bluuebunny/crossref_metadata_2025 huggingface dataset:
The Guilt of Nations: Restitution and Negotiating Historical Injustices. By Elazar Barkan. Baltimore: Johns Hopkins University Press, 2001. 456p. $18.95.
Authors: Hanasz Waldemar
Published: May 2019

It seems timely and appropriate that the twentieth century—the century of the Holocaust, the Gulag Archipelago, the Killing Fields, the Cultural Revolution, and the “ethnic cleansing” in the Balkans and Rwanda—ended with a wave of growing interest in healing past injustices. Human rights organizations and international commissions investigate violations of human rights. International tribunals judge political leaders, warlords, and their soldiers. Historians, political scientists, and legal theorists study the implications of such crimes and punishments.
Hospitalisation and length of hospital stay following first-episode psychosis: systematic review and meta-analysis of longitudinal studies
Authors: Ajnakina Olesya , Stubbs Brendon , Francis Emma , Gaughran Fiona , David Anthony S. , Murray Robin M. , Lally John
Published: May 2019

Background

Reducing hospitalisation and length of stay (LOS) in hospital following first episode psychosis (FEP) is important, yet reliable measures of these outcomes and their moderators are lacking. We conducted a systematic review and meta-analysis to investigate the proportion of FEP cases who were hospitalised after their first contact with services and the LOS in a hospital during follow-up.

Methods

Studies were identified from a systematic search across major electronic databases from inception to October 2017. Random effects meta-analyses and meta-regression analyses were conducted.

Results

81 longitudinal studies encompassing data for 23 280 FEP patients with an average follow-up length of 7 years were included. 55% (95% CI 50.3–60.5%) of FEP cases were hospitalised at least once during follow-up with the pooled average LOS of 116.7 days (95% CI 95.1–138.3). Older age of illness onset and being in a stable relationship were associated with a lower proportion of people who were hospitalised. While the proportion of hospitalised patients has not decreased over time, LOS has, with the sharpest reduction in the latest time period. The proportion of patients hospitalised during follow-up was highest in Australia and New Zealand (78.4%) compared to Europe (58.1%) and North America (48.0%); and lowest in Asia (32.5%). Black ethnicity and longer duration of untreated psychosis were associated with longer LOS; while less severe psychotic symptoms at baseline were associated with shorter LOS.

Conclusion

One in two FEP cases required hospitalisation at least once during a 7-year follow-up with an average length of hospitalisation of 4 months during this period. LOS has declined over time, particularly in those countries in which it was previously longest.
How does God know that 2 + 2 = 4?
Authors: BRENNER ANDREW
Published: May 2019

Sometimes theists wonder how God's beliefs track particular portions of reality, e.g. contingent states of affairs, or facts regarding future free actions. In this article I sketch a general model for how God's beliefs track reality. God's beliefs track reality in much the same way that propositions track reality, namely via grounding. Just as the truth values of true propositions are generally or always grounded in their truthmakers, so too God's true beliefs are grounded in the subject matters of those beliefs (i.e. God believes thatpin virtue of the fact thatp). This is not idle speculation, since my proposal allows the theist to account for God's true beliefs regarding causally inert portions of reality.
Belief and religious ‘belief’
Authors: AHMED ARIF
Published: May 2019

Is the analysis of religion best conducted in terms of the beliefs of its practitioners? I describe a Wittgenstein-inspired approach to belief on which it is dubious that religious practices satisfy the criteria for the attribution of belief. I defend this more moderate and plausible version of Needham's thesis against two natural reasons to think religious belief widespread.
James Madison's Political Theory: Hostage to Democratic Fortune
Authors: Matthews Richard K.
Published: May 2019

Professor Alan Gibson's insightful article contains much that is admirable. He is, in my view, correct in calling scholars' attention—particularly political scientists—to James Madison's often neglected views in his National Gazette essays and the foundational role of public opinion on all governments. In addition, Gibson asserts several claims hoping to establish Madison's credentials as a democratic theorist that should be of interest as well. Specifically, he seeks to accomplish four tasks: (1) “to clarify the enduring debate over the credibility of Madison's democratic credentials”; (2) to “examine Madison's role in justifying, popularizing, and understanding… public opinion”; (3) to “highlight some of Madison's neglected insights into democratic theory, especially his understanding of the problem of collective action, and thereby establish him as a prescient democratic theorist”; and (4) to argue the case that Madison “contributed to a developing tradition of political thought in America upon a broad-based conception of freedom of speech and on the belief that political truths best emerge from the full flow of ideas.”

While I concur with much of Gibson's position—especially his fourth, indisputable point—I also disagree with him on at least one significant position: James Madison was not a democrat.
Prerogative and the Rule of Law in John Locke and the Lincoln Presidency
Authors: Mattie Sean
Published: May 2019

Locke'sSecond Treatise of Governmentargues for the rule of law as just and rightful politics, not only in the fundamental legislation that is the constitution but also in regular governance by the legislature. Locke also argues for executive prerogative, the power of doing good without or even against law during contingency and necessity. Rule by legislation and rule by prerogative each preserve the political community and reflect its foundation out of the state of nature. But they do not easily coexist in the constitution, which provides no means to judge the rightful use of prerogative. President Lincoln's strong, discretionary actions during the crisis of the Civil War illustrate Locke's argument about prerogative's fundamental importance and its problematic relation to ordinary lawfulness. However, as Lincoln recognized, both the Constitution and Congress formally provided for an executive power that was remarkably compatible with the rule of law—and that thereby responded to the Lockean problem.
A Roman Marching Camp in Ayr
Authors: Arabaolaza Iraia
Published: May 2019

26 carefully positioned fire-pits indicate the location of a Roman marching camp situated near a river crossing and on a terrace of the river Ayr, South Ayrshire, Scotland. Radiocarbon dates from six of the pits provided dates ranging from 2b.c. toa.d.231, with an overlap around the Flavian period (a.d. 77–86 to 90). There is some evidence for the clay superstructure of ovens, and botanical evidence for the fuel used and crops cooked. Supplementary Material available online athttps://doi.org/10.1017/S0068113X19000059.
A Miniature Cist from the Roman Villa at Warblington, Hampshire
Authors: Kenny James , Davies Trevor
Published: May 2019

Excavations by Chichester and District Archaeology Society on the site of a Roman villa at Warblington, near Emsworth, Hampshire, revealed a small stone cist containing two lead packages. While interpretation as a burial is explored, it appears more likely that the cist and its contents represent a ritual deposit within a domestic structure.
Hitching a Lift: Functional Context and Magical Symbolism in a Roman Linchpin from Wootton, North Lincolnshire
Authors: Parker Adam , Mckie Stuart
Published: May 2019

A unique linchpin depicting a human thumb, discovered in North Lincolnshire in the 1980s, is here reconsidered and particular emphasis is placed on its potential as an apotropaic symbol. This function is explored in terms of the wider material and literary basis for magical gestures in Roman Britain and the Roman world. The relationship between this image and the space in which it was used is also explored.
A Hint of Exeter's Hinterland and Port: A New Large Aisled Hall Building at Wessex Close, Topsham, Devon
Authors: Rainbird Paul , Farnell Alex
Published: May 2019

A large aisled hall building excavated at Topsham, near Exeter, Devon, dates to the late second and third centuries a.d. and would have been used simultaneously for domestic accommodation, crop processing, fish sauce making, industrial activities and storage. Its large size is unique in the hinterland of Roman Exeter and this is almost certainly due to its prime position next to both the Exe estuary and the Roman road between Topsham and Exeter. The issues raised in regard to the relationship between Exeter and its hinterland are discussed.
Cultural and Commercial Intermediaries in an Extra-Legal System of Exchange: ThePrácticosof the Venezuelan Littoral in the Eighteenth Century
Authors: Cohen Jeremy David
Published: May 2019

Human social organisation intrinsically includes borders, divisions that mark inside and outside, civilised and barbaric, acceptable and unacceptable. Human groups establish physical and ideational boundaries that help order, explain, and direct their lives. Those groups and activities that blur or cross over these lines receive special attention, as their violations of or challenges to what are presented as logical, natural, and moral standards force their reconciliation with generalised norms. Such people and actions are categorised as immoral, uncouth, detrimental, seditious, or non-human. They are also often considered endowed with special powers.
THE PROCESSING OF ENGLISH PREFIXED WORDS BY CHINESE-ENGLISH BILINGUALS
Authors: Li Junmin , Taft Marcus
Published: May 2019

The present study examined whether Chinese-English bilinguals showed morphological sensitivity toward prefixed words. In the experiment, English monolinguals showed masked priming effects in a Transparent condition (disagree-AGREE) and an Opaque condition (mischief-CHIEF), but not in a Form condition (stranger-ANGER). In contrast, bilinguals showed equivalent priming effects across the three conditions. Indeed, the difference between the magnitude of priming in the Form condition relative to that in the other two conditions was statistically smaller for the bilinguals than for the monolinguals. These findings suggest Chinese-English bilinguals are less sensitive to the morphological status of prefixes, compared with monolinguals.
Methodology to design ontologies from organizational models: application to creativity workshops
Authors: Alex Gabriel , Chavez Barrios Pedro , Davy Monticolo
Published: May 2019

Innovation and creativity are a mandatory for companies who wish to stay competitive. In order to promote an inventive dynamic, it implies to set up tools, habits, and an adapted environment to foster creativity. Creativity is the wealth of companies that should be valorized. To promote creativity, companies implement creativity workshops that gather people with various roles and expertise exchange and create knowledge to solve collectively open-ended engineering problems. However, group dynamics or facilitation can make the wrong decision and make the creative problem-solving unfruitful. The aim of our research project is to create a digital system to manage and valorize knowledge during creativity workshops. To design this system, we need to formalize the knowledge domain of creative workshops. The ontologies are used for decades to structure and manage information and knowledge in different domains. However, methodologies to design these ontologies are either hardly reproducible or not oriented to extract knowledge from organization. This article describes a methodology based on an organizational modeling to build ontologies. We will illustrate our approach by designing an ontology that models knowledge of creativity workshops.
Intergenerational transmission of emotion dysregulation: Part II. Developmental origins of newborn neurobehavior
Authors: Ostlund Brendan D. , Vlisides-Henry Robert D. , Crowell Sheila E. , Raby K. Lee , Terrell Sarah , Brown Mindy A. , Tinajero Ruben , Shakiba Nila , Monk Catherine , Shakib Julie H. , Buchi Karen F. , Conradt Elisabeth
Published: May 2019

We investigated whether neurobehavioral markers of risk for emotion dysregulation were evident among newborns, as well as whether the identified markers were associated with prenatal exposure to maternal emotion dysregulation. Pregnant women (N= 162) reported on their emotion dysregulation prior to a laboratory assessment. The women were then invited to the laboratory to assess baseline respiratory sinus arrhythmia (RSA) and RSA in response to an infant cry. Newborns were assessed after birth via the NICU Network Neurobehavioral Scale. We identified two newborn neurobehavioral factors—arousal and attention—via exploratory factor analysis. Low arousal was characterized by less irritability, excitability, and motor agitation, while low attention was related to a lower threshold for auditory and visual stimulation, less sustained attention, and poorer visual tracking abilities. Pregnant women who reported higher levels of emotion dysregulation had newborns with low arousal levels and less attention. Larger decreases in maternal RSA in response to cry were also related to lower newborn arousal. We provide the first evidence that a woman's emotion dysregulation while pregnant is associated with risks for dysregulation in her newborn. Implications for intergenerational transmission of emotion dysregulation are discussed.
Emotional insecurity as a mediator of the moderating role of dopamine genes in the association between interparental conflict and youth externalizing problems
Authors: Davies Patrick T. , Pearson Joanna K. , Cicchetti Dante , Martin Meredith J. , Cummings E. Mark
Published: May 2019

This study tested whether the association between interparental conflict and adolescent externalizing symptoms was moderated by a polygenic composite indexing low dopamine activity (i.e., 7-repeat allele ofDRD4; Val alleles ofCOMT; 10-repeat variants ofDAT1) in a sample of seventh-grade adolescents (Mean age = 13.0 years) and their parents. Using a longitudinal, autoregressive design, observational assessments of interparental conflict at Wave 1 predicted increases in a multi-informant measurement of youth externalizing symptoms 2 years later at Wave 3 only for children who were high on the hypodopaminergic composite. Moderation was expressed in a “for better” or “for worse” form hypothesized by differential susceptibility theory. Thus, children high on the dopaminergic composite experienced more externalizing problems than their peers when faced with more destructive conflicts but also fewer externalizing problems when exposed to more constructive interparental conflicts. Mediated moderation findings indicated that adolescent reports of their emotional insecurity in the interparental relationship partially explained the greater genetic susceptibility experienced by these children. More specifically, the dopamine composite moderated the association between Wave 1 interparental conflict and emotional insecurity 1 year later at Wave 2 in the same “for better” or “for worse” pattern as externalizing symptoms. Adolescent insecurity at Wave 2, in turn, predicted their greater externalizing symptoms 1 year later at Wave 3. Post hoc analyses further revealed that the 7-repeat allele of the dopamine receptor D4 (DRD4) gene was the primary source of plasticity in the polygenic composite. Results are discussed as to how they advance process-oriented Gene x Environment models of emotion regulation.
Reported Strategies for Responding to the Aggressive and Extremely Disruptive Behaviour of Students Who Have Special Needs
Authors: Murik Joe , Shaddock Anthony , Spinks Anthony , Zilber David , Curry Craig
Published: May 2019

This research examines the strategies reported by teachers who have managed aggressive and extremely disruptive behaviour of students who have special needs. A sample of 52 teachers from mainstream and special settings listed the strategies that they have used to respond to this behaviour, the reasons for their choice and their estimate of the effectiveness of the strategies. The results indicate that teachers of students with special needs encounter a significant amount of challenging behaviour directed towards themselves and others. The study found that although teachers’ years of experience and level of training were unrelated to their choice of strategies and their perceived success, the majority of teachers relied heavily on their own and their colleagues’ experiences rather than on evidence‐based/empirical research. The study also found a low reported incidence of negative or coercive interventions and that approximately half of the teachers adopted strategies that involved some form of functional assessment of aggressive and/or extremely disruptive behaviours. The implications for further research, policy development, in‐service training and professional development were explored.
Tourette’s Syndrome and the School Experience: A Qualitative Study of Children’s and Parents’ Perspectives
Authors: Grace Rebekah , Russell Cherry
Published: May 2019

This article reports on research exploring the school experiences of 26 children (aged between 8 and 15.5 years) diagnosed with Tourette’s Syndrome. The research adopted a qualitative methodology, and is reported here from the perspective of both the parents and the children themselves. Three different groups of families emerged: those who were moderately satisfied in their experiences with the school system, those who were dissatisfied in their experiences with the school system, and families who were so completely dissatisfied that they removed their child from the school system altogether. There was no participating child or parent who was entirely satisfied in their experiences with teachers and the school. Themes that emerged for each of these groups are discussed. This research stresses the importance of teacher understanding and flexibility, as well as parent/school communication. The facilitation of social acceptance for a child with Tourette’s Syndrome is also extremely important to successful classroom integration.
Students with Asperger’s Syndrome in an Inclusive Secondary School Environment: Teachers’, Parents’, and Students’ Perspectives
Authors: Hay Ian , Winn Stephen
Published: May 2019

This qualitative study used focus groups and interviews to investigate the inclusion of students with Asperger’s Syndrome (AS) into secondary education from the perspectives of: general teachers; special education teachers; students with AS; and their parents(N =122). Across the four cohorts, five main themes emerged, however, different cohorts concentrated more on one theme than another. Mainstream teachers concentrated more on the nature of the AS condition and its influence on behaviour and social interactions; special education teachers on collaboration and relationships; parents on burnout and a lack of services; and the students with AS on the notion special educators worked hard to assist others. The fifth theme across the four cohorts was the quality of school facilities. The study found that diversity was both an inter‐cohort and an intra‐cohort variable. The research provides insight into how inclusive practice can be enhanced and why it is a complex, dynamic and multidimensional concept.
Subclinical rheumatic valvitis: a long-term follow-up
Authors: Lanna Cristina Costa Duarte , Tonelli Edward , Barros Marcio Vinicius Lins , Goulart Eugenio Marcos Andrade , Mota Cleonice Carvalho Coelho
Published: May 2019

In order prospectively to investigate the frequency and evolution of subclinical valvitis, we selected 40 consecutive patients suffering their initial attack of rheumatic fever, seen in our clinic from 1992 to 1994, and followed-up until 2001, with a mean period of follow-up of 8.1 years, and a standard deviation of 0.6 year. We also assembled a matched control group of 37 healthy children and adolescents. We discovered a murmur of mitral regurgitation in 28 (70.0%) of the patients. In 3 (7.5%) of these patients, there was also a murmur of aortic regurgitation. In the group of 28 symptomatic patients, Doppler echocardiography showed mitral regurgitation in all, and aortic regurgitation in 17. In the group of 12 patients without clinical evidence of cardiac involvement, Doppler echocardiography identified mitral regurgitation in 2, isolated in one and associated with aortic regurgitation in the other. Thus, the frequency of subclinical valvitis was 16.7%. In patients with subclinical valvitis only the aortic regurgitation regressed during the period of follow-up. In the group of 28 symptomatic patients, mitral regurgitation disappeared in 6 (21.4%), aortic regurgitation in 7 of the 17 having this feature (41.2%), while 2 patients (7.1%) developed mitral stenosis. The sensitivity and specificity of cardiac auscultation were, respectively, 93.3%, with 95% confidence intervals between 72.3% and 97.4%, and 100%, with 95% confidence intervals between 65.5% and 100%, for the diagnosis of mitral regurgitation, and 16.7%, with 95% confidence intervals between 4.4% and 42.3%, and 100%, with 95% confidence intervals between 81.5% and 100%, for that of aortic regurgitation. We conclude that the Doppler echocardiogram is an important means of diagnosing and assessing the evolution of subclinical rheumatic valvar lesions, which are not always transient. We suggest that Doppler echocardiography should be performed in all patients with acute rheumatic fever. Subclinical valvitis should be considered as mild carditis, provided that strict criterions are observed in the differential diagnosis from physiological regurgitation, and Doppler echocardiographic findings are analyzed in the context of the other manifestations of the disease.
Pulmonary regurgitation after percutaneous balloon valvoplasty for isolated pulmonary valvar stenosis in childhood
Authors: Poon Louisa K. H. , Menahem Samuel
Published: May 2019

Objectives: A retrospective study was undertaken to determine the degree of pulmonary regurgitation following percutaneous balloon valvoplasty for isolated pulmonary valvar stenosis. Background: Percutaneous balloon valvoplasty is the recognised treatment of choice in pulmonary valvar stenosis with effective relief of gradient. Few studies have reviewed the degree of pulmonary regurgitation after the balloon valvoplasty. Methods: We reviewed all patients with isolated pulmonary valvar stenosis undergoing percutaneous balloon valvoplasty at a tertiary centre between December 1984 and August 1996. Those with an associated haemodynamically insignificant atrial septal defect or patent oval foramen were also included. Their medical records, echocardiograms and angiograms were studied. Colour flow Doppler was used as a semi-quantitative way of assessing the pulmonary incompetence. Results: Over the period of review, 57 procedures had been performed in 49 patients. The median age at the time of the procedure was 1.08 years, with a range from 0.01 to 13.3 years. The median period of follow-up was 5.64 years, with a range from 3.00 to 14.26 years. Immediately following the dilation of the pulmonary valve, the peak-to-peak instantaneous systolic pressure gradient was significantly reduced. Seven patients required a second dilation of the valve. Their median age at the first valvoplasty, at 0.49 year, was significantly lower than those who required only one procedure, at a median of 1.50 years. Following the valvoplasty, mild pulmonary incompetence was noted in 26 out of 42 patients the day after the procedure, but only 7% had moderate incompetence. On follow-up, there was an increase in the number of patients with moderate to severe pulmonary incompetence, from 7% to 29%. Those patients in whom the procedure was performed at a younger age had more significant pulmonary incompetence. Neither the initial gradient across the pulmonary valve, nor the size of the balloon used, were related with statistical significance to the subsequent development of pulmonary incompetence. Conclusions: The majority of the patients with congenital isolated pulmonary valvar stenosis had only a mild increase in the degree of pulmonary incompetence following a single pulmonary valvoplasty. Patients who required the procedure early in life were more likely to develop significant pulmonary incompetence. The ratio of the size of the balloon to the diameter of the valve did not significantly affect the outcome. We suggest that those patients who had more severe stenosis because of a more abnormal pulmonary valve, and hence required early intervention, were more likely to develop greater pulmonary incompetence after the valvoplasty.
A fatal case of idiopathic restrictive cardiomyopathy
Authors: Palka Przemysław , Lange Aleksandra , Ward Cameron
Published: May 2019

We describe the clinical features of idiopathic restrictive cardiomyopathy in a female infant. A marked elevation of left ventricular end-diastolic pressure, and profoundly abnormal myocardial relaxation, were detected with the use of Doppler blood flow echocardiography, coupled with the relatively new technique of Doppler tissue echocardiography. There was no clinical evidence of ongoing heart failure, but she had signs of myocardial ischaemia, and unfortunately died suddenly at the age of 13 months.
Critical pulmonary stenosis with an aortopulmonary window
Authors: Marwah Ashutosh , Soto Rodrigo , Penny Daniel J.
Published: May 2019

In neonates with severe aortic or pulmonary stenosis, the obstructed circulation is usually supported through patency of the arterial duct. We describe a neonate in whom an aortopulmonary window supported a critically obstructed pulmonary circulation.
Cardiovascular findings, and clinical course, in patients with Williams syndrome
Authors: Bruno Eva , Rossi Norma , Thüer Oscar , Córdoba Roque , Alday Luis E.
Published: May 2019

Aims:We investigated the incidence and outcome of cardiac malformations in 53 patients with Williams syndrome.Methods and results:The mean age, and period of follow-up, were 3.6 and 5.3 years, with standard deviations of 4.0 and 5.6 years, respectively. Of the patients, 45 (85%) had cardiovascular anomalies, often combined. Males presented earlier than females, at the ages of 2.1 years, with standard deviation of 2.8 years, as opposed to 4.5 years, with standard deviation of 4.2 years (p < 0.01). Supravalvar aortic stenosis occurred in 32 patients (71%), pulmonary arterial stenosis in 17 (38%), and mitral valvar prolapse in 12 (27%), 9 of these having regurgitant valves. Pulmonary valvar stenosis, ventricular septal defect, coarctation of the aorta, persistent patency of the arterial duct, hypertrophic cardiomyopathy, and subaortic stenosis all occurred less frequently. In 21 patients (47%), 24 surgical or catheter interventions had been made, most often for repair of supravalvar aortic stenosis, undertaken on 16 occasions with just one recurrence, and in 4 along with surgery to the mitral valve. Other lesions requiring intervention were pulmonary valvar stenosis, pulmonary arterial stenosis, coarctation of the aorta, and subaortic stenosis. We lost 3 patients (7%), with severe supravalvar aortic stenosis and moderate or severe mitral regurgitation, 2 early and one late after surgery.Conclusion:The most frequent cardiovascular anomalies in Williams syndrome were supravalvar aortic stenosis, pulmonary arterial stenosis, and mitral valvar prolapse, which occurred more frequently in our patients than previously observed. Patients with left ventricular pressure and volume overload were at greater risk.
Surgical ligation of a residually patent arterial duct following failed occlusion using transcatheter coils
Authors: Wheeler Derek S. , Maxwell James Matthew , Poss W. Bradley
Published: May 2019

Transcatheter techniques for occlusion of the persistently patent arterial duct using coils have become standard therapy at many centers for pediatric cardiology, and in selected patients have demonstrated comparable efficacy to surgical ligation. Surgical ligation may still be required in many cases, including premature infants or those born with low weight, those with ducts of large diameter, those with associated structural heart disease, and in circumstances of unsuccessful occlusion subsequent to attempted closure using coils. We report on the successful surgical ligation of an arterial duct of moderate size that exhibited residual patency despite two separate attempts at occlusion using coils.
Cardiac features in the presymptomatic period in a neonate with anomalous left coronary artery arising from the pulmonary trunk
Authors: Bolt Isabel , Spalinger Johannes , Pfammatter Jean-Pierre
Published: May 2019

We describe a neonate presenting with a cholestatic jaundice due to Alagille syndrome. On echocardiography as part of the diagnostic work-up, we noted a slight dilation of the normally functioning left ventricle at the initial examination in the third week of life. Over the next 2 weeks, serial echocardiograms showed slowly progressive dilation and dysfunction of the left ventricle, together with a persistent mild elevation of levels of cardiac Troponin-I in the serum. These findings, unrelated to the underlying Alagille syndrome, prompted cardiac catheterisation, which confirmed that the main stem of the left coronary artery was originating from the pulmonary trunk. Surgery was successfully performed still in the presymptomatic period. The association of Alagille syndrome with anomalous left coronary artery arising from the pulmonary trunk is most unusual. We emphasise the cardiac findings prior to detection of the anomalous origin of the coronary artery.
Vaccine Administration by Paramedics: A Model for Bioterrorism and
Disaster ResponsePreparation
Authors: Walz Bruce J. , Bissell Richard A. , Maguire Brian , Judge James A.
Published: May 2019

The events of 11 September 2001 have had a profound effect on disaster
planning efforts in the United States. This is true especially in the area
of bioter-rorism. One of the major tenets of bioterrorism response is the
vaccination of at-riskpopulations. This paper investigates the efficacy of
training emergency medical services paramedics to administer vaccines in
public health settings as preparation for and response to bioterrorism
events and other disaster events.

The concept of vaccination administration by specially trained
paramedics is not new. Various programs to provide immunizations for
emergency services personnel and at-risk civilian populations have been
reported.

Vaccination programs by paramedics should follow the guidelines of the
National Vaccine Advisory Committee of the Centers for Disease Control and
Prevention (CDC). Thispaper compares the seven standards of the CDC
guidelines to routine paramedic practice and education. It is concluded that
paramedics are adequately trained to administer vaccines. However, specific
training and protocols are needed in the areas of administrative paperwork
and patient education. A proposed outline for a paramedic-training program
is presented.
Dallas Mega Shelter Onsite Medical Operations Supporting Evacuee Functional Independence and Family Unit Integrity During Response to Hurricane Harvey
Authors: Swienton Raymond E. , Klein Kelly R. , Liu E. Liang , Flax Lindsay A. , Fowler Raymond L.
Published: May 2019

Introduction:

In the United States, over 50% of people have at least one chronic medical condition, access, or functional limitation. In 2017 during Hurricane Harvey, the establishment of a comprehensive multidisciplinary onsite medical clinic provided health and medical services to over 3,800 evacuees at the Dallas Mega Shelter, providing large-scale general population sheltering support to all evacuees and prioritizing family unit integrity by meeting physical, sensory, and cognitive limitations, and chronic medical conditions. The effectiveness of the Dallas Mega Shelter onsite medical operations supporting this aim is reviewed.

Aim:

To utilize onsite health and medical resources to meet access and functional needs of evacuees seeking general population mass sheltering in Dallas, Texas during Hurricane Harvey.

Methods:

Observational.

Results:

Over 3,800 evacuees were evaluated for functional needs support services (FNSS) resulting in over 2,500 evacuee patient encounters during 21 continuous days of onsite health and medical clinic operations.1 A comprehensive array of services were available at no cost to the evacuees and were in accordance with the Federal Emergency Management Association (FEMA) published Guidance on Planning for Integration of Functional Needs Support Service in General Population Shelters.2 The goal to maintain nearly all evacuees choosing to stay in the Mega Shelter was achieved. The challenges, limitations, and risks identified are reviewed.

Discussion:

FNSS guidelines require all persons, regardless of limitations, when evacuated from home be provided all services necessary to allow them to remain in general population sheltering.2 This prioritization of personal choice, functional independence, and family integrity for those with comprehensive FNSS requirements presented notable challenges, including public health and safety risks impacting the wellbeing of others. Meeting these expectations must be balanced with maintaining shelter integrity.
Development of an Evacuation Exercise for Residential Aged Care Facilities Using the Emergo Train System (ETS)
Authors: Cronan Karl , Winn Linda
Published: May 2019

Introduction:

Events such as the Sydney Quakers Hill Nursing Home fire highlighted the great need for robust evacuation plans for Residential Aged Care Facilities (RACFs). However, plans alone are not sufficient and routine exercises are necessary to test the capability of a facility’s emergency plan. Current methods of exercising facility evacuations, such as live drills, are limited and only test isolated elements of the evacuation process, which fall drastically short of being able to simulate the real-time resources and procedures required to perform a large scale evacuation of a RACF.

Aim:

To develop an exercise tool that assists Residential Aged Care Facilities (RACF) to evaluate their evacuation procedures using quantifiable data, based on real-time and providing minimal disruption to existing residents.

Methods:

Utilizing the existing ETS framework, an aged care resident patient bank was developed by NSW Health Emergency Management Unit, including:

A bank of 200 residents from data sourced from the Australian Institute of Health and Welfare.

Layout for the resident gubers and Summary Care Plans.

Resources and equipment routinely used in RACF’s.

Real-world testing of the prototype in exercises across NSW, Australia

Mortality and morbidity data to measure outcomes.

Validation of the exercise tool nationally and internationally.

Results:

A bank of residents was developed to test evacuation systems and processes, in a scalable, realistic simulation based on patient outcomes. This will result in improved planning and process, empowerment of RACFs, better patient outcomes, and increased resilience and preparedness.

Discussion:

A significant investment of data, time, and effort has gone into producing this resident bank for use in RACF evacuation exercises across NSW Australia. A presentation delivered at the ETS World Congress in the Netherlands (2018), by NSW Health Emergency Management Unit, showcased the relevance and suitability of this tool across the world.
Multiple Patients with Burn Injury Induced by a Chemical Explosion Managed by Physician-staffed Helicopters
Authors: Yanagawa Youichi , Kondo Akihiko , Nagasawa Hiroki , Takeuchi Ikuto , Jitsuiki Kei , Osaka Hiromichi , Ishikawa Kouhei , Omori Kazuhiko
Published: May 2019

Introduction:

The management of chemical and explosive events is critical to reducing morbidity and mortality. However, initial patient care considerations and protective actions for staff are unfamiliar to most frontline clinicians.

Methods:

This study evaluated an Incident report.

Results:

On December 1, 2017, a factory of chemical industries in Japan exploded. Dust forming as a byproduct from the crushing and packing process of the resin for ink exploded at the facility. A local fire department requested the dispatch of two physician-staffed helicopters (known as a doctor helicopter [DH] in Japan). The first party of emergency services established a headquarters and first-aid station. However, this area was feared to be at risk of a second explosion. Physicians performed re-triage for all 11 burned patients. Three severely injured patients were transported to emergency medical service centers either by ground ambulance or the DH without undergoing any decontamination. The physician who escorted the patient by ground ambulance complained of a headache. One of the severely injured patients was treated at a local hospital and then transported to an emergency medical service center after undergoing decontamination and intubation. Fortunately, all patients who were transported to medical facilities obtained a survival outcome.

Discussion:

Chemical, biological, radiological, nuclear, and explosive incidents are rare, but can be fatal for responders to this kind disaster. As such, all who work at such scenes should be prepared and train adequately to ensure they have the knowledge and skill to both manage patients and protect themselves from harm.
Chemical Warfare Agent Terrorist Attacks in Latin America and the Caribbean Region (CWA-LAC)
Authors: Argote Killiam A , Molloy Michael , Hart Alexander , Voskanyan Amalia , Sarin Ritu R , Ciottone Gregory R
Published: May 2019

Introduction:

In the past five decades, the region of Latin America and the Caribbean (LAC) has been subject to several types of terrorist attacks, with most committed by local terrorist organizations. However, there have also been attacks by international terrorist groups. Internationally, terrorist attacks are increasing in both frequency and complexity. Significant concerns exist regarding the use of Chemical Warfare Agents (CWAs) in civilian settings. Asphyxiants (e.g. cyanide), opioids (e.g. fentanyl), and nerve agents (e.g. sarin) represent some of the most lethal CWAs. To date, there is very little published data on their use in the LAC region despite the fact that the recent attacks in Syria have sparked international interest in the use and regulation of CWAs.

Aim:

To improve civilian health service preparedness in response to CWAs attacks by describing the types of agents historically used within the LAC region.

Methods:

Information was extracted and analyzed from the open-source Global Terrorist Database hosted by the University of Maryland, regarding CWA-LAC from January 1, 1970, to December 31, 2017.

Results:

During the forty-seven year period reviewed, there were 29,846 terrorist attacks in the LAC region, with 63.6% occurring in the southern region. Twenty-nine CWA attacks were reported, with the most common agents being tear gas (37%) and cyanide (29.6%). The most frequent targets were religious figures/institutions (22.2%), law enforcement (18.5%), and government agencies/personnel (18.5%).

Discussion:

Cyanide is one of the most prevalent agents used for chemical weapons attacks in the LAC region. Preparedness should be enhanced for CWA terrorist attacks, especially those involving cyanide, given its life-threatening nature, prevalence, and the existence of reversal agents. First responders, physicians, and nurses should be aware of this potential hazard and be trained to respond appropriately. Additionally, regional stockpiles of antidotes should be considered by governmental bodies within the LAC region.
A National Model for Tactical Emergency Medical Support in Finland
Authors: Hallikainen Juhana , Lund Vesa
Published: May 2019

Introduction:

Tactical Emergency Medical Response (TEMS) originated in the 1990s in Finland. It is a nationally standardized joint-effort with EMS and police special units, such as SWAT.

Aim:

To describe a national system of TEMS in Finland.

Methods:

In Finland, TEMS is a national response system of specially trained paramedics and pre-hospital doctors, working normally in HEMS or a local physician staffed rapid response car. There is a two-tier selection to get accepted in the basic course. The police run background checks for all participants before they are accepted to the course. The course itself is four days and it covers the basics of police tactics, protective gear, penetrating wounds, evacuation, etc. After graduating from the basic course, the paramedic/doctor is qualified to participate in missions. Although healthcare professionals are involved, a TEMS mission is under the police command and is used as one of the police’s special teams to operate in areas where normal EMS cannot be allowed for safety reasons. TEMS does not carry any weapons. The Police provide the teams with the same protective equipment that the SWAT/CTU has. After some years, there is a three-day refresher course for active TEMS service. In this course, the main training points are working in austere environments, such as helicopters, boats, and in urban environments wearing civilian clothing. Police pay for the usage of TEMS in missions, but they do not pay for training days.

Results:

TEMS has good national coverage. In 2017, there were 131 TEMS activations. The normal response to a mission is a team of one or two TEMS operators.

Discussion:

TEMS has achieved good national coverage and is deployed often. TEMS has also channeled information and training, such as TECC, to normal EMS personnel and raised their preparedness as well.
In What Ways Does Australian Emergency Management Reflect the Criteria of a Profession?
Authors: Mcardle Dudley , Archer Francis , Spencer Caroline
Published: May 2019

Introduction:

The term “profession” to describe the people who carry out emergency management (EM) in Australia continues to gain momentum. Many emergency managers see themselves and are seen by others as professionals, yet little evidence exists to confirm this proposition. Unlike other professions, there is no peak body or overarching organization in Australia to help the diverse group of emergency managers to identify standards of performance and to lobby decision-makers on their behalf.

Aim:

This study identifies criteria that define a profession and considers how the emergency management sector in Australia reflects them.

Methods:

A literature review and review of established professions informed criteria of what constitutes a profession. Using these criteria, a survey was conducted to identify the demographic profiles of Australian emergency managers, their perception of the criteria of a profession, and their attitudes towards professionalization of their sector. Semi-structured interviews were conducted with a representative sample. Ethics approval was obtained.

Results:

A set of criteria for an EM context in Australia was created. 859 emergency managers in Australia were surveyed using an online questionnaire. No common profile emerged from the survey in terms of age, gender, background, expertise, skills, or experience. Likewise, no clear career path, no clearly defined standard training, no universal standards of performance, and no statutory certification to qualify an emergency manager as a professional were revealed. Participants variously identified some of the necessary criteria of a profession, but no uniformity emerged.

Discussion:

This unique study concludes that the sector is not yet in a position to regard emergency management as a profession. Recommendations suggest steps be taken in the short- and long-term to facilitate the establishment of EM as a profession and identifies further research to inform the journey towards professionalizing the emergency management sector.
Long-Term Disaster Resilience: A Research Gap
Authors: Spencer Caroline , Majeed Saadia , McArdle Dudley , Parkinson Deb , Archer Frank
Published: May 2019

Introduction:

This research identified a gap in understanding the lived experience of long-term disaster resilience (LTDR). Increasing disasters could influence more people. Therefore, understanding LTDR becomes imperative. Little research documents men and women’s reflections following disasters. Current research highlights survivors’ mental health, particularly clinical diagnoses like PTSD. Research remains limited on the social impacts long after disasters.

Aim:

Research aimed to identify a gendered perspective of the lived experience about what contributes to LTDR three years after Ash Wednesday in 1983, the Victorian floods in 1993 and 2010-11, and the 2009 Black Saturday fires.

Methods:

A comprehensive, systematized search was conducted of peer-reviewed, grey, and secondary literature for a narrative review and thematic analysis.

Results:

106 references were identified. After removing duplicates and papers not fitting the inclusion criteria, two papers met the criteria. However, two borderline papers were included due to the closeness of the timeframe and brevity of research available.

Discussion:

Most research is related to the immediate aftermath or short-term resilience. Papers provided no specific attributes to enhance the lived experience of LTDR as it related to gender. However, factors that could enhance the lived experience of LTDR were drawn from six themes in sociological studies. Presumptive interpretations were made about what factors may provide insight into the social and contextual issues of LTDR. The literature dearth identified the need for long-term disaster resilience research. The most striking conclusion drawn from themes tells how people perceived the way a disaster and the ensuing period affected their personal relationships and circumstances. Overall, positive experiences strengthened their resilience while negative experiences hindered their resilience. While the review resulted in a disappointing outcome, the dearth of LTDR research lacked any reference to gender but confirmed research opportunities for innovative research that could influence policy and practice.
Emergency Medical Teams in ASEAN Region - Challenges for Global EMT Classification
Authors: Kai Soichiro
Published: May 2019

Introduction:

Quality assurance of Emergency Medical Teams (EMTs) is a world concern. The World Health Organization (WHO) published an international guideline for EMTs in 2013 and started the global EMT classification, a quality assurance program for EMTs, in 2015. There are 16 classified EMTs in the world as of October 2018. The Association of Southeast Asian Nations (ASEAN) region is a disaster-prone area. Therefore, the need for EMTs is relatively high. However, there is no classified EMT in the ASEAN region. Factors that prevent the global classification of EMTs in the ASEAN region are unknown.

Aim:

The objective of this study was to analyze the inhibitory factors of the global EMT classification in the ASEAN region.

Methods:

A questionnaire survey was taken to the 10 national groups of ASEAN countries. Each group consisted of EMT-related personnel. They were 39 participants for the third AMS Training of the ARCH Project held in May 2018. 10 national groups were asked to answer whether governmental EMT of their country is able to meet the criteria for the EMT global classification. The criteria were written in the WHO-provided minimum standard self-assessment checklist for the Type 1 fixed EMT.

Results:

Among 39 categories in the self-assessment checklist, 5 were the most difficult categories to meet the criteria: [Core Standards] Self-sufficiency, Sanitation, and Waste Management; Indemnity and Malpractice; [Technical Standards] Logistics; EMT Capacity.

Discussion:

There are some limitations to the study. Non-governmental EMTs were not covered. Participants of the training were not at the official EMT focal point for the global EMT classification. Logistical requirements may be inhibitory factors of the global EMT classification in the ASEAN region.