly due to methodological issues common in prior studies, including comparatively smaller sample sizes, fewer trials, and a tendency to exclusively examine conditions of relatively high prevalence. Our findings call into question accounts of threat prioritization and suggest that prior attention findings may be constrained to a narrow range of circumstances.

Just say 'I don't know': Understanding information stagnation during a highly ambiguous visual search task.

Visual search experiments typically involve participants searching simple displays with two potential response options: 'present' or 'absent'. Here we examined search behavior and decision-making when participants were tasked with searching ambiguous displays whilst also being given a third response option: 'I don't know'. Participants searched for a simple target (the letter 'o') amongst other letters in the displays. We made the target difficult to detect by increasing the degree to which letters overlapped in the displays. The results showed that as overlap increased, participants were more likely to respond 'I don't know', as expected. RT analyses demonstrated that 'I don't know' responses occurred at a later time than 'present' responses (but before 'absent' responses) when the overlap was low. By contrast, when the overlap was high, 'I don't know' responses occurred very rapidly. We discuss the implications of our findings for current models and theories in terms of what we refer to as 'information stagnation' during visual search.

E-genetics: exploring the acceptability and feasibility of using technology in cancer genetics services.

The use of information and communication technologies (ICTs) in the delivery of cancer genetics services could improve equality of access in rural areas and help meet the increasing demand for specialist genetics services. An online patient survey and focus groups with patients and staff from the Cancer Genetics Service for Wales (CGSW) were used to explore the acceptability and feasibility of utilizing ICTs within genetics services, which we have termed e-genetics. A total of 225 patients completed the online survey. Many aspects of e-genetics proposed in the survey were highly acceptable to patients, including an electronic version of the family history questionnaire, an email facility for cancer genetic queries, and a computerized decision-aid. Participants in the focus groups emphasized the importance of patient choice when developing new models of service delivery. For example, the use of genetic counselling via telemedicine was not considered to be preferable to face-to-face clinic appointments but could benefit those unable to travel. This article highlights the fact that e-genetics initiatives may not be appropriate for all cancer genetics service users. However, user-friendly developments that can be easily implemented and attend to individual needs could improve efficiency and cost-effectiveness, whilst providing high-quality services to remote areas.

Predictors of longer-term depression trajectories during the COVID-19 pandemic: a longitudinal study in four UK cohorts.

BACKGROUND: The COVID-19 pandemic has caused an increase in mental ill health compared with prepandemic levels. Longer-term trajectories of depression in adults during the pandemic remain unclear. OBJECTIVE: We used latent growth curve modelling to examine individual trajectories of depression symptoms, and their predictors, beyond the early stage of the pandemic. METHODS: Data were collected in three waves in May 2020, September/October 2020 and February/March 2021 in four UK cohorts (Millennium Cohort Study, Next Steps cohort, British Cohort and National Child Development Study). We included n=16 978 participants (mean age at baseline: 20, 30, 50 and 62, respectively). Self-reported depressive symptoms were the study outcome. FINDINGS: Symptoms of depression were higher in younger compared with older age groups (d=0.7) across all waves. While depressive symptoms remained stable from May 2020 to Autumn 2020 overall (standardized mean difference (SMD)=0.03, 95% CI 0.02 to 0.04), they increased in all age groups from May 2020 to Spring 2021 (SMD=0.12, 95% CI 0.11 to 0.13). Feelings of loneliness were the strongest predictor and concurrent correlate of increasing depressive symptoms across all cohorts, prepandemic mental health problems and having a long-term illness were also significantly associated with an increase in depression symptoms across all ages. By contrast, compliance with social distancing measures did not predict an increase in depression symptoms. CONCLUSIONS: Feeling lonely and isolated had a large effect on depression trajectories across all generations, while social distancing measures did not. CLINICAL IMPLICATIONS: These findings highlight the importance of fostering the feeling of connectedness during COVID-19-related distancing measures.

Examining the effects of passive and active strategy use during interactive search for LEGO® bricks.

In many important search tasks, observers must find what they are looking for using only visual information (e.g., X-ray baggage screening/medical screening). However, numerous other search tasks can only be effectively completed when the searcher uses their hands to find what they are looking for (e.g., "rummage" search). Unfortunately, it is not currently well understood how observers conduct such "interactive" searches nor what the best strategies might be for doing so. Here, we first review the limited literature on interactive search. We then present a novel methodology for the study of interactive search that involves having observers seek out LEGO® targets in a cluttered tray of assorted bricks. In our validation task, we confirm the validity of this approach by demonstrating that it produces sensible patterns of diminishing returns in response time as targets are removed from the set as well as hastened search times for larger targets. In our experiment, we modify the approach, refining its systematicity and experimental control. We also build on prior work exploring strategy use in visual search by investigating the extent to which active and passive strategy use impacts performance in interactive search. In contrast to our prior findings in hybrid visual search (Madrid & Hout, 2019), our current findings suggest that in interactive search, an active search strategy can be superior to a passive one. We close by offering a conceptual model (the Interactive Multiple Decision Model [i-MDM]) that explicates the steps involved in a search task of this nature, and we then provide suggestions for how to further refine the task to achieve higher internal validity and to delve deeper into questions of theoretical importance in the field of interactive search. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Patient perceptions of a mobile cancer support unit in South Wales.

Many patients have to travel long distances to receive treatment and support for cancer, which can lead to increased anxiety and fatigue. Tenovus, the cancer charity, working with the NHS, has developed a new concept of closer-to-home delivery for chemotherapy and other cancer support - a mobile cancer support unit (Bus). Researchers at Cardiff University evaluated the Bus during its first year of operation. The evaluation aimed to determine who was using the Bus and to explore patients' perceptions about having their appointments on the Bus. Data were collected from patients, social care clients and their family and friends using a mixed-methods approach. Quantitative data were collected using postal surveys and qualitative data were collected through semi-structured interviews. In its first year, 3487 people visited the Bus, which included the delivery of 549 chemotherapy treatments. Patient attitudes towards the Bus were extremely positive. Respondents rated highly key aspects of the Bus including comfort and the level of care provided. This evaluation demonstrates that all users are highly receptive to this model of service delivery and agree that the Tenovus Bus is a unique mobile unit, providing excellent clinical and social care to cancer patients and their families.

Avoiding potential pitfalls in visual search and eye-movement experiments: A tutorial review.

Examining eye-movement behavior during visual search is an increasingly popular approach for gaining insights into the moment-to-moment processing that takes place when we look for targets in our environment. In this tutorial review, we describe a set of pitfalls and considerations that are important for researchers - both experienced and new to the field - when engaging in eye-movement and visual search experiments. We walk the reader through the research cycle of a visual search and eye-movement experiment, from choosing the right predictions, through to data collection, reporting of methodology, analytic approaches, the different dependent variables to analyze, and drawing conclusions from patterns of results. Overall, our hope is that this review can serve as a guide, a talking point, a reflection on the practices and potential problems with the current literature on this topic, and ultimately a first step towards standardizing research practices in the field.