Paramedics as Researchers: A Systematic Review of Paramedic Perspectives of Engaging in Research Activity From Training to Practice.

BACKGROUND: The need for a stronger evidence-base in paramedicine has precipitated a rapid development of prehospital research agendas. Paramedics are increasingly involved in research, leading to changes in their role. Yet, the integration of research responsibilities has proven to be challenging, resulting in varying attitudes and levels of engagement. OBJECTIVE: This systematic review aimed to explore paramedics' views and experiences of research as researchers during training and within practice. METHODS: A systematic search was performed across six databases. Qualitative empirical peer-reviewed articles that discussed paramedic perspectives on engaging with research activity were included. Of 10,594 articles identified initially, 11 were included in the final synthesis after quality appraisal. Data were extracted and subjected to narrative synthesis. RESULTS: The following four themes were identified: motivation to engage, moral dilemmas, structural issues within the profession, and reflections on trial involvement. Attitudes toward research, understanding of related concepts, and the drive for patient benefit were interwoven core issues. CONCLUSIONS: Research was highly valued when links to patient benefit were obvious, however, this review highlights some cultural resistance to research, particularly regarding informed consent and changes to standard practice. Paramedic research methods training should provide structured opportunities to explore concerns and emphasize the role of research in developing a high-quality evidence base to underpin safe practice. Currently, there is inadequate organizational support for paramedics to engage effectively in research activity, with minimal allocations of time, training, and remuneration. Without properly integrating research activity into the paramedic role, their capacity to engage with research activity is limited.

Diagnostic procedures of paediatric speech and language therapists in the UK: Enabling and obstructive factors.

BACKGROUND: Extensive variation in the terminology used for paediatric diagnoses across the speech and language therapy research literature is an internationally recognized problem. Little is known, however, about how and how often diagnoses are given in a clinical context. In the UK, speech and language therapists (SLTs) identify and support children who have speech and language needs. To understand and address clinically rooted terminological issues that may directly impact clients and families, there is a need for exploration of how the diagnostic process is operationalized in practice. AIM: To identify, from the perspective of SLTs, areas that present as enabling and obstructive factors to conducting diagnosis in clinical practice. METHODS & PROCEDURES: Taking a phenomenological approach, 22 paediatric SLTs were interviewed using a semi-structured format. Thematic analysis revealed a number of factors that were either classified as 'enabling' or 'obstructive' to their diagnostic processes. OUTCOMES & RESULTS: Participants were often hesitant to provide a diagnosis to families and universally reported the need for targeted guidance, which accounts for the demands of current clinical practice, to guide their diagnostic process. Four enabling factors were identified from participant data: (1) working to a medical model, (2) the availability of collegiate support, (3) recognizing the benefits of diagnosis,, and (4) relating to the needs of the family. Seven themes portrayed obstructive factors in practice: (1) the complex presentation of clients, (2) the risk of giving a 'wrong' diagnosis, (3) participants' uncertainty about diagnostic criteria, (4) insufficient training, (5) service models, (6) concerns about stigma and (7) not having enough clinical time. The obstructive factors created dilemmas for participants and resulted in hesitancy to give a diagnosis, potentially contributing to delays in diagnosis experienced by families as reported in previous literature. CONCLUSIONS & IMPLICATIONS: Of paramountcy to SLTs were the individual needs and preferences of their clients. Practical barriers and areas of uncertainty increased hesitance to diagnose, which may inadvertently preclude families from accessing resources. Recommendations include more widely accessible training in diagnostic practice, guidelines to support clinical decision-making, and a greater understanding of client preferences with regard to terminology and its potential relationship with social stigma. WHAT THIS PAPER ADDS: What is already known on the subject Inconsistency in terminology for paediatric language diagnoses has been broadly discussed, mostly in reference to variation within research literature. The Royal College of Speech and Language Therapists' (RCSLT) position statement on developmental language disorder (DLD) and language disorder made recommendations for SLTs to use these terms in clinical practice. There is some evidence that SLTs face challenges in operationalizing diagnostic criteria in practice, particularly given financial and resource constraints. What this paper adds to existing knowledge SLTs disclosed several issues that either supported or were obstructive to the practice of diagnosing paediatric clients and delivering this information to families. Whilst most SLTs faced constraints related to the practicalities and demands of clinical practice, a number also held reservations about the impact of a lifelong diagnosis for young clients. These issues resulted in considerable avoidance of formal diagnostic terminology, in favour of description or informal terminology. What are the potential or actual clinical implications of this work? If diagnoses are not given, or if SLTs are using informal diagnostic terms as an alternative strategy, clients and families may experience reduced opportunities to yield benefits associated with a diagnosis. Clinical guidance that specifically addresses the prioritization of time and provides directives for clinical action in instances of uncertainty may support SLTs to feel confident in giving diagnoses.

Are finasteride-related penile curvature/Peyronie's disease Adverse Event Reports worthy of further clinical investigation? Disproportionality analysis based on both the Food and Drug Administration (FDA) and the European Medicines Agency (EMA) pharmacovigilance databases.

A limited number of studies have described patients on finasteride showing findings which were consistent with Peyronie's disease (PD). We aimed to detect a pharmacovigilance signal of possible association between finasteride and PD-related clinical features. The Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS) database was queried to identify the ten drugs which were associated the most with the adverse drug reactions (ADRs) recorded as "penile curvature" and/or "Peyronie's disease". A similar analysis, including the same drugs, was carried out for the EMA (European Medicines Agency) EudraVigilance (EV) database. Descriptive data have been analyzed, and Proportional Reporting Ratios (PRRs) have been computed against the other nine drugs of the database. Overall, 860 reports of "penile curvature" and/or "Peyronie's disease", were identified in the FAERS database, 214 of which (24.9%) were associated with finasteride. Most reports (56.9%) were submitted by healthcare professionals. Where a treatment-indication was stated, the vast majority of reports (176/210; 83.8%) were associated with androgenetic alopecia. The outcome of most ADRs was "serious" (82.2%), with 96 ADRs resulting in levels of permanent disability. For 97/214 individual cases, penile curvature/PD reports were not part of a syndromic cluster suggestive of post-finasteride syndrome (PFS). The PRR resulted 6.6 (95% CI: 5.6-7.8) and 11.8 (95% CI: 9.08-15.33), respectively, in the FAERS and in the EV databases. Notwithstanding the related limitations and biasing factors of pharmacovigilance studies based on spontaneous reporting, the PRR values here identified should be interpreted as strong signals of disproportionality. These findings, per se, are however not useful to confirm any causal association. Clinical studies are needed to investigate on the possible role for finasteride in causing PD-related clinical features, an hypothesis which remains highly speculative due to the very questionable quality of present data.

A Rare Case of a Large Primary Renal Neuroendocrine Tumour: A Case Report and Brief Review of Literature.

Primary renal neuroendocrine tumours are very rare clinical entities, and as such, relatively little is known about their clinical progression. Here, we outline the case of a young female patient presenting with abdominal pain and a large 14 cm right renal mass. Initial radiological studies demonstrated localised disease, but during surgical resection, widespread liver metastasis was identified. Histological analysis revealed a grade 2, well-differentiated neuroendocrine tumour pT3a. Whilst surgical resection remains the gold standard for localised disease, further work is required to understand the pathogenesis, prognostic indicators and treatment following metastatic spread. The poor prognosis seen in primary renal neuroendocrine neoplasia highlights the importance of further directed research in this area.

A comparison of reading, in people with simulated and actual central vision loss, with static text, horizontally scrolling text, and rapid serial visual presentation.

Reading with central vision loss (CVL), as caused by macular disease, may be enhanced by presenting text using dynamic formats such as horizontally scrolling text or rapid serial visual presentation (RSVP). The rationale for these dynamic text formats is that they can be read while holding gaze away from the text, potentially supporting reading while using the eccentric viewing strategy. This study was designed to evaluate the practice of reading with CVL, with passages of text presented as static sentences, with horizontal scrolling sentences, or as single-word RSVP. In separate studies, normally sighted participants with a simulated (artificial) central scotoma, controlled by an eye-tracker, or participants with CVL resulting from macular degeneration read passages of text using the eccentric viewing technique. Comprehension was better overall with scrolling text when reading with a simulated CVL, whereas RSVP produced lower overall comprehension and high error rates. Analysis of eye movement behavior showed that participants consistently adopted a strategy of making multiple horizontal saccades on the text itself. Adherence to using eccentric viewing was better with RSVP, but this did not translate into better reading performance. Participants with macular degeneration and an actual CVL also showed the highest comprehension and lowest error rates with scrolling text and the lowest comprehension and highest errors with RSVP. We conclude that scrolling text can support effective reading in people with CVL and has potential as a reading aid.

The Postural Tachycardia Syndrome (PoTS) Bladder-Urodynamic Findings.

OBJECTIVE: To evaluate the urodynamics (UDS) of patients with postural tachycardia syndrome (PoTS). METHODS: Patients with a confirmed diagnosis of PoTS referred by the department of neuro-cardiology to the neuro-urology were identified and their UDS were retrospectively reviewed. RESULTS: In total, 50 patients (47 = 94.0% female) with confirmed PoTS and available UDS were identified. Mean age of females and males was 32.4 and 28.2 years, P = .15. Intermittent self-catheterisation was being used by 15/47 (31.9%) females at assessment. Detrusor overactivity was observed in 6 females (12.8%) (all at end fill and associated with urgency). In total, 14 (29.8%) females had no sensation of filling. No patients had an "unsafe" bladder. In total, 15/47 (31.9%) of women were unable to void with UDS catheters. Straining was reported in 22/35 (68.8%) of females. The female bladder outflow obstruction index = PDetQmax - 2.2(Qmax) was over 5 in 10/28 (35.7%) and over 18 in 5 (17.9%). The bladder contractility index = PDetQmax + 5Qmax was under 100 in 18/28 (28.6%) women. CONCLUSION: The UDS of patients with "PoTS bladder" often demonstrate a poorly sensate but stable and safe bladder with functional obstruction and impaired bladder contractility that may necessitate straining or intermittent self-catheterisation.

Mini PCNL: A viable single stage treatment for pediatric nephrolithiasis in resource limited countries.

INTRODUCTION: There is increasing enthusiasm for the value of mini PCNL for pediatric stone clearance. In developing countries, it is important to arrange a single stage treatment as a significant proportion of patients do not comply with repeated treatments, such as SWL. OBJECTIVE: To assess the safety, feasibility and outcomes of Mini PCNL in a pediatric cohort. MATERIALS AND METHODS: Retrospective analysis was performed of all paediatric patients undergoing Mini-PCNL at our institute between December 2016 and December 2019. Data was collected on stone size, stone clearance rate, complications, fluoroscopic exposure, mean procedural time and length of hospital stay. Follow up data included imaging to assess stone free status at 1 and 3 months postoperatively. RESULTS: Mini PCNL was performed in 113 pediatric patients, a total of 135 procedures, accounting for bilateral disease in 22. The age range was from 1 to 14 years with a mean age of 8.45 ± 3.14 years. The mean stone burden was 2.1 ± 0.4 cm. Partial and complete staghorn stones were observed in 7 and 3 patients, respectively. The mean operative time was 63.8 ± 13.2 min (range: 25 min to 116min) and mean length of stay was 4.3 ± 2.2 days. Primary stone clearance was achieved in 91.1% (123 patients). Ancillary procedures were undertaken in 10 patients resulting in a secondary clearance rate of 97.0% (131 patients) at 3 months. Complications occurred in 16.3% (22 patients) using the modified Clavien Classification. Metabolic abnormalities were seen in 56.7% of patients with hypocitraturia and hypercalciuria being the most common abnormalities. DISCUSSION: Our study reports a clearance rate of 91.1%, whereas, Zeng et al. documented a stone clearance rate of 80.4%. This contrast may be attributed to the difference in followup imaging protocols of the two studies and the energy source used for fragmentation. The incidence of complications with PCNL ranges from 10.6% to 36.3%, we found complications in 16.3% of our cohort. Our study is limited due to its retrospective design with a short follow-up protocol. Computed tomography being gold standard for qualitative and quantitative assessment of stone burden was not used in all patients to assess the preoperative stone size. Furthermore, postoperatively stone clearance was determined on the basis of ultrasound and x-ray films that could limit the accuracy of our stone clearance rate. CONCLUSION: Our study suggests that mini PNCL in pediatrics patients is an effective single stage treatment for definitive stone clearance with an acceptable complication risk.

The Underreporting of Vision Problems in Statutory Documents of Children with Williams Syndrome and Down Syndrome.

Vision problems can lead to negative developmental outcomes. Children with Williams syndrome and Down syndrome are at higher risk of vision problems, and these are less likely to be detected due to diagnostic overshadowing and difficulty accessing eye-care. Education, Health and Care (EHC) plans are statutory documents, introduced by the Children and Families Act 2014 in England, with the intention of integrating provision across these domains. Vision issues should be reported in these plans, and recommendations made about appropriate adjustments for them. We analysed the EHC plans from 53 children with Down or Williams syndrome. Our results showed significant underreporting, especially for children with Williams syndrome, and little explanation of what adjustments should be made. We also report pockets of good practice.

Skilled readers' sensitivity to meaningful regularities in English writing.

Substantial research has been undertaken to understand the relationship between spelling and sound, but we know little about the relationship between spelling and meaning in alphabetic writing systems. We present a computational analysis of English writing in which we develop new constructs to describe this relationship. Diagnosticity captures the amount of meaningful information in a given spelling, whereas specificity estimates the degree of dispersion of this meaning across different spellings for a particular sound sequence. Using these two constructs, we demonstrate that particular suffix spellings tend to be reserved for particular meaningful functions. We then show across three paradigms (nonword classification, spelling, and eye tracking during sentence reading) that this form of regularity between spelling and meaning influences the behaviour of skilled readers, and that the degree of this behavioural sensitivity mirrors the strength of spelling-to-meaning regularities in the writing system. We close by arguing that English spelling may have become fractionated such that the high degree of spelling-sound inconsistency maximises the transmission of meaningful information.

Increased Word Spacing Improves Performance for Reading Scrolling Text with Central Vision Loss.

SIGNIFICANCE: Scrolling text can be an effective reading aid for those with central vision loss. Our results suggest that increased interword spacing with scrolling text may further improve the reading experience of this population. This conclusion may be of particular interest to low-vision aid developers and visual rehabilitation practitioners. PURPOSE: The dynamic, horizontally scrolling text format has been shown to improve reading performance in individuals with central visual loss. Here, we sought to determine whether reading performance with scrolling text can be further improved by modulating interword spacing to reduce the effects of visual crowding, a factor known to impact negatively on reading with peripheral vision. METHODS: The effects of interword spacing on reading performance (accuracy, memory recall, and speed) were assessed for eccentrically viewed single sentences of scrolling text. Separate experiments were used to determine whether performance measures were affected by any confound between interword spacing and text presentation rate in words per minute. Normally sighted participants were included, with a central vision loss implemented using a gaze-contingent scotoma of 8° diameter. In both experiments, participants read sentences that were presented with an interword spacing of one, two, or three characters. RESULTS: Reading accuracy and memory recall were significantly enhanced with triple-character interword spacing (both measures, P ≤ .01). These basic findings were independent of the text presentation rate (in words per minute). CONCLUSIONS: We attribute the improvements in reading performance with increased interword spacing to a reduction in the deleterious effects of visual crowding. We conclude that increased interword spacing may enhance reading experience and ability when using horizontally scrolling text with a central vision loss.

Evidence for a reduction of the rightward extent of the perceptual span when reading dynamic horizontally scrolling text.

The dynamic horizontally scrolling text format produces a directional conflict in the allocation of attention for reading, with a necessity to track each word leftward (in the direction of movement) concurrently with normal rightward shifts made to progress through the text (in left-to-right orthographies such as English). The gaze-contingent window paradigm was used to compare the extent of the perceptual span in reading of scrolling and static sentences. Across two experiments, this investigation confirmed that the allocation of attentional resources to the right of fixation was compressed with scrolling text. There was no evidence for a reversal of the direction of asymmetry or a confounding shift of landing position. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Reading comprehension and its relationship with working memory capacity when reading horizontally scrolling text.

The horizontally scrolling format, where text is presented in a single line drifting right to left, is relatively commonly used to display text on digital screens. This format presents a potentially challenging reading situation as the text must be followed smoothly to the left (to track individual words) while rightward eye movements are made as usual to progress through the text. This conflict may reduce attention allocated to upcoming text. Returning to previously encountered text is also more difficult with this format. Here, a sustained reading comprehension task was used to compare performance with horizontally scrolling and multi-line static text formats. Results showed that literal comprehension can be reasonably well maintained with scrolling text, although small decrements are seen at faster scrolling rates. However, they indicated that this format makes it more difficult to answer questions requiring an inference to be made. The contribution of working memory capacity and the impact of display speed on these effects were considered. These findings have implications for the application of this format in digital media and also more widely for the conditions required for successful in-depth reading comprehension with any text format.

Laparoscopic repair of a migrated adjustable gastric band connecting tube with colonic erosion.

Laparoscopic adjustable gastric bands are a popular and effective surgical option to treat morbid obesity. The overall complication rate is 10-20% and the most common complication is of 'slippage'. Although other complications such as gastric band migration and erosion have been reported, the phenomenon of a migrated gastric band connecting tube eroding into the colon (after port removal) is seldom reported in the literature. In this article we describe such a case of an incidentally found colonic erosion on colonoscopy and describe the subsequent laparoscopic repair, as well as a review of the literature.

Oculomotor and linguistic processing effects in reading dynamic horizontally scrolling text.

Two experiments are reported investigating oculomotor behavior and linguistic processing when reading dynamic horizontally scrolling text (compared to reading normal static text). Three factors known to modulate processing time in normal reading were investigated: Word length and word frequency were examined in Experiment 1, and target word predictability in Experiment 2. An analysis of global oculomotor behavior across the 2 experiments showed that participants made fewer and longer fixations when reading scrolling text, with shorter progressive and regressive saccades between these fixations. Comparisons of the linguistic manipulations showed evidence of a dissociation between word-level and sentence-level processing. Word-level processing (Experiment 1) was preserved for the dynamic scrolling text condition with no difference in length and frequency effects between scrolling and static text formats. However, sentence-level integration (Experiment 2) was reduced for scrolling compared to static text in that we obtained no early facilitation effect for predictable words under scrolling text conditions. (PsycINFO Database Record

The value of Tablets as reading aids for individuals with central visual field loss: an evaluation of eccentric reading with static and scrolling text.

PURPOSE: Technological devices such as smartphones and tablets are widely available and increasingly used as visual aids. This study evaluated the use of a novel app for tablets (MD_evReader) developed as a reading aid for individuals with a central field loss resulting from macular degeneration. The MD_evReader app scrolls text as single lines (similar to a news ticker) and is intended to enhance reading performance using the eccentric viewing technique by both reducing the demands on the eye movement system and minimising the deleterious effects of perceptual crowding. Reading performance with scrolling text was compared with reading static sentences, also presented on a tablet computer. METHODS: Twenty-six people with low vision (diagnosis of macular degeneration) read static or dynamic text (scrolled from right to left), presented as a single line at high contrast on a tablet device. Reading error rates and comprehension were recorded for both text formats, and the participant's subjective experience of reading with the app was assessed using a simple questionnaire. RESULTS: The average reading speed for static and dynamic text was not significantly different and equal to or greater than 85 words per minute. The comprehension scores for both text formats were also similar, equal to approximately 95% correct. However, reading error rates were significantly (p = 0.02) less for dynamic text than for static text. The participants' questionnaire ratings of their reading experience with the MD_evReader were highly positive and indicated a preference for reading with this app compared with their usual method. CONCLUSIONS: Our data show that reading performance with scrolling text is at least equal to that achieved with static text and in some respects (reading error rate) is better than static text. Bespoke apps informed by an understanding of the underlying sensorimotor processes involved in a cognitive task such as reading have excellent potential as aids for people with visual impairments.

Parental reminder, recall and educational interventions to improve early childhood immunisation uptake: A systematic review and meta-analysis.

Vaccination is one of the most effective ways of reducing childhood mortality. Despite global uptake of childhood vaccinations increasing, rates remain sub-optimal, meaning that vaccine-preventable diseases still pose a public health risk. A range of interventions to promote vaccine uptake have been developed, although this range has not specifically been reviewed in early childhood. We conducted a systematic review and meta-analysis of parental interventions to improve early childhood (0-5 years) vaccine uptake. Twenty-eight controlled studies contributed to six separate meta-analyses evaluating aspects of parental reminders and education. All interventions were to some extent effective, although findings were generally heterogeneous and random effects models were estimated. Receiving both postal and telephone reminders was the most effective reminder-based intervention (RD=0.1132; 95% CI=0.033-0.193). Sub-group analyses suggested that educational interventions were more effective in low- and middle-income countries (RD=0.13; 95% CI=0.05-0.22) and when conducted through discussion (RD=0.12; 95% CI=0.02-0.21). Current evidence most supports the use of postal reminders as part of the standard management of childhood immunisations. Parents at high risk of non-compliance may benefit from recall strategies and/or discussion-based forums, however further research is needed to assess the appropriateness of these strategies.

I thought that I heard you laughing: Contextual facial expressions modulate the perception of authentic laughter and crying.

It is well established that categorising the emotional content of facial expressions may differ depending on contextual information. Whether this malleability is observed in the auditory domain and in genuine emotion expressions is poorly explored. We examined the perception of authentic laughter and crying in the context of happy, neutral and sad facial expressions. Participants rated the vocalisations on separate unipolar scales of happiness and sadness and on arousal. Although they were instructed to focus exclusively on the vocalisations, consistent context effects were found: For both laughter and crying, emotion judgements were shifted towards the information expressed by the face. These modulations were independent of response latencies and were larger for more emotionally ambiguous vocalisations. No effects of context were found for arousal ratings. These findings suggest that the automatic encoding of contextual information during emotion perception generalises across modalities, to purely non-verbal vocalisations, and is not confined to acted expressions.

A Q-methodology study of parental understandings of infant immunisation: Implications for health-care advice.

This study used Q-methodology to explore systematically parental judgements about infant immunisation. A total of 45 parents completed a 31-statement Q-sort. Data were collected after vaccination in general practitioner practices or a private day nursery. Q factor analysis revealed four distinct viewpoints: a duty to immunise based on medical benefits, child-orientated protection based on parental belief, concern and distress and surprise at non-compliance. Additionally, there was a common view among parents that they did not regret immunising their children. Implications of these results are discussed in terms of health-care policy and future research.

The role of glial cells and the complement system in retinal diseases and Alzheimer's disease: common neural degeneration mechanisms.

Many age-related degenerative diseases of the central nervous system (CNS) increasingly appear to have similarities in their underlying causes. By applying knowledge between disorders, and in particular between degenerative diseases of different components of the CNS (e.g. the eye and the brain), we can begin to elucidate general mechanisms of neural degeneration. Age-related macular degeneration and glaucoma, two diseases of retinal neurons, which have recently been discussed in view of their common mechanisms with Alzheimer's disease, highlight this perspective. This review discusses the common roles of the complement system (an immunological system) and glial cells (providing, amongst other functions, trophic support to neurons) in these three disorders. A number of facets of these systems would seem to be involved in the mechanisms of degeneration in at least two of the three diseases considered here. Regulatory proteins of the complement system (such as factor H), neurotrophin levels, and the interaction of microglia with the complement system in particular may be general to all three presentations of neural degeneration. Investigating the functioning of these fundamental systems across different diseases exemplifies the importance of considering advances in knowledge across a wider base than specific disease pathology. This may give insights both for understanding the function of these supporting systems and providing an avenue for developing future therapeutic targets general to neural degenerative diseases.

Reading with peripheral vision: a comparison of reading dynamic scrolling and static text with a simulated central scotoma.

Horizontally scrolling text is, in theory, ideally suited to enhance viewing strategies recommended to improve reading performance under conditions of central vision loss such as macular disease, although it is largely unproven in this regard. This study investigated if the use of scrolling text produced an observable improvement in reading performed under conditions of eccentric viewing in an artificial scotoma paradigm. Participants (n=17) read scrolling and static text with a central artificial scotoma controlled by an eye-tracker. There was an improvement in measures of reading accuracy, and adherence to eccentric viewing strategies with scrolling, compared to static, text. These findings illustrate the potential benefits of scrolling text as a potential reading aid for those with central vision loss.