bluuebunny/crossref_metadata_2025 huggingface dataset:
Fish Bone Migrating into the Thyroid Gland
Authors: Kotecha Jay Kantilal
Published: June 2014

Many cases have been reported in the literature about foreign bodies lodged in the hypopharynx. A foreign body penetrating the esophagus and migrating into the soft tissue of neck is a rare phenomenon. We report a case of 35 years male who ingested a fish bone which then migrated into left lobe of thyroid and the role of imaging in its detection and management.

How to cite this article

Kotecha JK. Fish Bone migrating into the Thyroid Gland. Int J Head Neck Surg 2014;5(1):42-44.
A Giant Combined Laryngomucocele
Authors: Dhoke Priti Rakesh , Deosthale Nitin Vasant , Khadakkar Sonali Prabhakar , Dhote Kanchan Sandeep , Harkare Vivek Vishwas , Singh Bhanupratap Surendrakumar
Published: June 2014

Laryngomucocele is a rare benign laryngeal disease characterized by cystic dilatation of laryngeal saccule with collection of mucous in it. The etiology behind its occurrence is still unclear, but congenital and acquired factors have been implicated in its development. Although it is a benign lesion, its presence in an old patient since many days should prompt the examiner to diligently search for laryngeal malignancy. We are presenting the case of a 61 years old male who presented with swelling in the neck, hoarseness of voice, dysphagia and dyspnea on exertion. The patient was thoroughly evaluated clinically, endoscopically and radiologically. He was diagnosed to be suffering from laryngomucocele and was managed by an external lateral cervical approach.

How to cite this article

Harkare VV, Dhote KS, Deosthale NV, Khadakkar SP, Dhoke PR, Singh BS. A Giant Combined Laryngomucocele. Int J Head Neck Surg 2014;5(1):45-47.
Maneuvers in Regional Flap Use in Reconstruction of Primary Defects in Head and Neck Cancer Patients: Presentation of Three Cases
Authors: Aloosi Suha Nafea
Published: June 2014

This case series highlights the advantages in the use of three regional flaps, submental flap, sternocleidomastoid flap and transverse cervical flap in maxillofacial primary defect reconstruction after ablative cancer surgery through presentation of three head and neck cancer patients in whom it was decided to do pedicled flaps rather than free flaps.

Aim and objective

This article is done in an attempt for encouraging for more introduction of these three flaps in head and neck reconstruction practice, and to encourage more studies be done to describe skin territory of cervical flap.

Materials and methods

Three patients presented to oral and maxillofacial department, diagnosed as having different kinds of cancer. All were managed according to the evidence-based guideline of head and neck cancer management, including the work up, diagnosis, TNM classification, surgical treatment, adjuvant treatment and follow-up. In all the three cases, regional flaps were used to close the primary defect. For the first patient, transverse cervical flap was used, the sternocleidomastoid flap in the second and submental flap in the third one.

Results

All flaps were easy to be harvested, in term of time and technique, and successful in term of viability, extension and in achieving the functional and cosmetic aim of reconstruction, with minimum donor site morbidity, all the patient are enjoying good quality of life.

Conclusion and recommendations

The regional flaps have their place to overcome limitation of free flaps due to the shortage in the armamentarium available in the hospital, especially in low resources regions, or limitations related to patients general condition, in addition, regional flaps are the best option available in case of failed free flap, or when free flap failure is anticipated and avoided. Highlighting the different maneuvers in harvesting and using regional pedicled flaps for further extensions widens the scope of indications and giving the reconstructive surgeon variability of options in reconstruction, obviates the need for special microvascular expertise in free flaps with comparable results and relatively less complication.

How to cite this article

Aloosi SN. Maneuvers in Regional Flap Use in Reconstruction of Primary Defects in Head and Neck Cancer Patients: Presentation of Three Cases. Int J Head Neck Surg 2014;5(1):48-55.
An Analysis of Biopsy-proven Tongue Lesions among 8,105 Dental Outpatients
Authors: Alaeddini Mojgan , Barghammadi Roohollah , Etemad-Moghadam Shahroo
Published: June 2014

Aim

The aim of the present study was to analyze data on the characteristics of tongue lesions in dental patients seeking care at the Oral Pathology Service of Tehran University of Medical Sciences, from 1985-2010.

Materials and methods

Demographic data and histopathologic diagnoses were recorded for all lesions that were documented as occurring on the tongue according to the patient records in our department. Statistical analysis included chi-square, t-, and Fisher's exact tests. A 95% confidence interval (CI) was calculated, and p < 0.05 was considered significant.

Results

Tongue lesions constituted 6.3% of all received specimens which included 46 different defects. The most common lesions were lichen planus (LP), irritation fibroma (IF), squamous cell carcinoma (SCC) and pemphigus vulgaris (PV). Tongue lesions were significantly more common in women compared to men (CI = 0.65-0.94, p = 0.02). Mean age (47 years) did not differ between male and female subjects (CI = −2.49 – 3.93, p = 0.06). The dorsal surface followed by the lateral aspect was the most common site for tongue lesions.

Conclusion

It seems that dental practitioners should be perceptive of LP, IF, SCC and PV, when examining the tongue. Histopathologic analysis is essential for achieving final diagnosis in a considerable number of lesions that commonly occur on this organ.

Clinical significance

Access to demographic/prevalence data in different populations may be useful in clinical settings and could be complimented by histopathologic diagnosis in most instances. The present findings can be compared with those obtained from other epidemiologic studies in this field resulting in valuable data which may be used in several types of investigations.

How to cite this article

Alaeddini M, Barghammadi R, Eshghyar N, Etemad-Moghadam S. An Analysis of Biopsyproven Tongue Lesions among 8,105 Dental Outpatients. J Contemp Dent Pract 2014;15(1):1-7.
Cuspal Movement related to Different Polymerization Protocols
Authors: Kuga Milton Carlos , Piccioni Máyra Andressa Rodrigues Valinhos , Baratto-Filho Flares , de Morais Eduardo Christiano Caregnatto , Campos Edson Alves
Published: June 2014

Objective

The aim of this study to investigate the effects of different polymerization protocols on the cuspal movement in class II composite restorations.

Materials and methods

Human premolar teeth were prepared with class II cavities and then restored with composite and three-step and two-step etch-and-rinse adhesive systems under different curing techniques (n = 10). It was used a lightemitting- diode curing unit and the mode of polymerization were: standard (exposure for 40 seconds at 700 mW/cm2), pulse-delay (initial exposure for 6 seconds at 350 mW/cm2 followed by a resting period of 3 minutes and a final exposure of 37 seconds at 700 mW/cm2) and soft-start curing (exposure 10 seconds at 350 mW/cm2 and 35 seconds at 700 mW/cm2). The cuspal distance (ìm) was measured before and after the restorative procedure and the difference was recorded as cuspal movement. The data were submitted to two-way ANOVA and Bonferroni test (p < 0.05).

Results

The type of adhesive system did not influenced the cuspal movement for all the curing methods. Standard protocol showed the highest values of cuspal movement and was statistically different from the pulse-delay and soft-start curing modes.

Conclusion

Although the cuspal displacement was not completely avoided, alternative methods of photocuring should be considered to minimize the clinical consequences of composites contraction stress.

How to cite this article

Piccioni MARV, Baratto-Filho F, Kuga MC, de Morais ECC, Campos EA. Cuspal Movement related to Different Polymerization Protocols. J Contemp Dent Pract 2014;15(1):26-28.
Wisdom Tooth—Complications in Extraction
Authors: Singh Nishi , Agrawal Amiya , Yadav Arvind , Chandel Siddhartha , Singhal Ankita
Published: June 2014

The purpose of this study is to analyze the incidence of complications in a group of 171 patients in whom extractions of impacted mandibular third molar have been performed by two oral surgeons between the period April 2010 and March 2012. This retrospective study comprises evaluation of 270 impacted mandibular third molars which were classified into two groups A and B on the basis of procedure of osteotomy only and osteotomy and odontotomy both respectively. Total no of complications reported were 40 (14.81%). Maximum no of cases reported alveolar osteitis (AO) (11.11%) while other complications reported root tip fractures (2.22%), lingual nerve parasthesia and TMJ problems (each 0.74%) in descending frequency. Conclusion drawn is that the risk of complications in extractions of impacted mandibular third molars always exists, and extractions associated with both osteotomy and odontotomy are associated with higher risk of complications.

How to cite this article

Agrawal A, Yadav A, Chandel S, Singh N, Singhal A. Wisdom Tooth—Complications in Extraction. J Contemp Dent Pract 2014;15(1):34-36.
Overlays or Ceramic Fragments for Tooth Restoration: An Analysis of Fracture Resistance
Authors: Bandéca Matheus Coelho , Malheiros Adriana Santos , de Jesus Tavarez Rudys Rodolfo , Firoozmand Leily Macedo , Silva Mônica Barros
Published: June 2014

Purpose

The aim of this study was to evaluate the mode of fracture and resistance of partial ceramic restorations of posterior teeth.

Materials and methods

Thirty healthy upper premolars were selected and divided into three groups (n = 10): Group 1— control, healthy unrestored teeth, group 2—teeth restored with ceramic fragments; and group 3—teeth restored with ceramic overlays. The restorations were manufactured with feldspathic ceramic and cemented with RelyX ARC resin cement. After being stored in distilled water for 7 days, the teeth were subjected to axial compression mechanical testing with a universal testing machine. Force was applied to the long axis of the tooth at a speed of 0.5 mm/min until fracture. The data were analyzed with one-way ANOVA and Tukey's test (5%). The mode of fracture was scored according to the degree of involvement of the tooth structure and the type of restoration.

Results

A significant difference (p < 0.05) was showed between groups 2 (1155 N) and 3 (846.6 N), but there was no significant difference between group 1 and the other groups (1046 N), More extensive fractures were prevalent in the healthy teeth group (Group 1), which had no occlusal coverage; less severe fractures were found in groups 2 and 3.

Conclusion

We conclude that teeth restored with ceramic fragments may offer greater resistance to fractures compared to teeth that have overlay restorations.

How to cite this article

de Jesus Tavarez RR, Firoozmand LM, Silva MB, Malheiros AS, Bandéca MC. Overlays or Ceramic Fragments for Tooth Restoration: An Analysis of Fracture Resistance. J Contemp Dent Pract 2014;15(1):56-60.
Clear Cell variant of Calcifying Epithelial Odontogenic Tumor without Calcification: A Rarity
Authors: Mutalik Vimi Sunil , Solomon Monica , Nichat Prasanna , Carnelio Sunitha , Radhakrishnan Raghu
Published: June 2014

Calcifying epithelial odontogenic tumor (CEOT) is a rare, benign, locally aggressive odontogenic epithelial tumor that affects the jaws. Although there are numerous reports on the variants of CEOT, occurrence of clear cells with complete absence of calcification has been a rarity. Histochemical analysis of tumor cells revealed glycogen granules with PAS staining, with absence of CD 1a staining in clear cells, while the amyloid-like deposit associated with clear cells showed green birefringence with Congo red. We report an unusual variant of CEOT occurring in a 27 years old male patient.

How to cite this article

Mutalik VS, Nichat P, Carnelio S, Solomon M, Radhakrishnan R. Clear Cell variant of Calcifying Epithelial Odontogenic Tumor without Calcification: A Rarity. J Contemp Dent Pract 2014;15(1):119-121.
Factors associated with inpatient mortality in a field hospital following the Haiti earthquake, January-May 2010
Authors: Dulski, MPH Theresa M. , Basavaraju, MD Sridhar V. , Hotz, PhD Gillian A. , Xu, MD, MS Likang , Selent, DVM, MPH Monica U. , DeGennaro, MD Vincent A. , Andrews, MD David , Ford, MD Henri , Coronado, MD, MPH Victor G. , Ginzburg, MD Enrique
Published: June 2014

Objective: To describe factors associated with inpatient mortality in a field hospital established following the 2010 Haiti earthquake.Design: Data were abstracted from medical records of patients admitted to the University of Miami Global Institute/Project Medishare hospital. Decedents were compared to survivors in terms of age, sex, length of stay, admission ward, diagnosis, and where relevant, injury mechanism and surgical procedure. Three multivariate logistic regression models were constructed to determine predictors of death among all patients, injured patients, and noninjured patients.Results: During the study period, 1,339 patients were admitted to the hospital with 100 inpatient deaths (7.5 percent). The highest proportion of deaths occurred among patients aged ≤15 years. Among all patients, adult intensive care unit (ICU) admission (adjusted odds ratio [AOR] = 7.6 and 95% confidence interval [CI] = 3.4-16.8), neonatal ICU/pediatric ICU (NICU/PICU) admission (AOR = 7.8 and 95% CI = 2.7-22.9), and cardiac/respiratory diagnoses (AOR = 8.5 and 95% CI = 4.9-14.8) were significantly associated with death. Among injured patients, adult ICU admission (AOR = 7.4 and 95% CI = 1.7-33.3) and penetrating injury (AOR = 3.3 and 95% CI = 1.004- 11.1) were significantly associated with death. Among noninjured patients, adult ICU admission (AOR = 6.6 and 95% CI = 2.7-16.4), NICU/PICU admission (AOR = 8.2 and 95% CI = 2.1-31.8), and cardiac/ respiratory diagnoses (AOR = 6.5 and 95% CI = 3.6- 12.0) were significantly associated with death.Conclusions: Following earthquakes in resourcelimited settings, survivors may require care in field hospitals for injuries or exacerbation of chronic medical conditions. Planning for sustained post-earthquake response should address these needs and include pediatric- specific preparation and long-term critical care requirements.
Radiostethoscopes: An innovative solution for auscultation while wearing protective gear
Authors: Candiotti, MD Keith A. , Rodriguez, MD Yiliam , Curia, MD Luciana , Saltzman, MD Bruce , Shekhter, MS Ilya , Rosen, MA Lisa , Birnbach, MD, MPH David J.
Published: June 2014

Objective: To demonstrate a radiostethoscope that could be modified and successfully used while wearing protective gear to solve the problem of auscultation in a hazardous material or infectious disease setting.Design: This study was a randomized, prospective, and blinded investigation.Setting: The study was conducted at the University of Miami-Jackson Memorial Hospital Center for Patient Safety.Participants: Two blinded anesthesiologists using a radiostethoscope performed a total of 100 assessments (50 each) to evaluate endotracheal tube position on a human patient simulator (HPS).Interventions: Each lung of the HPS was ventilated separately using a double lumen tube. Four ventilation patterns (ie, right lung ventilation only; left lung ventilation only; ventilation of both lungs; and an esophageal intubation or no breath sounds) were simulated. The ventilation pattern was determined randomly and participants were blinded. An Ambu-Bag was used for ventilation. An assistant moved the radiostethoscope to the right and left lung fields and then to the abdomen of the HPS while ventilating. Subjects had to identify the ventilation pattern after listening to all three locations. A third member of the research team collected responses. Each subject, who wore both types of respirator (positive and negative), performed a total of 25 trials. Participants later compared the two types of respirators and their ability to auscultate for breath sounds.Results: Subjects were able to verify the correct ventilation pattern in all attempts (100 percent).Conclusions: Radiostethoscopes appear to provide a viable solution for the problem of patient auscultation while wearing protective gear.
A survey on disaster management among postgraduate students in a private dental institution in India
Authors: Rajesh, MDS G. , Chhabra, MDS Kumar Gaurav , Shetty, MDS Preetha J. , Prasad, MPH K. V. V. , Javali, MPhil, PhD S. B.
Published: June 2014

Objective: To assess the knowledge, attitude, and behavior regarding disaster management among postgraduate (PG) students in a private dental institution in India.Design: Questionnaire survey with cross-sectional design.Setting: Sri Dharmasthala Manjunatheshwara (SDM) College of Dental Sciences and Hospital, Dharwad, Karnataka, India.Patients and participants: All PG students in SDM college of Dental Sciences and Hospital, Dharwad, Karnataka, were included.Interventions: None.Main outcome measures: Knowledge, attitude, and behavior regarding disaster management.Results: A total of 125 of 135 PG students participated (response rate of 92.59 percent) in the study. Mean knowledge, attitude, and behavior scores were 58.74, 85.78, and 31.60 percent, respectively. Significant correlations were observed between knowledge and year of study (ᵪ2 value = 45.301, p = 0.000), and behavior and place of residence of respondents (ᵪ2 value = 4.112, p = 0.043).Conclusions: Participants had low knowledge and behavior scores, but high attitude scores regarding disaster management. The year of study and the place of residence were associated with knowledge and behavior, respectively. This study highlights the need for curriculum changes in dental education and has policy implications for disaster management in India.
High-frequency percussive ventilation for intercontinental aeromedical evacuation
Authors: Barillo, MD, FACS, FCCM COL David J. , Renz, MD COL Evan M. , Wright, CRT SFC Gabriel R. , Broger, CCRN MAJ Kristine P. , Chung, MD LTC Kevin K. , Thompson, PA-C Charles K. , Cancio, MD, FACS COL Leopoldo C.
Published: June 2014

High-frequency percussive ventilation (HFPV) has been used for the management of patients with smoke inhalation injury for more than 20 years and is considered a standard of care at many burn centers. Because the ventilator is powered by air and oxygen rather than electricity, prehospital use has been limited by largevolume medical gas requirements.Since 2003, Operations Iraqi Freedom and Enduring Freedom have created a need for long-range aeromedical transfer of service members with severe burn and inhalation injuries. Unique to these conflicts is the availability of US Air Force C-17 cargo aircraft as the primary longdistance airframe. Because C-17 aircraft have a built-in medical oxygen supply, transcontinental patient transport using HFPV has become feasible.In this study, the authors report their initial experiences with the aeromedical transportation of 33 burn patients over a combined distance of 174,145 air miles using HFPV. HFPV is safe and efficacious for transcontinental flight when used by an experienced medical transport team.
A decision process for determining whether to conduct responder health research following large disasters
Authors: Decker, MS John A. , Kiefer, MS Max , Reissman, MD, MPH Dori B. , Funk DVM, MPH Renée , Halpin, MD, MPH John , Bernard, MD, MPH Bruce , Ehrenberg, MD Richard L. , Schuler, PhD Christine R. , Whelan, PhD Elizabeth , Myers, MS Kyle , Howard, MD John
Published: June 2014

Disasters often set the stage for scientific inquiry within the field of occupational safety and health. This is especially true when the long-term consequences of exposures associated with a particular disaster are unclear. However, a responder research study can be costly and difficult to design, and researchers must consider whether the proposed study will produce useful, reliable results and is a prudent public health investment.The decision process can be segregated into various components, including scientific rationale that should be formally recognized as critical to efficiently and effectively determine whether a research study is warranted. The scientific rationale includes certain controlling or “gatekeeper” factors that should be present to proceed with research.
La Gloria, Mexico: The possible origins and response of a worldwide H1N1 flu pandemic in 2009
Authors: Hashmi, MD Sahar
Published: June 2014

This article traces the spread and route of the H1N1 pandemic in 2009 from its possible origin in La Gloria to Mexico City. A lack of health control measures or nonpharmaceutical interventions (NPIs) in La Gloria accounts for the unprecedented high basic reproductive number (R0) in that town and a higher incidence of H1N1 flu in Mexico City.We analyzed data collected from Mexican news articles, the Healthmaps dataset, the Google search engine, and telephone interviews with Mexican community physicians and residents. Our article uses a simple Susceptible Infected and Recovered model based on the data collected, to show the relationship between the disease curve and the implementation of NPI use. As a result of this study, we conclude that, with strict government measures to control the disease over an extended period of time, it is possible that many hundreds or even thousands of lives might be saved in the future.
Assessing hospital disaster preparedness in Shiraz, Iran 2011: Teaching versus private hospitals
Authors: Mahdaviazad, MD Hamideh , Abdolahifar, MD, MPH Gholam Reza
Published: June 2014

Background: In disasters, hospitals play a crucial role in supplying essential medical care to the society but there is no standardized checklist for assessing hospital disaster preparedness.Objectives: The objective of this study was to recognize and compare almost all the components of disaster preparedness between teaching and private hospitals in Shiraz, Iran, focusing on incident command systems (ICS), communications, surge capacity, human resources, supply management, logistic service, case management, surveillance, laboratory and operating room management.Methods: From May to August 2011, we assessed the preparedness of teaching and private hospitals in Shiraz, using the 10-key component World Health Organization checklist.Results: Twenty four out of 31 hospitals responded. The scores for preparedness of ICS, communication, surge capacity and human resources was 73.9 percent, 67.3 percent, 49 percent, and 52.6 percent respectively. The preparedness scores for supply management and logistic services were 68.5 percent and 61.8 percent. While the levels of preparedness of laboratory and operating room management were low, preparedness of the surveillance system and case management were 66.7 percent and 70.8 percent, respectively.The average total preparedness of all hospitals was 59.5 percent, with scores of 62.2 percent in teaching hospitals and 55 percent in private hospitals.Conclusion: At the time of our study, the total preparedness among hospitals was at the intermediate level, but in some key components such as operating room management, surge capacity, and human resources, the total preparedness was very limited and at an early stage of development, therefore, requiring urgent attention and improvement.
Internal radiation exposure of Ground Self-Defense Force members involved in the management of the Fukushima Nuclear Power Plant disaster
Authors: Naoi, MD Yutaka , Fujikawa, MD Akira , Kyoto, MD Yukishige , Kunishima, MD Naoaki , Ono, RT Masahiro , Watanabe, Nrs Yukie
Published: June 2014

When the Great East Japan Earthquake occurred on March 11, 2011, the Ground Self-Defense Force (GSDF) was dispatched nationally to Northeast area in Japan. The highly trained GSDF members were simultaneously assigned to various missions for the Fukushima Nuclear Power Plants disaster. The missions of GSDF terminated on August 31, 2011. Special medical examinations were conducted for the members as they returned to each military unit. GSDF members who were assigned to the nuclear power plant were at risk of radiation exposure; therefore, pocket dosimeters were used to assess external radiation exposure. A few months after the mission was terminated, measurements of internal radiation exposure were performed. This is the first report of the internal exposure of GSDF members who worked in the restricted radiation contamination area. Here, we report the amounts of internal and external exposure of and the equipment used by the GSDF members.
Disaster-related fatalities among US citizens traveling abroad
Authors: Partridge, MD, MPH Robert , Bouslough, MD, MPH David , Proano, MD Lawrence
Published: June 2014

Objective: To describe the locations and risk of death associated with natural disaster fatalities for US citizens traveling abroad.Design, setting, and participants: A retrospective database review of US citizen disaster deaths occurring worldwide.Interventions: None.Main outcome measures: Information on fatalities due to disasters was abstracted from the US Department of State Web site reporting deaths of US citizens abroad by non-natural causes from October 2002 through June 2012. The main outcome measures were the frequency of disaster deaths and countries where disasters occurred. Descriptive statistics and rates were used to evaluate the study data.Results: There were 7,963 total non-natural deaths of US citizens traveling abroad during the study period. Of these, 163 (2.0 percent) were disasterrelated deaths, involving 19 disaster events in 15 countries. Only two disaster-related events resulted in more than two deaths of US travelers—the 2010 earthquake in Haiti causing 121 fatalities (74.2 percent of disaster deaths), and the 2004 tsunami in Thailand causing 22 fatalities (13.5 percent of disaster deaths).The approximate annual mean death rate for US citizen travelers as a result of disaster events is 0.27 deaths/1 million travelers, compared with 1.4 deaths/1 million residents due to disaster annually within the United States.Conclusions: The risk of disaster-related fatality is low for US citizens traveling abroad. Although disaster- related death among travelers is unpredictable, during a period of almost 10 years, there was only one reported death due to disaster in the five countries most frequently visited by US travelers. Further investigation may identify population-, seasonal-, country-, or location-specific risks from which prevention strategies can be developed.
Evaluation of regional hospitals’ use of children in disaster drills
Authors: Gardner, MD Aaron H. , FitzGerald, PhD Michael R. , Schwartz, MD Hamilton P. , Timm, MD Nathan L.
Published: June 2014

Objective: Describe the prevalence of pediatric casualties in disaster drills by community hospitals and determine if there is an association between the use of pediatric casualties in disaster drills and the proximity of a community hospital to a tertiary children’s hospital.Design: Survey, descriptive study.Setting: Tertiary children’s hospital and surrounding community hospitals.Participants: Hospital emergency management personnel for 30 general community hospitals in the greater Cincinnati, Ohio region.Interventions: NoneMain Outcome Measure(s): The utilization of pediatric casualties in community hospital disaster drills and its relationship to the distance of those hospitals from a tertiary children’s hospital.Results: Sixteen hospitals reported a total of 57 disaster drills representing 1,309 casualties. The overwhelming majority (82 percent [1,077/1,309]) of simulated patients from all locations were 16 years of age or older. Those hospitals closest to the children’s hospital reported the lowest percentage of pediatric patients (10 percent [35/357]) used in their drills.The hospitals furthest from the children’s hospital reported the highest percentage of pediatric patients (32 percent [71/219]) used during disaster drills.Conclusions: The majority of community hospitals do not incorporate children into their disaster drills, and the closer a community hospital is to a tertiary children’s hospital, the less likely it is to include children in its drills. Focused effort and additional resources should be directed toward preparing community hospitals to care for children in the event of a disaster.
Simple, school-based mass distribution as a small-town strategy
Authors: Knauf, RS, MS, MPH David , Phelps, JD, MPH Scot
Published: June 2014

Objective: Test a radically simple school-based point-of-dispensing model.Design: Prospective study.Setting: CommunityParticipants: Community residents with children at one middle school.Interventions: Rapid dispensing of medication.Main Outcome Measure(s): 1) Measure and extrapolate ability to distribute medications to Darien residents through school-based distribution model; 2) assess if using a limited staffing model with limited training was functional. Identify stress points; 3) understand the existing school communication model; 4) track and extrapolate the breakdown of adult-tochild doses distributed and compare to existing census data; and 5) measure throughput of school-based distribution model in the 50-minute drop-off period.Results: 1) This exercise supported the concept that rapid medication distribution through the public schools is an appropriate strategy for health departments, particularly departments with limited resources. 2) Just-in-time briefing worked well as a training strategy. The primary stress points identified were in restock—if medication was in blister packs, we would not be able to stock vests with 100 of each as they are substantially bigger than mints. 3) The secure Darien Public School notification system was ideal for distributing information to parents since they tend to receive school communication on a regular basis and by definition, access is limited to town residents. 4) When asked about household size, most drivers indicated “two adults and two (or more) children.”We distributed medication for 784 adults and 963 children. This ratio was higher than the 2010 Census, which had an average household size of 3.08 in Darien. 5) In 50 minutes, using a mix of Health Department and school staff, medication was distributed to 1,747 residents, almost 10 percent of the population. The hourly throughput from this model was distribution to 2,096 people per hour or 699 people per distributor per hour. This compares favorably to almost every other nonmedical distribution model.Conclusions: Using four Health Department staff and six public school staff, we distributed medication to 784 adults and 963 pediatric residents in 50 minutes at one school. If we extrapolated that across the six other public schools in Darien, we could provide medication to more than 10,000 residents within 8 hours. While we are cognizant of the limitations and drawbacks of this model, we strongly believe that it is the only practical solution to the problem of rapid distribution of medication to the entire community.
Community health facility preparedness for a cholera surge in Haiti
Authors: Mobula, MD, MPH Linda Meta , Jacquet, MD, MPH Gabrielle A. , Weinhauer, MSN, MPH Kristin , Alcidas, RN, MPH Gladys , Thomas, MD, MPH Hans-Muller , Burnham, MD, PhD Gilbert
Published: June 2014

With increasing population displacement and worsening water insecurity after the 2010 earthquake, Haiti experienced a large cholera outbreak. Our goal was to evaluate the strengths and weaknesses of seven community health facilities’ ability to respond to a surge in cholera cases.Since 2010, Catholic Relief Services (CRS) with a number of public and private donors has been working with seven health facilities in an effort to reduce morbidity and mortality from cholera infection. In November 2012, CRS through the Centers for Disease Control and Prevention (CDC)’s support, asked the Johns Hopkins Center for Refugee and Disaster Response to conduct a cholera surge simulation tabletop exercise at these health facilities to improve each facility’s response in the event of a cholera surge. Using simulation development guidelines from the Pan American Health Organization and others, a simulation scenario script was produced that included situations of differing severity, supply chain, as well as a surge of patients.A total of 119 hospital staff from seven sites participated in the simulation exercise including community health workers, clinicians, managers, pharmacists, cleaners, and security guards. Clinics that had challenges during the simulated clinical care of patients were those that did not appropriately treat all cholera patients according to protocol, particularly those that were vulnerable, those that would need additional staff to properly treat patients during a surge of cholera, and those that required a better inventory of supplies.Simulation-based activities have the potential to identify healthcare delivery system vulnerabilities that are amenable to intervention prior to a cholera surge.
First responder and physician liability during an emergency
Authors: Eddy, BA Amanda
Published: June 2014

First responders, especially emergency medical technicians and paramedics, along with physicians, will be expected to render care during a mass casualty event. It is highly likely that these medical first responders and physicians will be rendering care in suboptimal conditions due to the mass casualty event. Furthermore, these individuals are expected to shift their focus from individually based care to community- or population-based care when assisting disaster response. As a result, patients may feel they have not received adequate care and may seek to hold the medical first responder or physician liable, even if they did everything they could given the emergency circumstances. Therefore, it is important to protect medical first responders and physicians rendering care during a mass casualty event so that their efforts are not unnecessarily impeded by concerns about civil liability. In this article, the author looks at the standard of care for medical first responders and physicians and describes the current framework of laws limiting liability for these persons during an emergency.The author concludes that the standard of care and current laws fail to offer adequate liability protection for medical first responders and physicians, especially those in the private sector, and recommends that states adopt clear laws offering liability protection for all medical first responders and physicians who render assistance during a mass casualty event.
The next challenge to interoperability? A first look at robotic system wireless interoperability in emergency response
Authors: Battle, MS Lee P. , Sarkani, PhD Shahram , Mazzuchi, DSc Thomas A.
Published: June 2014

System interoperability enables public safety agencies to communicate and share information. Past failures have demonstrated that systems of different agencies are not inherently interoperable. Therefore, as efforts continue toward the resolutions of these problems, it is incumbent on technology developers to assess the interoperability of new systems. Robotic systems can offer new capabilities to public safety personnel; however, these systems also include new communication technology to share and distribute information. Research has been initiated to examine the interoperability of public safety robotic systems. Definitions for robotic communication interoperability types are introduced.
Using a simulation cell for exercise realism
Authors: Lerner, JD Ken
Published: June 2014

A simulation cell or SimCell is an effective and flexible tool for control of emergency management exercises. It allows exercise participants to interact, via simulation, with a wide variety of nonplaying organizations and officials. Adapted from military application, the Chemical Stockpile Emergency Preparedness Program (CSEPP) applied, developed, and refined the SimCell concept for emergency management exercises. It has now been incorporated into national exercise guidance through the Homeland Security Exercise and Evaluation Program, and has been used in a wide variety of national, regional, and local exercises. This article reviews development of the SimCell concept in CSEPP, briefly surveys current practice incorporating SimCells in exercise control, and offers practical lessons-learned and tips on using a SimCell to best advantage. Lessons learned include using a SimCell as an exercise-control hub; preparing inject material for exercise controllers as part of the Master Scenario Event List; laying the groundwork for success through exercise player and controller training; developing protocol for SimCell communications; and capturing feedback from SimCell controllers for inclusion in the exercise evaluation reporting process. The SimCell concept is flexible and can be applied to a variety of exercise types and through a variety of methods.
Emergency managers as community change agents: An expanded vision of the profession
Authors: Drabek, PhD Thomas E.
Published: June 2014

Reflecting the historical evolution of attack preparedness, technological failures, and so-called natural disaster events, the profession of emergency management confronts new challenges today. In part, these reflect important cultural differences among stakeholder groups, especially local emergency managers, homeland security personnel, and those focused on public health threats and business continuity. An expanded and more strategic vision of the profession is required wherein fundamental assumption sets are placed into broader contexts. Contrary to the drift experienced in the US during the past decade, a major paradigm shift is required reflecting new orientations and program priorities.
Professional responsibilities versus familial responsibilities: An examination of role conflict among first responders during the Hurricane Katrina disaster
Authors: Adams, PhD Terri , Turner, MA Mila
Published: June 2014

In the event of a human-caused or natural disaster, the police are essential front-line first responders. The ability of police departments to provide adequate services is contingent upon critical response personnel working and functioning in an efficient manner. Currently, it is assumed that first responders will continue to work in the event of a disaster, even if they are personally impacted by the disaster to which they are expected to respond. This study examines role conflict among police officers who served as first responders during the Hurricane Katrina disaster.
Poor Sleep Quality is Associated with Decreased Emotional Arousal in Healthy Girls
Authors: Alfano Candice A. , Reddy Radhika , Reynolds Katharine C. , Pane Heather , Reuter Tyson , Sharp Carla
Published: June 2014

A growing number of studies in adults document critical relationships between sleep and emotional processing based on responses to affective images from the International Affective Picture System (IAPS; Lang, Bradley, & Cuthbert, 2005). Our aim was to extend examination of the interrelationships between sleep and emotional processing to a sample of healthy girls, ages 10 to 16 years. A total of 86 girls (M = 12.88 years, SD = 1.92) without psychiatric disorders were recruited. In addition to structured diagnostic interviews, report of sleep quality was examined in relation to valence and arousal ratings of pleasant, neutral and unpleasant IAPS images. Overall, picture ratings were consistent with findings from previous research showing pleasant images to produce high arousal and valence ratings in childhood and that these relationships decrease with age. Regression models revealed poor sleep quality to be associated with decreased subjective arousal in response to negative/unpleasant images, but not pleasant or neutral images. Findings are discussed in terms of a need for more research aimed at better elucidating how sleep quality during the childhood years relates to the processing of emotional information.
Evaluating the ocean biogeochemical components of earth system models using atmospheric potential oxygen (APO) and ocean color data
Authors: Nevison C. D. , Manizza M. , Keeling R. F. , Kahru M. , Bopp L. , Dunne J. , Tjiputra J. , Mitchell B. G.
Published: June 2014

Abstract. The observed seasonal cycles in atmospheric potential oxygen (APO) at a range of mid to high latitude surface monitoring sites are compared to those inferred from the output of 6 Earth System Models participating in the fifth phase of the Coupled Model Intercomparison Project (CMIP5). The simulated air–sea O2 fluxes are translated into APO seasonal cycles using a matrix method that takes into account atmospheric transport model (ATM) uncertainty among 13 different ATMs. Half of the ocean biogeochemistry models tested are able to reproduce the observed APO cycles at most sites, to within the current large ATM uncertainty, while the other half generally are not. Net Primary Production (NPP) and net community production (NCP), as estimated from satellite ocean color data, provide additional constraints, albeit more with respect to the seasonal phasing of ocean model productivity than the overall magnitude. The present analysis suggests that, of the tested ocean biogeochemistry models, CESM and GFDL ESM2M are best able to capture the observed APO seasonal cycle at both Northern and Southern Hemisphere sites. In the northern oceans, the comparison to observed APO suggests that most models tend to underestimate NPP or deep ventilation or both.
New Pliocene localities with micromammals from the Czech Republic: a preliminary report
Authors: Čermák S. , Wagner J. , Fejfar O. , Horáček I.
Published: June 2014

The first well defined Pliocene mammalian faunas in the Czech Republic – found at localities Měňany 3 and Vitošov – are reported herein. Pilot samples from the localities have yielded an assemblage of at least 23 taxa of small mammals (Lipotyphla, Chiroptera, Lagomorpha, and Rodentia). The key taxa Mimomys hassiacus, M. cf. gracilis (an advanced form), Baranomys, and Germanomys in the assemblage suggest age of the fauna is Pliocene, possibly near the Ruscinian – Villanyian (MN15b – MN16a) boundary.

 Die ersten gut definierten Säugetierfaunen des Pliozäns – aus Měňany 3 und Vitošov – werden hier zum erstenmal untersucht. Die ersten Proben lieferten eine Fauna von 23 Säugetiertaxa der Ordnungen Lipotyphla, Chiroptera, Lagomorpha und Rodentia. Die biochronologisch wichtigen Formen Mimomys hassiacus, M. cf. gracilis (eine fortschrittliche Form), Baranomys und Germanomys unterstützen die Alterseinstufung der Fauna an der Grenze des Ruscinium – Villanyium (MN15b – MN16a).

 doi:10.1002/mmng.200600019
Limb swinging in elephants and giraffes and implications for the reconstruction of limb movements and speed estimates in large dinosaurs
Authors: Christian A. , Müller R. H. G. , Christian G. , Preuschoft H.
Published: June 2014

Speeds of walking dinosaurs that left fossil trackways have been estimated using the stride length times natural pendulum frequency of the limbs. In a detailed analysis of limb movements in walking Asian elephants and giraffes, however, distinct differences between actual limb movements and the predicted limb movements using only gravity as driving force were observed. Additionally, stride frequency was highly variable. Swing time was fairly constant, but especially at high walking speeds, much shorter than half the natural pendulum period. An analysis of hip and shoulder movements during walking showed that limb swinging was influenced by accelerations of hip and shoulder joints especially at high walking speeds. These results suggest an economical fast walking mechanism that could have been utilised by large dinosaurs to increase maximum speeds of locomotion. These findings throw new light on the dynamics of large vertebrates and can be used to improve speed estimates in large dinosaurs.

 Geschwindigkeiten gehender Dinosaurier, die fossile Fährten hinterlassen haben, wurden als Produkt aus Schrittlänge und natürlicher Pendelfrequenz der Beine abgeschätzt. Eine detaillierte Analyse der Beinbewegungen von gehenden Asiatischen Elefanten und Giraffen offenbarte allerdings klare Unterschiede zwischen den tatsächlichen Extremitätenbewegungen und den Bewegungen, die zu erwarten wären, wenn die Gravitation die einzige treibende Kraft darstellte. Zudem erwies sich die Schrittfrequenz als hochgradig variabel. Die Schwingzeit der Gliedmaßen war recht konstant, aber besonders bei hohen Gehgeschwindigkeiten viel kürzer als die halbe natürliche Pendelperiode der Extremitäten. Eine Analyse der Bewegungen der Hüft- und Schultergelenke während des Gehens zeigte, daß das Schwingen der Gliedmaßen durch Beschleunigungen dieser Gelenke beeinflußt wurde, insbesondere bei hohen Gehgeschwindigkeiten. Die Resultate legen einen ökonomischen Mechanismus für schnelles Gehen nahe, der von großen Dinosauriern zur Erhöhung der Höchstgeschwindigkeiten eingesetzt worden sein könnte. Die Ergebnisse werfen neues Licht auf die Dynamik großer Wirbeltiere. Sie können zu Verbesserungen in den Schätzungen der Fortbewegungsgeschwindigkeiten großer Dinosaurier eingesetzt werden.

 doi:10.1002/mmng.1999.4860020105
Gymnosperms from the Early Cretaceous Crato Formation (Brazil). II. Cheirolepidiaceae
Authors: Kunzmann L. , Mohr B. A. R. , Bernardes-de-Oliveira M. E. C. , Wilde V.
Published: June 2014

Conifers are common in the Early Cretaceous Crato flora. Sterile foliage shoots of several morphotypes occur. Good preservation of several of these specimens allows detailed morphological and anatomical studies. Based on these characters, two taxa of Cheirolepidiaceae, Tomaxellia biforme and Frenelopsis sp., are identified. The palaeogeographic distribution of the genus Tomaxellia currently extends from southern South America northwards to the palaeoequatorial region. The morphological and anatomical characters of both taxa might be interpreted as adaptations to a warm and temporarily dry palaeoclimate, however their habitat can not be reconstructed yet, due to scarcity of the remains.

 Koniferen stellen eine wesentliche Komponente der unterkretazischen Crato-Flora dar. Es kommen sterile beblätterte Zweige verschiedener Morphotypen vor. Die gute Erhaltung einiger dieser Fossilreste lässt detaillierte morphologisch-anatomische Untersuchungen zu. Auf der Basis solcher Merkmale wurden zwei Taxa der Cheirolepidiaceae, Tomaxellia biforme und Frenelopsis sp., identifiziert. Das Areal der Gattung Tomaxellia wird damit vom südlichen Südamerika nordwärts, in die paläoäquatoriale Region erweitert. Morphologische und anatomische Merkmale beider Taxa können als Anpassungserscheinungen an ein warmes und periodisch trockenes Paläoklima interpretiert werden. Auf Grund des seltenen Vorkommens solcher Fossilreste können noch keine Angaben zu ihrem ehemaligen Habitat gemacht werden.

 doi:10.1002/mmng.200600009
Quantifying mass balance processes on the Southern Patagonia Icefield
Authors: Schaefer M. , Machguth H. , Falvey M. , Casassa G. , Rignot E.
Published: June 2014

Abstract. We present surface mass balance simulations of the Southern Patagonia Icefield driven by downscaled reanalysis data. The simulations were validated and interpreted using geodetic mass balances, measured point balances and a complete velocity field of the Icefield from spring 2004. The high measured accumulation of snow as well as the high measured ablation is reproduced by the model. The overall modeled surface mass balance was positive and increasing during 1975–2011. Subtracting the surface mass balance from geodetic balances, calving fluxes were inferred. Mass losses of the SPI due to calving were strongly increasing from 1975–2000 to 2000–2011 and higher than losses due to surface melt. Calving fluxes were inferred for the individual glacier catchments and compared to fluxes estimated from velocity data. Measurements of ice thickness and flow velocities at the glaciers' front and spatially distributed accumulation measurements can help to reduce the uncertainties of the different terms in the mass balance of the Southern Patagonia Icefield.