bluuebunny/crossref_metadata_2025 huggingface dataset:
Factors of psychiatric morbidity during perinatal period
Authors: Parveen Shahana , Akteruzzaman Mohammad , Maruf Mohammad Muntasir , Akhter Sumiya , Tarannum Sadya
Published: August 2018

The presence of psychiatric disorders during perinatal period imposes negative and long-term effect on maternal health and child development as well as normal family environment. The purpose of our study was to investigate the socio-demographic factors associated with psychiatric morbidity during perinatal period. It was a descriptive cross-sectional study conducted among purposively selected 197 perinatal women attending the Obstetrics & Gynaecology Outpatient Department (OPD) of Bangabandhu Sheikh Mujib Medical University and Dhaka Medical College Hospital, Dhaka from August 2012 to July 2013. Data were collected through face-to-face interview by administering a semistructured questionnaire, containing socio-demographic and other variables and translated Bangla version of Structured Clinical Interview for DSM-IV Axis-I Disorders – Clinician Version (SCID-CV). Majority (79.7%) of the women were included in the age group of 20-34 years. The mean (±SD) age of the respondents were calculated as 24.60 (±4.88) years. Rural habitat was predominant (53.6%). A good number (5.1%) of respondents with psychiatric disorders had positive family history of psychiatric illness which was found statistically significant. Majority (7.6%) of the respondents with psychiatric disorders had previous history of psychiatric illness. Women in perinatal period with the risk factors for developing psychiatric disorders need proper psychiatric evaluation to prevent and treat perinatal mental illness.Bang J Psychiatry December 2015; 29(2): 53-58
Factors associated with relapse of schizophrenia
Authors: Haque AKM Akramul , Kamal AHM Kazi Mostofa , Laila Zinat De , Laila Luna , Ahmed Helal Uddin , Khan Niaz Mohammad
Published: August 2018

Schizophrenia is a chronic psychiatric illness with high rate of relapse which is commonly associated with noncompliance of medicine, as well as stress and high expressed emotions. The objective of the study was to determine the factors of relapse among the schizophrenic patients attending in outpatient departments of three tertiary level psychiatric facilities in Bangladesh. This was a cross sectional study conducted from July, 2001 to June, 2002. Two hundred patients including both relapse and nonrelapse cases of schizophrenia and their key relatives were included by purposive sampling. The results showed no statistically significant difference in terms of relapse with age, sex, religion, residence, occupation and level of education (p>0.05), but statistically significant difference was found with marital status and economic status (p<0.01). The proportion of non-compliance was found to be 80% and 14%, of high expressed emotion was 17% and 2% and of the occurrence of stressful life events was 10% and 1% in relapse and non-relapse cases respectively which were statistically significant (p<0.001). The study indicated that stressful life events, high expressed emotion, and noncompliance with medication had a role in schizophrenic patients for its relapse.Bang J Psychiatry December 2015; 29(2): 59-63
DRESS: a rare adverse drug reaction of olanzapine
Authors: Islam Mohammad Monirul , Islam Md Azizul , Hasan M Kumrul , Khan Md Abdul Latif
Published: August 2018

A boy of 17 years was brought by his parents with the complaints of aggressive, violent and assaultive behavior towards parents, using abusive language, demanding money, restlessness, irritability, irrelevant talk and sleep disturbance. His urine test for cannabinoid was positive. He was diagnosed as substance use disorder and was treated with olanzapine along with psychotherapy. After few days, he developed fever followed by erythematous rash with pruritus and swelling of the face, eyelids, trunk and extremities with raised serum bilirubin, ALT and alkaline phosphatase. He was diagnosed as DRESS (Drug Reaction with Eosinophilia and Systemic Symptoms), a rare complication of olanzapine. This is a dangerous and life threatening adverse effect. Early diagnosis can reduce its morbidity and mortality.Bang J Psychiatry December 2015; 29(2): 64-66
Personal factors and its association with depression among secondary school children
Authors: Sarkar Mekhala , Roy Susmita , Akhter Mahfuza
Published: August 2018

Depression is one of the most significant mental health problems among children and adolescents. The objective of the study was to find out the personal factors and its association with depression among secondary school children in two selected schools of Dhaka, Bangladesh. It was a crosssectional study conducted from November 2008 to October 2009 among one boys’ and one girls’ school of Dhaka, Bangladesh. Purposive sampling technique was used to select 144 respondents from class VI to class IX. A self administered semi-structured questionnaire was used to assess the personal factors of children whereas the Center for Epidemiologic Studies Depression Scale for Children (CES-DC) was used to assess their depressive status. The results showed that 13 to 15 years age group constituted the highest proportion which was followed by the age group of 10 to 12 years. There was no significant difference of age of the respondents with or without depression (p>0.05). It was found that girls were two times more likely to have depression than boys. Among all the respondents, 43 students (29.9%) were suffering from depression. Depression was found highest (36.1%) among the respondents of class VIII but no significant association was found between the presence of depression and educational status of the respondents (p>0.05). Depression was found to be proportionately higher among occasional or regular smokers in comparison to those who never smoked. The overall result of the study indicates that possibility of depression is considerably present in school-going children. So, arrangement for the school mental health services is of utmost importance.Bang J Psychiatry June 2016; 30(1): 1-6
Psychiatric morbidity in children with epilepsy
Authors: Ferdous Fahmida , Alam Md Faruq , Maruf Mohammad Muntasir , Choudhury Shoebur Reza , Chisty Md Mashukur Rahman , Afroza Sayeda , Chakravarty Hariprakash
Published: August 2018

Suffering from psychiatric illness is relatively common in epilepsy. There is now general agreement that incidence of neuro-behavioral disorders is higher in patients with epilepsy. The objective of the study was to find out the proportion of psychiatric disorders among the children suffering from epilepsy. It was a cross sectional study conducted during the period from July 2009 to June 2011 at the department of Paediatrics in Sir Salimullah Medical College and Mitford Hospital, Dhaka, Bangladesh. In the study 104 children, aged 5-16 years, having epilepsy were purposively included and patients with febrile seizure were excluded. Data were collected through face-to-face interview using a semistructured questionnaire and diagnosis of psychiatric disorders was assigned according to the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text-revision (DSM-IV-TR). The results showed that among all patients 56.7% were male and 43.3% were female. Most of them (80.8%) were within 5-10 years of age. Among them, 57.7% of the cases had associated psychiatric disorders, where 21.2% had intellectual disability, 10.6% communication disorder, 7.7% learning disorder, 6.7% major depressive disorder, 5.8% ADHD and 1.9% had autistic disorder. This study suggests that significant number of children with epilepsy has been suffering from psychiatric illnesses. So, during diagnosis of epilepsy, early psychological assessment should be done.Bang J Psychiatry June 2016; 30(1): 7-9
Pattern of psychiatric morbidity among patients attended at psychiatry outpatient department in a private medical college hospital
Authors: Monzur Md Sultan E , Maruf Mohammad Muntasir , Roy Susmita , Royle Ramendra Kumar Singha , Rahman Md Shafiqur
Published: August 2018

Mental health problems are often unrecognized and neglected by patients, their relatives and by the society. The objective of the study was to find out the pattern of psychiatric morbidity of the patients attending at the psychiatry outpatient department. This was a cross sectional study carried out in the department of Psychiatry at North Bengal Medical College Hospital (NBMCH), Sirajganj from August, 2015 to July, 2017. For this purpose, 918 respondents attending in psychiatry outpatient department of NBMCH were enrolled in the study by using convenient sampling technique. The results showed that majority (26.3%) were from the age group of 31-40 years with female preponderance (58.7%). Among them 71.8% were married and 71.1% came from rural background. Maximum respondent’s (56.3%) monthly family income was in between 15,000-30,000 BDT. The most common psychiatric morbidity among the respondents was major depressive disorder (38.6%) followed by anxiety disorsers (25.8%). Most (85.1%) of the respondents were referred either by themselves or by their family members, friends or by relatives. The rest (14.9%) were referred by general physicians and specialists of different disciplines. The result of this study may help in the planning for better mental health service in private medical college hospitals.Bang J Psychiatry June 2016; 30(1): 10-13
Mass psychogenic illness: comparison on selected variables between cases and non-cases
Authors: Mamun Abdullah Al , Maruf Mohammad Muntasir , Bhowmik Avra Das , Begum Khaleda , Amin Zulfiquer Ahmed
Published: August 2018

Mass psychogenic illness is not new in Bangladesh but in the year 2007, the sudden outbreak all over Bangladesh created a panic nationwide. The objective of the study was to investigate sociodemographic and other variables attributed to the disease. The first outbreak of this illness took place in Adiabad Islamia High School and College, Raipura, Narsinghdi. We rationally decided to conduct our research in this school in case-control design. Within 12 months’ study period, 125 students of class VI to X (45 cases and 80 controls) were interviewed face-to-face by structured questionnaire containing separate questionnaire for students and guardians. The result of the study showed that, all the cases came from lower socioeconomic class, majority (71.1%) from 14 to 16 years age group and most (77.8%) of the cases were female. Outbreak rapidly spread among the cases mostly by smelling foul odor (40%) and seeing index cases (33.3%). Majority (51.2%) of the cases and controls thought that the illness was due to both physical and psychological causes though most of them (93.6%) did not hear about the disease previously. It was evident that the role of socio-demographic variables for attributing the symptoms pattern of the disease was ambiguous. However early recognition of psychological stressors and prompt exclusion of physical illness can prevent the occurrence and rapid spread of the disease.Bang J Psychiatry June 2016; 30(1): 14-19
Trauma focused cognitive behavior therapy in a traumatized female child
Authors: Gaffar Mahjareen Binta , Uddin Md Zahir
Published: August 2018

Children and adolescents of this era are experiencing more traumatic events than earlier, resulting in more diagnosed cases of post traumatic stress disorder. One such case is discussed here following exposure to molestation. After assessment and case formulation, an extensive psychological management (Trauma Focused Cognitive Behavior Therapy) was done which is presented through the report. Mentionable improvement was acknowledged by client who paves the way for future evidence-based work.Bang J Psychiatry June 2016; 30(1): 20-22
Recycling of Organic Wastes through the Vermicomposting Process of Cow Dung and Crop Residues
Authors: Islam Md Aminul , Talukder Md Sharif Uddin , Islam Md Shafiqul , Hossian Mohammed Sadid , Mostofa MG
Published: August 2018

Fertilizer is considered to be one of the main inputs for increasing crop yields. Chemical fertilizer industries are highly energy intensive and have a fundamental dependence on natural gas supply. On the other hand, organic fertilizers are the safer sources of plant nutrients without any detrimental effect on crops and soil. In the era of technological innovation, the farmers are interested to grow HYV rice and other diversified crops to support huge population of Bangladesh. So various harmful chemicals were used which degraded the health of the soil. Vermicompost is an excellent, nutrient-rich organic fertilizer and soil conditioner. It can bring back the fertility of the soil. Vermicomposting with earthworms has been recognized as a composting technique that transforms complex organic substances into stabilized, humus-like product. The application of vermicompost to the soil is considered as a good management practice in any agricultural production system because of the stimulation of soil microbial growth and activity and mineralization of plant nutrients and increased soil fertility and quality. This research focuses on producing nutrient-rich organic fertilizer by vermicomposting process from biomass. An experimental setup was carried out in Doulatpur, Kushtia targeting 10 tons output per month. Cow dung and crop residues were collected and followed vermicomposting method. Three cycles were maintained in the experiments i.e. 120 days per cycle-360 days in total and counted the vermi population for each consecutive cycle. The output fertilizer was analyzed in the laboratory and it was observed that the component ratios were suitable for agricultural lands. This fertilizer can also be used as a remedy for the barren lands. For the sustainable crop production and net improvement of soil productivity, vermicomposing is an excellent process to produce organic fertilizer from biomass.Journal of Bangladesh Academy of Sciences, Vol. 42, No. 1, 1-9, 2018
Variation in Salinity through the Soil Profile in South Coastal Region of Bangladesh
Authors: Haque Mohammad Asadul
Published: August 2018

The spatial variability of salt accumulation through the soil profile was studied at Latachapali union of Kalapara upazila, Patuakhali district, Bangladesh. The soil samples were collected from 30 locations covering six villages of the union: Kuakata, Malapara, Fashipara, Khajura, Mothaopara and Tajepara. Five locations were randomly selected from each village. From each location soil samples were collected from three soil depths at 0-2 cm, 2.1-4 cm and 4.1-6 cm. Electrical conductivity of top 0-2 cm soil depth was 20.49 dS/m, in 2.1-4 cm soil depth was 7.14 dS/m and in 4.1-6 cm soil depth 4.15 dS/m. The study soils were strongly acidic having pH value 4.73, 4.99 and 5.20 in 0-2, 2.1-4 and 4.1-6 cm soil depth, respectively. The highest of 8.8 Na:K ratio was found in 0-2 cm soil depth. The Na:K ratio gradually decreased with the increase of soil depth, having 6.59 in 2.1-4 cm and 5.42. in 4.1-6 cm soil depth. The results clearly reveal that the top soil is very much sensitive to salt stress. Based on the electrical conductivity and Na:K ratio the Fashipara, Kuakata and Tajepara village were found seriously affected by salinity.Journal of Bangladesh Academy of Sciences, Vol. 42, No. 1, 11-23, 2018
Hydrogeologic Characteristics and Groundwater Potentiality of Lower Aquifer of Singair Upazila, Manikganj District, Bangladesh
Authors: Islam Mazeda , Bashar Khairul , Ahmed Nasir , Rasul Md Golam , Hossain Sahadat , Sarker Md Mizanur Rahman
Published: August 2018

The study area is located in the central part of Bangladesh. The aims of this study were to explain the hydrogeological characteristics of aquifers and evaluate the groundwater potentiality. The borehole logs revealed three types of zones: upper aquitard (low permeability clays, silty clays & silts), upper aquifer (very fine sand to fine sand) and lower aquifer (medium to coarse sands and gravels). Both aquifer waters are mainly Ca-Mg-HCO3 type. Except arsenic (As), most of the ions of both aquifer waters are within the limit of drinking standard of WHO (2004) and Bangladesh (DoE, 1997). Arsenic concentrations of upper aquifer exceed both the WHO (10 μg/l) and Bangladesh standard (50 μg/l) and for lower aquifer exceed only WHO standard. Waters of both aquifers in north western and central part of the study area show high arsenic concentration due to lack of continuous impermeable layer between them as revealed from borelog data. Water quality index map also indicates that north western and central part is not suitable for groundwater development because of inferior quality. The average δ18O values for upper and lower aquifer waters are isotopically enriched compared to river water (~10.08‰). Similar isotopic composition of upper (~4.77‰) and lower aquifer waters (~5.50‰) indicates both waters were mixed in the past and mixing may be continued in the future. The mixing may be preferentially from the upper aquifer to lower aquifer because of water abstraction, lack of impermeable layer and high permeability of the upper aquifer etc. Therefore, the potentiality of the lower aquifer may not be suitable for large-scale groundwater development project without any mitigation measure.Journal of Bangladesh Academy of Sciences, Vol. 42, No. 1, 25-40, 2018
Hydrogeological Classification and the Correlation of Groundwater Chemistry with Basin Flow in the South-Western Part of Bangladesh
Authors: Dola Shahpara Sheikh , Bahsar Khairul , Islam Mazeda , Sarker Md Mizanur Rahman
Published: August 2018

Attempt has been made to find the relationship between the basin groundwater flow and the current water chemistry of south-western part of Bangladesh considering their lithological distribution and aquifer condition. The correlation of water chemistry and basin groundwater flow is depicted in the conceptual model. The water-types of shallow groundwater are predominantly Mg-Na-HCO3 and Ca- Mg-Na-HCO3 type. In the deep aquifer of upper delta plain is predominately Na-Cl, Ca-HCO3 and Mg- HCO3 type. In the lower delta plain Na-Cl type of water mainly occurs in the shallow aquifer and occasionally Ca-HCO3, Ca-Mg-Na-HCO3 and Mg-HCO3 type may also occur in shallow aquifer of the eastern part of lower delta plain which could have originated from the recent recharge of rain water. Na- Cl type water is also found in the deep aquifer of lower delta plain. The origin of Na-Cl type water in the deep aquifer of lower delta part might be connate water or present day sea water intrusion. Fresh water occurring in the deep aquifer in the lower delta area is mostly of Mg-Ca-HCO3 and Na-HClO3 types. This type of water originate from intermediate or deep basin flow from the northern part of Bangladesh. The probable source of deep groundwater is Holocene marine transgression (Khan et al. 2000) occurred in 3000–7000 cal years BP and the deep groundwater of Upper Delta plain and Lower Delta plain is clearly influenced by deep basin flow coming from north part of BangladeshJournal of Bangladesh Academy of Sciences, Vol. 42, No. 1, 41-54, 2018
The Fukushima Daiichi NPP Accident, Its After Effects And The Lessons Learnt From It
Authors: Aziz Md Akhlak Bin , Huq Md Fazlul , Mahmood Zahid Hasan , Kabir Khorshed Ahmad
Published: August 2018

A tsunami induced by an earthquake of magnitude nine hit the Fukushima Daiichi NPP on 11th March, 2011. A seawall of only 10 m high above sea level against tsunami waves of 15 m, led to a series of catastrophic events like inundation of the backup diesel generators exceptionally located at the basement, hydrogen explosions at three units etc. Immediate evacuation and efficient management ensured negligible harmful effects due to radiation exposure. By 2012, 160,000 people were evacuated. Government gave land and housing to evacuees and an additional USD $1030 per month for psychological suffering. But evacuees were not allowed to return to regions with radiation of 20-50 mSv/y despite IAEA effective dose limit for one year being 50 mSv. Moreover, dose limit for clean up workers were also set at 250 mSv compared to international allowable limit of 500 mSv. Post accidents efforts taken by the government were praiseworthy but a less conservative limit to allow return of evacuees could have saved a lot more people.Journal of Bangladesh Academy of Sciences, Vol. 42, No. 1, 55-66, 2018
Certain Properties of Fuzzy Path Connectedness and Maximal Fuzzy Path Connectedness
Authors: Amin Ruhul , Rana Sohel
Published: August 2018

This paper deals with some properties of fuzzy path connectedness and maximal fuzzy path connectedness on a fuzzy topological space by means of fuzzy points.Journal of Bangladesh Academy of Sciences, Vol. 42, No. 1, 67-71, 2018
Level Separation on Intuitionistic Fuzzy T1 Spaces
Authors: Islam Md Saiful , Hossain Md Sahadat , Asaduzzaman Md
Published: August 2018

Intuitionistic fuzzy T1 spaces are defined and studied in this paper. Eight new notions of intuitionistic fuzzy T1 spaces are defined and some relationship among them has been investigated. Some relations between the defined notions and other given notions of intuitionistic fuzzy T1 spaces has also been investigated. Under some conditions it is observed that image and preimage preserve intuitionistic fuzzy T1 spaces. Hereditary and productive property of such spaces has been also investigated.Journal of Bangladesh Academy of Sciences, Vol. 42, No. 1, 73-85, 2018
Absorption Enhancement of Organic Solar Cell using Aluminum Oxide as a Photonic Crystal
Authors: Hasan Md Mehedhi , Rahman Shah Ashikur , Prodhan Md Mahidul Haque , Talukder ABM Hasan
Published: August 2018

Enhancement of light absorption in solar cell presents a strong challenge to its overall performance. We analyzed an Organic Solar Cell (OSC) with Photonic Crystal (PC) structure using Finite Difference Time Domain (FDTD) method. Aluminum oxide (Al2O3) has been used as photonic crystal structure and the lattice structure has been chosen to be hexagonal. Absorption enhancement has been observed by changing the height of the Hexagonal Lattice structure (HLS). When height is increased to 0.26 and radius to period ratio (r/a ratio) is set to 0.4, there is a significant increase of absorption in the middle wavelength region approximately from 463 nm to 575 nm and a significant decrease in lower wavelength. As the height is increased further, these changes in absorption begins to increase and at a certain value, these changes begin to reverse. Almost same phenomena occur when r/a ratio is 0.2 and 0.3 taken at approximately same height.Journal of Bangladesh Academy of Sciences, Vol. 42, No. 1, 87-97, 2018
Comparative Study of the Performance of Silicon Solar Panel at three Different Locations of Bangladesh
Authors: Haque Mohammad Asadul , Rifat Md Takrim Alam
Published: August 2018

Solar cell is a device that converts photons into electricity. The performance of a solar cell depends on its efficiency. The efficiency of a solar cell depends on some atmospheric variables such as light intensity, temperature, pressure, wind, humidity, precipitation and the sky condition etc. Geographical locations are the main factor for the variation of atmospheric variables. Due to atmospheric variables the solar cell efficiency is not same for all places of the World. Solar cell has been analyzed from different approach to improve its efficiency. The objective of this research is to analyze the efficiency of a silicon solar panel at three different places: Chittagong University Campus, Sandwip Island and Shibpur thana of Narshingdi district of Bangladesh. The efficiency mostly depends on the light intensity and temperature, however slightly depends on humidity. The experimental study shows that among the three places Norshingdi district is more suitable for solar power with the efficiency of 16.25% than other two places, where the efficiencies are 15.7% at Chittagong University Campus and 15.83% at Sandwip Island.Journal of Bangladesh Academy of Sciences, Vol. 42, No. 1, 99-104, 2018
The Position of Neutrophils-To-Lymphocytes and Lymphocytes-To-Platelets Ratio as Predictive Markers of Progression and Prognosis in Patients with Non-Small Cell Lung Cancer
Authors: Minkov Plamen , Gulubova Maya , Chilingirov Petar , Ananiev Julian
Published: August 2018

BACKGROUND: Non-small cell lung cancer (NSCLC) is an insidious metastasis condition of the lungs often presenting no symptoms at the onset. Defining markers for quick determination of prognosis is essential for building up a treatment strategy.AIM: The aim of this study is to define the role of the Neutrophils-to-Lymphocytes ratio (NLR) and Platelets-to- Lymphocytes ratio (PLR) as biomarkers in patients with NSCLC, according to the stage and prognosis of the disease.METHODS: We investigated 20 patients with NSCLC. NLR and PLR are calculated and are evaluated according to the presence or absence of metastasis, stage of the disease, histological type and survival rate.RESULTS: We found that thirteen of the patients had low NLR, while the rest 7 had high NLR (mean 3.15). By analysing PLR we found that 11 patients have low and 9 have high level of PLR (mean 1.42). After the correlations have been made we discovered that in 90.1% of the patients with low PLR no lymph metastasises were detected, while in 50% of the patients with high PLR lymph metastasises were observed (c2 = 3.99; P = 0.046). We also discovered that in 84.6% of the patients with low NLR lymph metastases were absent, while in 42.9% with high NLR lymph metastasises were present (c 2 = 1.83; P = 0.176).CONCLUSION: In conclusion, NLR and PLR were discovered as prominent biomarkers which provide relatively fast determination for prognosis in patients with NSCLC.
De l’accession et de l’ouvrage dans le Code civil
Authors: Lesquins Jean-Louis
Published: August 2018

Selon le Code civil français de 1804, « la propriété des biens s’acquiert et se transmet par succession, par donation entre vifs ou testamentaire et par l’effet des obligations » (art. 711). « La propriété s’acquiert également par accession ou incorporation et par prescription » (art. 712). La présente étude est consacrée à l’articulation de deux de ces modes d’acquisition : par droit d’accession et par l’effet des obligations (en particulier par l’effet du louage d’ouvrage). Une approche généalogique peut déboucher sur des questions de grande actualité et des perspectives d’évolution pour le contrat de travail, le contrat d’entreprise et le contrat de société.
A care deficit? The roles of families and faith-based organisations in the lives of youth at the margins in Pretoria Central
Authors: Rabe Marlize
Published: August 2018

After completing or dropping out of school, many young people leave their family households and in some cases they move from rural or semi-rural areas to urban centres. Faith-based organisations (FBOs) in major cities in South Africa sometimes act as a safety net for marginalised youth, especially as government departments are overburdened and not addressing all the needs of youth at the margins. This qualitative research is based on an analysis of individual and focus group interviews undertaken with young people living in the central areas of Pretoria. It is shown how families and FBOs engage as separate, although at times not unrelated, entities in the lives of youth at the margins. In certain cases, the FBO became an institution of last resort and only in rare cases is a certain synergy achieved between FBOs and families.
Chemotherapy administration standards and guidelines: The development of a resource document
Authors: Eedes David J. , Bailey Belinda , Burger Henriette
Published: August 2018

There are no nationally recognised guidelines for the handling and administration of chemotherapy in South Africa. The Independent Clinical Oncology Network’s Chemotherapy Administration Standards and Guidelines Resource Documentwas developed over 2 years and first introduced at a South African international oncology conference in 2017. A working group consisting of oncologists and oncology nurses was set up to address this deficiency. Pragmatic guidelines suitable to a wide range of local chemotherapy administration practices were developed using an iterative, multidisciplinary, collaborative process. The consensus was that these guidelines should be appropriate to the South African context. Safety, standard operational procedures, recommended professional competencies and training were central to the document. Guidelines for prescribing, storing, mixing, dispensing, administering and disposing of chemotherapy were included. Patient consent and involvement, patient and staff safety, recommended professional competencies, management of accidents and errors, error reporting and local legal requirements are dealt with in detail. The hope is that these guidelines will be used as a resource document for South African chemotherapy practices, both public and private. The document is supported by standard operating procedures and action steps. These were developed to promote the use of the guidelines and to support pragmatic quality assurance measures at practice level. These standards and guidelines will be regularly updated, based on needs identified and deficiencies noted.
Earthquake loss estimates help and challenge medical disaster responders
Authors: Wyss, PhD Max
Published: August 2018

Earthquake loss estimates help and challenge medical disaster responders
60 seconds to survival: A pilot study of a disaster triage video game for prehospital providers
Authors: Cicero, MD Mark X. , Whitfill, MPH Travis , Munjal, MD Kevin , Madhok, MD, MPH Manu , Diaz, MD Maria Carmen G. , Scherzer, MD Daniel J. , Walsh, MD Barbara M. , Bowen, RN, BSN, CPEN, NREMT-P Angela , Redlener, MD Michael , Goldberg, MD, MPH Scott A. , Symons, MD Nadine , Burkett, DHSc, PA-C, DFAAPA James , Santos, MPH, NREMT Joseph C. , Kessler, MD, MSc, RDMS David , Barnicle, MD, MEd Ryan N. , Paesano, NREMT-P Geno , Auerbach, MD, MSc Marc A.
Published: August 2018

Introduction: Disaster triage training for emergency medical service (EMS) providers is not standardized. Simulation training is costly and time-consuming. In contrast, educational video games enable low-cost and more time-efficient standardized training. We hypothesized that players of the video game “60 Seconds to Survival” (60S) would have greater improvements in disaster triage accuracy compared to control subjects who did not play 60S.Methods: Participants recorded their demographics and highest EMS training level and were randomized to play 60S (intervention) or serve as controls. At baseline, all participants completed a live school-shooting simulation in which manikins and standardized patients depicted 10 adult and pediatric victims. The intervention group then played 60S at least three times over the course of 13 weeks (time 2). Players triaged 12 patients in three scenarios (school shooting, house fire, tornado), and received in-game performance feedback. At time 2, the same live simulation was conducted for all participants. Controls had no disaster training during the study. The main outcome was improvement in triage accuracy in live simulations from baseline to time 2. Physicians and EMS providers predetermined expected triage level (RED/YELLOW/GREEN/BLACK) via modified Delphi method.Results: There were 26 participants in the intervention group and 21 in the control group. There was no difference in gender, level of training, or years of EMS experience (median 5.5 years intervention, 3.5 years control, p = 0.49) between the groups. At baseline, both groups demonstrated median triage accuracy of 80 percent (IQR 70-90 percent, p = 0.457). At time 2, the intervention group had a significant improvement from baseline (median accuracy = 90 percent [IQR: 80-90 percent], p = 0.005), while the control group did not (median accuracy = 80 percent [IQR:80-95], p = 0.174). However, the mean improvement from baseline was not significant between the two groups (difference = 6.5, p = 0.335).Conclusion: The intervention demonstrated a significant improvement in accuracy from baseline to time 2 while the control did not. However, there was no significant difference in the improvement between the intervention and control groups. These results may be due to small sample size. Future directions include assessment of the game's effect on triage accuracy with a larger, multisite site cohort and iterative development to improve 60S.
Are you ready? Crisis leadership in a hyper-VUCA environment
Authors: Alkhaldi, MD Khaldoon H. , Austin, MSPH, MA Meredith L. , Cura, MS, HSE Boris A. , Dantzler, PhD Darrell , Holland, MS Leslie , Maples, MBA David L. , Quarrelles, MPA, CEM Jamie C. , Weinkle Jr, MS, ACC Robert K. , Marcus, PhD Leonard J.
Published: August 2018

The current hyper-volatile, -uncertain, -complex, and -ambiguous (VUCA) threat environment demands a more cohesive support structure for crisis leaders who may be faced with crises of increasing magnitude and frequency and, in some instances, multiple crisis events simultaneously. The project team investigates the perceptions of crisis leaders regarding establishing a crisis leader advisor position for crisis leaders to benefit from their experience while prosecuting crisis response activities. The team linked hyper-VUCA crises, crisis response frameworks, meta-leadership, crisis leader attributes, and advisor attributes. The overall goal of the project is to increase the ability of the crisis leaders to more effectively and efficiently navigate crisis events resulting in more efficient and effective response and recovery. Three research questions were developed to assess the following: thoughts of integrating a crisis leader advisor position; development of a crisis leader advisor certification program; and attributes of crisis leader advisors. A qualitative research methodology using a phenomenological approach was employed. Forty-one participants were purposefully selected and administered a short, on-line survey consisting of 11 questions. Data were analyzed using percentage analysis, weighted sums, and inductive thematic analysis. The project team found an overwhelming support for the crisis leader advisor position and the crisis leader advisor certification program. Additionally, experience and trustworthiness ranked among the top sought after attributes of a crisis leader advisor. The team recommendations included (1) implement a crisis leaders advisor guide/framework; (2) create a formal crisis leader advisor position in national incident management system; (3) implement a crisis leader advisor certification framework; (4) benchmark established advisor programs; and (5) implement a framework to match leaders and advisors.
Volume 12, Number 2
Authors: DeVito, Jr. Richard A.
Published: August 2018

Complete issue
The Canadian Paediatric Triage and Acuity Scale algorithm for interfacility transport
Authors: Holt, MD Tanya , Prodanuk, BSc Michael , Hansen, MD, MPH, MSc Gregory
Published: August 2018

Objective: Determining pediatric severity of illness in referring centers may be useful for establishing appropriate patient disposition and interfacility transport. For this retrospective review, the authors evaluated the Canadian Paediatric Triage and Acuity Scale (PaedCTAS) tool in regards to individual patient disposition and outcomes.Methods: A disposition score using the PaedCTAS algorithm was retrospectively calculated from referring center data at the time our transport team was consulted. Data included children < 17 years transported to our tertiary pediatric center between April 2013 and March 2014. Patients were excluded if transported because of elective or planned interventions, investigations, and/or treatment.Results: A total of 194 pediatric patients were identified, with 49 requiring a pediatric intensive care unit (PICU) admission. A PaedCTAS assessment of 1 was the only transport characteristic evaluated that was significantly associated (odds ratio [OR] 6.15; p < 0.0001) with PICU admissions, with an area under the receiver-operating characteristic curve of 0.72 (95% CI 0.64, 0.77). On multivariate analysis, a PaedCTAS assessment of 1 was also associated with a length of hospital stay greater than 3 days (OR 1.81; 95% CI 0.99, 3.31; p = 0.05).Conclusions: A PaedCTAS assessment of 1 may be a reasonable predictor for PICU admissions and longer hospitalizations when calculated in referral centers at time of pediatric transport consultation. PaedCTAS assessments may provide useful adjuvant information for specialized pediatric transport programs.
Performance of a novel, manually operated intraosseous device in adult human cadavers
Authors: Singh, MD, DM Sandeep , Bhargava, MD, DM Balram , Aggarwal, MD Praveen , Dhingra, MSc, PhD Renu , Gupta, MD Arun Kumar , Lodha, MD Rakesh , Agarwal, MD Ramesh , Karve, BTech, MDes Jayant S.
Published: August 2018

Aim: Intraosseous (IO) access in adults is preferred using semi-automatic devices as it is difficult to penetrate the thick cortical layer of long bones using manual needles. The authors have developed an IO device which generates both rotational and axial thrust using a manual driver. This drilling mechanism addresses certain pain-points of current IO devices. The objective of this study was to evaluate the performance of this device in human cadavers.Methods: The authors tested the ability of this device for IO access at proximal and distal tibia in 10 adult cadavers. Needle position was confirmed by fluoroscopy after contrast injection. Needle penetration time—defined as the time required for manual drilling of bone—and the total procedure time were calculated from video analysis. A successful IO procedure was defined as an appropriate needle position without any contrast extravasation, device, or procedure-related complication. After each procedure, the authors recorded damage to the device or fracture of the bone.Results: A single physician performed 40 IO procedures. The IO access was successful in 35 (87.5 percent) and was accomplished in first attempt in 33 (82.5 percent) insertions. Reasons for failure were undershooting of needle (2/40, 5 percent), trocar damage (1/40, 2.5 percent), and detachment of plastic hub of the needle during removal in (2/40, 5 percent) procedures. There were no bone fractures. In all but one instance, needle penetration time was <3 seconds. The mean total procedure time was 40 ± 13 seconds.Conclusion: In this pilot study, the authors have demonstrated the efficacy of a novel, manually introduced IO device in adult cadavers.
Post-traumatic stress symptoms following sniper attacks: Effects of television viewing and identification with victims
Authors: Mash, PhD Holly B. Herberman , Fullerton, PhD Carol S. , Ursano, MD Robert J.
Published: August 2018

Objective: A series of sniper attacks in the Washington, DC, area left 10 people dead and three wounded. The authors examined the relationship of sniper-related television (TV) viewing, identification with victims, and peritraumatic dissociation to posttraumatic stress symptoms.Methods: Participants were 1,238 DC residents (ages 18-90, M = 41.7; 51 percent female; 68 percent White) who completed an online survey including items assessing identification, amount of TV, peritraumatic dissociation, and post-traumatic stress symptoms. Identification was measured by assessing to what extent participants identified victims as similar to themselves, a friend, or a family member. Peritraumatic dissociation and post-traumatic stress symptoms were assessed with the Peritraumatic Dissociative Experiences Questionnaire and Impact of Event Scale-Revised. Relationships of TV viewing, identification, and peritraumatic dissociation to post-traumatic stress symptoms were examined by univariable and multivariable regressions and variable interactions.Results: Female gender and higher levels of TV viewing, identification, and peritraumatic dissociation were each related to greater post-traumatic stress symptoms. After adjusting for gender and the predictor variables, higher TV viewing was associated with posttraumatic stress symptoms (B = 0.72, p < 0.01, ΔR2 = 0.05). Participants with greater identification (B = 0.85, p < 0.001, ΔR2 = 0.08) and peritraumatic dissociation (B = 1.58, p < 0.001, ΔR2 = 0.39) reported more post-traumatic stress symptoms. Among those with both high (B = 1.19, p < 0.001) and low TV viewing, identification was associated with post-traumatic stress symptoms. Among those reporting low TV viewing, this association was greater for those who experienced more peritraumatic dissociation (B = −0.09, p < 0.001).Conclusions: Trauma-related TV viewing, which may stimulate identification and peritraumatic dissociation, is an important consideration in understanding development of post-traumatic stress symptoms.
Tourniquet use in the prehospital setting: Are they being used appropriately?
Authors: Duignan, MS, EMT-B Kevin M. , Lamb, MD Laura C. , DiFiori, BS Monica M. , Quinlavin, BS John , Feeney, MD, FACS James M.
Published: August 2018

Objective: The objective of this study was to evaluate tourniquet use in the Hartford prehospital setting during a 34-month period after the Hartford Consensus was published, which encouraged increasing tourniquet use in light of military research.Design: This was a retrospective review of patients with bleeding from a serious extremity injury to determine appropriateness of tourniquet use or omission.Setting: Level II trauma center between April 2014 and January 2017.Participants: Eighty-four patients met inclusion criteria and were stratified based on tourniquet use during prehospital care.Main Outcome Measures: Five of the 84 patients received a tourniquet. All five of those tourniquets (100 percent of the group, 6.0 percent of the population) were not indicated and deemed inappropriate. Three of the 84 patients did not receive a tourniquet when one was indicated (3.8 percent of the group, 3.6 percent of the population) and these omissions were also deemed inappropriate. Total error rate was 9.5 percent (8/84).Results: There was a significant association between Mangled Extremity Severity Score (MESS) and likelihood of requiring a tourniquet (p = 0.0013) but not between MESS and likelihood of receiving a tourniquet (p = 0.1055). There was also a significant association between wrongly placed tourniquets and the type of providers who placed them [first responders, p = 0.0029; Emergency Medicine Technicians (EMTs), p = 0.0001].Conclusions: Tourniquets are being used inappropriately in the Hartford prehospital setting. Misuse is associated with both EMTs and first responders, highlighting the need for better training and more consistent protocols.
Responding to a medical crisis: Lessons from the Halifax disaster 100 years ago
Authors: Zona, BS Candidate Emily E. , Morris, MLIS Alina J. , Briggs, MD, MPH Susan M. , Rockoff, MD Mark A.
Published: August 2018

One hundred years ago, a massive explosion occurred in the harbor of Halifax, Nova Scotia, destroying the city and killing more than 2,000 and injuring more than 9,000. It was the worst manmade explosion the world had ever seen, not exceeded until the atomic bomb blast over Hiroshima in 1945. An urgent appeal for assistance came from the survivors, and many volunteers responded. This report describes the prompt and remarkable medical relief effort of the citizens of Massachusetts to help their Canadian neighbors.
A global therapeutic recreation discussion: An overview from Rimini, Italy
Authors: Banhidi, PhD Miklos , Daly, EdD, CTRS Fran Stavola , De Paula Azzine, MS Eduardo , Dieser, PhD Rodney B. , Hebblethwaite, PhD Shannon , Jones, EdD, CTRS David , Kimura, MS Fumika , McKenzie, PhD, CTRS Sharon E. , Meyer, PhD Charlé , Young, DPhil Marié E. M.
Published: August 2018

The 2012 World Leisure Congress (hosted by the World Leisure Organization) took place in Rimini, Italy, from September 30 to October 3. The World Leisure Organization currently has 12 global commissions on various topics (eg, children and youth, leisure education, tourism and the environment, and women and gender), which is focused on having global interactions and discussions related to the three main objectives of research, information dissemination, and advocacy.1 The purpose of this article is to summarize the World Leisure Commission on Accessibility and Inclusion academic labor related to the topic of global therapeutic recreation. To this end, the question at hand for this global commission to discuss was as follows: Is the United States National Council for Therapeutic Recreation Certification (NCTRC) an appropriate credentialing framework for professionals in different countries who are dedicated to working with people with disabilities/special needs in the area of accessibility, inclusion, and therapeutic recreation? The purpose of this article is to share, to the wider United States therapeutic recreation profession, responses and thoughts of members of the global therapeutic recreation commission.
Leisure in hospitals and its interface with health: A study about the reality of a Brazilian city
Authors: Pinto Gabriela Baranowski , Gomes Christianne
Published: August 2018

The purpose of this research is to understand the role of leisure in shaping the reality of hospitalized patients in Brazil. The methodology combines both bibliography and field research techniques performed in internment units of three hospitals in the city of Belo Horizonte. The field research consisted of direct observations and semistructured interviews with 30 volunteers, among hospitalized subjects, companions, and health professionals. The data were analyzed qualitatively through iterative analysis. Results show that leisure activities can improve the health status of hospitalized subjects. Its role in the hospital is mainly related to compensatory and utilitarian functions, with contributions to rest, pain, and suffering reduction, expansion of friendship network, creativity, ability of doing critics, of educating sensitivity, through the dissemination of content and cultural practices among the subjects.
The value of therapeutic outdoor programs with adolescents in a rural residential treatment center: A pilot study
Authors: Coll, PhD Kenneth M. , Sass, EdD Margaret , Freeman, PhD Brenda J. , Thobro, MS Patti , Hauser, MSW Nicole
Published: August 2018

The purpose of this study is to investigate how therapeutic recreation within a wilderness setting (aka therapeutic outdoor programming) affects youth functionality as measured by the Youth Comprehensive Risk Assessment (YCRA) utilizing pretest and post-test results. For purposes of this article, therapeutic recreation is defined as “a treatment service designed to restore, remediate and rehabilitate a person’s level of functioning and independence in life activities, to promote health and wellness as well as reduce or eliminate the activity limitations and restrictions to participation in life situations caused by an illness or disabling condition.”1 Results showed that youth from a residential treatment center (RTC) engaged in a therapeutic outdoor program in the form of overnight trips of at least 3 days reported overall improvements when compared to a matched control group.
Clinical reasoning: A concept for recreation therapy
Authors: Austin, PhD, FDRT, FALS David R. , McCormick, PhD, CTRS, FDRT, FALS Bryan P.
Published: August 2018

Clinical reasoning is a concept adopted by healthcare disciplines such as nursing, occupational therapy, and physical therapy, but it has been largely neglected in the literature of recreation therapy. The purpose of this article is to acquaint those in recreation therapy with clinical reasoning and to discuss how the concept can be useful within the profession of recreation therapy. The authors believe clinical reasoning should be perceived to be a core skill for recreation therapists.