Objective-To derive and validate a predictive model and novel Emergency Medical Services (EMS) screening tool for severe sepsis (SS). Design-Retrospective cohort study.Setting-A single EMS system and an urban, public hospital.Patients-Sequential adult, non-trauma, non-arrest, at-risk, EMS-transported patients between January 1, 2011 and December 31, 2012. At-risk patients were defined as having all 3 of the following criteria present in the EMS setting: heart rate >90bpm, 2) respiratory rate >20bpm, and 3) systolic blood pressure <110mmHg. Interventions-None.Measurements and Main Results-Among 66,439 EMS encounters, 555 met criteria for analysis. Fourteen percent (n=75) of patients had SS, of which 19% (n=14) were identified by EMS clinical judgment. In-hospital mortality for patients with SS was 31% (n=23). Six EMS characteristics were found to be predictors of SS: older age, transport from nursing home, Emergency Medical Dispatch (EMD) 9-1-1 chief complaint category of "Sick Person", hot tactile temperature assessment, low systolic blood pressure, and low oxygen saturation. The final predictive model showed good discrimination in derivation and validation subgroups (AUC 0.843 and 0.820, respectively). Sensitivity of the final model was 91% in the derivation group and 78% in the validation group. At a pre-defined threshold of 2 or more points, prehospital severe sepsis (PRESS) score sensitivity was 86%.Corresponding Author: Carmen C Polito, MD, MS, Division of Pulmonary, Allergy, and Critical Care Medicine, Emory University School of Medicine, 615 Michael Street, Suite 205M, Atlanta, GA 30322, Phone: (404) 712-2970, Fax: (404) 712-2974, cpolito@emory.edu. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Conclusions-The PRESS score is a novel EMS screening tool for SS that demonstrates a sensitivity of 86% and specificity of 47%. Additional validation is needed before this tool can be recommended for widespread clinical use. HHS Public Access

Introduction Sports participation is among the leading causes of catastrophic cervical spine injury (CSI) in the United States. Appropriate prehospital care for athletes with suspected CSIs should be available at all levels of sport. The goal of this project was to develop a set of best-practice recommendations appropriate for athletic trainers, emergency responders, sports medicine and emergency physicians, and others engaged in caring for athletes with suspected CSIs. Methods A consensus-driven approach (RAND/UCLA method) in combination with a systematic review of the available literature was used to identify key research questions and develop conclusions and recommendations on the prehospital care of the spine-injured athlete. A diverse panel of experts, including members of the National Athletic Trainers' Association, the National Collegiate Athletic Association, and the Sports Institute at UW Medicine participated in 4 Delphi rounds and a 2-day nominal group technique meeting. The systematic review involved 2 independent reviewers and 4 rounds of blinded review. Results The Delphi process identified 8 key questions to be answered by the systematic review. The systematic review comprised 1544 studies, 49 of which were included in the final full-text review. Using the results of the systematic review as a shared evidence base, the nominal group technique meeting created and refined conclusions and recommendations until consensus was achieved. Conclusions These conclusions and recommendations represent a pragmatic approach, balancing expert experiences and the available scientific evidence.

Introduction: Sports participation is among the leading causes of catastrophic cervical spine injury (CSI) in the United States. Appropriate prehospital care for athletes with suspected CSIs should be available at all levels of sport. The goal of this project was to develop a set of best-practice recommendations appropriate for athletic trainers, emergency responders, sports medicine and emergency physicians, and others engaged in caring for athletes with suspected CSIs. Methods: A consensus-driven approach (RAND/UCLA method) in combination with a systematic review of the available literature was used to identify key research questions and develop conclusions and recommendations on the prehospital care of the spine-injured athlete. A diverse panel of experts, including members of the National Athletic Trainers' Association, the National Collegiate Athletic Association, and the Sports Institute at UW Medicine participated in 4 Delphi rounds and a 2-day nominal group technique (NGT) meeting. The systematic review involved 2 independent reviewers and 4 rounds of blinded review. Results: The Delphi process identified 8 key questions to be answered by the systematic review. The systematic review comprised 1544 studies, 49 of which were included in the final full-text review. Using the results of the systematic review as a shared evidence base, the NGT meeting created and refined conclusions and recommendations until consensus was achieved. Conclusions: These conclusions and recommendations represent a pragmatic approach, balancing expert experiences and the available scientific evidence.

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This article is a response to the review of Adrian et al. (2018) by Yudaeva (2018), which summarizes the case of the Bank of Russia against the publication of key rate forecasts, a communication strategy known as conventional forward guidance. We believe that the case in favour of publishing the Bank of Russia'a key rate forecast is at present not stated sufficiently coherently. Our note attempts to fill this gap. Extending the argument put forward by Adrian et al. (2018) we provide a comprehensive review of the working papers, staff notes, and leadership comments related to interest rate expectations and monetary policy communication by four central banks that have had practical experience with the application of conventional forward guidance. We conclude with an evaluation of the validity of the commonly voiced concerns regarding its adoption in Russia, based on the reviewed literature.