bluuebunny/crossref_metadata_2025 huggingface dataset:
Incidence of Patella Baja Before and After Primary Total Knee Arthroplasty Based on Body Mass Index
Authors: Francois Elvis L. , Abdel Matthew P. , Sousa Paul L. , Chapman Danielle M. , Miller Mike J. , Dalury David F. , Berry Daniel J.
Published: March 2019

In the setting of total knee arthroplasty, patella baja has been associated with decreased range of motion and increased risk of certain extensor mechanism complications. The goal of this study was to determine whether obese patients had an increased prevalence of patella baja before and/or after primary total knee arthroplasty. A multicenter retrospective review of 5089 unilateral total knee arthroplasties performed between 1998 and 2012 for osteoarthritis was conducted. Only total knee arthroplasties with cemented modular, metal-backed constructs and patellar resurfacing were included. An a priori power analysis determined that 500 patients (stratified into 5 World Health Organization body mass index groups, matched by age and sex) were needed to detect a significant Insall–Salvati ratio difference of 0.07. Patella baja was defined as an Insall–Salvati ratio of less than 0.8. Preoperative and postoperative Insall–Salvati ratios were compared between groups and analyzed using linear regression and analysis of variance. Preoperatively, there was a higher prevalence of patella baja in the higher body mass index groups (>25 kg/m
2
) compared with normal weight patients (10% vs 6%;
P
=.02). Postoperatively, there was no difference in the prevalence of patella baja between the 2 groups (5% vs 5%;
P
=.91). On comparison of postoperative Insall–Salvati ratio with preoperative Insall–Salvati ratio, the higher body mass index groups had a greater change in Insall–Salvati ratio (Δ 0.10 vs Δ 0.07;
P
=.01). This is the first study to report an increased prevalence of patella baja in obese patients and to show that the prevalence normalizes to that of a control group after total knee arthroplasty. Obese patients undergoing primary total knee arthroplasty had a higher rate of preoperative patella baja. [
Orthopedics
. 2019; 42(2):90–94.]
Difference in Treatment Effect Between Intravitreal Aflibercept Injection and Laser by Baseline Factors in Diabetic Macular Edema
Authors: Singh Rishi P. , Silva Fabiana Q. , Gibson Andrea , Thompson Desmond , Vitti Robert , Berliner Alyson J. , Saroj Namrata
Published: March 2019

BACKGROUND AND OBJECTIVE:

To evaluate the effect of baseline factors on differences in vision gains with intravitreal aflibercept injection (IAI) versus laser control in patients with diabetic macular edema (DME).

PATIENTS AND METHODS:

This was an integrated post-hoc subanalysis of two phase 3 trials (VISTA, VIVID) in patients with DME. Least square (LS) mean differences of patients treated with IAI compared to laser control in best-corrected visual acuity (BCVA) change from baseline at week 100 were evaluated for association with baseline demographics and baseline systemic disease characteristics.

RESULTS:

At week 100, LS mean differences in BCVA change from baseline with IAI compared to laser control were not significant for association with baseline age, gender, and race or status of glycosylated hemoglobin, body mass index, renal impairment, hypertension, cerebrovascular disease, and ischemic heart disease.

CONCLUSION:

Vision gains with IAI were significantly greater than laser control and were not influenced by demographics and systemic disease control at baseline.

[
Ophthalmic Surg Lasers Imaging Retina
. 2019;50:167–173.]
Comparative assessment of conventional chromosomal analysis and fluorescence in situ hybridization in the evaluation of suspected myelodysplastic syndromes: A single institution experience
Authors: Zakhia Denyo Adjoa , Voronel Olga , Zaiem Feras , Raval Kunil , Yang Jay , Schloff Deborah , Mohamed Anwar N , Gabali Ali M
Published: March 2019

Background: Myelodysplastic syndromes (MDSs) are a heterogeneous group of clonal hematopoietic neoplasms, roughly half of which harbor cytogenetic abnormalities with diagnostic, prognostic, and therapeutic significance. Fluorescence in situ hybridization (FISH) for the most commonly seen abnormalities (5/5q, –7/7q, +8, and –20/20q–) is routinely performed alongside conventional cytogenetics (CC) in the evaluation of suspected MDS despite conflicting reports of its relative contribution compared to CC alone.Objectives: To assess the additional diagnostic and prognostic value of performing concurrent FISH versus CC alone in cases of suspected MDS.Materials and Methods: A total of 127 bone marrow samples submitted to our cytogenetic laboratory with a presumptive diagnosis of MDS were evaluated by concurrent CC and an MDS FISH panel.Results: CC was used as the gold standard method with 100% sensitivity in detecting suspected MDS-associated cytogenetic abnormalities. FISH alone had a sensitivity of 76%, whereas CC alone achieved a sensitivity of 97%. The addition of FISH did not change the diagnosis nor change the Revised International Prognostic Scoring System score in any patient. Moreover, in 12 cases identified as positive by both CC and FISH, CC identified multiple chromosomal aberrations of clinical significance not interrogated by the FISH probe panel.Conclusion: CC alone is sufficiently sensitive in detecting suspected MDS-associated cytogenetic abnormalities that influence clinical decision-making. Routine FISH testing does not provide a significant increase in test sensitivity when an adequate karyotype is obtained. Therefore, FISH testing is best reserved for suspected MDS cases lacking sufficient metaphases.
Impacts of land-use change on southeast Amazonia basin streamflow
Authors: Louzada Vinicius Marques , Ribeiro Celso Bandeira de Melo
Published: March 2019

The Amazon region is the subject of growing interest in the international scientific community due to the environmental services provided by its dense forests in climate regulation and freshwater. Despite many efforts from environmental management agencies and research centers, this region can still be considered poorly monitored, especially given its large regional and global importance. Rainfall-runoff models are presented as a good alternative to the estimated flow rates in inaccessible or difficult to watch places. This study simulated stream flows for a representative part of the Amazon basin using the Soil and Water Assessment Tool (SWAT) redistributed hydrological model, adopting as reference the streamflow observed in Altamira gauge station. The authors emphasize that a database was specially prepared with physical parameters such as land use, topography and soil types, and weather data encompassing the years from 1985 to 2012, at a daily time step. The chosen approach allowed carrying out hydrologic simulations that were consistent with the flow values observed at the Altamira gauge station, providing better understanding of hydraulic-hydrological processes in the Xingu subbasin and information for planning and decision-making on the management of water resources in this important river basin.
Ozonation improves physical attributes in domestic sewage effluent
Authors: Camilo Júnior Osli Barreto , Sandri Delvio , Alencar Ernandes Rodrigues de , Hebling Lucas Ferraz
Published: March 2019

Root Zone Wastewater Treatment (RZWT) is an option of natural wastewater treatment widely studied throughout the world, being a technology based on physical, chemical and biological processes. However, there are some attributes in effluent that occasionally are not eliminated by RZWT. In this context, the use of ozone may contribute to mineralization, disinfection, detoxification, and, especially, color and turbidity removal. Ozone is an excellent oxidant, with great potential to reduce color, turbidity and other attributes in liquids, such as in wastewater treatment. This paper evaluated the effect of different ozone exposure times (0, 30, 60, 90, 120 and 150 minutes) and the application of different dosages of ozone (0, 4, 10, 17, 25 and 35 mg L-1 of O3) on Hydrogeonic Potential (pH), Electrical Conductivity (EC), Dissolved Oxygen (OD), Total Alkalinity (Alk.), Sodium (Na) and Potassium (K) in domestic sewage effluent treated by the RZWT. Different exposure times and ozone dosages did not influence the attributes Potassium, Sodium, Ammonia and Total Solids. Color and turbidity decreased, while pH, Alkalinity and Dissolved Oxygen increased at all exposure times and O3 dosages in relation to the non-ozonized effluent.
Coupling mechanism of a loop‐type ground radiation antenna
Authors: Zahid Zeeshan , Kim Hyeongdong
Published: March 2019

The coupling mechanism of a loop‐type ground radiation antenna is investigated in this paper. We use the equivalent circuit model of the antenna and a full‐wave simulation to explain the coupling mechanism of the antenna. We analyze the effects of various antenna parameters on the coupling between the antenna element and the ground plane to examine the conditions for enhancing the coupling. Based on simulations with the equivalent circuit model, full‐wave simulations, and measurements, we propose optimal design considerations for the antenna. The findings of this study will aid the design and understanding of loop‐type ground radiation antennas for mobile devices.
Antimicrobial Susceptibility Testing of Leptospira spp. in the Lao People’s Democratic Republic Using Disk Diffusion
Authors: Boss Jennifer , Dance David A. B. , Chanthongthip Anisone , Newton Paul N. , Wuthiekanun Vanaporn , Robinson Matthew T.
Published: March 2019

Leptospirosis is a global zoonotic disease caused by pathogenic bacteria of the Leptospira genus, which are fastidious, slow-growing organisms. Antimicrobial susceptibility data are limited; traditionally, the organisms have not been culturable on solid media. The recent development of Leptospira Vanaporn Wuthiekanun (LVW) agar, which facilitates rapid growth of Leptospira spp., provides the opportunity for antimicrobial susceptibility testing. Eighty-three Leptospira spp. clinical isolates originating from patients in Laos between 2006 and 2016 were tested against six antimicrobials (azithromycin, ceftriaxone, ciprofloxacin, doxycycline, gentamicin, and penicillin G) using disk diffusion on LVW agar. Quality control was undertaken using American Type Culture Collection (ATCC) reference strains with known susceptibilities on both standard media and LVW agar. All Leptospira spp. isolates produced large zones of inhibition around each of the six antimicrobials. All zones were greater than 25 mm: gentamicin produced the smallest zones (median 35 mm; interquartile range 30 mm–37 mm) and azithromycin produced the largest zones (median 85 mm; interquartile range 85 mm–85 mm). Zones produced by non-leptospiral ATCC reference strains on LVW agar were within 2 mm of accepted strain-specific quality control range on standard media. Antimicrobial activity on LVW agar appears to be similar to that on standard media. As there are no published susceptibility guidelines for the Leptospira genus, zone interpretation was subjective. Leptospira Vanaporn Wuthiekanun agar enabled antimicrobial susceptibility testing of multiple Leptospira isolates on solid media; the large zone sizes observed suggest that resistance has not emerged to these six antimicrobials in Lao Leptospira spp.
Simulation and Systems Engineering: Lessons Learned
Authors: Conroy Michael , Rabelo Luis
Published: March 2019

Aerospace projects live a long time. Around the turn of the century, NASA first began to discuss multi-decadal projects with respect to the tools, methods, infrastructure and culture necessary to successfully establish outposts and bases both on the Moon as well as in adjacent space. Pilot projects were completed, capabilities developed and solutions were shared across the Agency. A decade later the Mars discussion was multi-generational with planning milestones 50 years in the future. The 1970’s Requirements Document, or the 1990’s System Model are nowhere near suitable for planning, development, integration and operations of multi-national, highly complex, incredibly expensive development efforts planned to outlast not only the careers of the developers but that of their children as well. Simulation in the different forms has become very important for this multi-decadal projects. The challenge will be to device ways to create formats and views which can stand time.

This paper will share and discuss challenges, tools, methods, plans, successes and unmet goals associated with development of multi-decadal projects and simulation. In addition, it will briefly discuss re-using and sharing multi-generational information.
Advanced Alignment and Shear Resistant Temporary Fasteners
Authors: McClure Travis , Childers Kelly
Published: March 2019

Over the last decades, a new class of reusable temporary fasteners having expanding mandrels have come to market. Their large-scale implementation has resulted in these fasteners being utilized in high shear stress environments resulting in the identification of several limitations. Parts shifting as a result of shear forces in the airframe assembly during temporary fastener installation or removal can cause current mandrel-based fasteners to become damaged and difficult to remove from the hole. Additionally, enhanced fastener shear resistance is desirable in very high shear forces environments.

This paper examines current mandrel based temporary fasteners while also examining two new concepts in reusable temporary fasteners that are specifically designed to offer mitigations to the aforementioned limitations.
Collaboration in a Hybrid Team of Human and Robot for Improving Working Conditions in an Aircraft Riveting Process
Authors: Mueller Rainer , Vette-Steinkamp Matthias , Kanso Ali , Masiak Tobias
Published: March 2019

Aircraft production is facing various technical challenges, such as large product dimensions, complex joining processes, and organization of assembly tasks. Overcoming such challenges, as well as maintaining low tolerances and small batch sizes, is often difficult to achieve whilst retaining economic viability.

ZeMA believes that a semi-automated approach is the most effective way to optimize aircraft section assembly. This can be achieved with a semi-automated riveting process for solid rivets, using Human-Robot-Collaboration in combination with an intuitive Human-Machine-Interaction operating concept.

In the assembly of aircraft structures - in this scenario the aircraft aft section - the pressure bulk head is mounted to the section barrel. Two operators work collaboratively in uncomfortable, non-ergonomic positions, yet of course have to maintain exacting quality standards. In order to improve this process, a dynamic task sharing strategy between human and robot according to their respective skills, with due consideration given to ergonomic factors is proposed. The ideal solution involves placing a robot inside the section barrel. The robot’s workspace is expanded by mounting it on top of a lifting unit so that it can position the anvil properly. In the meantime, the human performs the more complex tasks of inserting the solid rivets and operating the riveting hammer from outside the section barrel.

In order to carry out the assembly tasks efficiently, the following components must be implemented: Human-Robot-Collaboration based on natural and intuitive interaction possibilities, and smart mixed reality devices for communication between human and robot in the hybrid team. By implementing a modular control system for configuration and operation of the assembly station with a variety of interaction possibilities, human and robot can perform the collaborative riveting process more efficiently than human operators alone. Additionally, due to the high forces and vibrations applied by the riveting hammer, a process-specific tool has been developed to prevent damage to the robot system. The implementation of natural and intuitive interaction within the Human-Robot-Collaboration achieves operator acceptance, improves ergonomics and therefore effectively optimizes aircraft production.

The results are part of the European Union’s Horizon 2020 research and innovation program, and present semi-automation as shown in the HRC riveting process.
Tolerance Management in a Semi-Automated and Collaborative Human-Robot Aircraft Riveting Process
Authors: Mueller Rainer , Vette-Steinkamp Matthias , Schirmer Leonie , Masiak Tobias
Published: March 2019

Large aircraft sizes with high precision requirements combined with complex joining tasks are typical challenges for aircraft production. To increase competitiveness and effectiveness, the automation of such production processes seems a viable solution for companies in the aircraft sector. When implementing automation, in order to handle small batch sizes and high variation while adhering to tight tolerances, the production equipment must meet high quality standards and flexibility requirements.

To achieve the objectives above, tolerance management is essential: deviations are acceptable within limits, as long as they do not result in quality losses and expensive rework. For these reasons, all the interactions between the product, production process and production equipment used must be analyzed in detail. The importance of this analysis is evident in assembly where new technologies are used, such as (semi-)automation using Human-Robot-Collaboration. Despite its innovative value, this approach must be robust, within tolerances and have minimal deviations from the outset. However, current planning and optimization of deviations and tolerances lack properly developed methods and approaches.

This paper proposes a method for securing and achieving proper tolerance in assembly processes: characteristic trees and tolerance chains are simple methods to make tolerance management more effective and attractive. The method combination promotes understanding of interactions and communication between all those involved in the development of products and the associated processes.

The methods developed are validated using a semi-automated riveting process, with Human-Robot-Collaboration, to complete a joining process in the assembly of the aft section. In this scenario the pressure bulkhead is mounted to the section barrel by means of hundreds of rivets. The intention is to implement a semi-automated production process to improve ergonomics, increase process traceability and efficiency, and minimize rework while meeting tolerance requirements.
What and how are EM residents being taught to respond to the next disaster?
Authors: Cornelius, MD Angela P. , Andress, BA, RN W. Knox , Ajayi, MS Reuben , Cvek, ScD, MBA Urska , Cornelius, DNP, CRNA Brian , Kilgore, MS Phillip C. S. R. , Trutschl, ScD Marjan , Kang, MD Christopher
Published: March 2019

Objective: Disasters, both natural and manmade, have become commonplace and emergency physicians serve on the front line. Residency may be the only time that emergency physicians are exposed to a disaster, through training, until one happens in their department; therefore, it is critical to provide residents with appropriate and timely disaster education. The goal of this study was to assess the current status of disaster education in emergency medicine (EM) residencies in the United States.Methods: A list of disaster topics was generated by reviewing disaster literature and validated by subject matter experts. Between May and December 2016, the authors conducted a national computerized survey of the 229 US EM residencies listed by the American Osteopathic Association and the American Medical Association. It focused on the methods of instruction and amount of time devoted to each topic.Results: Of the 229 eligible residency programs, 183 (79.9 percent) completed the survey. Of those, 98.9 percent report teaching disaster management topics. Nine of 18 disaster medicine topics were taught at >60 percent of responding programs. The most common topics were emergency management principles and mass casualty triage, while the least common was hazard vulnerability analysis. The most common method of instruction was lecture (68.5 percent) and the least common methods were journal club and field exercises.Conclusions: Broad education in disaster medicine is provided in most US EM residencies. Standardization of topics is still lacking and would be beneficial to encourage comprehensive education. Addressing the educational gaps and curriculum methodology changes identified in this survey would increase curriculum standardization.
Effects of life review program on emotional well-being of Korean elderly with Alzheimer’s disease
Authors: Lee, PhD, CTRS Yongho , Tabourne, PhD Carla E. S. , Yoon, PhD Jaesub
Published: March 2019

Emotional well-being is an important aspect of health for individuals with Alzheimer's disease, and self-esteem, depression, and life satisfaction have been identified as factors that comprise emotional well-being. As individuals undergo physical and psychological change associated with aging process, they tend to review their lives to achieve a sense of well-being in an effort to compensate for loss due to aging process. It evidences in the literature that the life review program (LRP) is an effective therapeutic recreation intervention to increase emotional well-being of elders with Alzheimer’s disease. With 17 Korean elders with Alzheimer’s disease, the findings of the current study showed some significant effects on Korean elderly with Alzheimer's disease in their emotional well-being. Although long-term effects of the LRP were questionable, the LRP was effective to make a therapeutic change in emotional well-being of Korean elderly with Alzheimer's disease.
The effectiveness of prescribed recreation activity in decreasing biochemical stress and improving mood in alcoholic patients
Authors: Russoniello, PhD, LRT/CTRS, LPC Carmen
Published: March 2019

The purpose of this controlled study was to determine whether prescribed recreation activity (RA) could decrease stress and improve mood. The study involved 20 male and female participants who were in alcohol rehabilitation. Ten participants served as matched controls. Treatment consisted of three groups of RAs classified according to physical intensity or the amount of oxygen required to perform them. Prescribed RAs (RXA) lasted 20 minutes and included three intensity levels. Biochemical analyses were coupled with psychological changes to test the study hypothesis. Results of the study indicated that participation in the RXAs reduced depression in the experimental group when compared with the control. Overall mood as well as its subcomponents, anger, tension, depression, fatigue, and vigor scores improved after both the low intensity (RXA1) and moderate intensity (RXA2) interventions. RXA1 and RXA2 interventions also produced statistically significant reductions in cortisol, a biochemical marker of stress. It is, therefore, concluded that prescribed RAs can produce biochemical and psychological changes consistent with decreased stress and improved mood. The ability to evoke positive physiological and psychological changes by more natural and less addicting behaviors provides rationale for this type of intervention as a potential complementary and alternative medicine. The findings of this study underscore the importance of recreational therapy in the treatment of alcoholism and other stress-related medical disorders.
Management of schizophrenia symptoms: Implications for recreation therapy
Authors: Dixon, MSc Chris M.
Published: March 2019

Effective interventions for the management of schizophrenia symptoms have been identified in the literature and have implication for recreation therapy. To prevent enduring negative symptoms that impact cognition, a high level of engagement in daily activity is recommended. Therapeutic interventions that show promise in reducing negative symptoms include participation in art, craft, music, and physical activity. To reduce high rates of distress and anxiety symptoms that exacerbate psychotic symptoms, animal assisted therapy, sensory experiences, and spiritual engagement were found to be effective. Early therapeutic intervention to rediscover a skill, talent, or hobby that establishes a sense of self and social identity may assist with reducing positive symptoms. Self-managed coping strategies such as distracting techniques may reduce auditory hallucinations. As positive symptoms reduce, a reduction of comorbid depressive symptoms may also occur. With reduction of negative and positive symptoms, as well as comorbid distress, anxiety, and depressive symptoms, individuals have an increased opportunity to attain their social and leisure goals.
New administration’s plan to empower Americans with disabilities
Authors: DeVito, Jr. Richard A.
Published: March 2019

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Yoga and self-management for people with chronic stroke: Effect on community reintegration and perceived activity constraints
Authors: Bolster, MS, OTR Ruby A. , Van Puymbroeck, PhD, CTRS, FDRT Marieke , Atler, PhD, OTR Karen E. , Portz, PhD, MSW Jennifer Dickman , Hinsey, MS, OTR Katie M. , Schmid, PhD, OTR, RYT-200 Arlene A.
Published: March 2019

After a stroke, it is common for individuals to experience challenges in both perceived activity constraints and community reintegration. Few interventions have addressed these two important variables that are related to post-stroke life and recovery. The objective was to assess the impact of an 8-week intervention on perceived activity constraints and community reintegration among individuals with chronic stroke. This noncontrolled pilot study with pre- and post-test design included 13 people with chronic stroke who completed group yoga and self-management intervention. Assessments were completed at baseline and at the completion of the 8-week intervention. Data were analyzed using Wilcoxon Signed-Rank tests to compare baseline and 8-week scores. Additionally, the correlation between activity constraints and community reintegration scores among this sample was analyzed. The average age of the 13 participants was 73.23 years, and 77 percent of the participants sustained a stroke >5 years ago. Perceived activity constraint scores improved significantly (76.82 ± 10.97 vs. 87.08 ± 9.5, p = 0.005; 13 percent change), as did community reintegration scores (79.25 ± 15.45 vs. 97.92 ± 11.46, p = 0.004; or a 24 percent improvement). Perceived activity constraint and Reintegration to Normal Living  Index (RNLI) scores demonstrated an excellent and significant correlation (rs = 0.864, p = 0.001). When working with people with chronic stroke, rehabilitation therapists may consider self-management combined with yoga. Due to the correlation between community reintegration and perceived activity constraints, potentially rehabilitation therapists, including recreational therapists, may target perceived activity constraints to improve community reintegration.
Volume 17, Number 2
Authors: DeVito, Jr. Richard A.
Published: March 2019

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Calendar
Authors: DeVito, Jr. Richard A.
Published: March 2019

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Why revolutionary change is needed in emergency management
Authors: Sylves, PhD Richard
Published: March 2019

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Standard operating procedures
Authors: Nicholson, JD William C.
Published: March 2019

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Building internal capacity for community disaster resiliency by using a collaborative approach: A case study of the University of New Orleans Disaster Resistant University Project
Authors: Kiefer, PhD John J. , Farris, PhD Monica T. , Durel, MPA Natalie
Published: March 2019

This paper describes the development of a disaster resistant community at the University of New Orleans (UNO). It includes the process for obtaining leadership support and “buy in,” for identifying specific expertise within the university community, and for enlisting and ensuring broad stakeholder support and participation in the plan.In late 2004, the author’s research team at the University of New Orleans successfully sought and was subsequently awarded a FEMA-sponsored grant to develop a Disaster Resistant University (DRU). This resulted in the formulation of a comprehensive mitigation plan aimed at identifying and reducing risks throughout UNO’s campus.Early in the planning process, the research team decided that, unlike other universities who had been awarded FEMA DRU grants, it would be important to develop local, “in-house” expertise in disaster resiliency to ensure sustainability. Rather than contracting an external agency to develop the mitigation plan, the researchers decided to leverage the disaster expertise already resident in the UNO community. At the same time, the UNO researchers considered it essential to use a methodology in developing the plan that would ensure representation from a broad range of stakeholders. To do this, the research team utilized a unique collaborative methodology in the hazard identification and mitigation process.
Should Tamiflu™ be stockpiled locally?
Authors: Cinti, MD Sandro , Blackburn, DO Gerald
Published: March 2019

The outbreak of H5N1 avian influenza in Asia raises serious concerns about an influenza pandemic of the kind seen in 1918. In addition, the recent federal response to Hurricane Katrina highlights the need for advanced local preparation for biological disasters. It is clear that there will not be enough vaccine early in an influenza pandemic. Without vaccine, the role of antivirals, especially oseltamivir (Tamiflu™), in treatment and prophylaxis becomes of paramount importance. It is unlikely that the Centers for Disease Control and Prevention (CDC) will be able to stockpile enough oseltamivir to protect every first responder in the United States. Thus, it is important that local governments and hospitals consider stockpiling oseltamivir for the treatment and/or prophylaxis of local first responders.
Risk communication and message mapping: A new tool for communicating effectively in public health emergencies and disasters
Authors: Covello, PhD Vincent T.
Published: March 2019

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Design, creation, and deployment of a sampling kit for hazardous material investigations
Authors: DeLisi, MS Steven M. , Martin Michael F. , Croley, PhD Timothy R.
Published: March 2019

Response to a hazardous material (HAZMAT) incident and/or an environmental crime often involves a legal investigation. Our laboratory, in collaboration with a number of state, local, and federal agencies, developed and deployed a sampling kit designed specifically for first responders to expedite both collection and transportation of physical evidence to the state laboratory for identification, while maintaining chain of custody. These kits have been used for sampling and transport of samples for a number of legal cases and have shown great utility in and among our local first responder community.
Emergency planning for municipalities: Emergency Planning 101
Authors: Scott, LTC (Ret) USA, CEM Clayton S.
Published: March 2019

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Family medicine capability in medical disaster response
Authors: AlShowair, MD Abdulmajeed M. , Bail, EdD, RN, MSN, CEN, EMT-P Jean , Parrillo, DO, FACOEP, FACEP Steven
Published: March 2019

Every disaster often holds a potential for significant impacts on human health and life. Every new threat presents new challenges to health risk management. However, family medicine faces an uncertainty on the specific roles it can assume to support urgent efforts at disaster surge response. Its preparedness level remains unknown. This research project, designed to explore issues of family medicine competency in this changed disaster response environment, conducted a disaster preparedness and response workshop among 28 family medicine physicians, testing their learning rate using a pre-test-post-test data collection method. Pre-test results (38.11 percent, x = 10.67) indicate that family medicine practitioners as a group were not ready by competency to respond to a disaster event and may instead increase the life risks of disaster victims. Post-test results (x = 21.67, 77.39 percent) showed an average doubling of their learning levels, indicating the workshop effectiveness in improving their disaster preparedness and response competency.
The next generation core competencies for emergency management
Authors: Feldmann-Jensen, RN, DPPD, MPH Shirley , Jensen, DPPD Steven J. , Smith, RN, PhD Sandy Maxwell , Vigneaux, MS Gregory
Published: March 2019

The Next Generation Core Competencies (NGCC) guide the professional development of future emergency managers. Once familiar roles are evolving as the world grows more interdependent; at the same time, disaster risk factors are intensified by the changing interactions between the social, built, and physical environments. The updated edition of emergency management core competencies is particularly important for refining the trajectory of the emergency management discipline and developing capacities requisite to reducing disaster risk and building resilient communities in the midst of a turbulent, complex, and uncertain future.The NGCC project was a multiphase study conducted by a FEMA-sponsored focus group. Oriented toward future needs, the competencies have been built on the current emergency management competencies, a review of related competencies and global risk trends, a multiphase Delphi study, and wider emergency management community listening sessions. Behavioral anchors and key actions for measurement accompany the new core competencies. The overarching goal of the work is to establish the next generation emergency management core competencies, which are likely to underpin the emergency management workforce of 2030 and beyond. The 13 core competencies fall into three nested categories that are interrelated, but have attributes that build the individual, the practitioner, or relationships.
The scholarship of teaching and learning in emergency management and homeland security: Trends, gaps, barriers, and opportunities
Authors: Feldmann-Jensen, RN, DPPD, MPH Shirley , Hackerott, PhD Caroline S. , Knox, PhD Claire Connolly , Ramsay, PhD, MA, CSP James D. , McEntire, PhD David A. , Jerolleman, PhD, MPA, CFM Alessandra
Published: March 2019

Underlying the nature of what is and is not a profession are education standards. Among the characteristics defining a profession’s specialized boundaries are the education standards comprising its academic programs. The status of the Scholarship of Teaching and Learning (SoTL) is explored for both emergency management and homeland security (EM/HS) at this point in time. The aim of this article is to increase the conceptual understanding of SoTL by discussing what SoTL is, explaining why it is important, exploring our current state of knowledge in this area, and by identifying current barriers and opportunities for improvement. Several possible means of better integrating SoTL into the EM/HS discipines are highlighted: Making SoTL a higher priority, increasing exposure to existing research, advancing knowledge within our own disciplines, sharing knowledge through publications and conferences, and applying knowledge in our teaching. Conclusively, the vital nature of SoTL research can more deeply establish the professional boundaries for both disciplines.
Promotion or transition: From fire officer to emergency manager
Authors: Chang, PhD Ray H. , Neal, PhD Dave
Published: March 2019

The field of emergency management has put much focus on disaster response activities. By overly emphasizing response, some people have come to regard fire officers as ideal candidates for promotion into emergency manager positions. To understand this process, we first review the basic definitions of emergency management. Next, drawing upon these definitions, we identify differences between fire officers’ and emergency managers’ tasks. Based on the analysis, we found that the task differences were large enough to distinguish emergency managers as a profession separate and distinct from that of the fire officer. Finally, we conclude with suggestions on how fire officers can enhance or expand their job skills to change effectively their career paths to emergency management.
Professionalization of emergency management: Are we our own worst enemy?
Authors: Gray, MS Jennifer R.
Published: March 2019

INTRODUCTIONBy nearly every measure available, the emergency management field is growing and will continue to grow. The US Bureau of Labor and Statistics indicates that emergency management director positions will continue to grow by 6 percent through 2024.1 Given the increase in both the frequency and severity of disasters of all types, this is not surprising. As the field of emergency management has evolved and grown through the post-9/11 years there has been a push toward professionalization, and recognition of emergency management as its own unique field, rather than merely an extension of the police and/or fire service.The status of progress toward recognizing emergency management as a profession depends on what definition we accept for what makes a profession. Arguments have been made that emergency management is not yet accepted as a profession because the field lacks some of the key features of a profession such as board certification, or a specialized body of knowledge to name a few (Canton, 2013)2. The growth of higher education, the International Association of Emergency Managers’ Certified Emergency Manager designation, as well as state-level certifications certainly speak to progress toward different aspects of achieving this goal. However, we still have a long way to go.Graduate-level emergency management education remains discipline-specific; many graduate programs offer emergency management as a track or concentration within a broader program (eg, public policy, public health, law, etc) Emergency management lacks standardized education that provides required minimum skill sets and competencies. Furthermore, education, while preferred, is not a requirement for employment in most jobs in the field, even at the senior executive level. Even as we move toward getting ourselves recognized as a profession, however, we insist on portraying ourselves to the world as first responders in our advertising of higher education programs, and even in our own doctrine. By misrepresenting ourselves, intentionally or not, we are doing a disservice to the next generation of emergency managers. We are taking a step back from becoming a unique and independent profession.
Diversity in emergency management scholarship
Authors: Bennett, PhD DeeDee M.
Published: March 2019

Women and racial/ethnic minorities have long been underrepresented in the field of emergency management. This is true for both practice and research. The lack of women and racial/ethnic minorities in the profession and their perceived absence in research or scholarly study may have impacts on the effectiveness of response and recovery efforts as well as the broader scientific knowledge within the field. Historically, women and racial/ethnic minority communities have disproportionately experienced negative impacts following disasters. Earlier related studies have pointed to the underrepresentation as a contributing factor in community vulnerability. The scarcity of women in practice and as students in this field has been particularly evident in the United States. Using data from a recent survey of emergency management programs nationwide, this article reviews the concerns in research with regards to women and ethnic minority communities during disasters, efforts to increase representation of these groups in the field, and discusses the implications for practice, policy, and future research. The findings show that women have a strong presence in emergency management programs nationwide, and while specific data on racial and ethnic minorities are lacking, the observed increases reported in this article encourages further study.
Entering and moving forward: Finding our way in emergency management
Authors: Walbeck, MS Amber , Land, MS Bryan , Iverson, MS Bradley , Wieland, MS Cole
Published: March 2019

Choosing a career path in emergency management can be simultaneously rewarding and taxing. The spectrum of knowledge that must be gained to be effective comes from a mix of practical experience and academic studies. Selecting a higher education program that furnishes the fundamentals of emergency management and offers a transition for many entering the field from established careers provides value worth investing in. Contained is a short dialogue of four individuals, from both public and private backgrounds, who committed to the ideal that their investment into academics will lend itself to success throughout their communities as emergency management practitioners.
From the editor
Authors: Waugh Jr, PhD William L.
Published: March 2019

As the profession of emergency management has matured, the roles and responsibilities of emergency managers  have  expanded,  new  technologies  have been deployed, and emergency management education grown and has become better connected to emergency management practice. This special topic coverage (in three parts) addresses many of the changes in emergency management education over the past four decades, including the expansion of academic programs for those preparing to enter the field, those transitioning from emergency response and other fields, and those moving into supervisory and management positions in emergency management and related organizations. It also addresses some of the issues that academic programs have encountered as they have developed and have found their places in academic institutions. (Click Full Text PDF and/or login to read more.)
Age differences in the association of nonmedical prescription opioid use and suicidality
Authors: Chan, MSW, PhD Keith T. , Winston, MSW Priya , Jennings, MS Rubin , Trant, MSW Jeffrey , Moller, MSW Mary
Published: March 2019

Objectives: To examine age differences in the associations of nonmedical prescription opioid use (NMPOU) and suicidality.Design: This is a population health study using the 2016 National Survey on Drug Use and Health.Participants: The sample included 38,136 persons 18 and older.Main outcome measures: Weighted logistic regression analyses were used to examine the odds of past year NMPOU with suicidality (suicidal thoughts, plans, and attempts in the past year), stratified by age groups.Results: Overall, the prevalence of suicidality was higher for persons who reported past year NMPOU across all age groups. For the full sample, NMPOU was associated with increased odds of suicidal thoughts (OR = 1.71, 95% CI = 1.36, 2.14), plans (OR = 1.95, 95% CI = 1.33, 2.84), and attempts (OR = 2.25, 95% CI = 1.27, 4.00). Users 18 to 34 had greater odds for reporting yes on all three suicidality measures. Users 50 and older had greater odds for suicidal thoughts in the past year.Conclusions: Among younger and older age groups, there is a higher prevalence and associated odds of suicidality for those who report any misuse within the 12-month period.
Tapentadol immediate release for moderate to severe acute post-surgery pain
Authors: Viscusi, MD Eugene R. , Allard, PhD René , Sohns, PhD Melanie , Eerdekens, MD, MBA Mariëlle
Published: March 2019

Objective: To investigate efficacy and tolerability of tapentadol immediate release (IR) in the treatment of moderate to severe acute pain in three surgical pain models. Design: Three randomized, double-blind, placebo- and active-controlled, multicenter, phase 3 trials were performed in total hip replacement surgery, abdominal hysterectomy, and bunionectomy with trial medications administered every 4-6 hours as needed for up to 72 hours. Tapentadol IR was included in all trials, oxycodone IR in the total hip replacement trial, and morphine IR in the abdominal hysterectomy and bunionectomy trials; active controls ensured assay sensitivity.Main outcome measures: The primary efficacy endpoint was the sum of pain intensity differences over the first 24 hours of treatment (SPID24) in the abdominal hysterectomy trial and SPID48 in the other two trials. Tolerability was assessed by adverse events reporting.Results: A total of 330, 832, and 285 patients with total hip replacement, abdominal hysterectomy, and bunionectomy, respectively, were assessed for efficacy. All three trials demonstrated statistically significant improvements of tapentadol IR on the primary endpoint versus placebo and similar improvements compared to morphine IR or oxycodone IR. These findings were consistent with results of total pain relief assessments and patients’ global impressions of change in their overall health status after 72 hours (abdominal hysterectomy, bunionectomy). The tolerability profile of tapentadol IR was as expected for a centrally acting analgesic in the post-surgery setting.Conclusions: Tapentadol IR has strong analgesic efficacy and is well tolerated in multiple post-surgery conditions of moderate to severe pain.
Opioid-induced constipation in chronic pain: Experience with 180 patients
Authors: Velázquez Rivera, MD Ignacio , Velázquez Clavarana, BSc Lourdes , García Velasco, BSc Pilar , Melero Ramos, BSc Carmen
Published: March 2019

Background: Opioid-induced constipation (OIC) is a common adverse effect of opioid analgesic therapy that significantly affects the patient's quality of life and may lead to poor adherence and treatment failure. Tapentadol, oxycodone/naloxone, and some transcutaneous opioids were associated with less frequent OIC than morphine or oxycodone in controlled clinical trials. However, few studies compare these newer opioids with each other in terms of OIC.Methods and patients: We performed a cross-sectional observational study that evaluated the degree of OIC and risk factors in patients receiving long-term treatment (>1 year) at a tertiary care pain unit with tapentadol, oxycodone/naloxone, hydromorphone, fentanyl, or buprenorphine. The degree of constipation was evaluated using the Bowel Function Index (BFI).Results: Out of 180 enrolled patients (median age: 61.5 years, 66.7 percent women, mean treatment duration: 3 years), 57.2 percent suffered from nociceptive pain, 33.9 percent from mixed pain, and 8.9 percent from neuropathic pain. The most commonly prescribed opioids were oxycodone/naloxone (44.4 percent) and tapentadol (37.8 percent). At the time of the study, 73.9 percent of patients had constipation (BFI > 29), and 21.7 percent had severe constipation (BFI > 69). In a multiple linear regression analysis, previous constipation, morphine equivalent dose, treatment with fentanyl and interaction between morphine equivalent dose and hydromorphone were associated with more severe constipation. Conclusions: Most patients receiving long-term treatment with opioids present symptoms of constipation. The bowel function profile was more favorable for tapentadol and oxycodone, with no differences between them, even though morphine equivalent doses were on average higher in the tapentadol group.
Volume 15, Number 1
Authors: Opioid Management Journal of
Published: March 2019

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