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Providing humanitarian relief to affected populations is a top priority following a major sudden onset disaster (SOD). The main form of medical relief to affected areas is the emergency medical teams (EMTs). These are groups of health professionals and support staff operating locally or outside their country of origin by providing healthcare to disaster-affected populations. Despite best intentions, for decades EMTs were disorganized and followed no clear standards. In the aftermath of the 2010 Haiti earthquake, the EMT Working Group of the World Health Organization‘s global health cluster initiated a global effort to standardize the EMTs system. This new system was put to the test in 2013 with the deployment of medical aid to the Philippines following Typhon Haiyan, and later on during the Ebola outbreak in West Africa and the earthquake in Nepal in 2015. This chapter reviews the history of medical aid to disaster affected areas, the process of coordinating and standardizing EMTs and the latest implementation of the new EMT coordination system.
This chapter deals with the modalities of the actions to be taken prior to the deployment of a field hospital to a foreign country in a disaster. It specifically examines the necessity and role of a recce mission, which should deploy before thefield hospital does. It covers the issues that the recce mission will face on arrival in a foreign country and the actions it should take to tackle these. It also deals with the specific duties of a recce mission in terms of establishing liaison with the host government and the coordination structures established at the disaster site. Actions that need to be taken for the smooth entry of the field hospital into the country and its deployment to the site are covered in detail from site selection for the field hospital to immigration and customs issues. It also covers the handing over of responsibility from the recce mission to the main body of the field hospital. The chapter includes numerous references to handbooks and articles that deal with international deployment and ends in some "take-home" conclusions for a team.
“Joint action”—the ability to coordinate actions with others—is critical for achieving individual and interpersonal goals and for our collective success as a species. Joint actions require accurate and rapid inferences about others’ goals, intentions, and focus of attention, skills that are thought to be impaired in individuals with autism spectrum disorder (ASD). Research to date has not investigated joint action abilities in individuals with ASD during real-world social interactions. We conducted an experimental study that required children with ASD and typically developing children to move tables by themselves or collaboratively through a maze. This involved developing innovative methodologies for measuring action coordination—a critical component of the joint action process. We found that children with ASD are less likely to benefit from the collaboration of a peer than are typically developing children, and they are less likely to synchronize their steps when moving the table. However, these differences were masked when scaffolded by an adult. There was no evidence that ASD differences were due to gross motor delays in the participants with ASD. We argue that action coordination is a highly adaptive social process that is intrinsic to successful human functioning that manifests as atypical synchronization of mind and body in children with ASD.
In this chapter the research question is answered but, more importantly, three scenarios as sketched concerning the way to move forward: cooperation, coordination, and collaboration. The cooperative scenario is an informal inter-organisational relationship lacking a common mission, structure or joint planning but focuses mostly on improving the current information exchange, for example, by the publication of more (translated) documents and enhancing current digital platforms. In the coordination scenario the CJEU and Supreme Administrative Courts are going to work together more actively to advance their separate, yet compatible missions to advance the working of the preliminary reference procedure via more formalized communication channels and a more active role for national courts, for example, as amicus curiae. In the third scenario, national Supreme Courts become European courts and not only from the receiving end. They will be given a more prominent role in filtering, synthesizing and distributing preliminary questions from lower courts and become decentralized EU courts dealing with most bulk cases that currently fill the docket of the CJEU. This would enable the Luxembourg court to develop into a real constitutional court of the EU with less attention for dispute resolution and more attention for judicial law making.
This chapter concludes the Handbook, returning to the research questions set out in the introduction. Drawing from the various contributions to the Handbook, this concluding chapter assesses the mismatch between global markets and territorially rooted national regulation; the impact of shareholder-orientation upon the achievement of corporate sustainability; salient trends in the organization of corporate firms, commercial markets, and financial systems; the status of various innovations in corporate law and governance and their capacity to achieve corporate sustainability; and areas where we consider the need for further research to be particularly pressing.
Good relations and trust are the foundation of soft power diplomacy and are essential for the accomplishment of domestic interventions and any bilateral or multilateral endeavor. Military use for assistance and relief is not a novel concept, but it has increased since the early 1990s with many governments choosing to provide greater numbers of forces and assets to assist domestically and internationally. The increase is due to the growing lack of capacity in global humanitarian networks and increasingly inadequate resources available to undertake United Nations humanitarian assistance and disaster relief (HADR) missions. In response, the military has been more proactive in pursuing the improvement of military-to-military and military-to-civilian integration. This trend reflects a move towards more advanced and comprehensive approaches to security cooperation and requires increased support from the civilian humanitarian sector to help meet the needs of the most vulnerable. Military assistance is progressing beyond traditional methods to place a higher value on issues relating to civil cooperation, restoring public health infrastructure, protection, and human rights, all of which are ensuring a permanent diplomatic role for this soft power approach.
Despite the significant improvement in all components of preparedness in the past decade, there are still gaps between the guidelines and the reality on the ground. The purpose of this study is to explore how Israeli public health and emergency medicine experts perceive the demands for health organization emergency preparedness and the actual practice.
Qualitative phenomenological research. We interviewed 22 Israeli public health and emergency medicine experts face-to-face and conducted a content analysis.
The findings revealed barriers in the following areas: preparation and readiness of hospitals, preparedness and readiness in the community, connection between the community and the hospital, inter-agency coordination and interface, interdisciplinary integration, preparedness resources, postcrisis evaluation, assimilating smart technologies, information accessibility, and communication.
To reduce the gap between theory and practice, retrospective research and evaluation must be included to learn in depth what strategies and resources should be used during a health crisis. Likewise, profiles should be constructed and the community should be segmented in order to design resilience programs and accommodate information to subpopulations.
We build a two-country New-Keynesian DSGE model of a Currency Union to study the effects of fiscal policy coordination, by evaluating the stabilization properties and welfare implications of different fiscal policy scenarios. Our main findings are that a government spending rule which targets the net exports gap rather than the domestic output gap produces more stable dynamics and that consolidating government budget constraints across countries with symmetric tax rate movements provides greater stabilization. A key role is played by the trade elasticity which determines the impact of the terms of trade on net exports. In fact, when goods are complements, the stabilization properties of coordinating fiscal policies are no longer supported. These findings point out to possible policy prescriptions for the Euro Area: to coordinate fiscal policies by reducing international demand imbalances, either by stabilizing trade flows across countries or by creating some form of Fiscal Union or both.
The prevalence and impact of motor coordination difficulties in children with copy number variants associated with neurodevelopmental disorders (ND-CNVs) remains unknown. This study aims to advance understanding of motor coordination difficulties in children with ND-CNVs and establish relationships between intelligence quotient (IQ) and psychopathology.
169 children with an ND-CNV (67% male, median age = 8.88 years, range 6.02–14.81) and 72 closest-in-age unaffected siblings (controls; 55% male, median age = 10.41 years, s.d. = 3.04, range 5.89–14.75) were assessed with the Developmental Coordination Disorder Questionnaire, alongside psychiatric interviews and standardised assessments of IQ.
The children with ND-CNVs had poorer coordination ability (b = 28.98, p < 0.001) and 91% of children with an ND-CNV screened positive for suspected developmental coordination disorder, compared to 19% of controls (OR = 42.53, p < 0.001). There was no difference in coordination ability between ND-CNV genotypes (F = 1.47, p = 0.184). Poorer coordination in children with ND-CNV was associated with more attention deficit hyperactivity disorder (ADHD) (β = −0.18, p = 0.021) and autism spectrum disorder trait (β = −0.46, p < 0.001) symptoms, along with lower full-scale (ß = 0.21, p = 0.011), performance (β = −0.20, p = 0.015) and verbal IQ (β = 0.17, p = 0.036). Mediation analysis indicated that coordination ability was a full mediator of anxiety symptoms (69% mediated, p = 0.012), and a partial mediator of ADHD (51%, p = 0.001) and autism spectrum disorder trait symptoms (66%, p < 0.001) as well as full scale IQ (40%, p = 0.002), performance IQ (40%, p = 0.005) and verbal IQ (38%, p = 0.006) scores.
The findings indicate that poor motor coordination is highly prevalent and closely linked to risk of mental health disorder and lower intellectual function in children with ND-CNVs. Future research should explore whether early interventions for poor coordination ability could ameliorate neurodevelopmental risk.
Since the early discussions of polycentricity, the concept (and variations such as polycentric political systems, polycentric governance, polycentric order, etc.) has seen the development of numerous permutations, digressions, and contradictions. This chapter is meant to carefully step through key notions tied to polycentricity and polycentric governance. The chapter’s purpose is to discuss polycentric governance in particular, while giving some attention to polycentricity as a term from which polycentric governance originates. We build upon the classic version of polycentric governance as a 'polycentric political system', link this concept with broader conceptualizations of polycentricity, and survey the related ideas that have been investigated around the concepts of polycentric political systems, polycentric order, polycentric governance, and polycentric arrangements.
Because many types of governance can be polycentric, an observer faces a challenge in trying to identify and understand polycentric governance in actual settings. This chapter adopts the perspective of thinking about polycentricity as a lens through which to view governance situations. We take an inquiry approach, considering how one might determine whether and in what ways a given governance situation demonstrates the characteristics of polycentric governance. We proceed through a series of questions an observer could pose as part of 'seeing polycentrically', i.e., looking at the aspects and dimensions of polycentric governance introduced in Stephan, Marshall, and McGinnis as a way of building an understanding of a governance situation. We attempt to describe why these queries are important and how posing and answering these questions helps in examining and understanding the situation. We close the chapter by considering the challenges of assessing the operation of polycentric governance arrangements.
This chapter explores the interface between competition and consumer policies, law and institutions as it is emerging in ASEAN. It analyses the reasons for the traditional separation of these two fields, both generally and ASEAN in particular, and then explains the case for an integrated approach to policymaking and a coordinated approach to institutional design, pointing to international examples of such approaches. The chapter considers the evidence of integration and coordination in ASEAN to date, and considers reasons for the functionally silo-ed approach that has been exhibited in most member states thus far. It argues that increased recognition of the positive interdependencies between competition and consumer policies should be a key element of ASEAN’s future development, consistent with theories of networked governance, trading up and contextualised transplantation.
The paper explores how elites can develop capacity for collective agency through coordination.. The challenge for elites is to simultaneously deter the state from abusing power while at the same time relying on it to discipline defectors in their midst..The basic insight holds that the credibility of the state's threats depends on the cost of carrying them out, which elites can control. The elites can coordinate by being compliant when the ruler's threats serve their collective interest, which by reducing the cost of carrying them out make them more credible. On the other hand, their coordinated non-compliance has the opposite effect...
Disasters, such as cyclones, create conditions that increase the risk of infectious disease outbreaks. Epidemic forecasts can be valuable for targeting highest risk populations before an outbreak. The two main barriers to routine use of real-time forecasts include scientific and operational challenges. First, accuracy may be limited by availability of data and the uncertainty associated with the inherently stochastic processes that determine when and where outbreaks happen and spread. Second, even if data are available, the appropriate channels of communication may prevent their use for decision making.
In April 2019, only six weeks after Cyclone Idai devastated Mozambique’s central region and sparked a cholera outbreak, Cyclone Kenneth severely damaged northern areas of the country. By June 10, a total of 267 cases of cholera were confirmed, sparking a vaccination campaign. Prior to Kenneth’s landfall, a team of academic researchers, humanitarian responders, and health agencies developed a simple model to forecast areas at highest risk of a cholera outbreak. The model created risk indices for each district using combinations of four metrics: (1) flooding data; (2) previous annual cholera incidence; (3) sensitivity of previous outbreaks to the El Niño-Southern Oscillation cycle; and (4) a diffusion (gravity) model to simulate movement of infected travelers. As information on cases became available, the risk model was continuously updated. A web-based tool was produced, which identified highest risk populations prior to the cyclone and the districts at-risk following the start of the outbreak.
The model prior to Kenneth’s arrival using the metrics of previous incidence, projected flood, and El Niño sensitivity accurately predicted areas at highest risk for cholera. Despite this success, not all data were available at the scale at which the vaccination campaign took place, limiting the model’s utility, and the extent to which the forecasts were used remains unclear. Here, the science behind these forecasts and the organizational structure of this collaborative effort are discussed. The barriers to the routine use of forecasts in crisis settings are highlighted, as well as the potential for flexible teams to rapidly produce actionable insights for decision making using simple modeling tools, both before and during an outbreak.
In the 19th century, triage emerged as an administrative concept to overcome the unjust and medically unreasonable consequences of an unsystematic adhoc selection of casualties. Until today, however, triage concepts are often applied incorrectly. High over-triage rates are a well-known phenomenon, which increase mortality rates. In order to examine their frequent occurrences, the article discusses different reasons and presents results of an experimental study. Two triage exercises were conducted: a paper-based triage exercise and a real-world simulation. Both exercises used the same case-vignettes consisting of 5 pairs. Each pair described a patient with the same injury pattern and vital parameters but with differing behaviour (calm/highly excited). Different behavior has a minor but no significant effect on over-triage rates. Over-triage is significantly higher in the real-world simulation than in the paper exercise. This is explained by the characteristics of face-to-face situations themselves: they are more complex and ambiguous, and hold more normative power. Accordingly, over-triage is understood as a means to resolve unclear situations (“better to over- than to under-triage”) and to comply with normative demands “within” the strict margins of an administrative concept.
In this paper a sophisticated conception of individuality is developed that extends beyond simple heterogeneity and is consistent with the approach of institutional economics. Studies of human biological and psychological development are used to illustrate the foundations of human individuality and the impact of the social environment on individual development. The link between the social environment and ongoing agential properties is established through the role of habits, which provide some continuity to individual personalities over time and assist them in navigating the social context they inhabit. Reflexivity is established via an agency-structure framework that endows individuals a changeable self-concept and an ability to interpret their relationship to the social context. The coordination of different individuals is explained not simply through reference to institutional structure, but also through the agent-level properties of shared habits. While reducing differences between individuals to one of degrees, shared habits are shown to be particularly important in the context of agent-sensitive institutions. Finally, the potential for different institutional experiences to impact the reflexivity of individuals is explored.
Within out-of-hospital emergencies, primary health care (PHC) nurses must face life-threatening emergencies (LTEs), which are defined as “a situation associated with an imminent life risk that entails the start-up of resources and special means to resolve the situation.”
The objectives of this study were to know the training received for out-of-hospital LTEs by PHC nurses of Asturias, Spain and the perception they have about their theoretical knowledge and practical skills in a series of emergency procedures or techniques used in LTE emergencies; as well as to analyze the differences according to the geographical area of their work.
Cross-sectional, descriptive, and observational study was conducted in 2018 of a sample of PHC service nurses of Asturias, Spain.
A total of 236 nurses from PHC service centers of Asturias, Spain, from among the total of 730 nurses who make up the staff of nurses of the PHC service of Asturias, between April and May 2018, were surveyed. The survey was designed ad hoc using the Doctrinal Body of Emergency Nursing (DBEN) proposed by the Spanish Society of Emergency Medicine (SEMES; Madrid, Spain), which indicates the theoretical and practical procedures that must be acquired by the PHC nurses. It is composed of 37 procedures or techniques employed in LTEs using an 11-point Likert scale rating to detect their self-perception about theoretical knowledge and practical skills from zero (“Minimum”) to ten (“Maximum”).
There were significant differences in the mean of theoretical knowledge and practical skills in many procedures or techniques studied, depending on the different areas of work.
All PHC nurses must be perfectly trained to provide initial quality assistance to the LTE, with both theoretical and practical knowledge of the different techniques, so that it can continue to be attended by the corresponding Emergency Service.
Coordination in system design requires an interplay between different roles. In this work, we identify five design team roles that pertain to the partitioning and coordination of distributed design team tasks. The proposed characterization is based on self-reported responsibilities and communication behaviors from 109 student designers in 22 teams at the conclusion of a semester-long design project. The self-reports capture both how team members viewed their own work as well as communication patterns between team members. We leverage two representations of this data. Through text analysis, we identify keywords describing team member roles and responsibilities. Social network analysis can further distinguish roles based on team communication behaviors. Cluster analysis on both types of data identifies groups of individuals with similar characteristics. The resulting five clusters capture common roles in system design teams that simultaneously capture the diverse responsibilities and communication patterns.
In familiar models, a decrease in the friction facing mobile factors (e.g., lowering their adjustment costs) increases a coordination problem, leading to more circumstances where there are multiple equilibria. We show that a decrease in friction can decrease coordination problems when a production externality arises from a changing stock, e.g. of pollution or knowledge. In general, the relation between the amount of friction that mobile factors face and the likelihood of multiple equilibria is non-monotonic.