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This study aims to identify the Jordanian nurses’ perception of their disaster preparedness and core competencies.
Methods:
A descriptive, cross-sectional research design was used. The data was collected via an online self-reported questionnaire using the disaster preparedness evaluation tool and the core disaster competencies tool.
Results:
A total of 126 nurses participated in the study. Jordanian nurses had moderate to high levels of core disaster competencies and moderate levels of disaster preparedness. Core disaster competencies and disaster preparedness levels differed based on previous training on disaster preparedness, and the availability of an established emergency plan in their hospitals. Lastly, a previous training on disaster preparedness and core disaster competencies were statistically significant predictors of disaster preparedness among Jordanian nurses.
Conclusions:
Organizational factors and environmental contexts play a role in the development of such capabilities. Future research should focus on understanding the barriers and facilitators of developing core disaster competencies and disaster preparedness among nurses.
It is well known that inertia-free shearing flows of a viscoelastic fluid with curved streamlines, such as the torsional flow between a rotating cone and plate or the flow in a Taylor–Couette geometry, can become unstable to a three-dimensional time-dependent instability at conditions exceeding a critical Weissenberg ($Wi$) number. However, the combined effects of fluid elasticity, shear thinning and finite inertia (as quantified by the Reynolds number $Re$) on the onset of elasto-inertial instabilities are not fully understood. Using a set of cone–plate geometries, we experimentally explore the entire $Wi$–$Re$ phase space for a series of nonlinear viscoelastic fluids (with the dependence on shear rate $\dot{\gamma}$ quantified using a shear-thinning parameter $\beta _P(\dot {\gamma })$). We tune $\beta _P(\dot {\gamma })$ by varying the dissolved polymer concentration in solution. This progressively reduces shear thinning but leads to finite inertial effects before the onset of elastic instability, and thus naturally results in elasto-inertial coupling. Time-resolved rheometric measurements and flow visualization experiments allow us to investigate the effects of flow geometry, and document the combined effects of varying $Wi, Re$ and $\beta _P(\dot {\gamma })$ on the emergence of secondary motions at the onset of instability. The resulting critical state diagram quantitatively depicts the competition between the stabilizing effects of shear thinning and the destabilizing effects of inertia. We extend the curved streamline instability criterion of Pakdel & McKinley (Phys. Rev. Lett., vol. 77, no. 12, 1996, p. 2459) for the onset of purely elastic instability in curvilinear geometries by using scaling arguments to incorporate shear thinning and finite inertial effects. The augmented condition facilitates predictions of the onset of instability over a broader range of flow conditions, and thus bridges the gap between purely elastic and elasto-inertial curved streamline instabilities.
Precautions taken before an earthquake are of vital importance. When buildings collapse, the weight of the ceiling crushes objects such as furniture, leaving a space or void within the rubble. This area is called the “triangle of life.” The larger and stronger the object, the more it will maintain its volume; the more the object maintains its volume, the larger the void will be, and the less likely it is that the person who uses this void will be injured.
Methods:
Durable, solid furniture such as beds and tables that can be tipped over during an earthquake in appropriate areas in the building can form a living triangle. Creating and using the triangle of life is the method of protection in an earthquake that produces the highest probability of survival.
Results:
Two earthquakes with magnitudes of 7.8 and 7.5 occurred in Kahramanmaraş, Turkey, on February 6, 2023. This report presents the case of a 43-y-old female victim of these earthquakes who used the triangle of life to survive; she was removed from the rubble 164 h after the earthquake.
Conclusions:
The case provides evidence that predetermining areas in which the triangle of life can be formed and storing supplies necessary for survival can decrease morbidity and mortality in an earthquake.
First-order sensitivities and adjoint analysis are used widely to control the linear stability of unstable flows. Second-order sensitivities have recently helped to increase accuracy. In this paper, a method is presented to calculate arbitrary high-order sensitivities based on Taylor expansions of the incompressible base flow and its eigenproblem around a scalar parameter. For the incompressible Navier–Stokes equations, general expressions for the sensitivities are derived, into which parameter-specific information can be inserted. The computational costs are low since, for all orders, a linear equation system has to be solved, of which the left-hand-side matrix stays constant and thus its preconditioning can be exploited. Two flow scenarios are examined. First, the cylinder flow equations are expanded around the inverse of the Reynolds number, enabling the prediction of the two-dimensional cylinder base flow and its leading eigenvalue as a function of the Reynolds number. This approach computes accurately the base flow and eigenvalue even in the unstable regime, providing, when executed subsequently, a mean to calculate unstable base flows. This case gives a clear introduction into the method and allows us to discuss its constraints regarding convergence behaviour. Second, a small control cylinder is introduced into the domain of the cylinder flow for stabilization. Higher-order sensitivity maps are calculated by modelling the small cylinder with a steady forcing. These maps help to identify stabilizing areas of the flow field for Reynolds numbers within the laminar vortex shedding regime, with the required number of orders increasing as the Reynolds number rises. The results obtained through the proposed method align well with numerically calculated eigenvalues that incorporate the cylinder directly into the grid.
At the heart of Sophia Moreau's theory of wrongful discrimination is the moral duty to treat others as equals. This article raises some challenges regarding the contours of this duty and suggests some ways to make the theory stronger. In particular, it suggests that we incorporate a cosmopolitan view of the duty's scope, that we illuminate the features at the basis of individuals’ equal moral status to determine its grounds, and that we identify some considerations about important interests to articulate its contents. The relation between Moreau's theory and human rights discourse is also briefly examined, and more engagement with the latter is recommended.
The threat of chemical, biological, radiologic, nuclear, and explosive (CBRNe) terrorist attacks has increased over time. The need for rapid and effective responses to such attacks is paramount. Effective medical counter-measures to CBRNe events are critical and training for such may effectively occur early in physician training. While some medical specialties are more involved than others, counter-terrorism medicine (CTM) spans all medical specialties.
Methods:
All United States allopathic medical schools were examined via online curriculums and queries for academic content related to CBRNe and terrorist medical counter-measures.
Results:
Analysis of 153 United States allopathic medical schools demonstrated that 15 (9.8%) medical schools offered educational content related to CBRNe and terrorist counter-measures. This is in contrast to legislation following the September 11, 2001 attacks that called for high priority for such education.
Conclusion:
Effective CBRNe medical counter-measures are currently in place; however, there is room for improvement in education that may begin during medical school. While certain medical specialties such as emergency medicine, primary care, and dermatology may have specific niches in such events, physicians of all medical specialties have something to offer, and even a basic education in medical school can help best prepare the nation for future attacks.
Sophia Moreau's Faces of Inequality adopts a provocative philosophical methodology: centring the experiences of victims of discrimination, and the basic contours of anti-discrimination law, in developing an account of wrongful discrimination. If, however, we take seriously sceptical accounts of law developed within feminist and critical race scholarship, we begin to see a tension within Moreau's methodological dyad: if victims of discrimination often experience discrimination law as hostile and disbelieving, how can both be treated as authoritative? This contribution will explore this tension as it emerges in Faces of Inequality, in light of Mari Matsuda's theory of “multiple consciousness.”
This study experimentally investigates the wake structure of a porous square cylinder in terms of permeability over two decades of $Da$ (i.e. $2.4 \times 10^{-5} < Da < 2.9 \times 10^{-3}$). The porous cylinder, featuring a simple cubic lattice structure, was fabricated using an additive manufacturing technique. This unique method, combined with a periodic and scalable lattice structure, effectively isolates permeability from porosity, making it suitable for an in-depth parametric study. The key parameter, permeability, was directly estimated by measuring the pressure drop and superficial velocity for each porous case in an open-loop pipe flow system. The downstream flow fields were obtained using standard planar particle image velocimetry measurements in an open-loop wind tunnel. Based on the experimental data, structural modifications in the near wake were examined in relation to permeability, leading to the identification of four distinct flow regimes depending on $Da$. Additionally, the downstream flow adjustment length ($L_i$) was assessed by introducing a permeability-based source term into the momentum equation, facilitating the development of an analytical model for $L_i$. The present experimental data support this analytical model, and our results further confirmed that $L_i$ plays a crucial role as a characteristic length scale in the near wake.
Sophia Moreau, in her important book, offers an insightful account of (one strand of) the wrong of discrimination based on the evil of subordination. My symposium contribution seeks to clarify the structure of Moreau's account of subordination and its normative and axiological status. On one plausible view, subordination is fundamentally bad or wrong. On another view, subordination is a distinctive social phenomenon, which is bad or wrong only derivatively. I will outline each view, and consider the implications each has for certain issues central to Moreau's book.
Combustion instabilities in annular systems raise fundamental issues that are also of practical importance to aircraft engines and ground-based gas turbine combustors. Recent studies indicate that the injector plays a significant role in the stability of combustors by defining the flame dynamical response and setting the inlet impedance of the system. The present investigation examines the effects of combinations of injectors of two different types ($U$ and $S$) on thermoacoustic instabilities in a laboratory-scale annular combustor and compares different circumferential staging strategies. The combustor operates in a stable fashion when all injection units belong to the $S$-family, but exhibits large amplitude pressure oscillations when all these units are of the $U$-type. When the system comprises a mix of $U$- and $S$-injectors, it is possible to determine the number of $S$-injectors leading to stable operation. For a fixed proportion of $U$- and $S$-injectors, some arrangements give rise to stable operation while others do not. Results also show that introducing symmetry-breaking elements affects the system's modal dynamics. These experimental observations are interpreted in an acoustic energy balance framework used to derive an expression for the growth rate as a function of the describing functions of the flames formed by the different injectors and their respective azimuthal locations. Growth rates are determined for the different configurations and used to explain the various observations, estimate the system damping rate and predict the location of the nodal line when the standing mode prevails.
Sophia Moreau's wide-ranging and nuanced book defends a pluralist view of wrongful discrimination. I argue three points. First, I argue that Moreau's account of deliberative freedom does not provide a distinct ground for objecting to discrimination. Second, I argue that there is not as wide a gap between her view and expressivism as she makes there out to be. Third, there is an intriguing gap in the argument that deserves further exploration: Moreau never provides us with an account of when and why social subordination is wrong.
Airway management is a cornerstone in the prehospital care of critically ill or injured patients. Surgical cricothyrotomy offers a rapid and effective solution when oxygenation and ventilation fail using less-invasive techniques. However, the exact indications, incidence, and success of prehospital surgical cricothyrotomy are unknown, with variable rates reported in the literature. This study aimed to examine prehospital indications and success rates for surgical cricothyrotomy within a large, suburban, ground-based Emergency Medical Services (EMS) system.
Methods:
This is a retrospective analysis of 31 patients who underwent paramedic performed surgical cricothyrotomy from 2012 through 2022. Key demographic parameters were analyzed, including the incidence of cardiac arrest, call type (trauma versus medical), initial airway management attempts, number of endotracheal intubation (ETI) attempts before surgical airway, and average time to the establishment of a surgical airway in relation to the number of ETI attempts. Surgical cricothyrotomy success was defined as the acquisition of four-phase end-tidal capnography reading. The primary data sources were the EMS electronic medical records, and descriptive statistics were calculated.
Results:
A total of 31 patients were included in the final analysis. Of those who received a surgical cricothyrotomy, 42% (13/31) occurred in the trauma setting, while 58% (18/31) were medical calls. In all patients who underwent surgical cricothyrotomy, the median (IQR) time to the procedure was 17 minutes (IQR = 11-24). In trauma patients, the median time to surgical cricothyrotomy was 12 minutes (IQR = 9-19) versus 19 minutes (IQR = 14-33) in medical patients. End-tidal carbon dioxide (ETCO2) detection and placement success was confirmed in 94% (29/31) of patients. Endotracheal intubation was attempted in 55% (17/31) before subsequent surgical cricothyrotomy, with 29% (9/31) receiving more than one ETI attempt. The median time to surgical cricothyrotomy when multiple prior intubation attempts occurred was 33 minutes (IQR = 23-36) compared to 14.5 minutes (IQR = 6-19) in patients without a preceding intubation attempt.
Conclusion:
Prehospital surgical airway can be performed by paramedics with a high degree of success. Identification of the need for surgical cricothyrotomy should be determined as soon as possible to allow for rapid securement of the airway and to ensure adequate oxygenation and ventilation.
Given any commutative Noetherian ring R and an element x in R, we consider the full subcategory $\mathsf{C}(x)$ of its singularity category consisting of objects for which the morphism that is given by the multiplication by x is zero. Our main observation is that we can establish a relation between $\mathsf{C}(x), \mathsf{C}(y)$ and $\mathsf{C}(xy)$ for any two ring elements x and y. Utilizing this observation, we obtain a decomposition of the singularity category and consequently an upper bound on the dimension of the singularity category.