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Survivors of mass casualty incidents are vulnerable to both physical and psychological injuries. Hospitals need to triage the walking wounded victims, their loved ones, and witnesses for symptoms of emotional distress to ensure that those who are traumatized benefit from proactive psychological treatment. Hospitals must also manage the influx of searching family and friends, and be able to reunite them with their loved ones, to reduce chaos and prevent hospital skipping.
To analyze previous research on institutional psychosocial disaster response, what has or has not worked, and lessons learned in order to develop evidence-based future planning suggestions.
A literature search was conducted on the following electronic databases: (Medline 2007 to July 2018), (Embase 2007 to July 2018), (PsycInfo 2007 to July 2018). A combination of subject headings and free text keywords were used to perform the searches. After removing duplicates, abstracts were screened independently by two reviewers for the following inclusion criteria: 1) crisis intervention (in a disaster situation), 2) mention of psychosocial response or lack thereof and lessons learned, 3)relevant outcomes, 4) OECD countries, and 5) journal articles published 2007–Present. Review articles were excluded. Primary and secondary reviewers are in the process of discussing discrepancies. Data extraction will be conducted from all articles that meet the inclusion criteria. Key themes to be analyzed include psychological casualties, searching family and friends, and family reunification plans.
The initial search yielded 6,267 results. 5,294 articles remained after duplicates were removed. Of the 4,890 reviewed thus far, 269 articles met inclusion criteria.
Although a wealth of existing literature notes the need for an effective psychosocial response in mass trauma and disaster situations, no prior study has analyzed the efficacy of such interventions or laid out an evidence-based plan. This study will fill this much-needed gap in the literature.
Pathological worry is a hallmark feature of generalised anxiety disorder (GAD), associated with dysfunctional emotional processing. The ventromedial prefrontal cortex (vmPFC) is involved in the regulation of such processes, but the link between vmPFC emotional responses and pathological v. adaptive worry has not yet been examined.
To study the association between worry and vmPFC activity evoked by the processing of learned safety and threat signals.
In total, 27 unmedicated patients with GAD and 56 healthy controls (HC) underwent a differential fear conditioning paradigm during functional magnetic resonance imaging.
Compared to HC, the GAD group demonstrated reduced vmPFC activation to safety signals and no safety–threat processing differentiation. This response was positively correlated with worry severity in GAD, whereas the same variables showed a negative and weak correlation in HC.
Poor vmPFC safety–threat differentiation might characterise GAD, and its distinctive association with GAD worries suggests a neural-based qualitative difference between healthy and pathological worries.
A program of accelerator mass spectrometry has been started at the Rehovot 14UD Pelletron Accelerator Laboratory. Part of the initial emphasis has been directed to the detection of the 36Cl radioisotope. We report here on the present status of our work and describe our experimental system. Preliminary results are presented, showing that 36Cl/Cl concentrations ranging down to 1×10−14 could be measured with our system.
Astronomical spectra are, with few exceptions, still being recorded on photographic emulsions. These generally have the advantages of better spatial resolution and larger available area than existing photoelectric imaging detectors. On the other hand they do suffer from a small dynamic range (15 or 20: 1), reciprocity failure, and a quantum efficiency of less than 1 per cent. Image intensifiers and image orthocons can be used to improve sensitivity, but where photographs are used for the record the other problems tend to remain. Calibration and extraction of the appropriate astronomical information in digital form involves a considerable amount of time and careful work, as one can appreciate from many of the papers presented at this colloquium.
Background: There is strong evidence that clinical outcomes are improved for stroke patients admitted to specialized Stroke Units. The Toronto Western Hospital (TWH) created a Neurovascular Unit (NVU) using resources from General Internal Medicine, Neurology, and Neurosurgery for patients with stroke and acute neurovascular conditions. Under resource-constrained conditions, the operational and economic impacts of the Neurovascular Unit were unknown. Methods: Retrospective patient-level data was studied from two years prior and one year post NVU implementation. Descriptive statistical analysis and non-parametric testing were conducted on the acute length of stay (LOS), alternate level of care LOS, total cost per bed-day and per visit, and patient flow within each medical service and hospital wide. Results: The median acute LOS per hospitalization for NVU-eligible patients decreased significantly (p=0.001). For Neurology patients, mean acute LOS decreased from 9.1 days pre-Neurovascular Unit to 7.6 days post and median acute LOS decreased from 6 to 5 days (p=0.002); however, mean alternate level of care LOS per visit more than doubled (from 1.6 to 4.1 days, p=0.001). For the Neurology service, the mean cost per visit decreased by $945, representing a 5% reduction (p=0.042) and the mean cost per bed-day decreased by $233, or 12.5% (p=0.026). Hospital wide, a saving of over C$450 000 was achieved. Conclusions: During the first year of operation, the NVU at TWH achieved decreased acute LOS per visit and lowered the total hospitalization cost per year for NVU-eligible patients. Addressing the issue of increased alternate level of care LOS could result in additional efficiencies.
Dramatic increases in human populations and per capita consumption, climate change, overexploitation of marine and freshwater resources, and deforestation have caused a litany of negative consequences for biodiversity. Such doom-and-gloom scenarios are widely known, frequently cited and frankly depressing. Although accurate assessments of threats have clear value for intervention planning, we believe there is also a need to reflect on successes. Such reflection provides balance to negative scenarios and may shift attention towards constructive, positive action. Here we use a systematic evaluation of 90 success stories provided by conservation scientists and practitioners to explore the characteristics of the projects perceived as being associated with success. Success was deemed to have occurred for 19.4% of the projects simply because an event had occurred (e.g. a law was passed) and for 36.1% of projects quantitative data indicated success (e.g. censuses demonstrated population increase). However, for most projects (63.9%) there was no evaluation and success was defined by the subjective opinion of the respondent. Conservation community members viewed successful projects most often as those being long-term (88%), small in spatial scale (52%), with a relatively low budget (68%), and involving a protectionist approach alone or in combination with another approach. These results highlight the subjectivity of definitions of success in conservation but also the characteristics of conservation efforts that the conservation community perceives as indicative of success.
Self-report questionnaires are frequently used in clinical and epidemiologic studies to assess post-traumatic stress disorder (PTSD). A number of studies have evaluated these scales relative to clinician administered structured interviews; however, there has been no formal evaluation of their performance relative to non-clinician administered epidemiologic assessments such as the Composite International Diagnostic Interview (CIDI). We examined the diagnostic performance of two self-report PTSD scales, the PTSD checklist (PCL) and the Vietnam Era Twin Registry (VET-R) PTSD scale, compared to the CIDI.
Data were derived from a large epidemiologic follow-up study of PTSD in 5141 Vietnam Era Veterans. Measures included the PCL, VET-R PTSD scale and CIDI. For both the PCL and VET-R PTSD scale, ROC curves, areas under the curve (AUC), sensitivity, specificity, % correctly classified, likelihood ratios, predictive values and quality estimates were generated based on the CIDI PTSD diagnosis.
For the PCL and VET-R PTSD scale the AUCs were 89.0 and 87.7%, respectively. Optimal PCL cutpoints varied from the 31–33 range (when considering sensitivity and specificity) to the 36–56 range (when considering quality estimates). Similar variations were found for the VET-R PTSD, ranging from 31 (when considering sensitivity and specificity) to the 37–42 range (when considering quality estimates).
The PCL and VET-R PTSD scale performed similarly using a CIDI PTSD diagnosis as the criterion. There was a range of acceptable cutpoints, depending on the metric used, but most metrics suggested a lower PCL cutpoint than in previous studies in Veteran populations.
The present paper examines dietary intake and body composition in antiretroviral (ARV)-naïve HIV-positive compared with HIV-negative South African women, as well as the impact of disease severity on these variables.
Baseline data from a longitudinal study assessing bone health in HIV-negative and HIV-positive premenopausal South African women over 18 years of age were used. Anthropometry and body composition, measured by dual energy X-ray absorptiometry, were analysed together with dietary intake data assessed using an interviewer-based quantitative FFQ.
Soweto, Johannesburg, South Africa.
Black, urban South African women were divided into three groups: (i) HIV-negative (HIV−; n 98); (ii) HIV-positive with preserved CD4 counts (HIV+ non-ARV; n 74); and (iii) HIV-positive with low CD4 counts and due to start ARV treatment (HIV+ pre-ARV; n 75).
The prevalence of overweight and obesity was high in this population (59 %). The HIV+ pre-ARV group was lighter and had a lower BMI than the other two groups (all P < 0·001). HIV+ pre-ARV women also had lower fat and lean masses and percentage body fat than their HIV− and HIV+ non-ARV counterparts. After adjustment, there were no differences in macronutrient intakes across study groups; however, fat and sugar intakes were high and consumption of predominantly refined food items was common overall.
HIV-associated immunosuppression may be a key determinant of body composition in HIV-positive women. However, in populations with high obesity prevalence, these differences become evident only at advanced stages of infection.
Although the target article emphasizes the important role of prediction in language use, prediction may well also play a key role in the initial formation of linguistic representations, that is, in language development. We outline the role of prediction in three relevant language-learning domains: transitional probabilities, statistical preemption, and construction learning.
The 18O(p, α)15N reaction rate has been extracted by means of the Trojan-Horse method. For the first time the contribution of the 20-keV peak has been directly evaluated, giving a value about 35% larger than previously estimated. The present approach has allowed to improve the accuracy of a factor 8.5, as it is based on the measured strength instead of educated guesses or spectroscopic measurements. The contribution of the 90-keV resonance has been determined as well, which turned out to be of negligible importance to astrophysics.
In a well-known New Yorker cartoon, a man and a woman sit together on a couch, clearly in the midst of a conversation about marriage for gay and lesbian couples. “Haven't they suffered enough?” one of them asks. Although the cartoon characters jest, the question of why gay people are fighting so hard for the right to marry is a serious one. After all, marriage rates have been dropping steadily in the United States and in much of the world, and divorce rates remain high. Why, then, are lesbians and gay men fighting so hard to join an institution that appears, by most indicators, to be on the decline?
There is no single answer to this question, of course. Political ideology and social experiences are important determinants of any given person's position, and individuals’ positions are often complex, with overlapping justifications. From among the many possible reasons, this chapter looks closely at several leading responses to the “Why bother with marriage?” question. Building on these responses, the chapter also offers an analytic framework for understanding contemporary marriage debates and a foundation for thinking about how marriage might fare as we move beyond the current crossroads.
Note that the inquiry here is not about why a particular gay or lesbian couple might want to get married. That question, for most couples, is answered by reference to love rather than rights; by desires for binding familial commitments rather than concerns about the signaling effects of legally recognized marital status. At an individualized level, one could answer the “why bother with marriage” question simply by saying that marriage has traditionally been, and continues to be, what adult couples seek when they want state sanctification of their relationships, and that same-sex couples are simply asking for what different-sex couples already have.
Delta-doped boron marker layers in silicon have been used to test further the relationship between B transient enhanced diffusion (TED) and the flux of silicon interstitials released during the annealing stage following self implantation. We present new data which address a number of questions raised by the present models. We show that in our experiments bulk trapping of interstitials is significant only for low implant fluences (∼1012 cm −2). The origin of the observed diffusion-like profiles for the interstitial flux is instead found to lie in local trapping within the δ-doped layers themselves. Boron trapped in immobile clusters may be associated with Si interstitials in approximately a 1:1 ratio; nevertheless this trapping contribution alone may not entirely account for the observed gradient. We suggest that some part of the observed TED response with depth is attributable to local trapping of silicon interstitials within the boron doped layers.
In any constitutional system, we must ask, as a foundational inquiry, when and why a government may distinguish between groups of constituents for purposes of allocating benefits or imposing penalties. For feminists and others with a stake in challenging inequalities, the rationales that a society deems acceptable for justifying these classifications are centrally important. Heightened scrutiny jurisprudence for sex-based and other distinctions may help capture some of the rationales that rest on stereotypes and outmoded biases. However, at the end of the day, whatever level of scrutiny is applied, the critical question at any level of review is whether, according to the decision maker, the government has adequately justified the distinction it has drawn.
For most official classifications, the rationales for differentiating among people are obvious and unremarkable, and the laws at issue provoke no challenges. Age-based rules that require only some people (youth) to attend school are a classic example. Similar are rules that restrict the issuance of drivers’ licenses to individuals without significantly impaired vision. In these instances, the government's line-drawing is linked to a demonstrable characteristic of the people who are burdened by the measure at issue.
Emergency department overcrowding plagues departments worldwide with grave implications on patient comfort and care quality. Many standard approaches have been introduced without widespread success. A new approach is required. Focused Operations Management (FM) integrates novel managerial theories and practical tools into a systematic approach to complex systems, promoting insight and improving performance. It has allowed systems in the industry and service sectors to radically improve throughput and quality with no or little additional cost. The implementation of the FM in the emergency department setting to alleviate overcrowding has never been attempted, and it could revolutionize emergency department operations management.
Emergency department patient flow data affecting factors and outcomes from a large tertiary medical center, exclusively utilizing electronic patient records, will be collected. Root causes and influencing variables of emergency department overcrowding will be mapped and analyzed using FM tools. Later, alleviating measures will be developed and evaluated. During phase two, data will be collected from two additional emergency departments, measuring the impact of implementation of FM operational changes on emergency department flow parameters such as length of stay, wait times, clinical outcomes, and patient and staff satisfaction.
Data collection and analysis of phase one of the study will be completed by March 2011 and presented at the conference. The authors speculate that the FM tools will allow better understanding of the root causes and affecting variables of emergency department overcrowding and help plan and later implement efficient interventions.
The implementation of the novel management strategies of FM has revolutionized operations in many industries and services, helping them to drastically improve performance. The emergency department is a perfect candidate for the use of these tools, due to the overwhelming current operational difficulties (with overcrowding as a prominent symptom) and its complex high volume and high acuity patient flow.
Pandemic influenza poses a great challenge to healthcare systems. Vaccinating medical teams and the population against pandemic influenza is the global recommended strategy to contain spread of the disease. As part of the efforts made to overcome the H1N1 pandemic, the Israeli Ministry of Health (MOH) initiated a general vaccination program for medical teams and the total country population. Due to low compliance rates of the medical staff, the MOH conducted regional conferences aimed at providing knowledge and encouraging staff to be vaccinated.
To evaluate the effect of the regional conferences on the compliance rates amongst medical providers to be vaccinated against H1N1.
Medical providers from the primary health care services were invited to conferences that were conducted in 3 regions. Attitudes of the teams regarding compliance to be vaccinated were assessed pre and post the conferences. Additionally, the actual rates of vaccinations were recorded over the period of vaccination program. Actual compliance rates before and after the conferences were compared to detect differences as well as the relationship between teams' attitudes and actual vaccinations.
Vaccination rates of medical providers remained low during the full vaccination period. Among the non-vaccinated, 24% to 29% reported before the conference that they agree to be vaccinated versus 57% to 62% following the conference. Analysis of the actual vaccination data among the medical providers did not demonstrate a change in compliance following the conferences and an overall decrease was noted after the first two weeks of the vaccinated project.
A statistically significant relationship was not found between reported attitudes of medical providers regarding readiness to be vaccinated and their actual vaccination. The MOH intervention did not achieve the expected result and did not raise compliance to be vaccinated.
Israeli Hospitals are required to maintain a high level of emergency preparedness.
To investigate the effect of on-going use of an evaluation tool on acute-care hospitals' emergency preparedness for mass casualty events (MCE).
Evaluation of emergency preparedness for MCE was carried out in all acute-care hospitals, based on an evaluation tool consisting of 306 objective and measurable parameters. Two cycles of evaluations were conducted in 2005 to 2009 and the scores were calculated to detect differences.
A significant increase was found in the mean total scores of emergency preparedness between the two cycles of evaluations (from 77.1 to 88.5). An increase was found in scores for standard operating procedures, training and equipment, but the change was significant only in the training category. The relative increase was highest in hospitals that did not experience real MCE.
This study offers a structured and practical approach for ongoing improvement of emergency preparedness, based on validated measurable benchmarks. An ongoing assessment of the level of emergency preparedness motivates hospitals' management and staff to improve their capabilities and thus results in a more effective response mechanism for emergency scenarios.
Utilization of predetermined and measurable benchmarks allows the institutions being assessed to improve their level of performance in the evaluated areas. The expectation is that these benchmarks will allow for a better response to actual MCEs. The study further demonstrated that even hospitals without “real-life” experience can gear up using preset benchmarks and reach a high standard of mass casualty event preparedness.
We analyze the dependence of the second-order G'-band profile in terms of their (n,m) indices by measuring the resonance Raman spectra of several semiconducting and metalic isolated single wal carbon nanotubes. We show that this profile is very sensitive to the electronic structure, thus making it possible to get structural (n,m) information and to probe the splitting of the van Hove singularities in the electronic density of states due to the trigona warping effect.
We present results from resonant Raman spectroscopy on the graphite-like G band by measuring Raman spectra on isolated single wal carbon nanotubes (SWNTs). We discuss the G-band lineshape dependence on nanotube diameter and chirality, as well as polarization studies related to the antenna effect. Symmetry selection rules, dipolar and multipolar antenna behaviors are discussed. Spectra at the single nanotube level are related to spectra observed from SWNT bundles.
Near field scanning optical microscopy (NSOM) is a recent technique where a tapered single-mode optical fiber probe is scanned over a sample surface at a height of a fraction of the wavelength. The tapered fiber provides a tiny aperture (a, ˜ 70nm) through which light is coupled and can yield resolutions as high as ˜, λ/40. We have used both room and low-temperature NSOM to study the local spectroscopic characteristics of a wide variety of material systems, from quantum dots and wires, to ordered GaInP, to heterojunctions and optoelectronic devices.
Low temperature near-field photoluminescence spectroscopy was used to study spectral emission maps of a set of samples of GaInP epilayers with varying degrees of ordering. The samples exhibit two peaks, a low energy (LE) and a high energy (HE) peak. Our data are inconsistent with expectations that the LE peak is due to emission from domain boundaries and alternative models will be discussed. NSOM spectral maps can yield information about the spatial dependence of the local optical matrix elements. NSOM data on the emission mode structure of strained (In, Ga)As quantum well lasers has yielded new information on the source kinks in the light response at high currents, while local photocurrent spectroscopy using the tip as a point source of photons provides analysis of the semiconductor layer composition.