Advanced clinicians' experience of participation in an escape room scenario designed to consolidate crisis resource management principles: An exploratory pilot study.

BACKGROUND: Intensive care outreach nurses are required to work as part of an ad hoc team to review and manage patients who are deteriorating outside of critical care environments. Nontechnical skills, such as those encompassed by crisis resource management principles, are essential when working in these situations. Used commercially for entertainment, escape rooms have recently been utilised by clinical educators to teach both technical and nontechnical skills. OBJECTIVE: This exploratory study evaluates how advanced clinicians, intensive care outreach nurses, experience an escape room scenario designed to consolidate crisis resource management (CRM) principles. METHODS: Three escape room sessions were conducted in a 1038-bed metropolitan tertiary referral hospital. A purposive sample of 12 intensive care outreach nurses were invited to participate. The participant's experience of the escape room scenario was determined by their responses to a post-escape room survey and focus group discussion. Transcripts of the audio recordings from focus group discussions were analysed using an inductive coding approach. RESULTS: Two primary categories emerged from analysis of the focus group discussions: (i) the clinicians' experiences of the escape room and (ii) CRM principles. The first category included descriptions of emotions, including confusion, frustration, and a dislike for puzzles. The second category included both the participants understanding of the CRM principles, and how the principles influence the work within the escape room. CONCLUSIONS: Escape rooms have shown promise as novel educational environments, which challenge participants. Despite initial negative descriptions of the escape room, focus group discussions demonstrated that the participants were able to recognise the impact of CRM principles and acknowledge how these affect their clinical work in an ad hoc team.

Oxidative phosphorylation K0.5ADP in vitro depends on substrate oxidative capacity: Insights from a luciferase-based assay to evaluate ADP kinetic parameters.

The K0.5ADP of oxidative phosphorylation (OxPhos) identifies the cytosolic ADP concentration which elicits one-half the maximum OxPhos rate. This kinetic parameter is commonly measured to assess mitochondrial metabolic control sensitivity. Here we describe a luciferase-based assay to evaluate the ADP kinetic parameters of mitochondrial ATP production from OxPhos, adenylate kinase (AK), and creatine kinase (CK). The high sensitivity, reproducibility, and throughput of the microplate-based assay enabled a comprehensive kinetic assessment of all three pathways in mitochondria isolated from mouse liver, kidney, heart, and skeletal muscle. Carboxyatractyloside titrations were also performed with the assay to estimate the flux control strength of the adenine nucleotide translocase (ANT) over OxPhos in human skeletal muscle mitochondria. ANT flux control coefficients were 0.91 ± 0.07, 0.83 ± 0.06, and 0.51 ± 0.07 at ADP concentrations of 6.25, 12.5, and 25 µM, respectively, an [ADP] range which spanned the K0.5ADP. The oxidative capacity of substrate combinations added to drive OxPhos was found to dramatically influence ADP kinetics in mitochondria from several tissues. In mouse skeletal muscle ten different substrate combinations elicited a 7-fold range of OxPhos Vmax, which correlated positively (R2 = 0.963) with K0.5ADP values ranging from 2.3 ± 0.2 µM to 11.9 ± 0.6 µM. We propose that substrate-enhanced capacity to generate the protonmotive force increases the OxPhos K0.5ADP because flux control at ANT increases, thus K0.5ADP rises toward the dissociation constant, KdADP, of ADP-ANT binding. The findings are discussed in the context of top-down metabolic control analysis.

Quantifying the benefits of peer support for people with dementia: A Social Return on Investment (SROI) study.

Objective Peer support for people with dementia and carers is routinely advocated in national strategies and policy as a post-diagnostic intervention. However there is limited evidence to demonstrate the value these groups offer. This study looked at three dementia peer support groups in South London to evaluate what outcomes they produce and how much social value they create in relation to the cost of investment. Methods A Social Return on Investment (SROI) analysis was undertaken, which involves collecting data on the inputs, outputs and outcomes of an intervention, which are put into a formula, the end result being a SROI ratio showing how much social value is created per £1 of investment. Results Findings showed the three groups created social value ranging from £1.17 to £5.18 for every pound (£) of investment, dependent on the design and structure of the group. Key outcomes for people with dementia were mental stimulation and a reduction in loneliness and isolation. Carers reported a reduction in stress and burden of care. Volunteers cited an increased knowledge of dementia. Conclusions This study has shown that peer groups for people with dementia produce a social value greater than the cost of investment which provides encouraging evidence for those looking to commission, invest, set up or evaluate peer support groups for people with dementia and carers. Beyond the SROI ratio, this study has shown these groups create beneficial outcomes not only for the group members but also more widely for their carers and the group volunteers.

Voice training and changing weight--are they reflected in speaking fundamental frequency, voice range, and pitch breaks of 13-year-old girls? A longitudinal study.

OBJECTIVE: Assessment of the voice-change progress of 20 girls (12-13 years) over 1 year by observing changes in speaking fundamental frequency (SFo), voice range, and register pitch breaks in the context of weight, height, voice training, and self-perception. STUDY DESIGN: One-year longitudinal collective case study. METHOD: Twenty girls were recorded at the beginning and end of a year; nine girls were recorded another three times. SFo, vocal range, and characteristics were analyzed and interactions between these data assessed against weight and height to indicate pubertal development, and to test the hypothesis that changes in weight, height, SFo, and pitch breaks were related. Effects of training and the girls' self-perception of their voice use were also assessed. RESULTS: Vocal characteristics changed as the girls passed through different weight ranges. During 47.5-52.4 kg (called band 2) and 52.4-57.5 kg (band 3), there was progressive contraction of vocal range and in some girls a slight rise in SFo between recording times 1 and 5. Both high- and low-pitch breaks were present in 45% of girls' voices. Girls in band 4 (<57.5 kg) had an increased vocal range, and pitch breaks in vocal-range areas that indicated the development of adult vocal registers. In this study, voice-trained girls were heavier, had higher SFo, used wider speech-range inflection, had a higher vocal range, and greater voice-use confidence; all girls lost confidence in their voice use over the year. CONCLUSIONS: In this longitudinal study of twenty 13-year-old girls, voice changes in SFo, vocal range, and pitch-break frequency were synchronous with certain weight ranges. Girls with training registered higher maximum phonational frequency and were more confident in their voice use than girls without training.

A scoping review of the knowledge base in WORK that addresses work related outcomes for individuals with chronic pain.

OBJECTIVE: Chronic pain such as arthritis has a significant impact on occupational performance in the workplace that contributes to decreased productivity, reduced rates of employment, personal and societal economic costs. In commemoration of the 20th anniversary of WORK, a scoping review was conducted to understand the knowledge base on chronic pain. The purpose of this was to examine and describe WORK's contribution to the literature relevant for rehabilitation professionals such as occupational therapists to improve work related outcomes for persons experiencing chronic pain. METHOD: The method employed the use of historical, citation and dimension analyses of assessment and intervention articles. RESULTS: Of the 30 articles identified in WORK, the historical analysis of their scope indicated an international representation of authors and a greater emphasis on quantitative study designs. The citation analysis revealed that the articles in WORK drew heavily on medical literature to inform their studies. The dimensional analysis of the assessment and intervention articles applied an occupational lens of self-care, productivity and leisure, to draw upon the Occupational Competence Model and identified that the majority of papers focused on 2 or more dimensions of the person, environment and occupation. CONCLUSIONS: WORK has contributed to the knowledge base of assessment and intervention approaches that inform work rehabilitation strategies for individuals with chronic pain. To advance its knowledge base for the rehabilitation and management of chronic pain, WORK is encouraged to include more prevention and multidimensional interventions articles, as well as articles that contain multidimensional assessment tools that address both clinical and outcome assessments of chronic pain. Additionally internal dialogue should be encouraged within WORK so that new authors build on previous submissions and increase the impact and quality of research on chronic pain as it pertains to work.

Medical responses to civil war and revolution in Spain, 1936-1939: international aid and local self-organization.

The traditional view that war is 'good' for medicine has been challenged by some historians in recent decades. In the case of the Spanish Civil War, 1936-1939, a number of advances in wound treatment, emergency surgery and other areas reputedly occurred, and were important in shaping the medical response to more extended warfare in 1939-1945. At the same time, there was a significant attempt at humanitarian intervention, aiming to provide medical aid and health care for the war's casualties and refugees, in parallel with local transformations in health provision. Political differences within as well as between the contending forces complicated matters. These developments are examined with a view to assessing their implications in the contemporary international context.

Relationship between weight, speaking fundamental frequency, and the appearance of phonational gaps in the adolescent male changing voice.

This 12-month prospective longitudinal study used acoustic analysis to identify phonational gaps in the vocal range of adolescent boys undergoing voice change and to investigate the relationship between the appearance of phonational gaps, weight gain, and changes in speaking fundamental frequency (SF0). Eighteen pubescent boys were recorded producing three descending and three ascending glides over their physiological voice range using the vowel "ah." Recordings were digitized over the range 0-16 kHz and then analyzed to determine both the frequency range and appearance and frequency characteristics of the phonational gaps. Data were plotted against changes in weight and SF0 both as an indicator of pubertal development and to test the hypothesis that changes in weight and SF0 were related to the appearance of phonational gaps. Results indicated that minimum F0 decreased significantly over the time period and phonational gaps increased significantly, but there were no significant changes in maximum F0 or range. Individual data indicated the initial appearance of a lower-frequency gap followed by a higher-frequency gap before the long-term establishment of a midrange gap. At time 5, all boys in the weight range 42.7-44.9 kg had either low- or high-range gaps. The SF0 for this group varied from 117 to 216 Hz. All boys heavier than 54.8 kg had highly variable phonational gaps. SF0 range for this group was 99.5-151 Hz. Transitory low- then high-frequency phonational gaps appeared before the establishment of a midrange phonational gap. In this study, these phonational gaps were associated with certain weight ranges and rapid weight gain, with changes to boys' speaking voices, and with loss of ability to use the mid- and falsetto vocal range.

Carbocation-forming reactions in ionic liquids.

A number of trifluoroacetates, mesylates, and triflates have been studied in ionic liquids. Several lines of evidence indicate that all of these substrates react via ionization to give carbocationic intermediates. For example, cumyl trifluoroacetates give mainly the elimination products, but the Hammett rho+ value of -3.74 is consistent with a carbocationic process. The analogous exo-2-phenyl-endo-3-deutero-endo-bicyclo[2.2.1]hept-2-yl trifluoroacetate gives an elimination where loss of the exo-hydrogen occurs from a cationic intermediate. 1-Adamantyl mesylate and 2-adamantyl triflate react to give simple substitution products derived from capture of 1- and 2-adamantyl carbocations by the residual water in the ionic liquid. The triflate derivative of pivaloin, trans-2-phenylcyclopropylcarbinyl mesylate, 2,2-dimethoxycyclobutyl triflate, the mesylate derivative of diethyl (phenylhydroxymethyl)-thiophosphonate, and Z-1-phenyl-5-trimethylsilyl-3-penten-1-yl trifluoroacetate all give products derived carbocation rearrangements (kDelta processes). anti-7-Norbornenyl mesylate gives products with complete retention of configuration, indicative of involvement of the delocalized 7-norbornenyl cation. 1,6-Methano[10]annulen-11-yl triflate reacts in [BMIM][NTf2] to give 1,6-methano[10]annulen-11-ol, along with naphthalene, an oxidized product derived from loss of trifluoromethanesulfinate ion. Analogous loss of CF3SO2- can be seen in reaction of PhCH(CF3)OTf. Ionic liquids are therefore viable solvents for formation of carbocationic intermediates via kC and kDelta processes.

Conference round-up 2003: historians and war.

Although the days when historians could be content to describe war largely in terms of battles 'won' or 'lost' (and medical historians to repeat the maxim that 'war is good for medicine') have long gone, the topic remains a favourite for authors and researchers. The 2003 conference season brought a rich crop of events, selectively reviewed here, with war either as the overall theme or as the subject of panel sessions and individual papers, approaching it from an impressive variety of different angles and analysing it in thoughtful and thought-provoking ways.

Contamination and compensation: Gruinard as a 'menace to the mainland'.

The decades-long contamination of Gruinard Island by anthrax is now a well-known part of the history of biological weapons (BW) development, as well as that of military encroachments in the Scottish Highlands and Islands (and the authorities' rather less persistent efforts at damage limitation). Some accounts have included the related episode, reportedly well-remembered by local people, of anthrax contamination on the mainland close to Gruinard. This occurred in 1942--43, when BW experiments were conducted on the island as part of the war effort by scientists from Porton Down under the auspices of the British government. After much top-level discussion, payments were made to the owners of animals that had died as a result of the contamination. The episode had a bearing on discussions about the future of the island and on subsequent policy with regard to the siting, conduct and secrecy of BW experiments.

Seascape with monkeys and guinea-pigs: Britain's biological weapons research programme, 1948-54.

The British biological weapons (BW) research programme based at Porton Down continued after the Second World War. Five series of BW experiments with animals at sea were undertaken to supplement laboratory work. The causative organisms for plague, brucellosis, tularemia and later Venezuelan equine encephalomyelitis and Vaccinia viruses were tested in the Caribbean near Antigua in the late 1940s, in Hebridean waters (north-west Scotland) in the early 1950s and off Nassau in the Bahamas in 1953-54. In September 1952, at the end of Operation 'Cauldron' off the Isle of Lewis, a trawler, the Carella, passed through the danger area when a toxic cloud had been released and was covertly watched until the incubation period had passed in case those on board had come into contact with the plague bacillus. Publicity about the trials was avoided, but a press statement was issued in March 1954. The last series provoked sustained agitation in Cuba. More recently an outline of the sequence has emerged in the UK parliamentary record and in Porton's official history, and a fuller account of the Scottish trials has awakened some interest locally.