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Despite the global expansion of electronic medical record (EMR) systems and their increased integration with artificial intelligence (AI), their utilization in disaster settings remains limited, and few studies have evaluated their implementation. We aimed to evaluate Fast Electronic Medical Record (fEMR), a novel, mobile EMR designed for resource-limited settings, based on user feedback.
Methods
We examined usage data through October 2022 to categorize the nature of its use for disaster response and determine the number of patients served. We conducted interviews with stakeholders and gathered input from clinicians who had experience using fEMR.
Results
Over eight years, fEMR was employed 60 times in 11 countries across four continents by 14 organizations (universities, non-profits, and disaster response teams). This involved 37,500+ patient encounters in diverse settings including migrant camps at the US-Mexico and Poland-Ukraine borders, mobile health clinics in Kenya and Guatemala, and post-earthquake relief in Haiti. User feedback highlighted adaptability, but suggested hardware and workflow improvements.
Conclusion
EMR systems have the potential to enhance healthcare delivery in humanitarian responses, offer valuable data for planning and preparedness, and support measurement of effectiveness. As a simple, versatile EMR system, fEMR has been deployed to numerous disaster response and low-income settings.
Caregivers are responsible for the in-home care of children with chronic medical conditions (CMCs) and may have care-related questions in order to support the child’s higher quality of life. We propose using a digital health platform, the personal health library (PHL), facilitating collection, organization, utilization, storage, and retrieval of health information, that will allow us to develop an mHealth smartphone app to facilitate patient/caregiver engagement and self-care management of children with CMCs.
Methods
Pilot Application of the PHL in the Pediatric Chronic Medical Conditions Population: We will design the PHL to collect and integrate data from health and non-health information, in various formats and modalities, including 1) Parent/caregiver-reported data; 2) Clinical data and; 3) Social determinants of health (SDoH) data; 4) Observations of Daily Living (ODL) data including the PedsQL Parent Questionnaire and the Functional Status Scale. The app will be customized to provide information regarding training in post-acute hospitalization care and deliver information on troubleshooting medical technology care, i.e. tracheostomy care.
Conclusion
We expect that the design of the PHL application will ultimately provide a layer of support for parents and caregivers of children with CMCs for whom home health is not available following hospitalization.
Humanitarian crises often require urgent medical care to people of concern. Such medical aid includes assessing and treating acute medical needs and ongoing chronic health conditions. Among the people of concern there are children, who are often the most vulnerable population in humanitarian contexts because they often lack the experience, independence, and cognitive and verbal skills to deal with the ordeals they are facing. These limitations might prevent identification and diagnosis of pain. The under-diagnosis and under-treated pain by health care providers might be also due to the perceived urgency of more acute or life-threatening medical needs with limited medical equipment and personnel, lack of awareness, or assessment tools in such contexts. Additionally, due to issues of anonymity and lack of formal guidelines, there is a severe lack of standardized registration of children’s pain conditions in humanitarian crises. Finally, acute pain is also a predictor of post-traumatic stress disorder, a common outcome in such disasters. We call on health care providers to use standardized scales to assess children’s pain intensity, frequency, and duration, and to treat it appropriately. These will not only reduce children’s physical suffering but may also prevent subsequent risk of PTSD.
Hemorrhage control, triage efficiency, and triage accuracy are essential skills for optimal outcomes in mass casualty incidents. This study evaluated user application of skills through a Virtual Reality (VR) simulation of a subway bombing.
Methods
EMS clinicians and healthcare professionals engaged in a VR simulation of a bomb/blast scenario utilizing VRFirstResponder, a high-fidelity, fully immersive, automated, customizable, and programmable VR simulation platform. Metrics including time to control life-threatening hemorrhage and triage efficacy were analyzed using median and interquartile ranges (IQR).
Results
389 EMS responders engaged in this high-fidelity VR simulation encountering 11 virtual patients with varying injury severity. The median time to triage the scene was 7:38 minutes (SD = 2:27, IQR = 6:13, 8:59). A robust 93% of participants successfully implemented all required hemorrhage control, with a median time of 3:51 minutes for life-threatening hemorrhage control (SD = 1:44, IQR = 2:41, 4:52). Hemorrhage control per patient took a median of 11 seconds (SD = 0:47, IQR = 0:06, 0:20). Participants accurately tagged 73% of patients and 17% effectively utilized the SALT sort commands for optimal patient evaluation.
Conclusion
The VRFirstResponder simulation, currently under validation, aims to enhance realism by incorporating distractors and refining assessment tools.
Recent studies of viscous dissipation mechanisms in impacting droplets have revealed distinct behaviours between the macroscale and nanoscale. However, the transition of these mechanisms from the macroscale to the nanoscale remains unexplored due to limited research at the microscale. This work addresses the gap using the many-body dissipative particle dynamics (MDPD) method. While the MDPD method omits specific atomic details, it retains crucial mesoscopic effects, making it suitable for investigating the impact dynamics at the microscale. Through the analysis of velocity contours within impacting droplets, the research identifies three primary contributors to viscous dissipation during spreading: boundary-layer viscous dissipation from shear flow; rim geometric head loss; and bulk viscous dissipation caused by droplet deformation. This prompts a re-evaluation of viscous dissipation mechanisms at both the macroscale and nanoscale. It reveals that the same three kinds of dissipation are present across all scales, differing only in their relative intensities at each scale. A model of the maximum spreading factor (βmax) incorporating all forms of viscous dissipation without adjustable parameters is developed to substantiate this insight. This model is validated against three distinct datasets representing the macroscale, microscale and nanoscale, encompassing a broad spectrum of Weber numbers, Ohnesorge numbers and contact angles. The satisfactory agreement between the model predictions and the data signifies a breakthrough in establishing a universal βmax model applicable across all scales. This model demonstrates the consistent nature of viscous dissipation mechanisms across different scales and underscores the importance of integrating microscale behaviours to understand macroscale and nanoscale phenomena.
The objective of this study was to determine what factors are associated with behavioral health in veterinary disaster responders.
Methods
An online cross-sectional survey was distributed via snowball sampling. Results were analyzed using chi-square analyses.
Results
Responses from 237 veterinarians were analyzed. Being involved in more than 1 disaster event was associated with higher anxiety and/or depression (43.4% vs 28.6%, respectively), difficulty with relationships (28.1% vs 14.3%, respectively), and a greater prevalence of sleep problems (44.6% vs 28.0%, respectively) compared to only being involved in 1 event. Veterinarians that were deployed longer than 2 months had the highest prevalence of anxiety and/or depression (43.9%) and sleep problems (50.0%). Veterinarians that received behavioral health training before deployment had lower rates of anxiety and/or depression (27.8% vs 42.9%, respectively) compared to those who did not receive training. Respondents involved with depopulation had the highest rates of anxiety and/or depression (66.7%) and sleep problems (58.1%).
Conclusions
Factors associated with behavioral health outcomes included the number and length of deployments, receiving behavioral health training, and being involved in depopulation. To reduce the risk of behavioral health outcomes, interventions such as time-off and behavioral health support are needed.
As humanity faces a future of rising global temperatures, and associated extreme weather events, distressing emotional responses are understandable, but often silenced. Climate Cafés are unique, dedicated spaces where such responses can be shared and validated with others. Semi-structured interviews were conducted with attendees of Climate Cafés facilitated by the Climate Psychology Alliance (CPA). An initial interview of 45 minutes was followed by a shorter follow-up interview 3 months later. Interpretative phenomenological analysis (IPA) methodology was used with seven female participants. Four superordinate themes were identified: (1) Having a keen awareness of threats to planetary health, (2) Action taken in the face of climate change, (3) Journeying from isolation to connection, and (4) Legacy of Climate Cafés. Participants described positive experiences both during and after the Climate Cafés, particularly having their concerns heard and validated, being with others who share their worldview, and feeling more connected. Attending Climate Cafés appears to offer important support to people experiencing distress related to the climate and ecological emergencies. Findings are discussed in light of the compassion-focused therapy (CFT) ‘Three Systems’ model, which offers a unifying theoretical conceptualisation that could support future development and research in this area.
Key learning aims
(1) To understand the idiosyncratic experiences of seven UK women at Climate Cafés.
(2) To begin to conceptualise and apply psychological models to current Climate Café practices, especially compassion-focused modalities.
(3) To use the experiences reported here to add to the growing understanding of eco-emotions.
Let $(A,\mathfrak{m})$ be a Cohen–Macaulay local ring, and then the notion of a $T$-split sequence was introduced in the part-1 of this paper for the $\mathfrak{m}$-adic filtration with the help of the numerical function $e^T_A$. In this article, we explore the relation between Auslander–Reiten (AR)-sequences and $T$-split sequences. For a Gorenstein ring $(A,\mathfrak{m})$, we define a Hom-finite Krull–Remak–Schmidt category $\mathcal{D}_A$ as a quotient of the stable category $\underline{\mathrm{CM}}(A)$. This category preserves isomorphism, that is, $M\cong N$ in $\mathcal{D}_A$ if and only if $M\cong N$ in $\underline{\mathrm{CM}}(A)$.This article has two objectives: first objective is to extend the notion of $T$-split sequences, and second objective is to explore the function $e^T_A$ and $T$-split sequences. When $(A,\mathfrak{m})$ is an analytically unramified Cohen–Macaulay local ring and $I$ is an $\mathfrak{m}$-primary ideal, then we extend the techniques in part-1 of this paper to the integral closure filtration with respect to $I$ and prove a version of Brauer–Thrall-II for a class of such rings.
Climate change distress is a challenge to people seeking help, and to those providing help. Those providing help are working in a new area of clinical practice where little is known, but they may also be experiencing climate change distress. The aim of this article is to highlight the personal and professional implications of the unfolding climate crisis and how we might better understand and support those with understandable, yet intense, emotional reactions to the climate crisis. This article consists of a first-person narrative by the first author, and a commentary on the narrative based on the psychology of climate change literature by the second author. We have worked independently on the narrative and commentary; each is responsible for their own contribution. The narrative highlights the first author’s personal experience of moving from denial to facing the truth of the climate crisis and the impact on professional practice. The commentary by the second author found that literature is scarce, but more familiar areas of practice may help to understand and respond to climate change distress. Practitioners face a situation where they may experience similar emotions to their clients, analogous to the shared threat of the pandemic. Awareness of the crisis is daunting, but therapy, self-reflection and action can help hold our emotions and support our clients. The evidence is limited but experience of the pandemic suggests that CBT can respond, adapt, innovate, and even revolutionise mental healthcare. These two perspectives suggest, despite the challenges, there may be reasons for hope.
Key learning aims
(1) To increase familiarity with climate change distress and its multi-faceted presentations.
(2) To understand the importance of self-care for climate activists and the different forms this may take.
(3) To consider the implications of being a practitioner helping people with climate change distress, while also experiencing climate change distress.
(4) To reflect on the tensions between, and the potential integration of, the personal and the professional in the context of climate change.
This article contributes to disciplinary histories of International Relations (IR) by revealing a little-known history: how a Nazi diplomat, Curt Max Prüfer, occupied the first chair in IR in India. While the paper documents how Prüfer, a discredited diplomat, landed in Delhi through his connections with peripatetic Indian anti-colonial networks and spent slightly over two years as the first IR chair at Delhi University, it also makes broader claims about how we narrate disciplinary histories. Intellectual genealogies, the predominant way in which disciplinary histories are written, often miss the contingent factors that play a considerable role in the fashioning of the discipline. Contingency-filled narratives also point towards the fact that International Relations/Affairs, at least in its early period of formation, operated as a term of mythical heft – a placeholder to fit anyone with academic or practical expertise in varied fields such as international law, colonial administration, anthropology, diplomacy, history, political economy, and military strategy.
Climate distress describes a complex array of emotional responses to climate change, which may include anxiety, despair, anger and grief. This paper presents a conceptual analysis of how acceptance and commitment therapy (ACT) is relevant to supporting those with climate distress. ACT aims to increase psychological flexibility, consisting of an open and aware orientation to one’s experiences, and an engaged approach to living, guided by personal values. We discuss the pertinence of each of these processes for adapting to the challenging reality of climate change. By embracing climate distress as a natural human experience and promoting value-guided action, ACT offers a promising approach that brings co-benefits to individuals and wider society.
Key learning aims
(1) To understand the concept of climate distress and its various emotional responses.
(2) To explore the relevance of acceptance and commitment therapy (ACT) in addressing climate distress and promoting psychological well-being.
(3) To examine the importance of psychological flexibility in coping with climate change.
(4) To analyse the role of ACT in embracing climate distress as a natural human experience.
(5) To investigate how ACT can encourage pro-environmental behaviours and climate change mitigation efforts.
The field of misinformation studies has experienced a boom of scholarship in recent years. Buoyed by the emergence of information operations surrounding the 2016 election and the rise of so-called “fake news,” researchers hailing from fields ranging from philosophy to computer science have taken up the challenge of detecting, analyzing, and theorizing false and misleading information online. In an attempt to understand the spread of misinformation online, researchers have adapted concepts from different disciplines. Concepts from epidemiology, for example, have opened doors to thinking about spread, contagion, and resistance. The life sciences offer concepts and theories to further extend what we know about how misinformation adapts; by viewing information as an organism within a complex ecosystem, we can better understand why some narratives succeed and others fail. Collaborations between misinformation researchers and life scientists to develop responsible adaptations of fitness models can bolster misinformation research.
A surveillance system for measuring patient-level antimicrobial adverse drug events (ADE) may support stewardship activities, however, design and implementation questions remain. In this national survey, stewardship experts favored simple, laboratory-based ADE definitions although there were tensions between feasibility, ability to identify attribution without chart review, and importance of specific ADE.
Following the declaration of the pandemic, students’ education has to be done at a distance due to the COVID-19 pandemic. This study evaluated the association of university students’ COVID-19 phobia, pain severity, sleep quality, physical activity, fatigue levels, and quality of life on students’ achievement.
Methods
This cross-sectional survey was conducted by including 353 students from the university faculty of health sciences. The Pain Quality Assessment Scale was used to assess pain, the Fatigue Severity Scale to evaluate fatigue, the COVID-19 Phobia Scale to assess fear of disease, the International Physical Activity Questionnaire Short Form to evaluate physical activity level, and the Jenkins Sleep Scale to assess sleep quality, The Short Form-36 to determine the quality of life, and Online Learning Systems Acceptance Scale to evaluate satisfaction with distance education. Multiple linear regression and path analysis were conducted to identify factors associated with academic achievement.
Results
It was found that age (B = 0.045; P = 0.040), BMI (B = −0.200; P = 0.004), and physical (B = 0.128; P = 0.008), psychological (B = 0.057; P = 0.012) and social (B = 0.189; P = 0.018) domains of quality of life were associated with the level of achievement.
Conclusions
Precautions must be taken to improve students’ academic achievement and quality of life in preparing for the future against infectious and epidemic diseases.
This article explores the strategic decision making of armed groups during war-to-peace transitions—critical time frames during which militant leaders must reconcile their commitment to armed survival with the imperative of postwar civilian conversion. We specify the internal organizational risks rebel groups confront, as well as the menu of strategies from which they select, in navigating the uncertainty inherent in these perilous periods. Our approach broadens the analysis of war-to-peace transitions, offering new insights into the question of why rebels sometimes successfully integrate into postconflict politics, economies, and society, while at other times they forgo participation in the postconflict state. It represents the first step in a wider research program—one that promises to open a number of new directions in the study of insurgent organizations, transitional societies, and postwar outcomes.