Search

We all have those patients whom we know on a first-name basis and whose address will live in our memory even beyond our EMS careers. Beyond our concerns for these [...]

Prehospital needle decompression can be lifesaving for trauma patients experiencing a tension pneumothorax. It is a skill rarely performed and carries a risk of complications. Research into this prehospital procedure [...]

Purpose: To evaluate total testosterone distribution in male idiopathic infertility. Methods: A retrospective, real-world case-control clinical study was conducted. Cases consisted of men evaluated for couple infertility, specifically those with alterations in semen parameters and normal gonadotropin levels, and after excluding all known causes of male infertility. Controls were male subjects who underwent semen analysis for screening purposes, without any abnormality detected. The total testosterone distribution was evaluated in cases and controls. Further analyses were performed subgrouping cases according to total testosterone reference threshold suggested by scientific societies (i.e., 3.5 ng/mL). Results: Cases included 214 idiopathic infertile men (mean age 38.2 ± 6.2 years) and controls 224 subjects with normozoospermia (mean age 33.7 ± 7.5 years). Total testosterone was not-normally distributed in both cases and controls, with positive asymmetric distribution slightly shifted on the left in cases. The rate of subjects with testosterone lower than 3.5 ng/mL was higher in cases (23.8%) than controls (4.5%) (p< 0.001). In cases with testosterone lower than 3.5 ng/mL, a significant direct correlation between testosterone and the percentage of normal morphology sperms was highlighted, also applying multivariate stepwise linear regression analysis (R= 0.430, standard error = 0.3, p= 0.020). Conclusion: Although idiopathic infertile men show by definition altered semen analysis and gonadotropins within reference ranges, testosterone serum levels are widely variable in this population. Approximately a quarter of these patients present some sort of functional hypogonadism. Our data support the need to better classify idiopathic male infertility and total testosterone serum levels could be a supportive parameter in tracing the patient’s therapeutic profile.

Any of us who have worked in the field know how challenging it can be to calculate a patient's Glasgow Coma Scale (GCS) score without using a cheat sheet. However, [...]

EMS often encounters patients who have fallen. This is particularly true among older adults. In fact, it has been estimated that about 25% of older adults experience a fall each [...]

While calls involving them are common, some might be surprised to learn there is limited research describing the prehospital management of pediatric asthma patients. This is despite the fact that [...]

The use of gait analysis techniques to identify health conditions has increased significantly in recent years. Among the many technologies available, inertial sensor-based solutions are one of the most popular due to their cost, accuracy, and portability. However, the accuracy obtained in gait analysis is primarily determined by a reliable segmentation of the steps. Most classical algorithms use some direct information extracted from accelerometers and gyroscopes, such as angles or signal magnitudes, and although they are effective for standard walking modes, they are very sensitive to unusual walking styles. In this sense, it would be desirable to obtain an effective and robust walking-style segmentation method. In this article, we analyze and compare a typical angular velocity-based algorithm for gait segmentation (AVGS), a commercial software for gait analysis (GaitUpLab), and a new algorithm proposed by the authors based on foot-forward displacement for gait segmentation (FoDiGS). The three algorithms have been evaluated under different walking-style tests using the Optitrack optical system (gold standard). The new proposed FoDiGS algorithm detects 96.9% of the 3205 steps analyzed and improves the gait parameter estimation, decreasing the mean relative error (MRE) by 20.89% against the AVGS algorithm and by 28.87% compared with the commercial system GaitUp. The results suggest that the proposed method, which does not require any previous training with a database or adaptive thresholds, provides an accurate segmentation method for different walking modes and outperforms other well-known methods.

The growing complexity of weather radar systems necessitates precise in situ antenna-pattern measurements, particularly for emerging phased array weather radars. Our study introduces an innovative method using the radio-frequency sonde (RFSonde), a custom-modified uncrewed aerial system (UAS). It conducts in-flight power measurements in the far-field (FF) region of operational radar antennas, employing a unique three-axis gimbal control strategy to maintain continuous polarization alignment with the antenna under test (AUT). This strategy, consistent with the Ludwig-3 definition of cross-polarization, avoids distortions due to probe misalignment and effectively utilizes the full dynamic range of the onboard power sensor. In multiple field experiments, the RFSonde demonstrated the viability and repeatability of this method, capturing copolar and cross-polar radiation patterns of an X-band weather radar. The maximum absolute differences in azimuth and elevation beamwidth estimates were 0.011 ° and 0.006 °, respectively, highlighting the system’s precision. The nearly negligible error contributions, amounting to just 0.014% of the power measured, further showcase the system’s accuracy. Additionally, we verified that our dynamic gimbal scan (DGS) algorithm accurately measures the AUT without needing posterior probe correction (PC). This groundbreaking work contributes to the emerging field of aerial RF measurement technology and has potential applications for the polarimetric calibration of phased array radars (PARs).

Previous studies have found EMS utilization is higher among pediatric patients from lower socioeconomic statuses. Some studies suggest EMS use is low among people from those groups but is more [...]

This month we review an interesting study that sought to identify systolic blood pressure (SBP) ranges associated with 'optimal' outcomes in patients suffering major traumatic brain injury (TBI). The authors [...]

It has been well established that early recognition of shockable rhythms followed by rapid defibrillation leads to better patient outcomes for prehospital cardiac arrest. Paramedics are often the first to [...]

The rarity of prehospital encounters with severely ill or injured pediatric patients can make it difficult for EMS providers to maintain medical knowledge, skill, and confidence when caring for children. [...]

This month we discuss a study that looks at the mental stress EMS professionals endure. It is no surprise patient care providers are at risk for developing secondary traumatic stress [...]

Literature makes it clear that multiple intubation attempts in non-cardiac arrest situations are associated with adverse events, but the relationship between multiple intubation attempts and patient outcomes for out-of-hospital cardiac [...]

Image segmentation, labeling, and landmark detection are essential tasks for pediatric craniofacial evaluation. Although deep neural networks have been recently adopted to segment cranial bones and locate cranial landmarks from computed tomography (CT) or magnetic resonance (MR) images, they may be hard to train and provide suboptimal results in some applications. First, they seldom leverage global contextual information that can improve object detection performance. Second, most methods rely on multi-stage algorithm designs that are inefficient and prone to error accumulation. Third, existing methods often target simple segmentation tasks and have shown low reliability in more challenging scenarios such as multiple cranial bone labeling in highly variable pediatric datasets. In this paper, we present a novel end-to-end neural network architecture based on DenseNet that incorporates context regularization to jointly label cranial bone plates and detect cranial base landmarks from CT images. Specifically, we designed a context-encoding module that encodes global context information as landmark displacement vector maps and uses it to guide feature learning for both bone labeling and landmark identification. We evaluated our model on a highly diverse pediatric CT image dataset of 274 normative subjects and 239 patients with craniosynostosis (age 0.63 ± 0.54 years, range 0–2 years). Our experiments demonstrate improved performance compared to state-of-the-art approaches.

Caring for children in the prehospital environment can be challenging. We don't see them as often as older patients, which is fantastic, since no one wants to see children hurt [...]

The reduction in emergency department visits in 2020 was well documented. While COVID-19 itself certainly played a role, it is difficult to determine the impact of associated factors such as [...]

We've reviewed a few stroke studies this year. While we've learned a lot, there's still a lot we don't know (like which prehospital stroke scale is best). One thing we [...]

The article focuses on a study categorizing opioid-related incidents in Massachusetts from 2013 to 2020. Topics include the development of categories for different opioid-related cases, the use of an algorithm for classification, and the trends observed in Emergency Medical Services (EMS) responses, including an increase in dead-on-arrival cases despite a decline in overall incidents.

Hospice care aims to support patients and families at the end of life. EMS was designed to reduce death and disability. While the goals of these two fields may not [...]

Mechanical thrombectomy is an incredibly effective therapy for large vessel occlusion (LVO) strokes. Flowever, it is only indicated within 24 hours of the patient's last known well time. Studies have [...]

As we have seen in previous Journal Watches, it is important to evaluate interventions that have been shown effective in-hospital in the prehospital environment. Use of a bougie has been [...]

In this month's column we review a quality improvement study that described the development, evolution, and outcomes for a community-level fall-prevention initiative that utilized community paramedics. As any field provider [...]

About 10% of out-of-hospital cardiac arrests (OHCAs) each year are witnessed by EMS. No prehospital provider wants to be in this situation, especially when it's unanticipated. It would be extremely [...]

In this month's Journal Watch we review a fascinating study that utilized machine learning to develop and evaluate dispatch rules for drone-delivered AEDs. Welcome to the future! As you might [...]

Lymphatic malformations (LMs) are congenital anomalies of the lymphatic system due to abnormalities that occur during the development of the lymphovascular system. Also known as lymphangiomas, they are usually multifocal, affect multiple organ systems, and are seen in a variety of developmental or overgrowth syndromes. Splenic lymphangiomas are uncommon and usually occur in the context of multiorgan lymphangiomatosis. Within the spleen, 7 prior cases have been reported of LMs with unusual papillary endothelial proliferations (PEPs), which can mimic more aggressive splenic lymphovascular tumors. It is not currently known if splenic LM-PEP represents a unique entity, or is simply an unusual, site-specific, morphologic variant of LM. To address this question, we conducted a retrospective, single-institutional review of this rare entity and systematically evaluated its clinical, histologic, radiologic, electron microscopical, and molecular features. In all 3 splenic LM-PEPs, the clinical course was benign, imaging demonstrated subcapsular lesions with characteristic “spoke-and-wheel” appearance, histology showed distinctive PEPs within lymphatic microcysts, immunohistochemistry confirmed a lymphatic endothelial phenotype and electron microscopy demonstrated lesional endothelial cells, rich in mitochondria and intermediate filaments with prominent cytoplasmic lumina and vacuoles and lacking Weibel-Palade granules. Occasional lymphothelial cells were situated within the cytoplasm of another lesional cell, appearing to be engulfed. Next-generation sequencing identified a PIK3CAmutation in 1 patient, while in 2 others no molecular alterations were identified. We conclude with a summary of all prior published cases and discuss key diagnostic elements that distinguish this benign entity from its more aggressive mimickers.

Dyskeratosis congenita (DC) is a rare multisystemic disorder associated with defective telomere maintenance. Frequent clinical manifestations of DC include reticular skin pigmentation, dystrophic nails, oral leukoplakia, and bone marrow failure. Hepatic disturbances are reported to occur in 7% of DC patients. This study aimed to evaluate the histopathologic spectrum of hepatic involvement in this disorder. DC patients with liver tissue in the pathology database at Boston Children’s Hospital from 1995 to 2022 were identified. Clinical and pathologic information was documented. Thirteen specimens from 11 DC patients were included (M:F = 7:4; median age at the time of liver tissue evaluation: 18 y). DC-associated gene mutations were identified in 9 patients; TERF1-interacting nuclear factor 2 (TINF2)was the most frequently represented gene mutation, seen in 4 patients. All patients had bone marrow failure, whereas dystrophic nails, cutaneous abnormal pigmentation, and oral leukoplakia were noted in 73%, 64%, and 55% of patients, respectively. Seven patients underwent bone marrow transplants before biopsy/autopsy (median interval of 45 mo). Histologically, 3 of 4 patients who presented with portal hypertension showed noncirrhotic changes (nodular regenerative hyperplasia and/or obliterative portal venopathy), whereas prominent central and sinusoidal fibrosis was noted in patients with intrahepatic shunting and those showing features of chronic passive congestion. All cases showed hepatocyte anisonucleosis. One patient developed hepatic angiosarcoma, and another 1 had colorectal adenocarcinoma metastatic to the liver. DC patients show heterogeneous histologic findings in their liver. The findings of noncirrhotic portal hypertension, intrahepatic shunting, and angiosarcoma suggest vascular functional/structural pathology as a possible unifying etiology of hepatic manifestations of DC.

L’interazione tra medico e paziente è una relazione istituzionale che necessita di una comunicazione efficace per creare un rapporto di fiducia solido in grado di influire sull’aspetto decisionale e sul successo terapeutico. Tuttavia, ciò non è così facile, soprattutto in alcuni ambiti clinici delicati, come quello andrologico, e/o in presenza di backgroundsocio-culturali diversi. È pertanto fondamentale focalizzarsi su un approccio patient-centredpersonalizzato in base al contesto clinico.

Purpose: To clarify the relationship between one the most gender-specific hormone, i.e. prolactin (PRL), and semen parameters in men. Methods: A retrospective, observational, cohort, real-world study was carried out, enrolling all men performing a semen analysis and PRL examination from 2010 to 2022. For each patient, the first semen analys was extracted, associated to PRL, total testosterone (TT), follicle stimulating hormone (FSH) and luteinizing hormone (LH). Hyperprolactinaemia (>35 ng/mL) was excluded. Results: 1211 subjects were included. PRL serum levels were lower in normozoospermia compared to azoospermia (p= 0.002) and altered semen parameters (p= 0.048) groups. TT serum levels were not different among groups (p= 0.122). Excluding azoospermic men, PRL serum levels were lower in normozoospermic patients, when compared to other groups of semen alterations. An inverse correlation was detected between PRL and sperm concentration. Considering normozospermic subjects, PRL was directly related to both non-progressive sperm motility (p= 0.014) and normal sperm morphology (p= 0.040). Subdiving the cohort in quartiles according to PRL distribution, the highest motilities were observed in the second PRL quartile (8.30–11.10 ng/mL) and asthenozoospermia was significantly predicted by FSH (p< 0.001) and second PRL quartile (p= 0.045). Conclusion: The PRL-spermatogenesis connection seems to be mild, although low-normal PRL levels are associated with the best spermatogenetic profile. PRL serum levels could mirror the immunoregulatory status within the testis, suggesting that there is a sort of ‘PRL optimal window’ reflecting an efficent spermatogenesis. Alternatively, men with good semen parameters might have a higher central dopaminergic tone resulting in low PRL levels.

ABSTRACT Understanding the mechanical effects of the corrosion pits on the steel surface requires an accurate definition of their geometry and distribution along the rebar. 3D optical measurement technique is [...]

ABSTRACT This experimental study assesses the bond performance of recycled aggregate concretes (RAC) with embedded uncorroded and corroded steel bars. The RAC were produced using 20%, 50% and 100% of [...]

Hemorrhage is the leading cause of preventable death following injury. Historically, crystalloid fluids were our primary method of treating patients suffering significant loss of blood. However, the Prehospital Air Medical [...]

Previous Journal Watch columns have noted that randomized controlled clinical trials (RCTs) are the gold standard for evaluating the effectiveness of interventions. However, it takes a lot of upfront work [...]

This month we review a study that performed a secondary post hoc analysis of data from the Pragmatic Airway Resuscitation Trial (PART), The PART study was a cluster-randomized clinical trial [...]

Nobody is born a surgeon, or a violin virtuoso. Great coaching and an indefatigable commitment to self-improvement are required to reach professional excellence. (1) A violinist will practice thousands of [...]

Over the last decade, the use of tranexamic acid (TXA) for traumatic hemorrhage control has increased. This was due to the results of a clinical trial, published in 2010, that [...]

Most of the time in Journal Watch we review studies focused on either EMS patients or EMS providers. This month we review an interesting study that examines the safety of [...]

Acute myeloid leukemia (AML) has an aggressive course and a historically dismal prognosis. For many patients, hematopoietic stem cell transplantation (HSCT) represents the best option for cure, but access, utilization, and health inequities on a global scale remain poorly elucidated. We wanted to describe patterns of global HSCT use in AML for a better understanding of global access, practices, and unmet needs internationally. Estimates of AML incident cases in 2016 were obtained from the Global Burden of Disease 2019 study. HSCT activities were collected from 2009 to 2016 by the Worldwide Network for Blood and Marrow Transplantation through its member organizations. The primary endpoint was global and regional use (number of HSCT) and utilization of HSCT (number of HSCT/number of incident cases) for AML. Secondary outcomes included trends from 2009 to 2016 in donor type, stem cell source, and remission status at time of HSCT. Global AML incidence has steadily increased, from 102,000 (95% uncertainty interval: 90,200-108,000) in 2009 to 118,000 (104,000-126,000) in 2016 (16.2%). Over the same period, a 54.9% increase from 9659 to 14,965 HSCT/yr was observed globally, driven by an increase in allogeneic (64.9%) with a reduction in autologous (−34.9%) HSCT. Although the highest numbers of HSCT continue to be performed in high-resource regions, the largest increases were seen in resource-constrained regions (94.6% in Africa/East Mediterranean Region [AFR/EMR]; 34.7% in America-Nord Region [AMR-N]). HSCT utilization was skewed toward high-resource regions (in 2016: AMR-N 18.4%, Europe [EUR] 17.9%, South-East Asia/Western Pacific Region [SEAR/WPR] 11.7%, America-South Region [AMR-S] 4.5%, and AFR/EMR 2.8%). For patients <70 years of age, this difference in utilization was widened; AMR-N had the highest allogeneic utilization rate, increasing from 2009 to 2016 (30.6% to 39.9%) with continued low utilization observed in AFR/EMR (1.7% to 2.9%) and AMR-S (3.5% to 5.4%). Across all regions, total HSCT for AML in first complete remission (CR1) increased (from 44.1% to 59.0%). Patterns of donor stem cell source from related versus unrelated donors varied widely by geographic region. SEAR/WPR had a 130.2% increase in related donors from 2009 to 2016, and >95% HSCT donors in AFR/EMR were related; in comparison, AMR-N and EUR have a predilection for unrelated HSCT. Globally, the allogeneic HSCT stem cell source was predominantly peripheral blood (69.7% of total HSCT in 2009 increased to 78.6% in 2016). Autologous HSCT decreased in all regions from 2009 to 2016 except in SEAR/WPR (18.9%). HSCT remains a central curative treatment modality in AML. Allogeneic HSCT for AML is rising globally, but there are marked variations in regional utilization and practices, including types of graft source. Resource-constrained regions have the largest growth in HSCT use, but utilization rates remain low, with a predilection for familial-related donor sources and are typically offered in CR1. Further studies are necessary to elucidate the reasons, including economic factors, to understand and address these health inequalities and improve discrepancies in use of HSCT as a potentially curative treatment globally.

Most of you probably know trauma is a leading cause of death in the U.S. Unintentional injury is the top cause of death for those younger than 45. An estimated [...]

The article focuses on analyzing inconsistencies in the care provided to stroke patients by EMS agencies in Michigan, highlighting performance measures crucial for improving patient outcomes. Topics include the evaluation of prehospital stroke care documentation, adherence to national guidelines, and disparities in recognition and treatment based on patient demographics. The study underscores the need for standardized practices and quality improvement initiatives across EMS agencies.

While most of you are likely aware of the injury risks associated with working in EMS, you may not know that risk is about three times higher than for all [...]

We have likely all asked our patients to rate their pain on a scale from 0-10. Because we do not have a test that can objectively determine a patient's level [...]

High-quality CPR increases the likelihood of survival from cardiac arrest. However, the best methods and initiatives to improve CPR quality can be system-dependent. This month we review a manuscript that [...]

Randomized controlled trials (RCTs) are the top level of the evidence scale. RCTs examine cause-and-effect relationships between interventions and outcomes. They can also be complicated, expensive, and hard to manage. [...]

You may wonder why we're not reviewing research related to the novel coronavirus this month. The fact is, studies regarding COVID19 are being published at a rapid pace, and our [...]

Almost everyone reading this knows EMS providers often work more than the typical 40-hour work week. Field providers often have multiple jobs and sometimes end a shift at one agency [...]