Longitudinal transkingdom gut microbial approach towards decompensation in outpatients with cirrhosis.

OBJECTIVE: First decompensation development is a critical milestone that needs to be predicted. Transkingdom gut microbial interactions, including archaeal methanogens, may be important targets and predictors but a longitudinal approach is needed. DESIGN: Cirrhosis outpatients who provided stool twice were included. Group 1: compensated, group 2: 1 decompensation (decomp), group 3: >1 decompensationwere followed and divided into those who remained stable or decompensated. Bacteria, viral and archaeal presence, α/ß diversity and taxa changes over time adjusted for clinical variables were analysed. Correlation networks between kingdoms were analysed. RESULTS: 157 outpatients (72 group 1, 33 group 2 and 52 group 3) were followed and 28%-47% developed outcomes. Baseline between those who remained stable/developed outcome: While no α/ß diversity differences were seen, commensals were lower and pathobionts were higher in those who decompensated. After decompensation: those experiencing their first decompensation showed greater decrease in α/ß-diversity, bacterial change (↑Lactobacillus spp, Streptococcus parasanguinis and ↓ beneficial Lachnospiraceae and Eubacterium hallii) and viral change (↑Siphoviridae, ↓ Myoviridae) versus those with further decompensation. Archaea: 19% had Methanobacter brevii, which was similar between/within groups. Correlation networks: Baseline archaeal-viral-bacterial networks were denser and more homogeneous in those who decompensated versus the rest. Archaea-bacterial correlations collapsed post first decompensation. Lactobacillus phage Lc Nu and C2-like viruses were negatively linked with beneficial bacteria. CONCLUSION: In this longitudinal study of cirrhosis outpatients, the greatest transkingdom gut microbial changes were seen in those reaching the first decompensation, compared with subsequent decompensating events. A transkingdom approach may refine prediction and provide therapeutic targets to prevent cirrhosis progression.

Anomalies in the review process and interpretation of the evidence in the NICE guideline for chronic fatigue syndrome and myalgic encephalomyelitis.

Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is a disabling long-term condition of unknown cause. The National Institute for Health and Care Excellence (NICE) published a guideline in 2021 that highlighted the seriousness of the condition, but also recommended that graded exercise therapy (GET) should not be used and cognitive-behavioural therapy should only be used to manage symptoms and reduce distress, not to aid recovery. This U-turn in recommendations from the previous 2007 guideline is controversial.We suggest that the controversy stems from anomalies in both processing and interpretation of the evidence by the NICE committee. The committee: (1) created a new definition of CFS/ME, which 'downgraded' the certainty of trial evidence; (2) omitted data from standard trial end points used to assess efficacy; (3) discounted trial data when assessing treatment harm in favour of lower quality surveys and qualitative studies; (4) minimised the importance of fatigue as an outcome; (5) did not use accepted practices to synthesise trial evidence adequately using GRADE (Grading of Recommendations, Assessment, Development and Evaluations trial evidence); (6) interpreted GET as mandating fixed increments of change when trials defined it as collaborative, negotiated and symptom dependent; (7) deviated from NICE recommendations of rehabilitation for related conditions, such as chronic primary pain and (8) recommended an energy management approach in the absence of supportive research evidence.We conclude that the dissonance between this and the previous guideline was the result of deviating from usual scientific standards of the NICE process. The consequences of this are that patients may be denied helpful treatments and therefore risk persistent ill health and disability.

Functional neurological disorder is a feminist issue.

Functional neurological disorder (FND) is a common and disabling disorder, often misunderstood by clinicians. Although viewed sceptically by some, FND is a diagnosis that can be made accurately, based on positive clinical signs, with clinical features that have remained stable for over 100 years. Despite some progress in the last decade, people with FND continue to suffer subtle and overt forms of discrimination by clinicians, researchers and the public. There is abundant evidence that disorders perceived as primarily affecting women are neglected in healthcare and medical research, and the course of FND mirrors this neglect. We outline the reasons why FND is a feminist issue, incorporating historical and contemporary clinical, research and social perspectives. We call for parity for FND in medical education, research and clinical service development so that people affected by FND can receive the care they need.

Hypnosis.

Clinical hypnosis is an important therapeutic tool with an increasingly understood cognitive and neurobiological basis, and evidence for efficacy. Hypnosis involves controlled modulation of components of cognition-such as awareness, volition, perception and belief-by an external agent (the hypnotist) or by oneself (self-hypnosis) employing suggestion. In this article, we describe what hypnosis is, how it can be used in clinical settings, and how it is done.

Impact of Globodera ellingtonae on yield of potato (Solanum tuberosum).

Globodera ellingtonae was described from Oregon and Idaho in 2012. Due to the close phylogenetic relationship of this nematode to the potato cyst nematodes G. pallida and G. rostochiensis, and evidence that G. ellingtonae reproduces on potato (Solanum tuberosum), potential damaging effects to potato by this nematode are of great concern. To evaluate the pathogenic effects of G. ellingtonae on potato, five field and two microplot trials were conducted over a four-year period including comparisons of a range of G. ellingtonae initial population densities (Pi) and potato cultivars. In two field trials, potato 'Russet Burbank' was inoculated with Pi of G. ellingtonae ranging from 0 to 80 eggs/g soil; a similar trial was conducted with potato 'Désirée.' In another field trial, potato cultivars varying in maturity lengths were either inoculated (80 eggs/g soil) or not with G. ellingtonae. In a final field trial, 'Ranger Russet' was inoculated with Pi of G. ellingtonae ranging from 0 to 360 eggs/g soil. Additionally, Russet Burbank was inoculated with G. ellingtonae Pi ranging from 0 to 169 eggs/g soil in microplots. In all trials, data on tuber yield, aboveground biomass, final eggs/cyst, final population densities (Pf), and reproduction factor (RF = Pf/Pi) were collected. In only two of six trials conducted with increasing levels of Pi, was there a significant negative correlation between Pi of G. ellingtonae and yield of potato. Based on the linear regression model of tuber yield on logPi for Russet Burbank, 30.5 to 40.9% yield loss was predicted at a Pi of 40 and 80 eggs/g soil, respectively, and for Ranger Russet, 16.5 and 19.7% yield loss was predicted at a Pi of 40 and 80 eggs/g soil, respectively. None of the potato cultivars inoculated with 80 G. ellingtonae eggs/g soil had significantly reduced yields compared to non-inoculated plants. Reproduction factor values across trials ranged from 4.0 to 8.3 when inoculated with Pi of 40 eggs/g soil, demonstrating that the nematode successfully invaded and reproduced on potato in all trials. Care should be taken in extrapolating the results from these experiments conducted in Oregon to probable effects of G. ellingtonae on potato in other environments.KeywordsPotato, Damage, Globodera, Regression.Globodera ellingtonae was described from Oregon and Idaho in 2012. Due to the close phylogenetic relationship of this nematode to the potato cyst nematodes G. pallida and G. rostochiensis, and evidence that G. ellingtonae reproduces on potato (Solanum tuberosum), potential damaging effects to potato by this nematode are of great concern. To evaluate the pathogenic effects of G. ellingtonae on potato, five field and two microplot trials were conducted over a four-year period including comparisons of a range of G. ellingtonae initial population densities (Pi) and potato cultivars. In two field trials, potato 'Russet Burbank' was inoculated with Pi of G. ellingtonae ranging from 0 to 80 eggs/g soil; a similar trial was conducted with potato 'Désirée.' In another field trial, potato cultivars varying in maturity lengths were either inoculated (80 eggs/g soil) or not with G. ellingtonae. In a final field trial, 'Ranger Russet' was inoculated with Pi of G. ellingtonae ranging from 0 to 360 eggs/g soil. Additionally, Russet Burbank was inoculated with G. ellingtonae Pi ranging from 0 to 169 eggs/g soil in microplots. In all trials, data on tuber yield, aboveground biomass, final eggs/cyst, final population densities (Pf), and reproduction factor (RF = Pf/Pi) were collected. In only two of six trials conducted with increasing levels of Pi, was there a significant negative correlation between Pi of G. ellingtonae and yield of potato. Based on the linear regression model of tuber yield on logPi for Russet Burbank, 30.5 to 40.9% yield loss was predicted at a Pi of 40 and 80 eggs/g soil, respectively, and for Ranger Russet, 16.5 and 19.7% yield loss was predicted at a Pi of 40 and 80 eggs/g soil, respectively. None of the potato cultivars inoculated with 80 G. ellingtonae eggs/g soil had significantly reduced yields compared to non-inoculated plants. Reproduction factor values across trials ranged from 4.0 to 8.3 when inoculated with Pi of 40 eggs/g soil, demonstrating that the nematode successfully invaded and reproduced on potato in all trials. Care should be taken in extrapolating the results from these experiments conducted in Oregon to probable effects of G. ellingtonae on potato in other environments.KeywordsPotato, Damage, Globodera, Regression.

Developmental Dynamics of Globodera ellingtonae in Field-Grown Potato.

Globodera ellingtonae is a recently described nematode parasite of potato, which is closely related to the economically significant potato cyst nematodes G. rostochiensis and G. pallida. Because of the close relationship of G. ellingtonae to the potato cyst nematodes, a greater understanding of its biology is critical. Two experiments were conducted in Oregon to explore the developmental biology of G. ellingtonae in field-grown potato. The first experiment was conducted in 2013 and 2014 to determine the developmental timing of G. ellingtonae life stages and reproduction by inoculating potato with soil containing cysts followed by weekly collection of soil and root samples. Life stages; second-stage juveniles (J2) in soil and roots, third-stage juveniles (J3) and fourth-stage (J4) females and males in roots, males and females or cysts in soil, and egg number and developmental state were quantified. Normalizing across years using accumulated developmental degree days above 6°C (DD6), J2 of G. ellingtonae were found in soil from 41 to 588 DD6; two peaks of J2 invasion of roots were observed. The first adult females were observed at 387 and 449 DD6 in 2013 and 2014, respectively. The next generation of eggs was first observed from 675 to 854 DD6 and 50% egg development (containing a vermiform juvenile) occurred at approximately 920 DD6. A second J2 hatch was observed in both years at 927 to 1,073 DD6. The developmental dynamics of G. ellingtonae observed here are similar to those reported for G. rostochiensis and G. pallida from several geographical locations. In the second experiment, the effect of potato and bare soil on G. ellingtonae egg hatch was evaluated; in 2014 and 2015, packages containing cysts in soil were buried under potato or in bare soil at the time of planting and eggs per cyst determined weekly. Across years, a significant reduction in eggs per cysts under potato (>50%) was observed 35 days after planting (DAP) and, at 63 DAP, eggs per cyst were reduced by 76 to 96% compared with initial egg per cyst densities. In bare soil, the maximum reduction in densities of eggs per cyst was 55 to 73%. This annual reduction in egg numbers of G. ellingtonae in bare soil is similar to that reported for G. pallida and G. rostochiensis.

Draft Transcriptome of Globodera ellingtonae.

Globodera ellingtonae is a newly described cyst nematode found in Idaho, Oregon, and Argentina. Here we present the first transcriptome assembly of G. ellingtonae, providing a valuable resource for comparing the evolution of expressed genes between potato cyst nematode species.

Control of Globodera spp. Using Brassica juncea Seed Meal and Seed Meal Extract.

The eradication program for the potato cyst nematode (PCN), Globodera pallida, in the Northwest of the United States revolves around the use of soil fumigation. Alternative, integrated strategies are needed to continue to battle this invasive nematode. Laboratory, greenhouse, and field experiments were conducted with G. pallida and another cyst nematode found in the United States, Globodera ellingtonae, to evaluate the efficacy of a new formulated Brassica juncea seed meal extract, as well as a traditional B. juncea seed meal, as alternate eradication strategies. This is the first report on the efficacy of B. juncea seed meal extract against plant-parasitic nematodes. Rates of B. juncea seed meal greater than 2.2 t/ha and 4.5 t/ha for G. pallida and G. ellingtonae, respectively, were required for egg hatch suppression, as determined by a potato root diffusate (PRD) bioassay. Reproduction of G. pallida on potato after exposure to B. juncea seed meal at a rate of 2.2 t/ha was also significantly reduced. In the field, 8.9 t/ha B. juncea seed meal almost eliminated egg hatch of G. ellingtonae. Rates needed for Globodera spp. suppression were greatly reduced when using the B. juncea seed meal extract. When compared side-by-side, half as much B. juncea seed meal extract, 1.1 t/ha, was required to suppress G. ellingtonae egg hatch to the same extent as B. juncea seed meal. Exposure of G. pallida to B. juncea seed meal extract at 4.5 t/ha reduced egg hatch by 90% compared with a nonamended control. The ability to reduce the amount of material being applied to soil by using an extract has the potential for integration into a G. pallida eradication program.

The Draft Genome of Globodera ellingtonae.

Globodera ellingtonae is a newly described potato cyst nematode (PCN) found in Idaho, Oregon, and Argentina. Here, we present a genome assembly for G. ellingtonae, a relative of the quarantine nematodes G. pallida and G. rostochiensis, produced using data from Illumina and Pacific Biosciences DNA sequencing technologies.

The mitochondrial genome of Globodera ellingtonae is composed of two circles with segregated gene content and differential copy numbers.

BACKGROUND: The evolution of animal mitochondrial (mt) genomes has resulted in a highly conserved structure: a single compact circular chromosome approximately 14 to 20 kb long. Within the last two decades exceptions to this conserved structure, such as the division of the genome into multiple chromosomes, have been reported in a diverse set of metazoans. We report on the two circle multipartite mt genome of a newly described cyst nematode, Globodera ellingtonae. RESULTS: The G. ellingtonae mt genome was found to be comprised of two circles, each larger than any other multipartite circular mt chromosome yet reported, and both were larger than the single mt circle of the model nematode Caenorhabditis elegans. The genetic content of the genome was disproportionately divided between the two circles, although they shared a ~6.5 kb non-coding region. The 17.8 kb circle (mtDNA-I) contained ten protein-coding genes and two tRNA genes, whereas the 14.4 kb circle (mtDNA-II) contained two protein-coding genes, 20 tRNA genes and both rRNA genes. Perhaps correlated with this division of genetic content, the copy number of mtDNA-II was more than four-fold that of mtDNA-I in individual nematodes. The difference in copy number increased between second-stage and fourth-stage juveniles. CONCLUSIONS: The segregation of gene types to different mt circles in G. ellingtonae could provide benefit by localizing gene functional types to independent transcriptional units. This is the first report of both two-circle and several-circle mt genomes within a single genus. The differential copy number associated with this multipartite mt organization could provide a model system for deconstructing mechanisms regulating mtDNA copy number both in somatic cells and during germline development.

En Route to Depression: Self-Esteem Discrepancies and Habitual Rumination.

Dual-process models of cognitive vulnerability to depression suggest that some individuals possess discrepant implicit and explicit self-views, such as high explicit and low implicit self-esteem (fragile self-esteem) or low explicit and high implicit self-esteem (damaged self-esteem). This study investigated whether individuals with discrepant self-esteem may employ depressive rumination in an effort to reduce discrepancy-related dissonance, and whether the relationship between self-esteem discrepancy and future depressive symptoms varies as a function of rumination tendencies. Hierarchical regressions examined whether self-esteem discrepancy was associated with rumination in an Australian undergraduate sample at Time 1 (N = 306; M(age) = 29.9), and whether rumination tendencies moderated the relationship between self-esteem discrepancy and depressive symptoms assessed 3 months later (n = 160). Damaged self-esteem was associated with rumination at Time 1. As hypothesized, rumination moderated the relationship between self-esteem discrepancy and depressive symptoms at Time 2, where fragile self-esteem and high rumination tendencies at Time 1 predicted the highest levels of subsequent dysphoria. Results are consistent with dual-process propositions that (a) explicit self-regulation strategies may be triggered when explicit and implicit self-beliefs are incongruent, and (b) rumination may increase the likelihood of depression by expending cognitive resources and/or amplifying negative implicit biases.

The Relationship between Temperature and Development in Globodera ellingtonae.

A new cyst nematode species, Globodera ellingtonae, was recently described from populations in Oregon and Idaho. This nematode has been shown to reproduce on potato. Because of this nematode's close relationship to the potato cyst nematodes, G. rostochiensis and G. pallida, an understanding of the risk of its potential spread, including prediction of potential geographical distribution, is required. To determine the development of G. ellingtonae under different temperatures, we conducted growth chamber experiments over a range of temperatures (10.0°C to 26.5°C) and tracked length of time to various developmental stages, including adult females bearing the next generation of eggs. Both the time to peak population densities of G. ellingtonae life stages and their duration in roots generally increased with decreasing temperature. Regression of growth rate to second-stage (J2) and third-stage (J3) juveniles on temperature yielded different base temperatures: 6.3°C and 4.4°C for J2 and J3, respectively. Setting a base temperature of 6°C allowed calculation of the degree-days (DD6) over which different life stages occurred. The largest population densities of J2 were found in roots between 50 and 200 DD6. Population densities of J3 peaked between 200 and 300 DD6. Adult males were detected in soil starting at 300 to 400 DD6 and remained detectable for approximately 500 DD6. By 784 to 884 DD6, half of the eggs in adult females contained vermiform juveniles. Given the similarity in temperature ranges for successful development between G. ellingtonae and G. rostochiensis, G. ellingtonae populations likely could survive in the same geographic range in which G. rostochiensis now occurs.

Profiles of psychological well-being in a sample of Australian university students.

The present study identified psychological well-being profiles in a sample of Australian university students (N = 207, Mean age = 30.16 years; SD = 11.90). Respondents completed two measures: Ryff's (1989) Psychological Well-Being (PWB) scale and Lovibond and Lovibond's (2002) Depression, Anxiety and Stress Scales-21 (DASS-21) assessing their levels of PWB and depression. Latent profile analysis was applied to six indices of positive functioning derived from PWB scale: self-acceptance, purpose in life, environmental mastery, positive relations with others, personal growth and autonomy. An optimal 5-profile solution, reflecting significant incremental shifts from very low to very high PWB, was interpreted. As predicted, profile membership distinguished participants on depression. Importantly, profiles indicating moderate to very high PWB, particularly with the presence of above average autonomy, reported significantly lower levels of depression. Our results suggest prevention of, and treatment efficacy for, mental health problems may be improved by incorporating strategies that address positive functioning attributes, particularly associated with a sense of autonomy.

Guidance for assessment of the inflammation etiologic criterion for the GLIM diagnosis of malnutrition: A modified Delphi approach.

BACKGROUND & AIMS: The Global Leadership Initiative on Malnutrition (GLIM) approach to malnutrition diagnosis is based on assessment of three phenotypic (weight loss, low body mass index, and reduced skeletal muscle mass) and two etiologic (reduced food intake/assimilation and disease burden/inflammation) criteria, with diagnosis confirmed by fulfillment of any combination of at least one phenotypic and at least one etiologic criterion. The original GLIM description provided limited guidance regarding assessment of inflammation and this has been a factor impeding further implementation of the GLIM criteria. We now seek to provide practical guidance for assessment of inflammation in support of the etiologic criterion for inflammation. METHODS: A GLIM-constituted working group with 36 participants developed consensus-based guidance through a modified-Delphi review. A multi-round review and revision process served to develop seven guidance statements. RESULTS: The final round of review was highly favorable with 99 % overall "agree" or "strongly agree" responses. The presence of acute or chronic disease, infection or injury that is usually associated with inflammatory activity may be used to fulfill the GLIM disease burden/inflammation criterion, without the need for laboratory confirmation. However, we recommend that recognition of underlying medical conditions commonly associated with inflammation be supported by C-reactive protein (CRP) measurements when the contribution of inflammatory components is uncertain. Interpretation of CRP requires that consideration be given to the method, reference values, and units (mg/dL or mg/L) for the clinical laboratory that is being used. CONCLUSION: Confirmation of inflammation should be guided by clinical judgement based upon underlying diagnosis or condition, clinical signs, or CRP.

Guidance for assessment of the inflammation etiologic criterion for the GLIM diagnosis of malnutrition: A modified Delphi approach.

BACKGROUND: The Global Leadership Initiative on Malnutrition (GLIM) approach to malnutrition diagnosis is based on assessment of three phenotypic (weight loss, low body mass index, and reduced skeletal muscle mass) and two etiologic (reduced food intake/assimilation and disease burden/inflammation) criteria, with diagnosis confirmed by fulfillment of any combination of at least one phenotypic and at least one etiologic criterion. The original GLIM description provided limited guidance regarding assessment of inflammation, and this has been a factor impeding further implementation of the GLIM criteria. We now seek to provide practical guidance for assessment of inflammation. METHODS: A GLIM-constituted working group with 36 participants developed consensus-based guidance through a modified Delphi review. A multiround review and revision process served to develop seven guidance statements. RESULTS: The final round of review was highly favorable, with 99% overall "agree" or "strongly agree" responses. The presence of acute or chronic disease, infection, or injury that is usually associated with inflammatory activity may be used to fulfill the GLIM disease burden/inflammation criterion, without the need for laboratory confirmation. However, we recommend that recognition of underlying medical conditions commonly associated with inflammation be supported by C-reactive protein (CRP) measurements when the contribution of inflammatory components is uncertain. Interpretation of CRP requires that consideration be given to the method, reference values, and units (milligrams per deciliter or milligram per liter) for the clinical laboratory that is being used. CONCLUSION: Confirmation of inflammation should be guided by clinical judgment based on underlying diagnosis or condition, clinical signs, or CRP.

Malnutrition among Hospitalized Children in the United States: A 2012-2019 Update of Annual Trends.

BACKGROUND: Malnutrition is associated with adverse clinical outcomes and increased health care utilization for hospitalized children. Yet pediatric malnutrition often goes undiagnosed and national prevalence research in this population is scarce. OBJECTIVE: The aim was to assess change in the coded diagnosis of malnutrition (CDM) among US hospitalized children given increased awareness of the need for improved recognition and standardized diagnosis. DESIGN: Retrospective, cross-sectional analysis using nationally representative data from the Nationwide Inpatient Sample. PARTICIPANTS/SETTING: Our sample was 13.2 million hospitalizations from 2012 to 2019 among pediatric patients between age 1 month and 17 years. MAIN OUTCOME MEASURE: CDM using International Classification of Diseases Ninth and 10th Revision-Clinical Modification diagnosis codes. STATISTICAL ANALYSES: Descriptive statistics and sampling weights were used to estimate the national frequency and prevalence of CDM. Temporal trends in CDM overall and stratified by age, race/ethnicity, and hospital type were analyzed using joinpoint regression. RESULTS: CDM prevalence increased from 3.9% in 2012 to 6.4% in 2019. During this period, failure to thrive decreased from 40.6% to 23.3% of all cases with concomitant increases in the diagnosis of protein-calorie malnutrition and children identified with more than one malnutrition subtype. Differences in CDM diagnoses are evident by hospital type, race/ethnicity, and age of the patient. CONCLUSIONS: Although pediatric malnutrition continues to be underdiagnosed in hospital settings, this study demonstrates improvement over time. There continues to be a need for continued professional education regarding best practices for diagnosis to improve health care provider knowledge and self-efficacy on this topic, especially in nonteaching hospitals.

Current nutrition assessment practice: A 2022 survey.

BACKGROUND: Malnutrition remains a significant problem in patients with acute or chronic illnesses. Nutrition assessment is an important component in detecting malnutrition; but not always performed using a standardized tool. This survey on nutrition assessment evaluates current clinical practices on the assessment, diagnosis, and treatment of malnutrition. METHODS: This 2022 survey of US-based nutrition clinicians collected data on assessment parameters used in hospitals, long-term care facilities, and the home care setting. RESULTS: A total of 686 surveys were available for analysis. Ninety-seven percent of adult and 91% of pediatric responding clinicians indicated that a dietitian completed the assessment. Parameters used most frequently among adult clinician respondents included nutrient intake, current weight, and weight history, those used by pediatric clinician respondents included nutrient intake, weight-for-age z score, and weight-for-length/height z score. Eighty-nine percent of adult clinicians in all care settings and 85% of pediatric clinicians use the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition Indicators of Malnutrition (AAIM). Respondents reported malnutrition rates of 32%-40% for adults and 4%-30% for pediatric patients, depending on the setting. Appropriate interventions for those with malnutrition (as perceived by the survey respondents) were ordered 70% of the time. CONCLUSION: This survey demonstrated significant use of the AAIM by both adult and pediatric clinicians across care settings. Reported malnutrition rates are consistent with others published in the literature. The authors suggest that quality improvement efforts should focus on the 30% of patients with malnutrition but without a reported appropriate nutrition intervention.

Emergency management in health: key issues and challenges in the UK.

BACKGROUND: Emergency planning in the UK has grown considerably in recent years, galvanised by the threat of terrorism. However, deficiencies in NHS emergency planning were identified and the evidence-base that underpins it is questionable. Inconsistencies in terminologies and concepts also exist. Different models of emergency management exist internationally but the optimal system is unknown. This study examines the evidence-base and evidence requirements for emergency planning in the UK health context. METHODS: The study involved semi-structured interviews with key stakeholders and opinion leaders. Purposive sampling was used to obtain a breadth of views from various agencies involved in emergency planning and response. Interviews were then analysed using a grounded approach using standard framework analysis techniques. RESULTS: We conducted 17 key informant interviews. Interviewees identified greater gaps in operational than technical aspects of emergency planning. Social and behavioural knowledge gaps were highlighted with regards to how individuals and organisations deal with risk and behave in emergencies. Evidence-based approaches to public engagement and for developing community resilience to disasters are lacking. Other gaps included how knowledge was developed and used. Conflicting views with regards to the optimal configuration and operation of the emergency management system were voiced. CONCLUSIONS: Four thematic categories for future research emerged:(i) Knowledge-base for emergency management: Further exploration is needed of how knowledge is acquired, valued, disseminated, adopted and retained.(ii) Social and behavioural issues: Greater understanding of how individuals approach risk and behave in emergencies is required.(iii) Organisational issues in emergencies: Several conflicting organisational issues were identified; value of planning versus plans, flexible versus standardized procedures, top-down versus bottom-up engagement, generic versus specific planning, and reactive versus proactive approaches to emergencies.(iv) Emergency management system: More study is required of system-wide issues relating to system configuration and operation, public engagement, and how emergency planning is assessed.

Ambulance ramping predicts poor mental health of paramedics.

OBJECTIVE: Ambulance ramping involves a patient remaining under paramedic care until a hospital emergency department bed becomes available. This study examined whether negative ramping experiences (verbal abuse, physical abuse, compromised patient care, and patient fatality) contribute to relatively high levels of depression, anxiety, stress, and posttraumatic stress disorder (PTSD) in paramedics. METHOD: Ninety Australian paramedics (Mage = 37.68, SD = 10.73; 52.2% male) completed an online survey. RESULTS: Path analysis found that negative ramping experiences were positively associated with symptoms of depression, anxiety, stress, and PTSD. Interactions indicated that negative ramping experiences predicted greater depression, stress, and PTSD among paramedics with higher, but not lower, work-related self-efficacy. All interactions with resilience were nonsignificant. CONCLUSIONS: These findings suggest that policymakers should aim to reduce ambulance ramping, and that future research could fruitfully investigate the mental health benefits of training programs that include strategies to minimize paramedics' feelings of powerlessness, frustration, and self-blame, during ramping. (PsycInfo Database Record (c) 2022 APA, all rights reserved).