bluuebunny/crossref_metadata_2025 huggingface dataset:
José de Nebra, la devoción y la Santa Capilla de la Virgen del Pilar
Authors: González Marín Luis Antonio
Published: January 2019

Las fuentes musicales autógrafas de José de Nebra, organista y vicemaestro de la Real Capilla de Madrid, y simultáneamente compositor para los teatros públicos, así como algunos hechos de su vida, ponen de manifiesto una personalidad extremadamente religiosa. De hecho, Nebra en cierta manera contribuye, a través de diversas acciones, a la construcción histórica de uno de los mayores símbolos religiosos hispánicos: el culto a la Virgen del Pilar.
El libreto de ópera en España como fuente para el estudio de la práctica musical: los libretos españoles de la primera mitad del siglo XIX
Authors: Heilbron Ferrer Marc
Published: January 2019

Los libretos que se publicaban con motivo de las representaciones de una ópera en la primera mitad del siglo XIX no han merecido mucha consideración como fuentes documentales para la investigación del teatro musical. La modestia de la mayoría de las ediciones -se trataba de un tipo de publicación de uso práctico y de formato reducido- puede haber contribuido a su infravaloración. A partir de ejemplos de libretos publicados en España en la primera mitad del siglo XIX, se señalan casos en los que el libreto permite documentar prácticas interpretativas en paralelo a las que pueden aportan otro tipo de fuentes musicales.
Los tientos 68, 65 y 67 de Obras de música: Estudio analítico de tres obras maestras de Cabezón
Authors: Roig-Francolí Miguel A.
Published: January 2019

El presente estudio se centra en tres tientos que sin duda pueden contarse entre las obras maestras de Cabezón: los números 68, 65 y 67 de Obras de música. Este orden en particular nos permite viajar analíticamente desde un tiento largo y brillante con gran unidad modal, hasta un tiento corto e introspectivo que sin embargo incluye tres secciones, cada una de las cuales está en un modo distinto, pasando por un tiento de longitud mediana que demuestra ambigüedad estructural entre dos modos. El mundo tonal de Cabezón (y también de su tiempo) se encuentra representado en estos tres tientos en toda su riqueza y variedad. Abordamos tres aspectos de cada uno de estos tientos: organización formal, coherencia temática y relationes motívicas entre diversos sujetos, y organización modal. Lejos de ser aspectos aislados dentro del proceso musical, veremos que estos tres elementos están íntimamente relacionados en estas obras de Cabezón, y juntos constituyen y determinan las estructuras compositivas que precisamente definen estos tientos como obras maestras.
Antonio de Cabezón y la música instrumental europea de los siglos XVI y XVII
Authors: Körndle Franz
Published: January 2019

Transcurridos ya más de treinta años después del trabajo académico de Macario Santiago Kastner (1977), podemos retomar la discusión a propósito de la importancia de Cabezón dentro de la música instrumental europea. Leyendo los documentos históricos en su contexto original, se puede en muchos casos realizar una nueva evaluación de los mismos, en lo relacionado con la así llamada influencia de Cabezón sobre otros compositores europeos. Parece digno de mención, que la memoria de Cabezón permeneció viva también a lo largo del siglo XVII. Además, este ensayo presenta una fuente desconocida hasta ahora. Un informe impreso sobre los esponsales del monarca español Carlos II "el hechizado” y María Luisa de Orleans en 1679, da noticia de la música instrumental de Cabezón para una representación teatral. Aunque este informe se ha inventado libremente en gran parte, muestra la gran importancia de Cabezón más de cien años después de su muerte.

[ge] Antonio de Cabezón in der europäischen Instrumentalmusik des 16. und 17. Jahrhunderts.

Mehr als 30 Jahre nach den Forschungen von Macario Santiago Kastner (1977) bietet es sich an, die Frage nach der Bedeutung von Antonio de Cabezón in der europäischen Instrumentalmusik neu zu diskutieren. Mit einer Erörterung der Aussagen in den historischen Dokumenten im originalen Kontext ergeben sich mehrfach andere Bewertungen im Hinblick auf den so genannten Einfl uss Cabezóns auf andere Komponisten in Europa. Wichtig ist, dass die Erinnerung an Cabezón weit über das 17. Jahrhundert hinaus lebendig blieb. Den Quellen hinzugefügt werden kann ein gedruckter Bericht über die Hochzeit des spanischen Königs Carlos II. mit der französischen Prinzessin Maie-Louise d’Orleans im Jahr 1679, in dem Cabezón als Komponist von Instrumentalmusik für eine Theateraufführung genannt wird. Obwohl der Bericht weitgehend erfunden ist, zeigt er doch die herausragende Bedeutung, die man dem Musiker noch über hundert Jahre nach seinem Tod zuteil werden ließ.
Práctica de tañedores, entre los siglos XVI y XXI
Authors: González Marín Luis Antonio , González Uriol José Luis
Published: January 2019

Este artículo ofrece una síntesis y una reflexión acerca de las circunstancias de la práctica de interpretación de la música de tecla de Antonio de Cabezón en su tiempo (los instrumentos a su disposición, los sistemas de temple, la técnica de la tecla y los refinamientos y primores del toque), como modelo para nuestra moderna recuperación de las obras de Cabezón y sus contemporáneos con criterios históricamente informados.
Improving Early Cancer Detection Knowledge through Mobile Learning Application
Authors: Muljo Hery Harjono , Perbangsa Anzaludin Samsinga , Lie Yulius , Pardamean Bens
Published: January 2019

The study aims to build a mobile-based application prototype with an Android platform for learning early cancer detection. This prototype design is emerged from data collection about the challenges faced by health workers to gain knowledge about cancer. It requires mobile-based learning technology to assist in their daily work. Based on the data gathered, an Android-based application is developed to be used to simplify the knowledge dissemination method and enhance the material quality by digitizing content into multimedia formats.
Imaginaires de l'espace fluvial : aspects d'une géocritique de l'Orénoque
Authors: Katsika Karolina
Published: January 2019

Au XIXe siècle, le fleuve Orénoque apparaît dans la littérature comme un espace « sauvage » et inquiétant, dépaysant, un espace de danger mortel mais aussi de l'extraordinaire. Une large part est faite à la description de la faune et de la flore. En revanche, aux XXe-XXIe siècles, des mutations s'opèrent concernant la perception de l'espace fluvial ainsi que son rôle dans la narration. L'espace fluvial semble davantage être un lieu où se joue un enjeu intérieur et le voyage devient quête personnelle. S'il reste un espace de souffrance, celle-ci peut aboutir – ou pas – à une transformation et une renaissance. Le récit enardien, offre l'image contemporaine d'un espace de circulation marchande.
Openly Available Resource for the Management and Promotion of Museum Exhibits
Authors: Vacalopoulou Anna , Markantonatou Stella , Toraki Katerina , Minos Panagiotis
Published: January 2019

This article describes ongoing work on the design of an online application to support standardized classification of collections of folk exhibits and contribute to the collections' management and promotion. The rationale behind this is the normalization of comparable and multilingual controlled terminologies and their parallelization with recognized schemata. The approach relies on the identification of the real needs of Greek museums, as depicted in the organization of their collections and the identification and exploitation of the terminological apparatus provided by the Greek language that expresses widely held conceptualizations serving museums as handy organization pathways. Results will contribute to the issue of openly available online resources by freely offering the collection (circa 600 terms) to interested parties and to the general public. From this point of view, the emphasis is mainly on term disambiguation and classification. The proposed application aspires to serve as a point of reference both for managing and for promoting cultural heritage in the field of tourism.
Cross-Shelf Exchange Associated With the Gulf Stream in the South Atlantic Bight: Direct Observations Using an Autonomous Underwater Glider
Authors: He Ruoying , Todd Austin C. , Lembke Chad , Kellison Todd , Taylor Chris , Mann David A.
Published: January 2019

AbstractAn autonomous underwater glider was deployed in March 2014 to sample the Gulf Stream and its adjacent shelf waters in the South Atlantic Bight, providing a new look at cross-shelf exchange associated with Gulf Stream dynamics. Observations collected over 4 weeks reveal
significant cross-shelf exchange (up to 0.5 Sv) at the shoreward edge of the Gulf Stream, which was 2 orders of magnitude larger than estimates from long-term mean hydrographic conditions. Gulf Stream frontal eddies may have contributed to some of the largest fluxes of heat (0.5°C Sv)
and salt (0.03 Sv g/kg) onto the shelf. We estimate that the largest upwelling event during the mission could have brought nitrate concentrations over 20 μM to within 125 m of the surface. This study demonstrates clear capabilities of autonomous underwater gliders for sampling in and near
fast moving boundary currents to obtain unique and critical in situ observations effectively.
The Tampa Bay Coastal Ocean Model Performance for Hurricane Irma
Authors: Chen Jing , Weisberg Robert H. , Liu Yonggang , Zheng Lianyuan
Published: January 2019

AbstractThe Tampa Bay response to Hurricane Irma in September 2017 is analyzed using a combination of in situ observations and numerical model simulations. The observations include winds and water levels from in situ recording stations. The model simulations
are by the Tampa Bay Coastal Ocean Model (TBCOM), which downscales from the continental shelf to the estuary by nesting the unstructured grid, Finite-Volume, primitive equation Community Ocean Model (FVCOM) in the West Florida Coastal Ocean Model, which in turn downscales from the deep ocean
across the continental shelf by nesting FVCOM in the Gulf of Mexico Hybrid Coordinate Ocean Model. Both the observations and the model simulations show a rapid negative storm surge (a setdown of sea level) followed by a positive surge associated with the change of wind direction. The initial
forecast underestimates the magnitude of the negative surge. After adjusting for the difference between the winds actually observed compared with the original forecast winds, the hindcast sea level simulation very closely matches the observations. These findings imply that a massive exchange
of water occurred between Tampa Bay and the adjacent continental shelf as the hurricane passed by the region. A large portion of the bay water was flushed out to the south, to be replaced by new waters advected in from the along the coast to the north.
Management of severe retinopathy of prematurity in Jaffna
Authors: Abeysekera H. , Chandrakumar S. T. S. , Malaravan M. , Gurusinghe L. , Jeyabalan S. , Srinani Rajima , Vicknan K. , Joseph A. , Gajalaksan B.
Published: January 2019

Introduction and objectives: Treatment of Retinopathy of Prematurity (ROP) is revolutionized by the use of Anti-Vascular Endothelial Growth Factor agents over the last decade. This study describes the results of the treatment in the newest paediatric ophthalmology unit in Sri Lanka- Teaching hospital, Jaffna. Methods: Retrospective analysis of the ROP screening and treatment data at the paediatric ophthalmology unit at teaching hospital was carried out. All the screening and treatment sessions were carried out under topical anaesthesia. Out of the 118 babies who underwent screening examinations, 12 babies had severe ROP requiring treatment with intravitreal injection of Bevacizumab. In conclusion intravitreal injection of Bevacizumab is very successful in managing severe Zone 1 and Zone 2 ROP although prolong follow up is mandatory to detect recurrences of ROP.
A preliminary survey of dementia amongst geriatric patients admitted to a single medical unit at the Teaching Hospital Jaffna (THJ), Sri Lanka using a locally validated scale - the concise cognitive assessment scale (CONCOG)
Authors: Arasalingam A. , Suganthan N.
Published: January 2019

Testing cognition is the background to dementia assessment. Most available assessment batteries are not developed or validated in developing countries. The Concise Cognitive test (CONCOG) validated in an elderly urban Sri Lankan population tested orientation to time, naming, registering 4 words, copying, verbal fluency and recall of the 4 words using native vernacular, creating a culturally acceptable and contextualized assessment tool. Patients above the age of 60 years admitted to the professorial medical unit of THJ were screened after excluding confounding factors (delirium, sepsis, chronic illness, degenerative neurological diseases) which would have affected the test results. Patients who consented voluntarily were screened using the CONCOG test. A convenient sampling method was used. The severity was decided based on the score (20 - 23 mild dementia, 13 – 19 moderate dementia and 12 or less severe dementia) Of 1001 patients screened (mean age 73.29±5.8 years; 522 or 52.1% males; 479 or 47.9% females) 675 (67.43%) had cognitive impairment. Of those with cognitive impairment mean age was 75.41±5.69, 329(48.7%) males and 346(51.3%) females. 293/675(43.41%) had mild dementia (mean age 71.8±3.66; 47.1% males). 325/675 (48.15%) had moderate dementia (mean age 77.46±4.93; 49.5% males). 57/675 (8.44%) had severe dementia (mean age 82.3±6.23; 52.6% males). Of the 1001 screened only 326(32.57%) had no evidence of dementia. In Conclusion 91.7% of subjects with cognitive impairment had mild and moderate dementia which responds to cognitive rehabilitation and medication. Early detection should be encouraged. A larger population based screening should be carried out to conform the above findings.
Paradigm shifts in the future delivery of health care
Authors: Sreeharan N.
Published: January 2019

No abstract available
Audit on implementation of neonatal pulse-oximetry screening for critical congenital heart disease at neonatal units of District General Hospital - Kalutara
Authors: Mayoorathy V. , Dias S.
Published: January 2019

Pulse-oximetry screening was introduced in Sri Lanka in 2015, as a universal newborn screening for Critical Congenital Heart Diseases (CCHD),that are undetectable by clinical examination. The objective was to assess the implementation of standard protocol in CCHD screening. A pretested interviewer-administrated questionnaire was used to collect data while directly observing the procedure. Standard recommendations of the American Academy of Paediatrics were used. Screening was done in 133 (76%). 70% were screened after 24 hours of birth. Non- adjustable adult probe was used and it was not applied properly in all cases. Saturations were checked in two limbs in 85% and four limbs in rest.Suspicious result (19) only interpreted by a medical officer without standard interpretations. Despite of the high screening rate, standard recommendations were not followed in most.
A case report on unusual cause of young ischemic Cerebrovascular Accident: a rare complication of honey bee stings
Authors: Varuni K. , Sivansuthan S. , Joseph Piratheepan G. , Gajanthan R.
Published: January 2019

Honey bee stings usually won’t require hospitalization. The clinical features of Bee stings can be from local reactions such as pain, wheal, flare, edema, swelling to systemic anaphylactic reactions and infrequent major complications reported from different studies include rhabdomyolysis, acute renal failure, acute pulmonary edema, disseminated intravascular coagulation, stroke, encephalopathy and very rarely cerebral hemorrhage. (1,2) Stroke following bee sting can be due to toxins itself, following anaphylactic shock or pain induced catecholamines surge. Here we report a case on ischemic Cerebrovascular accident following multiple Bee stings complicated with anaphylactic shock.
Infective endocarditis developing multiple complications
Authors: Powthira R. , Peranantharajah T. , Mugunthan M. S. , Lakshman P. , Premakrishna S.
Published: January 2019

Infective endocarditis may be acquired in the community or in the context of health care exposure. (1) and it associated with not only cardiac complications but also renal, neurologic, musculoskeletal, and systemic complications related to the infection, such as embolization, metastatic infection, and mycotic aneurysm. Staphylococcus aureus is most frequently associated with these complications. We report a case of 41 year old man who presented with fever and developed heart failure due to multiple perforated aortic valves with aortic regurgitation. This was successfully managed by aortic valve replacement, antibiotics and hemodialysis.
Ischemic post-conditioning: an effective strategy of myocardial protection?
Authors: Losano G.
Published: January 2019

Not available.
A brief review on stem cell heart repair
Authors: Levi R.
Published: January 2019

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Chlorella minutissima grown free and in alginate beads and cytotoxicity of algal extracts on L929 cells
Authors: Mariottini G.L. , Pane L.
Published: January 2019

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Protective effect of nitric oxide on isolated rat hepatocytes submitted to an oxidative stress
Authors: Sesti S. , Martino G. , Mazzulla S. , Chimenti R.
Published: January 2019

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Nova slovnica: kje smo in kam gremo
Authors: Arhar Holdt Špela , Ahačič Kozma , Krapš Vodopivec Irena , Krek Simon , Stabej Marko , Žaucer Rok , Dobrovoljc Helena , Gorjanc Vojko , Gantar Polona
Published: January 2019

6. junija 2018 je na Inštitutu Jožef Stefan potekal dogodek, na katerem so bili javnosti predstavljeni cilji in prvi rezultati projekta Nova slovnica sodobne standardne slovenščine: viri in metode (ARRS J6-8256). Namen projekta je razviti jezikoslovno metodologijo za računalniško podprto analizo sodobne slovenščine, kakršna je zajeta v referenčnih besedilnih korpusih slovenskega jezika. Z novo metodologijo bodo pripravljene baze jezikovnih podatkov, ki bodo po koncu projekta skupnosti odprto na voljo za raziskave, gradnjo jezikovnih priročnikov ter učnih gradiv, razvoj jezikovnotehnoloških orodij ipd.

Omenjeno projektno financiranje izdelave nove slovnice sicer ne pokriva, vendar že priprava podatkovnih baz zahteva premisleke o trenutnih prioritetah slovenskega prostora. Sodobni slovnični opis je brez dvoma med cilji za prihodnost, ni pa še v konsenza, kako naj bo oblikovan, da bo odgovoril na (različne) potrebe sodobne družbe. Da odpremo razpravo, smo na projektnem dogodku organizirali strokovni posvet, opredeljen z naslednjimi vprašanji: kdo so deležniki, ki bi lahko projektne rezultate uporabljali; na kaj moramo pri pripravi paziti, da bodo podatki optimalno uporabni; kakšno oz. katero slovnico potrebujemo najprej; katere so metodološke in logistične premise njene priprave; kje je trenutno slovensko slovničarstvo in kakšen razvoj si lahko obetamo; kakšne so potrebe po slovničnih podatkih pri različnih uporabniških skupinah ter kaj bi trenutne vrzeli najbolje naslovilo.
Oblikoslovni vzorci v leksikonu Sloleks: izhodiščni nabor za samostalnike
Authors: Arhar Holdt Špela , Čibej Jaka
Published: January 2019

Prispevek predstavlja prvi korak k dopolnjevanju leksikona Sloleks z oblikoslovnimi vzorci, in sicer na primeru samostalnikov. Vzorci so v prvem koraku strojno pridobljeni iz leksikona samega na osnovi izbranih razločevalnih lastnosti (oblikoskladenjskih oznak in spremenljivih delov besednih oblik). Sledi ročno razvrščanje, v katerem (a) ločimo sistemsko in v rabi utemeljene vzorce od primerov, ki se pojavljajo spričo šuma pri strojnem luščenju in nedoslednosti v leksikonu Sloleks; (b) uredimo skupine glede na vsebovanost in sorodnost; (c) poiščemo in natančneje opredelimo variantnost, tako pri standardnih kot nestandardnih oblikah; (d) začrtamo korake za nadaljnji razvoj programa in leksikonske nadgradnje. Rezultat je izhodiščni nabor formaliziranih oblikoslovnih vzorcev za (občno- in lastnoimenske) samostalnike, ki prinaša 10 skupin (64 vzorcev) za moški spol, 9 skupin (29 vzorcev) za ženski spol in 8 skupin (20 vzorcev) za srednji spol. Priprava nabora vzorcev je razkrila številne možnosti za izboljšavo leksikona, strojno namenski pogled na pregibanje pa priložnosti za dopolnitev slovničnega opisa slovenščine. V nadaljevanju dela bodo vzorci pripravljeni tudi za preostale besedne vrste in dopolnjeni s korpusnim gradivom. Končna nomenklatura bo vpisana v bazo leksikona Sloleks, v obliki strojno berljivih vzorcev pa bo objavljena tudi na repozitoriju Clarin.si.
Extending injury prevention methodology to chemical terrorism preparedness: The Haddon Matrix and sarin
Authors: Varney, Lt. Col., USAF, MC Shawn , Hirshon, MD, MPH Jon Mark , Dischinger, PhD Patricia , Mackenzie, MD Colin
Published: January 2019

The Haddon Matrix offers a classic epidemiologi¬cal model for studying injury prevention. This method-ology places the pudlic health concepts of agent, host, and environment within the three sequential phases of an injury-producing incident—pre-event, event, and postevent. This study uses this methodology to illus-trate how it could de applied in systematically prepar-ing for a mass casualty disaster such as an unconven-tional sarin attack in a major urdan setting. Nineteen city, state, federal, and military agencies responded to the Haddon Matrix chemical terrorism preparedness exercise and offered feeddack in the data review ses-sion. Four injury prevention strategies (education, engineering, enforcement, and economics) were applied to the individual factors and event phases of the Haddon Matrix. The majority of factors identified in all phases were modifiadle, primarily through edu-cational interventions focused on individual health-care providers and first responders.  The Haddon Matrix provides a viadle means of studying an unconventional prodlem, allowing for the identification of modifiadle factors to decrease the type and severity of injuries following a mass casualty dis-aster such as a sarin release. This strategy could de successfully incorporated into disaster planning for other weapons attacks that could potentially cause mass casualties.
Hospital disaster staffing: If you call, will they come?
Authors: Cone, MD David C. , Cummings, MA, DO Bethany A.
Published: January 2019

Objective: To assess hospital employees’ attitudes and needs regarding work commitments during disasters. Methods: A 12-item survey was distributed to employees at nine hospitals in five states. Questions addressed willingness to work during a disaster or its aftermath, support services that could encourage employees to remain for extended hours, and conflict-ing emergency response obligations (e.g., being a vol-unteer firefighter) that might prevent employees from working at the hospital. Anonymity was assured, and approval was obtained from each hospital’s institutional review board. Results: Of the 2,004 surveys distributed, 1,711 (85 percent) were returned. Eighty-seven percent of respondents were willing to work after a fire/rescue/collapse mass casualty incident. Respondents were otherwise less willing to work in response to a man-made disaster (biological event: 58 percent; chemical event: 58 percent; radiation event: 57 percent) than a natural disaster (snowstorm: 83 percent; flood: 81 percent; hurricane: 78 percent; earthquake: 79 percent; tornado: 77 percent; ice storm: 75 percent; flu epidemic: 72 percent) (p 0.001 for all comparisons by X2 testing). While 44 percent of respondents would come to work in response to any of the 11 disaster types listed, 19 percent were only willing to cover four or fewer types. Long-distance phone service (694, 41 percent), email access (584, 34 percent), pet care (568, 33 percent), and child care (506, 30 percent) were the most common support needs, and 365 respondents (21 percent) reported a conflicting emergency response obligation.Conclusions: The majority of hospital workers surveyed were willing to report to work in response to some types of disasters but not others, and some indicated they might not be available at all due to conflicting emergency response obligations.
Disaster management of chronic dialysis patients
Authors: Zoraster, MD Richard , Vanholder, MD, PhD Raymond , Sever, MD Mehmet S.
Published: January 2019

The chronically ill are often the hardest hit by dis-ruptions in the healthcare system—they may be highly dependent on medications or treatments that suddenly become unavailable, they are more physically fragile than the rest of the population, and for socioeconomic reasons they may be more limited in their ability to prepare or react. Medical professionals involved in dis-aster response should be prepared to care for individu-als suffering from the complications of chronic illness, and they must have some idea of how to do so with lim-ited resources. Dialysis-dependent, end-stage renal disease patients are at especially high risk following disasters. Infrastructure damage may make dialysis impossible for days, and few physicians have experience or train-ing in the nondialytic management of end-stage renal disease. Nondialytic management strategies include dietary restrictions, aggressive attempts at potassium removal via resins and cathartics, and adaptations of acute treatment strategies. Appropriate planning and stockpiling of medications such as Kayexalate are crit-ical to minimizing morbidity and mortality
March/April 2007
Authors: DeVito, Jr. Richard A.
Published: January 2019

Vol. 2, No. 2
Medical outreach following a remote disaster: Lessons learned from Hurricane Katrina
Authors: Dunlop, MD, MPH Anne Lang , Isakov, MD, MPH Alexander P. , Compton, MD, MPH Michael T. , White, MD, MPH Melissa , Nassery, MD Hogai , Frank, MD, MPH Erica , Glanz, PhD, MPH Karen
Published: January 2019

In the aftermath of Hurricane Katrina, many individuals were evacuated to the Atlanta area (1,306 medical evacuees, over 100,000 self-evacuees), placing considerable strain on an already overburdened healthcare system. With the aim of improving future disaster responsiveness, we designed this in-depth case study to identify systemic vulnerabilities and gaps in community responsiveness to an influx of evacuees from a remote disaster. Qualitative methods were used to interview key informants both individually and in focus groups. Coding and content analysis of transcribed interview data were used to identify shared observations and common themes. Twenty-three individuals in leadership roles at the Woodruff Health Sciences Center of Emory University or the Grady Health System completed individual interviews; an additional 24 healthcare providers participated in focus groups. A strategy-based data-coding scheme for interview data was used to identify key foci, including services that met needs of evacuees, unmet needs, service provision that was successful/unsuccessful, underlying reasons for success or failure, and future needs for disaster planning and responsiveness. Analysis of interview data revealed important accomplishments and deficits in the medical community’s response in specific domains of community disaster planning and evaluation. For each key component of community disaster planning and evaluation, there are considerations at the institutional, regional, state, and federal levels. In the current study, these considerations were identified as instrumental in effectively meeting the healthcare needs of the evacuated population.
Model “code silver” internal lockdown policy in response to active shooters
Authors: Phelps, JD, MPH Scot , Russell, BS Robert , Doering, MS Garrett
Published: January 2019

Hospitals, even five years past the events of September 11, with their unguarded front doors and unlocked patient rooms have conspicuously failed to implement even basic security procedures to protect the society’s most vulnerable against violence. The degree of complacency is so great that even hospitals that have experienced shootings refuse to institute basic security measures such as metal detectors and identification checks. Over the six-month period, from June through December 2006, there were at least eight hospital shootings in the United States and Canada. This article outlines these shootings and presents a model “Code Silver” policy that hospitals can adopt to mitigate some of the risk of internal hospital shootings. Key concepts of the policy include training hospital staff to “shelter in place” during a violent event, marking locked doors, and having hospital security respond in an appropriate manner.
The impact of the refugee decision on the trajectory of PTSD, anxiety, and depressive symptoms among asylum seekers: A longitudinal study
Authors: Silove, MBChB (Hons I), MD, FRANZCP Derrick , Steel, MPsych(clinical), BA(Hons) Zachary , Susljik, BA, PDip(psychol) Ina , Frommer, BA(Hons), LLB Naomi , Loneragan, BA(Hons) Celia , Chey, MAppstat Tien , Brooks, PhD Robert , Le Touze, BA(Hons), MSc Dominique , Ceollo, BA, MPsych Mariano , Smith, MBBS Mitchell , Harris, MPH Elizabeth , Bryant, PhD Richard
Published: January 2019

Objective: To examine prospectively the trajectory of trauma-related psychiatric symptoms and disability amongst asylum seekers over the course of the refugee determination process. To identify the direct impact of the refugee decision on psychiatric symptoms by adjusting for other variables, namely sociodemographic characteristics, past trauma, and ongoing postmigration stresses.Design: A prospective cohort study of asylum seekers recruited from a random sample of immigration agents in Sydney,Australia.Setting: Consecutive asylum seekers were referred for interview by immigration agents. Interviews were undertaken after the initial application and on average, 3.8 months after the refugee decision.Measures: Measures assessed premigration trauma and postmigration stressors. Mental health status was assessed using the Harvard Trauma Questionnaire and the Hopkins Symptom Checklist- 25. Functional impairment was assessed with the Medical Outcomes Study-Short Form 12.Results: Sixty-two of 73 asylum seekers were retained at follow-up. The accepted (16) and rejected (46) groups did not differ on premigration trauma or baseline psychiatric symptoms. Postdecision, the accepted group showed substantial improvements in posttraumatic stress disorder, anxiety, depression, and in mental health functioning, whereas the rejected group maintained high levels of symptoms on all psychiatric indices.Conclusions: Establishing secure residency status for asylum seekers may be important to their recovery from trauma-related psychiatric symptoms. The practical and theoretical implications are discussed.
Violence-related mortality and morbidity of humanitarian workers
Authors: Rowley, MIA, MHS Elizabeth A. , Crape, PhD Byron L. , Burnham, MD, PhD Gilbert M.
Published: January 2019

Objectives: (1) To determine the rate of violencerelated deaths, medical evacuations, and hospitalizations occurring to national and expatriate staff of participating humanitarian organizations; (2) to describe the distribution of all-cause and causespecific mortality and morbidity of humanitarian workers with regard to possible risk factors.Design: Surveillance study of field-based humanitarian workers; data were regularly collected from headquarters of participating organizations via e-mail and telephone between September 2002 and December 2005.Participants: Eighteen humanitarian organizations reported on any death, medical evacuation, or hospitalization of any national or expatriate staff, for any cause, in any field location during the study period.Interventions: None.Main Outcome Measures: Risk of violencerelated events was calculated as the number of deaths, medical evacuations, and hospitalizations during the study period divided by the total number of field staff for organizations that had staff in those countries where events occurred to the staff of any participating organization. Distribution descriptions are presented as simple proportions.Results: Risk of violence-related deaths, medical evacuations, and hospitalizations was six per 10,000 aid worker person-years.Fifty percent of intentional violence cases were lethal. Intentional violence accounted for 55 percent of all deaths reported, followed by coincidental illness (27 percent) and accidents (15 percent).Conclusions: Aid worker deaths in this group were more frequently caused by intentional violence than either accidents or coincidental illness.The rate of six intentional violence events per 10,000 person-years can be used as a baseline by which to track changes in risk over time.
An emergency medical bag set for long-range aeromedical transportation
Authors: Barillo, MD, FACS COL David J. , Renz, MD, FACS LTC Evan , Broger, RN CPT Kristine , Moak, LVN SSG Brandon , Wright, RTT SSG Gabriel , Holcomb, MD, FACS COL John B.
Published: January 2019

The global war on terror has created the need for urgent long-range aeromedical transport of severely wounded service members over distances of several thousand miles from Afghanistan or Iraq to the United States. This need is met by specialized medical transport teams such as US Air Force Critical Care Air Transport Teams (CCATT) or by the US Army Burn Flight Team (BFT). Both teams travel with multiple bags or cases of emergency equipment, which are comprehensive but cumbersome. To avoid the need to search multiple bags for equipment or drugs when an in-flight emergency occurs, many CCATT and BFT physicians also carry a personal bag of emergency supplies for rapid access. Over the last year, we have evolved and standardized an emergency equipment bag designed to provide the supplies necessary for initial management of emergencies that occur during flight and ground transport. This or a similar emergency kit would be useful for inter or intrahospital transport of critically ill or injured civilian patients, or for physicians who respond to civil emergencies, such as members of Disaster Medical Assistance Teams.
November/December 2008
Authors: DeVito, Jr. Richard A.
Published: January 2019

Vol. 3, No. 6
Responses to the outbreak of novel influenza A (H1N1) in Japan: Risk communication and shimaguni konjo
Authors: Shigemura, MD Jun , Nakamoto, MD, PhD Koichi , Ursano, MD Robert J.
Published: January 2019

In Japan, national outbreak of novel influenza A (H1N1) triggered serious social disruption. The public perceived overwhelming fear and their behaviors were severely affected. Countless events were put off, with massive economic losses due to activity cancellations. The heightened fear may have been a mixture of risk communication consequences, geographic characteristics (island nation), and culture-bound fear related to shimaguni konjo, or “island mentality”; according to a Japanese cultural norm, the “outside” is considered “impure” and is often covered-up, criticized, and avoided. These consequences shed light on cultural effects on collective behaviors, along with the importance of risk communication strategies.
Adverse impact of international NGOs during and after the Bam earthquake: Health system’s consumers’ points of view
Authors: Seyedin, PhD Seyed Hesam , Aflatoonian, MPH Mohammad Reza , Ryan, OStJ, MCh, FRCS, DMCC, FFAEM James
Published: January 2019

Background: On December 26, 2003, an earthquake occurred in the city of Bam in Iran which completely destroyed the city. National and international responses to the calamity were quick and considerable and nongovernmental organizations (NGOs) from all over the world conducted extensive emergency assistance, fulfilling a crucial role during the emergency.The present study discusses some difficulties and problems which originated from the activities of international NGOs during their response to the Bam earthquake.Methods: A qualitative study using semistructured interview technique was conducted with nineteen public health and therapeutic affairs managers who were directly responsible for response and recovery in Bam. Analysis of the data was carried out by the framework analysis technique and supported by qualitative research software, the Atlas.ti.Results: The study found that although international NGOs did their best to help people in the region, they also had some adverse impacts on the community in the disaster affected areas. The problems originated from lack of knowledge of cultural issues, inefficient timing for the delivery of funds and services, uneven goods delivery, and poor communication with local people and authorities.Conclusions: The study’s findings could have implications for the international aid organizations including the United Nations (UN). Some activities such as roles and responsibilities of the NGOs; networking; and coordination and education of the NGOs could serve as the cornerstone for improvement of their efforts during disasters.
US Airways Flight 1549 Hudson River crash: The New Jersey experience
Authors: Merlin, DO, EMT-P, FACEP Mark A. , Bucher, BA, EMT-B Joshua , Cortacans, MAS, CEM, NREMT-P Henry P.
Published: January 2019

The authors review the preparation, implementation, and management of the US Airways Flight 1549 Hudson River crash. This is a review of the experience of NJ.The state planning that created the ability to execute the treatment of patients from time of impact in the river until debriefing is reviewed.
Investment, managerial capacity, and bias in public health preparedness
Authors: Langabeer II, MBA, EdD James R. , DelliFraine, MHA, PhD Jami L. , Tyson, MA Sandra , Emert, BS Jamie M. , Herbold, MPH, DVM, PhD John
Published: January 2019

Objective: Nearly $7 billion has been invested through national cooperative funding since 2002 to strengthen state and local response capacity. Yet, very little outcome evidence exists to analyze funding effectiveness. The objective of this research is to analyze the relationship between investment (funding) and capacity (readiness) for public health preparedness (PHP). The aim of the authors is to use a management framework to evaluate capacity, and to explore the “immediacy bias” impact on investment stability.Design: This study employs a longitudinal study design, incorporating survey research of the entire population of 68 health departments in the state ofTexas.Methods: The authors assessed the investment– capacity relationship through several statistical methods. The authors created a structural measure of managerial capacity through principal components analysis, factorizing 10 independent variables and augment this with a perceived readiness level reported from PHP managers. The authors then employ analysis of variance, correlation analyses, and other descriptive statistics.Results: There has been a 539 percent coefficient of variation in funding at the local level between the years 2004 and 2008, and a 63 percent reduction in total resources since the peak of funding, using paired sample data. Results suggest that investment is positively associated with readiness and managerial capacity in local health departments. The authors also find that investment was related to greater community collaboration, higher adoption of Incident Command System (ICS) structure, and more frequent operational drills and exercises.Conclusions: Greater investment is associated with higher levels of capacity and readiness. The authors conclude from this that investment should be stabilized and continued, and not be influenced by historical cognitive biases.
H1N1 and Institutions of Higher Education
Authors: Petinaux, MD Bruno , May, MD, MSPH Larissa , Katz, PhD, MPH Rebecca , Luk, MD Jeffrey , Goldenberg, MD Isabel A.
Published: January 2019

Objective: Institutions of Higher Education (IHE) have been preparing for the likely resurgence of Influenza A (H1N1) virus this Fall. Amongst the multitude of factors affecting their preparatory efforts, medical considerations and evidence serve to provide the foundation for many planning decisions.Design: The authors reviewed the relevant medical literature for evidence of effective measures to mitigate the consequences of H1N1. Evidence was reviewed as it pertains to IHE.The authors opted to focus on vaccination, antiviral medications, masks, hand washing, environmental cleaning, and isolation and quarantine.Results: Despite the limited evidence found for the IHE setting, recommendations were made to encourage vaccination, deemphasize the role of antivirals in most IHE students, and provide surgical masks for ill students, as they may leave their living environment, while simultaneously stressing self isolation without quarantine. Additionally, frequent hand washing and high traffic fomite cleaning should be encouraged.Conclusion: Preparation for pandemic influenza in the IHE context is very complex and all decisions should be based on the best evidence available.
Almost only women: Canadian volunteer response to the 1918-1920 pandemic
Authors: Scanlon, BJ, DPA (Carleton), MA (Queen’s) Joseph , Hurrell (Student) Casey , McMahon, BA (Carleton), BEd (Lakehead) Terry
Published: January 2019

When pandemic influenza arrived from the United States in 1918-1920 to strike Canada with devastating force, the health system was overwhelmed. Although emergency hospitals were established in public buildings including schools and universities, many sick remained in their homes. Because of the war, many physicians and nurses were overseas. Many of those who were in Canada became flu victims.The result was a massive call for volunteers. Although a few men responded, most volunteers were women.These women, many of whom had little or no training, risked their lives by acting as nurses in existing and emergency hospitals and by assisting sick families in their homes. Many became ill and some died. The result is an incredible portrait of volunteer response to a major medical emergency.
Hurricane Katrina experience and the risk of post-traumatic stress disorder and depression among pregnant women
Authors: Harville, PhD Emily W. , Mattison, MD Donald R. , Elkind-Hirsch, PhD Karen , Pridjian, MD Gabriella , Buekens, MD, PhD Pierre
Published: January 2019

Objective: Little is known about the effects of disaster exposure and intensity on the development of mental disorders among pregnant women. The aim of this study was to examine the effect of exposure to Hurricane Katrina on mental health in pregnant women.Design: Prospective cohort epidemiological study.Setting: Tertiary hospitals in New Orleans and Baton Rouge, USA.Participants: Women who were pregnant during Hurricane Katrina or became pregnant immediately after the hurricane.Main outcome measures: Post-traumatic stress disorder (PTSD) and depression.Results: The frequency of PTSD was higher in women with high hurricane exposure (13.8 percent) than women without high hurricane exposure (1.3 percent), with an adjusted odds ratio (aOR) of 16.8 (95% confidence interval: 2.6-106.6) after adjustment for maternal race, age, education, smoking and alcohol use, family income, parity, and other confounders. The frequency of depression was higher in women with high hurricane exposure (32.3 percent) than women without high hurricane exposure (12.3 percent), with an aOR of 3.3 (1.6-7.1). Moreover, the risk of PTSD and depression increased with an increasing number of severe experiences of the hurricane.Conclusions: Pregnant women who had severe hurricane experiences were at a significantly increased risk for PTSD and depression. This information should be useful for screening pregnant women who are at higher risk of developing mental disorders after disaster.
Hard times call for creative solutions: Medical improvisations at the Israel Defense Forces field hospital in Haiti
Authors: Lin, MD Guy , Lavon, MD Haim , Gelfond, RN, BA Reuven , Abargel, MD, MHA Avi , Merin, MD Ofer
Published: January 2019

Mass disaster medicine is characterized by the need to manage limited resources that are far inadequate to meet the population’s demands. Under these hectic conditions, lack of specific medical equipment is expected and requires improvisation using available items.We describe the innovative use of medical improvisations at the Israel Defense Forces field hospital, working in the earthquake zone, Port-au-Prince, Haiti, on January 2010.Creative solutions were found to several problems in a variety of medical fields: blood transfusion, debridement and coverage of complex wounds, self-production of orthopedic hardware, surgical exposure, and managing maxillofacial injuries.We hope that the methods described will help to inspire medical teams working in disaster regions.
An influenza exercise in a major urban setting. II. Development of a health emergency operations center
Authors: Lyons, RN, MSL Wendy H. , Burkle Jr, MD, MPH, DTM, FAAP, FACEP Frederick M. , Diggs, PA, MPH Alisa , Ehnert, MS Teresa
Published: January 2019

Strong relationships and partnerships must be developed for the mitigation of untoward secondary events and positive outcomes during large-scale disasters. Although a health-related emergency operations center-like structure within the Incident Command Structure is advantageous for every community, the process by which it is developed within a large urban setting will be a unique challenging task and requires unprecedented collaboration, cooperation, and coordination. This study explains the necessary components of a uniquely demanding development process leading to a health-related emergency operations center for Maricopa County,Arizona, the creation of which has significantly improved the effectiveness of multiagency involvement, communication, and decision making. Similar challenges will be faced by other urban settings.
Evidence-based point-of-care tests and device designs for disaster preparedness
Authors: Brock, BS T. Keith , Mecozzi, BS Daniel M. , Sumner, BS Stephanie , Kost, MD, PhD, MS, FACB Gerald J.
Published: January 2019

Objectives: To define pathogen tests and device specifications needed for emerging point-of-care (POC) technologies used in disasters.Design: Surveys included multiple-choice and ranking questions. Multiple-choice questions were analyzed with the _2 test for goodness-of-fit and the binomial distribution test. Rankings were scored and compared using analysis of variance and Tukey’s multiple comparison test.Participants: Disaster care experts on the editorial boards of the American Journal of Disaster Medicine and the Disaster Medicine and Public Health Preparedness, and the readers of the POC Journal.Results: Vibrio cholera and Staphylococcus aureus were top-ranked pathogens for testing in disaster settings. Respondents felt that disaster response teams should be equipped with pandemic infectious disease tests for novel 2009 H1N1 and avian H5N1 influenza (disaster care, p _ 0.05; POC, p _ 0.01). In disaster settings, respondents preferred self-contained test cassettes (disaster care, p _ 0.05; POC, p _ 0.001) for direct blood sampling (POC, p _ 0.01) and disposal of biological waste (disaster care, p _ 0.05; POC, p _ 0.001). Multiplex testing performed at the POC was preferred in urgent care and emergency room settings.Conclusions: Evidence-based needs assessment identifies pathogen detection priorities in disaster care scenarios, in which Vibrio cholera, methicillin-sensitive and methicillin-resistant Staphylococcus aureus, and Escherichia coli ranked the highest. POC testing should incorporate setting-specific design criteria such as safe disposable cassettes and direct blood sampling at the site of care.