bluuebunny/crossref_metadata_2025 huggingface dataset:
Cell microencapsulation: a potential tool for the treatment of neuronopathic lysosomal storage diseases
Authors: Matte Ursula , Lagranha Valeska Lizzi , de Carvalho Talita Giacomet , Mayer Fabiana Quoos , Giugliani Roberto
Published: May 2011

Lysosomal storage disorders (LSD) are monogenic diseases caused by the deficiency of different lysosomal enzymes that degrade complex substrates such as glycosaminoglycans, sphingolipids, and others. As a consequence there is multisystemic storage of these substrates. Most treatments for these disorders are based in the fact that most of these enzymes are soluble and can be internalized by adjacent cells via mannose‐6‐phosphate receptor. In that sense, these disorders are good candidates to be treated by somatic gene therapy based on cell microencapsulation. Here, we review the existing data about this approach focused on the LSD treatments, the advantages and limitations faced by these studies.
Vaccenic and Elaidic Acid Equally Esterify into Triacylglycerols, but Differently into Phospholipids of Fed Rat Liver Cells
Authors: Du Zhen‐Yu , Degrace Pascal , Gresti Joseph , Loreau Olivier , Clouet Pierre
Published: May 2011

Elaidic acid (trans‐9‐C18:1 or trans‐9) is assumed to exert atherogenic effects due to its double bond configuration. The possibility that trans‐9 and vaccenic acid (trans‐11‐C18:1 or trans‐11), its positional isomer, were biochemically equivalent and interchangeable compounds, was investigated by reference to their cis‐isomers through esterification‐related activities using rat liver cells and subcellular fractions. In hepatocytes, both trans‐C18:1 were incorporated to the same extent in triacylglycerols, but trans‐9 was more esterified than trans‐11 into phospholipids (P < 0.05). Glycerol‐3‐phosphate acyltransferase activity in microsomes was lower with trans‐11 than with trans‐9, while this activity in mitochondria was ~40% greater with trans‐11 than with trans‐9 (P < 0.05). Activity of 2‐lysophosphatidic acid acyltransferase in microsomes was of comparable extent with both trans isomers, but activity of 2‐lysophosphatidylcholine acyltransferase was significantly greater with trans‐9 than with trans‐11 at P < 0.01. Lipoproteins secreted by hepatocytes reached equivalent levels in the presence of any isomers, but triacylglycerol production was more elevated with trans‐11 than with trans‐9 at P < 0.05. Cholesterol efflux from previously labelled hepatocytes was lower with trans‐11 than with trans‐9. When these cells were exposed to either trans‐C18:1, the gene expression of proteins involved in fatty acid esterification and lipoprotein synthesis was unaffected, which indicates that the biochemical differences essentially depended on enzyme/substrate affinities. On the whole, vaccenic and elaidic acid were shown to incorporate cell phospholipids unequally, at least in vitro, which suggests they can differently affect lipid metabolic pathways in normal cells.
Lobar and segmental liver atrophy associated with hilar cholangiocarcinoma and the impact of hilar biliary anatomical variants: a pictorial essay
Authors: Friesen Brendon R. , Gibson Robert N. , Speer Tony , Vincent Janette M. , Stella Damien , Collier Neil A.
Published: May 2011

The radiological features of lobar and segmental liver atrophy and compensatory hypertrophy associated with biliary obstruction are important to recognise for diagnostic and therapeutic reasons. Atrophied lobes/segments reduce in volume and usually contain crowded dilated bile ducts extending close to the liver surface. There is often a “step” in the liver contour between the atrophied and non-atrophied parts. Hypertrophied right lobe or segments enlarge and show a prominently convex or “bulbous” visceral surface. The atrophied liver parenchyma may show lower attenuation on pre-contrast computed tomography (CT) and CT intravenous cholangiography (CT-IVC) and lower signal intensity on T1-weighted magnetic resonance imaging (MRI). Hilar biliary anatomical variants can have an impact on the patterns of lobar/segmental atrophy, as the cause of obstruction (e.g. cholangiocarcinoma) often commences in one branch, leading to atrophy in that drainage region before progressing to complete biliary obstruction and jaundice. Such variants are common and can result in unusual but explainable patterns of atrophy and hypertrophy. Examples of changes seen with and without hilar variants are presented that illustrate the radiological features of atrophy/hypertrophy.
The Cheder iron meteorite (Tuva): mineral composition, structure, and PGE and REE contents
Authors: Agafonov L.V. , Popov V.A. , Anoshin G.N. , Pospelova L.N. , Zabelin V.I. , Kudryavtsev V.I.
Published: May 2011

The Cheder meteorite, found 23 km south of Kyzyl, has been studied in terms of mineral composition and internal structure. Structurally, it is a medium octahedrite, which measures 26 × 9 × 8 cm and weighs 5.39 kg. Its surface is streamlined and features flow lines. One of the sides, probably that facing the flight direction, features regmaglypts and a sinuous cavern (9 × 1.5 cm). The meteorite consists of kamacite admixed with taenite. The inside of Widmanstätten bands is of complex kamacite–taenite composition and flanked by taenite lamellae. Phosphides are present in kamacite in small amounts as variously sized and shaped bodies. They are divided into three types depending on the Ni/Fe ratio. Small shapeless wormlike grains, which are usually assigned to rhabdites, consist of nickelphosphide (Ni-rich variety). All the minerals in the meteorite contain Co (up to 0.67 wt.%) and, sometimes, Cu and P (just above the detection limit). The total PGE content of the meteorite is several times higher than that of chromitites, which are one of the terrestrial PGE sources. The REE in the meteorite are dominated by HREE. The total REE content of the meteorite is lower than that of chondrite C1 by two orders of magnitude.
Slab shape in subduction zones beneath the Kurile–Kamchatka and Aleutian arcs based on regional tomography results
Authors: Koulakov I.Yu. , Dobretsov N.L. , Bushenkova N.A. , Yakovlev A.V.
Published: May 2011

A 3-D model of the seismic heterogeneities of P- and S-velocities has been constructed down to 1100 km beneath the Kurile–Kamchatka and Aleutian subduction zones on the basis of the regional tomographic inversion of data from global seismic catalogs. Particular attention is paid to verifying the data by different tests. A clear image of a classic subducting oceanic slab is observed along the entire Kurile–Kamchatka arc, which coincides in the P- and S-models and with the distribution of deep seismicity. These data served as a basis for a parametric model of the upper and lower slab boundaries beneath the Kurile–Kamchatka arc. According to this model, the slab has various thicknesses and maximum penetration depths in different arc segments. In the southern part of the arc, between depths of 600 and 700 km, the slab moves horizontally and does not penetrate the lower mantle. Beneath the North Kuriles and southern Kamchatka, it subducts down to 900 km. These data suggest that the subducting slab becomes a viscous and nonelastic body and the changes in its shape may be due to phase transitions with increasing temperature and pressure. We attribute its gentler dipping and thickening beneath the South Kuriles to the oceanic “pushing” mechanism. The lithospheric thinning, steeper subsidence, and penetration into the lower mantle beneath the North Kuriles are due to the predominant “gravity sinking,” or “slab pull,” mechanism.

Unlike some other researchers, we have obtained a high-velocity anomaly beneath the western Aleutian arc (not as clear as beneath the Kurile–Kamchatka arc, yet quite reliable). It suggests the presence of a slab subducting down to 200–250 km. In the eastern Aleutian arc, we clearly observe the Pacific slab subducting down to 500–600 km (somewhat deeper than in the previous studies).
Petrophysical interpretation of time-lapse electromagnetic sounding in wells
Authors: Yeltsov I.N. , Nesterova G.V. , Kashevarov A.A.
Published: May 2011

Terrigenous reservoirs are studied by a joint analysis of processes of various physical nature. This study is urgent because new methods for formation evaluation (first of all, permeability) from electric and electromagnetic logging data are required. We propose a method for the complex processing and interpretation of time-lapse well logging electromagnetic measurements, which show the dynamics of processes in the well influence zone. The constructed electrohydrodynamic model of the borehole environment is used to estimate the hydrophysical (petrophysical) parameters of the formation.
Natural ventilation driven by periodic gusting of wind
Authors: MOTT RICHARD W. , WOODS ANDREW W.
Published: May 2011

We investigate the mixing of a warm enclosed space by a series of discrete gusts of cold air from a high-level opening. Initially we examine the case of a series of gusts of identical size each modelled as a turbulent buoyant thermal. We develop a model of the filling box-like flow which develops in the space and identify the key parameter in the system as the ratio between the initial gust size and the product of the height of the room and the entrainment coefficient. We find an approximate analytic solution for the evolution of the density profile within the space which is in good agreement with a full numerical solution of the governing equations. We successfully test the predictions of the model with a series of new laboratory experiments. The experiments combined with the model also provide a new independent estimate for the entrainment coefficient of a thermal, ε = 0.37 ± 0.02, based on the propagation speed of a filling box front. We then examine the mixing produced by a series of thermals of non-identical size which we characterize in terms of a mean size and coefficient of variation. We find that as the coefficient of variation increases, the density profile becomes progressively more stratified owing to the asymmetry of dilution through entrainment of large and small thermals. We discuss the implications of these results for the ventilation of a building subject to gusts of wind.
Energy transfer mechanism of the instability of an axisymmetric swirling flow in a finite-length pipe
Authors: WANG S. , RUSAK Z.
Published: May 2011

The rate of change of the perturbation's kinetic energy E of a perturbed inviscid, incompressible, axisymmetric, columnar and near-critical swirling flow in a finite-length, straight, circular pipe with periodic and non-periodic inlet–outlet conditions is studied using the Reynolds–Orr equation. The perturbation's mode shape and growth rate are computed from the linear-stability eigenvalue problem using a novel asymptotic solution in the case of a flow in a long pipe. This solution technique is general and can be applied to any vortex flow profile, in a range of swirl levels around the critical level, and for various boundary conditions. The solutions are used to analytically estimate the production (or loss) of E at the pipe boundaries and inside the domain and to shed new light on the Wang–Rusak mechanism of exchange of global stability around the critical swirl, that is leading to the vortex breakdown process. It is shown that the production of E inside the domain is modulated by the base flow strain-rate tensor. For the special case of a solid-body rotating flow, this term vanishes and the stability is determined only by the asymmetric transfer of E at the boundaries. For a general base flow, the dominant perturbation's mode shape develops deviations in response to the non-periodic inlet–outlet conditions. These deviations couple with the base flow strain-rate tensor to generate production or loss of E in the bulk. Together with the asymmetric transfer of E at the boundaries, they form a critical balance of production of E and determine the flow stability around the critical state. This behaviour is demonstrated for the Lamb–Oseen and Q vortex models. This analysis reveals a more complicated, as well more realistic, interaction between the perturbed flow in the domain and at the boundaries that dominates vortex flow dynamics.
Turbulence structure in boundary layers over periodic two- and three-dimensional roughness
Authors: VOLINO RALPH J. , SCHULTZ MICHAEL P. , FLACK KAREN A.
Published: May 2011

Measurements are presented from turbulent boundary layers over periodic two- and three-dimensional roughness. Cases with transverse rows of staggered cubes and cases with solid square transverse bars of two sizes were considered. Previous results by Volino, Schultz & Flack (J. Fluid Mech. vol. 635, 2009, p. 75) showed outer-layer similarity between cases with three-dimensional roughness and smooth walls, and deviations from similarity in cases with large two-dimensional transverse bars. The present results show that differences also occur with small two-dimensional bars and to a lesser extent when the bars are replaced with rows of staggered cubes. Differences are most apparent in correlations of turbulence quantities, which are of larger spatial extent for the rough-wall cases. The results with the staggered cubes indicate that part of the periodic roughness effect is caused by the repeated disturbance and recovery of the boundary layer as it encounters a row of roughness followed by a smooth surface. A larger effect, however, is due to the blockage caused by the two-dimensional transverse bars, which extend across the entire width of the boundary layer. The small two-dimensional bars have a larger effect than the staggered cubes, in spite of the bar height being only 11 viscous units and 1/7 of the cube height. The effect of the small bars extends well into the outer flow, indicating that effects observed previously with larger bars were not due only to a thickening of the roughness sublayer. The observed differences between the rough- and smooth-wall results are believed to be caused by large-scale attached eddies which extend from the roughness elements to the edge of the boundary layer.
Untouched Antarctica: mapping a finite and diminishing environmental resource
Authors: Hughes Kevin A. , Fretwell Peter , Rae Joanna , Holmes Keith , Fleming Andrew
Published: May 2011

Globally, areas categorically known to be free of human visitation are rare, but still exist in Antarctica. Such areas may be among the most pristine locations remaining on Earth and, therefore, be valuable as baselines for future comparisons with localities impacted by human activities, and as sites preserved for scientific research using increasingly sophisticated future technologies. Nevertheless, unvisited areas are becoming increasingly rare as the human footprint expands in Antarctica. Therefore, an understanding of historical and contemporary levels of visitation at locations across Antarctica is essential to a) estimate likely cumulative environmental impact, b) identify regions that may have been impacted by non-native species introductions, and c) inform the future designation of protected areas under the Antarctic Treaty System. Currently, records of Antarctic tourist visits exist, but little detailed information is readily available on the spatial and temporal distribution of national governmental programme activities in Antarctica. Here we describe methods to fulfil this need. Using information within field reports and archive and science databases pertaining to the activities of the United Kingdom as an illustration, we describe the history and trends in its operational footprint in the Antarctic Peninsula since c. 1944. Based on this illustration, we suggest that these methodologies could be applied productively more generally.
Spinal surgery in older people: indications, techniques and outcomes
Authors: Baker ADL , Sanderson P
Published: May 2011

This article provides an overview of spine surgery in older people and reviews outcome and novel techniques. Improvements in pain, disability, and quality of life can be expected following surgery and demand for surgery of this type is likely to increase as the mean age of the population increases. Novel techniques and improved intsrumentation offer surgical treatments for conditions that were previously untreatable and show encouraging early results.
Nutritional issues and potential interventions in older people
Authors: Hankey Catherine R , Leslie Wilma S
Published: May 2011

The prevalence of undernutrition in older individuals, living independently in a community setting, or living in a supported setting, is considerable. The negative health effects of undernutrition are wide ranging, with implications for quality of life (QOL), well-being and general health, through to the individual's ability to recovery from acute disease. There are a number of key measures that indicate both nutritional status and the effectiveness of any intervention. These include conventional anthropometric and biochemical measures of nutrient status, as well as measures of QOL, well-being and depression. The latter have huge importance to the life of the individual, and to date appear to have undergone only preliminary investigation. This review suggests that the efficacy of interventions to address undernutrition and improve health in older people living in a variety of settings is highly variable, and that considerable opportunities for research in this area exist.
(A11) Beyond Illness and Trauma: A Study of the Interface between Disaster Mental Health and Recovery
Authors: Joseph J. , Jaswal S.
Published: May 2011

Today there is adequate research evidence at national and international level regarding the health and mental health consequences of disasters. The realization of the larger impact of mental health on the recovery process has been instrumental in prioritizing mental health and psychosocial well-being of affected populations in recent years. Traditionally the bio medical models were used to understand the disaster mental health outcomes, however over the last two decade a gradual change is visible in the understanding of the mental health and psychosocial consequences of disasters. It is more inclusive of varied expressions of distress and the services to address the same. A review of various disaster mental health research and interventions documented since 2001 reveals that most studies/interventions attempt to list the various mental health problems and psychosocial consequences. There are very few studies which go beyond listing of consequences, to focus on implications of disaster mental health for long term disaster recovery. There is dearth of research based literature on the concept of community trauma, factors contributing to negative emotions and emotional distress/ problems, community response (social and cultural) to disaster mental health issues, long term emotional implications of psychosocial consequences of disasters and the life course of individuals with mental health issues in the long run following disasters. The paper attempts to address the above mentioned issues in the context of 2004 tsunami. The paper is based on a study carried out in India two years after the disaster. A Case study approach was used and 177 case studies were collected from 104 villages in 14 affected districts of three states in India. The paper contributes to understanding the long term implications of disaster mental health for disaster recovery and reiterates the significance of integrating disaster mental health services within humanitarian services.
(A12) From a Helpless Victim to a Coping Survivor: Innovative Mental Health Intervention Methods during Emergencies and Disasters
Authors: Farchi M.U.
Published: May 2011

Crisis, disasters, terror attacks or any other traumatic event may cause among the survivors acute stress reaction (ASR). The main goal of the first responder in terms of mental health in the acute phase is to provide the victim the basic support that will stabilized the needed coping resources and re-establish the sense of control and safety (Kutz & Bleich, 2005). This process encourages the shift of the victim's perspective from a helpless victim to a coping survivor. The emergency mental health interventions are differentiated by the location: Location 1: The event's location: Pacing & Leading using varied communications channels. Re-establishing sequences of contingency. Regaining sense of control. Using the cognitive communication channel. Yes-set sequences. Location 2: Emergency rooms or Traumatic Stress First Aid Centers (TSFAC) Stress symptoms reduction using suggestive techniques Memory Structure Intervention (MSI). Psychological Inoculation (PI). Group interventions. Basic deferential diagnosis: ASR-PTSD Patent release decision making. The higher the number of casualties, the more likely is the need for early interventions by non-professionals. This may be particularly true for a mega-terror attack, when the numbers of survivors with ASR can flood the hospital gates. The general principles for intervention by non-professionals, adopted by the Israel Ministry of Health (2002), are: a. Establish personal contact with the survivors and provide words of comfort or supportive touch. b. Encourage survivors to verbalize their experiences. c. Provide orienting information about what happened and what is about to happen in the hospital. d. Ensure physical needs such as hydration, food, and rest when appropriate. e. Enable contact with any significant other as soon as possible through phone or personal contact. During the presentation the above subjects will be elaborated and demonstrated by case studies and short videos.
(A24) Does Community Emergency Care Initiative Improves the Knowledge, Skill And Attitude of Healthcare Workers and Laypersons in Basic Emergency Care in India?
Authors: Bhoi S. , Thakur N. , Chauhan S. , Kumar R. , Aggarwal D. , Gulati V. , Sawhney C.
Published: May 2011

Background

Basic emergency care at primary, secondary and tertiary health care level in India is in its infancy. Lack of training in emergency care is an important factor. We designed AIIMS basic emergency care course (AIIMS BECC) to address the issue.

Objective

To improve the knowledge, skill and attitude of healthcare workers and laypersons in basic emergency care and to identify and train instructors.

Methods

Prospective study conducted over a period of one and half years. The target groups were medical, police, fire fighter, paramilitary forces, teachers, school children of India. Provider AIIMS BECC is of one day duration. The contents of the course are cardio-pulmonary resuscitation, chocking and special scenarios like trauma, electrocution, drowning, hypothermia, pregnancy, etc. Course was disseminated via lectures, audio-visual and hands on training. The participants were evaluated by pre and post test questions. Subjects had to score 80% to be successful and those who scored more than 90% were eligible for instructor course. The confidence levels at baseline and at the end of the course were evaluated in policecourses were evaluated on course clarity, course delivery and trainers quality on a likert scale (1 = worst, 5 = excellent).

Results

1614 subjects were trained. 99.81% became providers and 2.6% were trained as instructors. 83.1% were non-medical and16.9% were medical personals. 76.14% were police, paramilitary 0.8%, teachers 1.6%, students 2.1% and mixed groups were 2.6%. The average and modal increase in confidence level among police were 66.14% and 62.49%. Likert scale of ≥ 4 was observed in 90.7% in course clarity, 91.28% in course delivery and 95.26% in trainer quality.

Conclusion

Knowledge, skill and attitude of healthcare care and laypersons in providing basic emergency care improved by community emergency care initiative. Instructors were identified for further dissemination of the course. The confidence levels increased among police.
(A29) Effect of Institutional Education and Exercise Programs on Knowledge, Views, and Compliance during Unusual Biological Events
Authors: Benin-goren O. , Miller E. , Dallal I. , Abu Hanna J.
Published: May 2011

Background

Unusual biological events (UBEs) pose a distinct challenge for emergency preparedness. Not only are these events rare and difficult to detect, but they also pose clear hazards for both medical personnel and their families. Distinct skills include identifying UBEs and activating institutional and national response. Staff attendance and confidence in the health system play a vital role in effective management of UBEs. The Israeli Ministry of health conducts yearly drills on the personal, institutional, and national response to UBEs.

Aim

The aim of this study was to evaluate the effect of various educational tools and personnel characteristics on personnel skills, views, and compliance to participate in the management of UBEs.

Methods

As part of the preparations for an institutional drill in the Tel Aviv Medical Center, several educational methods were employed. These included e-mail notifications, computer-based self learning, publication of an institutional protocol, tabletop drills, personal briefings, and finally, a large scale exercise. Questionnaires regarding personnel characteristics, participation in pre-drill education, personal views, compliance, and familiarity of institutional protocols and selected diseases were distributed.

Results

Age, family status, and years of experience had no significant influence on personal views. Confidence in the health system increased with experience. Intensity of training had significant positive effect on personal confidence and compliance to attend work during a UBE, however it did not appear to significantly influence personal views or medical knowledge.

Conclusions

Comprehensive education and exercise of personnel is beneficial effect in terms of personal confidence and work attendance during UBEs. Specific educational tools, such as self-learning software, increase proficiency.
(A33) Application of the Modular Emergency Medical System (MEMS) for Community Response to All-Hazards Public Health Emergencies
Authors: Gougelet R.M.
Published: May 2011

The Modular Emergency Medical System (MEMS) is a flexible and scalable model for community-based response to all catastrophic emergencies. This paper highlights the development of MEMS at the local and regional levels, including training exercises to demonstrate MEMS capabilities, implementation strategies, and its role in the H1N1 response and vaccination clinics. The MEMS was introduced in 2002 as a bioterrorism response by the US Army Edgewood Biological and Chemical Command (ECBC). All-hazards MEMS, as part of a Regional Response System (RRS), was developed by the New England Center for Emergency Preparedness (NECEP) working with state and federal partners. The MEMS presents a modular response framework to mobilize communities and local resources to meet the medical surge demands during a catastrophic event. The modular components of MEMS empower a community-based response to catastrophic emergencies. The Neighborhood Emergency Help Center (NEHC) provides triage and initial treatment, or can function as a point for dispensing prophylaxis medications or vaccinations. During a medical surge, the Acute Care Center (ACC) moves non-critical patients outside of the hospital setting, creating more space for critical care patients. The Community Outreach (CO) module supports casualties recovering in their own homes, under quarantine, and other home-care support. The Casualty Transportation System (CTS) operates between MEMS components, patients' homes and outside of the affected area, meeting all transfer needs. The Medical Control Center (MCC) and Multi-Agency Coordinating Entity (MACE) provide command, control, and coordination of community emergency medical services (EMS), hospital, and public health response assets. Local, regional, and statewide exercises have demonstrated the capabilities of MEMS in Northern New England. The MEMS system, specifically with the MACE concept, was used in New Hampshire during the 2009 H1N1 event. These proven implementation strategies will assist local communities in developing and refining all-hazards response plans.
(A34) Space Technology to Support Disaster Risk Reduction and Emergency Medical and Rescue Teams
Authors: Ravan S. , Szarzynski J. , Stevens D.
Published: May 2011

Space technology plays important role during emergency as well as non-emergency situation to provide the information that is relevant for disaster preparedness and to the rescue and emergency medical teams. During emergency situation, first and immediate information rescue and medical teams like to have is the area impacted, severity of the disaster and the population at risk. Such information is of critical nature for emergency medical teams in order to plan and mobilize the medical personnel, resources and infrastructure needed to provide effective medical services. Space based observation is the most efficient way to provide this preliminary information. Often emergency maps generated based on the space based observations are useful to the medical and rescue teams during emergency situation while detailed information from the field is still awaited. UN-SPDIER offers the platform for providing such services effectively by connecting with the end users the international and regional mechanism that provides such information. During non-emergency phase, the space technology contributes in strengthening disaster risk reduction (DRR) efforts, especially through telemedicines and Global Positioning System (GPS) technologies. These tools integrated with Geographical Information System (GIS) provide effective mechanism for predicting risks (risk mapping) and early warning. It also ensures the rapid distribution of information during catastrophic events. In recognition of these needs the United Nations General Assembly established the United Nations Platform for Space-based Information for Disaster Management and Emergency Response (UN-SPIDER). The programme aims at providing universal access to all types of space-based information by: being a Gateway to space information for disaster management support; serving as a Bridge to connect the disaster management and space communities; and being a Facilitator of capacity-building and institutional strengthening.
(A36) What is there to Show for the Last 5 Years?
Authors: Smyth V.A.
Published: May 2011

A disaster creates disruption and threats to life and society, mental anguish, and leads to feelings of instability around such areas as security and safety. It causes suffering and requires assistance from experts within a structured and tested response framework. After 11 September 2001, the demarcation between disasters caused by natural hazards and terrorism virtually disappeared. The two now get treated concurrently, but there is a danger that anti-terrorism might hijack the agenda, overshadowing important work that must be done in the field of disasters caused by natural hazards. With this in mind, the Health Emergency Management Unit in South Australia was born. The unit was established for preparedness planning around the growing concerns of the potential for an impending pandemic caused by avian influenza. From those shaky beginnings, South Australia now has a dedicated and trained team. The unit provides a 24/7 health responses to planned events and unexpected incidents caused by natural or deliberate forces that may occur in the region. It also participates as part of the National Disaster Deployment Program. Currently, the unit is focused on risk reduction and increasing resilience by implementing a sound, comprehensive approach including all elements of prevention, as well as preparedness, response, and recovery strategies. The unit also provides an extensive education, training, and exercise program to health facilities across South Australia. This paper will describe the ongoing journey of the unit, how it works and interacts with all levels of health service staff and other emergency services, and some of the recent events and incidents in which it has been involved in within Australia and overseas.
(A45) When Nothing is Left Standing: Nursling's Integral Role during Disaster Response in Indonesia and Haiti
Authors: Hynes G.T.
Published: May 2011

The purpose of this presentation is to compare the lessons learned in acute nursing care in the post-disaster settings of Aceh Jaya, Indonesia (2004) and Port-au-Prince, Haiti (2010). The impact of such disasters disproportionally affects populations made vulnerable by poverty, marginalization, and structural violence. The recognition of these vulnerabilities heightens the role of the nurse as an advocate for the ill and injured. In addition, the lack of adequate human and material resources on all levels necessitates insisting on best practices for patient care despite the resource constraints. Consideration of best practices begins with rigorous personnel selection of nurses adequately trained in emergency/critical care, complex humanitarian emergencies, and disaster response. A proficient level of resource-specific triage knowledge is required to adequately provide the most effective care to patients. Not infrequently, disaster nursing care involves being tasked with a clinical skill or procedures that would be outside the scope of practice in the home country. While the expansion to such practices often is justified by need, an ethical framework demands consideration of the central tenet of “first do no harm”. A heavy burden of coordination among other caregivers, family, and the local staff is required by nurses in this environment. The substantial challenges include communication and continuity of care during the initial response phase among multiple partners with varied backgrounds and goals. Drawing from experiences in Haiti and Aceh, this presentation seeks to define the best practices in disaster nursing care and explore the ethical considerations that arise in such challenging environments.
(A47) Disaster Nurses in Developing Countries: Strengthening Disaster Nurses' Competencies through Training and Disaster Drills
Authors: Hilmi L.M. , Bristow R. , Balsari S. , Anthony D. , Vortman M. , Cordi H. , Gonzales D. , Heerboth A.
Published: May 2011

Introduction

In many developing countries nurses are the front-line of care, yet do not receive appropriate theoretical or clinical skills related to disaster and emergency medicine. The ICN/WHO have outlined disaster nursing competencies for improving disaster nursing globally. These can serve as a basis for strengthening nursing through increased participation in training programs. In Mumbai, India during December 2010, MEMEX II occurred: a 7 day training in disaster preparedness and humanitarian response. This was the first time nurses were included in a separate disaster nursing track to improve skills and knowledge.

Methods

Through Cornell and Columbia Universities; faculty, Indian nurses clinical competencies and disaster theory were strengthened through training in clinical trauma management, CPR, disaster preparedness and drills, public health evaluation, and the disaster cycle. 700 participants from medical, education, government and private/public entities collaborated in the training program, culminating in a large scale disaster drill and needs assessment workshop for high-level stakeholders.

Results

Nurses improved emergency clinical skills and gained theoretical disaster knowledge for the first time. Nurses located at the disaster event site gained important insight into the role of Emergency Medical Services, police, fire, and civilian defense during disaster response. Triage skills were improved and an evaluation component enabled vital information to be collected for hospital preparedness. A video was made for future training and for evaluation purposes. Nurses planned to establish coordination networks amongst the 9 hospitals present to regularly review disaster preparedness plans.

Conclusions

Strengthening nursing competencies in disaster planning and emergency response is vital to advancing nursing in developing countries and building capacity through global networking. Through a multi-disciplinary approach, professional networks can be formed, disaster plans reviewed and clinical skills improved. Nursing input is vital to hospital and community preparedness and nurses must be included in training programs and needs assessments.
(A50) The Nurse as Incident Commander
Authors: Persell D.J.
Published: May 2011

The year 2010 brought an unprecedented public health response to the novel H1N1 influenza pandemic. Included in that response were colleges and universities across the globe. At universities not associated with medical centers, medical directors of student health looked to nursing faculty or nurse practitioner directors of student health for leadership. From the day novel H1N1 was formally declared a public health emergency, Arkansas State University utilized a nurse faculty member with expertise in homeland security as its Incident Commander. A portion of the nurse's time was dedicated to managing the incident. The nurse was positioned to provide guidance and lead the response with an understanding of university structures as well as business and academic continuity. From the beginning, the nurse utilized the Incident Command System to manage the response. Portions of the University's Incident Command structure were activated and Incident Command meetings were held no less than every two weeks. A tabletop exercise was developed specifically for a university setting and to give University officials practice at pandemic management. The nurse's clinical focus and pre-established relationships with disaster response and public health officials allowed critical access to important resources that the University would have otherwise gone without. She guided the University through redefining their pandemic plan, including assisting residence life in establishing alternative housing for sick students. An on-line reporting system was developed that was utilized by faculty, students, staff, and other concerned constituents. A public awareness campaign on the campus was instituted and 1,000 posters were posted around campus encouraging sick students to stay home and/or seek medical care. The World Health Organization, (US) Centers for Disease Control and Prevention, and Department of Education guidelines were monitored and implemented. Two mass-immunization clinics were held on the campus with > 7,000 immunizations provided.
(A47) Pediatric Mass-Casualty Triage: The New York City Approach
Authors: Cooper A. , Gonzalez D. , Frogel M. , Flamm A. , Prezant D. , Goldfeder M. , Treiber M. , Tunik M. , Uraneck K. , Foltin G.
Published: May 2011

Introduction

A Mass-Casualty Event (MCE) involving pediatric victims could overwhelm existing pediatric resources. Therefore, early recognition of critically ill infants and children is essential for proper distribution among pediatric capable hospitals. However, emergency medical services (EMS) personnel have limited experience with pediatric assessments, and less with pediatric mass-casualty triage (MCT). To address these gaps, the New York City (NYC) Pediatric Disaster Coalition (PDC) in collaboration with the Fire Department (FDNY) and Office of Emergency Management, made simple alterations to the START-based NYC-MCT Algorithm that can be rapidly and accurately applied by EMS personnel in the field with minimal additional education and preparation, obviating the requirement for extensive and expensive retraining.

Methods

The PDC includes experts in pediatric emergency preparedness, emergency medicine, critical care, and trauma surgery in NYC, as well as DOHMH, FDNY-OMA, and OEM. Its Triage Subcommittee determined the minimum essential pediatric alterations to the Algorithm, which then was tested by FDNY-EMS.

Results

After focused literature review and multiple draft revisions aimed to maximize pediatric benefit yet minimize unnecessary complexity, the Algorithm was modified to ensure that: (1) five rescue breaths will be provided to infants or children prior to being categorized as Dead or Expectant; (2) infants under 12 months old will be categorized as Critical and receive priority transport, and (3) children initially categorized as Delayed or Minor will be uptriaged to a new Urgent (Orange) category to receive such care in a rapid manner. To date, > 3,000 FDNY personnel have been trained in its use, and tested its accuracy using tabletop scenarios. Mean accuracy is 80–90%.

Conclusions

The model is an effective, multidisciplinary approach to planning. Minimum alterations to the Algorithm were adopted by the regional EMS system. The Modified Algorithm improves identification of critically ill infants and children. This approach could be adopted by other large urban centers.
(A59) Advent of the Confide Guidelines for Disaster Medicine Reporting
Authors: Bradt D.A. , Aitken P.
Published: May 2011

Disaster reports are common in the literature. Accurate and complete reporting assists readers and researchers in developing best practices. There have been notable efforts, such as the Utstein Template, to standardize the language of disasters and promote consistent use of definitions. However, case reports are complicated by the presence of four dominant types recognized in the literature. Moreover, the disciplines of medicine, public health, and disaster management differ in origins, definitions, research paradigms, and tools of evidence-based decision-making. Finally, biomedical journal guidelines for authors writing disaster case reports have lacked the rigor of standards associated with observational studies (2007 STROBE statement, 2010 MOOSE statement), or with randomized controlled trials (1996 CONSORT statement, 1999 QUORUM statement). This paper examines current efforts to intensify the rigor of future disaster case reports through uniform reporting requirements for authors. The initial workgroup comprised editorial board members of two biomedical journals indexed in the US National Library of Medicine—Prehospital and Disaster Medicine, and Emergency Medicine Australasia. The workgroup members self-selected based on extensive disaster field experience as technical advisor with governmental, non-governmental, Red Cross and UN agencies. The workgroup identified key information needed to understand the context, structure, process, and outcome/impact of disaster field interventions. Then, the workgroup organized this information in thematic domains. Consensus guidelines emerged for Reports of Field Interventions in Disasters and Emergencies (CONFIDE). The CONFIDE Statement addresses 16 keys areas within seven domains, including: field authorization for access, field logistics, initial assessment, clinical epidemiology, and funding. The Statement was first published in December 2010, at which time, the authors began integrating the guidelines with biomedical journal instructions for authors. The paper details current efforts to broaden editorial acceptance of the guidelines, implications for future authors, and potential benefits to the disaster medicine community.
(A61) Utstein-Style Template for Uniform Reporting of Medical Response in Disasters and Health Crises
Authors: Debacker M. ,   Emdm Academy Consensus Group
Published: May 2011

Introduction

As in other branches of medicine, disaster medicine needs a scientific basis. A disaster medical response is only as good as the assumptions on which it is based. Many of these assumptions are incorrect and/or are not based on systematically collected evidence. Although guidelines for evaluation and research on health disaster management and guidelines for reports on health crises and critical health events have been published, no uniform template for collecting empirical data on medical care response in disaster situations have been published.

Method

An EMDM Academy Consensus Group was established representing several disaster medicine research centers, the disaster medicine section of the European Society for Emergency Medicine (EuSEM), the World Association for Disaster and Emergency Medicine (WADEM), and the World Health Organization WHO. The Consensus Group decided to limit the project to the acute medical care response. The project was organized around a series of workshops, which created a forum for the presentation, analysis, and listing of descriptors (variables) and their indicators relevant for the disaster medical response. An adapted Delphi method and the Utstein-style method were used to reach consensus on the descriptors and indicators.

Results

A uniform template of describing pre-event, event, medical response and outcome variables and their indicators relevant for evaluation and research on the disaster medical response have been developed, including the agreement on standard definitions.

Conclusion

A uniform reporting template and method are essential to gather empirical data on disaster medical response management in order to establish robust databases allowing disaster medical response investigators and researchers to collect evidence that will impact on response outcomes and provide best practice.
(A62) Real World Event Data Collection and Analysis for after Action Reporting
Authors: Schlegelmilch J. , Paturas J. , Smith R.
Published: May 2011

Background

In response to recent real world events impacting public health and medical services, The Yale New Have Center for Emergency Preparedness and Disaster Response (YNH-CEPDR) has developed a methodology for collection and analysis for after action reporting of response operation effectiveness. This process has been implemented to multiple real-world events including the 2009/2010 H1N1 response activities. This method utilizes the US Department of Homeland Security Exercise and Evaluation Program (HSEEP) doctrine for the collection of response information, analysis and development of After Action Reports.

Objectives

In this session, participants will be introduced to data collection methods that include a combination of onsite response evaluation by subject matter experts applying a set of established operational response objectives, targeted web-based surveys collecting both qualitative and quantitative data regarding public health and medical staff opinions regarding response operations and achievement of objectives. Also introduced will be focus group interviews to determine response successes, opportunities and recommendations for improvement. This session will also provide an overview on the utilization of additional data sources including situational status reports, press releases, incident action plans and meeting minutes. In additional to providing a framework for developing a comprehensive After Action Report for a real-world response, this process can yield data that can be used to enhance ongoing response operations as well as to support anticipated response operations, such as applying lessons from one pandemic wave to the next. During the session, participants will be provided an opportunity to discuss their process for evaluating real-world events and to identify how this methodology can be integrated into their organization's response evaluation activities.