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To determine the ability of a novel responder mental health self-triage system to predict post-traumatic stress disorder (PTSD) in emergency medical responders after a disaster.
Participants in this study responded to Typhoon Haiyan, which struck the Philippines in November 2013. They completed the Psychological Simple Triage and Rapid Treatment (PsySTART) responder triage tool, the PTSD Checklist (PCL-5) and the Patient Health Questionnaire-8 (PHQ-8) shortly after responding to this disaster. The relationships between these 3 tools were compared to determine the association between different risk exposures while providing disaster medical care and subsequent levels of PTSD or depression.
The total number of PsySTART responder risk factors was closely related to PCL-5 scores ≥38, the threshold for clinical PTSD. Several of the PsySTART risk factors were predictive of clinical levels of PTSD as measured by the PCL-5 in this sample of deployed emergency medical responders.
The presence of a critical number and type of PsySTART responder self-triage risk factors predicted clinical levels of PTSD and subclinical depression in this sample of emergency medical workers. The ability to identify these disorders early can help categorize an at-risk subset for further timely “stepped care” interventions with the goals of both mitigating the long-term consequences and maximizing the return to resilience. (Disaster Med Public Health Preparedness. 2018;12:19–22)
We report on a target system supporting automated positioning of nano-targets with a precision resolution of
in three dimensions. It relies on a confocal distance sensor and a microscope. The system has been commissioned to position nanometer targets with 1 Hz repetition rate. Integrating our prototype into the table-top ATLAS 300 TW-laser system at the Laboratory for Extreme Photonics in Garching, we demonstrate the operation of a 0.5 Hz laser-driven proton source with a shot-to-shot variation of the maximum energy about 27% for a level of confidence of 0.95. The reason of laser shooting experiments operated at 0.5 Hz rather than 1 Hz is because the synchronization between the nano-foil target positioning system and the laser trigger needs to improve.
We describe the experience from a single institution with the Norwood sequence of palliation for hypoplasia of the left heart, emphasizing complications related to placement of a conduit from the right ventricle to the pulmonary arteries and their management.
Between November, 2002 and January, 2006, we palliated 32 patients with hypoplastic left heart syndrome or its variants by placing a conduit from the right ventricle to the pulmonary arteries. We reviewed retrospectively the charts and angiograms from these patients.
Hospital survival after construction of the conduit was 90.6%. There were 3 interstage deaths, of which 2 were likely due severe obstruction of the conduit. Stents were implanted into the proximal or medial portions of the conduits of 3 patients. Early revision of the distal anastomosis, and shortening the conduit, was performed early postoperatively in 2 patients. So far, 24 out 26 survivors of the first stage underwent a bi-directional cavopulmonary anastomosis after a mean interval of 4.3 plus or minus 1.4 months. Of these, 3 required a semi-urgent second stage of palliation because of worsening cyanosis, with one patient dying after the second stage. Completion of the Fontan circulation by insertion of an extracardiac conduit was performed in 8 patients at the mean age of 19.8 plus or minus 2.2 months. We were able to achieve biventricular repair in 1 patient, with aortic atresia, hypoplastic arch and ventricular septal defect, 4.3 months after the initial palliative procedure. Overall survival of the whole cohort of 32 patients was 78.9%, plus or minus 7.8%, at 5 months, and 74.3%, plus or minus 8.6%, up to 25 months.
The introduction of the conduit placed from the right ventricle to the pulmonary arteries has led to an improved outcome in the complex entity of hypoplastic left heart syndrome and its variants. Stenosis of the conduit, nonetheless, may account for significant interstage morbidity, and often requires intervention or early installation of the second stage of palliation.
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