Does participation in the European Trauma Course lead to new behaviours and organisational change? A Portuguese experience.

Background: Medical educational courses can be successful from an immediate feedback perspective but not lead to new behaviour or organisational changes in the workplace. The aim of this study was to assess the self-perceived impact of the European Trauma Course (ETC) on Reanima trainees' behaviour and organisational change.

Methods: A 40-item questionnaire based on Holton's evaluation model was used to evaluate the candidate's perceptions.

Laparoscopic Lumen-guided cholecystectomy in face of the difficult gallbladder.

Background: Where the critical view of safety cannot be established during cholecystectomy, certain salvage techniques are indicated to reduce the likelihood of bile duct injury. The present study describes a salvage technique termed the "laparoscopic lumen-guided cholecystectomy" (LLC) and reports its peri-operative outcomes.

Method: A summary of the technique is as follows: (1) Hartmann's pouch is incised and stones are evacuated; (2) the cystic anatomy is inspected from the inside of the gallbladder; (3) the lumen is used to guide retrograde dissection towards the cystic pedicle; (4) cystic duct control is achieved if deemed safe.

Thermal conductivity of Fe-Si alloys and thermal stratification in Earth's core.

Light elements in Earth's core play a key role in driving convection and influencing geodynamics, both of which are crucial to the geodynamo. However, the thermal transport properties of iron alloys at high-pressure and -temperature conditions remain uncertain. Here we investigate the transport properties of solid hexagonal close-packed and liquid Fe-Si alloys with 4.

Neurobehavioral and neurodevelopmental profiles of a heuristic genetic model of differential schizophrenia- and addiction-relevant features: The RHA vs. RLA rats.

The Roman High- (RHA) and Low-(RLA) avoidance rat lines/strains were generated through bidirectional selective breeding for rapid (RHA) vs. extremely poor (RLA) two-way active avoidance acquisition. Compared with RLAs and other rat strains/stocks, RHAs are characterized by increased impulsivity, deficits in social behavior, novelty-induced hyper-locomotion, impaired attentional/cognitive abilities, vulnerability to psychostimulant sensitization and drug addiction.

Melting and density of MgSiO determined by shock compression of bridgmanite to 1254GPa.

The essential data for interior and thermal evolution models of the Earth and super-Earths are the density and melting of mantle silicate under extreme conditions. Here, we report an unprecedently high melting temperature of MgSiO at 500 GPa by direct shockwave loading of pre-synthesized dense MgSiO (bridgmanite) using the Z Pulsed Power Facility. We also present the first high-precision density data of crystalline MgSiO to 422 GPa and 7200 K and of silicate melt to 1254 GPa.

The Habitability of Proxima Centauri b: Environmental States and Observational Discriminants.

Proxima Centauri b provides an unprecedented opportunity to understand the evolution and nature of terrestrial planets orbiting M dwarfs. Although Proxima Cen b orbits within its star's habitable zone, multiple plausible evolutionary paths could have generated different environments that may or may not be habitable. Here, we use 1-D coupled climate-photochemical models to generate self-consistent atmospheres for several evolutionary scenarios, including high-O, high-CO, and more Earth-like atmospheres, with both oxic and anoxic compositions.

The definite risks and questionable benefits of liberal pre-hospital spinal immobilisation.

Introduction: The routine practice of pre-hospital spinal immobilisation (phSI) for patients with suspected spinal injury has existed for decades. However, the controversy surrounding it resulted in the 2013 publication of a Consensus document by the Faculty of Pre-Hospital Care. The question remains as to whether the quality of evidence in the literature is sufficient to support the Consensus guidelines.

A practical approach to Events Medicine provision.

In the past three decades, mass casualty incidents have occurred worldwide at multiple sporting events and other mass gatherings. Organisational safety and healthcare provision can consequently be scrutinised post-event. Within the UK, such incidents in the 1980s provided incentives to improve medical services and subsequent high profile UK-based international sporting events (London Olympics and Paralympics 2012, Glasgow Commonwealth Games 2014, Rugby World Cup 2015) added a further catalyst for developing services.

Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. BET 1: Brachial arterial blood sampling: safe or not?

A shortcut review was carried out to establish whether brachial artery puncture is safe in patients requiring arterial blood sampling. 47 papers were found using the reported searches, of which one presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of this paper are tabulated.

Surgical management of emergency and elective giant paraesophageal hiatus hernias.

Background: Uncertainty exists surrounding the laparoscopic approach to the repair of giant paraesophageal hiatus hernias (GPHHs), in regard to both long-term outcomes and its role in the emergency presentation. The aim of this study was to assess the outcome of laparoscopic GPHH repair, compared with traditional open surgery, in both the elective and emergency setting.

Subjects And Methods: Data regarding all patients who underwent GPHH repair between January 1994 and June 2008 were retrieved from the prospectively maintained Lothian Surgical Audit database.

Swiss multidisciplinary and multilingual experience of the Advanced Trauma Life Support course: lessons for Europe.

Objective: Courses in the Advanced Trauma Life Support are a well-accepted concept throughout the world for training in the emergency treatment of polytraumatized patients. Switzerland, a multilingual country with a long tradition of multidisciplinary collaboration in trauma care, introduced its first student courses in 1998. Unlike some countries where the courses are attended only by surgeons, instructors and students in Switzerland include surgeons, anaesthetists and physicians from other specialties.

Sustaining recovery through the night: impact of a peer-run warm line.

Objective: This exploratory study describes the impact of a peer-run warm line on the lives of individuals with psychiatric disabilities.

Methods: Phone surveys were completed with 480 warm line callers over four years.

Results: Warm line callers reported a reduction in the use of crisis services and a reduction of feelings of isolation.

'Effectiveness of Continuing Professional Development' project: a summary of findings.

This article reports on a study examining continuing professional development (CPD) for consultant doctors. The aim of the study was to identify what promotes or inhibits the effectiveness of CPD and met the following objectives: comparing and contrasting the experiences of CPD across the range of specialties; identifying and describing the range of different models of CPD employed across the different specialties and clinical contexts; considering the educational potential of reflective practice in CPD and its impact on professional practice and exploring how different professionals judge the effectiveness of current CPD practices. Using a mixture of qualitative (interviews, letters, observation) and quantitative (online questionnaire) methods, the views of CPD providers and users were surveyed.

A multilayered approach to complex surface patterning.

A method for developing complex nanopatterns on surfaces has been developed by combining self-assembly, photolabile protecting groups, and multilayered films. An o-nitrobenzyl protecting group has been incorporated into molecular level films utilizing thiol-gold interactions. When the o-nitrobenzyl group is cleaved by ultraviolet light, a carboxylic acid terminated layer remains on the surface and is available for activation and further functionalization through amide bond formation.

The European Trauma Course (ETC) and the team approach: past, present and future.

The European Trauma Course (ETC) was officially launched during the international conference of the European Resuscitation Council (ERC) in 2008. The ETC was developed on behalf of ESTES (European Society of Trauma and Emergency Surgery), EuSEM (European Society of Emergency Medicine), the ESA (European Society of Anaesthesiology) and the ERC. The objective of the ETC is to provide an internationally recognised and certified life support course, and to teach healthcare professionals the key principles of the initial care of severely injured patients.

Unlearned anxiety predicts learned fear: a comparison among heterogeneous rats and the Roman rat strains.

Anxiety-related behaviors were evaluated across five tests in a sample of 277 rats from a genetically heterogeneous stock (N/Nih-HS rats), derived from an eight-way cross of inbred strains, and compared with the performance of RLA-I (high anxious) and RHA-I (low anxious) rats in the same tests. These tests either evoke unlearned (novel-cage activity (NACT), elevated "zero" maze (ZM), baseline acoustic startle response (BAS)) or learned (fear-potentiated startle (FPS), two-way active-shuttle box-avoidance acquisition (SHAV)) anxious/fearful responses. The results overall showed that unlearned anxiety responses/behaviors were predictive of behavior in learned fear (i.

Effect of electrode roughness on the capacitive behavior of self-assembled monolayers.

Analytical gold electrodes were polished mechanically and electrochemically and the true area of the electrode surface was measured by quantitative oxidative/reductive cycling of the electrode. A roughness factor for each electrode was determined from the ratio of the true area to the geometric area. The roughness is fully described by a combination of microscopic roughness (up to tens of nanometers) and macroscopic roughness (on the order of hundreds of nanometers) terms.

13C NMR study of the ion-binding selectivity of a new ammonium ionophore.

A bicyclic peptide, cyclo (L-Glu(1)-D-Leu(2)-Aib(3)-L-Lys(4)-D-Leu(5)-D-Ala(6))-cyclo-(1gamma-4epsilon) (I), was designed and synthesized to provide an ammonium ion complexation site in a tetrahedral geometry. Molecular modeling, dynamics and electrostatic studies for I indicated that it exhibits some selectivity for ammonium ions over potassium and sodium ions. NMR measurements in CDCl(3)/CD(3)OD (1:1) show that for those carbonyl groups involved in cation binding, (13)C resonances shifted downfield with increasing cation concentration.

Video assessment of basic surgical trainees' operative skills.

Background: We previously described a feasible, reliable, valid, and acceptable clinical assessment form for basic surgical trainees (BSTs). We now recently assessed tissue-handling skills using real-time assessment (RTA) and video assessment (VA) and addressed feasibility, reliability, validity, and trainer-trainee agreement using the same assessment form.

Methods: Nine BSTs were videotaped as they performed open inguinal hernia repairs at 6 and 12 months of surgical training.

Photocurrent generation in noncovalently assembled multilayered thin films.

Multilayered photocurrent generating thin films were fabricated by templated noncovalent assembly via stepwise assembly of molecular components. Each of films I-IV contained an underlying self-assembled monolayer (SAM) consisting of an alkanethiol linked covalently to a 2,6-dicarboxypyridine ligand that served as a binding site for attaching additional molecular components. The SAM subsequently was functionalized by sequential deposition of Cu(II), Co(II), or Fe(III) ions followed by a variety of substituted 2,6-dicarboxypyridine ligands as a means to incorporate one or more layers of pyrene chromophores into the film.

Late malignant change in an ileal conduit.

Around 3000 bowel segment transpositions are performed in the UK each year and although malignancy is well-recognized following ureterosigmoidostomy, reports of similar changes in ileal conduits are sparse. We report a case of ileal adenocarcinoma in a 67-year-old lady some 49 years after ileal conduit, demonstrating previously unassociated histopathological features similar to those seen in collagenous colitis.

Reversible photoswitchable wettability in noncovalently assembled multilayered films.

Reversible and irreversible photoinduced changes in surface wettability were observed in noncovalently assembled multilayered films. The multilayered films studied were fabricated from a self-assembled monolayer (SAM) consisting of 4-(10-mercaptodecyloxy)pyridine-2,6-dicarboxylic acid on gold, Cu(II) ions complexed to the pyridine head group of the SAM, and either cis- (film 1) or trans- (film 2) stilbene-4,4'-dicarboxylic acid complexed to the Cu(II) ions. Irradiation of film 1 at wavelengths corresponding to the absorption band of the cis-stilbene isomer resulted in an irreversible chemical change and an irreversible increase in wettability, as indicated by surface contact angle and grazing incidence IR measurements.