Inter-Unit Consistency and Validity of 10-Hz GNSS Units in Straight-Line Sprint Running.

The present study aimed to investigate the inter-unit consistency and validity of multiple 10-Hz Catapult Global Navigation Satellite System (GNSS) units in measuring straight-line sprint distances and speeds. A total of 13 participants performed one 45.72-m linear sprint at maximum effort while wearing all eight GNSS units at once. Total run distance and peak speed recorded using GNSS units during the sprint duration were extracted for analysis. Sprint time and peak speed were also obtained from video recordings as reference values. Inter-unit consistency was assessed using intraclass correlation coefficients (ICC) and standard errors of measurements (SEM). For a validity test, one-sample t-tests were performed to compare each GNSS unit's distance with the known distance. Additionally, Wilcoxon signed-rank tests were performed to compare each unit's peak speed with the reference peak speed measured using video analysis. Results showed poor inter-unit consistency for both distance (ICC = 0.131; SEM = 8.8 m) and speed (ICC = 0.323; SEM 1.3 m/s) measurements. For validity, most units recorded a total distance (44.50 m to 52.69 m) greater than the known distance of 45.72 m and a lower peak speed (7.25 (0.51) m/s) than the video-based reference values (7.78 (0.90) m/s). The present findings demonstrate that there exist variations in distance and speed measurements among different units of the same GNSS system during straight-line sprint running. Practitioners should be aware of the window of errors associated with GNSS measurements and interpret the results with caution. When making comparisons over a season, players should wear the same unit every time if logistically possible.

Rural emergency care facilities may be adapting to their context: A population-level study of resources and workforce.

OBJECTIVE: To provide a structured understanding of rural hospital-based emergency care facility workforce and resources. DESIGN: The resources of regional training hubs were used to survey eligible emergency care facilities in their surrounding region. SETTING: Rural emergency care facilities manage more than one third of Australia's emergency presentations. These emergency care facilities include emergency departments and less-resourced facilities in smaller towns. PARTICIPANTS: Hospital facilities located outside metropolitan areas that report emergency presentations to the Australian Institute of Health and Welfare. INTERVENTIONS: A survey tool was sent by email. MAIN OUTCOME MEASURES: Presence of human, diagnostic and other resources as reported on a questionnaire. RESULTS: A completed questionnaire was received from 195 emergency care facilities. Over 60% of Small hospitals had on-call doctors only. General practitioners/generalists and nurses with extended emergency skills were found in all hospital types. Emergency physicians were present across all remoteness areas, but more commonly seen in larger facilities. All Major/Large facilities and most Medium facilities reported having onsite pathology and radiology. Point of care testing and clinician radiography were more commonly reported in smaller facilities. Among Small hospitals, Very Remote hospitals were more likely than Inner Regional hospitals to have an onsite doctor in the emergency care facility and/or a high dependency unit. CONCLUSION: Smaller and more remote facilities appear to adapt by using different workforce structures and bedside investigations.

Wearable Technologies in Field Hockey Competitions: A Scoping Review.

The aim of this review is to investigate the common wearable devices currently used in field hockey competitions, and to understand the hockey-specific parameters these devices measure. A systematic search was conducted by using three electronic databases and search terms that included field hockey, wearables, accelerometers, inertial sensors, global positioning system (GPS), heart rate monitors, load, performance analysis, player activity profiles, and competitions from the earliest record. The review included 39 studies that used wearable devices during competitions. GPS units were found to be the most common wearable in elite field hockey competitions, followed by heart rate monitors. Wearables in field hockey are mostly used to measure player activity profiles and physiological demands. Inconsistencies in sampling rates and performance bands make comparisons between studies challenging. Nonetheless, this review demonstrated that wearable devices are being used for various applications in field hockey. Researchers, engineers, coaches, and sport scientists can consider using GPS units of higher sampling rates, as well as including additional variables such as skin temperatures and injury associations, to provide a more thorough evaluation of players' physical and physiological performances. Future work should include goalkeepers and non-elite players who are less studied in the current literature.

Airway Pressure Release Ventilation in Adult Patients With Acute Hypoxemic Respiratory Failure: A Systematic Review and Meta-Analysis.

OBJECTIVES: To evaluate the efficacy and safety of airway pressure release ventilation in critically ill adults with acute hypoxemic respiratory failure. DATA SOURCES: A systematic literature search of MEDLINE via PUBMED, EMBASE, the Cochrane Library, published conference proceedings and abstracts, reference lists of eligible studies and review articles, and hand searches of relevant journals and trial registers. STUDY SELECTION: Eligible studies included randomized controlled trials published between years 2000 and 2018, comparing airway pressure release ventilation to any ventilation mode, in critically ill adults with acute hypoxemic respiratory failure and reporting at least one mortality outcome. DATA EXTRACTION: Screened citations were reviewed and extracted independently by two investigators onto a prespecified proforma. DATA SYNTHESIS: There were 412 patients from seven randomized controlled trials included in the qualitative and quantitative data synthesis. Airway pressure release ventilation was associated with a significant mortality benefit (relative risk, 0.67; 95% CI, 0.48-0.94; I < 0.1%; p = 0.97) and improvement in day 3 PaO2/FIO2 ratio (weighted mean difference, 60.4; 95% CI, 10.3-110.5). There was no significant difference in requirement to initiate rescue treatments including inhaled pulmonary vasodilators, prone positioning, or extracorporeal membrane oxygenation (relative risk, 0.51; 95% CI, 0.22-1.21; I = 64.7%; p = 0.04). The risk of barotrauma was only reported in three studies and did not differ between groups (relative risk, 0.39; 95% CI, 0.12-1.19; I < 0.1%; p = 0.99). CONCLUSIONS: In adult patients requiring mechanical ventilation for acute hypoxic respiratory failure, airway pressure release ventilation is associated with a mortality benefit and improved oxygenation when compared with conventional ventilation strategies. Given the limited number of patients enrolled in the available studies, larger multicenter studies are required to validate these findings.

Iron Metabolism: An Emerging Therapeutic Target in Critical Illness.

This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2019. Other selected articles can be found online at https://www.biomedcentral.com/collections/annualupdate2019 . Further information about the Annual Update in Intensive Care and Emergency Medicine is available from http://www.springer.com/series/8901 .

Casemix and performance of Australian emergency departments: A comparison of major city, regional and remote locations.

OBJECTIVE: EDs are an essential service, and higher rates of presentations per population are seen in regional and remote areas compared to major cities. Australia-wide differences in utilisation and performance remain largely unknown. METHODS: This was a descriptive, retrospective epidemiological study analysing data collected via the National Non-Admitted Patient Emergency Department Care Database managed by the Australian Institute of Health and Welfare. Data from all reporting public hospitals in Australia for the period between 1 July 2018 and 30 June 2019 were analysed. Reporting EDs were geographically categorised using the 2016 Australian Statistical Geography Standard - Remoteness Area. RESULTS: ED presentations for the 293 reporting EDs were 8 352 192 (median 17 904, range 8-113 929), one-third (33.09%, 95% CI 33.06-33.12) were outside major cities. Remote ED presentations were less likely to arrive by ambulance (12.13% [12.01-12.26]; major cites 28.07% [28.03-28.10]; regional 22.55% [22.50-22.60]) but more likely by police/correctional services vehicle (major cities 0.59% [0.58-0.60]; regional 0.71% [0.70-0.72]; remote 1.71% [1.66-1.76]). Presentations to remote EDs were more likely to leave without being attended by a health professional (5.29% [5.21-5.38]; major cities 3.93% [3.92-3.95]; regional 3.53% [3.51-3.55]). A larger proportion of admitted patients stayed at least 8 h in remote (21.83% [21.46-22.20]) and regional (21.52% [21.41-21.62]) EDs compared to major cities (19.82% [19.76-19.88]). CONCLUSIONS: Our study highlights ED utilisation, casemix and performance by location. The differences observed, especially areas of inequity and need for interventions, reiterate that imperative regional and remote EDs are appropriately resourced to support the communities they serve.

Characteristics of Aboriginal and Torres Strait Islander peoples attending Australian emergency departments.

OBJECTIVE: Aboriginal and Torres Strait Islander patients are overrepresented in Australian EDs. The present study aimed to assess their characteristics in utilising ED services at a national level. METHODS: This exploratory, quantitative study used 2016-2017 de-identified data from the National Non-admitted Patient Emergency Department Care Database to assess the proportions (with 95% confidence interval) of Indigenous and non-Indigenous Australians across various aspects of ED presentations, including mode of arrival, triage scale, diagnosis information, episode end status and ED length of stay. Episode level ED data were compared by Indigenous status and geographical remoteness of EDs. RESULTS: Of 7.4 million presentations, 6.58% were Indigenous presentations, with over two-thirds occurring in regional and remote EDs. Indigenous patients were more likely than non-Indigenous patients to arrive to EDs by ambulance and police/correctional services vehicle across all remoteness areas. Additionally, they were more likely to present with respiratory system illness, illness of the skin/subcutaneous tissue/breast and mental/behavioural disorders. Indigenous Australians were more likely to leave EDs before being seen or care complete (odds ratio 1.73, 95% confidence interval 1.71-1.74), and this was observed for patients classified across all levels of triage scale. CONCLUSIONS: This is the first national study looking at the characteristics of and reasons for presenting to Australian EDs for Indigenous and non-Indigenous patients. Our findings provide important insight into the potential factors affecting Indigenous patient care, and an impetus for ongoing research and advocacy work to improve the quality of emergency care provided to Indigenous Australians.

Air pistol shooting: upper limb muscle activation between training and simulated competition.

Heightened stress during air pistol competitions may impair shooters' abilities to maintain gun stability, resulting in inferior performance. This study aimed to compare the pre-trigger muscle activation levels of upper muscles in 10-m air pistol shooters between training and simulated competition conditions. Seven sub-elite shooters from the Singapore National Youth Air Pistol Team shot 30 shots in a training versus simulated competition condition in randomised orders on separate days. Muscle activation for the forearm and shoulder muscles, namely extensor carpi radialis, flexor carpi ulnaris, anterior deltoid, and posterior deltoid, were recorded using electromyography (EMG). Shooting performance was evaluated by total shot scores. Stress level was monitored via heart rate and the Mental Readiness Form-3. No statistically significant differences were found in EMG, performance, or stress-related variables between conditions, although moderate-to-large effect sizes were observed in some muscle activation and self-reported stress indicators. Analysis of individual performances using smallest worthwhile change showed that two participants improved under the simulated competition condition, while two declined, and three remained unaffected. In conclusion, sub-elite youth air pistol shooters were able to exhibit good neuromuscular control under high anxiety situations and thus their performance was largely unaffected.

Where are children seen in Australian emergency departments? Implications for research efforts.

OBJECTIVE: With most paediatric emergency research in Australia conducted at tertiary EDs, it is important to understand how presentations differ between those at tertiary paediatric EDs and all other EDs. METHODS: Retrospective epidemiological study assessing paediatric case-mix and time-based performance metrics (aged 0-14 years) obtained from a national health service minimum dataset for the 2017-2018 financial year, comparing tertiary paediatric EDs and all other EDs. We defined a 'major tertiary paediatric hospital' as one which was accredited for training in both paediatric emergency medicine and paediatric intensive care. RESULTS: Of the 1 695 854 paediatric ED presentations, 23.8% were seen in nine major metropolitan tertiary paediatric hospitals. Reasons for presentations were more distinctive between cohorts among children aged 10-14 years, where psychiatric illness (5.2% vs 2.5%) and neurological illness (4.5% vs 2.5%) were more commonly seen in major tertiary paediatric EDs. Australian Indigenous children were significantly less likely to present to tertiary paediatric EDs (3.0%), compared with other EDs (9.7%) (odds ratio 0.27, 95% confidence interval 0.26-0.27). While median waiting times were longer in major tertiary paediatric EDs (28 min [interquartile range 11-65]) than in other EDs (20 min [interquartile range 8-48], P < 0.001), patients were also less likely to leave without being seen (5.5% in tertiary paediatric EDs vs 6.9% in other EDs; odds ratio 0.80, 95% confidence interval 0.78-0.81). CONCLUSIONS: The present study identified key areas of difference in paediatric presentations between tertiary paediatric EDs and other EDs. It is vital to broaden paediatric ED research beyond tertiary paediatric centres, to ensure relevance and generalisability.

Early and sustained Lactobacillus plantarum probiotic therapy in critical illness: the randomised, placebo-controlled, restoration of gut microflora in critical illness trial (ROCIT).

PURPOSE: In adults requiring treatment in an intensive care unit, probiotic therapy using Lactobacillus plantarum 299v may reduce nosocomial infection. The aim of this study was to determine whether early and sustained L. plantarum 299v therapy administered to adult ICU patients increased days alive and at home. METHODS: A multicentre, parallel group, placebo-controlled, randomised clinical trial was conducted. Adult patients within 48 h of intensive care admission and expected to require intensive care beyond the day after recruitment were eligible to participate. L plantarum 299v or placebo were administered immediately after enrolment and continued for 60 days. The primary outcome was days alive and out of hospital to Day 60 (DAOH60). Secondary outcomes included nosocomial infections. RESULTS: The median [interquartile range (IQR)] number of DAOH60 in the probiotic (n = 110) and placebo group (n = 108) was 49.5 (IQR 37.0-53.0) and 49.0 (IQR 43.8-53.0) respectively, between-group difference of 0.0 [95% confidence interval (CI) - 6.10 to 7.1, P = 0.55]. Nosocomial infection occurred in 8 (7.3%) and 5 (4.6%) of the probiotic and placebo group participants, respectively, odds ratio 1.62 (95% CI 0.51-5.10), P = 0.57. There were no serious, or probiotic-associated adverse events. CONCLUSION: Early and sustained untargeted administration of probiotic therapy with Lactobacillus plantarum 299v to adult patients admitted to the ICU is safe, but not associated with improved patient outcomes.

Study protocol for the safety and efficacy of probiotic therapy on days alive and out of hospital in adult ICU patients: the multicentre, randomised, placebo-controlled Restoration Of gut microflora in Critical Illness Trial (ROCIT).

INTRODUCTION: The effect of early and sustained administration of daily probiotic therapy on patients admitted to the intensive care unit (ICU) remains uncertain. METHODS AND ANALYSIS: The Restoration Of gut microflora in Critical Illness Trial (ROCIT) study is a multicentre, randomised, placebo-controlled, parallel-group, two-sided superiority trial that will enrol 220 patients in five ICUs. Adult patients who are within 48 hours of admission to an ICU and are expected to require intensive care beyond the next calendar day will be randomised in a 1:1 ratio to receive early and sustained Lactobacillus plantarum 299v probiotic therapy in addition to usual care or placebo in addition to usual care. The primary endpoint is days alive and out of hospital to day 60. ETHICS AND DISSEMINATION: ROCIT has been approved by the South Metropolitan Health Service Human Research Ethics Committee (ref: RGS00000004) and the St John of God Health Care Human Research Ethics Committee (ref: 1183). The trial results will be submitted for publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER: Australian and New Zealand Clinical Trials Registry (ANZCTR12617000783325); Pre-results.

New Fellows Early Career Survey 2014-2017: Shift of trends in emergency medicine workforce.

OBJECTIVE: Within the complex and dynamic emergency medicine workforce setting, the Australasian College for Emergency Medicine (ACEM) New Fellows (FACEMs) Early Career Survey was established in 2014 to capture information on the work profiles, future career plans and challenges experienced among new FACEMs. METHODS: The voluntary online survey is distributed twice yearly to new FACEMs who gained their Fellowship the preceding 6-12 months. Eligible new FACEMs were contacted by email and invited to participate. RESULTS: A representative sample of 348 (53%) of 660 eligible new FACEMs responded to the survey from 2014 to 2017. New Fellows in the 2017 cohort were less likely to have secured a specialist position at attainment of Fellowship or 6-12 months later. Compared with new FACEMs in earlier cohorts, they were significantly more likely to be working in regional areas, across multiple workplaces and in more than one area of clinical/professional practice. The proportion of new FACEMs working part-time or in casual positions (42%) remained reasonably consistent across the 4 years. Finding a specialist position and securing a permanent position were among the main challenges experienced by new FACEMs after attaining their Fellowship. CONCLUSION: A shift in the employment profile of early career Fellows was observed between 2014 and 2017, with the potential push factor of limited specialist positions in metropolitan areas now starting to result in an increase in new FACEMs choosing to work in regional and rural areas and in the number working across multiple workplaces.

Characteristics and outcomes of patients treated with airway pressure release ventilation for acute respiratory distress syndrome: A retrospective observational study.

BACKGROUND: The optimal mode of ventilation in acute respiratory distress syndrome (ARDS) remains uncertain. Airway pressure release ventilation (APRV) is a recognized treatment for mechanically-ventilated patients with severe hypoxaemia. However, contemporary data on its role as a rescue modality in ARDS is lacking. The goal of this study was to describe the clinical and physiological effects of APRV in patients with established ARDS. METHODS: This retrospective observational study was performed in a 23-bed adult intensive care unit in a tertiary extracorporeal membrane oxygenation (ECMO) referral centre. Patients with ARDS based on Berlin criteria were included through a prospectively-collected APRV database. Patients receiving APRV for less than six hours were excluded. RESULTS: Fifty patients fulfilled the eligibility criteria. Prior to APRV initiation, median Murray Lung Injury Score was 3.5 (interquartile range (IQR) 2.5-3.9) and PaO2/FiO2 was 99mmHg (IQR 73-137). PaO2/FiO2 significantly improved within twenty-four hours post-APRV initiation (ANOVA F(1, 27)=24.34, P<.005). Two patients (4%) required intercostal catheter insertion for barotrauma. Only one patient (2%) required ECMO after APRV initiation, despite a majority (68%) fulfilling previously established criteria for ECMO at baseline. Hospital mortality rate was 38%. CONCLUSIONS: In patients with ARDS-related refractory hypoxaemia treated with APRV, an early and sustained improvement in oxygenation, low incidence of clinically significant barotrauma and progression to ECMO was observed. The safety and efficacy of APRV requires further consideration.

Is the length of time in acute burn surgery associated with poorer outcomes?

BACKGROUND: Acute wound closure surgery improves outcomes, after burn particularly mortality, but also imposes physiological stress on the patient. The duration of surgery is associated with adverse outcomes in other populations. This study aimed to examine if extended acute burn surgery duration was associated with poorer in-hospital outcomes. METHODS: This retrospective cohort study included adult burn patients who required a single wound closure surgery at Royal Perth Hospital between 2004 and 2011. Multivariable regression analyses were used to assess the influence of patient and injury factors on surgery duration and length of stay (LOS). RESULTS: Surgery duration independently increased LOS (incidence rate ratio [IRR]=1.004, p<0.001). This translates to a predicted 13% increase in LOS for a 30min increase in surgery 'knife to skin' time. Total body surface area (TBSA) was identified as a significant predictor of surgery duration (IRR=1.047, p<0.001), estimating that a 10% TBSA increase results in a 59% increase in surgery duration. CONCLUSION: The results show that surgery duration is associated with LOS after adjusting for size of burn and other factors. The study justifies the need to explore strategies to reduce acute burn surgery duration.