bluuebunny/crossref_metadata_2025_split huggingface dataset:
Into the Fray: Integration of Emergency Medical Services and Special Weapons and Tactics (SWAT) Teams
Authors: Jones Jeffrey S. , Reese Kevin , Kenepp Greg , Krohmer Jon 
Published: July 2016

AbstractIntroduction:The purpose of this study was to determine current experience and training of emergency medical support personnel for special weapons and tactics (SWAT) teams in North America.Methods:This cross-sectional, epidemiologic survey was sent to SWAT unit commanders from the 200 largest metropolitan areas. Questions included basic demographics, specialized training of emergency medical services (EMS) personnel, and where such personnel are deployed during tactical operations. Unit commanders also were asked to estimate the number and type of injuries sustained during tactical operations and to list any recommendations to improve the EMS response.Results:A total of 150 surveys was completed, for a response rate of 75%. The most common medical support (69%) was a civilian ambulance on standby at a predesignated location. Ninety-four percent of these prehospital care providers had no specialized training, and could not enter an area that was not secured tactically. Police officers with first aid or EMT training comprised the next largest group of medical support. Overall, 31% of SWAT commanders depended on remote EMS dispatch by radio to the scene when injuries occurred. Thirty-eight percent of respondents reported a significant injury had occurred during their tactical operations within the past 24 months. Common injuries included gunshot wounds, chemical exposure, and fractures. However, 78% (117/150) of respondents did not have a medical director, and 23% (35/150) of teams did not have an EMS preplan or protocol.Conclusion:The results suggest a need for established EMS protocols, medical direction, and specialized tactical medical training, especially in large metropolitan areas.
A Comparison of EMS Continuing Education for Paramedics in the United States
Authors: Herman Linda L. , Willoughby Paula J. , Koenigsberg Max D. , Ward Sharon , McDonald Cary C. 
Published: July 2016

AbstractObjective:To determine characteristics of continuing education programs for paramedics in large metropolitan areas, and to make recommendations for changes in the Chicago Emergency Medical Services (EMS) system.Design:A survey of 95 metropolitan areas from each state in the United States.Participants:EMS medical directors, coordinators, and administrators.Results:The survey population included 56 respondents. Within this group, 23% were from areas of 1 million people or more, 61% in areas with populations of 100,000 to 1 million and 16% from areas populated by < 100,000 people. Several system types were represented in the survey. In the systems surveyed, 98% mandate didactic continuing education requirements. Clinical continuing education was required by 34% of the systems. Ten systems (18%) awarded continuing education hours for documented in-field experience. This method did not have a specific structure by the majority of users. Both written and skills testing were used by most EMS systems to evaluate paramedic competency. No statistically significant differences (p >0.05) could be found among population subgroups or EMS system types when evaluating the use of these various methods.Conclusion:EMS systems primarily use didactic sessions to meet their continuing education requirements. Nearly half of the systems requiring clinical continuing education use in-field credit to fulfill these requirements. In-field credit systems are poorly developed to date. This mechanism may be an effective alternative to usual clinical experiences for paramedics and deserves further investigation.
Emerging Issues and Future Needs in Humanitarian Assistance
Authors: VanRooyen Michael J. , Hansch Steven , Curtis Donna , Burnham Gilbert 
Published: July 2016

AbstractDuring the past two decades, there has been tremendous investment in the ability to intervene in disaster settings, and significant barriers remain to providing appropriate services to populations affected by natural and manmade calamities. Many of the barriers to providing effective assistance exist within the NGO community, and illustrate emerging needs for international agencies. These emerging needs include improving methods of recipient participation to promote the local health system, developing improved methods for quality assurance, enhancing options for personnel development, and addressing long-term needs of reconstruction and rehabilitation. Relief agencies face challenges on all levels to develop sound practices in providing humanitarian assistance that can lead to long-term benefits to populations affected by disaster.
Physicians and International Humanitarian Law in Complex Emergencies: Controversies and Future Opportunities
Authors: Hoffman Michael H. 
Published: July 2016

AbstractThis paper describes the areas in which the Geneva Conventions no longer are adequate as a source of legal description or prescription for the challenges faced by physicians working in complex emergencies. It covers the conceptual pitfalls facing the medical profession in connection with humanitarian interventions, which often are conventional military operations, but are not recognized as such because they may vary in some respects from more familiar forms of interstate conflict. Emerging categories of combatants who pose a major threat during complex emergencies also are identified.Opportunities to meet these challenges with the tools and culture of medicine are explored, and are proposed to the medical community as an opportunity for leadership. The paper proposes that new, epidemiological standards should be developed in order to identify the outbreak of armed conflicts and the trigger points for application of international humanitarian law. Such could replace the political model that presently underlies international humanitarian law. It also argues that international humanitarian law is not the starting point for application of humanitarian standards in war zones, but rather is built upon a peacetime medical culture that must be replicated in complex emergencies as a precursor to effective application of the law.
Communicating Across Cultures: Improving Translation to Improve Complex Emergency Program Effectiveness
Authors: Bolton Paul A. , Weiss William M. 
Published: July 2016

AbstractTranslation is a vital activity in Complex Emergencies (CEs) in which the responders and the affected populations do not share the same language or culture. This particularly applies to CEs in developing countries in which a lack of local resources usually results in the importation of foreign aid workers. This paper describes many of the common issues surrounding translation that can affect CE response effectiveness, issues that frequently are not appreciated by aid workers, including clinicians. The authors describe how these issues can arise, their effects, and outline approaches to addressing them.
Mobile Intensive Care Units
Authors: Dick Wolfgang F. 
Published: July 2016

Mobile intensive care units (MICU) will take care of all real emergency patients with presumed or proven disturbances of vital functions. These vehicles are equipped according to standardized criteria, and usually stationed at emergency hospitals. MICU's are accompanied by one rescue assistant, one emergency medical technician (EMT) and one physician.Eighty-five to 90% of the total number of emergency calls were primary emergency calls, where the emergency patient had to be treated at the scene; 10% to possibly 20% were emergency patients who had already received treatment by medical or paramedical personnel.
An Economic Professional Rescue Organization for Civil Disasters with Mass Casualties
Authors: Reich Hanns 
Published: July 2016

The newspapers present almost daily reports on great accidents some place on earth. However, on a national basis, catastrophes occur at rare intervals. There is hardly anywhere a professional rescue personnel which is ready for major accidents with mass casualties because of underutilization and for financial reasons.That means that at major accidents with mass casualties, the need for rescue personnel and equipment usually exceeds the daily professional readiness for rescue services, and the required manpower and equipment in sufficient numbers are seldom available to handle such big accidents. Voluntary lief organizations will then lend a hand, but they mostly consist of helpers who are neither educated nor trained for such difficult rescue work.
The Burn Disaster at Los Alfaques, Spain, 1978
Authors: Blomberg Rune , Arturson Gösta , Brandsjö Kaare 
Published: July 2016

On July 11, 1978, a truck with a tank loaded with liquid propylene crashed into a camping ground, Los Alfaques, on the Eastern coast of Spain, giving rise to a Boiling Liquid Expanding Vapour Explosion (BLEVE) with a large number of casualties. The Swedish Organizing Committee for Disaster Medicine initiated a study of the events by sending the authors to Spain to make all possible observations at the scene. We were in the camp 48 hours after the explosion.The CampThe camping ground Los Alfaques is situated about 190 kilometers south of Barcelona and 165 kilometers north of Valenica. There are hospitals of varying sizes on the route to these big cities, both of which have large hospitals equipped with burn units of high standards, Francisco Franco Hospital in Barcelona and La Fe Hospital in Valencia.
16. First Responder Defibrillation Does Not Increase Survival from Sudden Cardiac Death in a Two-Tiered Urban-Suburban EMS System
Authors: Sweeney Thomas A. , Runge Jeffrey W. , Gibbs Michael A. , Carter Janet M. , Schafermeyer Robert W. , Norton James A. 
Published: July 2016

Purpose: The use of automatic external defibrillators (AED) by emergency medical service (EMS) first responders (FR) is widely advocated based largely on reports from one metropolitan area, but widespread impact on survival remains unproven. We hypothesized that the addition of AEDs to an EMS system with short FR and prolonged paramedic response times (4 vs. 10 minutes) would improve survival from sudden cardiac death.Methods: Prospective, controlled, crossover study (AED vs. no AED) of consecutive cardiac arrests managed by 24 FR fire companies from 1992–1995 in a city of 440,000. Patients were stratified by the Utstein criteria. Primary end-point was survival to hospital discharge among patients with bystander witnessed arrests of cardiac etiology. Power was set at 0.8 to detect a 10% difference in survival.Results: A total of 627 patients were studied. Groups were comparable for age, gender, history of myocardial infarction, congestive heart failure or diabetes, arrest at home, bystander CPR, and ventricular fibrillation (VF) as initial rhythm.
08. Missed Diagnosis of Pneumothorax During Aeromedical Transport
Authors: Thomas SH , DeVellis P , Harrison T , Wedel SK 
Published: July 2016

Purpose: Difficulties with physical assessment inherent to the helicopter environment have led to suggestion that aeromedical crews may be unable to identify hemo- or pneumothorax (HTX/PTX) while in-flight. This study was conducted to determine the frequency of missed HTX/PTX in trauma patients undergoing air transport.Methods: One year (1994) of an air medical service's trauma transports to a Level I trauma center were analyzed to identify patients undergoing tube thoracostomy (TT) within 2 hours of trauma center arrival. Patients who had received intra-transport needle thoracostomy were excluded. Records were reviewed to determine how HTX/PTX was diagnosed at the trauma center.Results: Only 11 patients who had not received aeromedical needle decompression underwent TT at the receiving center. Two of the 11 were trauma arrests and received TT as part of thoracotomy, without air or blood return on TT. None of the remaining 9 patients had TT on clinical suspicion alone. Four had normal physical examination and underwent TT after chest X-ray (CXR). Remaining patients had no HTX/PTX clues on exam or CXR; one had a small HTX identified on chest computed tomography and the other four received intra-operative TT because of rib fractures in the setting of multisystem trauma.
What is the evidence that point sources of anthropogenic effluent increase antibiotic resistance in the environment? Protocol for a systematic review
Authors: Williams-Nguyen Jessica , Bueno Irene , Sargeant Jan M. , Nault André J. , Singer Randall S. 
Published: July 2016

AbstractHerein we describe a protocol for a systematic review of the evidence on whether point sources of anthropogenic effluent are associated with an increase in antibiotic resistance in the adjacent environment. The review question was based on the Population, Exposure, Comparator, Outcome, Study Design (PECOS) framework as follows: Is the prevalence or concentration of antibiotic resistant bacteria or resistance genes (O) in soil, water, air or free-living wildlife (P) higher in close proximity to, or downstream from, known or suspected sources of anthropogenic effluent (E) compared to areas more distant from or upstream from these sources (C)? A comprehensive search strategy was created to capture all relevant, published literature. Criteria for two stages of eligibility screening were developed to exclude publications that were not relevant to the question, and determine if the study used a design that permitted estimation of an association between a source and levels of resistance. A decision matrix was created for assessment of risk of bias to internal validity due to sample selection bias, information bias, and confounding. The goal of this protocol is to provide a method for determining the state of knowledge about the effect of point sources on antibiotic resistance in the environment.
Where literature is scarce: observations and lessons learnt from four systematic reviews of zoonoses in African countries
Authors: Alonso Silvia , Lindahl Johanna , Roesel Kristina , Traore Sylvain Gnamien , Yobouet Bassa Antoine , Ndour Andrée Prisca Ndjoug , Carron Maud , Grace Delia 
Published: July 2016

AbstractThe success of a systematic review depends on the availability, accessibility and quality of literature related to the review question. This paper presents the literature found in four systematic reviews conducted for a selection of zoonotic hazards in four livestock value chains in Africa, as well as setting out the challenges in conducting the reviews. The protocol was designed following international standards, and addressed four questions around prevalence, risk factors, control options and impact of various hazards and populations. Searches were conducted in four online databases. Articles were screened for relevance, and quality was assessed before data extraction. Literature on zoonotic hazards was in general scarce and access to full articles was limited. Overall, 25–40% of papers were considered poor quality. The diversity of approaches and designs in the studies compromised the ability to generate summarized estimates. We found that the emphasis of veterinary research has been on livestock problems rather than public health issues, although this seems to be shifting in the last decade; we also found there are limited studies on impact and control. While increasing literature is being published around zoonoses in Africa, this is still inadequate to appropriately inform policy and guide research efforts.
My Brother's Keeper? Religious Cues and Support for Foreign Military Intervention
Authors: Wu Joshua Su-Ya , Knuppe Austin J. 
Published: July 2016

AbstractAmericans are reluctant to support foreign military intervention. However, if victims of violence are identified as Christians, support for intervention is higher. We term this a “Brother's Keeper” effect as Americans, especially more religious Americans, will support intervention that aids co-religionists. To test our argument, we use a survey experiment that randomly assigns respondents to varying accounts of violence in the Central African Republic. Respondents who read Christians are the victims of violence are more supportive of military intervention compared to respondents who read vignettes that do not identify the religious identities of victims. Moreover, these Brother's Keeper effects are stronger among more religious respondents. We also find even stronger effects when extrapolating results as a population effect with survey weights. Our findings reveal that labeling otherwise unknown foreign actors as Christian have significant effects on support for foreign military intervention.
A toolkit of thread-based microfluidics, sensors, and electronics for 3D tissue embedding for medical diagnostics
Authors: Mostafalu Pooria , Akbari Mohsen , Alberti Kyle A. , Xu Qiaobing , Khademhosseini Ali , Sonkusale Sameer R. 
Published: July 2016

AbstractThreads, traditionally used in the apparel industry, have recently emerged as a promising material for the creation of tissue constructs and biomedical implants for organ replacement and repair. The wicking property and flexibility of threads also make them promising candidates for the creation of three-dimensional (3D) microfluidic circuits. In this paper, we report on thread-based microfluidic networks that interface intimately with biological tissues in three dimensions. We have also developed a suite of physical and chemical sensors integrated with microfluidic networks to monitor physiochemical tissue properties, all made from thread, for direct integration with tissues toward the realization of a thread-based diagnostic device (TDD) platform. The physical and chemical sensors are fabricated from nanomaterial-infused conductive threads and are connected to electronic circuitry using thread-based flexible interconnects for readout, signal conditioning, and wireless transmission. To demonstrate the suite of integrated sensors, we utilized TDD platforms to measure strain, as well as gastric and subcutaneous pH in vitro and in vivo.
Dynamic reconfiguration of the default mode network during narrative comprehension
Authors: Simony Erez , Honey Christopher J , Chen Janice , Lositsky Olga , Yeshurun Yaara , Wiesel Ami , Hasson Uri 
Published: July 2016

AbstractDoes the default mode network (DMN) reconfigure to encode information about the changing environment? This question has proven difficult, because patterns of functional connectivity reflect a mixture of stimulus-induced neural processes, intrinsic neural processes and non-neuronal noise. Here we introduce inter-subject functional correlation (ISFC), which isolates stimulus-dependent inter-regional correlations between brains exposed to the same stimulus. During fMRI, we had subjects listen to a real-life auditory narrative and to temporally scrambled versions of the narrative. We used ISFC to isolate correlation patterns within the DMN that were locked to the processing of each narrative segment and specific to its meaning within the narrative context. The momentary configurations of DMN ISFC were highly replicable across groups. Moreover, DMN coupling strength predicted memory of narrative segments. Thus, ISFC opens new avenues for linking brain network dynamics to stimulus features and behaviour.
Multi-omics landscapes of colorectal cancer subtypes discriminated by an individualized prognostic signature for 5-fluorouracil-based chemotherapy
Authors: Tong M , Zheng W , Li H , Li X , Ao L , Shen Y , Liang Q , Li J , Hong G , Yan H , Cai H , Li M , Guan Q , Guo Z 
Published: July 2016

AbstractUntil recently, few prognostic signatures for colorectal cancer (CRC) patients receiving 5-fluorouracil (5-FU)-based chemotherapy could be used in clinical practice. Here, using transcriptional profiles for a panel of cancer cell lines and three cohorts of CRC patients, we developed a prognostic signature based on within-sample relative expression orderings (REOs) of six gene pairs for stage II–III CRC patients receiving 5-FU-based chemotherapy. This REO-based signature had the unique advantage of being insensitive to experimental batch effects and free of the impractical data normalization requirement. After stratifying 184 CRC samples with multi-omics data from The Cancer Genome Atlas into two prognostic groups using the REO-based signature, we further revealed that patients with high recurrence risk were characterized by frequent gene copy number aberrations reducing 5-FU efficacy and DNA methylation aberrations inducing distinct transcriptional alternations to confer 5-FU resistance. In contrast, patients with low recurrence risk exhibited deficient mismatch repair and carried frequent gene mutations suppressing cell adhesion. These results reveal the multi-omics landscapes determining prognoses of stage II–III CRC patients receiving 5-FU-based chemotherapy.
High-throughput ab-initio dilute solute diffusion database
Authors: Wu Henry , Mayeshiba Tam , Morgan Dane 
Published: July 2016

AbstractWe demonstrate automated generation of diffusion databases from high-throughput density functional theory (DFT) calculations. A total of more than 230 dilute solute diffusion systems in Mg, Al, Cu, Ni, Pd, and Pt host lattices have been determined using multi-frequency diffusion models. We apply a correction method for solute diffusion in alloys using experimental and simulated values of host self-diffusivity. We find good agreement with experimental solute diffusion data, obtaining a weighted activation barrier RMS error of 0.176 eV when excluding magnetic solutes in non-magnetic alloys. The compiled database is the largest collection of consistently calculated ab-initio solute diffusion data in the world.
Development of a millimetrically scaled biodiesel transesterification device that relies on droplet-based co-axial fluidics
Authors: Yeh S. I. , Huang Y. C. , Cheng C. H. , Cheng C. M. , Yang J. T. 
Published: July 2016

AbstractIn this study, we investigated a fluidic system that adheres to new concepts of energy production. To improve efficiency, cost, and ease of manufacture, a millimetrically scaled device that employs a droplet-based co-axial fluidic system was devised to complete alkali-catalyzed transesterification for biodiesel production. The large surface-to-volume ratio of the droplet-based system, and the internal circulation induced inside the moving droplets, significantly enhanced the reaction rate of immiscible liquids used here – soybean oil and methanol. This device also decreased the molar ratio between methanol and oil to near the stoichiometric coefficients of a balanced chemical equation, which enhanced the total biodiesel volume produced, and decreased the costs of purification and recovery of excess methanol. In this work, the droplet-based co-axial fluidic system performed better than other methods of continuous-flow production. We achieved an efficiency that is much greater than that of reported systems. This study demonstrated the high potential of droplet-based fluidic chips for energy production. The small energy consumption and low cost of the highly purified biodiesel transesterification system described conforms to the requirements of distributed energy (inexpensive production on a moderate scale) in the world.