bluuebunny/crossref_metadata_2025 huggingface dataset:
Involvement of IL‐17A‐producing TCR γδ T cells in late protective immunity against pulmonary Mycobacterium tuberculosis infection
Authors: Umemura Masayuki , Okamoto‐Yoshida Yuko , Yahagi Ayano , Touyama Seigo , Nakae Susumu , Iwakura Yoichiro , Matsuzaki Goro
Published: August 2016

Introduction

Interleukin (IL)‐17A is a cytokine originally reported to induce neutrophil‐mediated inflammation and anti‐microbial activity. The CD4+ T cells, which produce IL‐17A, have been well characterized as Th17 cells. On the other hand, IL‐17A‐producing TCR γδ+ T cells have been reported to participate in the immune response at an early stage of infection with Listeria monocytogenes and Mycobacterium bovis in mice. However, the involvement of IL‐17A in protective immunity was not clearly demonstrated in the chronic stage of M. tuberculosis‐infected mice.

Methods

We analyzed role of IL‐17A in host defense against chronically infected M. tuberculosis using IL‐17A KO mice.

Results

We found that TCR γδ+ T cells are a primary source of IL‐17A, but that mycobacterial antigen‐specific Th17 cells were hardly detected even at the chronic stage of M. tuberculosis infection. IL‐17A‐deficient mice showed a decreased survival rate, and increased bacterial burden in the lungs after the infection when compared to the wild‐type mice. Furthermore, a histological analysis showed an impaired granuloma formation in the infected lungs of IL‐17A‐deficient mice, which was considered to be due to a decrease of IFN‐γ and TNF at the chronic stage.

Conclusion

Our data suggest that the IL‐17A‐producing TCR γδ+ T cells, rather than the Th17 cells, in the infected lungs are an indispensable source of protective immunity against M. tuberculosis infection.
Application of high resolution OCT to evaluate irregularity of Bowman's layer in asymmetric keratoconus
Authors: Pahuja Natasha , Shroff Rushad , Pahanpate Pratik , Francis Mathew , Veeboy Leio , Shetty Rohit , Nuijts Rudy M. M. A. , Roy Abhijit Sinha
Published: August 2016

Irregularity of the Bowman's layer (BL) in keratoconus (KC, sample size (n) = 28) and forme fruste keratoconus (FFKC, n = 18) eyes was evaluated. Subjects underwent high resolution OCT imaging (Bioptigen Inc., USA) and corneal tomography (Pentacam v1.20r41, OCULUS Optikgeräte GmbH, Germany). Anterior edge of the BL was segmented. A Bowman's roughness index (BRI) was defined as the sum of the enclosed areas between segmented edge and a smooth 3rd order polynomial fit to the edge. BRI was compared with corneal aberrations, Keratoconus percentage index (KISA), Cone location magnitude index (CLMI) and Belin–Ambrosio enhanced ectasia display overall deviation index (BAD‐D). Area under the curve (AUC) was determined with logistic regression (LR). Mean BRI (×10–3) was 2.12 mm2, 1.81 mm2 and 1.7 mm2 in normal (n = 26), FFKC and KC eyes, respectively (p < 0.001). BAD‐D (0.79) and BRI (0.74) had the best AUC for FFKC. By combining BAD‐D and BRI, the AUC improved to 0.85 (p = 0.01). For KC eyes, KISA (0.94), CLMI (0.88), BAD‐D (0.96) and aberrations had comparable AUC (p > 0.05). However, LR with BRI and other indices didn't improve the AUC in KC eyes (p > 0.05). BRI was significantly reduced in FFKC and KC eyes. It improved the detection of FFKC but not KC eyes.

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Density functional theory for molecular and periodic systems using density fitting and continuous fast multipole method: Analytical gradients
Authors: Łazarski Roman , Burow Asbjörn Manfred , Grajciar Lukáš , Sierka Marek
Published: August 2016

A full implementation of analytical energy gradients for molecular and periodic systems is reported in the TURBOMOLE program package within the framework of Kohn–Sham density functional theory using Gaussian‐type orbitals as basis functions. Its key component is a combination of density fitting (DF) approximation and continuous fast multipole method (CFMM) that allows for an efficient calculation of the Coulomb energy gradient. For exchange‐correlation part the hierarchical numerical integration scheme (Burow and Sierka, Journal of Chemical Theory and Computation 2011, 7, 3097) is extended to energy gradients. Computational efficiency and asymptotic O(N) scaling behavior of the implementation is demonstrated for various molecular and periodic model systems, with the largest unit cell of hematite containing 640 atoms and 19,072 basis functions. The overall computational effort of energy gradient is comparable to that of the Kohn–Sham matrix formation. © 2016 Wiley Periodicals, Inc.
From the Volume‐Filling Effect to the Stress‐Bearing Network: The Reinforcement Mechanisms of Carbon Black Filler in Natural Rubber
Authors: Chen Liang , Song Lixian , Li Jing , Chen Pinzhang , Huang Ningdong , Li Liangbin
Published: August 2016

Using synchrotron‐radiation X‐rays for nanoscale computed tomography (X‐ray nano‐CT), the structure and corresponding reinforcement effects of carbon black (CB) filler at various amounts in natural rubber (NR) are studied during cyclic loading. All structural parameters of the CB filler, which are extracted from X‐ray images—such as the destruction and reconstruction ratios of the aggregates and the network connectivity, show a transition point with the CB content at around 30 phr (phr = parts by weight per hundred parts of rubber). When the CB content is above the transition point, the effective volume fraction exceeds the percolation threshold, and a stress‐bearing filler network can form; this network can effectively transmit the external stress to the entire sample and abruptly enhance the reinforcement factor. Below the percolation threshold, the CB filler is mainly disconnected aggregates, where its reinforcement of the rubber matrix can be mainly described by the volume‐filling effect. Using the dynamic cluster–cluster aggregation (CCA) model, calculations of the mechanical properties related to the CB content suggest that the network structure plays a major role in the reinforcement of the NR.

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Diffusion‐weighted MRI of breast lesions: a prospective clinical investigation of the quantitative imaging biomarker characteristics of reproducibility, repeatability, and diagnostic accuracy
Authors: Spick Claudio , Bickel Hubert , Pinker Katja , Bernathova Maria , Kapetas Panagiotis , Woitek Ramona , Clauser Paola , Polanec Stephan H. , Rudas Margaretha , Bartsch Rupert , Helbich Thomas H. , Baltzer Pascal A.
Published: August 2016

Diffusion‐weighted MRI (DWI) provides insights into tissue microstructure by visualization and quantification of water diffusivity.

Quantitative evaluation of the apparent diffusion coefficient (ADC) obtained from DWI has been proven helpful for differentiating between malignant and benign breast lesions, for cancer subtyping in breast cancer patients, and for prediction of response to neoadjuvant chemotherapy. However, to further establish DWI of breast lesions it is important to evaluate the quantitative imaging biomarker (QIB) characteristics of reproducibility, repeatability, and diagnostic accuracy.

In this intra‐individual prospective clinical study 40 consecutive patients with suspicious findings, scheduled for biopsy, underwent an identical 3T breast MRI protocol of the breast on two consecutive days (>24 h). Mean ADC of target lesions was assessed (two independent readers) in four separate sessions. Reproducibility, repeatability, and diagnostic accuracy between examinations (E1, E2), readers (R1, R2), and measurements (M1, M2) were assessed with intraclass correlation coefficients (ICCs), coefficients of variation (CVs), Bland–Altman plots, and receiver operating characteristic (ROC) analysis with calculation of the area under the ROC curve (AUC). The standard of reference was either histopathology (n = 38) or imaging follow‐up of up to 24 months (n = 2).

Eighty breast MRI examinations (median E1–E2, 2 ± 1.7 days, 95% confidence interval (CI) 1–2 days, range 1–11 days) in 40 patients (mean age 56, standard deviation (SD) ±14) were evaluated. In 55 target lesions (mean size 25.2 ± 20.8 (SD) mm, range 6–106 mm), mean ADC values were significantly (P < 0.0001) higher in benign (1.38, 95% CI 1.27–1.49 × 10−3 mm2/s) compared with malignant (0.86, 95% CI 0.81–0.91 × 10−3 mm2/s) lesions. Reproducibility and repeatability showed high agreement for repeated examinations, readers, and measurements (all ICCs >0.9, CVs 3.2–8%), indicating little variation. Bland–Altman plots demonstrated no systematic differences, and diagnostic accuracy was not significantly different in the two repeated examinations (all ROC curves >0.91, P > 0.05).

High reproducibility, repeatability, and diagnostic accuracy of DWI provide reliable characteristics for its use as a potential QIB, to further improve breast lesion detection, characterization, and treatment monitoring of breast lesions.
Initial testing (stage 1) of tazemetostat (EPZ‐6438), a novel EZH2 inhibitor, by the Pediatric Preclinical Testing Program
Authors: Kurmasheva Raushan T. , Sammons Melissa , Favours Edward , Wu Jianwrong , Kurmashev Dias , Cosmopoulos Katherine , Keilhack Heike , Klaus Christine R. , Houghton Peter J. , Smith Malcolm A.
Published: August 2016

Background

Tazemetostat (EPZ‐6438) is a selective inhibitor of the histone methyltransferase EZH2 and currently in clinical development for non‐Hodgkin lymphoma and genetically defined tumors.

Procedures

Tazemetostat was tested against the Pediatric Preclinical Testing Program (PPTP) solid tumor xenografts using a dose of 400 mg/kg administered twice daily by oral gavage for 28 days. H3K27me3:H3 ratios were determined in control and treated tumors.

Results

Tazemetostat induced significant differences in event‐free survival (EFS) distribution compared with control in nine of 30 (30%) of the xenografts studied. Significant differences in EFS distribution were observed in five of seven (71%) rhabdoid tumor xenograft lines compared with four of 23 (17%) nonrhabdoid xenograft lines (chi‐square [χ2] test P = 0.006). Tazemetostat induced tumor growth inhibition meeting criteria for intermediate and high EFS treated‐to‐control (T/C) activity in two of 25 (8%) and one of 25 (4%) xenografts, respectively. Intermediate and high activity for the EFS T/C metric was observed exclusively among rhabdoid tumor xenografts (three of five rhabdoid tumor vs 0 of 22 nonrhabdoid tumors (χ² test P < 0.001). One rhabdoid tumor xenograft (G401) showed stable disease. For one rhabdoid tumor (G401), delayed tumor regression to tazemetostat was noted following 1 week of tumor growth. Tazemetostat induced significant reduction of H3K27me3 levels in the majority of tumors compared with controls.

Conclusions

Tazemetostat demonstrated significant antitumor activity in rhabdoid tumor models but showed no consistent activity against any other histology. Tazemetostat reduced H3K27me3 levels irrespective of tumor response. Further preclinical testing to evaluate tazemetostat in combination with other anticancer agents is warranted.
A qualitative study looking at informed choice in the context of non‐invasive prenatal testing for aneuploidy
Authors: Lewis Celine , Hill Melissa , Chitty Lyn S.
Published: August 2016

Objective

To explore women's attitudes towards non‐invasive prenatal testing (NIPT) and determine factors influencing their decisions around uptake of NIPT.

Method

We conducted qualitative interviews to assess knowledge, attitude and deliberation amongst women offered NIPT in a public health service. In total, 45 women took part in telephone interviews (79% participation rate).

Results

Most women could recount the key aspects of NIPT discussed during pre‐test counselling but had variable knowledge about Down syndrome. Analysis of women's attitudes towards undergoing NIPT revealed three dominant factors they considered when reflecting on the test: (1) how NIPT compared with alternative testing options, (2) reflections on coping and (3) moral or religious values. Exploring the deliberative process revealed the different paths women take when making decisions. For some, it was an extension of the decision to have Down syndrome screening; some considered it early on following the booking‐in appointment; others made step‐wise decisions about NIPT when it became relevant to them.

Conclusion

Our findings support the importance of personalised counselling, whereby women and their partners have the opportunity to reflect on the implications of the test results in the context of their own lives and values. Our data highlight the influence of personal circumstances on decision‐making. © 2016 The Authors. Prenatal Diagnosis published by John Wiley & Sons, Ltd.
Preparation of compatibilizer with large specific surface and its application in immiscible polymer blends with ultra‐high molecular weight
Authors: Wang Yuexin , Xing Wenxiao , Meng Qing , Zhang Qian
Published: August 2016

In this work, a compatibilizer (UHMWPE‐g‐GO) with large specific surface was prepared from graphene oxide (GO) and ultra‐high molecular weight polyethylene (UHMWPE). First, GO was modified by 2, 3‐epoxypropyltrimethylammonium chloride (GTA), subsequently grafted with UHMWPE. UHMWPE‐g‐GO was used to compatibilize the immiscible monomer casting (MC) nylon/UHMWPE blends. With the addition of very low content of UHMWPE‐g‐GO, the compatibility of UHMWPE and the matrix (MC nylon) was remarkably improved without visible agglomerates, which was proved by photographs, scanning electron microscope, dynamic thermomechanical analysis, and contact angle measurement. Therefore, thermal stability, mechanical and tribological properties were obviously increased. A dramatic increment of 94.1% in the impact strength and a decrement of 39.4% in the coefficient friction were observed in the presence of UHMWPE‐g‐GO in the immiscible polymer blends. The approach used in this work was an efficient strategy for immiscible polymer blends with ultra‐high molecular weight. POLYM. ENG. SCI., 57:335–344, 2017. © 2016 Society of Plastics Engineers
Polarity control and residual strain in ZnO epilayers grown by molecular beam epitaxy on (0001) GaN/sapphire
Authors: Ullah Md. Barkat , Avrutin Vitaliy , Li Si Qian , Das Saikat , Monavarian Morteza , Toporkov Mykyta , Özgür Ümit , Ruterana Pierre , Morkoç Hadis
Published: August 2016

We report on the polarity control of ZnO grown by plasma assisted molecular beam epitaxy on Ga polar (0001) GaN/sapphire templates simply via the oxygen‐to‐Zn (VI/II) ratio during the growth of a thin nucleation layer at 300 °C. Following Zn pre‐exposure, the ZnO layers nucleated with low VI/II ratios (<1.5) exhibited Zn‐polarity. Those nucleated with VI/II ratios above 1.5, exhibited O‐polarity. Supported by scanning transmission electron microscopic imaging, we have unequivocally demonstrated that polarity inversion takes place without formation of any vertical inversion domains and within one monolayer of presumably non‐stoichiometric GaOx formed at the ZnO/GaN interface. A direct correlation between polarity and strain sign of ZnO layers has been found. The Zn‐polar ZnO layers were under tensile biaxial strain, whereas the O‐polar material exhibited compressive strain. Moreover, the amount of residual strain varied linearly with VI/II ratio used during the low‐temperature nucleation layer growth. Strain control with VI/II ratio has been explained by the potential formation of Zn interstitials.
Replication in strategic management
Authors: Ethiraj Sendil K. , Gambardella Alfonso , Helfat Constance E.
Published: August 2016

SMJ is committed to publishing high‐quality replications on a regular basis. SMJ's overriding goal in publishing replications is to provide additional evidence that helps to build a cumulative body of knowledge in strategic management, not to overturn prior results. SMJ is interested in replications that accord with prior findings as well as those that do not. Copyright © 2016 John Wiley & Sons, Ltd.
Advancement in Catalytic Asymmetric Hydrogenation of Ketones and Imines, and Development of Asymmetric Isomerization of Allylic Alcohols
Authors: Ohkuma Takeshi , Arai Noriyoshi
Published: August 2016

Catalytic asymmetric hydrogenation of ketones through the “metal–ligand cooperative mechanism” has been improved in terms of the efficiency, stereoselectivity, and scope of substrates by varying the arrangement of the catalyst structure and reaction conditions. Imino compounds are also smoothly converted to the optically active amines with appropriate catalysts. This type of catalyst exhibits excellent performance on the asymmetric isomerization of primary allylic alcohols into the optically active aldehydes. This personal account describes recent progress on these topics.

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Introduction on the Commentaries on Roger A. Layton's “There Could be More to Marketing than you Might Have Thought!” ()
Authors: Haase Michaela , Kleinaltenkamp Michael
Published: August 2016

Based on Roger Layton's paper on the nature and future of marketing that was published in this year's March issue of AMJ, a panel discussion took place at the 41st Macromarketing Conference at Trinity College in Dublin within the marketing theory track. Besides Roger Layton himself, eight panelists were invited to comment on his article. In this issue of AMJ, these scholars further elaborate on their comments, after their presentation and discussion at the Macromarketing Conference. In this introduction we synthesize the discussion and provide a short overview of the authors’ contributions.
Qualitative study of the role of men in maternal health in resource‐limited communities in western Kenya
Authors: Brubaker Kathryn , Nelson Brett D. , McPherson Heather , Ahn Roy , Oguttu Monica , Burke Thomas F.
Published: August 2016

Objective

To better understand the beliefs of men and women in western Kenya regarding the appropriate role of men in maternal health and to identify barriers to greater involvement.

Methods

Between June 1 and July 31, 2014, a cross‐sectional qualitative study enrolled lay men, lay women, and community health workers from Kisumu and Nyamira counties in western Kenya. Semi‐structured focus group discussions were conducted and qualitative approaches were utilized to analyze the transcripts and identify common themes.

Results

In total, 134 individuals participated in 18 focus group discussions. Participants discussed the role of men and a general consensus was recorded that it was a man's duty to protect women during pregnancy. When discussing obstacles to male involvement, female participants highlighted gender dynamics and male participants raised financial limitations.

Conclusion

There was considerable discrepancy between how men described their roles and how they actually behaved, although educated men appeared to describe themselves as performing more supportive behaviors compared with male participants with less education. It is suggested that interventions aimed at increasing male involvement should incorporate the existing culturally sanctioned roles men perform as a foundation upon which to build, rather than attempting to construct roles that oppose prevailing norms.
The relative importance of anxiety and depression in pain impact in individuals with migraine headaches
Authors: Tomé-Pires Catarina , Solé Ester , Racine Mélanie , Galán Santiago , Castarlenas Elena , Jensen Mark P. , Miró Jordi
Published: August 2016

Background

Psychological factors are thought to impact headache as triggering, maintaining, and exacerbating factors. A better understanding of the role that modifiable factors, such as anxiety or depression, play in the impact of migraine could help identify potential treatment targets in this population.

Objectives

The objective of this study was to evaluate the relative importance of anxiety and depression as predictors of the impact of migraine on function. Thus, we aim to understand the relative importance that anxiety and depression have on the impact of migraines by assessing both and some life domains.

Methods

Cross-sectional study involving forty-three individuals, mostly females (93%), with migraine headaches aged between 20 and 60 years old. Participants answered questions about headache pain intensity at the time of data collection and the usual in the past 30 days (0–10 Numerical Rating Scales) as well as other pain characteristics (i.e., duration, frequency, and duration), headache impact (vitality and social, role, and cognitive functioning), anxiety and depression by using the Hospital Anxiety and Depression Scale.

Results

Anxiety (r = 0.56, p < .001), but not depression (r = 0.09, p = .59), was significantly associated with headache impact. Thus showing the relative importance that anxiety has on headache impact.

Conclusions

The findings support a larger role for anxiety than depression in the impact of migraine headaches on patient function. There are a number of mechanisms by which anxiety could potentially influence the impact of headache on patient function, and this study highlights that anxiety could potentially be a trigger of headache activity.

Implications

The findings thus suggest the possibility that treatments that focus on anxiety might be potentially more important for individuals with migraine than treatments that focus on depression, at least with respect to having a beneficial impact on the interference of headache with activity. Research is needed to evaluate the beneficial impact of anxiety treatment in individuals with migraine headaches. Clinicians should evaluate and consider treating, as appropriate and necessary, anxiety in patients with migraine.
Evaluation of a Semi-Quantitative CO2 Monitor with Pulse Oximetry for Prehospital Endotracheal Tube Placement and Management
Authors: George Shawn , Macnab Andrew J.
Published: August 2016

Objective:

To evaluate three prototype versions of semi-quantitative end-tidal CO2 monitors with different alarm features during prehospital or inter-facility use.

Methods:

Subjects were 43 adult, non-pregnant patients requiring intubation, or who already were intubated and required transport. Teams at one AirEvac and seven Advanced Life Support (ALS) paramedic stations were trained in the use of the monitors. Team members at each station evaluated each model for eight days. Participants completed questionnaires following each use.

Results:

The monitors performed properly in all cases, but in one case, vomit in the airway adapter tube prevented obtaining a readout. The monitors aided management in 40 of 43 cases (93%); in one, the monitor reading was reported as variable (between 20 and 30 mmHg) although the teams knew the monitors were semi-quantitative; in another, the monitor was not required, but performed properly; and the third was the one in which vomit in the tube prevented a reading. In 26 of 43 cases (60.4%), the monitor was used to confirm endotracheal tube placement (there were no instances of incorrect placement). In all cases, the devices were used to monitor respiration and oxygen saturation. Alarms were audible in the environment, but only preferred in the AirEvac situation. The “breath beep” feature was useful, particularly in patients in whom chest movements during respiration were difficult to observe.

Conclusions:

“Breath beeps” were clearly audible and were a useful feature in all prehospital and transport environments, while audible alarms were desired only in the AirEvac situation. Semi-quantitative CO2 detection is valuable in the ALS/AirEvac environment, even for teams with high intubation success rates.
The Value of EMS Experience when Applying to Medical School?
Authors: Pipas Lauren , Audet Robert F. , Brown Lawrence H.
Published: August 2016

Introduction:

This study explores the value of Emergency Medical Services (EMS) experience for students applying to medical school. Methods: Surveys were sent to 67 medical schools in the eastern United States and Canada. Using a five-point Likert scale, the survey asked the respondent to rate the amount of consideration given to Emergency Medical Technician (EMT) or paramedic experience when making admissions decisions (1 = very little to 5 = strong), and to describe the influence of that experience (1 = very negative to 5 = very positive).

Results:

Usable responses were received from 21 schools. The median rating for the consideration given to EMS experience was “some consideration” for both EMT and paramedic experience, with 85.7% of respondents assigning that rating or higher. The median rating for the influence of that experience was “somewhat positive” for both EMT and paramedic experience. Only 14.3% of the returned surveys rated EMS experience as “neutral”, and no respondent reported EMS experience as a “negative”.

Conclusion:

EMS experience receives at least some consideration during the admissions process at most of the responding institutions in the United States and Canada. Experiences at either the EMT or Paramedic level are viewed similarly. None of the responding institutions viewed EMS experience negatively.
Health of Displaced Albanian Kosovars in the Former Yugoslav Republic of Macedonia: Fitness to Travel and Health Outcomes Assessment
Authors: MacPherson Douglas W. , Weekers Jacqueline E. M. , O'Rourke Thomas F. , Stiles Cecilia , Gushulak Brian D.
Published: August 2016

Introduction:

During the 1999 conflict in Kosovo, an estimated 850,000 people were displaced from Kosovo. Many thousands of these people arrived in the Former Yugoslav Republic of Macedonia (FYROM), for whom a humanitarian evacuation programme (HEP) was conducted by the United Nations High Commissioner for Refugees (UNHCR) and the International Organization for Migration (IOM). More than 91,000 people were moved to third countries under this programme.

Methods:

A health assessment tool was designed, validated, and implemented to document the health status of the refugees prior to departure. The IOM evaluated 41,652 pre-travel “fitness to travel” medical assessments for refugees transported by the Organization. A colour coding system for fitness-to-travel was used to clearly identify refugees to the receiving health authorities according to their health condition at the time of departure.

Results:

A total of 41,652 fitness-to-travel assessments were performed between 05 April and 25 June 1999, and were entered into a database. There were 21,923 females and 19,566 males. The average age was 25.3 years (women, 26 years; men, 24.3 years). Of these assessments, 4,647 (11.2%) individuals who were deemed fit-to-travel required medical assessment at the host destination, and of those 1,204 required urgent care. The majority of health complaints were acute respiratory tract infections and hypertension.

Conclusions:

A rapid and efficient system for fitness-to-travel was created to assist in the management of health issues related to the urgent and mass movement of refugees. The collected health information was of use to health-care planners during the crisis and for those responsible for the health-care of newly arrived refugees. The lessons learned have implications for future similar operations and for the development of research and education programs for both the refugees and the host recipient nations.
Emergency Health and Risk Management in Sub-Saharan Africa: A Lesson from the Embassy Bombings in Tanzania and Kenya
Authors: Clack Zoanne A. , Keim Mark E. , Macintyre Anthony G. , Yeskey Kevin
Published: August 2016

In 1998, terrorists simultaneously bombed United States Embassies in Dar es Salaam, Tanzania and Nairobi, Kenya. The local response to these bombings was unorganized and ad hoc, indicating the need for basic disaster preparedness and improvement of emergency management capabilities in both countries.

In this context, risk and risk management are defined and are related to the health hazards affecting Tanzanians and Kenyans. In addition, the growing number of injuries in Tanzania is addressed and the relationship between risk management and injury is explored. Also, an emergency medicine-based strategy for injury control and prevention is proposed. Implications of implementing such a protocol in developing nations also are discussed.
Rapid Epidemiological Assessment of Health Status in Displaced
Populations—An Evolution toward Standardized Minimum Essential Data
Sets
Authors: Bradt David A. , Drummond Christina M.
Published: August 2016

Rapid epidemiological assessment (REA) has evolved over the past 30
years into an essential tool of disaster management. Small area survey and
sampling methods are the major application. While REA is protocol driven,
needs assessment of displaced populations remains highly non-standardized.
The United Nations and other international organizations continue to call
for the development of standardized instruments for post-disaster needs
assessment.

This study examines REA protocols from leading agencies in humanitarian
health assistance across an evaluation criteria of best-practice attributes.
Analysis of inconsistencies and deficits leads to the derivation of a
Minimum Essential Data Set (MEDS) proposed for use by relief agencies in
post-disaster REA of health status in displaced populations. This data set
lends itself to initial assessment, ongoing monitoring, and evaluation of
relief efforts. It is expected that the task of rapid epidemiological
assessment, and more generally, the professional practice of post-disaster
health coordination, will be enhanced by development, acceptance, and use of
standardized Minimum Essential Data Sets (MEDS).
Terrorism in South Korea
Authors: Wang Soon Joo , Choi Jin Tae , Arnold Jeffrey
Published: August 2016

South Korea has experienced >30 suspected terrorism-related events
since 1958, including attacks against South Korean citizens in foreign
countries. The most common types of terrorism used have included bombings,
shootings, hijackings, and kidnappings. Prior to 1990, North Korea was
responsible for almost all terrorism-related events inside of South Korea,
including multiple assassination attempts on its presidents, regular
kidnappings of South Korean fisherman, and several high-profile bombings.
Since 1990, most of the terrorist attacks against South Korean citizens have
occurred abroad and have been related to the emerging worldwide pattern of
terrorism by international terrorist organizations or deranged
individuals.

The 1988 Seoul Olympic Games provided a major stimulus for South Korea
to develop a national emergency response system for terrorism-related events
based on the participation of multiple ministries. The 11 September 2001
World Trade Center and Pentagon attacks and the 2001 United States of
America (US) anthrax letter attacks prompted South Korea to organize a new
national system of emergency response for terrorism-related events. The
system is based on five divisions for the response to specific types of
terrorist events, involving conventional terrorism, bioterrorism, chemical
terrorism, radiological terrorism, and cyber-terrorism. No terrorism-related
events occurred during the 2002 World Cup and Asian Games held in South
Korea. The emergency management of terrorism-related events in South Korea
is adapting to the changing risk of terrorism in the new century.
Terrorism in Spain: Emergency Medical Aspects
Authors: Riesgo Luis García-Castrillo , Merino Antonio García
Published: August 2016

A terrorism movement has been active in Spain during the last 20 years,
with a painful number of victims. Civil Defense is in charge of the
coordination of all the structures that are implicated in a terrorist
incident. There are three typical patterns of attacks: (1) individual
attacks; (2) group attacks; and (3) mass attacks. The individual attacks are
done with guns, usually 9 mm, fired from a short distance; victims die from
serious intracranial damage. Collective attacks are done using explosives
under vehicles, tramp bombs, or “bomb vehicles;” victims are of different
severity with wounds, burns, and blast injuries. With mass attacks with
“bomb vehicles” in buildings or crowded public places, the numbers of
victims are elevated and produce brutal social consequences.

Emergency Medical Services integrated in to “Civil Defense” try to
minimize the damage by initializing treatment on-scene and with the rapid
provision of definitive care. During the last year, post-traumatic stress
disorder treatment groups have been providing care to the victims and
personnel. Chemical or biological weapons have not been used, although this
is a great concern to the authorities.
Variables Influencing Medical Usage Rates, Injury Patterns, and Levels of
Care for Mass Gatherings
Authors: Milsten Andrew M. , Seaman Kevin G. , Liu Peter , Bissell Rick A. , Maguire Brian J.
Published: August 2016

Objectives:

Mass gatherings create difficult environments for which to plan
emergency medical responses. The purpose of this study was to identify
those variables that are associated with increased medical usage rates
(MURs) and certain injury patterns that can be used to facilitate the
planning process.

Methods:

Patient information collected at three types of mass gatherings
(professional American football and baseball games and rock concerts)
over a three-year period was reviewed retrospectively. Specific
variables were abstracted: (1) event type; (2) gender; (3) age; (4)
weather; and (5) attendance. All 216 events (total attendance9,708,567)
studied were held in the same metropolitan region. All MURs are reported
as patients per 10,000 (PPTT).

Results:

The 5,899 patient encounters yielded a MUR of 6.1 PPTT. Patient
encounters totaled 3,659 for baseball games (4.85 PPTT), 1,204 for
football games (6.75 PPTT), and 1,036 for rock concerts (30 PPTT). The
MUR for Location A concerts (no mosh pits) was 7.49 PPTT, whereas the
MUR for the one Location B concert (with mosh pits) was110 PPTT. The MUR
for Location A concerts was higher than for baseball, but not football
games (p = 0.005). Gender distribution was
equal among patrons seeking medical care. The mean values for patient
ages were 29 years at baseball games, 33 years at football games, and 20
years at concerts. The MUR at events held when the apparent temperature
was £80°F significantly lower statistically than that at events
conducted at temperatures <80°F were (18°C) (4.90 vs. 8.10 PPTT
(p = 0.005)). The occurrence of
precipitation and increased attendance did not predict an increased MUR.
Medical care was sought mostly for minor/basic-level care (84%) and less
so for advanced-level care (16%). Medical cases occurred more often
atsporting events (69%), and were more common than were cases with
traumatic injuries (31%). Concerts with precipitation and rock concerts
had a positive association withthe incidence of trauma and the incidence
of injuries; whereas age and gender were not associated with medical or
traumatic diagnoses.

Conclusions:

Event type and apparent temperature were the variables that best
predicted MUR as well as specific injury patterns and levels of
care.
Randomized, Controlled Trial of Three Levels of Critical Incident Stress
Intervention
Authors: Macnab Andrew , Sun Charles , Lowe John
Published: August 2016

Background:

Stress debriefing following exposure to a critical incident
isbecoming more prevalent. Its aim is to prevent or minimize the
development of excessive stress response symptoms that lead to loss of
productivity or effectiveness in the workplace or at home. There is
little evidence that any form of psychological debriefing is effective.
This study evaluated the effectiveness of three intervention strategies,
and attempted to correlate the symptoms with the severity of the
incidentand level of intervention.

Methods:

A randomized, controlled trial of three levels of critical stress
intervention was conducted in the British Columbia Ambulance Service
(BCAS), in British Columbia, Canada, among paramedics and emergency
medical technicians (EMTs), reporting critical incident stress. Outcomes
were measured at one week (Stanford Acute Stress Reaction Questionnaire
(SASRQ), the Life Impact Score (LIS), and Schedule of Recent Events
(SRE)), and at three months and six months following the intervention
(Impact of Events (IE), Coping Mechanisms, LIS, and SRE).

Results:

Fifty calls were received during the 26-month study period (<1
per 10,000 BCAS response calls): 23 were by third parties, but the
involved EMT did not call;nine were placed by crew unwilling to
participate in the study; 18 subjects enrolled, but six completed no
forms. No correlation was found between severity of the incident and
scores on the SASRQ, IE, or LIS, or between any of these scores. There
was no consistent pattern in the stress scores over time.

Conclusion:

Requests for critical incident stress intervention were uncommon.
The need for intervention may not be as great as generally is assumed.
Further randomized trials, ideally multicenter studies, are
indicated.
The Traumatic Process: Conceptualization and Treatment
Authors: Noy Shabtai
Published: August 2016

Traumatic stress stems from a threat to an individual's or a group's very existence. The impact of the existential threat may be compounded by an inability to cope, which affects the perception of helplessness and loss of lawfulness. A model is proposed in which the traumatic process is conceptualized to develop through three stages: (1) alert; (2) impact; and (3) post-trauma. In this model, treatment of traumatic stress emphasizes the need to control and expand life, and to achieve lawfulness and meaningfulness. In the proposed model of treatment, there are essential differences at each of the stages of the traumatic process: (1) primary prevention at the stage of alert focuses on planning strategies for coping; (2) secondary prevention at the stage of impact is based on forward treatment and debriefing; and (3) tertiary treatment at the post-trauma stage attends to coping with internal chaos and arbitrariness.
Acute Psychological Impact of Disaster and Large-Scale Trauma: Limitations of Traditional Interventions and Future Practice Recommendations
Authors: Gray Matt J. , Maguen Shira , Litz Brett T.
Published: August 2016

Nearly everyone will experience emotional and psychological distress in the immediate aftermath of a disaster or other large-scale traumatic event. Although extremely upsetting and disruptive, the reaction is understood best as a human response to inordinate adversity, which in the majority of cases remits over time without formal intervention. Nevertheless, some people experience sustained difficulties. To prevent chronic post-traumatic difficulties, mental health professionals provide early interventions soon after traumatic exposure. These interventions typically take the form of single-session debriefings, which have been applied routinely following disasters. The research bearing on these traditional forms of early crisis interventions has shown that, although well-received by victims, there is no empirical support for their continued use. However, promising evidence-based, early interventions have been developed, which are highlighted. Finally, traumatic bereavement and complicated grief in survivors of disasters, an area largely neglected in the field, is discussed.
Risk Factors for Adolescent Alcohol Use Following a Natural Disaster
Authors: Schroeder Janine M. , Polusny Melissa A.
Published: August 2016

Introduction:

On 29 March 1998, a series of category F-3 and F-4 tornadoes caused wide-spread destruction in four rural southern Minnesota counties in the United States. Extensive research has examined the impact of disaster exposure on adults' psychological functioning, including alcohol use. However, there has been little research on potential risk factors for adolescents' alcohol use following disaster exposure.

Hypothesis:

It was hypothesized that demographic variables such as age and gender, prior drinking involvement, extent of prior trauma history, level of disaster exposure, and current disaster-related, post-traumatic stress disorder (PTSD) symptomatology would predict alcohol use among adolescents.

Methods:

Six months following a natural disaster, survey data were collected from 256 adolescents assessing these factors. Risk factors for adolescents' alcohol use were identified using hierarchical, multiple regression and logistic regression analyses.

Results:

Greater age, prior drinking involvement, and the extent of prior trauma history were significantly associated with higher levels of binge drinking. Prior trauma history and current levels of disaster-related PTSD symptomatology were significant risk factors for adolescents' report of increases in their alcohol consumption since the tornado.

Conclusion:

In general, the extent of trauma exposure was associated with greater binge drinking among adolescents. Similar to adults, post-traumatic stress symptoms experienced in the aftermath of a disaster can lead to increased alcohol consumption among adolescents.
Counting Crises: US Hospital Evacuations, 1971–1999
Authors: Sternberg Ernest , Lee George C. , Huard Danial
Published: August 2016

Objectives:

To investigate the relative distribution of hazards causing hospital evacuations, thereby to provide rudimentary risk information for hospital disaster planning.

Methods:

Cases of hospital evacuations were retrieved from newspaper and publication databases and classified according to hazard type, proximate and original cause, duration, and casualties. Both partial and full evacuations were included. The total number of evacuation incidents for all hazards were compared to the total number of hospital incidents for the one hazard, fire, for which national data is available.

Results:

There were 275 reported evacuation incidents from 1971–1999, with an annual average of 21 in the 1990s, the period for which databases were more reliable. The most, 33, were recorded in 1994, the year of the Northridge Earthquake. Of all incidents, 63 (23%) were attributable primarily to internal fire, followed by internal hazardous materials (HazMat) events (18%), hurricane (14%), human threat (13%), earthquake (9%), external fire (6%), flood (6%), utility failure (5%), and external HazMat (4%).

Conclusions:

More than 50% of the hospital evacuations occurred because of hazards originating in the hospital facility itself or from human intruders. While natural disasters were not the preponderant causes of evacuations, they caused severe problems when multiple hospitals in the same urban area were incapacitated simultaneously. Clearly, as hospitals are vulnerable to many hazards, mitigation investments should be assessed not in terms of single-hazard risk-cost-benefit analysis, but in terms of capacity to mitigate multiple hazards. In view of the many qualifications and limitations of the dataset used here, but value of such data for disaster planning, hospitals should be asked to submit standardized incident reports to permit national data gathering on major disruptions.
Where's the Tube? Evaluation of Hand-held Ultrasound in Confirming Endotracheal Tube Placement
Authors: Chun Rosaleen , Kirkpatrick Andrew W. , Sirois M. , Sargasyn A.E. , Melton S. , Hamilton D.R. , Dulchavsky S.
Published: August 2016

Introduction:

The diagnosis of endotracheal tube (ETT) mal-position may be delayed in extreme environments. Several methods are utilized to confirm proper ETT placement, but these methods can be unreliable or unavailable in certain settings. Thoracic sonography, previously utilized to detect pneumothoraces, has not been tested to assess ETT placement.

Hypothesis:

Thoracic sonography could correlate with pulmonary ventilation, and thereby, help to confirm proper ETT placement.

Methods:

Thirteen patients requiring elective intubation under general anesthesia, and data from two trauma patients were evaluated. Using a portable, hand-held, ultrasound (PHHU) machine, sonographic recordings of the chest wall visceral-parietal pleural interface (VPPI) were recorded bilaterally in each patient during all phases of airway management: (1) preoxygenation; (2) induction; (3) paralysis; (4) intubation; and (5) ventilation. Results: The VPPI could be well-imaged for all of the patients. In the two trauma patients, right mainstem intubations were noted in which specific pleural signals were not seen in the left chest wall VPPI after tube placement. These signs returned after correct repositioning of the ETT tube. In all of the elective surgery patients, signs correlating with bilateral ventilation in each patient were imaged and correlated with confirmation of ETT placement by anesthesiology.

Conclusions:

This report raises the possibility that thoracic sonography may be another tool that could be used to confirm proper ETT placement. This technique may have merit in extreme environments, such as in remote, prehospital settings or during aerospace medical transports, in which auscultation is impossible due to noise, or capnography is not available, and thus, requires further scientific evaluation.
The Impact of Terrorism on Children: A Two-Year Experience
Authors: Sandell Julian M. , Maconochie I.K.
Published: August 2016

Waismanet al1have once more highlighted the very real challenge of triaging children in mass-casualty events (MCE) in the pre-hospital setting. Difficulties encountered measuring vital signs and different patterns of injury, reflecting significant anatomical and physiological differences, necessitates a modified approach when applying traditional “adult” triage methods to paediatric trauma victims. When using physiological parameters to triage children, their faster respiratory rates and heart rates frequently result in younger children being triaged to a higher category than their injuries demand. These differences become less apparent during adolescence, as the young person matures into adulthood.
Disasters and Development: Part 2: Understanding and Exploiting Disaster-Development Linkages
Authors: Stephenson Rob S. , DuFrane Charles
Published: August 2016

This lesson is a continuation of Disasters and Development: Part 2: Understanding and Exploiting Disaster-Development Linkages published in Prehospital and Disaster Medicine in Volume 17, Number 3. It identifies the goals of a specific damage mitigation project that can be incorporated into a regular development project and the mechanisms for obtaining the mitigation component of such a project. Mechanisms for assessing the success of such a project are discussed. It stresses the importance of the application of building codes, associated training programs, and more extensive use of zoning regulations in urban development that decrease the population at risk and the likelihood of damage to industrial facilities. Disasters can elevate the development potential of a society at risk for damage from a hazard. The political impact of damage and disruption can be a catalyst for change. Development opportunities often are compromised because of an excessive focus on relief assistance. Interventions designed to mitigate the damage from a given hazard are particularly effective when they focus on areas at particularly high risk for actualization of the hazard. Support from the private sector, including the non-formal sector, is a key element of successful reconstruction management. The period of recovery is an opportunity for general assistance to government with administrative procedures, including enhanced management training programs.