bluuebunny/crossref_metadata_2025 huggingface dataset:
Focus group study on perceptions and information needs regarding vaccines targeting the older population: a cross-country comparison in four European countries
Authors: Wennekes Manuela Dominique , Eilers Renske , Caputo Antonella , Gagneux-Brunon Amandine , Gavioli Riccardo , Nicoli Francesco , Vokó Zoltán , Timen Aura ,   on behalf of the VITAL Consortium, Gagneux-Brunon Amandine , Czwarno Anna , Caputo Antonella , Abelin Atika , Timen Aura , Angelin-Duclos Cristina , Botelho-Nevers Elisabeth , Baron-Papillon Florence , Nicoli Francesco , Wennekes Manuela , Syrochkina Maria , Stein Mart , Stephane Paul , Eilers Renske , Gavioli Riccardo , Quilici Sibilia , Lewin Simon , Sergerie Yan , Vokó Zoltán , van Baarle Debbie , Janimak Jim
Published: November 2022

The increasing life expectancy leads to more older adults suffering from infectious diseases. Vaccines are available against diverse infections such as influenza, pneumococcal disease, herpes zoster and tetanus. However, vaccine acceptance is crucial for optimal preventive effect. The objective of the study is to perform a cross-country analysis of the perceptions and decision-making behaviour of older adults regarding vaccinations and their information needs. Focus groups with older adults were conducted in four countries: France, Hungary, Italy and the Netherlands. Data were analysed using thematic analysis. Demographic characteristics of participants were gathered with a questionnaire. Influenza and tetanus vaccines were commonly known, as was the disease influenza. On the contrary, the awareness of the vaccines against pneumococcal disease and herpes zoster were low. Participants also expressed a need for more information on vaccines, such as possible side effects, contra-indications and duration of protection, emphasizing that information is a condition for decision-making on vaccination. General practitioners were found to be the most important in information provision on vaccines. Perceptions on vaccines, such as effectiveness, side effects and safety, as well as perceptions on infectious diseases, such as severity, susceptibility and experiencing an infectious disease, played a role in the decision-making of older adults on vaccines. More awareness of the information needs among older adults with regard to vaccines should be raised among general practitioners and other healthcare providers. This requires appropriate knowledge about the vaccines among healthcare providers as well as communication skills to meet the information needs of older adults.
WHO approves? Relative trust, the WHO, and China’s COVID-19 vaccines
Authors: Sheen Greg Chih-Hsin , Tung Hans H. , Wu Chien-Huei , Wu Wen-Chin
Published: November 2022

This paper aims to answer a general question: whether an international organization (IO) is able to shape public opinion in the context of the COVID-19 pandemic. Since the pandemic took hold in early 2020, countries across the globe have switched gear from prevention to vaccination. Most had to not only secure a sufficient supply of vaccines, but also to curb vaccine hesitancy among their populations. Can endorsement by an international organization like the World Health Organization (WHO) enhance a vaccine’s acceptability? Based on a survey experiment conducted in Taiwan, our study leverages the special relationship between China and Taiwan to show that WHO endorsement can induce acceptance of Chinese vaccines among Taiwanese people. However, the effect is found to be contextual in the sense that it only works when people’s trust in the WHO is higher than their trust in the vaccine’s country of origin. Our study not only contributes to the literature of IO legitimacy by empirically showing IOs’ causal effects on public opinion, but also sheds light on how a vaccine’s credibility can be enhanced to promote vaccination uptake.
Developments in the Treatment of Leber Hereditary Optic Neuropathy
Authors: Chen Benson S. , Yu-Wai-Man Patrick , Newman Nancy J.
Published: November 2022

Purposeof Review

To outline the current landscape of treatments for Leber hereditary optic neuropathy (LHON) along the therapeutic delivery pipeline, exploring the mechanisms of action and evidence for these therapeutic approaches.

Recent Findings

Treatments for LHON can be broadly classified as either mutation-specific or mutation-independent. Mutation-specific therapies aim to correct the underlying mutation through the use of a gene-editing platform or replace the faulty mitochondrial DNA-encoded protein by delivering the wild-type gene using a suitable vector. Recent gene therapy clinical trials assessing the efficacy of allotopically expressed MT-ND4 for the treatment of LHON due to the m.11778G > A mutation in MT-ND4 have shown positive results when treated within 12 months of symptom onset. Mutation-independent therapies can have various downstream targets that aim to improve mitochondrial respiration, reduce mitochondrial stress, inhibit or delay retinal ganglion cell apoptosis, and/or promote retinal ganglion cell survival. Idebenone, a synthetic hydrosoluble analogue of co-enzyme Q10 (ubiquinone), is the only approved treatment for LHON. Mutation-independent approaches to gene therapy under pre-clinical investigation for other neurodegenerative disorders may have the potential to benefit patients with LHON.

Although approved treatments are presently limited, innovations in gene therapy and editing are driving the expansion of the therapeutic delivery pipeline for LHON.
Anaerobic Digestion and Microfiltration of the Liquid Fraction of Pig Slurry: N Mineralization, C-CO2 Emissions and Agricultural Value of the Products
Authors: Fernández-Labrada Miguel , López-Mosquera María Elvira , López-Fabal Adolfo
Published: November 2022

Pig slurry contains valuable nutrients and organic matter, although its high water content makes its management and use as a fertilizer more expensive. It is also an interesting bioenergy resource for biogas production. We propose a treatment that consists of solid–liquid separation followed by the anaerobic digestion of liquid fraction of slurry (LFS) while a microfiltration membrane module concentrates the solids in the digester and removes a liquid fraction of the digestate (LFD). The aims of the work were to evaluate the fertilizer value of the LFS, digestate and concentrated digestate and the possibility of reusing the LFD in agriculture. The LFS contained 72% less dry matter than the slurry. The solid–liquid separation mainly removed N and P. Thanks to microfiltration, the remaining solids were partially recirculated to the digester, concentrating there. To do this, the membrane module continuously removed the LFD, which was made up of 99% water with dissolved elements, mainly C, N, K and Na. The concentrated digestate contained less K, similar amounts of N and P, and more dry matter and C than the initial LFS. The entire slurry treatment affected the mineralization dynamics by increasing recalcitrant C and decreasing labile C without modifying N release. The proposed process allowed taking advantage of the nutrients and stabilized organic matter contained in the LFS, producing a concentrated digestate. LFD did not meet the reclaimed water requirements. However, it could be useful as a fertirrigation solution and a post treatment could be enough to comply with the regulations.

Graphical Abstract
XAINES: Explaining AI with Narratives
Authors: Hartmann Mareike , Du Han , Feldhus Nils , Kruijff-Korbayová Ivana , Sonntag Daniel
Published: November 2022

Artificial Intelligence (AI) systems are increasingly pervasive: Internet of Things, in-car intelligent devices, robots, and virtual assistants, and their large-scale adoption makes it necessary to explain their behaviour, for example to their users who are impacted by their decisions, or to their developers who need to ensure their functionality. This requires, on the one hand, to obtain an accurate representation of the chain of events that caused the system to behave in a certain way (e.g., to make a specific decision). On the other hand, this causal chain needs to be communicated to the users depending on their needs and expectations. In this phase of explanation delivery, allowing interaction between user and model has the potential to improve both model quality and user experience. The XAINES project investigates the explanation of AI systems through narratives targeted to the needs of a specific audience, focusing on two important aspects that are crucial for enabling successful explanation: generating and selecting appropriate explanation content, i.e. the information to be contained in the explanation, and delivering this information to the user in an appropriate way. In this article, we present the project’s roadmap towards enabling the explanation of AI with narratives.
Momordica charantia extracts obtained by ultrasound-assisted extraction inhibit the inflammatory pathways
Authors: Kim Ha-Rim , Noh Eun-Mi , Lee Seung-Hyeon , Lee Saerom , Kim Dong Hee , Lee Nam Hyouck , Kim Seon-Young , Park Mi Hee
Published: November 2022

Background

Momordica charantia is a member of the Cucurbitaceae family and has traditionally been used for medical nutritional therapy to cure diabetes, and its various biological properties have been reported. However, several studies have demonstrated that M. charantia may exert toxic or adverse effects under different conditions. In this study, we prepared an M. charantia extract using ultrasound-assisted extraction, which is a green technology, and verified its anti-inflammatory effects.

Objectives

The aim of this study was to investigate the anti-inflammatory effects of M. charantia extract using ultrasound-assisted extraction in LPS-induced Raw264.7 macrophages and explore the potential mechanism mediated by the MAPK/NF-κB signaling pathway.

Results

We found that the M. charantia extract was non-toxic up to a concentration of 500 μg/mL in Raw264.7 cells. We verified that treatment with M. charantia extract significantly reduced the production of nitric oxide and proinflammatory cytokines, including TNF-α, IL-1β, IL-2, and IL-6, in LPS-stimulated RAW264.7 cells. Moreover, the anti-inflammatory cytokine IL-10 was dramatically increased by treatment with the M. charantia extract. In addition, the phosphorylation of the transcription factor NF-κB, which modulates the production of inflammatory proteins, including JNK, ERK, and p38, was reduced by downregulation of the MAPK signaling pathway.

Conclusion

These results indicate that the M. charantia extract collected using an industrial ultrasonic system is non-toxic and has an anti-inflammatory effect through regulation of the NF-κB and MAPK pathways, suggesting that it can act as a therapeutic candidate for the treatment of inflammatory diseases.
Counting points on smooth plane quartics
Authors: Costa Edgar , Harvey David , Sutherland Andrew V.
Published: November 2022

We present efficient algorithms for counting points on a smooth plane quartic curve X modulo a prime p. We address both the case where X is defined over $${\mathbb {F}}_p$$

F
p

and the case where X is defined over $${\mathbb {Q}}$$
Q
and p is a prime of good reduction. We consider two approaches for computing $$\#X({\mathbb {F}}_p)$$

#
X
(

F
p

)

, one which runs in $$O(p\log p\log \log p)$$

O
(
p
log
p
log
log
p
)

time using $$O(\log p)$$

O
(
log
p
)

space and one which runs in $$O(p^{1/2}\log ^2p)$$

O
(

p

1
/
2

log
2

p
)

time using $$O(p^{1/2}\log p)$$

O
(

p

1
/
2

log
p
)

space. Both approaches yield algorithms that are faster in practice than existing methods. We also present average polynomial-time algorithms for $$X/{\mathbb {Q}}$$

X
/
Q

that compute $$\#X({\mathbb {F}}_p)$$

#
X
(

F
p

)

for good primes $$p\leqslant N$$

p
⩽
N

in $$O(N\log ^3 N)$$

O
(
N

log
3

N
)

time using O(N) space. These are the first practical implementations of average polynomial-time algorithms for curves that are not cyclic covers of $${\mathbb {P}}^1$$

P

1

, which in combination with previous results addresses all curves of genus $$g\leqslant 3$$

g
⩽
3

. Our algorithms also compute Cartier–Manin/Hasse–Witt matrices that may be of independent interest.
Enabling direct kinetic simulation of dense plasma plume expansion for laser ablation plasma thrusters
Authors: Chan Wai Hong Ronald , Boyd Iain D.
Published: November 2022

Laser ablation plasma thrusters are an emerging space propulsion concept that provides promise for lightweight payload delivery. Predicting the lifetime and performance of these thrusters hinges on a comprehensive characterization of the expansion dynamics of the ablated plasma plume. While state-of-the-art techniques for simulating plasmas are often particle-based, a grid-based direct kinetic solver confers advantages in such a transient and inhomogeneous problem by eliminating statistical noise. A direct kinetic solver including interparticle collisions is employed on a plume expansion model problem spanning one dimension each in configuration and velocity space. The high degree of thermodynamic nonequilibrium inherent in plume expansion is characterized, justifying the need for a kinetic rather than a hybrid or fluid solver. Thruster-relevant metrics such as the momentum flux are also computed. The plume dynamics are observed to be highly inhomogeneous in space with insufficient time for thermalization in the region preceding the expansion front, and the theoretical possibility of reducing the local grid resolution by up to two orders of magnitude at the far end of the domain is established. These grid-point requirements are verified via the employment of nonuniform grids of various expansion ratios, several of which also employ coarsening in velocity space. Longer domain lengths are explored to characterize thruster-scale phenomena and larger ambient pressures are simulated as a testbed to probe facility effects due to collisions with background particles.
Reproductive advance of fertility preservation in patients with early endometrial carcinoma or endometrial atypical hyperplasia
Authors: Yu Jiao , Zhang Yangyang , Yang Huixia , Xu Yang
Published: November 2022

Endometrial cancer (EC) is the fourth common cancer in women worldwide with its incidence rising each year. 10%–15% young patients are diagnosed of EC. For patients of childbearing age with early endometrial cancer or atypical hyperplasia, it is necessary to consider surgical removal of uterus after they have given birth. It is a big challenge for reproductive doctors and oncologists to help such patients get pregnant safely as soon as possible. In this article, we will review the latest progress in conservative treatment and candidates for fertility preservation, application of molecular detection, the fertility outcome and follow-up treatment which aims to stimulate more thinking.
'Thank you M. Monnet'
Authors: Griffiths Richard
Published: November 2022

This book collects contributions by Richard T. Griffiths on the history of European integration, some published for the first time in English. The essays range in chronology from the early experiences with the Marshall Plan to the difficulties and opportunities for the EFTA countries afforded by association with the EEC in the 1970s and 80s. The book interprets European integration far wider than simply the current European Union and its forerunners. Thus, it devotes chapters to EFTA, the OECD, and to issues as agriculture, cartels and monetary problems. The volume also contains the essay in the title which poses the question of what would have happened had there been no Schuman Plan back in 1950. This book should appeal to students of contemporary history, especially those interested in EU history, and to political scientists who will discover a rich palette of case studies upon which to test their theories. Its constructively critical slant on developments provides interesting perspectives to those general readers seeking a nuanced approach between the extremes of the current pro- or anti- in the debates on Europe.
Le développement économique des campagnes romaines dans le nord de la Gaule et l’île de Bretagne
Authors: Reddé Michel
Published: November 2022

Deux vastes enquêtes archéologiques récentes sur le monde rural de la Bretagne insulaire et de la Gaule du Nord à l’époque romaine offrent l’occasion de proposer une vision renouvelée des campagnes et de réfléchir sur les modalités de la croissance de l’économie antique dans les provinces du nord-ouest de l’Empire. Il apparaît aujourd’hui que celle-ci s’est appuyée sur un socle protohistorique déjà très solide et que la conquête n’a pas, en elle-même, provoqué des mutations immédiates ou de véritable boom économique. Le développement de l’agriculture s’apparente à un mouvement de long terme qui a atteint son pic au IIe siècle, avant de régresser doucement, ses limites ayant alors probablement été atteintes. L’émergence de la villa romaine, traditionnellement considérée comme le moteur du progrès, s’est faite plus lentement qu’on ne le pensait, et il s’agit maintenant de revenir sur l’opposition classique entre grands domaines réputés productifs et petites fermes vouées à l’autosuffisance. Les deux enquêtes menées de part et d’autre de la Manche ont en outre beaucoup insisté sur la diversité des systèmes agro-pastoraux observés. L’article se propose donc de réexaminer les indices de la croissance à l’aide de divers proxies (densité de l’occupation du sol, volume des greniers, taille des animaux), les possibles facteurs de l’essor économique (démographie en hausse, accroissement de la surface cultivée, méthodes de culture, meilleure productivité, nouveaux marchés) et le rythme du développement, tout en soulignant les limites de celui-ci et la différenciation régionale qui en a résulté.
Buoyancy-driven bubbly flows: scaling of velocities in bubble columns operated in the heterogeneous regime
Authors: Mezui Y. , Obligado M. , Cartellier A.
Published: November 2022

The hydrodynamics of bubble columns in the heterogeneous regime is revisited. Focusing on air–water systems at large aspect ratio, we show from dimensional analysis that buoyancy equilibrates inertia, and that velocities scale as

$(gD\varepsilon )^{1/2}$

, where

$D$

is the bubble column diameter,

$\varepsilon$

the void fraction and

$g$

the gravitational acceleration. From new experiments in a

$0.4$

m diameter column with

${{O}}(10^3)$

particle Reynolds number bubbles and from a detailed analysis of published data, we confirm the self-organization prevailing in the heterogeneous regime, and that the liquid flow rate is only set by the column diameter

$D$

. Besides, direct liquid and gas velocity measurements demonstrate that the relative velocity increases above the terminal velocity

$U_T$

in the heterogeneous regime, and that it tends to

${\sim }2.4 U_T$

at very large gas superficial velocities

$V_{sg}$

. The proposed velocity scaling is shown to hold for liquid and gas mean velocities and for their standard deviations. Furthermore, it is found to be valid over a wide range of conditions, corresponding to Froude numbers

$Fr=V_{sg}/(gD)^{1/2}$

from 0.02 to 0.5. Then, the relevance of this scaling for coalescing media is discussed. Moreover, following the successful prediction of the void fraction with a Zuber & Findlay approach at the beginning of the heterogeneous regime, we show how the void fraction is correlated with

$Fr$

. Further investigations are finally suggested to connect the increase in relative velocity with meso-scale structures known to exist in the heterogeneous regime.
High-fat diet consumption by male rat offspring of obese mothers exacerbates adipose tissue hypertrophy and metabolic alterations in adult life
Authors: Rodríguez-González Guadalupe L. , De Los Santos Sergio , Méndez-Sánchez Dayana , Reyes-Castro Luis A. , Ibáñez Carlos A. , Canto Patricia , Zambrano Elena
Published: November 2022

Obese mothers’ offspring develop obesity and metabolic alterations in adulthood. Poor postnatal dietary patterns also contribute to obesity and its comorbidities. We aimed to determine whether in obese mothers’ offspring an adverse postnatal environment, such as high-fat diet (HFD) consumption (second hit) exacerbates body fat accumulation, metabolic alterations and adipocyte size distribution. Female Wistar rats ate chow (C-5 %-fat) or HFD (maternal obesity (MO)-25 %-fat) from weaning until the end of lactation. Male offspring were weaned on either control (C/C and MO/C, maternal diet/offspring diet) or HFD (C/HF and MO/HF) diet. At 110 postnatal days, offspring were killed. Fat depots were excised to estimate adiposity index (AI). Serum glucose, triglyceride, leptin, insulin, insulin resistance index (HOMA-IR), corticosterone and dehydroepiandrosterone (DHEA) were determined. Adipocyte size distribution was evaluated in retroperitoneal fat. Body weight was similar in C/C and MO/C but higher in C/HF and MO/HF. AI, leptin, insulin and HOMA-IR were higher in MO/C and C/HF v. C/C but lower than MO/HF. Glucose increased in MO/HF v. MO/C. C/HF and MO/C had higher triglyceride and corticosterone than C/C, but lower corticosterone than MO/HF. DHEA and the DHEA/corticosterone ratio were lower in C/HF and MO/C v. C/C, but higher than MO/HF. Small adipocyte proportion decreased while large adipocyte proportions increased in MO/C and C/HF v. C/C and exacerbated in MO/HF v. C/HF. Postnatal consumption of a HFD by the offspring of obese mothers exacerbates body fat accumulation as well as the decrease of small and the increase of large adipocytes, which leads to larger metabolic abnormalities.
Bede, Bishops and Bisi of East Anglia: Questions of Chronology and Episcopal Consecration in the Historia Ecclesiastica gentis Anglorum
Authors: Platts Calum
Published: November 2022

This article examines a contradiction in Bede’s Historia Ecclesiastica between Bede’s own claims and the implications of the list of bishops in the conciliar document produced at the Synod of Hertford, concerning the date of Bisi’s consecration. Modern reconstructions of East Anglian episcopal chronology rely on Bede’s account. The article opens by considering Bede’s concern to identify episcopal consecrators, which led to the contradiction. The implications of the Synod of Hertford are then explored for dating East Anglia’s bishops and the consequent impact this has upon interpreting East Anglia’s royal chronology and the evangelization of the kingdom. This further exposes Bede’s motives for writing his history and how he constructed his narrative.
Building National Emergency Medical Teams in West Africa: Lessons Learnt and Challenges (2017-2022)
Authors: Lokossou Virgil Kuassi , Catraye Sedjro Onesime , Sogbossi Lionel
Published: November 2022

Background/Introduction:

The World Health Organization (WHO) Emergency Medical Teams (EMT) Initiative is an important mechanism for strengthening surge capacities for clinical care during public health emergencies (PHE) in West Africa. To enhance preparedness, response capacity, and resilience, the West African Health Organization (WAHO) helps countries to establish, manage, and strengthen essential EMT capacities with other partners.

Objectives:

We describe the EMT capacity-building experience in West Africa and highlight gaps and lessons learnt.

Method/Description:

We conducted a descriptive, cross-sectional assessment using data from regional and national EMT awareness workshops and other activities reports. We also administrated a questionnaire to a convenient sample of EMT stakeholders for identifying challenges and gaps in strengthening EMTs.

Results/Outcomes:

A total of 14 EMT awareness workshops have been performed in West Africa resulting in on-going implementation national actions plans. Member States were at different levels of implementation of their EMT’s action plan. Only one National EMT is fully operational. The main challenges in EMT implementation included lack of political will, lack of skilled workforce, lack of guidelines for developing SOPs, and inadequate funding for EMT operations. A total of 606 health workers have been trained including 492 males (80.92%). The trainees were public health specialists (44.90%), clinicians (15.80%), support staff (13.65%), and non-health actors (25,66%).

Conclusion:

Our study highlighted critical challenges to guide the EMT implementation in West Africa. Despite the knowledge gained from the trainings, there is a need to take some urgent actions in West Africa for improving national EMT functionality and performance in West Africa.
Establishing a National Emergency Medical Team (EMT) in Papua New Guinea (PNG)
Authors: Nou Garry G. , Casey Sean T. , Balasubramaniam B. Priya L.T.
Published: November 2022

Background/Introduction:

Papua New Guinea (PNG) is a Pacific nation of over nine million. It is one of the world’s most diverse nations, with over 800 languages and geographic diversity that includes both tropical islands and highland mountains. Located on the Pacific “ring of fire,” PNG is regularly struck by disasters and outbreaks. The COVID-19 pandemic triggered multiple deployments of international EMTs to PNG, which were coordinated through a national EMT Coordination Cell. To strengthen rapid, national response to future emergencies, the PNG Government through its National Department of Health is now developing the “PNG EMT.”

Objectives:

To describe the development of the PNG EMT.

Method/Description:

PNG’s national EMT development was inspired by multiple international EMT deployments, including the 2018 Highlands earthquake and multiple COVID-19 deployments. With support from WHO, PNG’s National Department of Health led EMT coordination efforts in those responses, and recognized the need for similar capabilities to be developed for national response.

Results/Outcomes:

To develop the PNG EMT, a focal point was appointed, a national technical working group was formed, and SOPs have been drafted with support from WHO and partners. In consultation with PNG and other Pacific EMTs, WHO is procuring a tailored Pacific EMT cache, including items specifically selected for PNG’s diverse geographic and climactic environments. PNG plans to train team members and be ready for self-sufficient national deployments by late 2022.

Conclusion:

PNG is strengthening readiness for future emergencies by developing a national EMT capable of rapid response to challenging and austere post-disaster environments.
Mapping Acute Care Systems’ Surge Capacity and Response Priorities – the ‘7S’ Framework Tool
Authors: Martin Bronte L.
Published: November 2022

Background/Introduction:

During health emergencies, significant disruptions occur concurrently within critical components of acute care systems such as workforce, medical supplies, clinical workflows, patient care pathways, and hospital essential support services. The ability to map both existing and surge capacities across the acute care health system is a complex, nuanced, and often lengthy process which is heavily dependent upon localized knowledge applied in specific, individual contexts.

Objectives:

Outline an innovative, “All Hazards” tool developed through a standardized framework approach to rapidly and consistently identify, assess, and prioritize key system-wide health capacity indicators in acute care hospital settings during health emergencies.

Method/Description:

Initially designed as a health systems preparedness and planning tool for use in sudden-onset disasters in 2017, the “7S” framework has been successfully applied during recent AUSMAT outbreak emergency responses to assist local Ministries of Health to effectively identify, articulate, rationalize, and prioritize clinical and operational health response priorities.

Results/Outcomes:

Multiple operational health leaders found the “7S” framework valuable in efficiently managing both the assessment of and priority allocation of resources in health systems under duress. The tool was simple to understand and explain, time efficient, and comprehensive. Additionally, the tool provided an effective structure for communicating with local health and response leaders.

Conclusion:

The “7S” framework has demonstrated excellent utility as a highly effective and scalable, locally adapted “All Hazards” tool for use during health planning, preparedness, and acute care response phases in diverse health emergencies contexts.
The Ethical Triage and Management Guidelines of the Entrapped and Mangled Extremity in Resource Scarce Environments: A Systematic Literature Review
Authors: Weinstein Eric S. , Gosney James E. , Hebert Teri Lynn , Weinstein Brielle , Ragazzoni Luca
Published: November 2022

Background/Introduction:

While there are accepted triage and treatment guidelines for the entrapped and mangled extremity in civilian and military resource rich environments, there are none for resource-scarce environments.

Objectives:

A PRISMA systematic literature review was performed to elucidate the current triage and treatment of the entrapped and mangled extremity to understand the factors that contribute to the decision to amputate, or not amputate, and to extract data to develop clinical guidelines.

Method/Description:

A lead researcher followed the PRISMA systematic literature review search strategy inclusion and exclusion criteria.

A first reviewer was randomly assigned sources. One of the two lead researchers was the second reviewer. Each determined the Level of Evidence (LOE) and Quality of Evidence (QE) from each source.

Results/Outcomes:

Five-hundred ninety-seven (597) records were screened. Fifty-eight (58) articles were entered into the final study. There was one study determined to be LOE-1, 29 LOE-2, and 28 LOE-3 with 15 determined to achieve QE-1, 37 QE-2, and six QE-3.

Data extracted included relevant information to develop clinical guidelines to include physiologic parameters, injury patterns or procedures, imaging, rehabilitation, ethics, and the informed consent process.

Conclusion:

This systematic literature review showed that there is a lack of studies producing strong evidence to support the triage and treatment of an entrapped or mangled extremity in resource-scarce environments. A Delphi method study is suggested to adapt and modify available evidence extracted to create clinical guidelines in the resource-scarce environment.
Stress and Burnout Levels among Emergency Medical Technicians Working during COVID-19 Pandemic: A Cross-Sectional Study in Spain
Authors: Amor Tahreer , Delgado Rafael , González Pedro , Viñuales Eduardo
Published: November 2022

Background/Introduction:

Among all health care workers, EMTs have played a notable role during COVID-19; working as a frontline, they faced many challenges, including working overload and an extremely cautious environment that requires a rapid and precise response, which led to experiencing higher severity of mental health symptoms.

Objectives:

To explore the association between stress and burnout among EMTs while working during the COVID-19 pandemic.

Method/Description:

A cross-sectional quantitative study with a descriptive design. It was conducted from March-April 2021 on 280 Spanish EMTs, using an online survey of 42 items about workload and working conditions during COVID-19 and other variables specific to COVID-19. The Perceived Stress Scale (PSS), Maslach Burnout Inventory (MBI), and Pearson’s correlation coefficient were used to determine the relationships between the variables.

Results/Outcomes:

The study revealed a moderate positive correlation between the perceived level of stress and burnout among the EMTs. Specifically, findings showed a strong positive correlation between stress and EE (0.62) and a moderate positive correlation with DP (0.48). However, it found a moderate negative correlation between the level of stress and the third subdimension of burnout, PA (0.45), where the increase in the stress level correlated with a decrease in PA of the EMTs.

Conclusion:

Burnout might be related to the persistent stress of the EMTs working during the COVID-19 pandemic, considering their work conditions and the socio-demographic variables. The mental health of the first responders is crucial, as it influences their achievement and works satisfaction, and it might affect the quality of the service they provide.

Tables and Figures (optional)

Table 1.

Pearson Correlation: Correlation between the Stress and Burnout among the Emergency Medical Technicians (n = 280)
Mental Health in Disaster Medical Response Teams: An Assessment of Existing Resources and Applications for Telemedicine
Authors: Woodward Christina A. , Voskanyan Amalia , Benham Todd L. , Issa Fadi S. , Hart Alexander , Ciottone Gregory R.
Published: November 2022

Background/Introduction:

Disaster responders operate in situations that are cognitively, emotionally, and morally distressing. The prevalence of mental health sequelae amongst disaster responders is well-documented. The World Health Organization (WHO) has published minimum standards for Emergency Medical Teams (EMTs), which requires them to assess the mental health and psychosocial support needs of their patients and staff, provide first aid, and ensure referral pathways for follow-up care are available. Specific to EMT staff and volunteers, the standards require that support services are always accessible. However, there is no requirement for EMTs to have their own mental health specialists, nor is having a mental health specialist assigned to each team and mission necessarily practical.

Objectives:

This study will assess the existing mental health resources of WHO EMTs and their use of telemedicine in mental health care.

Method/Description:

A survey will be distributed to the leadership of all WHO EMTs that are currently credentialed to capture descriptive statistics.

Results/Outcomes:

Data expected to be collected and analyzed by October 1, 2022.

Conclusion:

The absence of a mental health specialist significantly limits the availability of support services for EMT personnel. Given that the use of telemedicine in both disaster response and mental health services has been well-documented, telemedicine could be a low-resource method to link WHO EMT staff and volunteers with mental health specialists throughout the deployment cycle.
Tonga’s National EMT Response to the Hunga-Tonga Hunga-Ha’apai Volcanic Eruption and Tsunami
Authors: Poloniati Penisimani , Akauola Ana , Fusi Sela K. , Setoya Yutaro , Tavo Kaloafo , Casey Sean T.
Published: November 2022

Background/Introduction:

The Tonga Emergency Medical Assistance Team (TEMAT) responded to the Hunga Tonga-Hunga Ha’apai (HTHH) volcano and tsunami in early 2022. The HTHH volcano erupted violently on January 15, 2022 triggering a tsunami that struck many of Tonga’s 169 islands.1 84% of the country’s population was affected.2 Tonga’s undersea internet cable was cut, stopping most communication. At the time of the eruption/tsunami, Tonga was COVID-19-free with its borders effectively closed, forcing reliance on national emergency resources, including TEMAT.

Objectives:

Describe TEMAT’s response to the 2022 HTHH volcano eruption and tsunami.

Method/Description:

TEMAT deployed four rotations of clinical and public health teams in response to the eruption/tsunami. Team members included clinicians from the Ministry of Health, with logistics support from His Majesty’s Armed Forces. TEMAT carried out emergency assessments, facilitated medical evacuations, aided in the evacuation of an entire island’s population, and provided essential health services.

Results/Outcomes:

From January 17 through March 4, 2022, TEMAT cared for 381 patients including patients with non-communicable diseases (>50), psychosocial complaints (39), communicable diseases (27), and traumatic injuries (13). The team supported five referrals to higher level care, conducted patients home visits, aided in health center repairs, and responded to a boat sinking during their deployment.

Conclusion:

TEMAT’s deployment demonstrates that deployment-ready and self-sufficient national EMTs are essential for response to sudden-onset disasters in vulnerable countries. A trained and well-prepared national EMT can respond independently, quickly, and effectively to emergencies, despite limited resources and high-impact events.
Review of the Senegalese Military Emergency Medical Team (EMT) Deployment Following a Tanker Explosion in Freetown, Sierra Leone
Authors: Kamara Rashidatu Fouad , Oyugi Boniface , Kamara Ibrahim Franklyn , Kabba Mustapha , Relan Pryanka , Baldé Thierno
Published: November 2022

Background/Introduction:

In November 2021, a tanker exploded in Freetown, injuring and killing people. The WHO facilitated a seven-week first deployment of the Senegalese military to support the Ministry of Health (MOH) in providing care to the wounded in three referral hospitals.

Objectives:

Review the deployed team’s processes and outputs of medical care provided to burns patients.

Method/Description:

This is a cross-sectional After-Action Review (AAR) debrief of the deployment, including the WHO and MOH staff (n =14) in a virtual workshop. Six thematic areas: mobilization, deployment, coordination, case management activities, national capacity, and community acceptance were analyzed.

Results/Outcomes:

The WHO facilitated the team’s deployment and mobilized medical supplies and equipment whilst the MOH provided accommodation and logistics through collaboration. The team dispensed their functions with professionalism, adapted to the environment and available resources, and augmented the care provided by the available health workers. They offered additional care: reconstructive surgery, pain management, palliative and wound care, rehabilitation, physiotherapy, and psychosocial counselling, which were initially inadequate. 87 out of 155 patients were discharged home at the end, the national clinicians acquired additional skills, and the community appreciated the team. Despite being perceived as a weakness, the language barrier did not hinder the patient-doctor/nurse relationship or the provision of clinical care.

Conclusion:

This sub-regional response had significant benefits, including speed, political acceptability, and health context experience to support rapid and safe deployment. Mechanisms to facilitate rapid and quality-assured deployment of EMTs at regional and sub-regional levels in collaboration with WHO should be strengthened in region to support future responses.
Establishing a National Emergency Medical Team in the Republic of Palau
Authors: Uherbelau Gaafar J. , Mekoll Ngirachisau , Omengkar Wally , Casey Sean T. , Noste Erin E. , Ferguson May M.
Published: November 2022

Background/Introduction:

Palau is a small island/large ocean nation in the Pacific with a population of approximately 18,000 and a high level of vulnerability to natural or climate-related disasters. In June 2022, Palau became the smallest nation in the world by population to establish a national Emergency Medical Team (EMT). The team is named “Klemat,” after the rope that holds the sails of Palau’s traditional canoes.

Objectives:

To establish a national EMT capable of self-sufficient, high-quality clinical response to disasters and outbreaks that may occur locally or in neighboring jurisdictions.

Method/Description:

The development of Klemat required a multi-step process with support from technical and funding partners. Online orientation webinars and meetings were held in 2019 and 2020, and a national Technical Working Group (TWG) was formed in 2022. A national EMT coordinator was jointly hired by the WHO and the Ministry of Health and Human Services of Palau in 2022, and EMT Standard Operating Procedures were drafted.

Results/Outcomes:

Klemat is the nation’s deployable clinical response capacity, capable of fully self-sufficient tented out-patient and emergency care in the most austere disaster or outbreak circumstances. There are now 18 fully trained clinical and support team members. Klemat is working with relevant stakeholders to be codified in the national disaster risk management framework of Palau.

Conclusion:

Palau’s development of a national EMT demonstrates that even the smallest of countries can establish self-sufficient EMTs capable of national or regional response.
Multi-Agency Collaboration Leading to WHO EMT Classification: The Korea Disaster Relief Team
Authors: Choi Eun-Young , Choi Wonmi , Ko Ara , Oh Yigyeong , Kwak Hyemin , Jung Eui Yup
Published: November 2022

Background/Introduction:

The Korea Disaster Relief Team (KDRT) was established in 2008 to systemize Korea’s overseas medical emergency response. Following multiple international deployments since 2008, KDRT embarked on its journey to achieve WHO Emergency Medical Team (EMT) Global Classification in 2017.

Objectives:

To outline the key success factors in KDRT’s work to reach classification as a Type 1 Fixed EMT.

Method/Description:

As the Korean government dispatches KDRT, a multi-agency collaboration is essential to respond to overseas disasters. To this end, KDRT leveraged a formal collaborative approach, assigning specific roles for EMT development and deployment to several national agencies: The Republic of Korea Ministry of Foreign Affairs, the Ministry of Health and Welfare, the Ministry of National Defense, the Korea International Cooperation Agency, Korea’s National Medical Center, and the Korea Foundation for International Healthcare. This network prepared KDRT for WHO EMT Verification and developing Standard Operation Procedures for the EMT Type 1. Based on this SOP, KDRT repeated simulations for each element to strengthening capabilities and enable deployment ensuring strong coordination with national and international partners in response.

Results/Outcomes:

After initiating KDRT’s journey towards EMT classification 2017, KDRT formalized cooperation with multiple agencies, and codified these roles and responsibilities in formal/published SOPs. Finally, the KDRT was verified by WHO in June 2022.

Conclusion:

This study provides a process within the operating system limited to the Republic of Korea, the country of the KDRT. However, it also can be used as a collaborative reference case in the EMT development and verification process.
Health Care Systems on the Brink of Failure – The Impact of War on the Pattern of Emergency Health Care Visits by Ukrainian Refugees in Poland
Authors: Goniewicz Krzysztof , Hertelendy Attila J. , Khorram-Manesh Amir
Published: November 2022

Background/Introduction:

One of the most severe outcomes of the Ukraine war has been the systematic destruction of communities resulting in mass migration of people to Poland. Millions of affected people have arrived in Poland as war refugees requiring medical attention from a fragile health care system overburdened by the COVID-19 pandemic. This study assesses ED utilization in Polish hospitals by Ukrainian refugees.

Objectives:

To assess the impact of Ukrainian refugees on ED utilization in Poland.

Method/Description:

Demographic data, chief presenting complaints, diagnosis, and the level of care needed were registered. Bivariate and multivariate logistic regression analysis were performed to yield odds ratios (OR) with a 95% confidence interval.

Results/Outcomes:

At the time of investigation, there were 4,000 Ukrainian refugees admitted to Polish hospitals, of which more than half were children. Results are forthcoming.

Conclusion:

Although COVID-19 pandemic highlighted the insufficiency of the Polish health care system, resulting in delayed treatment for many patients, the current mass migration from Ukraine emphasizes the lack of a proper organization for crisis management in Poland. Facing an unprecedented and historic challenge, the Polish health care system, operating at the limit of its capacity, is stretched beyond capacity resulting in excess mortality, which exceeded 200,000 deaths during the pandemic. The impact was directly due to the pandemic or the delay in treating other diseases such as cardiovascular diseases and cancer. Inconsistency in medical decision making, lack of proper recommendations from the authorities, and organizational insufficiency requires a renewed focus on adaptive capacity and long-term solutions that promote systems resiliency.
Emergency Medical Teams (EMT) Education and Training – Improving Disaster Preparedness with the Portuguese Emergency Medical Team (PT EMT) E-Learning Course
Authors: Ladeira Luis Manuel , Cardoso Ivo Manuel , Correia Ana Margarida , Rato Fátima
Published: November 2022

Background/Introduction:

EMT’s training is considered of high importance for disaster preparedness and response. The PT EMT, joined the TEAMS 3.0 Consortium, seeking to develop a universal training program for EMTs.

Objectives:

The purpose of this study is to evaluate the effectiveness of the PT EMT E-learning Course in preparing trainees for disaster during their EMT initial training.

Method/Description:

The analyzed data were collected through the application of a final questionnaire, which aimed to assess the effectiveness of the topics covered and the self-perception of disaster preparedness. A total of 31 trainees attended the E-learning Course, but only 25 answers were collected.

Results/Outcomes:

The results showed that 92% of the trainees considered as the most important themes three areas: (1) Disaster and Humanitarian Principles; (2) Safety & Self-Protection; and (3) Disaster Logistics. The overall mean score was 4.52 points (SD = 0.770) out of five for the importance of this training for the performance of their mission roles and 4.48 points (SD = 0.770) in the contribution of these contents to their individual development. After completing this E-learning module, 88% consider themselves better prepared to disaster response and to attend the practical module of the initial training program.

Conclusion:

The PT EMT E-learning Course, preceding the practical TEAMS 3.0 course, proved to be effective in the preparation of trainees for the practical training, but especially, it adds a huge variety of important knowledge, solidifying their preparedness for disaster response.

The development of common training bases for EMTs, with both modules, will improve the disaster preparedness and response.
Opportunity Cost Analysis for Emergency Medical Teams: A Tool for Policy Making Support
Authors: Negrette Juan Carlos
Published: November 2022

Background/Introduction:

To some planners, allocating resources for emergency response may look unnecessary if not wasteful. Low-probability events can be perceived as unlikely, and for that reason, not worth considering within the regular planning structure. This is almost a dictum when planners must operate in a low-resource setting, where competition for available resources favors an approach that focuses in addressing pressing, not eventual needs.

Objectives:

Understanding this context, it is also important for planners to consider the importance of systemic resiliency, implicit in the early utilization of Emergency Medical Teams for disasters mitigation, and for that reason, as necessary instruments to reduce impact - in terms of lives lost - and cost - financial and social - of medical emergencies that result from natural and man-made disasters.

Method/Description:

Conducting an adverted DALYs cost analysis of a recent disaster is an instrument that could help policy, decision makers, and planners in general gain greater visualization of the potential social and financial costs reduction associated to the implementation of EMTs and, as a corollary, acknowledge the importance of preparation for necessary systemic resilience and its impact in equity and societal well-being.

Results/Outcomes:

Initial analysis shows that preparation for early responses by EMTs to mitigate disasters can result in lower costs while reducing overall mortality and morbidity and potentially favoring faster systemic recovery.

Conclusion:

The approach utilized requires improvement and expanded discussion with experts and beneficiaries will most likely result in its refinement and advancement.