The Young Canadians Roundtable on Health: promising practices for youth and adults working in partnership

SETTING

Canadian youth (aged 15-29 years) are more diverse, educated, connected and socially engaged than ever before. However, many face health-related challenges, including mental health problems (10-20%), substance use concerns (14%) and obesity (45%).

INTERVENTION

The Young Canadians Roundtable on Health (YCRH) was created in 2013 to be Canada's youth voice on health. Supported by the Sandbox Project, this youth-led advisory works primarily virtually, leading advocacy projects and wide-ranging health initiatives.

OUTCOMES

Youth and adult allies engaged in a participatory research evaluation of the YCRH, which was identified as a living laboratory, where youth could experiment with ideas and provide new perspectives on health issues. Adult allies reported learning new skills from youth, and youth gained advocacy and leadership skills. Collaborative projects resulted in a sense of shared achievement. Further, youth increased their connections to health and youth-serving spaces across the country. Identified challenges included difficulties in coordinating a national roundtable and defining shared responsibilities.

IMPLICATIONS

The researchers generated the following evidence-based promising practices for youth engagement in health systems and program planning: (1) provide a consistent platform for youth input; (2) appreciate different forms of knowledge, expertise and communication methods; (3) invest in relationships and build mutual understanding among youth and adults; (4) for adult allies, be patient and comfortable with the ambiguity and unpredictability of working with youth; and (5) continually revisit and renegotiate structure and flexibility.

PP28 ‘They are not silly people – they know the difference’: clinician focus group views on a pilot randomised controlled trial of prehospital continuous positive airway pressure (CPAP)

Background

Continuous positive airway pressure (CPAP) is not in widespread use in UK ambulance services, but could benefit patients with acute respiratory failure (ARF). As a new treatment in this context, clinician acceptability is an important factor in the feasibility of conducting definitive research in the prehospital arena.

Methods

As part of a pilot randomised controlled trial (the ACUTE study), nine trial-trained paramedics took part in three semi-structured focus groups. 204 trained staff had been given the opportunity to take part. The sample included six staff who had recruited to the trial, one who had not, and two who had withdrawn from it. Audio-recordings were transcribed and analysed thematically.

Results

Participants described facilitators to trial participation including: clear eligibility criteria and patient documentation, access to demonstration equipment, training away from the work environment, and repeated patient recruitment. Barriers to taking part included: the lack of protected time for training, inadequate workplace facilities for the electronic learning package used, adverse responses by receiving hospital staff, and infrequent patient exposure. Both paramedics who withdrew cited the inconvenience of carrying packs each shift. Some participants described anxiety and distress when opening packs to find a standard-care mask, and reported patients having similar reactions.

Conclusions

Future researchers could promote improved workplace computing facilities and increased provision of face-to-face training days, which were praised by participants in these focus groups, but limited to a single event distant from some staff. Greater stakeholder engagement by researchers could reduce the difficulties at hospital handover reported by some ambulance staff. Where blinding is not possible, the perceptions of clinicians and patients should be considered carefully, as this study shows both may have adverse emotional responses to being treated with standard care, particularly when prospective consent discussions describe the trial intervention as potentially beneficial.

PP25 ‘I wish there was CPAP in every box’: internet-based survey responses of clinicians recruiting to a pilot randomised controlled trial of continuous positive airway pressure (CPAP) for patients with acute respiratory failure

Background

Continuous positive airway pressure (CPAP) is not in widespread use in UK ambulance services, but could benefit patients with acute respiratory failure (ARF). As a new treatment in this context, clinician acceptability is an important factor in the feasibility of conducting definitive research in the prehospital arena.

Methods

As part of a pilot randomised controlled trial (the ACUTE study), recruiting clinicians were emailed after enrolling patients to either the CPAP or standard-care arm, and were asked to complete an optional, anonymous, internet-based survey. The survey used a mixture of closed questions, Likert-scaled answers and free text to explore staff views on both the treatment and the trial procedures. Quantitative responses were analysed descriptively, and qualitative answers thematically.

Results

Recruiting clinicians for all 77 patients were sent survey links, with 40 email responses received. Respondents felt confident diagnosing ARF and determining trial eligibility. CPAP-arm respondents found the equipment easy-to-use and felt it did not delay transport to hospital. Most standard-care respondents said they would have liked CPAP to be available to their patients. Respondents described varying responses from receiving hospital staff.

Conclusions

Prehospital CPAP seems acceptable to clinicians. Limitations of this survey are that it was targeted only at clinicians who have already opted to take part in the trial, and so may exclude a body of staff who find the treatment unacceptable at face value. Not all clinicians who enrolled patients completed the survey, which could suggest a response bias or simply a reflection of its optional nature within the trial. Future pilot studies could mandate an acceptability survey, and also seek the views of staff not taking part in the interventional study. Trial teams may need to better explain the rationale of comparing a new intervention with standard care, and offer more widespread hospital staff awareness sessions.

Development of National Newborn Screening Quality Indicators in the United States

Newborn screening is a public health program facilitated by state public health departments with the goal of improving the health of affected newborns throughout the country. Experts in the newborn screening community established a panel of eight quality indicators (QIs) to track quality practices within and across the United States newborn screening system. The indicators were developed following iterative refinement, consensus building, and evaluation. The Newborn Screening Technical assistance and Evaluation Program (NewSTEPs) implemented a national data repository in 2013 that captures the quality improvement metrics from each state. The QIs span the newborn screening process from collection of a dried blood spot through medical intervention for a screened condition. These data are collected and analyzed to support data-driven outcome assessments and tracking performance to improve the quality of the newborn screening system.

A-63 The Fatigue Severity Scale and Depression in an Aging Population

Objective

The Fatigue Severity Scale (FSS) is often used in clinical populations in which fatigue is a common symptom (e.g., multiple sclerosis). Despite the prevalence of fatigue in depression, relatively few investigations have examined the relationship between the FSS and mood symptoms, particularly in aging populations with concerns of memory loss. Thus, the primary aim of the present investigation was to elucidate the relationship between fatigue symptoms and depression among older adults evaluated in a cognitive disorders clinic.

Method

Data were collected as part of a neuropsychological battery administered to patients presenting to clinic due to complaints of memory impairment. Scores on the FSS and the Geriatric Depression Scale (GDS) were collected from 430 patients (48.10% women). Mean age was 74.97 years (SD = 5.81) and 147 subjects were diagnosed with depression, based on a score of 10 or above on the GDS.

Results

We observed a small, but significant inverse relationship between age and scores on the FSS [r = -.103, p = .033], such that older adults endorsed less severe fatigue. A moderate, positive relationship between FSS and GDS was observed [r = .416, p = .000]. Comparing FSS endorsement between depressed and non-depressed individuals finds individuals with depression endorsed significantly greater levels of fatigue than non-depressed individuals, even after accounting for the effects of age [F(1, 427) = 85.79. p < .001; Cohen's d = 0.96].

Conclusion

Present findings suggest that older adults do not necessarily endorse higher rates of fatigue on the FSS. However, the presence of depression in older adults has large effects on fatigue severity.

A-61 The Cattell-Horn-Carroll Model Does Not Outperform a Traditional Neuropsychological Model When Using a Digital Test Battery

Objective

Following recent (meta-)analyses showing that the Cattell-Horn-Carroll (CHC) model outperforms traditional neuropsychological models of cognition, we investigated the relative performance of the traditional neuropsychological model (TNM) of cognitive functioning and the CHC model using the digital Philips IntelliSpace Cognition (ISC) test battery.

Method

The ISC battery consists of 11 conventional cognitive tests, which were administered to 221 healthy participants. We used confirmatory factor analysis (CFA) to map outcome measures to cognitive domains. Both models contained processing speed, working memory, memory, and visuospatial ability. TNM included executive functioning consisting of TMT B, Stroop interference, and Phonetic and Semantic Fluency. In the CHC model, these outcome measures were distributed over processing speed and a word fluency domain. The models’ fit was compared through Vuong test for non-nested models.

Results

Both models were a good fit (TNM: χ2(64) = 91.95, p = .013, CFI = .971, RMSEA = .044; CHC: χ2(64) = 83.66, p = .050, CFI = .979, RMSEA = .037). The Vuong test showed that the models could be significantly distinguished based on the observed data, ω2 = 0.21, p < .001. However, the non-nested likelihood ratio test did not offer evidence that either model was a better fit, z = -0.61, p = .727. The 95% confidence interval of the AIC difference contained zero [-18.60, 35.20].

Conclusions

Recent findings showing that the CHC model outperforms the TNM are not corroborated by our findings. Instead, both models captured the data equally well, suggesting that the two theoretical frameworks are not necessarily mutually exclusive.

B-59 Prevalence of Pseudobulbar Affect Symptoms in Professional Fighters

Objective

Pseudobulbar Affect (PBA) is defined as dysregulation of emotional expression and is characterized by sudden, uncontrollable, laughing and/or crying that is discordant with the present mood or social context. This study sought to establish the prevalence of PBA symptoms in individuals with a high incidence of sports-related head injuries and explore the relationship between two rating scales designed to measure PBA symptoms.

Methods

Sixty-three professional fighters (age: M = 44.7, SD = 10.0; 98% male) underwent neurological and neuropsychological assessment including completion of the Pathological Laughing and Crying Scale (PLCS) and the Center for Neurologic Study – Lability Scale (CNS-LS). Diagnostic criteria for PBA were reviewed during the neurological exam to establish the prevalence of the clinical syndrome. Prevalence statistics for item endorsement on the rating scales and diagnostic status were calculated. To investigate the rate of agreement between rating scales, concordance correlation coefficient (CCC) and root mean square difference (RMSD) were calculated.

Results

Eleven percent of participants met clinical criteria for PBA diagnosis, 25% of participants endorsed clinically significant PBA symptoms on the CNS-LS (M = 10.9, SD = 4.9), and 8% endorsed significant symptoms on the PLCS (M = 3.1, SD = 6.5). The rating scales were significantly positively correlated (r = .58; p < .01), though overall agreement was low (CCC = 0.55; RMSD = 5.4).

Conclusions

This study demonstrates that the prevalence of PBA symptoms in a sample of professional fighters is not uncommon. Although both the CNS-LS and PCLS are designed to measure PBA symptoms, they appear to be measuring unique aspects of PBA that may provide complimentary, rather than redundant information.

A-48 The Role of Processing Speed in Verbal and Nonverbal Learning within a Clinical Sample of Older Adults

Objective

Prior research revealed that processing speed predicts nonverbal learning in healthy older adults (Tam & Schmitter-Edgecombe, 2013). This study aims to examine the role of processing speed in both verbal and nonverbal learning in a clinical sample. We expect that processing speed will lend the most variance to the initial learning trials.

Method

Records from 718 patients were reviewed (mean age = 74). Hierarchical regression analyses were conducted using Brief Visuospatial Memory Test –Revised (BVMT-R) and Hopkins Verbal Learning Test –Revised (HVLT-R) learning trials as outcome variables. Demographics were entered in a first step followed by BVMT-R copy or Wechsler Adult Intelligence Scale (WAIS-IV) Digit Span –longest digit span forward raw score, to account for visuoconstruction or simple auditory attention for nonverbal and verbal learning outcomes respectively. A processing speed composite of sample-standardized raw scores was entered in a final step.

Results

Processing speed accounted for 5.4% of the variance in BVMT-R trial 1, 7.5% of the variance in trial 2, and 8.5% of the variance in trial 3, all p < .001. Processing speed accounted for 6.6% of the variance in HVLT-R trial 1, 11.1% of the variance in trial 2, and 11.5% of the variance in trial 3, all p < .001.

Conclusions

Processing speed significantly predicted all verbal and nonverbal learning trials. Contrary to our hypotheses, processing speed actually had a greater contribution during subsequent learning trials. These findings have implications for evaluating memory performance in patients with syndromes where processing speed is typically affected (e.g., cerebrovascular disease, Parkinson’s disease).

B-23 Non-Motor Symptom Profile in Parkinson’s Disease Patients and its impact on Quality of Life

Objective

Non-motor Symptoms (NMS) in Parkinson’s Disease (PD) are known to be diverse and may include cognitive, psychiatric and sleep disturbance, fatigue, and autonomic disorders (e.g., cardiovascular dysregulation, orthostatic hypotension, thermo-dysregulation, sexual dysfunction, urinary and bowel dyscontrol). The aim of this study was to define the NMS profile in a large sample of PD patients with and without Deep Brain Stimulation (DBS) and its impact on quality of life (QOL).

Method

Cross-sectional, survey-based research design was used. 1,164 individuals with PD participated in this survey: 275 participants who underwent DBS and 889 without DBS. Participants completed the Non-Motor Symptom Scale (NMSS) and answered questions assessing the impact of NMS on everyday life. Participants were divided into younger (ages 50-69) and older (ages 70+) age cohorts and disease duration cohorts with early stage ( < 6 years) and advanced stage (6-10 years; 11+ years) groups.

Results

24 out of 31 NMS categories were experienced by more than 50% of the participants. Urination difficulty, fatigue, sleep, constipation, and cognitive difficulties were symptoms most frequently reported to adversely impact day-to-day living, and cognitive difficulties followed by sleep disturbance had the strongest impact to quality of life.

Conclusions

NMS burden drives quality of life for many individuals and has remained a relatively new frontier for exploration, at least in depth and scope as it relates to assessment and treatment of NMS. Management of NMS remains an unmet need for individuals with PD. Implications for neuropsychologists are discussed.

A-62 The Philips IntelliSpace Cognition Platform: Ability to Classify a Mixed Clinical Sample

Objective

We developed a cloud-based platform, Philips Intellispace Cognition (ISC), containing tablet-based versions of conventional cognitive tests. We investigated the battery’s sensitivity for subtle cognitive impairment in a mixed clinical sample.

Method

The sample consisted of 221 healthy participants and 98 traumatic brain injury (TBI) and stroke patients who all scored above the MMSE-2 cutoff of 24, but reported subjective cognitive complaints. All completed the following ISC tests: Phonetic Fluency; Semantic Fluency; Trail-Making; Stroop; O-Cancellation; Star-Cancellation; Digit Span; Rey Auditory Verbal Learning; Rey-Osterrieth Complex Figure. We used ROC analyses to investigate our ability to distinguish the patient and healthy samples. Specifically, we assessed the area under the curve (AUC), where a value of .50 indicates random classification and 1 indicates perfect distinguishability. To this end, we compared sensitivity of cognitive domain scores distilled from the ISC tests (using confirmatory factor analysis) with the sensitivity of MMSE-2 scores. The cognitive domains were executive functioning, processing speed, working memory, memory, and visuospatial ability.

Results

The AUC of the MMSE-2 was .46, as expected given the fact that all patients scored above the cut-off. The AUCs of the model domain scores ranged from .56 to .73. The differences between these AUCs and the MMSE AUC were all significant (ps ≤ .004), except for visuospatial ability (p = .070).

Conclusions

The ISC test battery was able to pick up on cognitive impairment in a mixed clinical sample consisting of patients that all scored normally on the MMSE-2. These findings show the usefulness of the digital platform in clinical practice.

Tests of General Relativity with GW170817

The recent discovery by Advanced LIGO and Advanced Virgo of a gravitational wave signal from a binary neutron star inspiral has enabled tests of general relativity (GR) with this new type of source. This source, for the first time, permits tests of strong-field dynamics of compact binaries in the presence of matter. In this Letter, we place constraints on the dipole radiation and possible deviations from GR in the post-Newtonian coefficients that govern the inspiral regime. Bounds on modified dispersion of gravitational waves are obtained; in combination with information from the observed electromagnetic counterpart we can also constrain effects due to large extra dimensions. Finally, the polarization content of the gravitational wave signal is studied. The results of all tests performed here show good agreement with GR.

'We wear too many caps': role conflict among ambulance service managers

Aims:

A qualitative study explored how UK ambulance service managers try to identify staff at risk of becoming traumatised by their work, including how they see their role in this task. As research on managers in this field is largely limited to settings outside the NHS, the study was planned as exploratory in nature and developed themes arising from the data.

Methods:

Face-to-face, semi-structured interviews were audio-recorded with a purposive sample of six paramedic managers working for an NHS ambulance service. The interview guide included specific questioning on role and identity. The author transcribed these interviews and analysed them using framework analysis. Ethical approval and informed consent were obtained.

Results:

The participants were all clinically-trained managers with responsibility for first-line management of front line ambulance crews. They discussed their varying roles both implicitly and explicitly. The roles included: manager, clinician, peer, referrer, ‘adjudicator’, parent figure, ‘the appropriate person’ and the challenger. They discussed the tensions of managing performance and providing emotional support to the same staff, including how some managers perceived this as making staff reluctant to disclose distress. Several participants acknowledged that they were actively creating narratives from different role perspectives, and that readers of the study would also judge them against these different roles.

Conclusion:

This study suggests that ambulance service managers within an NHS trust may feel conflicted between varying roles, some relating to their professional identities, and some to work tasks such as performance management and staff support, which may be in tension. Some respondents felt this could make potentially traumatised staff reluctant to disclose distress, which has negative implications in a sector where stress and psychological illness is ascribed as contributing to around 15% of staff sickness. Further research could be conducted into whether this possible role conflict is seen by front line staff as a barrier to disclosing distress.

Constraining the p-Mode-g-Mode Tidal Instability with GW170817

We analyze the impact of a proposed tidal instability coupling p modes and g modes within neutron stars on GW170817. This nonresonant instability transfers energy from the orbit of the binary to internal modes of the stars, accelerating the gravitational-wave driven inspiral. We model the impact of this instability on the phasing of the gravitational wave signal using three parameters per star: an overall amplitude, a saturation frequency, and a spectral index. Incorporating these additional parameters, we compute the Bayes factor (lnB_{!pg}^{pg}) comparing our p-g model to a standard one. We find that the observed signal is consistent with waveform models that neglect p-g effects, with lnB_{!pg}^{pg}=0.03_{-0.58}^{+0.70} (maximum a posteriori and 90% credible region). By injecting simulated signals that do not include p-g effects and recovering them with the p-g model, we show that there is a ≃50% probability of obtaining similar lnB_{!pg}^{pg} even when p-g effects are absent. We find that the p-g amplitude for 1.4  M_{⊙} neutron stars is constrained to less than a few tenths of the theoretical maximum, with maxima a posteriori near one-tenth this maximum and p-g saturation frequency ∼70  Hz. This suggests that there are less than a few hundred excited modes, assuming they all saturate by wave breaking. For comparison, theoretical upper bounds suggest ≲10^{3} modes saturate by wave breaking. Thus, the measured constraints only rule out extreme values of the p-g parameters. They also imply that the instability dissipates ≲10^{51}  erg over the entire inspiral, i.e., less than a few percent of the energy radiated as gravitational waves.

PP10 ‘The ones that don’t say’; challenges in managers identifying potentially traumatised ambulance staff

Background

Stress and psychological illness among emergency services personnel is reported at higher prevalence than the general population, with one UK ambulance service ascribing it to 15% of staff sickness. Research in this field has focused on ambulance crew views, while manager experiences are limited to EMS systems outside the UK. This qualitative study explored how UK ambulance service managers try to identify staff at risk of becoming traumatised by their work.

Methods

Face-to-face, semi-structured interviews were audio-recorded with a purposive sample of six paramedic managers working for an NHS ambulance service. The author transcribed these interviews and analysed them using framework analysis. Ethical approval and informed consent were obtained.

Results

All participants claimed to see the identification of potentially traumatised staff as a vital part of their role. They outlined the use of case factors such as visceral elements and child involvement, and staff factors such as home life and resilience. Interviewees talked about their changing roles as managers, peers, parent figures, clinicians, and adjudicators.

Factors found as enabling the identification of potentially traumatised staff included: knowing the staff, formalising handover to other managers, and manager presence – both at incidents and on station. Disabling factors included: atypical cases, hierarchical culture, and isolated remote staff. All participants reported concerns about staff being reluctant to report distress.

Conclusions

Limitations of this study include the small sample size, possible response bias, and respondents conforming to social norms, as their practice was self-reported, rather than observed. Manager presence was highlighted as very important by participants; services should consider this in their structures and policies. Further studies could examine staff reluctance to report psychological distress, as well as staff resilience, which participants saw as beneficial, yet difficult to define or predict.