What counts and what is being counted – The social organization of knowledge on the front lines of emergency medical services.

Paramedics are trained to use specialized medical knowledge and a variety of medical procedures and pharmaceutical interventions to “save patients and prevent further damage” in emergency situations, both as members of “health-care teams” in hospital emergency departments (Swanson, 2005: 96) and on the streets – unstandardized contexts “rife with chaotic, dangerous, and often uncontrollable elements” (Campeau, 2008: 3). The paramedic’s unique skill-set and ability to function in diverse situations have resulted in the occupation becoming ever more important to health care systems (Alberta Health and Wellness, 2008: 12).
Today, prehospital emergency services, while varying, exist in every major city and many rural areas throughout North America (Paramedics Association of Canada, 2008) and other countries around the world (Roudsari et al., 2007). Services in North America, for instance, treat and/or transport 2 million Canadians (over 250,000 in Alberta alone ) and between 25 and 30 million Americans annually (Emergency Medical Services Chiefs of Canada, 2006; National EMS Research Agenda, 2001). In Canada, paramedics make up one of the largest groups of health care professionals, with numbers exceeding 20,000 (Pike and Gibbons, 2008; Paramedics Association of Canada, 2008). However, there is little known about the work practices of paramedics, especially in light of recent changes to how their work is organized, making the profession “rich with unexplored opportunities for research on the full range of paramedic work” (Campeau, 2008: 2).

This presentation reports on findings from an institutional ethnography that explored the work of paramedics and different technologies of knowledge and governance that intersect with and organize their work practices. More specifically, my tentative focus of this presentation is on discussing some of the ruling discourses central to many of the technologies used on the front lines of EMS in Alberta and the consequences of such governance practices for both the front line workers and their patients. In doing so, I will demonstrate how IE can be used to answer Rankin and Campbell’s (2006) call for additional research into “the social organization of information in health care and attention to the (often unintended) ways ‘such textual products may accomplish…ruling purposes but otherwise fail people and, moreover, obscure that failure’ (p. 182)” (cited in McCoy, 2008: 709).

Integer-valued APARCH processes in the analysis of time series of counts

The Asymmetric Power Arch representation for the volatility was introduced by Ding et al.(1993) in order to account for asymmetric responses in the volatility in the analysis of continuous-valued financial time series like, for instance, the log-return series of foreign exchange rates, stock indices or share prices. As reported by Brannas and Quoreshi (2010), asymmetric responses in volatility are also observed in time series of counts such as the number of intra-day transactions in stocks. In this work, an asymmetric power autoregressive conditional Poisson model is introduced for the analysis of time series of counts exhibiting asymmetric overdispersion. Basic probabilistic and statistical properties are summarized and parameter estimation is discussed. A simulation study is presented to illustrate the proposed model. Finally, an empirical application to a set of data concerning the daily number of stock transactions is also presented to attest for its practical applicability in data analysis.

Regional Importance of Alnus Pollen as an Aeroallergen: A Comparative Study of Alnus Pollen Counts from Worcester (UK) and Poznań (Poland)

Daily average Alnus pollen counts (1996-2005) from Worcester (UK) and Poznań (Poland) were examined with the aim of assessing the regional importance of Alnus pollen as an aeroallergen. The average number of Alnus pollen grains recorded annually at Poznań was more than 2.5 times that of Worcester. Furthermore, daily average Alnus pollen counts exceeded the thresholds of 100, 500 and 1,000 grains/m3 more times at Poznań than Worcester. Skin prick test results (1996-2005) and allergen-specific IgE(asIgE) measurements using the CAP (Pharmacia) system (2002-2005), were supplied by the Allergic Diseases Diagnostic Centre in Poznań. The annual number of positive skin prick tests to Alnus pollen allergens was significantly related (p<0.05) to seasonal variations in the magnitude of the Alnus pollen catch recorded at Poznań (r=0.70). The symptoms of patients with positive skin prick tests to Alnus pollen allergens were: 51% pollinosis, 43% atopic dermatitis, 4% asthma, 1% chronic urticaria and 1% eczema. On a scale of 0-6, 20.5% of patients examined for serum asIgE in relation to Alnus pollen allergens had asIgE measurements in classes 5 and 6. Alnus pollen is generally considered to be mildly allergenic. However, the amount of Alnus pollen released into the atmosphere in places such as Poznań may increase its impact on the population and make it one of the more important aeroallergens present.

Influence of the North Atlantic Oscillation on Grass Pollen Counts in Europe

Relationships between temporal variations in the North Atlantic Oscillation (NAO) and grass pollen counts at 13 sites in Europe, ranging from Córdoba in the South-West and Turku in the North-East, were studied in order to determine spatial differences in the amount of influence exerted by the NAO on the timing and magnitude of grass pollen seasons. There were a number of significant (p<0.05) relationships between the NAO and start dates of the grass pollen season at the 13 pollen-monitoring sites. The strongest associations were generally recorded near to the Atlantic coast. Several significant correlations also existed between winter averages of the NAO and grass pollen season severity. Traditional methods for predicting the start or magnitude of grass pollen seasons have centred on the use of local meteorological observations, but this study has shown the importance of considering large-scale patterns of climate variability like the NAO.

Airborne Olive Pollen Counts are not Representative of 1 Exposure to the Major Olive Allergen Ole e 1

Pollen is routinely monitored, but it is unknown whether pollen counts represent allergen exposure. We therefore simultaneously determined olive pollen and Ole e 1 in ambient air in C"ordoba, Spain, and "Evora, Portugal, using Hirst-type traps for pollen and high-volume cascade impactors for allergen. Pollen from different days released 12-fold different amounts of Ole e 1 per pollen (both locations P < 0.001). Average allergen release from pollen (pollen potency) was much higher in C"ordoba (3.9 pg Ole e 1/pollen) than in "Evora (0.8 pg Ole e 1/pollen, P = 0.004). Indeed, yearly olive pollen counts in C"ordoba were 2.4 times higher than in "Evora, but Ole e 1 concentrations were 7.6 times higher. When modeling the origin of the pollen, >40% of Ole e 1 exposure in "Evora was explained by high-potency pollen originating from the south of Spain. Thus, olive pollen can vary substantially in allergen release, even though they are morphologically identical.

Comparison of Poaceae Pollen Counts Recorded at Sites in Portugal, Spain and the UK

The main aim of this study was to analyse the temporal and spatial variations in grass (Poaceae) pollen counts (2005–2011) recorded in Évora (Portugal), Badajoz (Spain) and Worcester (UK). Weekly average data were examined using nonparametric statistics to compare differences between places. On average, Évora recorded the earliest start dates of the Poaceae pollen seasons and Worcester the latest. The intensity of the Poaceae pollen season varied between sites, with Worcester usually recording the least and Évora the most grass pollen in a season. Mean durations of grass pollen seasons were 77 days in Évora, 78 days in Badajoz and 59 days in Worcester. Overall, longer Poaceae pollen seasons coincided with earlier pollen season start dates. Weekly pollen data, from March to September, from the three pollen-monitoring stations studied were compared. The best fit and most statistically significant correlations were obtained by moving Worcester data backward by 4 weeks (Évora, r = 0.810, p < 0.001) and 5 weeks (Badajoz,r = 0.849, p < 0.001). Weekly data from Worcester therefore followed a similar pattern to that of Badajoz and Évora but at a distance of more than 1,500 km and 4–5 weeks later. The sum of pollen recorded in a season was compared with monthly rainfall between January and May. The strongest positive relationship between season intensity and rainfall was between the annual sum of Poaceae pollen recorded in the season at Badajoz and Évora and total rainfall during January and February. Winter rainfall noticeably affects the intensity of Poaceae pollen seasons in Mediterranean areas, but this was not as important in Worcester.

Nuclear factor I-C links platelet-derived growth factor and transforming growth factor beta1 signaling to skin wound healing progression.

Transforming growth factor beta (TGF-beta) and platelet-derived growth factor A (PDGFAlpha) play a central role in tissue morphogenesis and repair, but their interplay remain poorly understood. The nuclear factor I C (NFI-C) transcription factor has been implicated in TGF-beta signaling, extracellular matrix deposition, and skin appendage pathologies, but a potential role in skin morphogenesis or healing had not been assessed. To evaluate this possibility, we performed a global gene expression analysis in NFI-C(-/-) and wild-type embryonic primary murine fibroblasts. This indicated that NFI-C acts mostly to repress gene expression in response to TGF-beta1. Misregulated genes were prominently overrepresented by regulators of connective tissue inflammation and repair. In vivo skin healing revealed a faster inflammatory stage and wound closure in NFI-C(-/-) mice. Expression of PDGFA and PDGF-receptor alpha were increased in wounds of NFI-C(-/-) mice, explaining the early recruitment of macrophages and fibroblasts. Differentiation of fibroblasts to contractile myofibroblasts was also elevated, providing a rationale for faster wound closure. Taken together with the role of TGF-beta in myofibroblast differentiation, our results imply a central role of NFI-C in the interplay of the two signaling pathways and in regulation of the progression of tissue regeneration.

Use of a human-like low-grade bacteremia model of experimental endocarditis to study the role of Staphylococcus aureus adhesins and platelet aggregation in early endocarditis.

Animal models of infective endocarditis (IE) induced by high-grade bacteremia revealed the pathogenic roles of Staphylococcus aureus surface adhesins and platelet aggregation in the infection process. In humans, however, S. aureus IE possibly occurs through repeated bouts of low-grade bacteremia from a colonized site or intravenous device. Here we used a rat model of IE induced by continuous low-grade bacteremia to explore further the contributions of S. aureus virulence factors to the initiation of IE. Rats with aortic vegetations were inoculated by continuous intravenous infusion (0.0017 ml/min over 10 h) with 10(6) CFU of Lactococcus lactis pIL253 or a recombinant L. lactis strain expressing an individual S. aureus surface protein (ClfA, FnbpA, BCD, or SdrE) conferring a particular adhesive or platelet aggregation property. Vegetation infection was assessed 24 h later. Plasma was collected at 0, 2, and 6 h postinoculation to quantify the expression of tumor necrosis factor (TNF), interleukin 1α (IL-1α), IL-1β, IL-6, and IL-10. The percentage of vegetation infection relative to that with strain pIL253 (11%) increased when binding to fibrinogen was conferred on L. lactis (ClfA strain) (52%; P = 0.007) and increased further with adhesion to fibronectin (FnbpA strain) (75%; P < 0.001). Expression of fibronectin binding alone was not sufficient to induce IE (BCD strain) (10% of infection). Platelet aggregation increased the risk of vegetation infection (SdrE strain) (30%). Conferring adhesion to fibrinogen and fibronectin favored IL-1β and IL-6 production. Our results, with a model of IE induced by low-grade bacteremia, resembling human disease, extend the essential role of fibrinogen binding in the initiation of S. aureus IE. Triggering of platelet aggregation or an inflammatory response may contribute to or promote the development of IE.

The clinical and biological impact of new pathogen inactivation technologies on platelet concentrates.

Since 1990, several techniques have been developed to photochemically inactivate pathogens in platelet concentrates, potentially leading to safer transfusion therapy. The three most common methods are amotosalen/UVA (INTERCEPT Blood System), riboflavin/UVA-UVB (MIRASOL PRT), and UVC (Theraflex-UV). We review the biology of pathogen inactivation methods, present their efficacy in reducing pathogens, discuss their impact on the functional aspects of treated platelets, and review clinical studies showing the clinical efficiency of the pathogen inactivation methods and their possible toxicity.

New gene functions in megakaryopoiesis and platelet formation.

Platelets are the second most abundant cell type in blood and are essential for maintaining haemostasis. Their count and volume are tightly controlled within narrow physiological ranges, but there is only limited understanding of the molecular processes controlling both traits. Here we carried out a high-powered meta-analysis of genome-wide association studies (GWAS) in up to 66,867 individuals of European ancestry, followed by extensive biological and functional assessment. We identified 68 genomic loci reliably associated with platelet count and volume mapping to established and putative novel regulators of megakaryopoiesis and platelet formation. These genes show megakaryocyte-specific gene expression patterns and extensive network connectivity. Using gene silencing in Danio rerio and Drosophila melanogaster, we identified 11 of the genes as novel regulators of blood cell formation. Taken together, our findings advance understanding of novel gene functions controlling fate-determining events during megakaryopoiesis and platelet formation, providing a new example of successful translation of GWAS to function.