bluuebunny/crossref_metadata_2025 huggingface dataset:
Potential Roles of Military-Specific Response to Natural Disasters—Analysis of the Rapid Deployment of a Mobile Surgical Team to the 2007 Peruvian Earthquake
Authors: Malish Richard , Oliver David E. , Rush Robert M. , Zarzabal Esmeraldo , Sigmon Michael J. , Burkle Frederick M.
Published: August 2016

The August 2007 earthquake in Peru resulted in the loss of critical health infrastructure and resource capacity. A regionally located United States Military Mobile Surgical Team was deployed and operational within 48 hours. However, a post-mission analysis confirmed a low yield from the military surgical resource. The experience of the team suggests that non-surgical medical, transportation, and logistical resources filled essential gaps in health assessment, evacuation, and essential primary care in an otherwise resource-poor surge response capability. Due to an absence of outcomes data, the true effect of the mission on population health remains unknown. Militaries should focus their disaster response efforts on employment of logistics, primary medical care, and transportation/evacuation. Future response strategies should be evidence-based and incorporate a means of quantifying outcomes.
Mustard Gas or Sulfur Mustard: An Old Chemical Agent as a New Terrorist Threat
Authors: Wattana Monica , Bey Tareg
Published: August 2016

Sulfur mustard is a member of the vesicant class of chemical warfare agents that causes blistering to the skin and mucous membranes. There is no specific antidote, and treatment consists of systematically alleviating symptoms. Historically, sulfur mustard was used extensively in inter-governmental conflicts within the trenches of Belgium and France during World War I and during the Iran-Iraq conflict. Longitudinal studies of exposed victims show that sulfur mustard causes long-term effects leading to high morbidity. Given that only a small amount of sulfur mustard is necessary to potentially cause an enormous number of casualties, disaster-planning protocol necessitates the education and training of first-line healthcare responders in the recognition, decontamination, triage, and treatment of sulfur mustard-exposed victims in a large-scale scenario.
Application of Outcome Measures in International Humanitarian Aid: Comparing Indices through Retrospective Analysis of Corrective Surgical Care Cases
Authors: McQueen K.A. Kelly , Magee William , Crabtree Thomas , Romano Christopher , Burkle Frederick M.
Published: August 2016

It is common for international organizations to provide surgical corrective care to vulnerable populations in developing countries. However, a current worsening of the overall surgical burden of disease in developing countries reflects an increasing lack of sufficient numbers of trained healthcare personnel, and renders outside volunteer assistance more desirable and crucial than ever. Unfortunately, program evaluation and monitoring, including outcome indices and measures of effectiveness, is not measured commonly. In 2005, Operation Smile International implemented an electronic medical record system that helps monitor a number of critical indices during surgical missions that are essential for quality assurance reviews. This record system also provided an opportunity to retrospectively evaluate cases from previous missions. Review of data sets from >8,000 cases in 2005 and 2006 has provided crucial information regarding the priority of surgery, perioperative and operative complications, and surgical program development.

The most common procedure provided was unilateral cleft lip repair, followed closely by cleft palate. A majority of these interventions occurred for patients who were older than routinely provided for in the western world. The average child treated had an age:weight ratio at or below the [US] Centers for Disease Control and Prevention (CDC) 50th percentile, with a small percentage falling below the CDC 20th percentile. A majority of children had acceptable levels of hemoglobin, but the relative decreased age:weight ratio nonetheless can reflect mild malnutrition. Complications requiring medical intervention were seen in 1.2% of cases in 2005 and 1.0% in 2006. Thirty percent were reported as anesthesia complications, and 61% reported as surgical complications. One death was reported, but occurred after discharge outside the perioperative period. Complication rates are similar to rates reported in the US and UK and emphasizes the importance of standardization with uniform indices to compare quality performance and equity of care. This study offers an important example of the importance of collecting, analyzing, and reporting measures of effectiveness in all surgical settings.
Laryngeal Tube and Intubating Laryngeal Mask Insertion in a Manikin by First-Responder Trainees after a Short Video-Clip Demonstration
Authors: Jokela Jorma , Nurmi Jouni , Genzwuerker Harald V. , Castrén Maaret
Published: August 2016

Introduction:

This study was performed in the Finnish Defense Forces to assess the potential applicability and value of short video clips as educational material to teach advanced airway management and as the first means of introducing the use of a laryngeal tube (LT) or an intubating laryngeal mask (ILMA) to inexperienced, military, first-responder trainees with no prior hands-on experience.

Methods:

The 60 non-commissioned medical officers participating in this study were randomly assigned into one of two groups: the LT- and the ILMA-group. After viewing the video clips, the trainees were required to perform 10 consecutive, successful insertions of the given instrument into a manikin. The number and duration of the attempts required prior to the 10 consecutive successful insertions were measured.

Results:

The goal of 10 consecutive successful insertions was attained by all 30 subjects in the LT-group, and by 27 of 29 subjects in the ILMA-group with a maximum of 30 attempts. Improvement in the ease and speed of insertion was evident between the first and last consecutive insertions in both groups.

Conclusions:

“Satisfactory” to “good” skill levels are achieved with the applied video-clip demonstration method, even in inexperienced first-responder trainees lacking previous hands on experience.
Ethical Considerations for Emergency Care Providers during Pandemic Influenza–Ready or Not…
Authors: Pena Margarita E. , Irvin Charlene B. , Takla Robert B.
Published: August 2016

When an infectious pandemic occurs in the United States, emergency care providers (ECPs) will be on the frontlines caring for infected, potentially infected, and non-infected patients. Logistically, the current emergency care system is not ready for a pandemic, but are the providers ethically ready? Some of the most difficult and challenging issues that will be raised during a pandemic will be ethical in nature. An ECP likely will be confronted with ethical values and value conflicts underlying restriction of liberty, duty to care, and resource allocation.

This report summarizes the ethical concerns and challenges that ECPs face during an infectious pandemic, and raises ethical questions that may arise related to the role of an ECP as a healthcare provider and stakeholder.
Effect of the Rural Rescue System on Reducing the Mortality Rate of Landmine Victims: A Prospective Study in Ilam Province, Iran
Authors: Saghafinia Masoud , Nafissi Nahid , Asadollahi Reza
Published: August 2016

Background:

In several Iranian provinces, there are large numbers of landmines that threaten the lives of many civilians. Ilam is one of the most polluted areas with 1,086 injuries from landmines between 1989 to 1999, with an overall mortality rate of 36.4%. A remarkable number of deaths occurred before the injured were conveyed to the hospital. In this survey, the effects of on trauma outcome of the use of prehospital trauma life support provided by t rained paramedics and ru ral health workers as first responders were examined.

Methods:

In an interventional, prospective study, 4,834 persons (general physicians, nurses, rural health workers, and emergency technicians, high- and low-educated people, layperson villagers, and nomads) were trained in one level of advanced (for general physicians and nurses) and four levels of basic life support courses during two years (2000–2001). Following the training, the data from 288 landmine victims who were referred to the main hospital in Ilam (trauma center) were registered prospectively (2001–2005). The effects of prehospital trauma life support training were assessed by using the Injury Severity Scale (ISS) score and prehospital physiologic severity (PSS) score.

Results:

There were 288 injuries from landmines in the Mehran region between 2002 and 2005. The mean ISS score was 20.3 with a median of 13. Forty percent were severely injured with an ISS score >15. Of the injured who received prehospital care at the Mehran Emergency Center, the mean value of the PSS scores was 6.40, which improved to 7.43 in the hospital (p = 0.01; 95% CI for difference -0.72 to -0.45), in comparison with 5.97 in the injured who were conveyed to Ilam Hospital directly (mean of ISS was approximately equal in both groups).The total mort ality rate was 27% between 2001 and 2005.

Conclusions:

Prehospital educations and training help improve PSS scores and reduce the death toll of landmine accidents in the remote areas.
Disaster Response to the Release of Biohazardous Agents: Instrument Development and Evaluation of a Firefighter's Exercise
Authors: Lenz Matthias , Richter Tanja
Published: August 2016

Introduction:

The release of biohazardous agents could affect many people. Preparedness is crucial for adequate responses to accidental or deliberate release of biohazardous agents. It is believed that exercises based on simulated incident scenes are effective methods for the training of firefighters and biohazard response teams. Structured evaluations are important methods used to identify areas of ineffectiveness and to assure the quality of responses to releases of biohazards.

Methods:

A local fire department conducted a full-scale biohazard exercise in an elementary school. The firefighters practiced prohibiting entry to the area, establishing security zones, evacuating victims, assessing hazards, preventing further dissemination, and sampling and keeping the suspicious material in safe custody.Trained observers systematically evaluated the exercise following a standardized evaluation protocol. A set of data collection templates were created based on standard operating procedures extracted from current guidelines.

Results:

There were 60 firefighters, eight members of the incident command, 16 simulated victims, and 18 trained observers that participated in the exercise. Out of 31 standard operating procedures, 20 were in accordance with the guidelines, 10 were performed incorrectly, and one was not applicable. Major problems related to the assessment and handling of the suspicious material, the use of protective equipment, and decontamination of victims. Reasons for incomplete and/or conflicting documentation included insufficient knowledge and training of observers, imprecise instructions about documentation, and the size of observation zones.

Conclusions:

Intensive education and training of response activities is necessary. Each fire department should perpetually reassess their technical equipment and specific skills and their communication and command structures. The applied documentation system performed well in disclosing discrepancies between observed response activities and current recommendations. Using external observers provided transparent and independent data. However, intensive observer training is necessary. Observer training should include detailed, written instructions and short guidelines that could be available during the exercise.
Preparing for an Influenza Pandemic: Mental Health Considerations
Authors: Perrin Paul C. , McCabe O. Lee , Everly George S. , Links Jonathan M.
Published: August 2016

There is a common belief that an influenza pandemic not only is inevitable, but that it is imminent. It is further believed by some, and dramatized by a 2006 made-for-television-movie, that such a pandemic will herald an end to life as we know it. Are such claims hyperboles, or does a pandemic represent the most significant threat to public health in the new millennium? Any potential effects of a disease on a population are mediated not only through the pathophysiological mechanisms of the disease itself, but through the psychological and behavioral reactions that such a disease might engender. It is the purpose of this paper to explore the potential psychological and behavioral reactions that may accompany an influenza pandemic.
Evidence-Based Decision-Making (Part 1): Origins and Evolution in the Health Sciences
Authors: Bradt David A.
Published: August 2016

Evidenceis defined as data on which a judgment or conclusion may be based. In the early 1990s, medical clinicians pioneered evidence-based decision-making. The discipline emerged as the use of current best evidence in making decisions about the care of individual patients. The practice of evidence-based medicine required the integration of individual clinical expertise with the best available, external clinical evidence from systematic research and the patient's unique values and circumstances. In this context, evidence acquired a hierarchy of strength based upon the method of data acquisition.

Subsequently, evidence-based decision-making expanded throughout the allied health field. In public health, and particularly for populations in crisis, three major data-gathering tools now dominate: (1) rapid health assessments; (2) population based surveys; and (3) disease surveillance. Unfortunately, the strength of evidence obtained by these tools is not easily measured by the grading scales of evidence-based medicine. This is complicated by the many purposes for which evidence can be applied in public health—strategic decision-making, program implementation, monitoring, and evaluation. Different applications have different requirements for strength of evidence as well as different time frames for decision-making. Given the challenges of integrating data from multiple sources that are collected by different methods, public health experts have defined best available evidence as the use of all available sources used to provide relevant inputs for decision-making.
If Schools Are Closed, Who Will Watch Our Kids? Family Caregiving and Other Sources of Role Conflict among Nurses during Large-Scale Outbreaks
Authors: O'Sullivan Tracey L. , Amaratunga Carol , Phillips Karen P. , Corneil Wayne , O'Connor Eileen , Lemyre Louise , Dow Darcie
Published: August 2016

Objectives:

The global impact of severe acute respiratory syndrome (SARS) brought attention to the role of healthcare professionals as “first receivers” during infectious disease outbreaks, a collateral aspect to their role as responders. This article records and reports concerns expressed by Canadian emergency and critical care nurses in terms of organizational and social supports required during infectious disease outbreaks. The nature of work-family and family-work conflict perceived and experienced by nurses during infectious disease outbreaks, as well as the supports needed to enable them to balance their social roles during this type of heightened stress, are explored.

Methods:

Five focus groups consisting of 100 nurses were conducted using a Structured Interview Matrix facilitation technique.

Results:

Four emergent themes included: (1) substantial personal/professional dilemmas; (2) assistance with child, elder, and/or pet care; (3) adequate resources and vaccinations to protect families; and (4) appropriate mechanisms to enable two-way communication between employees and their families under conditions of quarantine or long work hours.

Conclusions:

Social and organizational supports are critical to help buffer the effects of stress for nurses and assist them in managing difficult role conflicts during infectious disease outbreaks. These supports are necessary to improve response capacity for bio-disasters.
Prospective Study of Validity of Neurologic Signs in Predicting Positive Cranial Computed Tomography following Minor Head Trauma
Authors: Rahman Yassir S. Abdul , Al Den Ahmed Sami S. , Maull Kimball I.
Published: August 2016

Introduction:

The ability to discriminate among a large number of patients with mild head injury to detect those most likely to have an intracranial abnormality may offer an advantage in mass-casualty situations and when clinical needs exceed diagnostic capabilities.

Hypothesis:

In patients with mild head injury (Glasgow Coma Scale score = 13−15), the likelihood of intracranial abnormality, as defined by cranial computed tomography (CT), varies according to presenting neurologic signs and symptoms.

Methods:

This prospective study consisted of 152 patients with blunt head trauma and one or more of the following: initial loss of consciousness (LOC), headache, vomiting, convulsions, or amnesia. All underwent cranial CT within one hour of presentation. Positive CT findings were defined as cerebral contusion, extra-axial hematoma, intra-ventricular or subarachnoid hemorrhage, brain edema, and skull fracture. Clinical findings were tabulated and compared with CT findings.

Results:

The most common symptoms were headache (61%) followed by followed by LOC (45%), vomiting (39%), amnesia (29%), and convulsions (4%). Convulsions were the most predictive of a CT positive finding (80%); history of LOC was least predictive (29%). The presence of two or more clinical findings tended to increase the likelihood of intracranial abnormality, but the association was neither consistent nor additive.

Conclusions:

Convulsions occurring in a patient with mild head injury are highly predictive of a positive intracranial finding on CT. Headache, amnesia, and vomiting are each likely to show positive findings in approximately 40–45% of cases. Although the least predictive of the neurologic findings studied, loss of consciousness still correlates with a positive cranial CT in 29% of cases. More than one sign or symptom increases the likelihood of concurrent brain injury.
Evaluation of the Effect of Prehospital Application of Continuous Positive Airway Pressure Therapy in Acute Respiratory Distress
Authors: Warner G. Scott
Published: August 2016

Objective:

The impact of the use of mask continuous positive airway pressure (CPAP) on patients with acute respiratory distress in the prehospital, rural setting has not been defined. The goal was to test the use of CPAP using the Respironics® WhisperFlow® CPAP in patients presenting with acute respiratory distress. This was a collaborative evaluation of CPAP involving a rural EMS agency and the regional medical center. Patient outcomes including the overall rate of intubation-both in the field and in the emergency department (ED), and length of stay in the hospital and Intensive Care Unit (ICU) were tracked.

Methods:

The study was an eight-month, crossover, observational, non-blinded study.

Results:

During the four months of baseline data collection, 7.9% of patients presenting with respiratory distress were intubated within the first 48 hours of care. Their average ICU length of stay was 8.0 days. During the four months of data collection when CPAP was available in the prehospital setting, intubation was not required for any patients in the field or in the ED. Admissions to the ICU decreased. Those patients admitted to the ICU, the average ICU length of stay deceased to 4.3 days.

Conclusions:

The use of the CPAP in the prehospital setting is beneficial for patients in acute respiratory distress.
Frequent Use of Emergency Medical Services by the Elderly: A Case-Control Study Using Paramedic Records
Authors: Tangherlini Niels , Pletcher Mark J. , Covec Mark A. , Brown John F.
Published: August 2016

Introduction:

The objective of this study was to identify the factors that lead to increased use of emergency medical services (EMS) by patients ≥65 years of age in an urban EMS system.

Methods:

Retrospective, case-control study of frequent EMS use among elderly patients transported during one year in an urban EMS system. Three distinct groups were examined for transports that took place in 1999: (1) 1–3 transports per year (low use); (2) 4–9 times per year (high use); and (3) those transported 10+ times (very high use). This frequency-use indicator variable is the primary outcome measurement. Predictors included age, gender, preexisting medical diseases, ethnicity, number of medications, number of medical problems, primary physician, psychiatric diagnosis, and homelessness. Analysis of predictors was done using ordinal logistic regression model, and a global test of interaction terms.

Results:

Male gender, black ethnicity, homelessness, and a variety of types of medical problems were associated with increased use of EMS resources. The strongest single predictor of case status remained homelessness, which was nearly eight times as commonly associated with frequent EMS use than for the controls. The number of medical problems and medications also were significantly associated with EMS use in this patient population. There was a lack of association of alcohol, substance abuse, and psychiatric disorders with EMS use. Patients with asthma who did not have a primary care physician were more likely to use EMS services than were those who had a physician.

Conclusions:

This analysis highlights homelessness as being strongly associated with frequent EMS use among the elderly and downplays other associated factors, such as psychiatric disease and substance use. Medical illness severity, particularly asthma when no primary care physician is available, also appears to drive frequent EMS use. Both findings have implications in terms of targeting of public resources; providing housing to medically ill elderly and primary care to asthmatics in particular, may provide dividends not only in terms of social welfare and medical care, but in preventing frequent EMS use by the elderly.
Pre-Traumatic Vaccination Intervention: Can Dissociative Symptoms be Reduced?
Authors: Essar Nir , Palgi Yuval , Saar Ronen , Ben-Ezra Menachem
Published: August 2016

The Pre-Traumatic Vaccination Intervention (PTV) has been developed in an attempt to help rescue personnel cope with anticipated and non-anticipated disasters, and to prevent trauma-related mental disorders during and after a traumatogenic exposure. Contrary to the generally accepted approach of treating trauma after it has occurred, the PTV has been designed to be administered prior to the potentially traumatic event. Based on empirical findings, the PTV training techniques were designed to prepare the participants for distressful situations. Trainees were gradually exposed to increasingly severe sights using cognitive-behavioral techniques along with foreseen situations relating to their profession. Various interventions were aimed at normalizing using personal resources and implementing relaxation techniques. The PTV was administrated as part of the Israeli Defense Forces rescue personnel's and military police training courses. The results of an uncontrolled, preliminary study suggest that the intervention reduced the level of dissociation leading to more awareness to the traumatic event's details, less suffering, lower probability of making mistakes, and increased likelihood of returning to normal functioning. Lower dissociation may suggest a lower probability to be diagnosed with post-traumatic stress disorder among rescue personnel.
Development of Disaster Pamphlets Based on Health Needs of Patients with Chronic Illnesses
Authors: Motoki Emi , Mori Kikuko , Kaji Hidesuke , Nonami Yoko , Fukano Chika , Kayano Tomonori , Kawada Terue , Kimura Yukari , Yasui Kumiko , Ueki Hiroko , Ugai Kazuhiro
Published: August 2016

The aim of this research was to develop a pamphlet that would enable patients with diabetes, rheumatic diseases, chronic respiratory disease, and dialysis treatment to be aware of changes in their physical conditions at an early stage of a disaster, cope with these changes, maintain self-care measures, and recover their health.

Illness-specific pamphlets were produced based on disaster-related literature, news articles, surveys of victims of the Great Hanshin-Awaji Earthquake Disaster and Typhoon Tokage, and other sources.

Each pamphlet consisted of seven sections—each section includes items common to all illnesses as well as items specific to each illness. The first section, “Physical Self-Care”, contains a checklist of 18 common physical symptoms as well as symptoms specific to each illness, and goes on to explain what the symptoms may indicate and what should be done about them. The main aim of the “Changes in Mental Health Conditions” section is to detect post-traumatic stress disorder (PTSD) at an early stage. The section “Preventing the Deterioration of Chronic Illnesses” is designed to prevent the worsening of each illness through the provision of information on cold prevention, adjustment to the living environment, and ways of coping with stress. In the sections, “Medication Control” and “Importance of Having Medical Examinations”, spaces are provided to list medications currently being used and details of the hospital address, in order to ensure the continued use of medications. The section, “Preparing for Evacuations” gives a list of everyday items and medical items needed to be prepared for a disaster. Finally, the “Methods of Contact in an Emergency” section provides details of how to use the voicemail service. The following content-specific to each illness also was explained in detail: (1) for diabetes, complications arising from the deterioration of the illness, attention to nutrition, and insulin management; (2) for rheumatic diseases, a checklist of factors indicating the worsening of the illness and methods of coping with stress; (3) for chronic respiratory disease, prevention of respiratory infections and management of supplemental oxygen; and (4) for patients requiring dialysis, conditions of dialysis (such as dry weight, dialyzer, number of dialysis treatments, and dialysis hours) and what to do if a disaster occurs during dialysis.

It is expected that these pamphlets will be useful to patients with chronic illnesses, and will be used to prepare for disasters, thereby helping the patients cope with the unusual situation that during a disaster and recover as soon as possible.
Guidelines for Reports on Health Crises and Critical Health Events
Authors: Kulling Per , Birnbaum Marvin , Murray Virginia , Rockenschaub Gerald
Published: August 2016

The proposed guidelines for a common structure for reports on health crises and critical health events are an attempt of capturing the experiences gained and a further step for promoting a standardized methodology for sharing results and experiences. Such a common and standardized approach will facilitate the analysis and comparison of findings in order to improve preparedness planning and response and advance international collaboration and learning. If future reporting follows common standards, then the documented findings would be comparable and could be used to learn and apply lessons within an individual field of activity and to apply those lessons learned also to other related preparedness activities. It could also facilitate the implementation of joint activities and joint reports involving different sectors.
Use of Interactive Voice Response Technology by Poison Centers during the H1N1 Outbreak
Authors: Forrester Mathias B. , Villanacci John F. , Valle Norma
Published: August 2016

Introduction:

Interactive voice response (IVR) technology may facilitate poison centers to handle increased call volumes that may occur during public health emergencies. On 28 April 2009, the Texas Poison Center Network (TPCN) added a H1N1 message in English and Spanish to its IVR system. This study tested whether IVR technology could be used to assist Texas poison centers during the H1N1 outbreak.

Methods:

The distribution of callers who accessed the H1N1 message during 29 April–31 May 2009 was determined with respect to message language, subsequent caller action, and date of the call.

Results:

The H1N1 message was accessed by 1,142 callers, of whom, 92.9% listened to the message in English, and 7.1% listened to the message in Spanish. After listening to the message, 33.3% hung up while 66.7% spoke to a poison center agent. The number of callers who accessed the message was highest on 29 April 2009 and then declined.

Conclusions:

Interactive voice response technology can be used to assist poison centers to provide information and handle calls from the public during a public health emergency.
Should Trauma Patients with a Glasgow Coma Scale Score of 3 Be Intubated Prior to Hospital Arrival?
Authors: Irvin Charlene B. , Szpunar Susan , Cindrich Lauren A. , Walters Justin , Sills Robert
Published: August 2016

Introduction:

Previous studies of heterogeneous populations (Glasgow Coma Scale (GCS) scores <9) suggest that endotracheal intubaton of trauma patients prior to hospital arrival (i.e., prehospital intubated) is associated with an increased mortality compared to those patients not intubated in the pre-hospital setting. Deeply comatose patients (GCS = 3) represent a unique population of severely traumatized patients and may benefit from intubation in the prehospital setting. The objective of this study was to compare mortality rates of severely comatose patients (scene GCS = 3) with prehospital endotracheal intubation to those intubated at the hospital.

Methods:

Using the National Trauma Data Bank (V. 6.2), the following variables were analyzed retrospectively: (1) age; (2) injury type (blunt or penetrating); (3) Injury Severity Score (ISS); (4) scene GCS = 3 (scored prior to intubation/without sedation); (5) emergency department GCS score; (6) arrival emergency department intubation status; (7) first systolic blood pressure in the emergency department (>0); (8) discharge status (alive or dead); (9) Abbreviated Injury Scale Score (AIS); and (10) AIS body region.

Results:

Of the 10,948 patients analyzed, 23% (2,491/10,948) were endotracheally intubated in a prehospital setting. Mortality rate for those hospital intubated was 35% vs. 62% for those with prehospital intubation (p <0.0001); mean ISS scores 24.2 ±16.0 vs. 31.6 ±16.2, respectively (p <0.0001). Using logistic regression, controlling for first systolic blood pressure, ISS, emergency department GCS, age, and type of trauma, those with prehospital intubation were more likely to die (OR = 1.9, 95% CI = 1.7−2.2). For patients with only head AIS scores (no other body region injury, n = 1,504), logistic regression (controlling for all other variables) indicated that those with prehospital intubation were still more likely to die (OR = 2.0. 95% CI = 1.4−2.9).

Conclusions:

Prehospital endotracheal intubation is associated with an increased mortality in completely comatose trauma patients (GCS = 3). Although the exact reasons for this remain unclear, these results support other studies and suggest the need for future research and re-appraisal of current policies for prehospital intubation in these severely traumatized patients.
Burn Disasters—An Audit of the Literature
Authors: Broeze Carsten L. , Falder Sian , Rea Suzanne , Wood Fiona
Published: August 2016

All events that result in disasters are unique, and it is impossible to become fully prepared. However, through thorough planning and preparedness, it is possible to gain a better understanding of the typical injury patterns and problems that arise from a variety of hazards. Such events have the potential to claim many lives and overwhelm local medical resources. Burn disasters vary in scope of injury and procedures required, and are much more labor and resource intensive than non-burn disasters.

This review of the literature should help determine whether, despite each event having its own unique features, there still are common problems disaster responders face in the prehospital and hospital phases, what recommendations were made from these disasters, and whether these recommendations have been implemented into practice and the current disaster planning processes.

The objective of this review was to assess: (1) prehospital and hospital responses used during past burn disasters; (2) problems faced during those disaster responses; (3) recommendations made following those disasters; (4) whether these recommendations were integrated into practice; and (5) the key characteristics of burn disasters and how they differ from other disasters. This review is important to determine why, despite having disaster plans, things still go wrong.
Measuring Mortality in Cross-sectional Surveys: Which Methods Are Best and Why?
Authors: Woodruff Bradley A.
Published: August 2016

In emergency situations, mortality rates are critical indicators of a population's health status. When surveillance systems are not yet functioning or cannot be implemented, rates can be derived from data collected in populationbased, cross-sectional surveys.
From Smoke Inhalation to Chemical Attacks: Acute Cyanide Poisoning in the Prehospital Setting
Authors: Maniscalco Paul M.
Published: August 2016

The International Programme on Chemical Safety (IPCS)—a cooperative program of the World Health Organization (WHO), the International Labour Organization (ILO), and the United Nations Environment Programme (UNEP)—designates cyanide a priority chemical in relation to the potential impact on human health and the environment. Like other IPCS priority chemicals, cyanide is highly toxic, is a transboundary safety concern, is a target for risk management in multiple countries, is produced in large quantities, has dispersive use, and poses a risk for human exposure (Table 1). Acute exposure to cyanide has caused significant morbidity and mortality in household and industrial accidents, as well as in suicides and attempted genocides, wars, and acts of terrorism. The most common, but perhaps least recognized source of cyanide in cases of acute poisoning is from smoke caused by fires. This review is the product of a collaboration among experts in prehospital emergency medicine, public health and safety, and disaster preparedness. Current understanding of the causes, consequences, and management of cyanide poisoning are described as a potential advancement in antidotal therapy that could transform the provision of prehospital care to cyanide-poisoned victims.
Terrorism Involving Cyanide: The Prospect of Improving Preparedness in the Prehospital Setting
Authors: Keim Mark E.
Published: August 2016

The potential for domestic or international terrorism involving cyanide has not diminished and in fact may have increased in recent years. This paper discusses cyanide as a terrorist weapon and the current state of readiness for a cyanide attack in the United States. Many of the factors that render cyanide appealing to terrorists are difficult to modify sufficiently to decrease the probability of a cyanide attack. For example, the relative ease with which cyanide can be used as a weapon without special training, its versatile means of delivery to intended victims, and to a large degree, its ready availability cannot be significantly modified through preparedness efforts. On the other hand, the impact of an attack can be mitigated through preparedness measures designed to minimize the physical, psychological, and social consequences of cyanide exposure. Although the nation remains ill-equipped to manage a cyanide disaster, significant progress is being realized in some aspects of preparedness. Hydroxocobalamin—a cyanide antidote that may be appropriate for use in the prehospital setting for presumptive cases of cyanide poisoning—currently is under development for potential introduction in the US. If it becomes available in the US, hydroxocobalamin could enhance the role of the prehospital emergency responder in providing care to victims of a cyanide disaster. Additional progress is required in the areas of ensuring local and regional availability of antidotal treatment and supportive interventions, educating emergency healthcare providers about cyanide poisoning and its management, and raising public awareness of the potential for a cyanide attack and how to respond.
Message from the Regional Director
Authors: Plianbangchang Samlee
Published: August 2016

With great pleasure, I warmly welcome you all to this regional meeting.

As we all are aware, approximately 200,000 lives were lost due to the Earthquake and Tsunami at the end oflast year. It was one of the worst catastrophes of our times.The tragic event affected nine countries and displaced an estimated 1.2 million people. This was in spite of prompt responses by the governments of affected countries and international organizations.
Emergency Preparedness for the Health Sector and Communities—Challenges and the Way Forward
Authors:   WHO Expert Consultation
Published: August 2016

In accordance with the World Health Assembly Resolution 58.1, the World Health Organization (WHO) convened an Expert Consultation in Geneva, Switzerland from 15–17 February 2006 to discuss and provide recommendations for enhancing emergency preparedness and capacity building at the community, country, regional, and global levels. The consultation included experts and representatives of non-governmental and inter-governmental organizations. Recommendations included a set of operational objectives and strategies for achieving them. It was recognized that emergency preparedness is part of development and that crises occur at the community level. The recommendations, therefore, were focused at the community and country levels and outlined processes by which WHO could assist countries in augmenting their abilities to cope with health emergencies. This document provides a detailed discussion of the issues addressed, the conclusions reached, and recommendations based on the conclusions.
Targeted Agenda Program: An Innovative Approach to Facilitate Progress in Disaster Health
Authors: Bierens Joost J.L.M. , Nooij Brigitte , Sturmans Ferd
Published: August 2016

The Targeted Agenda Program (TAP) has been introduced for the first time during the 15th World Congress on Disaster and Emergency Medicine (15WCDEM) in Amsterdam in 2007 to stimulate interaction between the participants before, during and after the congress. A TAP process consists of 11 steps, starting with defining a relevant issue and ending with the publication of a TAP report based on expert opinions. Seven TAP groups participated during the 15WCDEM. The TAP issues referred to: (1) the need for health impact assessment of disasters; (2) the golden standard for preparedness for a chemical, biological, radiological and nuclear disasters; (3) the role of acute psychosocial first aid; (4) the 10 most important issues for policy makers to minimize health effects of floods; (5) the search for a golden standard in the treatment of wounded combatants; (6) the preparedness of health organizations for consequences of extreme weather conditions; and (7) the health problems of high-vulnerability groups during disasters. This article describes the motivation and operational aspects of the TAP and advocates that this concept can play an important facilitating role in focus, networking and enhancement of knowledge in the field of disaster health.
Human Resources in Humanitarian Health Working Group Report
Authors: Janneck Laura , Cooper Nicholas , Frehywot Seble , Mowafi Hani , Hein Karen
Published: August 2016

Humanitarian responses to conflict and disasters due to natural hazards usually operate in contexts of resource scarcity and unmet demands for healthcare workers. Task shifting is one avenue for delivering needed health care in resource poor settings, and on-the-ground reports indicate that task shifting may be applicable in humanitarian contexts. However, a variety of obstacles currently restrict the ability to employ task shifting in these situations, including issues of regulation, accreditation, funding, and a lack of commonly agreed-upon core competencies for different categories of humanitarian health workers. The Human Resources in Humanitarian Health (HRHH) Working Group during the 2009 Humanitarian Action Summit evaluated the potential strengths and weaknesses of task shifting in humanitarian relief efforts, and proposed a range of strategies to constructively integrate task shifting into humanitarian response.
Elephant Seals' Dives Show Slowdown in Ocean Circulation
Authors: Wendel JoAnna
Published: August 2016

Data from instruments mounted on elephant seals reveal that melting ice flushes fresh water into the Southern Ocean, suppressing an important arm of the global ocean circulation belt.
Hydrogel microphones for stealthy underwater listening
Authors: Gao Yang , Song Jingfeng , Li Shumin , Elowsky Christian , Zhou You , Ducharme Stephen , Chen Yong Mei , Zhou Qin , Tan Li
Published: August 2016

Exploring the abundant resources in the ocean requires underwater acoustic detectors with a high-sensitivity reception of low-frequency sound from greater distances and zero reflections. Here we address both challenges by integrating an easily deformable network of metal nanoparticles in a hydrogel matrix for use as a cavity-free microphone. Since metal nanoparticles can be densely implanted as inclusions, and can even be arranged in coherent arrays, this microphone can detect static loads and air breezes from different angles, as well as underwater acoustic signals from 20 Hz to 3 kHz at amplitudes as low as 4 Pa. Unlike dielectric capacitors or cavity-based microphones that respond to stimuli by deforming the device in thickness directions, this hydrogel device responds with a transient modulation of electric double layers, resulting in an extraordinary sensitivity (217 nF kPa−1 or 24 μC N−1 at a bias of 1.0 V) without using any signal amplification tools.
Water ordering controls the dynamic equilibrium of micelle–fibre formation in self-assembly of peptide amphiphiles
Authors: Deshmukh Sanket A. , Solomon Lee A. , Kamath Ganesh , Fry H. Christopher , Sankaranarayanan Subramanian K. R. S.
Published: August 2016

Understanding the role of water in governing the kinetics of the self-assembly processes of amphiphilic peptides remains elusive. Here, we use a multistage atomistic-coarse-grained approach, complemented by circular dichroism/infrared spectroscopy and dynamic light scattering experiments to highlight the dual nature of water in driving the self-assembly of peptide amphiphiles (PAs). We show computationally that water cage formation and breakage near the hydrophobic groups control the fusion dynamics and aggregation of PAs in the micellar stage. Simulations also suggest that enhanced structural ordering of vicinal water near the hydrophilic amino acids shifts the equilibrium towards the fibre phase and stimulates structure and order during the PA assembly into nanofibres. Experiments validate our simulation findings; the measured infrared O–H bond stretching frequency is reminiscent of an ice-like bond which suggests that the solvated water becomes increasingly ordered with time in the assembled peptide network, thus shedding light on the role of water in a self-assembly process.
Temporal regulation of Lsp1 O-GlcNAcylation and phosphorylation during apoptosis of activated B cells
Authors: Wu Jung-Lin , Wu Hsin-Yi , Tsai Dong-Yan , Chiang Ming-Feng , Chen Yi-Ju , Gao Shijay , Lin Chun-Cheng , Lin Chun-Hung , Khoo Kay-Hooi , Chen Yu-Ju , Lin Kuo-I.
Published: August 2016

Crosslinking of B-cell receptor (BCR) sets off an apoptosis programme, but the underlying pathways remain obscure. Here we decipher the molecular mechanisms bridging B-cell activation and apoptosis mediated by post-translational modification (PTM). We find that O-GlcNAcase inhibition enhances B-cell activation and apoptosis induced by BCR crosslinking. This proteome-scale analysis of the functional interplay between protein O-GlcNAcylation and phosphorylation in stimulated mouse primary B cells identifies 313 O-GlcNAcylation-dependent phosphosites on 224 phosphoproteins. Among these phosphoproteins, temporal regulation of the O-GlcNAcylation and phosphorylation of lymphocyte-specific protein-1 (Lsp1) is a key switch that triggers apoptosis in activated B cells. O-GlcNAcylation at S209 of Lsp1 is a prerequisite for the recruitment of its kinase, PKC-β1, to induce S243 phosphorylation, leading to ERK activation and downregulation of BCL-2 and BCL-xL. Thus, we demonstrate the critical PTM interplay of Lsp1 that transmits signals for initiating apoptosis after BCR ligation.
Graft-infiltrating host dendritic cells play a key role in organ transplant rejection
Authors: Zhuang Quan , Liu Quan , Divito Sherrie J. , Zeng Qiang , Yatim Karim M. , Hughes Andrew D. , Rojas-Canales Darling M. , Nakao A. , Shufesky William J. , Williams Amanda L. , Humar Rishab , Hoffman Rosemary A. , Shlomchik Warren D. , Oberbarnscheidt Martin H. , Lakkis Fadi G. , Morelli Adrian E.
Published: August 2016

Successful engraftment of organ transplants has traditionally relied on preventing the activation of recipient (host) T cells. Once T-cell activation has occurred, however, stalling the rejection process becomes increasingly difficult, leading to graft failure. Here we demonstrate that graft-infiltrating, recipient (host) dendritic cells (DCs) play a key role in driving the rejection of transplanted organs by activated (effector) T cells. We show that donor DCs that accompany heart or kidney grafts are rapidly replaced by recipient DCs. The DCs originate from non-classical monocytes and form stable, cognate interactions with effector T cells in the graft. Eliminating recipient DCs reduces the proliferation and survival of graft-infiltrating T cells and abrogates ongoing rejection or rejection mediated by transferred effector T cells. Therefore, host DCs that infiltrate transplanted organs sustain the alloimmune response after T-cell activation has already occurred. Targeting these cells provides a means for preventing or treating rejection.
Crystal structure and functional characterization of a light-driven chloride pump having an NTQ motif
Authors: Kim Kuglae , Kwon Soon-Kyeong , Jun Sung-Hoon , Cha Jeong Seok , Kim Hoyoung , Lee Weontae , Kim Jihyun F. , Cho Hyun-Soo
Published: August 2016

A novel light-driven chloride-pumping rhodopsin (ClR) containing an ‘NTQ motif’ in its putative ion conduction pathway has been discovered and functionally characterized in a genomic analysis study of a marine bacterium. Here we report the crystal structure of ClR from the flavobacterium Nonlabens marinus S1-08T determined under two conditions at 2.0 and 1.56 Å resolutions. The structures reveal two chloride-binding sites, one around the protonated Schiff base and the other on a cytoplasmic loop. We identify a ‘3 omega motif’ formed by three non-consecutive aromatic amino acids that is correlated with the B–C loop orientation. Detailed ClR structural analyses with functional studies in E. coli reveal the chloride ion transduction pathway. Our results help understand the molecular mechanism and physiological role of ClR and provide a structural basis for optogenetic applications.