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To analyze the evacuation preparedness of hospitals within the European Union (EU).
This study consisted of 2 steps. In the first step, a systematic review of the subject matter, according to the PRISMA flow diagram, was performed. Using Scopus (Elsevier, Amsterdam, Netherlands), PubMed (National Library of Medicine, Bethesda, MD), and Gothenburg University´s search engine, 11 questions were extracted from the review and were sent to representatives from 15 European Union (EU)- and non-EU countries.
The findings indicate that there is neither a full preparedness nor a standard guideline for evacuation within the EU or other non-EU countries in this study. A major shortcoming revealed by this study is the lack of awareness of the untoward consequences of medical decision-making during an evacuation. Some countries did not respond to the questions due to the lack of relevant guidelines, instructions, or time.
Hospitals are exposed to internal and external incidents and require an adequate evacuation plan. Despite many publications, reports, and conclusions on successful and unsuccessful evacuation, there is still no common guide for evacuation, and many hospitals lack the proper preparedness. There is a need for a multinational collaboration, specifically within the EU, to establish such an evacuation planning or guideline to be used mutually within the union and the international community.
Successful management of an event where health-care needs exceed regional health-care capacity requires coordinated strategies for scarce resource allocation. Publications for rapid development, training, and coordination of regional hospital triage teams to manage the allocation of scarce resources during coronavirus disease 2019 (COVID-19) are lacking. Over a period of 3 weeks, over 100 clinicians, ethicists, leaders, and public health authorities convened virtually to achieve consensus on how best to save the most lives possible and share resources. This is referred to as population-based crisis management. The rapid regionalization of 22 acute care hospitals across 4500 square miles in the midst of a pandemic with a shifting regulatory landscape was challenging, but overcome by mutual trust, transparency, and confidence in the public health authority. Because many cities are facing COVID-19 surges, we share a process for successful rapid formation of health-care care coalitions, Crisis Standard of Care, and training of Triage Teams. Incorporation of continuous process improvement and methods for communication is essential for successful implementation. Use of our regional health-care coalition communications, incident command system, and the crisis care committee helped mitigate crisis care in the San Diego and Imperial County region as COVID-19 cases surged and scarce resource collaborative decisions were required.
Radiocarbon (14C) ages cannot provide absolutely dated chronologies for archaeological or paleoenvironmental studies directly but must be converted to calendar age equivalents using a calibration curve compensating for fluctuations in atmospheric 14C concentration. Although calibration curves are constructed from independently dated archives, they invariably require revision as new data become available and our understanding of the Earth system improves. In this volume the international 14C calibration curves for both the Northern and Southern Hemispheres, as well as for the ocean surface layer, have been updated to include a wealth of new data and extended to 55,000 cal BP. Based on tree rings, IntCal20 now extends as a fully atmospheric record to ca. 13,900 cal BP. For the older part of the timescale, IntCal20 comprises statistically integrated evidence from floating tree-ring chronologies, lacustrine and marine sediments, speleothems, and corals. We utilized improved evaluation of the timescales and location variable 14C offsets from the atmosphere (reservoir age, dead carbon fraction) for each dataset. New statistical methods have refined the structure of the calibration curves while maintaining a robust treatment of uncertainties in the 14C ages, the calendar ages and other corrections. The inclusion of modeled marine reservoir ages derived from a three-dimensional ocean circulation model has allowed us to apply more appropriate reservoir corrections to the marine 14C data rather than the previous use of constant regional offsets from the atmosphere. Here we provide an overview of the new and revised datasets and the associated methods used for the construction of the IntCal20 curve and explore potential regional offsets for tree-ring data. We discuss the main differences with respect to the previous calibration curve, IntCal13, and some of the implications for archaeology and geosciences ranging from the recent past to the time of the extinction of the Neanderthals.
Disaster Medicine (DM) education for Emergency Medicine (EM) residents is highly variable due to time constraints, competing priorities, and program expertise. The investigators’ aim was to define and prioritize DM core competencies for EM residency programs through consensus opinion of experts and EM professional organization representatives.
Investigators utilized a modified Delphi methodology to generate a recommended, prioritized core curriculum of 40 DM educational topics for EM residencies.
The DM topics recommended and outlined for inclusion in EM residency training included: patient triage in disasters, surge capacity, introduction to disaster nomenclature, blast injuries, hospital disaster mitigation, preparedness, planning and response, hospital response to chemical mass-casualty incident (MCI), decontamination indications and issues, trauma MCI, disaster exercises and training, biological agents, personal protective equipment, and hospital response to radiation MCI.
This expert-consensus-driven, prioritized ranking of DM topics may serve as the core curriculum for US EM residency programs.
The atom-probe field ion microscope was introduced in 1967 at the 14th Field Emission Symposium held at the National Bureau of Standards (now, NIST) in Gaithersburg, Maryland. The atom-probe field ion microscope was, and remains, the only instrument capable of determining “the nature of one single atom seen on a metal surface and selected from neighboring atoms at the discretion of the observer”. The development of the atom-probe is a story of an instrument that one National Science Foundation (NSF) reviewer called “impossible because single atoms could not be detected”. It is also a story of my life with Erwin Wilhelm Müller as his graduate student in the Field Emission Laboratory at the Pennsylvania State University in the late 1960s and his strong and volatile personality, perhaps fostered by his pedigree as Gustav Hertz’s student in the Berlin of the 1930s. It is the story that has defined by scientific career.
Small additions of boron can remarkably improve the long-term creep resistance of 9–12% Cr steels. The improvement has been attributed to boron segregation to grain boundaries during quenching, and subsequent boron incorporation into certain families of precipitates during tempering. However, the detailed mechanisms are not yet fully understood. Atom probe tomography (APT) is an excellent technique for gaining insights into boron distribution, however, in order to acquire accurate analysis of boron in 9–12% Cr steels using APT, there are several key challenges. In order to better understand and address these challenges, we developed a novel method for site-specific APT specimen preparation, which enables convenient preparation of specimens containing specifically selected grain boundaries positioned approximately perpendicular to the axis of the APT tip. Additionally, when analyzing boron at boundaries and in carbides (as diluted solute) and borides, a widening of the profile of boron distribution compared to other elements was repeatedly observed. This phenomenon is particularly analyzed and discussed in light of the evaporation field of different elements. Finally, the possible effects of detector dead-time on quantitative analysis of boron in metal borides are discussed. A simple method using 10B correction was used to obtain good quantification.
To determine the effect of mandatory and nonmandatory influenza vaccination policies on vaccination rates and symptomatic absenteeism among healthcare personnel (HCP).
Retrospective observational cohort study.
This study took place at 3 university medical centers with mandatory influenza vaccination policies and 4 Veterans Affairs (VA) healthcare systems with nonmandatory influenza vaccination policies.
The study included 2,304 outpatient HCP at mandatory vaccination sites and 1,759 outpatient HCP at nonmandatory vaccination sites.
To determine the incidence and duration of absenteeism in outpatient settings, HCP participating in the Respiratory Protection Effectiveness Clinical Trial at both mandatory and nonmandatory vaccination sites over 3 viral respiratory illness (VRI) seasons (2012–2015) reported their influenza vaccination status and symptomatic days absent from work weekly throughout a 12-week period during the peak VRI season each year. The adjusted effects of vaccination and other modulating factors on absenteeism rates were estimated using multivariable regression models.
The proportion of participants who received influenza vaccination was lower each year at nonmandatory than at mandatory vaccination sites (odds ratio [OR], 0.09; 95% confidence interval [CI], 0.07–0.11). Among HCP who reported at least 1 sick day, vaccinated HCP had lower symptomatic days absent compared to unvaccinated HCP (OR for 2012–2013 and 2013–2014, 0.82; 95% CI, 0.72–0.93; OR for 2014–2015, 0.81; 95% CI, 0.69–0.95).
These data suggest that mandatory HCP influenza vaccination policies increase influenza vaccination rates and that HCP symptomatic absenteeism diminishes as rates of influenza vaccination increase. These findings should be considered in formulating HCP influenza vaccination policies.
On August 25, 2017, Hurricane Harvey made landfall near Corpus Christi, Texas. The ensuing unprecedented flooding throughout the Texas coastal region affected millions of individuals.1 The statewide response in Texas included the sheltering of thousands of individuals at considerable distances from their homes. The Dallas area established large-scale general population sheltering as the number of evacuees to the area began to amass. Historically, the Dallas area is one familiar with “mega-sheltering,” beginning with the response to Hurricane Katrina in 2005.2 Through continued efforts and development, the Dallas area had been readying a plan for the largest general population shelter in Texas. (Disaster Med Public Health Preparedness. 2019;13:33–37)
We present an abstract framework for the axiomatic study of diagram algebras. Algebras that fit this framework possess analogues of both the Murphy and seminormal bases of the Hecke algebras of the symmetric groups. We show that the transition matrix between these bases is dominance unitriangular. We construct analogues of the skew Specht modules in this setting. This allows us to propose a natural tableaux theoretic framework in which to study the infamous Kronecker problem.
The college accreditation movement that arose at the turn of the twentieth century had an important antecedent in the Society for the Promotion of Collegiate and Theological Education at the West. Founded in 1843, this nondenominational philanthropy aspired to direct the development of higher education by dispersing eastern funds to Protestant colleges that met its standards for instruction, administration, and piety. For all its ambitions, the Society did not always offer dependable or disinterested supervision. Its relationships with Knox College and Iowa College (now Grinnell) exposed its shortcomings. Coinciding with the rising sectional conflict over slavery, the activities of these institutions forced the regulatory association to engage in the very brand of ecclesiastical politics it had vowed to transcend. This article shows how institutional resistance and church rivalry helped delay the growth of accreditation until the turn of the twentieth century, when secular organizations took up the reins of regulation.
The Last Glacial–Interglacial Transition (LGIT; 15,000–11,000 cal BP) was characterized by complex spatiotemporal patterns of climate change, with numerous studies requiring accurate chronological control to decipher leads from lags in global paleoclimatic, paleoenvironmental, and archaeological records. However, close scrutiny of the few available tree-ring chronologies and radiocarbon-dated sequences composing the IntCal13 14C calibration curve indicates significant weakness in 14C calibration across key periods of the LGIT. Here, we present a decadally resolved atmospheric 14C record derived from New Zealand kauri spanning the Lateglacial from ~13,100–11,365 cal BP. Two floating kauri 14C time series, curve-matched to IntCal13, serve as a 14C backbone through the Younger Dryas. The floating Northern Hemisphere (NH) 14C data sets derived from the YD-B and Central European Lateglacial Master tree-ring series are matched against the new kauri data, forming a robust NH 14C time series to ~14,200 cal BP. Our results show that IntCal13 is questionable from ~12,200–11,900 cal BP and the ~10,400 BP 14C plateau is approximately 5 decades too short. The new kauri record and repositioned NH pine 14C series offer a refinement of the international 14C calibration curves IntCal13 and SHCal13, providing increased confidence in the correlation of global paleorecords.
The thin but widespread Cornbrash Formation is a marine sedimentary deposit of particular interest and importance to stratigraphers because, as revealed by its palaeontology, within it lies a transgressive event which marks the boundary between the Middle Jurassic Bathonian and Callovian stages. The monographic treatment of its varied fauna was started by John Frederick Blake (1839–1906), but he died before the work was completed, and it remained unfinished. This one-volume reissue comprises the two parts that were originally published separately. Part 1 (issued in November 1905) includes details of Cornbrash exposures from Dorset to Yorkshire, and systematic descriptions of the vertebrates (reptiles, crocodiles, fish) and molluscs (nautiloids, ammonites, belemnites and gastropods). The second part (issued posthumously in December 1907) continues to cover the molluscs (scaphopods) and draws the monograph to a premature close. Some seventy taxa are illustrated in nine lithographic plates.