The World Health Organization (WHO) Emergency Medical Teams (EMTs) frequently deploy in high-risk environments, including conflict zones, where Chemical, Biological, Radiological, Nuclear (CBRN) threats are a concern. This study aimed to develop a CBRN assessment tool to evaluate the preparedness of WHO EMTs to respond effectively to such incidents.

Develop a comprehensive CBRN assessment tool for evaluating the preparedness of WHO Emergency Medical Teams (EMTs) to respond effectively to CBRN incidents.

Utilizing the WHO Classification and Minimum Standards for EMTs and adapting the Harvard Public Health School’s hospital decontamination self-assessment tool, this tool focuses on key areas aligned with WHO recommendations, including decontamination, staffing, training, response procedures, alert systems, security, personal protective equipment (PPE), staff safety, medical monitoring, decontamination zone setup, and triage.

The developed CBRN assessment tool provides a structured framework to evaluate EMT preparedness across multiple domains critical for CBRN incident response. The tool highlights potential gaps in preparedness and facilitates targeted improvements. This assessment tool can be a valuable resource for WHO EMTs to proactively assess CBRN capabilities. Regular use of this tool can enhance preparedness, response efforts, and improve patient outcomes in the face of CBRN events. Further research is needed to validate the tool’s effectiveness in team preparedness and refine its components.

This CBRN assessment tool is an important step towards strengthening the capacity of WHO EMTs to manage CBRN incidents. By facilitating self-assessment and targeted improvements, the tool contributes to a more effective and coordinated preparedness and response to these complex and challenging events.

In the event of CBRN mass casualty incidents, a specialized approach is essential that includes decontamination procedures. There are two types of decontamination systems most often used for CBRN incidents: wet and dry. While wet decontamination is more common, it can be problematic in cold weather or when logistical equipment is unavailable. This scoping review seeks to assess the effectiveness of dry decontamination.

Evaluating the effectiveness of dry decontamination methods for mass decontamination.

A scoping review was done on dry decontamination using various databases, including MEDLINE, CINAHL, Embase, Web of Science, and Scopus. Following the PRISMA approach, nine eligible articles were included in this scoping review. The methods of dry decontamination, types of decontamination materials, methods of analyzing decontamination, and the main conclusions from each study were extracted, summarized, and compared.

The review found that dry decontamination is an effective method (4 articles), particularly when dealing with liquid contaminants (1 article). However, its efficacy diminishes in cases of more hairy parts of the body (1 article) and when dealing with chemicals in particle form. Effectiveness of dry decontamination varies depending on the material used and the chemical agent involved (3 articles). Moreover, the technique of blotting and rubbing was found to increase effectiveness (1 article).

This scoping review found that dry decontamination can be effective and may be an alternative to wet decontamination in CBRN mass casualty incidents, particularly for liquid contaminants. Its effectiveness varies depending on factors such as the type of contaminants, and the decontaminant material used.

Anxiety disorders and treatment-resistant major depressive disorder (TRD) are often comorbid. Studies suggest ketamine has anxiolytic and antidepressant properties.

To investigate if subcutaneous racemic ketamine, delivered twice weekly for 4 weeks, reduces anxiety in people with TRD.

The Ketamine for Adult Depression Study was a multisite 4-week randomised, double-blind, active (midazolam)-controlled trial. The study initially used fixed low dose ketamine (0.5 mg/kg, cohort 1), before protocol revision to flexible, response-guided dosing (0.5–0.9 mg/kg, cohort 2). This secondary analysis assessed anxiety using the Hamilton Anxiety (HAM-A) scale (primary measure) and ‘inner tension’ item 3 of the Montgomery–Åsberg Depression Rating Scale (MADRS), at baseline, 4 weeks (end treatment) and 4 weeks after treatment end. Analyses of change in anxiety between ketamine and midazolam groups included all participants who received at least one treatment (n = 174), with a mixed effects repeated measures model used to assess the primary anxiety measure. The trial was registered at www.anzctr.org.au (ACTRN12616001096448).

In cohort 1 (n = 68) the reduction in HAM-A score was not statistically significant: −1.4 (95% CI [−8.6, 3.2], P = 0.37), whereas a significant reduction was seen for cohort 2 (n = 106) of −4.0 (95% CI [−10.6, −1.9], P = 0.0058), favouring ketamine over midazolam. These effects were mediated by total MADRS and were not maintained at 4 weeks after treatment end. MADRS item 3 was also significantly reduced in cohort 2 (P = 0.026) but not cohort 1 (P = 0.96).

Ketamine reduces anxiety in people with TRD when administered subcutaneously in adequate doses.

Research using latent variable models demonstrates that pre-attentive measures of early auditory processing (EAP) and cognition may initiate a cascading effect on daily functioning in schizophrenia. However, such models fail to account for relationships among individual measures of cognition and EAP, thereby limiting their utility. Hence, EAP and cognition may function as complementary and interacting measures of brain function rather than independent stages of information processing. Here, we apply a data-driven approach to identifying directional relationships among neurophysiologic and cognitive variables.

Using data from the Consortium on the Genetics of Schizophrenia 2, we estimated Gaussian Graphical Models and Bayesian networks to examine undirected and directed connections between measures of EAP, including mismatch negativity and P3a, and cognition in 663 outpatients with schizophrenia and 630 control participants.

Chain structures emerged among EAP and attention/vigilance measures in schizophrenia and control groups. Concerning differences between the groups, object memory was an influential variable in schizophrenia upon which other cognitive domains depended, and working memory was an influential variable in controls.

Measures of EAP and attention/vigilance are conditionally independent of other cognitive domains that were used in this study. Findings also revealed additional causal assumptions among measures of cognition that could help guide statistical control and ultimately help identify early-stage targets or surrogate endpoints in schizophrenia.

Chylothorax following paediatric cardiac surgery is associated with significant morbidity, particularly those that are refractory to conservative therapy. It is our impression that there is important variability in the medical, surgical, and interventional therapies used to manage refractory chylothorax between congenital heart programmes. We therefore conducted a survey study of current practices for managing refractory chylothorax.

The Chylothorax Work Group, formed with the support of the Pediatric Cardiac Critical Care Consortium, designed this multi-centre survey study with a focus on the timing and indication for utilising known therapies for refractory chylothorax. The survey was sent to one chylothorax expert from each Work Group centre, and results were summarised and reported as the frequency of given responses.

Of the 20 centres invited to participate, 17 (85%) submitted complete responses. Octreotide (13/17, 76%) and sildenafil (8/17, 47%) were the most utilised medications. Presently, 9 (53%) centres perform pleurodesis, 15 (88%) perform surgical thoracic duct ligation, 8 (47%) perform percutaneous lymphatic interventions, 6 (35%) utilise thoracic duct decompression procedures, and 3 (18%) perform pleuroperitoneal shunts. Diagnostic lymphatic imaging is performed prior to surgical thoracic duct ligation in only 7 of the 15 (47%) centres that perform the procedure. Respondents identified barriers to referring and transporting patients to centres with expertise in lymphatic interventions.

There is variability in the treatment of refractory post-operative chylothorax across a large group of academic heart centres. Few surveyed heart centres have replaced surgical thoracic duct ligation or pleurodesis with image-guided selective lymphatic interventions.

Vancomycin therapy is associated with an increased risk of acute kidney injury (AKI). Previous studies suggest that area under the curve (AUC) monitoring reduces the risk of AKI, but literature is lacking to support this in patients receiving longer durations of vancomycin therapy.

Retrospective cohort study.

Patients ≥18 years old, admitted between August 2015 and July 2017 or October 2017 and September 2019, and received at least 14 days of intravenous (IV) vancomycin therapy were included in the study. Our primary outcome was the incidence of AKI between trough monitoring and AUC monitoring groups using Kidney Disease Improving Global Outcomes criteria. Secondary outcomes included inpatient mortality, median inpatient length of stay, and median intensive care unit length of stay.

Overall, 582 patients were included in the study, with 318 patients included in the trough monitoring group and 264 included in the AUC monitoring group. The median duration of vancomycin therapy was 23 days (interquartile range, 16–39). Patients within the trough monitoring group had a higher incidence of AKI compared to the AUC monitoring group (45.6% vs 28.4%, p < 0.001). Furthermore, logistic regression analysis showed that AUC monitoring was associated with a 54% lower incidence of AKI (OR 0.46, 95% CI [0.31–0.69]). All-cause inpatient mortality was numerically higher in the trough monitoring group (12.9% vs 8.3%, p = 0.078).

In patients who received at least 14 days of IV vancomycin therapy, AUC monitoring was associated with a lower incidence of AKI.

We identify a set of essential recent advances in climate change research with high policy relevance, across natural and social sciences: (1) looming inevitability and implications of overshooting the 1.5°C warming limit, (2) urgent need for a rapid and managed fossil fuel phase-out, (3) challenges for scaling carbon dioxide removal, (4) uncertainties regarding the future contribution of natural carbon sinks, (5) intertwinedness of the crises of biodiversity loss and climate change, (6) compound events, (7) mountain glacier loss, (8) human immobility in the face of climate risks, (9) adaptation justice, and (10) just transitions in food systems.

The Intergovernmental Panel on Climate Change Assessment Reports provides the scientific foundation for international climate negotiations and constitutes an unmatched resource for researchers. However, the assessment cycles take multiple years. As a contribution to cross- and interdisciplinary understanding of climate change across diverse research communities, we have streamlined an annual process to identify and synthesize significant research advances. We collected input from experts on various fields using an online questionnaire and prioritized a set of 10 key research insights with high policy relevance. This year, we focus on: (1) the looming overshoot of the 1.5°C warming limit, (2) the urgency of fossil fuel phase-out, (3) challenges to scale-up carbon dioxide removal, (4) uncertainties regarding future natural carbon sinks, (5) the need for joint governance of biodiversity loss and climate change, (6) advances in understanding compound events, (7) accelerated mountain glacier loss, (8) human immobility amidst climate risks, (9) adaptation justice, and (10) just transitions in food systems. We present a succinct account of these insights, reflect on their policy implications, and offer an integrated set of policy-relevant messages. This science synthesis and science communication effort is also the basis for a policy report contributing to elevate climate science every year in time for the United Nations Climate Change Conference.

We highlight recent and policy-relevant advances in climate change research – with input from more than 200 experts.

Prior trials suggest that intravenous racemic ketamine is a highly effective for treatment-resistant depression (TRD), but phase 3 trials of racemic ketamine are needed.

To assess the acute efficacy and safety of a 4-week course of subcutaneous racemic ketamine in participants with TRD. Trial registration: ACTRN12616001096448 at www.anzctr.org.au.

This phase 3, double-blind, randomised, active-controlled multicentre trial was conducted at seven mood disorders centres in Australia and New Zealand. Participants received twice-weekly subcutaneous racemic ketamine or midazolam for 4 weeks. Initially, the trial tested fixed-dose ketamine 0.5 mg/kg versus midazolam 0.025 mg/kg (cohort 1). Dosing was revised, after a Data Safety Monitoring Board recommendation, to flexible-dose ketamine 0.5–0.9 mg/kg or midazolam 0.025–0.045 mg/kg, with response-guided dosing increments (cohort 2). The primary outcome was remission (Montgomery-Åsberg Rating Scale for Depression score ≤10) at the end of week 4.

The final analysis (those who received at least one treatment) comprised 68 in cohort 1 (fixed-dose), 106 in cohort 2 (flexible-dose). Ketamine was more efficacious than midazolam in cohort 2 (remission rate 19.6% v. 2.0%; OR = 12.1, 95% CI 2.1–69.2, P = 0.005), but not different in cohort 1 (remission rate 6.3% v. 8.8%; OR = 1.3, 95% CI 0.2–8.2, P = 0.76). Ketamine was well tolerated. Acute adverse effects (psychotomimetic, blood pressure increases) resolved within 2 h.

Adequately dosed subcutaneous racemic ketamine was efficacious and safe in treating TRD over a 4-week treatment period. The subcutaneous route is practical and feasible.

The complexity of disaster management is rising because of rapidly advancing technological changes and the challenges associated with coordinating responses among multi-organizational contexts. One of the common problems with multi-organizational disaster management is the need for an interoperability language. Therefore, by maintaining effective communication, risk can be reduced, and lives can be saved in times of crisis. The United States SCIPs represent one of the solutions used to achieve a culture of better interoperability. In 2019, The National Council of Statewide Interoperability Coordinators (NCSWIC) and CISA collaborated to create a tool that identified 25 Interoperability Markers. This tool is integrated with SCIPs to increase interoperability and serves as a national framework to describe interoperability maturity at the state levels.

This is a descriptive study documenting each state's 25 interoperability markers and analyzing common gaps and successes. Two methods were used for collecting data. First, an online search for each state's SCIP. Then, an email was sent to all state's Statewide Interoperability Coordinators (SWIC) to request the most recent update of that state’s SCIP. Data were collected from October 1-31, 2022 and exported into an Excel spreadsheet (Microsoft Corp; Redmond, Washington, USA) for descriptive statistics and analysis.

The level of interoperability maturity across the United States is 66%. The governance level in the interoperability continuum scored the highest across states with 76.4%. While the other levels of the interoperability continuum like technology, training and exercise, and interstate emergency communication scored 63.5%, 64%, and 60% respectively.

This study identifies a high level of interoperability maturity across the United States at the governance level. It is essential to continue to improve interstate interoperability through compatible technological solutions and multi-agency training. Finally, further research on interoperability markers is needed to enhance multi-agency emergency response.