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The WHO endorsed the Emergency Medical Team (EMT) Minimum Data Set (MDS) as a real-time data collection and reporting tool during health emergencies and disasters in 2017. It was for the first time activated in 2019 during Cyclone Idai in Mozambique. Since then, it has been used in 16 countries during various events. However, no assessment on data quality collected via MDS has been conducted.
Objectives:
This study aimed to assess data completeness using data from Cyclone Idai.
Method/Description:
We analyzed 282 daily reports containing 18,468 patient consultations from 14 international EMTs between 2019/03/27 and 2019/07/12. We considered data incomplete if inputs for demographic information, health events, outcomes, and relation to disaster were lower than the total number of patient consultations. We calculated the percentage of missing values for MDS items. Logistic regression identified associations between data incompleteness and EMT type.
Results/Outcomes:
Completeness of information on team and location was 100%. Incompleteness rates were 7.1% for sex and age, 37.2% for health events, 48.9% for outcomes, and 41.8% for the relation of health events to the disaster. Type 1 Fixed EMTs reported less complete data compared to Type 1 Mobile and Type 2 EMTs. Classified EMTs were more likely to report complete data.
Conclusion:
Overall, MDS daily report completeness needs improvement. Type 1 Fixed EMTs may have lower completeness due to busier schedules, while Type 1 Mobile EMTs benefit from more effective just-in-time training. Type 2 teams, being less busy, achieve more accurate data entry. Training for data collection is essential for better data completeness.
The demanding nature of the EMT members’ work in providing care for the affected population in the 7.6 magnitude earthquake that struck the Noto Peninsula, Japan, on January 1, 2024 is noted.
Objectives:
This study aims to examine the relationship between fatigue and the presenteeism of EMT members during this disaster.
Method/Description:
A cross-sectional study was conducted from January 1st to March 31st using the J-SPEED (Japanese-Surveillance in Post-Extreme Emergencies and Disasters) health check-up among EMT members. The questionnaire items included fatigue level and presenteeism measured using WFun-D (Work Functioning Impairment Scale for disaster), along with information on the type of activity, occupation, duration of working (days), and symptoms due to fatigue. Logistic regression analysis was applied to determine the association between fatigue and presenteeism of EMT members.
Results/Outcomes:
Among the 20,551 cases, 66.2% worked in the field, with the majority being operation coordinators (31.8%), nurses (30.9%), and medical doctors (19.9%). Presenteeism is strongly associated with having medium and high fatigue levels (p<0.0001). Other factors associated with presenteeism in EMT members included: working in January (aOR: 2.13, 95% CI: 1.21-3.74), being a medical doctor (aOR: 1.53, 95% CI: 1.15-2.04) or administrative supporter (aOR: 2.07, 95% CI: 1.28-3.36), experiencing symptoms due to stress (aOR: 4.95, 95% CI: 3.80-6.46).
Conclusion:
The study reveals a significant relationship between increasing fatigue levels and presenteeism among EMT members. These findings contribute to evidence-based strategies for fatigue management in disaster response scenarios, with implications for improving the effectiveness of medical response efforts in future large-scale disasters globally.
Vitamin D is crucial for normal organ function, vascular health and exercise performance, yet its deficiency is widespread. Patients with CHD often exhibit reduced exercise capacity. Limited research exists on vitamin D in CHD.
Methods:
This study investigates serum 25-hydroxy vitamin D levels in 55 adult CHD patients (median age 31 years) compared to 55 age- and gender-matched controls without cardiac disease and examines associations with exercise capacity, peripheral microvascular function, muscle strength and biventricular function in CHD. Therefore, patients underwent fingertip arterial tonometry, transthoracic echocardiography, muscle strength measurements and cardiopulmonary exercise testing.
Results:
Results indicated that 93% of CHD patients and 91% of controls had 25-hydroxy vitamin D levels <30 ng/ml, with both groups showing varying values depending on the season in which the studies were conducted. No significant difference in 25-hydroxy vitamin D levels was found between patients and controls. While vitamin D levels in CHD patients did not significantly correlate with age, body mass index, blood pressure, peripheral microvascular function, high-sensitivity C-reactive protein, cholesterol levels, N-terminal-pro hormone B-type natriuretic peptide, ventricular function or muscle strength, a significant correlation was found with percent-predicted peak oxygen consumption (ρ=0.41, p = 0.005 and ρ=0.34, p = 0.02 for reference values following Wasserman and the LowLands registry, respectively), even after adjusting for season (p = 0.03 and 0.05, respectively).
Conclusions:
In conclusion, vitamin D levels were similar between CHD patients and controls, but vitamin D insufficiency is common and linked to reduced exercise capacity in CHD. Further research is needed to determine whether vitamin D supplementation combined with exercise could be beneficial in CHD with vitamin D insufficiency.
This research examines the ways the hostile environment in the UK utilises domestic violence as a deterrent measure, weaponising this endemic form of interpersonal violence against migrant women. I argue that the state’s own processes of accountability and responsibility for domestic violence fatalities, and the active exclusion of migrant women from state-provided services that are key in intervening in cases of domestic violence, are sufficient for domestic violence against migrant women to be constituted as state violence. I frame this in the context of what an ontological security approach can offer to our understanding of the multiplicity of encounters and experiences that migrant women have with a state apparatus that is designed to offer both security and accountability to address the particularly gendered insecurity of domestic violence. The active exclusion of migrant women from these monitoring mechanisms embeds both an affective and a very real empirical insecurity in the lives of migrant women. This ontological insecurity is both inside and outside of state, making ontological security for some while unmaking it for others.
Shiga toxin-producing Escherichia coli (STEC) is a group of bacteria that causes gastrointestinal illness and occasionally causes large foodborne outbreaks. It represents a major public health concern due to its ability to cause severe illness which can sometimes be fatal. This study was undertaken as part of a rapid investigation into a national foodborne outbreak of STEC O145. On 22 May 2024, United Kingdom (UK) public health agencies and laboratories identified an increase in stool specimens submissions and patients testing positive for Shiga toxin-producing E. coli (STEC). Whole genome sequencing (WGS) identified serotype O145:H28 stx2a/eae belonging to the same five single nucleotide polymorphism (SNP) single linkage cluster as the causative agent. By 3 July 2024, 288 cases had been linked to the cluster. Most cases were adults (87%) and females (57%), 49% were hospitalized with a further 10% attending emergency care. Descriptive epidemiology and analytical studies were conducted which identified consumption of nationally distributed pre-packed sandwiches as a common food exposure. The implicated food business operators voluntarily recalled ready-to-eat sandwiches and wraps containing lettuce on 14 June 2024.
The primary objective of this study was to evaluate the feasibility and clinical impact of utilizing low-field portable MRI in a remote setting in Canada.
Methods:
This was a single-site prospective cohort study. An ultra-low-field (0.064 T) portable MRI was installed in Weeneebayko General Hospital, Moose Factory, Ontario. Adults presenting with any indication for neuroimaging between November 2021 and June 2023 were eligible for study inclusion. Clinical presentation, indication for imaging,and radiology report turnaround time were recorded. Images were evaluated for diagnostic quality, and radiology reports were analyzed to determine the diagnostic utility of ultra-low-field MRI.
Results:
An ultra-low-field portable MRI was successfully installed in a remote Canadian location. Fifty patients received a portable MRI scan. Comments on suboptimal image quality were made for 12 (24%) of the portable MRI examinations; however, only 2 (4%) of these were deemed nondiagnostic requiring conventional imaging for further evaluation. Clinically significant pathology was identified in 5 (10%) of the examinations.
Conclusion:
This first-of-its-kind study demonstrates the application of ultra-low-field portable MRI in a remote setting in Canada is feasible and offers clinical information that may help triage which patients require transfer to a center with conventional high-field MRI availability.
Spinal muscular atrophy (SMA) is a leading genetic cause of infant death and represents a significant burden of care. An improved understanding of the epidemiology of SMA in Canada may help inform strategies to improve the standard of care for individuals living with SMA.
Methods:
We employed a multisource approach to estimate the minimal incidence and prevalence of 5q SMA and to gain greater insight into recent clinical practices and treatment trends for the Canadian SMA population. Data sources included the Canadian Paediatric Surveillance Program (CPSP), Canadian Neuromuscular Disease Registry (CNDR), and molecular genetics laboratories in Canada.
Results:
The estimated annual minimum incidence of 5q SMA was 4.38, 3.44, and 7.99 cases per 100,000 live births in 2020 and 2021, based on CPSP, CNDR, and molecular genetics laboratories data, respectively, representing approximately 1 in 21,472 births (range 12,516–29,070) in Canada. SMA prevalence was estimated to be 0.85 per 100,000 persons aged 0–79 years. Delay in diagnosis exists across all SMA subtypes. Most common presenting symptoms were delayed milestones, hypotonia, and muscle weakness. Nusinersen was the most common disease-modifying treatment received. Most patients utilized multidisciplinary clinics for management of SMA.
Conclusion:
This study provides data on the annual minimum incidence of pediatric 5q SMA in Canada. Recent therapeutic advances and newborn screening have the potential to drastically alter the natural history of SMA. Findings underline the importance of ongoing surveillance of the epidemiology and long-term health outcomes of SMA in the Canadian population.
In this chapter Innes explores how Soviet economics, and the neoclassical economics behind British neoliberalism, came to conceive of the political economy as a closed system, governed by predetermined economic laws and dependable behaviours. Both orthodoxies are shown to depend on arguments about the universal truths of the political economy that are not just utopian, but tautological - circular - in their reasoning. Their axiomatic assumptions and actions are valid, as distinct from true, by virtue only of their logical formulation, and their end goals are consequently as impossible to realise as they are to refute. By exploring the evolution of both Soviet and neoclassical economic thought, Innes outlines the affinities between the ‘social physics’ of neoclassical economics and the deterministic assumptions of Stalinist central planning, and explains why it is that even the relatively critical, ‘second best world’ neoclassical economics that became associated with New Labour policy is freighted with no less determinism than the ‘first best world’ assumptions adopted by the New, neoliberal right.
The chapter examines what gets lost analytically when governments move from thinking empirically about complex interdependent systems to relying instead on decision-making models that assume an unchanging mode of human rationality and fixed economic laws. Having set out the neoclassical theory behind outsourcing, privatisation and agencification, the chapter investigates how these policies have played out in practice. It demonstrates that although more critical i.e. ‘second best world’ neoclassical economic theories help us understand the chronic contractual, regulatory and oversight problems that prevail at the microeconomic level, it is the lessons of Soviet enterprise planning that tell us more about the systemic failures of these policies. Soviet planning failures illuminate why these reforms induce bargaining games between firms and ‘firm-like’ state agencies that the state cannot win, and why government attempts to solve chronic policy failures with remedial regulations that conform to orthodoxy create an ever more rigid bureaucracy over time, and in the case of outsourcing, increasingly informal relations prone to corruption, exactly as they did in the USSR.
This chapter sets out the dystopian critique of the liberal democratic state that emerged when neoclassical economic reasoning was applied to the political realm. The resulting ‘public choice theory’ made assertive claims of democratic state failure that became a mainstay of neoliberal argument, but here they are shown to possess clear affinities with the Leninist account of bureaucracy as the ‘real’ centre of power in a bourgeois democracy. It follows from the deterministic, closed-system reasoning in both Leninist and neoclassical 'public choice' theory that these affinities continued into the respective prescriptions for the preferred constitutional order. The ideal constitution of limited government set out in public choice theory, most notably by James Buchanan, Gordon Tullock, and Geoffrey Brennan is shown to be a logically inevitable counterpart to the ‘withering away of the state’ under socialism anticipated by Lenin. The adjacent constitutional arguments of Friedrich August von Hayek are also considered, as is the more empirically robust account of bureuacracy as an essential feature of modernity set out by Max Weber.
This chapter examines UK welfare reforms. The strategy of ‘quasi-markets’ in welfare was a New Labour innovation, and this chapter sets out why even intentionally ‘progressive’ neoliberal state reforms succumb to the flaws in neoclassical reasoning. The ‘choice and competition’ agenda was conceived in arguments about the relative benefits for ‘end-users’ of publicly funded but privately provided welfare services. As a closed-system argument about a marketplace, it thus wished away the actual terrain of education policy in which the state becomes the disempowered, and yet still responsible planner of outsourced educational enterprises, now governed through contract. The chapter investigates how quasi-market theory played out in the Academy Schools programme in England. It demonstrates why outsourcing complex welfare provision will tend create the worst of public and private regimes: the exploitation of incomplete contracts by producers, informational fragmentation, a loss of public accountability, financial corruption and increasingly Kafkaesque efforts at bureaucratic remedy, all reminiscent of Soviet enterprise planning failures.
This chapter shows how successive UK governments have applied a first-best-world neoclassical approach to climate policy: one that understands risk as something that can be calculated, modelled, and integrated within market mechanisms by essentially rational market actors. This was not just the economics that gave us the Global Financial Crisis, the chapter shows that the underlying Rational Expectations and Efficient Markets hypotheses are the market analogues to Soviet theories of optimal planning, and built on the same ontological and epistemological fallacies. The chapter explores how dependence on closed-system reasoning condemns government to ‘write out’ the uncertain dynamics of the climate emergency and the precautionary principle that should follow. The empirical section shows how successive governments of New Left and New Right have implemented regulatory and market-making policies built on the assumption that market agents not only can but will behave rationally in the face of future risk. They have also relied on carbon budgeting, forecasting and audit as dependable methods of risk management, though such methodologies are only coherent in a closed-system world.
British neoliberalism was taken up by democratic parties in an open society, so this chapter explores what, if any, lessons about its political consequences can be drawn from the political evolution of the Soviet Union. Political parties in Western Europe by the 1970s were struggling to keep pace with the changing social needs and preferences of their electorates when neoliberalism emerged. This social dis-embedding of parties would only worsen in the UK, however, when neoclassical economic diagnoses became the bipartisan methodology, and electoral choices around economic strategies were duly narrowed. The chapter traces how, as the tide of neoliberal developmental failures has risen, the Conservative Party embraced the same political strategies as late Soviet regimes. The ‘combat task’ rhetoric of economic change was replaced with the charismatic politics of nationalism, and governments increasingly resorted to demonstrable lies and invented realities to deflect from the real effects of policy and after 2016, its most utopian expression: Brexit. The chapter also reviews the rise of political corruption under neoliberalism, another Soviet affinity, as ideology morphs into alibi.
Neoliberalism is often framed as the victorious doctrine against Soviet communism: its nemesis and antidote. When we examine how Soviet and neoliberal economics understand the nature of political economic reality, however, British neoliberalism and Soviet communism turn out to be exact mirror images. In this introduction, Innes sets out the book’s argument, and the philosophy of science perspective on which it is based. Why do Soviet and neoliberal orthodoxies have such affinities? Both are based on closed-system reasoning about the political economy; both assert that there are predetermined laws of the economy that each doctrine alone can apprehend, and both schemes require the operation of a universal and consistent rationality: socialist versus utilitarian. The ‘critical realist’ perspective in the philosophy of science focuses on how we apprehend reality, and what we can reasonably claim to know about it, and the introduction explains how this lens allows us to see why a ‘governing science’ built on closed system reasoning is doomed to produce a rising tide of unanticipated social and institutional consequences in societies that are evolving, open, and hence uncertain systems.