bluuebunny/crossref_metadata_2025 huggingface dataset:
Retention of laparoscopic psychomotor skills after a structured training program depends on the quality of the training and on the complexity of the task
Authors: Molinas Carlos Roger , Campo Rudi
Published: July 2016

This follow-up RCT was conducted to evaluate laparoscopic psychomotor skills retention after finishing a structured training program. In a first study, 80 gynecologists were randomly allocated to four groups to follow different training programs for hand-eye coordination (task 1) with the dominant hand (task 1-a) and the non-dominant hand (task 1-b) and laparoscopic intra-corporeal knot tying (task 2) in the Laparoscopic Skills Testing and Training (LASTT) model. First, baseline skills were tested (T1). Then, participants trained task 1 (G1: 1-a and 1-b, G2: 1-a only, G3 and G4: none) and then task 2 (all groups but G4). After training all groups were tested again to evaluate skills acquisition (T2). For this study, 2 years after a resting period, 73 participants were recruited and tested again to evaluate skills retention (T3). All groups had comparable skills at T1 for all tasks. At T2, G1, G2, and G3 improved their skills, but the level of improvement was different (G1 = G2 > G3 > G4 for task 1; G1 = G2 = G3 > G4 for task 2). At T3, all groups retained their task 1 skills at the same level than at T2. For task 2, however, a skill decay was already noticed for G2 and G3, being G1 the only group that retained their skills at the post-training level. Training improves laparoscopic skills, which can be retained over time depending on the comprehensiveness of the training program and on the complexity of the task. For high complexity tasks, full training is advisable for both skills acquisition and retention.
Set-point Control of Mobile Robot with Obstacle Detection and Avoidance Using Navigation Function - Experimental Verification
Authors: Kowalczyk Wojciech , Przybyla Mateusz , Kozlowski Krzysztof
Published: July 2016

This paper presents the results of an experimental verification of mobile robot control algorithm including obstacle detection and avoidance. The controller is based on the navigation potential function that was proposed in work (Urakubo, Nonlinear Dyn. 81(3), 1475–1487 2015). Conducted experiments considered the task of reaching and stabilization of robot in point. The navigation potential agregates information of robot position and orientation but also the repelling potentials of obstacles. The obstacle detection is performed solely with the use of laser scanner. The experiments show that the method can easily handle environments with one or two obstacles even if they instantly hide or show-up due to the scanner range limits. The experiments also indicate that the utilized control method has a good potential for being used in parallel parking task.
Psychosocial and Clinical Factors Associated with Family Communication of Cancer Genetic Test Results among Women Diagnosed with Breast Cancer at a Young Age
Authors: Elrick Ashley , Ashida Sato , Ivanovich Jennifer , Lyons Sarah , Biesecker Barbara B. , Goodman Melody S. , Kaphingst Kimberly A.
Published: July 2016

Genetic test results have medical implications beyond the patient that extend to biological family members. We examined psychosocial and clinical factors associated with communication of genetic test results within families. Women (N = 1080) diagnosed with breast cancer at age 40 or younger completed an online survey; 920 women that reported prior cancer genetic testing were included in analysis. We examined the proportion of immediate family members to whom they communicated genetic test results, and built multivariable regression models to examine clinical and psychosocial variables associated with the proportion score. Participants were most likely to communicate test results to their mother (83 %) and least likely to their son (45 %). Participants who carried a BRCA mutation (OR = 1.34; 95 % CI = 1.06, 1.70), had higher interest in genomic information (OR = 1.55; 95 % CI = 1.26, 1.91) and lower genetic worry (OR = 0.91; 95 % CI = 0.86, 0.96) communicated genetic test results to a greater proportion of their immediate family members. Participants with a BRCA1/2 mutation shared their genetic test results with more male family members (OR = 1.72; 95 % CI = 1.02, 2.89). Our findings suggest that patients with high worry about genetic risks, low interest in genomic information, or receive a negative genetic test result will likely need additional support to encourage family communication.
Traumatic Acid Reduces Oxidative Stress and Enhances Collagen Biosynthesis in Cultured Human Skin Fibroblasts
Authors: Jabłońska‐Trypuć Agata , Pankiewicz Walentyn , Czerpak Romuald
Published: July 2016

Traumatic acid (TA) is a plant hormone (cytokinin) that in terms of chemical structure belongs to the group of fatty acids derivatives. It was isolated from Phaseolus vulgaris. TA activity and its influence on human cells and organism has not previously been the subject of research. The aim of this study was to examine the effects of TA on collagen content and basic oxidative stress parameters, such as antioxidative enzyme activity, reduced glutathione, thiol group content, and lipid peroxidation in physiological conditions. The results show a stimulatory effect of TA on tested parameters. TA caused a decrease in membrane phospholipid peroxidation and exhibited protective properties against ROS production. It also increases protein and collagen biosynthesis and its secretion into the culture medium. The present findings reveal that TA exhibits multiple and complex activity in fibroblast cells in vitro. TA, with its activity similar to unsaturated fatty acids, shows antioxidant and stimulatory effects on collagen biosynthesis. It is a potentially powerful agent with applications in the treatment of many skin diseases connected with oxidative stress and collagen biosynthesis disorders.
Identification of Ingredients for Stabilizing Frying Oil Through a New Screening Method
Authors: Ban Lan , Patel Neil M. , Schroeder William D.
Published: July 2016

Frying oils are prone to quality deterioration; because of the high surface area, lipid molecules can interact with air, moisture, and oxidative reagents that promote various reactions. However, the search for effective ingredients for stabilizing frying oil has been slow, given the complexity of the frying processes and lack of effective tools to accurately predict the performance of emerging ingredients. On the other hand, demand for label‐friendly food ingredients has increased. This study aimed to develop a rapid method mimicking real frying conditions to allow the screening of a large number of treatments with improved throughput, while evaluating their effectiveness in stabilizing frying oils. The design utilizes multi‐well heating blocks of conventional OSI. Repeated frying was conducted using miniature baskets, and validations were conducted to examine the accuracy of the relative efficacy of individual treatments. Utilizing this method as a tool, natural plant extracts, standard antioxidants, and their combinations were evaluated and compared in frying palm oil, which demonstrated that the combination of tocopherols, rosemary extract, and oil‐soluble green tea extract was effective for the stabilization of frying oil.
Comparative Gene Expression Analysis of Mouse and Human Cardiac Maturation
Authors: Uosaki Hideki , Taguchi Y-h
Published: July 2016

Understanding how human cardiomyocytes mature is crucial to realizing stem cell-based heart regeneration, modeling adult heart diseases, and facilitating drug discovery. However, it is not feasible to analyze human samples for maturation due to inaccessibility to samples while cardiomyocytes mature during fetal development and childhood, as well as difficulty in avoiding variations among individuals. Using model animals such as mice can be a useful strategy; nonetheless, it is not well-understood whether and to what degree gene expression profiles during maturation are shared between humans and mice. Therefore, we performed a comparative gene expression analysis of mice and human samples. First, we examined two distinct mice microarray platforms for shared gene expression profiles, aiming to increase reliability of the analysis. We identified a set of genes displaying progressive changes during maturation based on principal component analysis. Second, we demonstrated that the genes identified had a differential expression pattern between adult and earlier stages (e.g., fetus) common in mice and humans. Our findings provide a foundation for further genetic studies of cardiomyocyte maturation.
Placental insufficiency among high‐risk pregnancies with a normal umbilical artery resistance index after 32 weeks
Authors: Geerts Lut , Van der Merwe Elrike , Theron Anneke , Rademan Kerry
Published: July 2016

Objective

To determine the incidence of abnormal multi‐vessel Doppler values among advanced pregnancies at risk of suboptimal placentation but with a normal umbilical artery resistance index (RI), and to assess whether clinical and ultrasonography findings can identify them.

Methods

In a prospective cross‐sectional study at Tygerberg Hospital, South Africa, women with high‐risk pregnancies but normal umbilical artery RI after 32 weeks underwent ultrasonography (fetal biometry, liquor, and placenta maturation) and Doppler assessment (uterine, umbilical, and middle cerebral arteries) between February 11 and October 21, 2013. Study data were compared among four groups: fetuses with normal uterofetoplacental Doppler values and those with any abnormal pulsatility index, each subdivided into small for gestational age (SGA) and appropriate for gestational age (AGA) by estimated fetal weight.

Results

Of 210 participants, 72 (36.2%) had abnormal Doppler results, and 60 (28.6%) fetuses were SGA (38 [63.3%] with abnormal Doppler results). Clinical characteristics did not differ between groups with normal or abnormal Doppler values; however, among normal Doppler results, SGA pregnancies demonstrated poorer fundal growth (P=0.006). Significant associations existed between abnormal Doppler results and asymmetric growth, inappropriately advanced placental maturation, and reduced liquor volume (all P≤0.04), but with very low sensitivities (3.9%, 4.8%, and 14.5%, respectively).

Conclusion

Maternal characteristics and imaging variables did not reliably identify more than one‐third of pregnancies with evidence of suboptimal placentation.
Evaluating the clinical relevance of a cognitive composite outcome measure: An analysis of 1414 participants from the 5‐year GuidAge Alzheimer's prevention trial
Authors: Coley Nicola , Gallini Adeline , Ousset Pierre‐Jean , Vellas Bruno , Andrieu Sandrine ,   GuidAge study group
Published: July 2016

Introduction

Composite cognitive scores have been developed as primary outcome measures for preclinical/prevention trials for Alzheimer's disease (AD), mainly using observational data and with little consideration of clinical relevance.

Methods

Secondary analysis of placebo group data from a 5‐year AD prevention trial. The composite score was the average of the following z scores: MMSE orientation items, Free and Cued Selective Reminding Test, Category Fluency, Trail Making Test—part B.

Results

Composite score change from baseline differed significantly by age, APOE genotype, and CDR progression and AD dementia status. A 1 point decrease in baseline score was highly predictive of 5‐year AD dementia risk (HR = 3.51, 95% CI, 2.62–4.71, P < .001). The 1 year minimum clinically important difference was estimated at −0.3 points and predicted AD dementia.

Discussion

We explored the clinical relevance of a composite score in a prevention trial setting. This type of analysis facilitates the interpretation of composite scores and informs power calculations.
Decreased hippocampal metabolism in high‐amyloid mild cognitive impairment
Authors: Hanseeuw Bernard J. , Schultz Aaron P. , Betensky Rebecca A. , Sperling Reisa A. , Johnson Keith A.
Published: July 2016

Introduction

Hippocampal volume (HV), cortical metabolism, and thickness are decreased in mild cognitive impairment (MCI). Hippocampal metabolism (HM) studies comparing MCI and clinically normal (CN) elderly gave inconsistent results. As hippocampus is a key region in Alzheimer's disease, we hypothesized that HM is specifically decreased in high‐amyloid MCI.

Methods

Overall, 250 CN and 45 MCI underwent three‐dimensional magnetic resonance imaging, fludeoxyglucose‐positron emission tomography, and fluorodeoxyglucose‐positron emission tomography (PET), and Pittsburgh Compound B (PiB) PET. We investigated the interaction between clinical and amyloid status on HM, HV, cortical metabolism, and thickness using linear models, covarying age, gender, and education. Analyses were conducted with and without correction for multiple comparisons and for partial volume effects.

Results

Volume‐adjusted HM was decreased in high‐amyloid MCI but close to normal in low‐amyloid MCI and in high‐amyloid CN. Both MCI groups had hippocampal atrophy, although less severe in low‐amyloid MCI. High‐amyloid CN and high‐amyloid MCI had cortical hypometabolism.

Discussion

HM is decreased when both cognitive impairment and amyloid are present.
Tract‐specific white matter hyperintensities disrupt neural network function in Alzheimer's disease
Authors: Taylor Alexander N.W. , Kambeitz-Ilankovic Lana , Gesierich Benno , Simon-Vermot Lee , Franzmeier Nicolai , Araque Caballero Miguel Á. , Müller Sophia , Hesheng Liu , Ertl-Wagner Birgit , Bürger Katharina , Weiner Michael W. , Dichgans Martin , Duering Marco , Ewers Michael ,   Alzheimer's Disease Neuroimaging Initiative (ADNI)
Published: July 2016

Introduction

White matter hyperintensities (WMHs) increase the risk of Alzheimer's disease (AD). Whether WMHs are associated with the decline of functional neural networks in AD is debated.

Method

Resting‐state functional magnetic resonance imaging and WMH were assessed in 78 subjects with increased amyloid levels on AV‐45 positron emission tomography (PET) in different clinical stages of AD. We tested the association between WMH volume in major atlas‐based fiber tract regions of interest (ROIs) and changes in functional connectivity (FC) between the tracts' projection areas within the default mode network (DMN).

Results

WMH volume within the inferior fronto‐occipital fasciculus (IFOF) was the highest among all tract ROIs and associated with reduced FC in IFOF‐connected DMN areas, independently of global AV‐45 PET. Higher AV‐45 PET contributed to reduced FC in IFOF‐connected, temporal, and parietal DMN areas.

Conclusions

High fiber tract WMH burden is associated with reduced FC in connected areas, thus adding to the effects of amyloid pathology on neuronal network function.
Performance measurement of plate fin heat exchanger by exploration: ANN, ANFIS, GA, and SA
Authors: Gupta A.K. , Kumar P. , Sahoo R.K. , Sahu A.K. , Sarangi S.K.
Published: July 2016

An experimental work is conducted on counter flow plate fin compact heat exchanger using offset strip fin under different mass flow rates. The training, testing, and validation set of data has been collected by conducting experiments. Next, artificial neural network merged with Genetic Algorithm (GA) utilized to measure the performance of plate-fin compact heat exchanger. The main aim of present research is to measure the performance of plate-fin compact heat exchanger and to provide full explanations. An artificial neural network predicted simulated data, which verified with experimental data under 10–20% error. Then, the authors examined two well-known global search techniques, simulated annealing and the genetic algorithm. The proposed genetic algorithm and Simulated Annealing (SA) results have been summarized. The parameters are impartially important for good results. With the emergence of a new data-driven modeling technique, Neuro-fuzzy based systems are established in academic and practical applications. The neuro-fuzzy interference system (ANFIS) has also been examined to undertake the problem related to plate-fin heat exchanger performance measurement under various parameters. Moreover, Parallel with ANFIS model and Artificial Neural Network (ANN) model has been created with emphasizing the accuracy of the different techniques. A wide range of statistical indicators used to assess the performance of the models. Based on the comparison, it was revealed that technical ANFIS improve the accuracy of estimates in the small pool and tropical ANN.

Highlights Performance of compact plate fin heat exchanger has been measured. Predicted data given by ANN has been verified by simulation data and the experimental data. Depicted the applications of optimization methods upon fin heat exchanger.
Results of videolaparoscopic surgical treatment of diverticular disease of the colon
Authors: Rodrigues Vinícius Pires , Queiroz Fábio Lopes de , Neto Paulo Rocha França , Carvalho e Carvalho Maria Emília
Published: July 2016

Introduction Diverticular disease of the colon (DDC) is the fifth most common gastrointestinal disease in developed Western countries, with mortality rates of 2.5 per 100,000 inhabitants per year.

Objective The objective of this study is to compare the occurrence of complications, conversion rate, use of stoma, deaths and time of hospitalization among patients undergoing rectosigmoidectomy for DDC and patients undergoing the same surgery for other reasons.

Method This was an observational retrospective comparative study. This study was approved by the ethics committee of the Hospital Felicio Rocho – Minas Gerais, Brazil – and the data were obtained from the same hospital database.

Results The groups were classified according to age, gender, presence of comorbidities, and ASA classification. There was no evidence indicating a significant difference between groups. In this analysis, no perioperative complications were observed and there was no need for a stoma, and no deaths or fistulas occurred.

Conclusion Elective laparoscopic surgical treatment of DDC in the analyzed group showed no difference in complications, duration of surgery and hospitalization time versus control group. Therefore, the laparoscopic surgical treatment of diverticular disease translates into an excellent tool for both the surgeon and the patient.
Evaluation of the characteristics of rotational activation at high‐dominant frequency and complex fractionated atrial electrogram sites during atrial fibrillation
Authors: Kumagai Koji , Minami Kentaro , Kutsuzawa Daisuke , Oshima Shigeru
Published: July 2016

Background

High‐dominant frequency (DF) and continuous complex fractionated atrial electrogram (CFAE) sites as surrogates for localized sources maintaining atrial fibrillation (AF) are potential AF ablation targets. This study aimed to evaluate the characteristics of a rotational activation at high‐DF and continuous CFAE sites in AF patients.

Methods

Thirty‐two consecutive AF patients (5 paroxysmal and 27 non‐paroxysmal) underwent ablation using the NavX system. When AF continued after circumferential pulmonary vein isolation (PVI), high‐DF sites of ≥8 Hz and continuous CFAE sites (fractionated intervals ≤50 ms) in the left (LA) and right (RA) atria were recorded using a high‐density 20‐pole circular mapping catheter for 5 s and ablated.

Results

The atrial electrogram characteristics during AF were assessed. A total of 2383 AF beats from 89 high‐DF and 19 continuous CFAE sites were investigated. A rotational activation of high‐DF and continuous CFAE sites was also observed at 4% and 3% of LA, and 4% and 4% of RA sites, respectively. However, rotational activation was identified in 29 (91%) of 32 patients (mean 3.0±2.6 beats per patient, 80% in the LA). Procedural endpoints were achieved in 26 (81%) of 32 patients: AF termination (n=2) and AF cycle length slowing of >10% (n=26).

Conclusions

Rotational activation could be identified in high‐DF and continuous CFAE sites during AF, but the documentation was limited. Therefore, only limited effects of rotational activation ablation at high‐DF and/or continuous CFAE sites following PVI could be concluded.
The impact of firms’ social media initiatives on operational efficiency and innovativeness
Authors: Lam Hugo K.S. , Yeung Andy C.L. , Cheng T.C. Edwin
Published: July 2016

Social media have been increasingly adopted for organizational purposes but their operational implications are not well understood. Firms’ social media initiatives might facilitate information flow and knowledge sharing within and across organizations, strengthening firm‐customer interaction, and improving internal and external collaboration. In this research we empirically examine the impact of social media initiatives on firms’ operational efficiency and innovativeness. Taking the resource‐based view of firms’ information capability, we consider firms’ social media initiatives as strategic resources for operational improvement. We posit that firms’ social media initiatives enhance dynamic knowledge‐sharing routines through an information‐rich social network, leading to both operational efficiency and innovativeness. Collecting secondary data in a longitudinal setting from multiple sources, we construct dynamic panel data (DPD) models. Based on system generalized method of moments (GMM) estimation, we show that firms’ social media initiatives improve operational efficiency and innovativeness. We identify the importance of an information‐rich social network to the creation of knowledge‐based advantage through firms’ social media initiatives, and discuss the theoretical and managerial implications from the perspective of operations management.
Evaluation and Treatment of Mild Traumatic Brain Injury Through the Implementation of Clinical Video Telehealth: Provider Perspectives From the Veterans Health Administration
Authors: Martinez Rachael N. , Hogan Timothy P. , Lones Keshonna , Balbale Salva , Scholten Joel , Bidelspach Douglas , Musson Nan , Smith Bridget M.
Published: July 2016

Background

Substantial numbers of U.S. military veterans who served in recent conflicts experience mild traumatic brain injury. Data suggest that as many as 25% of veterans do not have a comprehensive traumatic brain injury evaluation to determine a diagnosis and develop a plan to treat symptoms. Technologies like clinical video telehealth offer a potential means to overcome travel distance and other barriers that can impact veteran receipt of a comprehensive traumatic brain injury evaluation after a positive screening; however, little is known about implementing clinical video telehealth in this context.

Objective

To examine the perspectives of Veterans Health Administration health care providers on implementing clinical video telehealth technology for the assessment and treatment of mild traumatic brain injury among veterans of Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn.

Design

Qualitative; semistructured interviews.

Setting

Veterans Health Administration Polytrauma System of Care.

Participants

Twenty‐six providers who participated in a Veterans Health Administration Rehabilitation and Prosthetic Services Teleconsultation Pilot Project for administering comprehensive traumatic brain injury evaluations over clinical video telehealth.

Methods

Semistructured interviews that used content‐analytic techniques to assess provider experiences implementing clinical video telehealth for veterans with traumatic brain injury, including inhibiting factors and best practices to administer comprehensive traumatic brain injury evaluations.

Results

The most commonly reported inhibiting factors to implementing clinical video telehealth for traumatic brain injury evaluation and treatment included scheduling, setting up the clinic, and conducting physical examinations over a virtual modality. To enhance clinical video telehealth implementation, participants described best practices including establishing solid communication and relationships with staff, building rapport with patients, and recognizing the unique needs of patients with traumatic brain injury.

Conclusions

Implementing clinical video telehealth programs involves coordinating multiple steps with providers at different sites, highlighting the need for effective communication. Provider‐patient communication also emerged as vital to successful clinical video telehealth implementation. These findings suggest that providers would benefit from efforts to build communication competencies.

Level of Evidence

Not applicable.
Innovations With 3‐Dimensional Printing in Physical Medicine and Rehabilitation: A Review of the Literature
Authors: Lunsford Christopher , Grindle Garrett , Salatin Benjamin , Dicianno Brad E.
Published: July 2016

Created more than 30 years ago, 3‐dimensional printing (3DP) has recently seen a meteoric rise in interest within medicine, and the field of Physical Medicine and Rehabilitation is no exception. Also called additive manufacturing (AM), the recent increase in the use of 3DP is likely due to lower‐cost printers as well as breakthroughs in techniques and processing. This thematic narrative review serves to introduce the rehabilitation professional to 3DP technology and how it is being applied to orthoses, prostheses, and assistive technology (AT). The basics of the technology, as well as the benefits and challenges of using it within the rehabilitation framework, are described. Proponents of the technology suggest that 3DP offers not only a better way to make devices, but a better way to make improved devices. However, the strength of this claim has not been properly tested by the current literature. This narrative review evaluates the evidence and provides a discussion of possible implications for the rehabilitation professional.
Internado médico: una difícil elección
Authors: Chinchay Ruesta Starly Alexis , Granados Burga Alex , Peña-Sánchez Eric Ricardo
Published: July 2016

El internado médico es indispensable para integrar y consolidar los conocimientos que se adquirieron durante los ciclos previos. Durante el mismo se tiene la oportunidad de estar en contacto permanente, lo que permite detectar riesgos, aplicar medidas preventivas, de diagnóstico, tratamiento y rehabilitación en los principales problemas de salud con sentido ético y humanista.
Significant Traumatic Intracranial Hemorrhage in the Setting of Massive Bee Venom–Induced Coagulopathy: A Case Report
Authors: Stack Kelsey , Pryor Lindsey
Published: July 2016

Bees and wasps of the Hymenoptera order are encountered on a daily basis throughout the world. Some encounters prove harmless, while others can have significant morbidity and mortality. Hymenoptera venom is thought to contain an enzyme that can cleave phospholipids and cause significant coagulation abnormalities. This toxin and others can lead to reactions ranging from local inflammation to anaphylaxis. We report a single case of a previously healthy man who presented to the emergency department with altered mental status and anaphylaxis after a massive honeybee envenomation that caused a fall from standing resulting in significant head injury. He was found to have significant coagulopathy and subdural bleeding that progressed to near brain herniation requiring emergent decompression. Trauma can easily occur to individuals escaping swarms of hymenoptera. Closer attention must be paid to potential bleeding sources in these patients and in patients with massive bee envenomation.
Earthquake Epidemiology: The 1994 Los Angeles Earthquake Emergency Department Experience at a Community Hospital
Authors: Kazzi A. Antoine , Langdorf Mark I. , Handly Neal , White Karen , Ellis Ken
Published: July 2016

Introduction:

To assess the volume of patients and the composition of their injuries and illnesses that presented to an emergency department (ED) close to the epicenter of an earthquake that occurred in a seismically prepared area.

Methods:

A retrospective analysis of data abstracted from charts and ED logs for patient census and types of injuries and illnesses of the patients who presented in the ED of a community hospital before and after the earthquake (6.8 Richter scale) that occurred in 1994 in Los Angeles. Illnesses were classified as trauma- and non-trauma related. Data were compared with epidemiological profiles of earthquakes in seismically prepared and unprepared areas.

Results:

A statistically significant increase in ED patient census over baseline lasted 11 days. There was a large increase in the number of traumatic injuries such as lacerations and orthopedic injuries during the first 48 hours. Beginning on the third day after the event, primary care conditions predominated. When the effects of the LA quake were compared with those of similar Richter magnitude and disruptive capability, the ED epidemiology profile was similar to those in seismically unprepared areas, except for the total number of casualties.

Conclusion:

The majority of patients with traumatic injuries presented within the first 48 hours. The increase relative to baseline lasted 11 days. Efforts to develop disaster response systems from resources outside the disaster-stricken area should focus on providing mostly primary care assistance. Communities in seismically prepared areas could require external medical assistance for their EDsfor up to two weeks following the event.
Hospital Responses to Acute-Onset Disasters: A Review
Authors: Milsten Andrew
Published: July 2016

Introduction:

Hospitals the world over have been involved in disasters, both internal and external. These two types of disasters are independent, but not mutually exclusive. Internal disasters are isolated to the hospital and occur more frequently than do external disasters. External disasters affect the community as well as the hospital. This paper first focuses on common problems encountered during acute-onset disasters, with regards to hospital operations and caring for victims. Specific injury patterns commonly seen during natural disasters are reviewed. Second, lessons learned from these common problems and their application to hospital disaster plans are reviewed.

Methods:

An extensive review of the available literature was conducted using the computerized databases Medline and Healthstar from 1977 through March 1999. Articles were selected if they contained information pertaining to a hospital response to a disaster situation or data on specific disaster injury patterns. Selected articles were read, abstracted, analyzed, and compiled.

Results:

Hospitals continually have difficulties and failures in several major areas of operation during a disaster. Common problem areas identified include communication and power failures, water shortage and contamination, physical damage, hazardous material exposure, unorganized evacuations, and resource allocation shortages.

Conclusions::

Lessons learned from past disaster-related operational failures are compiled and reviewed. The importance and types of disaster planning are reviewed.
Ally or Adversary? Using Media Systems for Public Health
Authors: Ball-Rokeach Sandra J. , Loges William E.
Published: July 2016

The media system controls information resources that public health agencies may wish to use to accomplish their goals, particularly in a crisis. The resources of the public health system sometimes are prized by the media system, and this provides opportunities for public health agencies to gain access to the media. This paper reviews the goals and resources of the media system as they relate to the mission of public health agencies in the periods before, during, and after a public health crisis. The various media are reviewed with attention to the role each can play for different purposes and at different stages of a crisis. The importance of presenting health information in the form of stories is emphasized, with specific advice regarding the attributes of an effective story.
Community Collaboration in Disaster: The Role of Voluntary Agencies
Authors: Bowenkamp Christine Dusty
Published: July 2016

Although the United States has been impacted by numerous devastating disasters over the last 10 years, there have been only limited efforts between the governmental and non-profit/voluntary organizations to meet the multiple disaster health and mental health needs of the community. Too often, responding organizations compete to provide services, duplicate efforts, and frequently under-estimate the need for services.

Recent efforts have been undertaken by The American Red Cross and other groups to resolve this issue. Governmental and community-based organizations have been invited to participate in planning sessions to pre-identify roles and responsibilities, as well as to exchange key information about the services each group can and does provide.

These efforts have lead to an increased awareness of the potential problems and the development of cohesive plans to provide medical and emotional support services to impacted communities. This has led to improved care for those with serious injuries or psychological crisis, while those with less critical problems have been managed appropriately without needing to be immediately referred to overcrowded emergency departments or physician's offices.
Theme 3. Sharing Pacific-Rim Experiences in Disasters: Summary and Action Plan
Authors: Hickson Catherine , Schull Michael , Arias Emilio Huertas , Asai Yasufumi , Chen Jih-Chang , Cheng Henry K. , Ishii Noboru , Kinugasa Tatsuya , Chow-In Ko Patrick , Koido Yuichi , Murayama Yoshio , Kwong Poon Wai , Ukai Takashi
Published: July 2016

Introduction:

The discussions in this theme provided an opportunity to address the unique hazards facing the Pacific Rim.

Methods:

Details of the methods used are provided in the preceding paper. The chairs moderated all presentations and produced a summary that was presented to an assembly of all of the delegates. Since the findings from the Theme 3 and Theme 7 groups were similar, the chairs of both groups presided over one workshop that resulted in the generation of a set of action plans that then were reported to the collective group of all delegates.

Results:

The main points developed during the presentations and discussion included: (1) communication, (2) coordination, (3) advance planning and risk assessment, and (4) resources and knowledge.

Discussion:

Action plans were summarized in the following ideas: (1) plan disaster responses including the different types, identification of hazards, focusing training based on experiences, and provision of public education; (2) improve coordination and control; (3) maintain communications, assuming infrastructure breakdown; (4) maximize mitigation through standardized evaluations, the creation of a legal framework, and recognition of advocacy and public participation; and (5) provide resources and knowledge through access to existing therapies, the media, and increasing and decentralizing hospital inventories.

Conclusions:

The problems in the Asia-Pacific rim are little different from those encountered elsewhere in the world. They should be addressed in common with the rest of the world.
Theme 8. Education Issues in Disaster Medicine: Summary and Action Plan
Authors: Pearce Laurie , Bourque Linda B. , Armour S.J. , Bastone Peter , Birnbaum Marvin , Garrett Christopher , Greenough P.G. , Manni Corrado , Ninomiya Norifumi , Renderos Jaime , Rottman Steven , Sahni Pardeep , Shih Chung-Liang , Siegel David , Younggren Bradley
Published: July 2016

Introduction:

Change must begin with education. Theme 8 explored issues that need attention in Disaster Medicine education.

Methods:

Details of the methods used are provided in the introductory paper. The chairs moderated all presentations and produced a summary that was presented to an assembly of all of the delegates. The chairs then presided over a workshop that resulted in the generation of a set of action plans that then were reported to the collective group of all delegates.

Results:

Main points developed during the presentations and discussion included: (1) formal education, (2) standardized definitions, (3) integration (4) evaluation of programs and interventions, (5) international cooperation, (6) identifying the psychosocial consequences of disaster, (7) meaningful research, and (8) hazard, impact, risk and vulnerability analysis.

Discussion:

Three main components of the action plans were identified as evaluation, research, and education. The action plans recommended that: (1) education on disasters should be formalized, (2) evaluation of education and interventions must be improved, and (3) meaningful research should be promulgated and published for use at multiple levels and that applied research techniques be the subject of future conferences.

Conclusions:

The one unanimous conclusion was that we need more and better education on the disaster phenomenon, both in its impacts and in our response to them. Such education must be increasingly evidence-based.
Toxic Trauma
Authors: Moles T.M. , Baker D.J.
Published: July 2016

Hazardous materials (HAZMAT) carry many inherent dangers. Such materials are distributed widely in industrial and military sites. Toxic trauma (TT) denotes the complex of systemic and organ injury caused by toxic agents. Often, TT is associated with other injuries that also require the application of life-support techniques. Rapid onset of acute respiratory failure and consequent cardiovascular failure are of primary concern. Management of TT casualties is dependent upon the characteristics of the toxic agents involved and on the demographics surrounding the HAZMAT incident.

Agents that can produce TT possess two pairs of salient characteristics: (1) causality (toxicity and latency), and (2) EMS system (persistency and transmissibility). Two characteristics of presentations are important: (1) incident presentation, and (2) casualty presentation. In addition, many of these agents complicate the processes associated with anaesthesia and must be dealt with. Failure of recognition of these factors may result in the development of respiratory distress syndromes and multiorgan system failure, or even death.
Y2K Medical Disaster Preparedness in New York City: Confidence of Emergency Department Directors in their Ability to Respond
Authors: Silber Steven H. , Oster Neill , Simmons Bonnie , Garrett Christopher
Published: July 2016

Objectives:

To study the preparedness New York City for large scale medical disasters using the Year 2000 (Y2K) New Years Eve weekend as a model.

Methods:

Surveys were sent to the directors of 51 of the 9-1-1-receiving hospitals in New York City before and after the Y2K weekend. Inquiries were made regarding hospital activities, contingencies, protocols, and confidence levels in the ability to manage critical incidents, including weapons of mass destruction (WMD) events. Additional information was collected from New York City governmental agencies regarding their coordination and preparedness.

Results:

The pre-Y2K survey identified that 97.8% had contingencies for loss of essential services, 87.0% instituted their disaster plan in advance, 90.0% utilized an Incident Command System, and 73.9% had a live, mock Y2K drill. Potential terrorism influenced Y2K preparedness in 84.8%. The post-Y2K survey indicated that the threat of terrorism influenced future preparedness in 73.3%; 73.3% had specific protocols for chemical; 62.2% for biological events; 51.1% were not or only slightly confident in their ability to manage any potential WMD incidents; and 62.2% felt very or moderately confident in their ability to manage victims of a chemical event, but only 35.6% felt similarly about victims of a biological incident. Moreover, 80% felt there should be government standards for hospital preparedness for events involving WMD, and 84% felt there should be government standards for personal protective and DECON equipment. In addition, 82.2% would require a moderate to significant amount of funding to effect the standards. Citywide disaster management was coordinated through the Mayor's Office of Emergency Management.

Conclusions:

Although hospitals were on a heightened state of alert, emergency department directors were not confident in their ability to evaluate and manage victims of WMD incidents, especially biological exposures. The New York City experience is an example for the rest of the nation to underscore the need for further training and education of preparedness plans for WMD events. Federally supported education and training is available and is essential to improve the response to WMD threats.
Job Satisfaction in EMS: A Different Approach
Authors: Wirth Stephen R.
Published: July 2016

There has been limited organizational research applied to EMS, especially in the area of job satisfaction. In the midst of a general shortage of health care workers, effective recruitment and retention of a qualified and satisfied work force is a critical issue. The purpose of this study was to examine the factors and elements in the structure or “design” of the work of emergency medical technicians (EMTs) and paramedics that can create conditions for high levels of work motivation, satisfaction, and performance.

A modified Job Diagnostic Survey was administered to a cross section of 102 paid and volunteer EMS personnel in Pennsylvania. The relationships between measured job characteristics, experienced psychological states, and job longevity on overall job satisfaction was examined.

Significant positive relationships (p<.05) exist between a number of the job characteristic variables (such as task significance, autonomy, and job feedback) and job satisfaction. Job longevity did not have a significant relationship to job satisfaction. Volunteer EMS personnel experienced higher levels of job satisfaction than did paid providers.

The results indicate that the EMT and paramedic perform complex jobs that have high levels of the characteristics that cause internal work motivation. Methods to increase the amount of these core job characteristics to improve overall job satisfaction are discussed.
Patient Distribution of an Urban-Rural Emergency Medical Services System
Authors: Jastremski Michael S. , Lagoe Ronald J.
Published: July 2016

This study describes a series of mechanisms to alleviate overcrowding of hospital emergency departments by distributing critically ill patients among facilities with available resources. The initial mechanism, which was based on the availability of critical care beds, was used successfully between 1982 and 1986, but had to be abandoned when several new factors caused the availability of emergency department resources to become the limiting factor. A second approach, based on the availability of critical care and emergency department resources, produced limited success over a one-year period. The system currently in use, implemented in 1989, includes a distribution system based on the availability of emergency department resources and critical care beds, as well as a mechanism for diversion of ambulances to hospitals in neighboring counties at times of extremely high utilization. This experience demonstrates that mechanisms for planning the distribution of emergency and critically ill patients have universal applicability.
Medical Responses to Terrorist Incidents
Authors: Sullivan John P.
Published: July 2016

Terrorism can be considered a form of low-intensity conflict. It results from extreme reactions to sociopolitical conditions. These reactions, through a variety of intellectual and emotional processes, are manifest as overt acts of violence. Terrorism includes acts by individuals or organizations which seek to change political or social conditions, make political or ideological statements, or obtain funds for sustaining ongoing terrorist or revolutionary campaigns. Terrorist incidents are increasingly prevalent. Often, they involve loss of lives and mass casualties and have special medical dimensions. As such, the role of EMS in terrorist incidents needs to be defined clearly.
Prehospital Administration of Rectal Diazepam in Pediatric Status Epilepticus
Authors: Drawbaugh Rodney E. , Deibler Christopher G. , Eitel David R.
Published: July 2016

Seizures are a common pediatric problem encountered by prehospital personnel. Status epilepticus is defined as seizure activity lasting longer than 15 minutes, or recurrent seizures that occur close together without a period of consciousness between ictal periods. It is estimated that 60,000 to 160,000 cases of status epilepticus occur each year within the United States. Prior to 1960, status epilepticus carried a 50% morbidity rate. However, improved anticonvulsive medications, aggressive airway management, and the spread of EMS Systems throughout the nation have reduced the morbidity rate to a range of 8% to 12%.

Prompt and vigorous treatment is paramount in the successful management of status epilepticus because delays can result in neuronal damage and death. Although intravenous diazepam currently is the drug of choice to terminate seizure activity, it may be difficult to rapidly establish a patent intravenous (IV) line during status epilepticus in young children with vigorous motor activity. Alternate routes, such as intramuscular injections, are unreliable due to unpredictable absorption. Rectal administration of diazepam may provide an useful alternate route for delivery of the drug during status epilepticus when IV attempts fail.

In this review, the authors discuss a case of status epilepticus wherein intravenous access could not be established rapidly and the patient was given diazepam rectally with favorable results.
EMS Response to a Major Aircraft Incident: Sioux City, Iowa
Authors: Kerns Donald E. , Anderson Paul B.
Published: July 2016

On July 19,1989, at 1515h, United Airlines flight 232 with 297 passengers and crew on board, experienced disintegration of the number 2 engine (in the tail section) while at 40-thousand feet above Alta, Iowa (Map 1). The DC-10, en route from Denver to Chicago, was diverted to Sioux City, Iowa's Gateway Airport. The disabled jet made a crash landing on an unused runway, burst apart, and caught fire upon impact. Due to the advanced warning of the potential crash, local crash-fire-rescue (CFR) units from the Air National Guard stationed at Gateway Airport, local and regional paramedic and fire units, an advanced life-support EMS helicopter service, and the two Sioux City hospitals were on alert and ready. Firefighters and Air National Guard personnel fought the fire and EMS personnel performed triage, provided emergency care in the field, and transported victims from the crash scene to local health care facilities in Sioux City. Injured victims in critical condition were transported first followed by those with lesser injuries. All were being treated within one hour and 45 minutes of the event. Of the 297 passengers and crew, 59 were admitted to local hospitals in critical condition, and 124 were treated for less severe injuries and later released.
International Red Cross Response to the Earthquake in Armenia, December 1988
Authors: Kisselev Andrei K.
Published: July 2016

An earthquake with the destructive magnitude of 6.9 on the Richter scale struck Armenia on Wednesday, 7 December 1988 at 1142 local time. It devastated an area 80 km in diameter in the northern part of the Armenian Soviet Socialist Republic (SSR), encompassed the towns of Leninakan, Spitak, Stepanovan, and Kirovakan, and killed some 25,000 persons (Table 1). Almost 15,000 persons were rescued alive. The load placed on medical facilities and transport capabilities was profound. Many Armenian nurses and physicians died during the earthquake and most of the hospitals and clinics within the disaster area were destroyed (Tables 1,2). More than 31,000 persons required some form of medical assistance in hospitals. Some 12,000 (38%) were conveyed by some form of ambulance. Of these, 82% were received by hospitals within the Armenian SSR and 22% still were hospitalized at the beginning of the newyear. Only 13% of those who received care at a hospital died in the hospital. More than 100-thousand victims had to be transported from the scene.