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Simulation is often employed to test mass casualty and disaster response planning within hospitals, but it is resource intensive and needs to achieve high-quality recreation of scenarios to be effective. The delivery of large-scale interdisciplinary team and system simulation requires consideration of physical safety, system integrity for real patients, simulation team communication, and effective dissemination of outcomes.
To describe challenges and potential solutions for effective delivery of disaster simulations, drawn from simulation service experience at Gold Coast Hospital and Health Service (GCHHS).
This case study reviews strategies used to deliver a large-scale multi-team in-hospital disaster and trauma simulation, involving more than 75 participants drawn from paramedic/ambulance, emergency, trauma service, anesthetics, perioperative, surgical, and hospital administrative teams.
Issues reviewed include simulation delivery team composition and briefing, safety strategies, matching simulation methodology to exercise objectives, the use of real-time communications technologies and apps for real-time communication and performance tracking, and leveraging the simulation experience for observers by narrated Facetime stream. Following the simulation, a debriefing was conducted with participants to address performance, communication and interfaces, strengths and weaknesses, and overall opportunity for improvement. Facility-wide dissemination of messages through standardized reporting, infographics, and video vignettes were also reviewed.
Simulation is an engaging way to assess protocols and practices for disaster response within a tertiary hospital, and effectiveness can be enhanced through the strategic use of contemporary techniques and technologies.
We estimate the values of bull phenotypic traits, performance measurements, and expected progeny differences (EPDs) over time using bull sale data from an auction in Tennessee from 2006 to 2016. Moreover, we determine how a state partial-cost reimbursement program for bulls with certain EPDs affects bull sale price. Purebred seed stock producers in this region should focus on selling large, fast-growing, mature bulls that produce lighter calves for reduced calving stress. The state cost-share payment did not significantly increase bull prices in most years, meaning this payment was retained by cow-calf producers in most years.
Decision-makers are increasingly recognizing the usefulness of qualitative research to inform patient-centered policy decisions, and are accordingly increasingly demanding qualitative evidence as part of health technology assessment (HTA). In the context of tight HTA timelines, a new form of evidence synthesis has emerged—rapid qualitative reviews. The need for rapidity requires either an increase in resources or, more commonly, a compromise in rigor, yet guidance on appropriate compromises for qualitative reviews is lacking.
In order to inform de novo guidance, we conducted a systematic scoping review to identify existing guidance and published examples of rapid qualitative reviews. We searched Medline and CINAHL using medical subject headings and keywords related to “rapid reviews” and “qualitative” research, and screened the 1,771 resultant citations independently in duplicate. Additionally, we searched the grey literature and solicited examples from our contacts and other evidence-synthesis organizations. We summarized included guidance and reviews using the Search, AppraisaL, Synthesis, Analysis (SALSA) framework to identify abbreviations in the review process.
We found no guidance documents specific to rapid qualitative reviews. We found one published peer-reviewed rapid qualitative review, and several more (>10; grey literature search in process) through our organizational contacts. While methods to abbreviate the process are poorly reported, an abbreviated literature search (years and databases searched) and the use of a single reviewer appear common.
A number of agencies are producing rapid qualitative reviews, however our review identifies the urgent need to develop and explore methods for the synthesis of qualitative research that balance rapidity and rigor.
Prevalence of skin sores and scabies in remote Australian Aboriginal communities remains unacceptably high, with Group A Streptococcus (GAS) the dominant pathogen. We aim to better understand the drivers of GAS transmission using mathematical models. To estimate the force of infection, we quantified the age of first skin sores and scabies infection by pooling historical data from three studies conducted across five remote Aboriginal communities for children born between 2001 and 2005. We estimated the age of the first infection using the Kaplan–Meier estimator; parametric exponential mixture model; and Cox proportional hazards. For skin sores, the mean age of the first infection was approximately 10 months and the median was 7 months, with some heterogeneity in median observed by the community. For scabies, the mean age of the first infection was approximately 9 months and the median was 8 months, with significant heterogeneity by the community and an enhanced risk for children born between October and December. The young age of the first infection with skin sores and scabies reflects the high disease burden in these communities.
OBJECTIVES/SPECIFIC AIMS: Endogenous RT (eRT) is necessary for the function of retrotransposons, elements that replicate via an RNA intermediate. One source of eRT activity is long interspersed elements (LINE). LINEs, of which there are several subgroups (L1, L2, L3), are retrotransposons that regulate cellular growth and gene expression. Given their diverse and important roles, we hypothesized that L1 elements regulate functional responses in megakaryocytes and platelets; a concept not yet examined in the field. METHODS/STUDY POPULATION: To study eRT in human platelets we used RT activity assays, PCR, and Western blot approaches. Furthermore, we used an RT-inhibitor to dissect the function of eRT, analyzed RT-dependent protein synthetic capacity, and immunoprecipitated RNA-DNA hybrids. RNA-DNA hybrids were also detected by means of ICC and automated analysis using CellProfiler software. RNA-DNA hybrids were validated by PCR and eRT regulated synthesis of target proteins was analyzed using autoradiography and Western blot techniques. Platelets from patients with HIV+ were examined in parallel. RESULTS/ANTICIPATED RESULTS: We identified that highly purified, isolated platelets from healthy subjects possess eRT activity. eRT activity was blocked with the non-nucleoside RT inhibitor nevirapine at concentrations within the therapeutic drug range. L1 elements are bicistronic, containing 2 open reading frames (ORFs), ORF1 and ORF2. Thus, we next identified that human platelets express full-length L1 mRNA containing ORF1 and ORF2. In human platelets, eRT activity was localized to L1 protein containing ribonucleo particles. Platelet eRT reverse transcribed exogenous RNAs, a process inhibited by nevirapine, acting in trans using the 3′-UTR of exogenous mRNAs as a template. To dissect the function of eRT in platelets, we next examined cytoskeletal and protein synthetic events in the presence or absence of nevirapine. Inhibition of eRT in isolated platelets led to characteristically beaded platelets in appearance, strongly resembling bone marrow proplatelets. Parallel increases in platelet reactivity were also observed. As these changes occurred over hours, not minutes, we hypothesized that inhibition of eRT would affect platelet protein synthetic events. Consistent with this, RT inhibition resulted in upregulation of global platelet protein synthesis. We validated upregulation of the synthesis of specific proteins (mitofilin, p-selectin, and L26—a component of the 60S ribosomal subunit essential for mRNA translation). RNA-DNA hybrids, noncanonical nucleic acid structures that regulate gene expression, are enriched in regions where L1 is abundant. RNA-DNA hybrids were present in platelets and expression confirmed via differential digestion of RNAs (eg, with RNase A and RNAse I). Next-generation sequencing of pulled down (eg, immunoprecipitated) platelet RNA-DNA hybrids identified numerous differentially expressed transcripts and we focused on MAP1LC3B (LC3B), a primary regulator of autophagy. Hybrid sequencing results for LC3B were validated using qPCR and we confirmed that LC3B RNA binds to L1-encoded RNA binding protein. Platelets treated with nevirapine had increased total LC3B protein expression. As RT inhibition is an important mechanism to control HIV infection, we examined platelet morphology, activation, and LC3B expression in platelets from HIV+ subjects treated with nevirapine. HIV+ patients treated with RT inhibitors had higher numbers of platelets that were beaded in appearance at baseline, increased platelet reactivity, and differential LC3B expression compared with healthy controls. DISCUSSION/SIGNIFICANCE OF IMPACT: Taken together, these results demonstrate that platelets possess eRT activity that regulates platelet morphology, platelet hyperreactivity, and protein synthetic events. We postulate that eRT activity in platelets may be a new post-transcriptional regulatory checkpoint. Moreover, our findings have implications in HIV+ patients treated with RT inhibitors, where off-target effects may contribute to platelet activation and an increased risk of thrombosis.
In this paper, we report progress on “Neighborhoods: our people, our places” an international study about how people living with dementia interact with their neighborhoods. The ideas of social health and citizenship are drawn upon to contextualize the data and make a case for recognizing and understanding the strengths and agency of people with dementia. In particular, we address the lived experience of the environment as a route to better understanding the capabilities, capacities, and competencies of people living with dementia. In doing this, our aim is to demonstrate the contribution of social engagement and environmental support to social health.
The study aims to “map” local spaces and networks across three field sites (Manchester, Central Scotland and Linkoping, Sweden). It employs a mix of qualitative and participatory approaches that include mobile and visual methods intended to create knowledge that will inform the design and piloting of a neighborhood-based intervention.
Our research shows that the neighborhood plays an active role in the lives of people with dementia, setting limits, and constraints but also offering significant opportunities, encompassing forms of help and support as yet rarely discussed in the field of dementia studies. The paper presents new and distinctive insights into the relationship between neighborhoods and everyday life for people with dementia that have important implications for the debate on social health and policy concerning dementia friendly communities.
We end by reflecting on the messages for policy and practice that are beginning to emerge from this on-going study.
Pertussis is a vaccine-preventable respiratory infection caused by Bordetella pertussis which can be fatal in infants. Although high vaccine coverage led to prolonged disease control in England, a national outbreak of pertussis in 2011 led to the largest increase in over two decades, including a marked increase in cases aged ⩾15 years. A case-control study in four regions of England was undertaken to investigate risk factors for pertussis in adolescents and adults, specifically employment type and professional and household contact with children. Pertussis cases were laboratory-confirmed and aged ⩾15 years. Controls were recruited through general practitioner nomination. Demographic and risk factor information were collected using an online survey. Multivariable logistic regression was used to estimate independent associations with outcome. Two hundred and thirty-one cases and 190 controls were recruited. None of the four employment variables (social care, education, health sector, patient contact) were significantly associated with pertussis. Professional contact with children aged < 1 year was associated with a significantly reduced odds of pertussis [odds ratio (OR) 0·25, 95% confidence interval (CI) 0·08–0·78, P = 0·017]. Household contact with ⩾1 child aged 10–14 years was associated with significantly increased odds of pertussis (OR 2·61, 95% CI 1·47–4·64, P = 0·001). Occupational contact with very young children was associated with reduced odds of pertussis, probably due to immune boosting by low-level exposures to B. pertussis. Sharing a household with a young adolescent was a significant risk factor for pertussis in adults and older teenagers. The primary focus of the childhood pertussis vaccination programmes is to prevent infant disease. Although evidence is emerging that adolescent vaccination does not provide indirect protection to infants, our results highlight the importance of children aged 10–14 years in pertussis transmission to older adolescents and adults.
We present an interesting and rare case of traumatic Gerbode ventricular septal defect and complete heart block. The multimodality images illustrate the diagnosis well. This case is an excellent demonstration of the diagnostic utility of multimodality imaging.
Recent advances in marine acoustic survey and land-based topographic monitoring technologies have resulted in increasingly cost-effective data acquisition in coastal areas. The DEFRA-funded National Network of Regional Coastal Monitoring Programmes of England are, for example, utilising swath bathymetry and airborne light detection and ranging (LiDAR) technology more routinely to survey the coastal zone around the coastline of England. The demand for data processing, visualisation and interpretation techniques to keep pace with such advances in data acquisition is clear. This study discusses collection and processing techniques for such data on the south coast of Dorset, England, which have enabled the production of a seamless, high spatial resolution digital elevation model across the coastal zone. Case studies demonstrate how this elevation model can be viewed and analysed using state-of-the-art digital techniques to allow geological mapping to be extended from onshore to offshore in unprecedented detail, effectively eliminating what is known as the ‘White Ribbon’ for coastal geological mapping. The potential for rolling out such techniques for wider surveying programmes across many environmental disciplines is significant, which could contribute towards improving the multi-disciplinary scientific evidence base in the complex coastal zone.
We analyzed the recent (< 25 yr) spread in New Hampshire, USA, of the exotic tree Kalopanax septemlobus, native to Asia. The invasion was likely initiated by a single tree planted ca. 1972. Our objective was to assess the viability of the invasion, especially in light of the small propagule size. We tallied, mapped, aged, and measured the height and growth of K. septemlobus individuals at two sites, the University of New Hampshire campus (UC) and Thompson Farm (TF), both in Durham. We found over 3,800 plants at UC and 270 at TF in < 120 ha (296 ac) total area. Plant age ranged from 0 to 22 yr, and UC plants were as far as 775 m (2,543 ft) from the purported parent tree. Annual height growth was comparable to midtolerant native trees. Plants occurred in both open and forested habitats, and the mean level of photosynthetically active radiation incident on understory plants was 4 to 6% of full sun. The large population size, shade tolerance, rapid height growth, and ability to sprout from damaged stems suggest potential for K. septemlobus to invade and persist in forests, the most common natural ecosystem in the northeastern United States. We further suggest that small propagule size, likely a single tree, has not prevented K. septemlobus from initiating a spatially extensive and vigorous population. Kalopanax septemlobus has been planted as an ornamental in the northeastern United States, and prevention of region-wide invasion might depend on removal of these trees, even when they occur as single individuals.
Some data suggest that older adults with anxiety disorders do not respond as well to treatment as do younger adults.
We examined age differences in outcomes from the Coordinated Anxiety Learning and Management (CALM) study, an effectiveness trial comparing usual care to a computer-assisted collaborative care intervention for primary care patients with panic disorder, generalised anxiety disorder, post-traumatic stress disorder (PTSD), and/or social anxiety disorder. This is the first study to examine the efficacy of a collaborative care intervention in a sample that included both younger and older adults with anxiety disorders. We hypothesised that older adults would show a poorer response to the intervention than younger adults.
We examined findings for the overall sample, as well as within each diagnostic category (clinicaltrials.gov identifier: NCT00347269).
The CALM intervention was more effective than usual care among younger adults overall and for those with generalised anxiety disorder, panic disorder and social anxiety disorder. Among older adults, the intervention was effective overall and for those with social anxiety disorder and PTSD but not for those with panic disorder or generalised anxiety disorder. The effects of the intervention also appeared to erode by the 18-month follow-up, and there were no significant effects on remission among the older adults.
These results are consistent with the findings of other investigators suggesting that medications and psychotherapy for anxiety disorders may not be as effective for older individuals as they are for younger people.
We describe the successful creation of new reef habitat on Pulau Weh, Indonesia. Coral cover on artificial reef modules increased from a mean of 24±SE 2.4% 1 year after the initial attachment of Acropora spp. coral fragments to 64±SE 4.8% after 3 years. The artificial reef modules were also rapidly colonized by coral recruits. Recruit densities were 53±SE 3.2 m−2 on modules that had been submerged for only 1 year, nearly twice as high as recruit densities on natural reef substratum (31±2.8 m−2). Consequently, the original Acropora assemblage had increased to include at least 23 coral taxa, including 10 additional Acropora species. The artificial reefs also supported at least 29 reef fish species, from 11 families. Unfortunately, this initial success in habitat creation was abruptly halted by a rapid rise in sea temperature in May 2010 that killed almost all corals on the artificial reefs and on nearby natural reefs. Notwithstanding the general view that reef rehabilitation is yet to deliver ecological and conservation benefits at meaningful scales, other benefits of this project included raising the awareness of reef conservation in the local community, promotion of tourism on Pulau Weh and job creation. We conclude, therefore, that habitat creation has a legitimate role as part of an integrated marine conservation strategy.
The Coral Triangle Initiative is an ambitious attempt to conserve the marine biodiversity hotspot known as the Coral Triangle. However, the reef fauna in many nearby regions remains poorly explored and, consequently, the focus on the Coral Triangle risks overlooking other areas of high conservation significance. One region of potential significance, Aceh, Indonesia, has not been visited by coral taxonomists since the Dutch colonial period. Here we document the species richness of scleractinian corals of Pulau Weh, Aceh. We also compare the species richness of the genus Acropora at 3–5 sites in each of nine regions in Indonesia and Papua New Guinea. Although dominated by widespread Indo-Pacific species, the coral fauna of Pulau Weh is also the eastern and western boundary for many Indian Ocean and Pacific Ocean species, respectively. We identified a total of 133 scleractinian species, of which three have been previously recorded only in the western Indian Ocean and five are presently undescribed. The mean species richness of the Acropora at Pulau Weh is similar to regions within the Coral Triangle. This high species richness plus the high proportion of endemics suggests that the Andaman Sea is of similarly high conservation value to the Coral Triangle. We suggest that an international initiative similar to the Coral Triangle Initiative is required to conserve this region, which includes the territorial waters of six countries.
One of the major goals of coral reef conservation is to determine the most effective means of managing marine resources in regions where economic conditions often limit the options available. For example, no-take fishing areas can be impractical in regions where people rely heavily on reef fish for food. In this study we test whether coral reef health differed among areas with varying management practices and socio-economic conditions on Pulau Weh in the Indonesian province of Aceh. Our results show that gear restrictions, in particular prohibiting the use of nets, were successful in minimizing habitat degradation and maintaining fish biomass despite ongoing access to the fishery. Reef fish biomass and hard-coral cover were two- to eight-fold higher at sites where fishing nets were prohibited. The guiding principle of the local customary management system, Panglima Laot, is to reduce conflict among community members over access to marine resources. Consequently, conservation benefits in Aceh have arisen from a customary system that lacks a specific environmental ethic or the means for strong resource-based management. Panglima Laot includes many of the features of successful institutions, such as clearly defined membership rights and the opportunity for resource users to be involved in making, enforcing and changing the rules. Such mechanisms to reduce conflict are the key to the success of marine resource management, particularly in settings that lack resources for enforcement.
In view of the challenge posed by climate change and the need to reduce dependence on fossil fuels, The Royal Society of Edinburgh Inquiry (2011) examined the barriers making it difficult for Scotland to change to a low-carbon society. The single most important finding is that, whilst widely desired, change is held back by the lack of coherence and integration of policy at different levels of governance. There is activity at the level of the EU, UK Government, Scottish Government, local authorities, local communities, households and civil society, but there is often a disconnection between policies at different levels. This impedes progress and also leads to mistrust among the general public. This paper brings together the background to ten primary recommendations featured in the Inquiry addressing the principal barriers. Above all, it is important to integrate the activities within city regions and to exploit opportunities in local communities. Reflecting on the Inquiry findings, we stress the economic, social and environmental opportunities to be gained from a low-carbon society and outline the step changes that need to take place within governance, city regions and local authorities and civil society.