bluuebunny/crossref_metadata_2025 huggingface dataset:
Knowledge of Severe Acute Respiratory Syndrome among Community Physicians, Nurses, and Emergency Medical Responders
Authors: Tice Alan Douglas , Kishimoto Mitsumasa , Dinh Chuong Hoang , Tak-Kin Lam Geoffrey , Marineau Michelle
Published: August 2016

Introduction:

The preparedness levels of front-line clinicians including physicians, nurses, emergency medical responders (EMRs), and other medical staff working in clinics, offices and ambulatory care centers must be assessed, so these personnel are able to deal with communicable and potentially lethal diseases, such as severe acute respiratory syndrome (SARS). In order to determine the knowledge of these clinicians, a survey of their understanding of SARS and their use of educational resources was administered.

Methods:

A questionnaire was distributed to physicians, nurses, and EMRs attending conferences on SARS in the summer of 2003. Questions related to information sources, knowledge of SARS, and plans implemented in their workplace to deal with it. Statistical analysis was performed using the Statistical Package for the Social Sciences (10.1 Program, SPSS Inc., Chicago, Illinois).

Results:

A total of 201 community healthcare providers (HCPs) participated in the study. A total of 51% of the participants correctly identified the incubation period of SARS; 48% correctly identified the symptoms of SARS; and 60% knew the recommended infection control precautions to take for families. There was little difference in knowledge among the physicians, nurses, and EMRs evaluated. Media outlets such as newspapers, journals, television, and radio were reported as the main sources of information on SARS. However, there appears to be a growing use of the Internet, which correlated best with the correct answers on symptoms of SARS. Fewer than one-third of respondents were aware of a protocol for SARS in their workplace. A total of 60% reported that N-95 masks were available in their workplace.

Conclusion:

These findings suggest the need for more effective means of education and training for front-line clinicians, as well as the institution of policies and procedures in medical offices, clinics, and emergency services in the community.
Pattern of Drug Prescription and Utilization among Bam Residents during the First Six Months after the 2003 Bam Earthquake
Authors: Sepehri Gholamreza , Meimandi Manzumeh-Shamsi
Published: August 2016

Introduction:

It is important to identify what kinds of drugs are required by disaster-affected populations so that appropriate donations are allocated. On 26 December 2003, an earthquake with an amplitude of 6.3 on the Richter scale struck southeastern Iran, decimating the city of Bam. In this study, the most frequently utilized and prescribed drugs for Bam outpatients during the first six months after the Bam Earthquake were investigated.

Methods:

In this descriptive, cross-sectional study, the data were collected randomly from 3,000 prescriptions of Bam outpatients who were examined by general practitioners from Emergency Medical Assistance Teams in 12 healthcare centers during the first six months after the Bam Earthquake. The data were analyzed for: (1) patient sex; (2) number of drugs/prescriptions; (3) drug category; (4) drug name (generic or brand); (5) route of administration; (6) percent of visits where the most frequent drug categories were prescribed; and (7) the 25 most frequently prescribed drugs, using World Health Organization (WHO) indicators of drug use in health facilities.

Results:

Male patients represented 47.4% and females 52.6% of the total number of outpatients. The mean number of drugs/prescriptions was 3.5 per outpatient. Oral administration was the most frequent method of administration (81.7%), followed by injections (10.9%). Respiratory drugs were the most frequently used drugs (14.2%), followed by analgesics/non-steroidal anti-inflammatory drugs (non-steroidal anti-inflammatory drugs) (11.3%), antibacterials (11.2%), gastroinestinal (GI) drugs (9.6%), and central nervous system drugs (7%). Penicillins (6.8%), cold preparations (8%), and systemic anti-acids (ranitidine and omeprazole) were among the 25 most frequently used drugs by outpatients and inhabitants of Bam during the first six months after the Bam Earthquake.

Conclusion:

Respiratory, analgesic, antibacterial, gastrointestinal, and psychiatric medications were among the most commonly prescribed pharmaceuticals after the catastrophic Bam Earthquake.The results of this study may help to predict the needs of patients during future disasters and prevent unnecessary donations of medicine.
The 2003 Bam Earthquake: Overview of First Aid and Transport of Victims
Authors: Mirhashemi Sedighe , Ghanjal Ali , Mohebbi Hassan Ali , Moharamzad Yashar
Published: August 2016

Introduction:

In December 2003, the residents of Bam, Iran experienced an earthquake that measured 6.6 on the Richter scale and destroyed more than 90% of the city.

Problem:

The purpose of this study was to assess the status of the rescue, evacuation, and transportation of the casualties during the early stages following the earthquake.

Methods:

A cross-sectional study of 185 casualties who were transferred to and hospitalized in the university hospital during the first week period following the earthquake was conducted. Information regarding different places of settlement after being removed from the rubble, initial medical care, and the means of transportation was obtained by reviewing medical records and interviewing the victims.

Results:

The mean value of the duration of times taken for the first rescuers to reach the scene and remove the casualties from the rubble was 1.7 ±2.7 and 0.9 ±1.1 hours, respectively. Sixty-nine (37.7%) of the patients stayed within the area immediately surrounding their home for average times of 8 ±10 hours. The majority of casualties (57.6%) were transferred manually to a first place of settlement; 45.8% were taken to a second place of settlement using blankets. Of the patients studied, 159 (85.9%) did not receive any basic medical care at the first place and intravenous fluid therapy was the most common treatment provided for 24 (13%) patients at the second place of settlement. Patients received medical care at the first place of settlement for a mean time of 16.8 ±13.5 hours after escaping the rubble.

Conclusions:

These findings indicate that the emergency medical service system in Bam was destroyed and not able to respond adequately. In order to reduce the negative effects of such disasters in the future, there is an essential need for a comprehensive disaster management plan and improvement of hospital structures, healthcare facilities, and communication between the different governmental departments for better coordination and planning.
Integrated Plan to Augment Surge Capacity
Authors: Dayton Christopher , Ibrahim Jamil , Augenbraun Michael , Brooks Steven , Mody Kiaran , Holford Donald , Roblin Patricia , Arquilla Bonnie
Published: August 2016

Introduction:

Surge capacity is defined as a healthcare system's ability to rapidly expand beyond normal services to meet the increased demand for appropriate space, qualified personnel, medical care, and public health in the event of bioterrorism, disaster, or other large-scale, public health emergencies. There are many individuals and agencies, including policy makers, planners, administrators, and staff at the federal, state, and local level, involved in the process of planning for and executing policy in respect to a surge in the medical requirements of a population. They are responsible to ensure there is sufficient surge capacity within their own jurisdiction.

Problem:

The [US] federal government has required New York State to create a system of hospital bed surge capacity that provides for 500 adult and pediatric patients per 1 million population, which has been estimated to be an increase of 15–20% in bed availability. In response, the New York City Department of Health and Mental Hygiene (NYC DOH) has requested that area hospitals take an inventory of available beds and set a goal to provide for a 20% surge capacity to be available during a mass-casualty event or other conditions calling for increased inpatient bed availability.

Methods:

In 2003, under the auspices of the NYC DOH, the New York Institute of All Hazard Preparedness (NYIHP) was formed from four unaffiliated, healthcare facilities in Central Brooklyn to address this and other goals.

Results:

The NYIHP hospitals have developed a surge capacity plan to provide necessary space and utilities. As these plans have been applied, a bed surge capacity of approximately 25% was identified and created for Central Brooklyn to provide for the increased demand on the medical care system that may accompany a disaster. Through the process of developing an integrated plan that would engage a public health incident, the facilities of NYIHP demonstrate that a model of cooperation may be applied to an inherently fractioned medical system.
Accuracy of Computer Simulation to Predict Patient Flow during Mass-Casualty Incidents
Authors: Franc-Law Jeffrey M. , Bullard Micheal J. , Corte F. Della
Published: August 2016

Introduction:

Although most hospitals have an emergency department disas- ter plan, most never have been implemented in a true disaster or been tested objectively. Computer simulation may be a useful tool to predict emergency department patient flow during a disaster.

Purpose:

The aim of this study was to compare the accuracy of a computer simulation in predicting emergency department patient flow during a masscasualty incident with that of a real-time, virtual, live exercise.

Methods:

History, physical examination findings, and laboratory results for 136 simulated patients were extracted from the disastermed.ca patient database as used as input into a computer simulation designed to represent the emergency department at the University of Alberta Hospital.The computer simulation was developed using a commercially available simulation software platform (2005, SimProcess, CACI Products, San Diego CA). Patient flow parameters were compared to a previous virtual, live exercise using the same data set.

Results:

Although results between the computer simulation and the live exercise appear similar, they differ statistically with respect to many patient benchmarks. There was a marked difference between the triage codes assigned during the live exercise and those from the patient database; however, this alone did not account for the differences between the patient groups. It is likely that novel approaches to patient care developed by the live exercise group, which are difficult to model by computer software, contributed to differences between the groups. Computer simulation was useful, however, in predicting how small changes to emergency department structure, such as adding staff or patient care areas, can influence patient flow.

Conclusions:

Computer simulation is helpful in defining the effects of changes to a hospital disaster plan. However, it cannot fully replace participant exercises. Rather, computer simulation and live exercises are complementary, and both may be useful for disaster plan evaluation.
Injury Patterns and Levels of Care at a Marathon
Authors: Nguyen Richard B. , Milsten Andrew M. , Cushman Jeremy T.
Published: August 2016

Introduction:

Marathons pose many challenges to event planners. The medical services needed at such events have not received extensive coverage in the literature.

Objective:

The objective of this study was to document injury patterns and medical usage at a category III mass gathering (a marathon), with the goal of helping event planners organize medical resources for large public gatherings.

Methods:

Prospectively obtained medical care reports from the five first-aid stations set up along the marathon route were reviewed. Primary and secondary reasons for seeking medical care were categorized. Weather data were obtained, and ambient temperature was recorded.

Results:

The numbers of finishers were as follows: 4,837 in the marathon (3,099 males, 1,738 females), 814 in the 5K race (362 males, 452 females), and 393 teams in the four-person relay (1,572). Two hundred fifty-one runners sought medical care. The day's temperatures ranged from 39 to 73°F (mean, 56°F). The primary reasons for seeking medical were medication request (26%), musculoskeletal injuries (18%), dehydration (14%), and dermal injuries (11%). Secondary reasons were musculoskeletal injuries (34%), dizziness (19%), dermal injuries (11%), and headaches (9%). Treatment times ranged from 3 to 25.5 minutes and lengthened as the day progressed. Two-thirds of those who sought medical care did so at the end of the race. The majority of runners who sought medical attention had not run a marathon before.

Conclusions:

Marathon planners should allocate medical resources in favor of the halfway point and the final first-aid station. Resources and medical staff should be moved from the earlier tents to further augment the later first-aid stations before the majority of racers reach the middle- and later-distance stations.
Medical Society's Blueprint for a Successful Community Response to Emergency Preparedness
Authors: Maese John
Published: August 2016

It is clear from disaster evaluations that communities must be prepared to act independently before government agencies can cope with the early ramifications of disasters. In response to devastation to the borough of Staten Island, New York in the wake of 11 September 2001, the Richmond County Medical Society established a structure to incorporate community needs and institutions to work together for the common good. A program that brings together two hospital systems, nursing homes, emergency medical services, and the Office of Emergency Management physician leadership in a meaningful way now is in place. This approach has improved the disaster preparedness of Staten Island and demonstrated how the Medical Society can provide leadership in disaster preparedness and serve as a conduit for communication amongst entities that normally do not communicate.
Antimicrobial Therapy for Water-Associated Wound Infections in a Disaster Setting: Gram-Negative Bacilli in an Aquatic Environment and Lessons from Banda Aceh
Authors: Okumura Junko , Kai Tatsurou , Hayati Zinatul , Karmil Fadrial , Kimura Kazuko , Yamamoto Yasuhiro
Published: August 2016

Introduction:

As members of the Japan Disaster Relief (JDR) team in Banda Aceh, three of the authors treated 1,891 patients following the tsunami of 2004. Of the 367 cases with traumatic injuries, 216 cases required antimicrobial therapy. The medical services were continued by the Japan Self-Defense (JSD) Medical Team until mid-March 2005. Of the 216 cases initially treated by JDR, 54 required prolonged antimicrobial therapy for persistent symptoms despite repeated debridement.The aim of this study is to recommend an appropriate antimicrobial therapy for water-associated wound infections in the absence of laboratory services in disaster settings following tsunami.

Methods:

The JDR and JSD treatment records were analyzed retrospectively. In August 2006, 19 months after the tsunami, the authors investigated pathogens in natural aquatic habitats in the affected area in Banda Aceh. At the same time, interviews with tsunami survivors were performed to determine the influential factors that facilitated wound infections after the tsunami.

Results:

From the 49 water samples tested,Aeromonas sp.,Vibrio sp.,Klebsiella sp., andProteus sp.were isolated from 24, 16, 15, and six samples, respectively. Regardless of the genus, almost all of the isolated gram-negative bacilli were sensitive to ciprofloxacin and gentamicin.

Conclusions:

From the microbiological test results and analyses of the medical records and interviews, the researchers recommend the following regimen when clinical microbiological tests are not available: initial treatment with beta-lactam penicillins for three days, followed, if the first antimicrobial is not effective, by ciprofloxacin or any other relevant new quinolones, with the addition of gentamicin if necessary.
Mass-Casualty Triage Training for International Healthcare Workers in the Asia-Pacific Region Using Manikin-Based Simulations
Authors: Vincent Dale S. , Berg Benjamin W. , Ikegami Keiichi
Published: August 2016

Introduction:

More than half of the world's disasters occur in the Asia-Pacific region. A simulation-based exercise to teach healthcare workers prehospital triage, tagging, and treatment methods was used to link disaster management theory to practice with a student-centered, hands-on educational activity. Various strategies for teaching disaster health education have been advocated, and best-practice disaster education models continue to be sought.

Methods:

A manikin-based, primary triage and treatment course was adapted for international healthcare providers in the Asia-Pacific region using symbolic representations of triage categories and physical findings. The pedagogical construct that was used was an interactive, formative assessment in which faculty members mediated learner information gathering and interpretation during four simulation scenarios. After establishing a multi-casualty disaster context, a wireless, audience response system anonymously collected learner responses to four clinical situations: (1) leg wound (hemorrhagic shock/immediate); (2) chest wound (tension pneumothorax/immediate); (3) head wound (traumatic brain injury/expectant); and (4) limb trauma (leg fracture/delayed).

Results:

There were 182 healthcare providers from eight Asia-Pacific countries (including the US) that participated in four simulation seminars. The simulation sessions were successfully tailored to groups of learners that varied in size and professional composition.Expectant and delayed triage categories posed the greatest challenge to learners. In one of two groups that were queried, learner self-confidence in applying principles of triage and treatment improved significantly. At the conclusion of the simulation sessions, learners strongly agreed that manikin-based simulation improved their understanding of triage, and should be used to teach principles of primary triage and treatment.

Conclusions:

Simulation training represents an opportunity to engage learners regardless of language and cultural barriers. Simulation-based training can be effective in introducing healthcare professionals to principles of primary triage and treatment in an effective and culturally sensitive manner.The characteristics of the course with respect to planned formative assessment and culturally competent scholarship were reviewed.
Single-Breath-Count Test: An Important Adjunct in the Triaging of Patients in a Mass-Casualty Incident Due to Botulism
Authors: Rega Paul P. , Bork Christopher E. , Burkholder-Allen Kelly , Bisesi Michael S. , Gold Jeffrey P.
Published: August 2016

Clostridium botulinum toxins, the most poisonous substance known to humankind, are considered to be a [US] Centers for Disease Control and Prevention Category A bioterrorist agent. Despite this concern, little has been published with regard to the tactical aspects of triaging a mass-casualty event involving botulism victims arriving at an emergency department. Because neuromuscular-ventilatory failure is a principal reason for botulism's early morbidity and mortality, using a quick and sensitive test to evaluate this possibility is imperative. The purpose of this article is to propose the adoption of the Single-Breath-Count Test (SBCT). The ease and validity of the use of the SBCT in evaluating complications associated with various neuromuscular disorders make it an attractive adjunct for triage during a mass-casualty incident due to botulism. While education, immune globulin, antitoxin, and invasive airway techniques are well-recognized steps in treating botulism, incorporating a time-honored technique such as the SBCT, will be an important addition to the triage process.
-PLUS Prehospital Mass-Casualty Triage: A Strategy for Addressing Unusual Injury Mechanisms
Authors: Neal Daniel J. , Barbera Joseph A. , Harrald John R.
Published: August 2016

Introduction:

Simple Triage and Rapid Treatment (START) and more recently developed prehospital casualty triage algorithms are widely used, in part because they are easy to teach and learn, and can be performed rapidly. Every rapid triage protocol has inherent, significant limitations: (1) no mechanism of injury (MOI) considerations; (2) limited assessment points; and (3) no refinement in truly mass-casualty situations where transport of “minor” or “moderate” patients may be delayed.

Hypothesis:

When rapid initial triage protocols are utilized, a significant triage deficiency (“under-triage”) may occur when “minor” or “moderate” casualties actually are more severely injured than initially triaged. Some MOI produce casualties with subtle or latent (i.e., hidden or delayed) signs and symptoms not considered in the commonly used prehospital triage algorithms. This research did not focus on START or other initial triage screening methods. Instead, it focuses on developing follow-on triage guidance to more specifically prioritize “delayed transport” casualties based upon signs and symptoms related to their MOI.

Methods:

Using expert opinion and accepted clinical criteria, triage algorithms were developed to re-evaluate patients triaged to “minor” and “moderate” cohorts. A detailed literature search produced a draft list of relevant signs and symptoms for each selected MOI. The lists then were evaluated by a multi-disciplinary panel of experts via an anonymous, mail-based Delphi method. The input shaped triage algorithms for each selected MOI, which then were subjected to a second stage Delphi process.

Results:

Consensus was achieved using the Delphi method. The algorithms extend patient assessment beyond the rapid initial triage protocols and incorporate triage criteria specific to each selected injury mechanism or condition: (1) penetrating injuries; (2) unconventional MOI (burns, blast, chemical, radiation); (3) smoke and other inhalation exposure; and (4) injuries with concomitant pregnancy. The full list of triage protocols is designated by the acronym “-PLUS”.

Conclusions:

“-PLUS” Prehospital Casualty Triage may supplement the strengths of already existing, widely accepted mass-casualty triage strategies. It does not displace START or other rapid initial triage protocols, but in mass-casualty situations with extensive delays in transport, it provides a method to identify under-triage of seriously injured casualties. “-PLUS” also presents a framework for capturing the triage considerations used by experienced medical providers, and so may provide a valuable teaching tool for training future triage professionals. Further research and field assessment is required.
Triage Performance of First-Year Medical Students Using a Multiple-Casualty Scenario, Paper Exercise
Authors: Sapp Robert F. , Brice Jane H. , Myers J. Brent , Hinchey Paul
Published: August 2016

Introduction:

Large-scale events may overwhelm the capacity of even the most advanced emergency medical systems. When patient volume outweighs the number of available emergency medical services (EMS) providers, a mass-casualty incident may require the aid of non-medical volunteers. These individuals may be utilized to perform field disaster triage, lessening the burden on EMS personnel.

Objective:

The purpose of this study was to evaluate the accuracy of triage decisions made by newly enrolled first-year medical students after receiving a brief educational intervention.

Methods:

A total of 315 first-year medical students from two successive classes participated in START triage training and completed a paper-based triage exercise as part of orientation. This questionnaire consisted of 15 clinical scenarios providing brief but sufficient details for prioritization. Subjects assigned each scenario a triage category of Red, Yellow, Green, or Black, based on the START protocol and were allowed four minutes to complete the exercise. Participants from the Class of 2009 were provided with printed START reference cards, while those from the Class of 2008 were not. Two test types varying in the order of patient age values were created to determine whether patient age was a factor in triage assessment.

Results:

The mean accuracy score of triage assignment by medical student volunteers after a brief START training session was 64.3%. The overall rate of over-triage was 17.8%, compared to an under-triage rate of 12.6%. There were no significant differences in triage accuracy between subjects with and without printed materials (63.9% vs. 64.6%,p= 0.729) or those completing the age-variant test types (64.4% vs. 64.1%,p= 0.889).

Conclusions:

First-year medical students who received brief START training achieved triage accuracy scores similar to those of emergency physicians, registered nurses, and paramedics in previous studies. Observed rates of underand over-triage suggest that a need exists for improving the accuracy of triage decisions made by medical and non-medical personnel. This study did not find that printed materials significantly improved triage accuracy, nor did it find that patient age affected the ability of participants to correctly assign triage categories. Future research might further evaluate disaster triage by non-medical volunteers.
Utilization of Warning Lights and Siren Based on Hospital Time-Critical Interventions
Authors: Marques-Baptista Andreia , Ohman-Strickland Pamela , Baldino Kimberly T. , Prasto Michael , Merlin Mark A.
Published: August 2016

Objective:

The objective of this study was to evaluate the time saved by usage of lights and siren (L&S) during emergency medical transport and measure the total number of time-critical hospital interventions gained by this time difference.

Methods:

A retrospective study was performed of all advanced life support (ALS) transports using lights and siren to this university emergency department during a three-week period. Consecutive times were measured for 112 transports and compared with measured transport times for a personal vehicle traveling the same day of the week and time of day without lights and siren. The time-critical hospital interventions are defined as procedures or treatments that could not be performed in the prehospital setting requiring a physician. The project assessed whether the patients received the hospital interventions within the average time saved using lights and siren transport.

Results:

The average difference in time with versus without L&S was -2.62 minutes (95% CI: -2.60− -2.63, paired t-test p <0.0001). The average transport time with L&S was 14.5 ±7.9 minutes (min) (1 standard deviation/minute (min), range = 1–36 min.). The average transport time without L&S was 17.1 ±8.3 min (range = 1−40 min). Of the 112 charts evaluated, five patients (4.5%) received time-critical hospital interventions. No patients received time-critical interventions within the time saved by utilizing lights and siren. Longer distances did not result in time saved with lights and siren.

Conclusions:

Limiting lights and siren use to the patients requiring hospital interventions will decrease the risks of injury and death, while adding the benefit of time saved in these critical patients.
Comparative Analysis of Showering Protocols for Mass-Casualty Decontamination
Authors: Amlôt Richard , Larner Joanne , Matar Hazem , Jones David. R. , Carter Holly , Turner Elizabeth A. , Price Shirley C. , Chilcott Robert P.
Published: August 2016

A well-established provision for mass-casualty decontamination that incorporates the use of mobile showering units has been developed in the UK. The effectiveness of such decontamination procedures will be critical in minimizing or preventing the contamination of emergency responders and hospital infrastructure. The purpose of this study was to evaluate three empirical strategies designed to optimize existing decontamination procedures: (1) instructions in the form of a pictorial aid prior to decontamination; (2) provision of a washcloth within the showering facility; and (3) an extended showering period. The study was a three-factor, between-participants (or “independent”) design with 90 volunteers. The three factors each had two levels: use of washcloths (washcloth/no washcloth), washing instructions (instructions/no instructions), and shower cycle duration (three minutes/six minutes). The effectiveness of these strategies was quantified by whole-body fluorescence imaging following application of a red fluorophore to multiple, discrete areas of the skin. All five showering procedures were relatively effective in removing the fluorophore “contaminant”, but the use of a cloth (in the absence of instructions) led to a significant (∼20%) improvement in the effectiveness of decontamination over the standard protocol (p <0.05). Current mass-casualty decontamination effectiveness, especially in children, can be optimized by the provision of a washcloth. This simple but effective approach indicates the value of performing controlled volunteer trials for optimizing existing decontamination procedures.
QuikClot Combat Gauze Use for Hemorrhage Control in Military Trauma: January 2009 Israel Defense Force Experience in the Gaza Strip—A Preliminary Report of 14 Cases
Authors: Ran Yuval , Hadad Eran , Daher Saleh , Ganor Ori , Kohn Jonathan , Yegorov Yana , Bartal Carmi , Ash Nachman , Hirschhorn Gil
Published: August 2016

Background:

Standard gauze field dressings and direct pressure occasionally are inadequate for the control of hemorrhage. QuikClot® Combat Gauze™ (QCG) combines surgical gauze with an inorganic material and is approved by the Food and Drug Administration and by the Israeli Standards Institute for external hemorrhage control. The purpose of this article is to report clinical use of this dressing during Operation Cast Lead in the Gaza strip during January 2009.

Methods:

QuikClot Combat Gauze and the QCG guidelines were issued to advanced life support (ALS) providers during the preparations for the Operation.

All cases of injuries involving hemorrhage were reviewed, as well as interviews with the ALS providers (physicians and paramedics) and injured soldiers.

Results:

Fourteen uses of QCG were reported and reviewed (out of a total of 56 hemostatic interventions in 35 cases). Dressings were applied to injuries to the head, neck, axilla, buttocks, abdomen, back, and pelvis in 10 cases, and to extremities in four cases. In 13 cases (93%), injuries were caused by blast or gunshot mechanisms. The success rate was reported as 79% (11/14). Failure to control hemorrhage was reported in three cases in three different locations: neck, buttock, and thigh. All failures were attributed to severe soft tissue and vascular injuries. No complications or adverse events were reported.

Conclusions:

This report on the clinical field use of the QCG dressing by ALS providers suggests that it is an effective and safe product, and applicable for prehospital treatment of combat casualties. This report further suggests that QCG should be issued to medics as well as ALS providers. Larger clinical investigations are needed to confirm these findings.
Health Impacts of Large-Scale Floods: Governmental Decision-Making and Resilience of the Citizens
Authors: Fundter Dick Q.P. , Jonkman Bas , Beerman Steve , Goemans Corsmas L.P.M. , Briggs Rosanna , Coumans Frits , Lahaye Jan Willem , Bierens Joost
Published: August 2016

During the 15th World Congress on Disaster and Emergency Medicine in Amsterdam, May 2007 (15WCDEM), a targeted agenda program (TAP) about the public health aspects of large-scale floods was organized. The main goal of the TAP was the establishment of an overview of issues that would help governmental decision-makers to develop policies to increase the resilience of the citizens during floods. During the meetings, it became clear that citizens have a natural resistance to evacuations. This results in death due to drowning and injuries. Recently, communication and education programs have been developed that may increase awareness that timely evacuation is important and can be life-saving. After a flood, health problems persist over prolonged periods, including increased death rates during the first year after a flood and a higher incidence of chronic illnesses that last for decades after the flood recedes. Population-based resilience (bottom-up) and governmental responsibility (top-down) must be combined to prepare regions for the health impact of evacuations and floods. More research data are needed to become better informed about the health impact and consequences of translocation of health infrastructures after evacuations. A better understanding of the consequences of floods will support governmental decision-making to mitigate the health impact. A top-10 priority action list was formulated.
Civilian Protection and Humanitarian Assistance—Report of the 2009 Civilian Protection Working Group
Authors: Loane Geoff , Leaning Jennifer , Schomig Sara , Tulleken Alexander van , O'Laughlin Kelli
Published: August 2016

The concept of protecting civilians in armed conflict is enshrined in international humanitarian law and widely acknowledged in humanitarian norms. Making this concept operational in humanitarian service delivery is a challenge. Yet, there are many ways in which humanitarian workers could learn from local people about underlying tensions in their community and with these new insights adjust service delivery accordingly.

The 2009 WG developed a qualitative verbal tool that could be used by humanitarian field staff to assist them in understanding issues of civilian protection from the local perspective. The attributes and uses of this tool are described in detail in this WG report. The fundamental aim of this tool is to enhance the capacity of humanitarian workers in their daily work to observe markers of activity and behavior and to inquire and listen from local people about what these markers might or might not mean. The WG emphasized the needs for confidentiality, focus on service delivery (not legal or advocacy work), and iterative routine integration of information gained into field team deliberations. The proposed tool is offered as a possible pilot step towards improving humanitarian understanding and response to local civilian protection needs.
Deciphering the Bay of Bengal's Tectonic Origins
Authors: Cook Terri
Published: August 2016

New magnetic and gravity data suggest that the boundary between continental and oceanic crust lies beneath northern Bangladesh, along the line of an Early Cretaceous spreading center.
Stratification and therapeutic potential of PML in metastatic breast cancer
Authors: Martín-Martín Natalia , Piva Marco , Urosevic Jelena , Aldaz Paula , Sutherland James D. , Fernández-Ruiz Sonia , Arreal Leire , Torrano Verónica , Cortazar Ana R. , Planet Evarist , Guiu Marc , Radosevic-Robin Nina , Garcia Stephane , Macías Iratxe , Salvador Fernando , Domenici Giacomo , Rueda Oscar M. , Zabala-Letona Amaia , Arruabarrena-Aristorena Amaia , Zúñiga-García Patricia , Caro-Maldonado Alfredo , Valcárcel-Jiménez Lorea , Sánchez-Mosquera Pilar , Varela-Rey Marta , Martínez-Chantar Maria Luz , Anguita Juan , Ibrahim Yasir H. , Scaltriti Maurizio , Lawrie Charles H. , Aransay Ana M. , Iovanna Juan L. , Baselga Jose , Caldas Carlos , Barrio Rosa , Serra Violeta , dM Vivanco Maria , Matheu Ander , Gomis Roger R. , Carracedo Arkaitz
Published: August 2016

Patient stratification has been instrumental for the success of targeted therapies in breast cancer. However, the molecular basis of metastatic breast cancer and its therapeutic vulnerabilities remain poorly understood. Here we show that PML is a novel target in aggressive breast cancer. The acquisition of aggressiveness and metastatic features in breast tumours is accompanied by the elevated PML expression and enhanced sensitivity to its inhibition. Interestingly, we find that STAT3 is responsible, at least in part, for the transcriptional upregulation of PML in breast cancer. Moreover, PML targeting hampers breast cancer initiation and metastatic seeding. Mechanistically, this biological activity relies on the regulation of the stem cell gene SOX9 through interaction of PML with its promoter region. Altogether, we identify a novel pathway sustaining breast cancer aggressiveness that can be therapeutically exploited in combination with PML-based stratification.
The aryl hydrocarbon receptor controls cyclin O to promote epithelial multiciliogenesis
Authors: Villa Matteo , Crotta Stefania , Dingwell Kevin S. , Hirst Elizabeth M. A. , Gialitakis Manolis , Ahlfors Helena , Smith James C. , Stockinger Brigitta , Wack Andreas
Published: August 2016

Epithelia function as barriers against environmental insults and express the transcription factor aryl hydrocarbon receptor (AhR). However, AhR function in these tissues is unknown. Here we show that AhR regulates multiciliogenesis in both murine airway epithelia and in Xenopus laevis epidermis. In air-exposed airway epithelia, induction of factors required for multiciliogenesis, including cyclin O (Ccno) and Multicilin (Mcidas), is AhR dependent, and air exposure induces AhR binding to the Ccno promoter. Submersion and hypoxic conditions impede AhR-dependent Ccno induction. This is mediated by the persistence of Notch signalling, as Notch blockade renders multiciliogenesis and Ccno induction by AhR independent from air exposure. In contrast to Ccno induction, air exposure does not induce the canonical AhR target cytochrome P450 1a1 (Cyp1a1). Inversely, exposure to AhR ligands induces Cyp1a1 but not Ccno and impeded ciliogenesis. These data indicate that AhR involvement in detoxification of environmental pollutants may impede its physiological role, resulting in respiratory pathology.
Assessing the utility of autofluorescence-based pulmonary optical endomicroscopy to predict the malignant potential of solitary pulmonary nodules in humans
Authors: Seth Sohan , Akram Ahsan R. , McCool Paul , Westerfeld Jody , Wilson David , McLaughlin Stephen , Dhaliwal Kevin , Williams Christopher K. I.
Published: August 2016

Solitary pulmonary nodules are common, often incidental findings on chest CT scans. The investigation of pulmonary nodules is time-consuming and often leads to protracted follow-up with ongoing radiological surveillance, however, clinical calculators that assess the risk of the nodule being malignant exist to help in the stratification of patients. Furthermore recent advances in interventional pulmonology include the ability to both navigate to nodules and also to perform autofluorescence endomicroscopy. In this study we assessed the efficacy of incorporating additional information from label-free fibre-based optical endomicrosopy of the nodule on assessing risk of malignancy. Using image analysis and machine learning approaches, we find that this information does not yield any gain in predictive performance in a cohort of patients. Further advances with pulmonary endomicroscopy will require the addition of molecular tracers to improve information from this procedure.
Correction: Corrigendum: The Cipher Code of Simple Sequence Repeats in “Vampire Pathogens”
Authors: Zou Geng , Bello-Orti Bernardo , Aragon Virginia , Tucker Alexander W. , Luo Rui , Ren Pinxing , Bi Dingren , Zhou Rui , Jin Hui
Published: August 2016

Scientific Reports 5: Article number: 12441; published online: 28 July 2015; updated: 23 August 2016 In this Article, there is a typographical error in the Acknowledgments section. “This work was supported by grants from National Natural Science Foundation of China (NSFC, grant no. 31201931), National Basic Research Program (973 Program, grant no.
Erratum: Stiffness of the microenvironment upregulates ERBB2 expression in 3D cultures of MCF10A within the range of mammographic density
Authors: Cheng Qingsu , Bilgin Cemal Cagatay , Fontenay Gerald , Chang Hang , Henderson Matthew , Han Ju , Parvin Bahram
Published: August 2016

Scientific Reports 6: Article number: 28987; published online: 07 July 2016; updated: 24 August 2016 The original version of this Article contained a typographical error in the spelling of the author Gerald Fontenay, which was incorrectly given as Gerald Fonteney. This has now been corrected in the PDF and HTML versions of the Article.
A novel transcription factor-like gene SbSDR1 acts as a molecular switch and confers salt and osmotic endurance to transgenic tobacco
Authors: Singh Vijay Kumar , Mishra Avinash , Haque Intesaful , Jha Bhavanath
Published: August 2016

A salt- and drought-responsive novel geneSbSDR1is predominantly localised to the nucleus, up-regulated under abiotic stresses and is involved in the regulation of metabolic processes.SbSDR1 showed DNA-binding activity to genomic DNA, microarray analysis revealed the upregulation of host stress-responsive genes and the results suggest thatSbSDR1 acts as a transcription factor. Overexpression ofSbSDR1did not affect the growth and yield of transgenic plants in non-stress conditions. Moreover, the overexpression ofSbSDR1stimulates the growth of plants and enhances their physiological status by modulating the physiology and inhibiting the accumulation of reactive oxygen species under salt and osmotic stress. Transgenic plants that overexpressedSbSDR1had a higher relative water content, membrane integrity and concentration of proline and total soluble sugars, whereas they showed less electrolyte leakage and lipid peroxidation than wild type plants under stress conditions. In field conditions,SbSDR1plants recovered from stress-induced injuries and could complete their life cycle. This study suggests thatSbSDR1functions as a molecular switch and contributes to salt and osmotic tolerance at different growth stages. Overall,SbSDR1is a potential candidate to be used for engineering salt and drought tolerance in crops without adverse effects on growth and yield.
Missing gene identification using functional coherence scores
Authors: Chitale Meghana , Khan Ishita K. , Kihara Daisuke
Published: August 2016

Reconstructing metabolic and signaling pathways is an effective way of interpreting a genome sequence. A challenge in a pathway reconstruction is that often genes in a pathway cannot be easily found, reflecting current imperfect information of the target organism. In this work, we developed a new method for finding missing genes, which integrates multiple features, including gene expression, phylogenetic profile and function association scores. Particularly, for considering function association between candidate genes and neighboring proteins to the target missing gene in the network, we used Co-occurrence Association Score (CAS) and PubMed Association Score (PAS), which are designed for capturing functional coherence of proteins. We showed that adding CAS and PAS substantially improve the accuracy of identifying missing genes in the yeast enzyme-enzyme network compared to the cases when only the conventional features, gene expression, phylogenetic profile, were used. Finally, it was also demonstrated that the accuracy improves by considering indirect neighbors to the target enzyme position in the network using a proper network-topology-based weighting scheme.
Single-electron Spin Resonance in a Quadruple Quantum Dot
Authors: Otsuka Tomohiro , Nakajima Takashi , Delbecq Matthieu R. , Amaha Shinichi , Yoneda Jun , Takeda Kenta , Allison Giles , Ito Takumi , Sugawara Retsu , Noiri Akito , Ludwig Arne , Wieck Andreas D. , Tarucha Seigo
Published: August 2016

Electron spins in semiconductor quantum dots are good candidates of quantum bits for quantum information processing. Basic operations of the qubit have been realized in recent years: initialization, manipulation of single spins, two qubit entanglement operations and readout. Now it becomes crucial to demonstrate scalability of this architecture by conducting spin operations on a scaled up system. Here, we demonstrate single-electron spin resonance in a quadruple quantum dot. A few-electron quadruple quantum dot is formed within a magnetic field gradient created by a micro-magnet. We oscillate the wave functions of the electrons in the quantum dots by applying microwave voltages and this induces electron spin resonance. The resonance energies of the four quantum dots are slightly different because of the stray field created by the micro-magnet and therefore frequency-resolved addressable control of each electron spin resonance is possible.
Tunable magnetism in metal adsorbed fluorinated nanoporous graphene
Authors: Kumar Pankaj , Sharma Vinit , Reboredo Fernando A. , Yang Li-Ming , Pushpa Raghani
Published: August 2016

Developing nanostructures with tunable magnetic states is crucial for designing novel data storage and quantum information devices. Using density functional theory, we investigate the thermodynamic stability and magnetic properties of tungsten adsorbed tri-vacancy fluorinated (TVF) graphene. We demonstrate a strong structure-property relationship and its response to external stimuli via defect engineering in graphene-based materials. Complex interplay between defect states and the chemisorbed atom results in a large magnetic moment of 7 μB along with high in-plane magneto-crystalline anisotropy energy (MAE) of 17 meV. Under the influence of electric field, spin crossover effect accompanied by a change in the MAE is observed. The ascribed change in spin-configuration is caused by the modification of exchange coupling between defect states and a change in the occupation of d-orbitals of the metal complex. Our predictions open a promising way towards controlling the magnetic properties in graphene based spintronic and non-volatile memory devices.
Central chronic apelin infusion decreases energy expenditure and thermogenesis in mice
Authors: Drougard Anne , Fournel Audren , Marlin Alysson , Meunier Etienne , Abot Anne , Bautzova Tereza , Duparc Thibaut , Louche Katie , Batut Aurelie , Lucas Alexandre , Le-Gonidec Sophie , Lesage Jean , Fioramonti Xavier , Moro Cedric , Valet Philippe , Cani Patrice D. , Knauf Claude
Published: August 2016

Apelin is a bioactive peptide involved in the control of energy metabolism. In the hypothalamus, chronic exposure to high levels of apelin is associated with an increase in hepatic glucose production, and then contributes to the onset of type 2 diabetes. However, the molecular mechanisms behind deleterious effects of chronic apelin in the brain and consequences on energy expenditure and thermogenesis are currently unknown. We aimed to evaluate the effects of chronic intracerebroventricular (icv) infusion of apelin in normal mice on hypothalamic inflammatory gene expression, energy expenditure, thermogenesis and brown adipose tissue functions. We have shown that chronic icv infusion of apelin increases the expression of pro-inflammatory factors in the hypothalamus associated with an increase in plasma interleukin-1 beta. In parallel, mice infused with icv apelin exhibit a significant lower energy expenditure coupled to a decrease in PGC1alpha, PRDM16 and UCP1 expression in brown adipose tissue which could explain the alteration of thermogenesis in these mice. These data provide compelling evidence that central apelin contributes to the development of type 2 diabetes by altering energy expenditure, thermogenesis and fat browning.
Monolithic integration of room-temperature multifunctional BaTiO3-CoFe2O4 epitaxial heterostructures on Si(001)
Authors: Scigaj Mateusz , Dix Nico , Gázquez Jaume , Varela María , Fina Ignasi , Domingo Neus , Herranz Gervasi , Skumryev Vassil , Fontcuberta Josep , Sánchez Florencio
Published: August 2016

The multifunctional (ferromagnetic and ferroelectric) response at room temperature that is elusive in single phase multiferroic materials can be achieved in a proper combination of ferroelectric perovskites and ferrimagnetic spinel oxides in horizontal heterostructures. In this work, lead-free CoFe2O4/BaTiO3 bilayers are integrated with Si(001) using LaNiO3/CeO2/YSZ as a tri-layer buffer. They present structural and functional properties close to those achieved on perovskite substrates: the bilayers are fully epitaxial with extremely flat surface and exhibit robust ferromagnetism and ferroelectricity at room temperature.