bluuebunny/crossref_metadata_2025 huggingface dataset:
Ocular Syphilis Unmasked Following Bilateral Intravitreal Dexamethasone Implant (Ozurdex) Injection
Authors: Akalp Fatma Düriye , Yılmaz Sami , Erol Muhammet Kazım , Avcı Emre , Avcı Remzi
Published: March 2019

Intraocular corticosteroids are used in ophthalmologic conditions such as macular edema secondary to vascular occlusions, diabetes, and uveitis. Infectious ocular diseases must be ruled out before intravitreal corticosteroid implantation. Here, the authors report a case that has been referred to their clinic for surgical treatment due to dense vitreous hemorrhage in the right eye after bilateral intravitreal dexamethasone implantation. As an intraoperative finding, diffuse changes in the color-like paleness of the retina as well as intraretinal white-colored deposits were observed. Serology tests were performed, and syphilis serology was positive. Intravenous penicillin provides resolution of inflammation.

[
Ophthalmic Surg Lasers Imaging Retina
. 2019;50:e77–e80.]
The Use of OCT and OCT Angiography in Detecting an Atypical Case of Retinal Capillary Hemangioma
Authors: Pierro Luisa , Brambati Maria , Arrigo Alessandro , Gagliardi Marco , Bandello Francesco
Published: March 2019

Retinal capillary hemangioma (RCH) is a benign retinal tumor defined by a vascular proliferation localized in the peripheral retina, juxtapapillary retina, or the intraneural portion of the optic nerve. In most cases, diagnosis of RCH is performed by fundus evaluation and confirmed by fluorescein fundus angiography. Nevertheless, a small RCH localized on or adjacent to the optic nerve head could be difficult to detect by fundus examination. Here, the authors report an atypical case of RCH, not ophthalmoscopically visible, but successfully detected first by optical coherence tomography (OCT) and then by OCT angiography, which confirmed its vascular nature.

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Ophthalmic Surg Lasers Imaging Retina
. 2019;50:e81–e83.]
The shape of writing
Authors: Morin Olivier , Roché Fabien
Published: March 2019

Historians and epigraphists examine the shape of letters to identify manuscripts or understand the development of a writing system. Analyzing letters and characters can also help bring an older story to light: that of the human brain and its evolution. It is at the intersection of these two stories that Olivier Morin became interested in an article published last year in the journal Cognitive Science. Fabien Roché, graphic designer and cartoonist, tells us this article for Terrain.
Knowledge Management in the Dark
Authors: Richter Shahper , Waizenegger Lena , Steinhueser Melanie , Richter Alexander
Published: March 2019

The voluntary use of private devices by employees without the formal approval of the IT department, commonly termed Shadow IT, is an increasingly widespread phenomenon. In this article, the authors study the role of private smartphones (and related applications like WhatsApp) in knowledge-intensive practices in the manufacturing domain. With an in-depth case study based on data gained from observations and interviews, the authors are able to empirically illustrate why workers use their private smartphones (contrary to company guidelines) and how they find significant gains of productivity by using the forbidden applications. This study gives rich insights into the rise of Shadow IT in a manufacturing context which takes place in a self-organised way without knowledge of the management.
An Inconvenient Variable: Sex Hormones and Their Impact on T Cell Responses
Authors: Brown Melissa A. , Su Maureen A.
Published: March 2019

Epidemiologic data demonstrate sex differences in autoimmune diseases, immune responses against infection, and antitumor immunity, and accumulating evidence suggests a major role for sex hormones in mediating these differences. In this study, we review recent advances in understanding how sex hormones regulate T cell responses to alter susceptibility to autoimmunity. Although sex hormones can directly alter gene transcriptional programs of T cells, we focus in this study on how sex hormones alter T cell development and function through their effects on thymic stromal cells and innate cell types. In addition to contributing to our understanding of sex differences, these findings also have implications for the therapeutic use of sex hormones and sex hormone modulators, which are now being prescribed to increasing numbers of patients for a wide variety of indications.
Heavy metals accumulation from sewage sludge in the Nile tilapia Oreochromis niloticus (Trewavas, 1983) during a sludge-earthworm-fish short-term cycling
Authors: Siddig Nahid A.A. , Ahmed Asma A. , Saad Sarra A.M. , Koua Faisal Hammad Mekky
Published: March 2019

Municipal sewage sludge from wastewater treatment is an important nutritional source for sustainable agriculture. Here, we report on the assessment of the accumulation of heavy metals in Nile tilapia Oreochromis niloticus (Trewavas 1983) fed on earthworms Eisenia fetida reared on soil treated with different concentrations of sewage sludge (25% and 100%) during sludge-earthworm-fish short-term cycling. In this short-term cycling the Nile tilapia collected from the White Nile were chosen as final consumers, whereas the earthworms reared on loam soil mixed with different ratios of sludge were used as a feed for the final consumers. Our results indicate that the concentrations of Cd2+, Cr2+, Pb2+ and Zn2+ in the sludge treated soil are proportional to the sludge content in the soil. Importantly, the accumulation of these heavy metals was significantly low in the earthworms and the Nile tilapia in comparison with the treated soil and that these concentrations in the Nile tilapia were below the international limits recommended by the US Environmental Protection Agency (2014). Moreover, the growth and overall flesh quality of the fish were improved as indicated by the growth increase up to 146% when fed on earthworm reared in 100% sludge. Additionally, our physicochemical properties (i.e. pH, soil moisture, electric conductivity and organic matters) evaluation on the soil indicates an improvement of the soil quality when mixed with sewage sludge. These results suggest a sustainable application of sewage sludge in fish culture owing to its high nutritional values, low cost, and low risk of hazardous heavy metals when using primary consumers with heavy metals bioaccumulation capability such as E. fetida.
Felt reports for the 1855 magnitude 5.2 Moncton, New Brunswick, earthquake
Authors: Lamontagne M , Burke K B S
Published: March 2019

The February 8th, 1855, magnitude 5.2 (mN) Moncton earthquake occurred sometime between 06:30am to 07:15am local time. It is one of the largest of southeastern New Brunswick and it caused minor damage. Chimney damage was reported in Moncton, New Brunswick. In
Hopewell, near the epicentre, the shock cracked the plastering of walls. The earthquake was felt over most of New Brunswick, Nova Scotia and Prince Edward Island and was also felt in the state of Maine. This Open File Report provides the felt information from 55 localities. For each locality, the
felt information is rated on the Modified Mercalli intensity (MMI) scale and tabulated in a Microsoft Excel sheet. When available, the description of the felt report is added. For many of the accounts, the second author copied the text by hand from the screen of the microfilm reader. In addition,
when the copier microfilm reader was available, newspapers were scanned or copied from the on-line digital newspapers. The Open File also provides a GoogleEarth kmz file that allows the felt information reports to be viewed in a spatial tool.
Hepatitis B: Knowledge and awareness among preclinical year medical students
Authors: Sannathimmappa Mohan B , Nambiar Vinod , Arvindakshan Rajeev
Published: March 2019

Background and Objective: Hepatitis B is an occupational health hazard to health-care workers. The complete knowledge of hepatitis B virus (HBV) transmission and prevention is indispensable for medical students. This study was conducted to assess the knowledge and awareness of hepatitis B among preclinical year medical students.Materials and Methods: This is a descriptive cross-sectional study. A predesigned self-administered questionnaire concerning hepatitis B knowledge and awareness was distributed to all the preclinical year medical students. The data were collected, tabulated, and analyzed by Microsoft Excel and Statistical Package for the Social Sciences (SPSS) software, version 22. The results were expressed in numbers and percentages.Results: Of 251 students, only 132 students voluntarily participated in the study. Majority of the students (84.8%) were aware of HBV infection. Many students knew that blood transfusion (81.1%) and use of contaminated needles and syringes (74.2%) are major modes of transmission. However, less than 30% of the students had knowledge about other modes of transmission. More than 50% of the students lacked in their knowledge about clinical features and complications of hepatitis B infection. Majority of students (72.7%) were aware of HBV vaccination. However, many students did not know their vaccination status, whereas only 23.5% of the students were fully immunized.Conclusion: This study revealed lack of complete knowledge regarding hepatitis B among preclinical year medical students. They are at high risk of acquiring HBV infection during their clinical practice, later in life. Hence, implementation of well-structured education program in the first year itself is needed to create complete awareness among medical students about hepatitis B.
Rainfall trends for the State of Paraná: present and future climate
Authors: Quadros Luciana Espindula de , Mello Eloy Lemos de , Gomes Benedito Martins , Araujo Fernanda Cristina
Published: March 2019

This paper analyzes the variability and the precipitation trend of the State of Paraná, in Brazil. For that, monthly precipitation data belonging to 24 precipitation stations in a 30-year period (1980-2010) were analyzed and they were compared with projections of precipitation for the years 2016-2050. These data were simulated by Eta/Miroc5 for RCP 4.5 (Representative Concentration Pathways) from the Center for Weather Forecasting and Climate Studies CPTEC/INPE and the historical data of precipitation were taken from National Water Agency (ANA). The Mann-Kendall non-parametric test and the Sen’s slope estimator were applied to detect trends and magnitudes, respectively. The Mann-Whitney test was used to compare the median of the historical series (1980-2010) with the simulated series (2016-2050) and the comparison of the means between the two series was performed by Test t. The results draw attention to the great variability and significant changes in the monthly average rainfall that may occur, if the climate change scenarios that were considered become a reality in the near future.
Relationships between land use and water quality obtained for the evaluation of genotoxic effects in plant bioindicators
Authors: Sieklicki Jéssica , Bione Nilton Cesar Pires , Oliveira-Filho Paulo Costa de , Souza Viviane Fernandes de , Martins Kelly Geronazzo
Published: March 2019

Anthropic activities as well as land use and occupation are closely linked to water and soil quality. An alternative to assess their influence on water quality in water bodies is through biomonitoring using Allium cepa as a bioindicator organism. This technique allows the detection of cytogenetic abnormalities in Allium cepa root meristematic cells after contact with analyzed water samples. Thus, we evaluated the genotoxic potential of water samples from the Rio das Antas (Antas River) along the urban perimeter of the city of Irati, Paraná, Brazil.  With the aid of GeoEye Satellite high-resolution fused orbital images, we searched for possible relationships between the use and occupation of land around this river. Biomonitoring was performed at three different sampling points. Statistical equality between the negative control and Point 1 and between Points 2 and 3 was obtained using Fisher's test and a Principal Coordinate Analysis (PCoA). The former presented a low frequency of abnormalities chromosomes and the latter presented larger averages. In addition, Point 1 had strong influence of tree vegetation.  Points 2 and 3, demonstrated a strong influence of urbanized area, with significant degradation of permanent preservation areas (áreas de preservação permanente – (APP). The results showed remarkable anthropogenic interference to the ecosystem. Furthermore, this indicates importance of an APP watercourses functioning to preserve the quality of the water resources.
Biomonitors to evaluate the toxic potential of urban solid waste landfill leachate
Authors: Vieira Catiele , Droste Annette
Published: March 2019

The accentuated increase in the production of solid urban waste (SUW) and the consequent accumulation of leachate in landfills increase the risk of environmental contamination. Biomonitors are used to assess the toxicity of pollutants on living organisms. In this study, the pollutant potential of leachate from SUW from a deactivated landfill was evaluated by bioassays with Lactuca sativa L. and Lycopersicon esculentum Mill., and the relationship between chemical characteristics of the effluent and biological parameters was analyzed. The effluent was tested in its raw form and diluted in distilled water at concentrations of 75 and 50%. The percentage of germination, root growth (RG), mitotic index (MI), chromosomal abnormalities index (CAI), and micronuclei frequency (MCN) were analyzed. In the presence of effluent, germination and MI decreased, while RG, CAI and MCN frequencies increased in relation to the negative control (distilled water) for both species. Lead, iron and zinc presented negative relation with seed germination for both species, with RG of L. sativa and MI of L. esculentum, as well as a positive relation with MCN frequency in the studied species. Because of its larger chromosomes, L. sativa is a more suitable biomonitor of SUW leachate toxicity than L. esculentum. Even though the landfill is deactivated, it is necessary to treat this effluent, in order to minimize environmental impacts.
Feasibility of a Comprehensive Targeted Cholera Intervention in The Kathmandu Valley, Nepal
Authors: Roskosky Mellisa , Acharya Bhim , Shakya Geeta , Karki Kshitij , Sekine Kazutaka , Bajracharya Deepak , von Seidlein Lorenz , Devaux Isabelle , Lopez Anna Lena , Deen Jacqueline , Sack David A.
Published: March 2019

A comprehensive targeted intervention (CTI) was designed and deployed in the neighborhoods of cholera cases in the Kathmandu Valley with the intent of reducing rates among the neighbors of the case. This was a feasibility study to determine whether clinical centers, laboratories, and field teams were able to mount a rapid, community-based response to a case within 2 days of hospital admission. Daily line listings were requested from 15 participating hospitals during the monsoon season, and a single case initiated the CTI. A standard case definition was used: acute watery diarrhea, with or without vomiting, in a patient aged 1 year or older. Rapid diagnostic tests and bacterial culture were used for confirmation. The strategy included household investigation of cases; water testing; water, sanitation, and hygiene (WASH) intervention; and health education. A CTI coverage survey was conducted 8 months postintervention. From June to December of 2016, 169 cases of Vibrio cholerae O1 were confirmed by bacterial culture. Average time to culture result was 3 days. On average, the CTI Rapid Response Team (RRT) was able to visit households 1.7 days after the culture result was received from the hospital (3.9 days from hospital admission). Coverage of WASH and health behavior messaging campaigns were 30.2% in the target areas. Recipients of the intervention were more likely to have knowledge of cholera symptoms, treatment, and prevention than non-recipients. Although the RRT were able to investigate cases at the household within 2 days of a positive culture result, the study identified several constraints that limited a truly rapid response.
Approval of Tafenoquine for Malaria Chemoprophylaxis
Authors: Berman Jonathan D.
Published: March 2019

Malaria chemoprophylaxis has become increasingly prominent now that it is used for vulnerable populations in endemic regions in addition to nonimmune travelers to those regions. The objective would be a drug with > 95% efficacy and that is easily tolerated, including in children and pregnant women. For individuals who prefer weekly rather than daily drug administration, a further objective is a product that is administered weekly. The deficiencies of present agents are parasite resistance to chloroquine, neuropsychiatric liability of mefloquine, the need for daily dosing for atovaquone–proguanil, and daily dosing plus adverse reactions for doxycycline. A primaquine analogue, tafenoquine, has a 17-day half-life and was approved for weekly prophylaxis in the United States and in Australia in 2018. Weekly tafenoquine was equal to mefloquine in efficacy in nonimmunes. The tafenoquine label contains a contraindication for preexisting psychosis, but not for the broad number of other neuropsychiatric disorders which are listed as contraindications in the mefloquine label. As an 8-aminoquinoline, tafenoquine is contraindicated for glucose-6-phosphate dehydrogenase (G6PD)-deficient persons or in pregnancy if the fetus might be G6PD deficient. Other possible significant adverse reactions for tafenoquine are declines in hemoglobin levels reported in some G6PD-normal patients, asymptomatic elevations in methemoglobin, and minor psychiatric events. The lack of broad neuropsychiatric adverse reactions suggests that tafenoquine may have a role as the weekly prophylactic of choice for G6PD-normal persons.
Pathogen Lists Do Not Tell Us What We Need to Do
Authors: Fedson David S.
Published: March 2019

Brett-Major and others remind us that pathogen lists for emerging infectious diseases aid in the development of tools that target specific pathogens (e.g., vaccines) and help attract financial support. These lists tell us what we need to have, not what we need to do. The authors call for more research on ways to prevent these diseases (e.g., platform technologies for vaccines) and mitigate disease impact. Vaccines and new treatments that target individual pathogens have many limitations. However, we might save lives by treating patients with inexpensive generic drugs that target common features of the host response to infection. Undertaking research on this approach to treatment is what we need to do.
Disaster medicine and response: Optimizing life-saving potential
Authors: Sever, MD Mehmet Sukru , Remuzzi, MD Giuseppe , Vanholder, MD Raymond
Published: March 2019

Background: Natural and technological mass disasters strike densely populated areas on a regular basis, causing ever growing numbers of deaths and injured, economical losses, social problems, and damage to the environment.Objective of the review: This review aims to provide a comprehensive idea about the spectrum of main problems, essentially presenting a number of basic principles to save as many lives as possible after natural and man-made mega disasters.Discussion: Medical problems following disasters may be acute, acute-on-chronic, or chronic; they appear from the disaster period up till long thereafter. All these problems may be nonspecific, or specific for particular disaster types. Decreasing death toll after mass disasters can be accomplished by preparations before, and effective medical response after disasters. These interventions should be considered at both national/governmental and regional/hospital levels. Disaster medicine, the art and science of providing healthcare to the victims, differs significantly from routine medical practice because of disparities between demand and supply of rescue and healthcare, the need for unusual medical interventions, and the occurrence of ethical and legal dilemmas.Conclusions: Adherence to the principles of disaster medicine, is vital to minimize the extent of medical, logistic, ethical, and legal problems, and saving as many lives as possible.
Dentists: Critical aspects of their own and their community’s disaster preparedness plan
Authors: Glotzer, DDS David L. , Perelman, DDS, MMI Sharon C. , Wolff, DDS, PhD Mark S.
Published: March 2019

The weather-related disasters in 2017 in Texas, Florida, Puerto Rico, the 2017-2018 wildfire seasons in California and Hurricanes Florence and Michael in 2018 have challenged all healthcare professionals, to have plans in place to protect their facility, patients, and staff from all possible hazards. These were “slowly developing” events, with enormous media coverage, and yet the results were still horrific. The need to have both a good evacuation plan and a good shelter-in-place plan has previously been dramatically demonstrated. When planning for disasters, it is critical for healthcare providers to understand the nature of a particular event and its possible consequences. When the concern arises about either an individual medical facility, or a whole community’s well-being, a proper response requires significant levels of preparedness, education, and training. Comprehension of the threat and an understanding of the resources available to combat an event can significantly mitigate the possible damage. This article reviews a dental school curriculum to prepare students to respond to such contingencies while describing the goals, and sources for a disaster preparedness syllabus.
The outcomes of therapeutic dance movement on physical and emotional functioning for elderly people
Authors: Lin, MS Li-Jung , McClear, CTRS Elizabeth , Tabourne, PhD, CTRS Carla E. S.
Published: March 2019

The purpose of this study is to explore the outcomes of therapeutic dance movement on physical and emotional domains for elderly people measured by the functional fitness assessment for adults elder than 60 years, Life Satisfaction Scale, and interview. The authors recruited eight volunteers who attended the dance program for 90 minutes per week and seven volunteers who did not attend but were in the same daycare unit. The interview data substantiated that therapeutic dance movement helped the elders maintain their physical functioning ability and reduced the fear of falling, but the results showed no statistical evidence of significant difference between the group-attended elders and the group-unattended elders. Additionally, the group-oriented dance program effectively helped elders to maintain their social network via talking intelligently and interacting smoothly.
The impact of the “Stirrup Some Fun” therapeutic horseback riding program: A qualitative investigation
Authors: Elliott, PhD Steven , Funderburk, PhD, LRT/CTRS Janet A. , Holland James M.
Published: March 2019

Therapeutic horseback riding is an intervention utilizing horses in the treatment of individuals with emotional, cognitive, and/or physical disabilities. The purpose of this study was to investigate the perceived impact of a therapeutic riding program on children with mild to moderate physical and mental disabilities. Two groups of participants including five children (with a variety of physical and cognitive disabilities) and at least one parent of each of the five children were interviewed to investigate the impact of the Stirrup Some Fun Therapeutic Riding Program (SSF TRP). Qualitative data analysis procedures were used to explore participants’ views and opinions of the SSF TRP. Several themes emerged from the interviews with the participants and their parents, including (a) enjoyment, (b) the child/animal connection, (c) social relationships with volunteers, (d) perceived physical benefits, and (e) the social and mental benefits of the program.
Understanding systematic reviews and their implications for evidence-based practice by examining aerobic exercise as a recreational therapy intervention for individuals with major depressive disorders
Authors: Coyle, PhD Catherine , Denault, BS Valerie , Miller, BS Rachel , Pham, BS Tan , Thomas, BS Colleen
Published: March 2019

This article reviews the need for and the process of conducting a systematic review of the research literature to guide intervention development and implementation in recreation therapy practice. Descriptive information of the process that was undertaken and the outcome that resulted from reviewing the research evidence for the use of aerobic exercise as a treatment for individuals with major depressive diagnosis is provided, along with practice and research recommendations for evidence-based practice that resulted from the systematic review.
Up the ante: Need for advanced roles for Geriatric Recreational Therapists for MDS 3.0
Authors: Buettner, PhD, CTRS, LRT Linda L.
Published: March 2019

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Bingocize®: Utilizing a mobile application to improve gait in community-dwelling older adults
Authors: Falls, MS Dustin , Shake, PhD Matthew , Norris, PhD, PT, OCS Elizabeth , Arnett, PhD, CSCS,*D Scott , Taylor, MS, CTRS Jenn , Crandall, PhD, EP-C K. Jason
Published: March 2019

Physical activity (PA) can improve older adults’ gait performance and decrease fall risks, yet adherence to PA programs is low. The purpose of this study was to evaluate the efficacy of a game-centered mobile health promotion application (app) to improve gait performance in community-dwelling older adults. Participants (N = 38; age 72.42 ± 12.58) from four independent living facilities were randomly assigned to experimental (n = 20; app with exercise) or control (n = 18; app without exercise) conditions. Each condition completed a 10-week intervention using an inclusive evidence-based health promotion program that combines bingo and exercise, Bingocize®. The investigators collected baseline/post gait assessments 1 week prior and 1-week post intervention. Data were analyzed using a mixed-model ANOVA (p < 0.05). There were no main effects; however, significant interactions (group × time) were observed, and interactions for gait speed (>5 cm/s) were observed in the experimental condition. Research supports this increase as a meaningful clinical change in gait speed, which may potentially reduce the risk of falls.
Mutual aid agreements
Authors: Nicholson, JD William C.
Published: March 2019

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Disaster globalization: Evaluating the impact of tsunami aid
Authors: Walker, PhD Peter
Published: March 2019

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EOC preparedness: Are we ready?
Authors: Lattanzio, BSE Mario , Peterson, PhD, CEM Danny
Published: March 2019

Emergency operations centers (EOCs) are extremely important facilities for responding to and recovering from various disasters. With the dramatic increase of available technology, EOC operations have evolved well beyond the days of dial telephones and paper messaging. The question addressed in this study is whether we are doing enough to ensure that this critically important emergency-management (EM) function is operating at peak performance. A survey was used to collect data from EM agencies across the United States. Based on the results of this survey, the authors concluded that designing and developing an EOC simulator might enhance US preparedness efforts.
November/December 2005
Authors: DeVito, Jr. Richard A.
Published: March 2019

Volume 3, Number 6
News briefs
Authors: DeVito, Jr. Richard A.
Published: March 2019

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There is no cold zone: The hazardous materials zone model and mass terrorism chemical weapon events
Authors: Phelps, JD, MPH, CEM, CBCP Scot
Published: March 2019

This study examined 70 after action reports (AARs) from full-scale chemical weapons exercises held in large cities across the United States by the Office of Domestic Preparedness’ Chemical Weapons Improved Response Program (CWIRP). These exercises were held to determine that, if “hot, warm, and cold” zones were established, did victims stay in the hot zone until they could be decontaminated, and did responders observe the hot-warm-cold zone demarcations? Only 35 percent of reports indicated that responders utilized the zone concept, less than 20 percent of reports indicated that victims were compliant with the zone model, and less than 15 percent of reports indicated that responders properly observed the zones that were created. Results indicate that use of the zone model for a mass terrorism chemical weapons attack (MTCWA) is not well utilized, and that responders operating in the cold zone need personal protective equipment.
FEMA: Change or die
Authors: Saunders Royce
Published: March 2019

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May/June 2006
Authors: DeVito, Jr. Richard A.
Published: March 2019

Volume 4, Number 3
Part 4: Social dimensions of interagency collaboration—Joining the collaboration: Individual subscription
Authors: Simon, BS, MA Neil
Published: March 2019

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Advanced IT support of crisis relief missions
Authors: Sapaty, PhD Peter , Sugisaka, PhD Masanori , Finkelstein, PhD Robert , Delgado-Frias, PhD Jose , Mirenkov, PhD Nikolay
Published: March 2019

A novel distributed control ideology and technology will be described for management of advanced crisis relief missions. The approach is based on the installation of a universal “social” module in highly portable electronic devices, like laptops and mobile phones, which can collectively interpret a spatial scenario language, exchanging high-level program code (waves), data, and control with other modules in a parallel fashion. This technology can dynamically integrate any human and technical resources that were scattered postdisaster into an operable, distributed system capable of solving—autonomously—complex survivability, relief, and reconstruction problems.
Post-disaster place attachment: A qualitative study of place attachment in the wake of the 2013 Moore tornado
Authors: Jamali, PhD Student Mehdi , Nejat, PhD Ali , Hooper, BS Arch Student Renee , Greer, PhD Alex , Binder, PhD Sherri Brokopp
Published: March 2019

Place attachment is the social, emotional, and functional bond people experience with a specific geographic area. The formation of this bond is based on several different characteristics of the place, such as property values, local relationships, and employment opportunities as well as the internal attributes of a person, such as age, gender, and income. While gaining an understanding of place attachment through these characteristics and attributes is indispensable to our understanding of disaster recovery, few studies have explored this relationship using qualitative methods. Here, the authors address two main questions: how does place attachment vary among different groups of individuals, and what factors contribute to place attachment in a disaster context? This study included a survey of 772 citizens of Moore, Oklahoma, who lived in the path of the May 20, 2013, tornado and decided to rebuild in situ after disaster. The authors explored place attachment using open-response questions probing residents’ perceptions of their place of living. The authors found 18 common codes within their descriptions, in which community (social network), infrastructure, and commercial were the three most commonly cited parameters. Also, comparisons of participants’ groups such as age and income showed that distinguishable parameters have formed post-disaster place attachment within different groups of participants.
Twenty-first century emergency response efforts of the Commissioned Corps of the US Public Health Service
Authors: Sumter, DrPH Jeffery L. , Goodrich-Doctor, PhD Adrienne , Roberts, PhD Jill , Mason, PhD Thomas J.
Published: March 2019

The impact of the Commissioned Corps of the US Public Health Service (Commissioned Corps) on the health and safety of the nation spans more than two centuries. The public health efforts of the highly qualified health professionals of this often-underreported uniformed service include fighting threats like the great flu pandemic of 1918, the anthrax attacks, Ebola, and natural disasters such as Hurricanes Maria, Irma, and Katrina. As we near the first quarter of the twenty-first century, it is important to take a snapshot of the critical contributions and response efforts the Commissioned Corps has made in the first 18 years of the twenty-first century. Today, the Commissioned Corps faces new challenges in the form of emerging diseases and a rapidly growing opioid epidemic, but under the guidance of the US Surgeon General, it remains vigilant and fully capable of minimizing any public health threat it encounters.
An empirical study on approaches to ambiguity in emergency and disaster response decision-making
Authors: Uhr, PhD Christian , Tehler, PhD Henrik , Wester, PhD Misse
Published: March 2019

Results from previous research suggest that the ability to manage ambiguous problems during acute emergency and disaster management is a desirable quality among decision-makers. Ambiguity is a perception that arises when the problem-solver is dissatisfied with his or her understanding of the structure of the problem, and consequently of the problem-solving process. This article presents the results of an empirical study of ambiguity tolerance among Swedish fire commanders. Two different personality tests have been employed. The findings show that the sampled fire commanders are no more ambiguity tolerant than other individuals with no experience of emergency and disaster management; consequently, there appears to be no correlation between ambiguity tolerance and this professional role. Commanders who see themselves as practically oriented are more ambiguity tolerant than those who see themselves as academics. Increasing professional experience and age decreases the frequency of situations in which commanders experience some form of ambiguity. However, experience and age do not affect tolerance if ambiguity is perceived. No correlation between risk tolerance and ambiguity tolerance is found. More research needs to be conducted on how ambiguity tolerance affects performance among decision- makers during emergency and disaster responses.
Public service motivation of county-level emergency managers
Authors: Malone, PhD Matthew
Published: March 2019

This study seeks to understand the public service motivations (PSMs) of professional emergency managers. In order to do this, county-level emergency managers completed an electronic survey designed to measure their PSM using standard PSM measures developed by Perry in 1996 along with my own emergency management specific measures. The survey results strongly indicate that county-level emergency managers have high levels of PSM, and they have a strong desire to specifically be emergency managers.
Mass casualty incidents and B-Con training
Authors: Robaina, MD Jose A. , Crawford, MD Scott B. , Huerta, MPH Diane , Austin, BA Danielle , Wells, MD Radosveta M. , Monks, PhD Stormy M.
Published: March 2019

Objective: The purpose of this study was to determine if providing mass casualty training, utilizing the Bleeding Control for the Injured (B-Con) course would allow participants to feel more confident to provide bystander aid to wounded victims in a mass casualty incident (MCI).Design: Quasi-experimental pre-post intervention study.Setting: Participants were healthcare providers attending a trauma research conference hosted by a medical university.Interventions: Participants were given a group lecture in each of the three B-Con skill areas. These include: bleeding control with a tourniquet, bleeding control with gauze, and airway control with a jaw thrust. Participants were then divided into three groups and practiced each skill with instruction from B-Con certified trainers.Main outcomes measures: The primary outcome was scores from pre- to post-intervention in the categories of self-efficacy, perceived benefit, perceived susceptibility, perceived barriers, and perceived severity related to involvement in an MCI.Results: The study included 67 participants, all identifying as medical providers. Means in the categories of self-efficacy, perceived benefit, perceived susceptibility, perceived barriers, and perceived severity significantly increased from pre-intervention to postintervention among the paired variables.Conclusions: This study demonstrates the effectiveness of B-Con training in improving the confidence of participants. By increasing the number of persons who are trained for an MCI, there will be an increased probability that triage and immediate care will be rendered when needed. Future research needs to be completed evaluating the effect of training on a layperson study sample.
The history of higher education in emergency management: The Emergency Management Institute, the National Science Foundation, and the William Averette Anderson Fund
Authors: Waugh Jr, PhD William L. , Goss, CEM Kay C.
Published: March 2019

As the profession of emergency management has matured, the roles and responsibilities of emergency managers  have  expanded,  new  technologies  have been deployed, and emergency management educa- tion grown and has become better connected to emer- gency management practice. This special topic cover- age (in three parts) addresses many of the changes in emergency management education over the past four decades, including the expansion of academic pro- grams for those preparing to enter the field, those transitioning from emergency response and other fields, and those moving into supervisory and man- agement positions in emergency management and related organizations. It also addresses some of the issues that academic programs have encountered as they have developed and have found their places in academic institutions. (Login to read more.)
The essential skill set of a resilient emergency manager
Authors: Tyler, MS Jenna , Sadiq, PhD Abdul-Akeem
Published: March 2019

The broadened mission of emergency management has required emergency managers to develop and maintain a diverse and evolving set of skills and competencies. While several scholars and practitioners have offered guidance on the skills, competencies, and education needed to be an effective emergency manager, there are other equally important characteristics of an effective emergency manager that have received relatively less attention in the emergency management literature. This article seeks to provide a more comprehensive list of the characteristics of an effective emergency manager by introducing the notion of the resilient emergency manager. A resilient emergency manager is someone who is able to adapt to changing conditions, make agile decisions, function interoperably, mobilize resources, scale programs, policies, and procedures, develop robust collaborative networks, and build redundant emergency management systems. This article concludes with a discussion on how to build and sustain the essential skill set of a resilient emergency manager.
Curricular innovation and emergency management in higher education: Making the general education connection
Authors: Jensen, PhD Jessica , Klenow, PhD Daniel J. , Youngs, Jr, PhD George A.
Published: March 2019

Objective: As a distributed function, emergency management in higher education must involve students from outside the field. An introductory emergency management course was redesigned to be attractive and visible to nonmajors via approval for inclusion in the university’s core general education curriculum.Design: Pre-/post comparisons were made of enrollment data for two interventions intended to broaden the course’s audience. Later, a survey assessed why students took the course.Setting: A land grant research university serving over 14,000 undergraduate and graduate students.Participants: Participants were students taking the Department’s introductory course.Interventions: Two interventions involved the Department’s entry level course originally titled, “Introduction to Emergency Management” and numbered at the sophomore level. First, the Department retitled the course, “Emergencies, Disasters, and Catastrophes,” and renumbered the course at the freshman level. Second, the Department later requested and received approval to have the course accepted in the University’s general education curriculum.Main outcome measures: Interventions were assessed by examining the average, annual number of nonmajors in the course, as well as, the academic diversity present among nonmajors.Results: Both interventions, and especially the general education intervention, increased both enrollment measures.Conclusions: A rapid approval for the course’s inclusion in general education validated faculty’s acceptance of emergency management as an academic discipline while each intervention increased both the number and academic diversity of nonmajors. Long-term, the result should prepare nonemergency management leaders for emergency management as a distributed function.
The development of Emergency Management and Homeland Security Degree program at historically black colleges and universities: The case of Texas Southern University, Houston, Texas
Authors: Olonilua, PhD Oluponmile O.
Published: March 2019

This article shares the experience of establishing the Emergency Management and Homeland Security degree program at Texas Southern University (TSU), Houston, Texas. Emergency management programs are evolving and keep increasing and the nature of jobs of emergency managers are becoming more complex. Consequently, there is increasing need to have minority emergency managers who would be able to relate directly with other minorities impacted by disasters. This study uses the case of TSU to discuss the challenges and successes of developing a fairly unknown program at a historically black college and university and how the obstacles were overcome. It further discusses the process of the degree program development, the curriculum, and the present state of the program. This article concludes there are many advantages in training emergency managers of color in the field. These would be professionals in the field with the added advantage of being people of color. They would understand planning for and responding to those affected because they most likely have the same background and similar experience. Additionally, the developer of any new program should expect some form of opposition from faculty, staff, and administration but once central administration buys in, the program is worth the while.
Opioid utilization patterns among patients with cancer and non-cancer pain
Authors: Datto, MD, MS Catherine J. , Hu, MD, PhD Yiqun , Wittbrodt, PharmD, MPH Eric , Fine, MD Perry G.
Published: March 2019

Objective: Opioid pain medication continues to be an important treatment option for patients with moderate to severe cancer and non-cancer pain; however, limited evidence is available regarding differences in opioid use between these two populations. The objective of this analysis was to compare real-world opioid use patterns over time in these two populations.Design: Retrospective analysis of administrative claims data.Setting: HealthCore Integrated Research Environment database.Patients: Adults with ≥1 opioid pharmacy claim (and a confirmed cancer diagnosis for the cancer pain cohort).Main outcome measures: Opioid doses and dose changes following the initial prescribed (index) dose were determined.Results: In the cancer pain (n = 9,209) and non-cancer pain (n = 409,703) cohorts, median index opioid doses were 51.7 and 45.0 morphine-equivalent units (MEU), respectively, and median post-index opioid doses were 55.8 and 45.1 MEU for the cancer pain and non-cancer pain cohorts, respectively. The most common dose escalation in both groups was up to a dose doubling (cancer pain, 31.8 percent; non-cancer pain, 28.3 percent). The proportions of patients with dose increases exceeding two times the index dose were low and clinically comparable between cohorts (cancer pain, 9.9 percent; non-cancer pain, 7.4 percent).Conclusions: Opioid use was consistent between patients with cancer pain and non-cancer pain, including clinically comparable total daily opioid doses and consistent rates of dose escalations and chronic utilization. Opioid medications are an important element of cancer and non-cancer pain management; thus, access to appropriate therapies, use patterns, and risk assessment and management are important for both patient populations.
Exploratory study examining associations between prescription opioid dose and delay discounting in patients with chronic pain
Authors: Morasco, PhD Benjamin J. , Dobscha, MD Steven K. , Hyde, MA Stephanie , Mitchell, PhD Suzanne H.
Published: March 2019

Objective: Although some research has identified correlates of high-dose opioid prescriptions, relatively little is known about factors that lead to higher doses. Delay discounting (DD), defined as the subjective value of a reward declining as a function of the delay to that reward, is an objective measure of impulsivity. DD is commonly studied in the context of addictive behaviors, and findings consistently demonstrate greater DD among individuals with opioid use disorders. The authors conducted a preliminary investigation to examine the extent to which DD is associated with prescription opioid dose among patients with musculoskeletal pain.Design: Cross-sectional study.Setting: A single veterans affairs medical center located in the Pacific Northwest.Subjects: Participants with chronic musculoskeletal pain. The authors identified patients prescribed with high doses of opioids (100 mg morphine equivalent per day [MED] or more; n = 17), traditional doses of opioids (5-99 mg MED; n = 34), and patients with pain who were not prescribed opioids (n = 24).Methods: All participants completed a battery of self-report measures assessing demographic characteristics, pain-related variables, and psychiatric symptoms. Participants also completed a computerized DD task.Results: DD was negatively correlated with average daily opioid dose (p = 0.003) and positively correlated with anxiety (p = 0.013). In a multivariable regression analysis, after controlling for the effects of demographic and clinical factors, DD was significantly associated with prescription opioid dose.Conclusions: Contrary to study expectations, higher opioid dose was associated with less DD. These findings call for prospective research to further elucidate the relationships between DD and other measures of impulsivity and prescription opioid doses.
Can QT interval prolongation or dispersion detected in a positive exercise ECG test predict critical coronary artery disease?
Authors: Demirtaş Abdullah Orhan , Urgun Orsan Deniz
Published: March 2019

Introduction

Exercise electrocardiography (EET) is frequently used in coronary artery disease, but the specificity of this test is very low. In the literature, parameters such as QT prolongation and QT dispersion which show coronary artery disease and arrhythmia were not sufficiently investigated using EET. The aim of this study was to investigate whether QT interval prolongation or dispersion (QT disp) in a positive EET test could predict critical coronary artery disease (CAD).

Material and methods

Patients with a positive exercise test were included in the study. Data regarding QT, QTc (corrected QT interval) and QT disp values before, during and after EET were noted. Critical coronary artery occlusions (≥ 70%) was recorded from coronary angiographic images. Patients were divided into two groups (critical CAD and non-critical CAD).

Results

A total of 192 patients were found to be eligible for the study. There were 126 patients in the non-critical CAD group (group 1) and 66 patients in the critical CAD group (group 2). Recovery QTc, peak QT disp, and recovery QT disp were significantly increased in group 2 (p < 0.001 for each). Also, target heart rate (p = 0.012), basal systolic blood pressure (p = 0.005) and diastolic blood pressure (p < 0.001) were significantly higher in group 1. Recovery QTc (OR = 1.051) and recovery QT disp (OR = 1.117) were determined as the independent predictors for critical CAD. The ROC analysis results indicated that critical CAD could be diagnosed with 90% sensitivity when the recovery QTc cut-off value was set as 404 ms.

Conclusions

In patients with positive EET, prolonged QTc and QT disp values measured during the recovery period would predict critical CAD. Thus, the clinical accuracy of EET may be enhanced.