bluuebunny/crossref_metadata_2025 huggingface dataset:
Influence of Low‐Intensity Repeated Impacts on Energy Absorption and Vibration Transmissibility of Honeycomb Paperboard
Authors: Wang Zhi‐Wei , Wang Li‐Jun , Xu Chen‐Yi , Zhang Yan
Published: August 2016

Packaging products in logistics typically will receive multiple low‐intensity repeated impacts, fewer moderate to high‐intensity impacts and vibration. As a result of low‐intensity repeated impacts, local buckling and fold will be formed in honeycomb paperboard, and its cushioning performance will be weakened. This paper investigates the influence of low‐intensity repeated impacts on the cushioning performance of honeycomb paperboard. The low‐intensity repeated impacts with dropping height 5 cm were conducted at first. Then, the moderate‐intensity impact with dropping height 80 cm and vibration experiment were, respectively, conducted. The results show: (a) honeycomb paperboard absorbs the energy produced by low‐intensity repeated impacts through layer upon layer folding of honeycomb structure. The highest buckling peak turns up in low‐intensity impact, followed by a series of buckling in intact honeycomb paperboard. However, the buckling is not obvious in repeated impacts; (b) the load carrying capacity of honeycomb paperboard after low‐intensity repeated impacts declines significantly. Three deformation stages are observed in the load–displacement curve. Most of impact energy is absorbed in the plateau stage. The absorbed energy of damaged honeycomb paperboard under moderate‐intensity impact decreases with the increasing of low‐intensity impact repetitions; and (c) the low‐intensity repeated impacts have an obvious influence on the resonance frequency of packaging product and stiffness of honeycomb paperboard. To confirm vibration properties of product using honeycomb paperboard cushioning, it should be considered in a designing process that honeycomb paperboard changes soften more in logistics. Copyright © 2016 John Wiley & Sons, Ltd.
Growth, Condition and Survival of Three Forage Fish Species Exposed to Two Different Experimental Hydropeaking Regimes in a Regulated River
Authors: Kelly B. , Smokorowski K. E. , Power M.
Published: August 2016

Hydroelectric dam operation can alter discharge and temperature patterns, impacting fish populations downstream. Previous investigations into the effects of river regulation on fish have focused on a single species within a river, yet different results among studies suggest the potential for species‐specific impacts. Here, we compare the impacts of two different hydropeaking regimes relative to a naturally flowing river on three ecologically important members of the forage fish community: longnose dace (Rhinichthys cataractae), slimy sculpin (Cottus cognatus) and trout‐perch (Percopsis omiscomaycus). Annual growth, estimated from otolith back‐calculations, was higher for each of the species in the regulated river relative to the naturally flowing river but did not differ between hydropeaking regimes. Condition was assessed using weight–length relationships and differed between rivers for each species, and between hydropeaking regimes for longnose dace and slimy sculpin. Survival of longnose dace and slimy sculpin was lower in the regulated river relative to the naturally flowing river, but comparable between rivers for trout‐perch. Annual growth was significantly related to mean summer discharge in the regulated river and to mean summer water temperature in the naturally flowing river for each species, and significantly different slopes among species indicate species‐specific responses to discharge and temperature alterations. This study demonstrates different biological responses among fish species within rivers to regulation in general, as well as to specific hydropeaking regimes. Future studies should focus on multiple species and multiple indicators of fish health to more fully characterize the impacts of river regulation on downstream fish communities. Copyright © 2016 John Wiley & Sons, Ltd.
Improving malware detection using multi‐view ensemble learning
Authors: Bai Jinrong , Wang Junfeng
Published: August 2016

The huge influx of new malware is created every day, and those malware have not been previously seen in the wild. Current anti‐virus software uses byte signature to identify known malware and has little hope of identifying new malware. Researchers have proposed several malware detection methods based on byte n‐grams, opcode n‐grams, and format information, and those methods partially capture the distinguishable information between benign and malicious programs. In this study, we design two schemes to incorporate the aforementioned three single‐view features and fully exploit complementary information of those features to discover the true nature of a program. Two datasets are used to evaluate new malware detection performance and generalization performance of the proposed schemes. Experimental results indicate that the proposed schemes increase the detection rate of new malware, improve the generalization performance of learning model, and reduce the false alarm rate to 0%. Because malware is hard to disguise itself in every feature view, the proposed schemes are more robust and not easy to be deceived. Copyright © 2016 John Wiley & Sons, Ltd.
Polycarbonate Composites Containing Carbon Encapsulated “Brick‐Like” Fe3O4 Nanoparticles as Efficient Microwave Absorbers with a Large Bandwidth
Authors: Pawar Shital P. , Gandi Mounika , Saraf Chinmay , Bose Suryasarathi
Published: August 2016

This study demonstrates lightweight microwave absorber materials designed using polycarbonate (PC) nanocomposites containing multiwall carbon nanotubes (MWNTs) and “brick‐like” lossy magnetic ferrite (Fe3O4) nanoparticles encapsulated with carbon (Fe3O4@C). The designed nanocomposites manifested in exceptional microwave attenuation through absorption (89 %). The unique strategy, of encapsulating ferrites with C, adopted here prevents the disruption of conducting pathway facilitated through the network of MWNTs and overcomes the eddy current effects. In addition, this strategy further led to improved dispersion of ferrites in PC matrix which rather agglomerates during processing. Unlike classical electromagnetic interference (EMI) shielding materials, the PC nanocomposites containing MWNTs and Fe3O4@C resulted in exceptional microwave attenuation in a broad frequency range and mostly through absorption. The absorption ability of these nanocomposites was further assessed by evaluating the reflection loss (RL). For instance, PC nanocomposites containing MWNTs and Fe3O4@C nanoparticles depicted in an exceptional RL of −41.3 dB at 17.7 GHz and with a remarkable bandwidth of 4.4 GHz for a thickness of 1 mm. Unlike previous studies where RL was improved by sacrificing dielectric losses, herein, the adopted strategy enhances both dielectric losses facilitating in enhanced total shielding effectiveness (SET) and RL through suitable impedance matching. This further result in excellent absorption. Therefore, this study provides comprehensive understanding about tailoring the complex microwave properties of the polymer nanocomposites in order to achieve enhanced microwave absorption.
Outcome of Laparoscopic Treatment of Anorectal Malformations in Children
Authors: Minaev Sergey V. , Kirgizov Igor V. , Gladkyy Aleksander , Shishkin Ilya , Gerasimenko Igor
Published: August 2016

Background

Operative correction of anorectal malformations (ARMs) remains a challenge in pediatric surgery. The study aimed to evaluate the outcomes of laparoscopic treatment of ARM in children.

Methods

From 2007 to 2014, we performed 104 laparoscopic‐assisted anorectal pull‐through procedures in children with a mean age of 11.3 ± 0.4 months and ARMs. Clinical assessment, surgical durations, complications, and postoperative outcome were investigated.

Results

The mean duration of the operation was 126.5 ± 17.2 min. Mean intraoperative bleeding was 20 ± 5.7 g. Three (2.9 %) children required conversion to laparotomy. One (0.9 %) child developed a pelvic abscess, requiring an additional intervention. Three to six months after laparoscopic‐assisted anorectal pull‐through, 72 patients were hospitalized for stoma closure. Good functional results were achieved in 39 (54.2 %) patients. On examination of the perineum, 11 (15.3 %) patients were found to have mucosal prolapse. The circular symmetric anal reflex to tactile stimulation was confirmed in 53 (73.6 %) patients and a tactile weakened anal reflex in 5 (6.9 %) children. At the 1‐year follow‐up, constipation was present in nine (12.5 %) patients and soling in two (2.8 %) patients. A barium enema study performed after the operation showed good outcomes in 67 (93.1 %) patients and fair outcomes in 5 (6.9 %) patients. None had a poor outcome.

Conclusions

Our experience confirms that laparoscopic‐assisted anorectal pull‐through enabled complete correction of ARM in the meanwhile avoiding damage to the rectum and anus. Also, the technique of double bipolar myostimulation of muscle complex in laparoscopic ARM might lead to these better results.
Metagenomic applications in environmental monitoring and bioremediation
Authors: Techtmann Stephen M , Hazen Terry C
Published: August 2016

With the rapid advances in sequencing technology, the cost of sequencing has dramatically dropped and the scale of sequencing projects has increased accordingly. This has provided the opportunity for the routine use of sequencing techniques in the monitoring of environmental microbes. While metagenomic applications have been routinely applied to better understand the ecology and diversity of microbes, their use in environmental monitoring and bioremediation is increasingly common. In this review we seek to provide an overview of some of the metagenomic techniques used in environmental systems biology, addressing their application and limitation. We will also provide several recent examples of the application of metagenomics to bioremediation. We discuss examples where microbial communities have been used to predict the presence and extent of contamination, examples of how metagenomics can be used to characterize the process of natural attenuation by unculturable microbes, as well as examples detailing the use of metagenomics to understand the impact of biostimulation on microbial communities.
Impact of long‐term elosulfase alfa treatment on respiratory function in patients with Morquio A syndrome
Authors: Hendriksz Christian J. , Berger Kenneth I. , Parini Rossella , AlSayed Moeenaldeen D. , Raiman Julian , Giugliani Roberto , Mitchell John J. , Burton Barbara K. , Guelbert Norberto , Stewart Fiona , Hughes Derralynn A. , Matousek Robert , Jurecki Elaina , Decker Celeste , Harmatz Paul R.
Published: August 2016

Objective

To present long‐term respiratory function outcomes from an open‐label, multi‐center, phase 3 extension study (MOR‐005) of elosulfase alfa enzyme replacement therapy (ERT) in patients with Morquio A syndrome.

Methods

In part 1 of MOR‐005, patients initially randomized to ERT in the 24‐week pivotal study (MOR‐004) remained on their regimen (2.0 mg/kg/week or every other week); placebo patients were re‐randomized to one of the two regimens. During part 2, all patients received elosulfase alfa 2.0 mg/kg/week. Respiratory function was one of the efficacy endpoints evaluated in MOR‐005. Change from MOR‐004 baseline to 120 weeks of treatment for the combined population was determined and compared with results from untreated patients from a Morquio A natural history study (MorCAP).

Results

Maximum voluntary ventilation (MVV) improved up to week 72 and then stabilized; forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1) increased continuously over 120 weeks. Mean increases in the modified per‐protocol population was 9.2 % for FVC, 8.8 % for FEV1, and 6.1 % for MVV after 120 weeks. All patients ≤14 years showed respiratory improvements, presumably in part related to growth; however, these were greater in treated patients. For those >14 years, treated patients showed improvements, while deterioration occurred in untreated. Altogether, the improvements were significantly greater (P < 0.05) in treated patients.

Conclusions

Long‐term ERT is associated with sustained improvements in respiratory function in Morquio A. In younger patients (≤14 years), some improvement may be ascribed to growth. In older patients, other mechanisms, e.g., decreased glycosaminoglycan storage, are likely involved.
Is Symptomatic Long QT Syndrome Associated with Depression in Women and Men?
Authors: Wesołowska Karolina , Elovainio Marko , Koponen Mikael , Tuiskula Annukka M. , Hintsanen Mirka , Keltikangas‐Järvinen Liisa , Määttänen Ilmari , Swan Heikki , Hintsa Taina
Published: August 2016

We examined whether long QT syndrome (LQTS) mutation carrier status or symptomatic LQTS are associated with depression, and whether there are sex differences in these potential relationships. The sample comprised 782 participants (252 men). Of the 369 genetically defined LQTS mutation carriers, 169 were symptomatic and 200 were asymptomatic. The control group consisted of 413 unaffected relatives. Depression was assessed using the Beck Depression Inventory‐II (BDI‐II). No association was found for LQTS mutation carrier status with depression. The multinomial logistic regression showed that LQTS mutation carrier men with arrhythmic events scored higher on depression compared with the control group, even when adjusting for age, β‐blockers, antidepressants, and social support (OR = 1.09, 95 % CI [1.02, 1.15], p = .007). The binary logistic regression comparing symptomatic and asymptomatic LQTS mutation carriers showed that symptomatic LQTS was associated with depression in men (OR = 1.10, 95 % CI [1.03, 1.19], p = .009). The results were unchanged when additionally adjusted for education. These findings suggest that symptomatic LQTS is associated with depression in men but not in women. Overall, however, depression is more frequent in women than men. Thus, regular screening for depression in LQTS mutation carriers and their unaffected family members can be important.
Philosopher contre la psychiatrie, tout contre
Authors: Demazeux Steeves
Published: August 2016

Depuis le début des années 1990, les recherches interdisciplinaires au croisement entre philosophie et psychiatrie ont connu un formidable regain d'intérêt sur le plan international. Elles ont été stimulées par la mise en place d'une association, d'un journal, et même d'une collection spécifiquement dédiée. Cet article cherche à reconstituer, à travers la profusion et la grande diversité des travaux individuels, la dynamique intellectuelle de ce qu'il est désormais convenu d'appeler« la nouvelle philosophie de la psychiatrie». Il s'agit là de cerner les lignes de force, mais aussi les rejets silencieux qui structurent de l'intérieur ce champ d'études devenu très prolifique depuis 25 ans.
Le research domain criteria (RDoC), le réductionnisme et la psychiatrie clinique
Authors: Faucher Luc , Goyer Simon
Published: August 2016

L'importance que les défenseurs duResearch Domain Criteria(RDoC) accordent aux circuits du cerveau dans la compréhension des désordres mentaux a conduit certains chercheurs à suspecter qu'on avait affaire à un programme de recherche foncièrement réductionniste. Puisque le RDoC devrait éventuellement affecter la psychiatrie clinique, on a craint qu'elle ne se transforme en une science neuro-comportementale appliquée sans tenir compte de l'esprit(mindless).Cet article montre en quoi le projet du RDoC s'éloigne du réductionnisme classique et comment il en évite les écueils. Pour cette raison, du moinsen principe,le RDoC pourrait enrichir plutôt qu'appauvrir la psychiatrie clinique. Pour conclure, les effets néfastes produits par le réductionnisme de façade des défenseurs du RDoC seront soulignés.
Où va la philosophie de la psychiatrie ?
Authors: Basso Elisabetta
Published: August 2016

Cet article expose les tendances actuelles de ce nouveau domaine de recherche qu'est la « philosophie de la psychiatrie » à travers son évolution dans la dernière décade. La première partie se concentre sur le passage d'une approche strictement conceptuelle des thèses issues du savoir psychiatrique à une approche qui prend en compte également les dimensions sociales, pratiques et cliniques de cette discipline. La seconde partie de l'article montre comment l'exigence d'un engagement mutuel de la philosophie et de la psychiatrie a été diversement perçue selon les pays engagés dans le programme de la philosophie de la psychiatrie. L'article s'intéresse en particulier à la France, où l'enthousiasme pour la« nouvelle philosophie de la psychiatrie» n'a pas eu le même retentissement sur la scène philosophique que dans les pays anglophones. Enfin cette contribution montre comment le domaine de la philosophie de la psychiatrie se présente comme un terrain fécond pour de nouvelles formes d'interaction entre la tradition analytique et la tradition continentale, en particulier à partir de la réflexion sur les thèmes de la normativité, du langage et de l'interprétation.
Cross-Sectional Associations of Objectively-Measured Physical Activity and Sedentary Time with Body Composition and Cardiorespiratory Fitness in Mid-Childhood: The PANIC Study
Authors: Collings Paul J. , Westgate Kate , Väistö Juuso , Wijndaele Katrien , Atkin Andrew J. , Haapala Eero A. , Lintu Niina , Laitinen Tomi , Ekelund Ulf , Brage Soren , Lakka Timo A.
Published: August 2016

Background

The minimum intensity of physical activity (PA) that is associated with favourable body composition and cardiorespiratory fitness (CRF) remains unknown.

Objective

To investigate cross-sectional associations of PA and sedentary time (ST) with body composition and CRF in mid-childhood.

Methods

PA, ST, body composition and CRF were measured in a population-based sample of 410 children (aged 7.6 ± 0.4 years). Combined heart-rate and movement sensing provided estimates of PA energy expenditure (PAEE, kJ/kg/day) and time (min/day) at multiple fine-grained metabolic equivalent (MET) levels, which were also collapsed to ST and light PA (LPA), moderate PA (MPA) and vigorous PA (VPA). Fat mass index (FMI, kg/m2), trunk fat mass index (TFMI, kg/m2) and fat-free mass index (FFMI, kg/m2.5) were derived from dual-energy X-ray absorptiometry. Maximal workload from a cycle ergometer test provided a measure of CRF (W/kg FFM). Linear regression and isotemporal substitution models were used to investigate associations.

Results

The cumulative time above 2 METs (221 J/min/kg) was inversely associated with FMI and TFMI in both sexes (p < 0.001) whereas time spent above 3 METs was positively associated with CRF (p ≤ 0.002); CRF increased and adiposity decreased dose-dependently with increasing MET levels. ST was positively associated with FMI and TFMI (p < 0.001) but there were inverse associations between all PA categories (including LPA) and adiposity (p ≤ 0.002); the magnitude of these associations depended on the activity being displaced in isotemporal substitution models but were consistently stronger for VPA. PAEE, MPA and to a greater extent VPA, were all positively related to CRF (p ≤ 0.001).

Conclusions

PA exceeding 2 METs is associated with lower adiposity in mid-childhood, whereas PA of 3 METs is required to benefit CRF. VPA was most beneficial for fitness and fatness, from a time-for-time perspective, but displacing any lower-for-higher intensity may be an important first-order public health strategy.

Clinical trial registry number (website): NCT01803776 (https://clinicaltrials.gov/ct2/show/NCT01803776).
A late Holocene molecular hydrogen isotope record of the East Asian Summer Monsoon in Southwest Japan
Authors: van Soelen Els E. , Ohkouchi Naohiko , Suga Hisami , Damsté Jaap S. Sinninghe , Reichart Gert-Jan
Published: August 2016

Precipitation in Japan is strongly affected by the East Asian monsoon system, resulting in wet summer conditions and relatively dry winter conditions. Few paleo-monsoon records exist from northeastern Asia, especially records showing decadal- to centennial-scale variability. Here we present a molecular hydrogen isotope (δD) record from Lake Kaiike, a small coastal lake in southwest Japan, to provide insight into monsoonal precipitation over the past two millennia. The δD record of friedelin, a terrestrial higher plant lipid, reveals three major shifts in precipitation: a decline from >-185‰ to <-190‰ at 1700 cal yr BP suggests a change to wetter conditions; values between -187.5‰ and -180‰ from 1480 to 800 cal yr BP indicate reduced precipitation; and a decline to below -195‰ after 800 cal yr BP reflects moist conditions during the Little Ice Age. These results highlight variability in the intensity of the East Asian Summer Monsoon occurring on decadal to centennial time scales. El Niño-like conditions are likely responsible for periods of high monsoon intensity, but comparison with other records in the region (northeast China and Japan) shows that contradicting patterns also exist, and so explaining these rainfall patterns is not straightforward.
National Strategy for Mass Casualty Situations and its Effects on the Hospital
Authors: Levi Leon , Michaelson Moshe , Admi Hanna , Bregman David , Bar-Nahor Ronen
Published: August 2016

A mass-casualty situation (MCS) usually is short in duration and resolves itself. To minimize the risks to patients during MCS, planning is essential. This article summarizes the preparations needed at the hospital level, for a local MCS involving numerous trauma victims arriving to the Emergency Department at a short notice. Experiences and conclusions related to the implementation of the Israeli strategy in one hospital that combines the responsibilities of both the military and civilians are summarized.

The Ministry of Health distributes the master MCS plan to each hospital where a local committee adapts it to the specific situation in a format of standing orders. After its approval by the Ministry of Health, an annual inspection is conducted to check the ability of the staff to manage a MCS. A full-scale drill is conducted every second year during which each site's readiness level and the continuity of the flow of care are tested.

In building the strategy for treating trauma victims during a MCS, a few assumptions were taken into account. The goal of treatment in a MCS is to deliver an acceptable quality of care while preserving as many lives as is possible. In theory, the capacity of the hospital is its ability to manage a load of patients in the range of 20% of the hospital bed capacity. Planning and drilling are the ways to minimize deviations from the guidelines and to avoid management mistakes. Special attention should be paid to problems related to the initial phase of receiving the first message, outside communication, inside hospital communication, and staff recruitment. Other issues include: free access to the hospital; opening a public information center; and dealing with the media and very important persons (VIPs).

A new method for creating the needed MCS plan in the hospital is suggested. It is based upon knowledge of management techniques that used multi-level documents, which are spread via Intranet between the different key figures. Using this method, it is possible to keep the strategy, the source documentation, and reasons for choosing it, as well as immediate release of checklists for each functions. This detailed, time consuming work is worthwhile in the long run, when the benefits of easy updating and better preparedness are apparent.
Can the “Golden Hour of Shock” Safely Be Extended in Blunt Polytrauma Patients? Prospective Cohort Study at a Level I Hospital in Eastern Switzerland
Authors: Osterwalder Joseph J.
Published: August 2016

Background:

The objective was to test, in this trauma system, the North American hypothesis that exceeding the 60-minute limit for the entire prehospital time (“golden hour of shock”) increases mortality of blunt polytrauma patients.

Methods:

In a prospective, observational, cohort study conducted between 1990 and 1996, a severity characterization of trauma (ASCOT) score was used to compare the actual mortality with the predicted mortality in 107 blunt polytrauma patients (Group 1) with prehospital rescue periods ≤60 minutes (time from accident until arrival at the emergency department). The same comparison was performed for 147 blunt polytrauma patients (Group 2) with rescue periods >60 minutes. Inclusion criteria were blunt trauma of at least two body sites, an Injury Severity Score (ISS) of ≥8, and direct admission to the trauma centre. Multivariate regression analysis was performed to test for bias and confounding, and to identify factors that might influence mortality. Odd ratio (OR) and 95% confidence interval (CI) were calculated.

Results:

The mortality in Group 1 was 14%, and was not statisticvally significantly higher than the 10.2% observed for Group 2. 4.8 patients, or 47% more than predicted, died in Group 1 (p = 0.057). The corresponding figures in Group 2 were 4.2 patients or 22% fewer than predicted (p = 0.19). Multivariate logistic regression confirmed this trend with a significant mortality odds ratio of 8 (95% CI 1.7 to 38.5) for Group 1 compared to Group 2. Significantly more patients in Group 2 were treated by emergency physicians.

Conclusions:

It appears in this trauma system, in which emergency physicians often are deployed, that the ‘golden hour of shock’ can be extended safely in many blunt polytrauma patients, since this was associated with better survival figures than in those patients for whom the time was <1 hour.
Population Density and Occurrence of Accidents in Finland
Authors: Nieminen Seppo , Lehtonen Olli-Pekka , Linna Miika
Published: August 2016

Introduction:

About one million accidents occur yearly in Finland (population 5.2
million), resulting in over 3,000 deaths, annually. The governmental and
municipal authorities are responsible for the healthcare services that
respond to these accidents. So far, resources for these services have
been allocated according to regional equality, or in some cases, on the
basis of population numbers. However, economical and effective resource
allocation should be based on detailed risk analysis of the
accidents.

Hypothesis:

In areas with more dense populations, the level of social activity
is greater, which leads to an increased risk for accidents (traffic,
civil disturbance, etc.).

Methods:

The number of accidents was estimated on the basis of registered
emergency trauma patients using the Finnish healthcare statistics for
the year 1999. The emergency visits were compared to the populations and
populations’ densities of the regional sub-units. The rate of emergency
injuries was analysed by regression analysis according to varying
population density in Finland.

Results:

The number of accidents per inhabitants was related directly to
population density. There was a correlation between emergency visits per
inhabitant and population density (p
<0.0001). According to estimates, each 1% increase in population
density is associated with a 0.4% increase in the risk of
accidents.

Conclusion:

The relationship between population density and rate of emergency
visits is decisive for the planning of emergency services. Services
should be placed in areas of high population densities where there are
more people with greater risk of accidents.
Aum Shinrikyo and the Japanese Law on Bioterrorism
Authors: Sugishima Masaaki
Published: August 2016

Before the sarin incidents in Tokyo and Matsumoto, the Aum Shinrikyo (now Aleph) had tried to conduct bioterrorism with botulinum toxin and Bacillus anthracis. Followers of the Aum could not overcome technical difficulties inherent in developing biological weapons, and the perpetrators had not been prosecuted for their failed attempts of bioterrorism. But the Aum's biological attack revealed several shortcomings in the Japanese law that regulated biological weapons. Since the missile experiment of North Korea conducted in 1998, the Japanese government has come to consider the threat posed by biological weapons more seriously. In 2001, after the 11 September 2001 terrorist attacks and the series of anthrax letter scares in the United States of America, the Japanese government established its Five Basic Principles for Chemical and Biological Weapons Terrorism and several measures were taken at the central and local levels. Activities of the Aum have been monitored by the Public Security Investigation Agency and the National Police Agency under the Anti-Aum Law since 2000.
Nursing in Sudden-Onset Disasters: Factors and Information that Affect
Participation
Authors: Mitani Satoko , Kuboyama Kazutoshi , Shirakawa Taro
Published: August 2016

Introduction:

Little has been reported regarding the minimum conditions,
information, and knowledge essential for dispatching nurses to join in
sudden-onset disaster events from the viewpoint of nurses. This paper
explores the issues and concerns that nurses faced when asked to respond
to the 1995 Great Hanshin-Awaji Earthquake event in Japan.

Methods:

A standardized written survey tool was developed using input from
four nurses who had responded to the disaster event. Questionnaires that
included both “yes” and “no” answers and multiple-choice answers were
developed and sent to 823 nurses who worked in four hospitals.

Results:

A total of 477/823(58.0%) questionnaires were completed and
returned. Of the respondents to the questionnaire, 309 (62.1%) were
qualified nurses, and 148 (37.9%) were students. Sixty-nine (15%) of the
total 477 respondents participated in the disaster response to the Great
Hanshin-Awaji Earthquake. Primary among respondents' concerns were that
they should wait for their superiors or institutions to direct them to
go “somewhere” and to do “something” and how far away from home would
they be required to travel. Home responsibilities conflicting with
disaster response were a common concern for respondents.

Conclusion:

Managers should consider including the following conditions in
disaster dispatch plans: (1) the dispatches should be made part of
nursing duties; (2) the disaster plan should be constructed with
organizations near disaster sites; and (3) clear directions regarding
destination and expected activities should be provided to
nurses.
Overview of the Psychosocial Impact of Disasters
Authors: Leon Gloria R.
Published: August 2016

The psychosocial sequelae can be intense and of long duration in the aftermath of natural and technological disasters, as well as terrorist attacks. Posttraumatic stress symptoms and full syndrome disorder, depression, anxiety, somatic complaints, and excessive alcohol use have been demonstrated consistently, particularly following large-scale disasters. This paper examines the psychological research conducted at various intervals after extensive natural disasters, the Three Mile Island and Chernobyl technological accidents, and recent terrorist events in the United States. Factors predictive of the emergence of emotional distress and psychological and physical problems following a disaster also are discussed.
Half-a-Million Strong: The Emergency Medical Services Response to a Single-Day, Mass-Gathering Event
Authors: Feldman Michael J. , Lukins Jane L. , Verbeek P. Richard , MacDonald Russell D. , Burgess Robert J. , Schwartz Brian
Published: August 2016

Introduction:

Emergency medical services (EMS) responses to mass gatherings have been described frequently, but there are few reports describing the response to a single-day gathering of large magnitude.

Objective:

This report describes the EMS response to the largest single-day, ticketed concert held in North America: the 2003 “Toronto Rocks!” Rolling Stones Concert.

Methods:

Medical care was provided by paramedics, physicians, and nurses. Care sites included ambulances, medically equipped, all-terrain vehicles, bicycle paramedic units, first-aid tents, and a 124-bed medical facility that included a field hospital and a rehydration unit. Records from the first-aid tents, ambulances, paramedic teams, and rehydration unit were obtained. Data abstracted included patient demographics, chief complaint, time of incident, treatment, and disposition.

Results:

More than 450,000 people attended the concert and 1,870 sought medical care (42/10,000 attendees). No record was kept for the 665 attendees simply requesting water, sunscreen, or bandages. Of the remaining 1,205 patients, the average of the ages was 28 ±11 years, and 61% were female. Seven-hundred, ninety-five patients (66%) were cared for at one of the first-aid tents. Physicians at the tents assisted in patient management and disposition when crowds restricted ambulance movement. Common complaints included headache (321 patients; 27%), heat-related complaints (148; 12%), nausea or vomiting (91; 7.6%), musculoskeletal complaints (83; 6.9%), and breathing problems (79; 6.6%). Peak activity occurred between 14:00 and 19:00 hours, when 102 patients per hour sought medical attention. Twenty-four patients (0.5/10,000) were transferred to off-site hospitals.

Conclusions:

This report on the EMS response, outcomes, and role of the physicians at a large single-day mass gathering may assist EMS planners at future events.
Implementing the Hospital Emergency Incident Command System: An Integrated Delivery System's Experience
Authors: Zane Richard D. , Prestipino Ann L.
Published: August 2016

Introduction:

Hospital disaster manuals and response plans often lack formal command structure; instead, they rely on the presence of key individuals who are familiar with hospital operations, or who are in leadership positions during routine, day-to-day operations. Although this structure occasionally may prove to be successful, it is unreliable, as this leadership may be unavailable at the time of the crisis, and may not be sustainable during a prolonged event. The Hospital Emergency Incident Command System (HEICS) provides a command structure that does not rely on specific individuals, is flexible and expandable, and is ubiquitous in the fire service, emergency medical services, military, and police agencies, thus allowing for ease of communication during event management.

Methods:

A descriptive report of the implementation of the HEICS throughout a large healthcare network is reviewed. Results and Conclusions: Implementation of the HEICS provides a consistent command structure for hospitals that enables consistency and commonality with other hospitals and disaster response entities.
Protecting New Health Facilities from Natural Hazards: Guidelines for the Promotion of Disaster Mitigation
Authors:   Area on Emergency Preparedness and Disaster Relief, Pan-American Health Organization (PAHO)/World Health Organization (WHO)
Published: August 2016

El conocimiento técnico y la experiencia acumulada en la reducción de los efectos de los desastres nos han enseñado que es posible reducir al mínimo los riesgos y los daños si se adoptan las medidas preventivas necesarias en el diseño, construcción y mantenimiento de las nuevas instalaciones de salud. Sin embargo, es un tema complejo que aún no tiene la presencia necesaria en las agendas políticas y de desarrollo de los países de América Latina y el Caribe.

La Organización Panamericana de la Salud, en colaboración con el Centro Colaborador de la OMS en Mitigación de Desastres de la Universidad de Chile y con el apoyo del Banco Mundial y el Consorcio ProVention, ha publicado lasGuías de reducción de vulnerabilidad en el diseño de nuevos establecimientos de salud, con el objetivo de orientar a los administradores, profesionales y asesores técnicos del área de la salud que tienen por misión la gestión, diseño, construcción e inspección de proyectos de construcción de nuevos establecimientos de salud.

Esta publicación presenta un resumen de esas Guías, enfatizando cómo pueden utilizarse, por quién y con que propósito. Asimismo, incluye algunas recomendaciones para promover su uso en la Región entre autoridades nacionales, planificadores y financiadores involucrados en el desarrollo de estos proyectos. Se trata de un instrumento de introducción al tema, que permite un acercamiento rápido y directo para comprender los beneficios sociales y económicos de la aplicación de medidas de mitigación en los procesos de diseño, planificación y construcción de instalaciones de salud y sobre todo, para saber cómo aplicarlas con el objetivo de alcanzar niveles de protección capaces, no solo de garantizar la seguridad de las personas, sino la seguridad de la infraestructura y de la operación de los servicios.
Out-of-Hospital Cardiac Arrest Locations in a Rural Community: Where Should We Place AEDs?
Authors: Portner Marc E. , Pollack Marc L. , Schirk Steven K. , Schlenker Melissa K.
Published: August 2016

Early defibrillation improves survival for patients suffering cardiac arrest from ventricular fibrillation (VF) or ventricular tachycardia (VT). Automated external defibrillators (AEDs) should be placed in locations in which there is a high incidence of out-of-hospital cardiac arrest (OOHCA). The study objective was to identify high-risk, rural locations that might benefit from AED placement. A retrospective review of OOHCA in a rural community during the past 5.5 years was conducted. The OOHCAs that occurred in non-residential areas were categorized based on location. Nine hundred, forty OOHCAs occurred during the study period of which 265 (28.2%) happened in non-residential areas. Of these, 127 (47.9%) occurred in healthcare-related locations, including 104 (39.2%) in extended care facilities. No location used in this study had more than two OOHCAs. Most (52.1%) non-residential OOHCAs occurred as isolated events in 146 different locations. Almost half of the OOHCAs that occurred in non-residential areas took place in healthcare-related facilities suggesting that patients at these locations may benefit from AED placement. First responders with AEDs are likely to have the greatest impact in a rural community.
OP or Not OP: The Medical Challenge at the Chemical Terrorism Scene
Authors: Krivoy Amir , Layish Ido , Rotman Eran , Goldberg Avi , Yehezkelli Yoav
Published: August 2016

Since the 1995 Tokyo subway sarin attack, terrorist attacks involving weapons of mass destruction or other industrial chemicals present worldwide security and health concerns. On-scene medical triage and treatment in such events is crucial to save as many lives as possible and minimize the deleterious effects of the toxic agent involved. Since there are many chemicals that can be used as potential terrorist weapons, the medical challenge for the emergency medical services (EMS) is a combination of: (1) recognizing that a chemical terrorist attack (non-conventional) has occurred; and (2) identifying the toxic agent followed by proper antidotal treatment. The latter must be done as quickly as possible, preferably on-scene. The most valuable decision at this stage should be whether the agent is organophosphate (OP) or not OP, based on clinical findings observed by pre-trained, first responders. This decision is crucial, since only OP intoxication has readily available, rapidly acting, onscene, specific agents such as atropine and one of the oximes, preferably administered using autoinjectors. Due to the lack of a specific antidote, exposure to other agents (such as industrial chemicals, e.g., chlorine, bromide, or ammonia) should be treated on-scene symptomatically with non-specific measures, such as decontamination and supportive treatment. This paper proposes an algorithm as a cognitive framework for the medical teams on-scene. This algorithm should be part of the medical team's training for preparedness for chemical terrorist attacks, and the team should be trained to use it in drills. Implementing this path of thinking should improve the medical outcome of such an event.
Survey of EMTs' Attitudes towards Death
Authors: Smith-Cumberland Tracy L. , Feldman Robert H.
Published: August 2016

Introduction:

The purpose of this study was to ascertain information about emergency medical technicians' (EMTs') attitudes towards their training, comfort, and roles when a patient dies on-scene.

Methods:

A sample of 136 EMTs (all levels) from 14 different states participated in a survey prior to completing a continuing education program. About 40% (n = 54) of the EMTs were attending a training program related to death based on the Emergency Death Education and Crisis Training Curriculum,1 while 60% (n = 82) were attending an EMT training program not related to death. Each participant answered questions about their attitudestowards a death on-scene using a five-point Likert scale. The EMTs were compared by level of training (EMT-B/EMT-I and EMT-P), and by type of educational program attended (death-related education and nondeath-related education).

Results:

Most (82%) participants reported that an EMT's actions impact the grief process of a bereaved family. About half (54%) reported that an EMT's role should include notifying the family of the death. However, three-quarters (76%) reported that they had not been trained adequately to make a death notification or help the family with their grief. Many (40%) felt uncomfortable making a death notification. Differences were present in EMTs enrolled in the death education courses as compared to those attending an educational program not related to death. Differences also were found in the levels of EMTs (EMT-B/EMT-I versus EMT-Paramedics).

Conclusion:

This study provides new insights about EMTs' attitudes towards death and the death-related training they receive.
Disaster Modeling: Medication Resources Required for Disaster Team Response
Authors: Rosenthal Marc S. , Klein Kelly , Cowling Kathleen , Grzybowski Mary , Dunne Robert
Published: August 2016

Introduction:

Responses to disasters involve many factors beyond personnel, such as medical andnon-medical equipment and supplies. When disaster teams respond, they must do so with sufficient amounts of medicine and supplies to manage all of the patients expected for several days before re-supply. In order for this process to be efficient and expedient, accurate and advanced planning for supplies needed by disaster workers is necessary. These supplies must provide for general medical care and for hazard-specific problems.

Objective:

To develop a model that provides the framework for determining supply requirements for the National Disaster Medical System, Disaster Medical Assistance Teams, or other responding disaster teams in a civilian environment.

Methods:

A community hospital was modeled to determine patient characteristics when presenting to an emergency department (ED), including patient demographics and chief complaint, medications administered during the emergency department visit and prescribed at discharge, and laboratory tests ordered to assess disaster team supply requirements. Data were downloaded from a patient tracking software package and abstracted from various hospital data information systems. Data from the community hospital were compared with data published from two hurricane disasters by members of the National Disaster Medical System.

Results:

To the extent possible, the model predicted the proportion of patient complaints and, therefore, the medicine and supplies needed for the management of these patients.

Conclusion:

This model offers a first step in preparing disaster medical teams for deployment.
Thiopental vs. Etomidate for Rapid Sequence Intubation in Aeromedicine
Authors: Sonday Charles J. , Higgins Robert , Axelband Jennifer , Jacoby Jeanne , Crider Duane
Published: August 2016

Introduction:

Although there is a general agreement that rapid sequence intubation (RSI) is thepreferred technique for intubation in aeromedical care, several pharamacological regimens have been employed without clear evidence of which is superior.

Hypothesis:

This study was designed to compare the use of etomidate (ETOM) with that of thiopental (THIO)as an adjunctive agent used with succinylcholine (SCh) for rapid sequence intubation in an urban, aeromedicalsystem.

Methods:

This was a retrospective, before-and-after study utilizing computer-assisted chart review. Adultpatients who received thiopental for rapid sequence intubation over a two-year period were compared to adult patients who received etomidate for rapid sequence intubation over a similar period, after a change in protocol, which mandated etomidate rather than thiopental for all intubations.

Results:

No difference was found in any of the primary endpoints. Stabilization time (13.1 vs. 12.9 minutes), number of intubation attempts (1.1 vs. 1.2), successful first intubation attempts (90% vs. 82%), overallsuccessful intubations (100% vs. 96%), and intubation time (18.4 vs. 21.7 seconds) were similar for all comparisons of thiopental vs. etomidate (allp>0.05).

Conclusion:

This study found no clinically relevant differences between the use of etomidate or thiopental as adjuncts with succinylcholine for rapid sequence intubation in the aeromedical setting.
Overview of the Tsunami Disaster
Authors: Wahlstrom Margareta
Published: August 2016

This is the text for the Opening Address for the Conference, Health Aspects of the Tsunami Disaster in Asia, convened by the World Health Organization (WHO) in Phuket, Thailand, 04-06 May 2005. The frightening reality of the costs (human and material) must be balanced by what has been and can be learned that, if applied, can make the world more resilient for the next event. At the time of this Conference, we are moving from response to recovery. The immediate conclusion relates to the consequences of the realization of a truly interdependent world. Given the huge resourcesmade available, there is an increased need for accountability. Several factors will bear heavily on the outcomes: (1) risk of loss of momentum; (2) ensuring that no gaps in services occur; (3) ensuring that already marginalized communities do not become forgotten or even more marginalized; (4) support and respect of national leadership; (5) commit to enhanced coordination; and (6) develop mechanisms for joint and shared assessments. The available resources must be used to stablize the livelihoods of people for years. Lastly, the reliability and sustainability of the important contributions of the military and the commercial private sectors for future events must be established
Panel 2.11: Food Security and Nutrition
Authors: Yoosuf Abdul Azeez , Prinzo Zita Weise , Atwood Stephen J. , Webb Patrick , Untoro Rachmi , Haider Rukhsana
Published: August 2016

This is a summary of the presentations and discussion of Panel 2.11, Food Security and Nutrition of the Conference, Health Aspects of the Tsunami Disaster in Asia, convened by the World Health Organization (WHO) in Phuket, Thailand, 04–06 May 2005. The topics discussed included issues related to food security and nutrition as pertain to the responses to the damage created by the Tsunami. It is presented in the following major sections: (1) findings; (2) key questions; (3) discussion; and (4) recommendations.