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Telehealth, or the use of digital health technology to support clinical care, education, and health administration over a distance, has increased dramatically in the 21st century. The frequency and severity of disasters that cause damage, disruption, loss of life, and health service deterioration have also increased over the same period. Advances in telecommunication networks and mobile technology have made telehealth systems more accessible and affordable, and rising acceptance has engaged hesitant users. Yet, telehealth remains underutilized particularly for cross-jurisdictional disaster response in the United States. In this presentation, we will discuss progress in the development and implementation of new regional disaster telehealth systems funded by the U.S. Administration for Strategic Preparedness and Response. We will review administrative and legal barriers to implementation in the context of real-world examples to understand how they impact domestic disaster response capabilities. We will also discuss innovative new global partnerships that have successfully leveraged digital tools to provide access to health resources for international humanitarian disaster response. Finally, we will consider next steps in the path to fully actualizing the potential for telehealth to transform disaster response.
Learning Objectives
Discuss current federally funded efforts to develop and implement regional telehealth systems designed to support cross-jurisdictional disaster medical response in the United States.
Examine administrative and legal barriers to adoption and implementation that can impact timely mobilization, deployment, and use of disaster telehealth services.
Review examples of successful and failed implementation to guide future research, development, and implementation efforts for system developers, sponsors, and governmental and non-governmental disaster response entities.
This paper considers a new corpus of 490,154 Roman coins (site finds) which have been recorded from England and Wales. The corpus provides British and regional means to aid in the preparation of coin reports in line with Historic England guidelines, along with spatial data providing new opportunities for research. The methods of data collection will be detailed and some of the possibilities this dataset can provide presented through a number of case studies. Through the consideration of applied numismatic analyses, the social distribution of the material and, crucially, the spatial distribution of Roman coinage, we can identify new trends and patterns. Case studies evaluating the fourth century will emphasise the changing importance of settlements in Roman Britain and identify those linked with the late Roman state. Furthermore, the retraction of coinage distributions in the second half of the fourth century will be explored. Building on the national and site type means explored within the paper, the full dataset has been made available in a range of forms on the Archaeology Data Service and in an interactive map developed by Maploom.
The ability to manipulate brain function through the communication between the microorganisms in the gastrointestinal tract and the brain along the gut-brain axis has emerged as a potential option to improve cognitive and emotional health. Dietary composition and patterns have demonstrated a robust capacity to modulate the microbiota-gut-brain axis. With their potential to possess pre-, pro-, post-, and synbiotic properties, dietary fibre and fermented foods stand out as potent shapers of the gut microbiota and subsequent signalling to the brain. Despite this potential, few studies have directly examined the mechanisms that might explain the beneficial action of dietary fibre and fermented foods on the microbiota-gut-brain axis, thus limiting insight and treatments for brain dysfunction. Herein, we evaluate the differential effects of dietary fibre and fermented foods from whole food sources on cognitive and emotional functioning. Potential mediating effects of dietary fibre and fermented foods on brain health via the microbiota-gut-brain axis are described. Although more multimodal research that combines psychological assessments and biological sampling to compare each food type is needed, the evidence accumulated to date suggests that dietary fibre, fermented foods, and/or their combination within a psychobiotic diet can be a cost-effective and convenient approach to improve cognitive and emotional functioning across the lifespan.
This study aimed to explore the combined association between the dietary antioxidant quality score (DAQS) and leisure-time physical activity on sleep patterns in cancer survivors. Data of cancer survivors were extracted from the National Health and Nutrition Examination Surveys database in 2007–2014 in this cross-sectional study. Weighted multivariable logistic regression models were used to estimate OR and 95 % CI for the association of DAQS and leisure-time physical activity on sleep patterns. The combined association was also assessed in subgroups of participants based on age and use of painkillers and antidepressants. Among the eligible participants, 1133 had unhealthy sleep patterns. After adjusting for covariates, compared with low DAQS level combined with leisure-time physical activity level < 600 MET·min/week, high DAQS level combined with leisure-time physical activity ≥ 600 MET·min/week was associated with lower odds of unhealthy sleep patterns (OR = 0·41, 95 % CI: 0·23, 0·72). Additionally, the association of high DAQS level combined with high leisure-time physical activity with low odds of unhealthy sleep patterns was also significant in < 65 years old (OR = 0·30, 95 % CI: 0·13, 0·70), non-painkiller (OR = 0·39, 95 % CI: 0·22, 0·71), non-antidepressant (OR = 0·49, 95 % CI: 0·26, 0·91) and antidepressant (OR = 0·11, 95 % CI: 0·02, 0·50) subgroups. DAQS and leisure-time physical activity had a combined association on sleep patterns in cancer survivors. However, the causal associations of dietary nutrient intake and physical activity with sleep patterns in cancer survivors need further clarification.
Mastoiditis commonly presents to ENT services. Following the UK introduction of the 13-valent conjugate pneumococcal vaccine in 2010, changes in the organisms of these infections were hypothesised. We aim to assess the microbiological profile of patients with acute mastoiditis in our centre.
Methods
Retrospective review of patients admitted to Alder Hey Children’s Hospital for mastoiditis between January 2017–September 2022. Data was collected from electronic patient records, microbiology and biochemistry reports.
Results
A total of 108 patients were admitted: 61 males and 47 females with a median age of 2 years (with a range of 4 months–14 years). A total of 82 organisms were isolated from 50 (46 per cent) children. Streptococcus spp. (22 specimens; 27 per cent) and Staphylococcus spp. (13 specimens; 16 per cent) were most common. Other organisms included Pseudomonas aeruginosa (6; 7 per cent), anaerobes (4; 5 per cent), Haemophilus influenzae (4; 5 per cent), and Fusobacterium (4; 6 per cent).
Conclusion
Mastoiditis predominantly involves gram-positive, facultative anaerobic bacteria. Empirical cefotaxime and metronidazole provide adequate coverage. Culture and sensitivity testing is essential for antibiotic stewardship.
Political wrangling over Critical Race Theory (CRT) in the United States has produced policies banning its teaching in jurisdictions across the country. However, laws touted as “anti-CRT” have little in common with the original, academic origins of the phrase. In this study, we use a Qualtrics-based survey experiment to assess how participants’ support for a ban will change depending on whether the ban reflects core tenets of academic researchers’ use of CRT, the phrase itself, or elements common to many of the laws intended to ban it. We find that these three different frames do indeed change support for such policies, and the effects are dependent upon partisanship. We interpret our results to be empirical evidence of the phrase “Critical Race Theory” complicating political discourse.
The nation-state is as much a narrative and ideational project as it is a spatial-territorial one. In the People’s Republic of China, Xi Jinping’s calls to “revitalize” China’s traditional culture, “Sinicize” religions, and “rejuvenate” the Chinese nation reflect a broader effort to reframe the national narrative and strengthen Communist Party control. This article examines the implications of Xi’s revisionist nationalism for China’s fifty-five minority nationalities, in particular the Hui, one of ten Muslim minority groups. It does so by analyzing the rise and demise of World Muslim City (WMC), a development project in western China that mobilized Hui identity and traditions for economic and diplomatic purposes. WMC was facilitated by a multicultural national narrative and by a fragmented authoritarian political system that for many years fostered policy improvisation, and deviation, at the local level. Its suspension underscores the increasingly anti-Muslim, anti-religious tenor of PRC policy, as evidenced by the Sinicization campaign that was a proximate cause of WMC’s demise. Its demise also highlights ongoing efforts to reassert CCP control over government, business, and the Party’s own rank-and-file. The fate of WMC furthermore reveals the spatial dimensions of Sinicization, and of Chinese cultural governance past and present. To paraphrase theorist Henri Lefebvre, Sinicization entails “spatial practices” that impose Xi-ist “representations of space” on lived “representational spaces,” from mosques and businesses to theme parks and luxury resorts.
This paper offers a non-Eurocentric account of raced capitalism in Malaysia, articulated as a developmental state project that has navigated the contested racial logics of British colonialism and Japanese imperialism. By historicising Malaysia’s experience, I provide a reading of the Malaysian developmental state as a project that has taken the form of anti-colonial raced capitalism. This is not meant to valorise raced capitalism as anti-colonial, but to suggest that decolonisation must also confront hegemonic elements engraved on the anti-colonial register of nationalised raced capitalism. In bringing a feminist critique to anti-colonial projects that leave capitalist relations uncontested, the paper makes three contributions. First, it recentres race and colonialism in its analysis of the developmental state, offering anti-colonial raced capitalism as a language that speaks to similar projects that enable, legitimise, and obscure new forms of racial/gender domination with counter-hegemonic frames. Second, it brings back politics to anti-colonialism, reestablishing it as a political space with competing visions, imaginations, and agendas, shaped by the geopolitics of empires. Third, it features gender, social reproduction, and the household as key sites to ground the politics of anti-colonialism, enacting the scaffolding for gendered understandings of raced capitalist development on the periphery of the global economy.
Models of cation exchange mechanisms and driving forces have proven effective predictors of clay behavior and chemistry, but are largely theoretical, particularly in complex systems involving high ionic strength brines or systems where hydration is controlled by relative humidity. In arid and cold environments, such as Mars, cyclical relative humidity variations may play a role in chemical alteration, particularly if clay minerals such as smectite are in the presence of salts. This study examines the effects of relative humidity on smectite-salt mixtures using environmental scanning electron microscopy (ESEM) to observe the physiochemical effects of salt deliquescence and desiccation on smectite textures and elemental distributions. Results demonstrate that even reaction periods as short as a few minutes allow ample time for relative humidity to affect the smectite-salt mixtures. In addition to smectite swelling and salt deliquescence, we also observed rapid changes in element distributions within the smectite and new crystal growth in the presence of high relative humidity. Even in the absence of bulk liquid water, exchangeable cations migrated out of the smectite and formed new crystals at the smectite-salt interface. The observed microscopic changes in elemental distributions indicate that the migration of cations driven by cation exchange led to secondary mineral precipitation, likely a CaSO4 mineral, within a sub-micrometer-thick layer of water on the smectite grains. The results of this study demonstrate that during periods of elevated relative humidity, active smectite mineral alteration and secondary mineral precipitation may be possible on present-day Mars where salts and smectites are in direct physical contact.
In this note, we study the effect of viscosity gradients on the energy dissipated by the motion of microswimmers and the associated efficiency of that motion. Using spheroidal squirmer model swimmers in weak linearly varying viscosity fields, we find that efficiency depends on whether they generate propulsion from the back (pushers) or the front (pullers). Pushers are faster and more efficient when moving down gradients, but slower and less efficient moving up viscosity gradients, and the opposite is true for pullers. However, both pushers and pullers display negative viscotaxis, therefore pushers dynamically tend to the most efficient orientation, while pullers tend to the least. We also evaluate the effect of shape on power expenditure and efficiency when swimming in viscosity gradients, and find that in general, the change in both due to gradients decreases monotonically with increasing slenderness. This work shows how shape and gait play an important role in determining dynamics and efficiency in inhomogeneous environments, and demonstrating that both efficiency minimizing and maximizing stable dynamical states are possible.
The ‘Gandhāra still’ has been an influential element in the archaeology of south-central Asia for decades. This project combines archival research, material synthesis and experimental evaluation to reappraise this eminent and pervasive reconstruction, and to systematically dismiss an assumed component in the history of distillation.
This pilot study assessed the feasibility of measuring time to perform pre-identified lifesaving interventions (LSIs) used during mass-casualty incidents (MCIs).
Methods
An observational simulation study involving pre-hospital providers (PHPs) was conducted at London’s Air Ambulance training center. PHPs performed 16 basic-to-advanced LSIs and were video-recorded to capture the LSIs’ time intervals (TTs) (time from picking up equipment to completing the LSIs). TTs are reported in seconds (median and interquartile range [IQR]). Ethical approval was obtained from Queen Mary University.
Results
Seven PHCPs (five paramedics and two physicians) performed 92 LSIs, with paramedics limited to 11 LSIs due to their scope of practice. Physician-only performed LSIs had the longest TT compared to other LSIs, Rapid-sequence intubation 175.00 IQR(162.50–187.50). The longest TT in all LSIs was related to circulation support, with fluid resuscitation taking 99 IQR(88–101) for paramedics and 80 IQR(74.5–85.5) for physicians. LSIs with a median time exceeding 30 seconds were generally characterized by substantial variability, as indicated by a wide IQR.
Conclusion
This pilot study demonstrated the feasibility of recording timings for LSIs. Physician-only performed LSIs had the longest TT but were more complex interventions. Further investigation within a simulated environment is planned.
Modern 21st century armed conflict is characterized by a proliferation of nonstate armed groups, asymmetric warfare, and increased explosive threats such as improvised explosive devices (IEDs), barrel bombs, and cluster munitions. Over the course of the wars in Iraq and Afghanistan, casualty data analysis of preventable deaths led to a radical restructuring of military trauma care through the Joint Trauma System. These changes increased survival among critically injured casualties in Afghanistan from 2.2 to 39.9% from 2001–2017. Many of these practices have been incorporated into civilian trauma systems in high-resource settings (e.g., bystander tourniquet application for hemorrhage control, damage control resuscitation and use of whole blood, trauma registries to benchmark outcomes and quality improvement). In contrast, the structure of humanitarian surgical care in conflict remains largely unchanged. This talk synthesizes gaps and opportunities to translate advances made in military and high-resource trauma systems to humanitarian care in low-resource settings to reduce preventable morbidity and mortality among civilians in conflict.
Learning Objectives
Provide an overview of the unique demographic populations and surgical conditions (including both trauma and non-traumatic emergencies) encompassed by humanitarian surgical care.
Synthesize the evidence base on (a) civilian conflict casualty epidemiology and (b) trauma intervention in low-resource settings to provide a framework for context-appropriate translation of trauma care advances in military and high-resource settings to low-resource conflict settings.
Highlight gaps and opportunities for targeted research and operational interventions to improve care for vulnerable subpopulations (e.g., pediatric patients, burn victims), leveraging enhanced coordination between the health and protection clusters.
Until a few years ago, it was assumed that oocyte renewal did not take place in the ovary of adult organisms; however, the existence of germline progenitor cells (GPCs), which renew the ovarian follicular reserve, has now been documented in mammals. Specifically, in the adult ovary of bats, the presence of cells located in the cortical region with characteristics similar to GPCs, called adult cortical germ cells (ACGC), has been observed. One of the requirements that a GPC must fulfil is to be able to proliferate mitotically, so the evaluation of cell proliferation in ACGC is of utmost importance in order to be able to relate them to a parental lineage. Currently, there are several methods to determine cell proliferation, including BrdU labelling or the use of endogenous proliferation markers. Thus, the aim of this work was to evaluate the proliferative activity of ACGC in the adult ovary of the bat Artibeus jamaicensis, using different proliferation markers and correlating these with the protein expression of the transcription factor Oct4 and the germ line marker Ddx4. We found that the expression pattern of the proliferation markers BrdU, PCNA, Ki-67 and pH3 occurs at different times of the cell cycle, so co-localization of two or more of these markers allows us to identify proliferating cells. This allowed us to identify ACGC with proliferative capacity in the adult ovary of A. jamaicensis, suggesting that GPCs renew the follicle reserve during the adult life of the organism.