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A national need is to prepare for and respond to accidental or intentional disasters categorized as chemical, biological, radiological, nuclear, or explosive (CBRNE). These incidents require specific subject-matter expertise, yet have commonalities. We identify 7 core elements comprising CBRNE science that require integration for effective preparedness planning and public health and medical response and recovery. These core elements are (1) basic and clinical sciences, (2) modeling and systems management, (3) planning, (4) response and incident management, (5) recovery and resilience, (6) lessons learned, and (7) continuous improvement. A key feature is the ability of relevant subject matter experts to integrate information into response operations. We propose the CBRNE medical operations science support expert as a professional who (1) understands that CBRNE incidents require an integrated systems approach, (2) understands the key functions and contributions of CBRNE science practitioners, (3) helps direct strategic and tactical CBRNE planning and responses through first-hand experience, and (4) provides advice to senior decision-makers managing response activities. Recognition of both CBRNE science as a distinct competency and the establishment of the CBRNE medical operations science support expert informs the public of the enormous progress made, broadcasts opportunities for new talent, and enhances the sophistication and analytic expertise of senior managers planning for and responding to CBRNE incidents.
Nurses’ broad knowledge and treatment skills are instrumental to disaster management. Roles, responsibilities, and practice take on additional dimensions to their regular roles during these times. Despite this crucial position, the literature indicates a gap between their actual work in emergencies and the investment in training and establishing response plans.
To explore trends in disaster nursing reflected in professional literature, link these trends to current disaster nursing competencies and standards, and reflect based on the literature how nursing can better contribute to disaster management.
A systematic literature review, conducted using six electronic databases, and examination of peer-reviewed English journal articles. Selected publications were examined to explore the domains of disaster nursing: policy, education, practice, research. Additional considerations were the scope of the paper: local, national, regional, or international. The International Nursing Councils’ (ICN) Disaster-Nursing competencies are examined in this context.
The search yielded 171 articles that met the inclusion criteria. Articles were published between 2001 and 2018, showing an annual increase. Of the articles, 48% (n = 82) were research studies and 12% (n = 20) were defined as dealing with management issues. Classified by domain, 48% (n = 82) dealt with practical implications of disaster nursing and 35% (n = 60) discussed educational issues. Only 11% of the papers reviewed policy matters, and of these, two included research. Classified by scope, about 11% (n =18) had an international perspective.
Current standards attribute a greater role to disaster-nursing in leadership in disaster preparedness, particularly from a policy perspective. However, this study indicates that only about 11% of publications reviewed policy issues and management matters. A high percentage of educational publications discuss the importance of including disaster nursing issues in the curricula. In order to advance this area, there is a need to conduct dedicated studies.
We present an overview of our Galactic Archaeology (GA) survey program with the Prime Focus Spectrograph (PFS) for Subaru. Following successful design reviews, the instrument is now under construction with first light anticipated in 2018. Main characteristics of PFS and the science goals in our PFS/GA program are described.
We present initial results from our study of the outer halo of the Milky Way using a large sample of RR Lyr(ab) variables datamined from the archives of the Palomar Transient Facility. Of the 464 RR Lyr in our sample with distances exceeding 50 kpc, 62 have been observed spectroscopically at the Keck Observatory. vr and σ(vr) are given as a function of distance between 50 and 110 kpc, and a very preliminary rather low total mass for the Milky Way out to 110 kpc of ~7±1.5×1011M⊙ is derived from our data.
I review the evidence supporting and characterizing multiple populations within globular clusters (GCs) based on spectroscopy, i.e. on abundance variations within the stellar population of an individual GC, which dates back to almost 40 years ago. I discuss some of my recent work in this area.
We review the properties of globular clusters (GCs) which make them useful for studying the Galactic halo, Galactic chemical evolution and the early stages of the formation of the Milky Way. We review the evidence that GCs have a chemical inventory similar to those of halo field stars. We discuss the abundance ratios for dSph galaxies and show that it is possible to have formed at least part of the Galactic-halo field stellar population by dissolving GCs and/or accreting dSph galaxies, but only if this occurred at an early stage in the formation of the Galaxy. We review the constraints on halo-formation timescales deduced from the low magnesium isotopic ratios in metal-poor halo field dwarfs, which indicate that asymptotic giant-branch (AGB) stars did not have time to contribute significantly, while M71 contains two populations, one without and also one with a substantial AGB contribution. We review the limited evidence for GCs with a second population showing additional contributions from Type II supernovae, currently confined to ω Cen, M54 and M22, all of which may have been the nuclei or central regions of accreted galaxies. We check our own data for additional similar GCs and find preliminary indications that NGC 2419, a massive GC far in the outer Galactic halo, may also belong to this group.
Low socioeconomic status (SES) background has been identified as a risk for several mental disorders. However evidence regarding SES and the developmental course of personality disorder (PD) has not been addressed. Nor is it clear whether an SES relationship to PD symptom course may be attributable to known associated risks. Further, specificity of such relationships to a particular PD diagnostic pattern independent of comorbidity with other PD or with depression has not been investigated. Data are from a general population studied longitudinally between ages 10 and 36 in four assessment waves. Effects of SES-associated risks on the level of symptoms of schizotypal and borderline disorders are estimated and compared to effects on depressive symptoms. Low family SES had robust modest independent effects on both PDs over the entire age span despite substantial cumulative effects of trauma history, stressful recent life events, IQ, poor parenting, and comorbid symptoms. SES effects on depressive symptoms were generally absent, but a small “protective” effect of low SES appeared when comorbidity with PD symptoms was taken into account. Cumulatively, these risks account for developmental failures of substantial magnitude and consequence, marking the importance of understanding the remaining mechanisms of SES effects and programmatic implications for minimizing associated risk.
The terrorist attacks of September 11, 2001, exposed every person in the USA to an experience that, in recent decades, was unprecedented in its scope and traumatic impact. Perhaps over 100,000 individuals directly witnessed these events, and many others viewed the attacks and their aftermath via the media (Yehuda, 2002). It has been argued that this national trauma “influenced and will continue to influence the clinical presentation of patients seeking health care services” in the USA (Yehuda, 2002, p. 108).
A wide range of responses can be expected following traumatic life events. Research conducted after the Oklahoma City, OK, bombing indicates that responses to a terrorist attack are likely to be highly variable (North et al., 1999). Research in the broader field of stress and coping has also demonstrated considerable variability in emotional and cognitive responses to stressful experiences (Silver & Wortman, 1980;Wortman & Silver, 1989, 2001). Despite advances in understanding reactions to traumatic events, our understanding of responses to community-level events in general, and terror attacks in particular, is limited. Progress in understanding the social and psychological process following such occurrences requires examination of how responses to a variety of stressful events are similar and different at both the group and individual level. Research has matured to the point that large-scale, prospective, longitudinal studies with the scope to examine mediators and moderators of adjustment processes are not only possible, but also necessary (North & Pfefferbaum, 2002). Moreover, the threat of future terrorist attacks demands that a higher level of urgency and research sophistication be directed not only at understanding the effects of such attacks, but also at the individual and social variables that predict psychological outcomes to such events over time.
We discuss the fraction of carbon stars (C-stars) and of C-enhanced stars among samples of candidate extremely metal poor (EMP: [Fe/H] $\le -3.0$ dex) stars selected from the Hamburg/ESO Survey (HES), obtaining a total for C-rich stars with [C/Fe] $\ge$ +1.0 dex of 14.4$\pm4$%. We also present the key results of detailed abundance analyses of a sample of 14 C-stars selected in this way.
Objective. The goal of this study is to determine the association between panic attacks in adolescence and the risk of personality disorders during young adulthood.
Method. Data were drawn from the Children in the Community Study, a longitudinal epidemiological study of psychopathology across the life-course in 717 individuals in the community. Multiple logistic regression analyses were used to determine the association between panic attacks during adolescence in 1983 and the risk of personality disorders during young adulthood in 1993, adjusting for differences in sociodemographic characteristics, adolescent personality disorders, and co-morbid depressive and substance use disorders.
Results. Panic attacks during adolescence (in 1983) were associated with an increased risk of any DSM-IV personality disorder (in 1993) during young adulthood, which persisted after adjusting for differences in sociodemographic characteristics, adolescent personality disorders, and co-morbid depressive and substance use disorders. Panic attacks were associated with a statistically significantly increased risk of Cluster A, B, and C personality disorders.
Conclusions. These data provide initial evidence that panic attacks early in life are a marker or risk factor for the development of personality disorders in young adulthood. Replication of these findings is needed, as is more in-depth investigation into the mechanism of this link. If replicated in future research, these results may reveal a novel potential pathway for identifying youth at high risk for personality disorders.
Developments in information technology and the ongoing restructuring of health services to increase provision in community settings militate in favour of a streamlining of communications and the exchange of information about patients among health and social care providers. Yet the principles of confidentiality and privacy appear to inhibit this process. In order to explore the practical, ethical, and legal imperatives attendant upon personal health information exchange, we conducted a series of interviews with professional care providers, persons with early-stage dementia, and their family caregivers. The findings indicate some degree of discordance. Professionals reported valuing disclosure both to colleagues and family caregivers on the basis of its being in the patients' best interests. Patients also valued inter-professional exchange, but sought strong control over disclosure to family members. Family caregivers valued being kept informed of the patient's condition, even without the latter's consent. Implications for research and policy are discussed.
The continuing spread and development of electronic data interchange in health care settings is fuelling a significant global debate about the practicality, ethics, and legality of such a practice. The uncertainties implicit in this debate are particularly acute in the context of disease or population groups for whom multidisciplinary, multipleagency teamworking has become acknowledged as the “best practice” for providing effective and timely care or support. The greying of the population is a demographic phenomenon that will have a profound impact on the health care system, social care agencies, and caregivers, and will require a greater degree of service coordination in order to meet the complex care needs of both care-receiver and caregiver.
Various aspects of personality or dispositional style predict risk for psychiatric disorders among adults. In particular, signs of neuroticism, emotional reactivity, or sensitivity to stress are strong predictors of later mood or anxiety disorders. The current report extends this literature to adolescents. An epidemiologic sample of 776 young people living in upstate New York received psychiatric assessments based on the Diagnostic and Statistical Manual of Mental Disorders, Third Edition-Revised, (DSM-III-R) and a self-report assessment of personality style in 1983 and 1985. Psychopathology was again assessed in 1992. The current study first examined demographic correlates of emotional reactivity. The study then considered the predictive relationship between emotionally reactive personality style at one study wave and psychopathology at later waves. In middle but not early adolescence, girls showed higher levels of emotional reactivity than boys. In turn, high levels of emotional reactivity predicted a range of psychiatric disorders at follow-up. The most consistent associations emerged for major depression and fearful spells, a term the authors use to describe a subclinical form of panic attacks. As in adults, midadolescent girls rate themselves as more emotionally reactive than midadolescent boys. Moreover, adolescents who rate themselves as emotionally reactive face a high risk for mood and anxiety disorders. High levels of emotional reactivity may represent a manifestation of underlying neurobiologic risk for mood and anxiety disorders.