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Managing Multiple-Casualty Incidents: A Rural Medical Preparedness Training Assessment
- Steven D. Glow, Vincent J. Colucci, Douglas R. Allington, Curtis W. Noonan, Earl C. Hall
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- Journal:
- Prehospital and Disaster Medicine / Volume 28 / Issue 4 / August 2013
- Published online by Cambridge University Press:
- 18 April 2013, pp. 334-341
- Print publication:
- August 2013
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Objective
The objectives of this study were to develop a novel training model for using mass-casualty incident (MCI) scenarios that trained hospital and prehospital staff together using Microsoft Visio, images from Google Earth and icons representing first responders, equipment resources, local hospital emergency department bed capacity, and trauma victims. The authors also tested participants’ knowledge in the areas of communications, incident command systems (ICS), and triage.
MethodsParticipants attended Managing Multiple-Casualty Incidents (MCIs), a one-day training which offered pre- and post-tests, two one-hour functional exercises, and four distinct, one-hour didactic instructional periods. Two MCI functional exercises were conducted. The one-hour trainings focused on communications, National Incident Management Systems/Incident Command Systems (NIMS/ICS) and professional roles and responsibilities in NIMS and triage. The trainings were offered throughout communities in western Montana. First response resource inventories and general manpower statistics for fire, police, Emergency Medical Services (EMS), and emergency department hospital bed capacity were determined prior to MCI scenario construction. A test was given prior to and after the training activities.
ResultsA total of 175 firefighters, EMS, law enforcement, hospital personnel or other first-responders completed the pre- and post-test. Firefighters produced higher baseline scores than all other disciplines during pre-test analysis. At the end of the training all disciplines demonstrated significantly higher scores on the post-test when compared with their respective baseline averages. Improvements in post-test scores were noted for participants from all disciplines and in all didactic areas: communications, NIMS/ICS, and triage.
ConclusionsMass-casualty incidents offer significant challenges for prehospital and emergency room workers. Fire, Police and EMS personnel must secure the scene, establish communications, define individuals’ roles and responsibilities, allocate resources, triage patients, and assign transport priorities. After emergency department notification and in advance of arrival, emergency department personnel must assess available physical resources and availability and type of manpower, all while managing patients already under their care. Mass-casualty incident trainings should strengthen the key, individual elements essential to well-coordinated response such as communications, incident management system and triage. The practice scenarios should be matched to the specific resources of the community. The authors also believe that these trainings should be provided with all disciplines represented to eliminate training “silos,” to allow for discussion of overlapping jurisdictional or organizational responsibilities, and to facilitate team building.
,Glow SD ,Colucci VJ ,Allington DR ,Noonan CW .Hall EC Managing Multiple-Casualty Incidents: A Rural Medical Preparedness Training Assessment . Prehosp Disaster Med.2013 ;28 (4 ):1 -8 .
2 - Pathology of gastric cancer
- Edited by Richard M. Gore, Northwestern University Medical School, Illinois
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- Book:
- Gastric Cancer
- Published online:
- 31 March 2010
- Print publication:
- 19 November 2009, pp 22-41
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Summary
Introduction
The stomach is an eccentric tubular organ between the esophagus and the duodenum that functions as a food capacitor and, using hydrochloric acid and pepsin secreted by cells within it, contributes to food digestion. Like other components of the gastrointestinal (GI) tract, the stomach includes several layers of tissue, the two most relevant to a discussion of gastric neoplasia being the mucosa and the muscularis propria. The mucosa is subject to inflammatory processes, a familiarity with which aids in the understanding of the genesis of neoplasms arising from that layer of tissue. Neoplastic pathology of the stomach has been well reviewed in depth in recent years; the following will serve as a brief introduction to the gross and microscopic characteristics of gastric neoplasms and their precursors, with special consideration of features relevant to prognosis. Current genetics and molecular biology of these processes will also be considered.
Gross and microscopical anatomy
The wall of the stomach is formed by several layers of tissue (Figure 2.1). The mucosa is the innermost layer and is derived from the fetal endoderm. The character of the mucosa varies somewhat depending on its location within the stomach. The mucosa lining the gastric fundus and body is made up of densely packed test-tube-like units divided into two zones: the pit and the gland. The pit, populated by tall mucus cells, extends from the surface to the glandular compartment, which is lined almost exclusively by parietal and chief cells.
Pollen-mediated gene flow from transgenic safflower (Carthamustinctorius L.) intended for plant molecular farming to conventional safflower
- Marc A. McPherson, Allen G. Good, A. Keith C. Topinka, Rong-Cai Yang, Ross H. McKenzie, R. Jason Cathcart, Jed A. Christianson, Curtis Strobeck, Linda M. Hall
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- Journal:
- Environmental Biosafety Research / Volume 8 / Issue 1 / January 2009
- Published online by Cambridge University Press:
- 11 February 2009, pp. 19-32
- Print publication:
- January 2009
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- Article
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Field experiments were conducted in Chile and western Canada to measure short-distance (0 to 100 m) outcrossing from transgenic safflower (Carthamus tinctorius L.) intended for plant molecular farming to non-transgenic commodity safflower of the same variety. The transgenic safflower used as the pollen source was transformed with a construct for seed-specific expression of a high-value protein and constitutive expression of a gene conferring resistance to the broad-spectrum herbicide glufosinate. Progeny of non-transgenic plants grown in plots adjacent to the transgenic pollen source were screened for glufosinate resistance to measure outcrossing frequency. Outcrossing frequency differed among locations: values closest to the transgenic pollen source (0 to 3 m) ranged from 0.48 to 1.67% and rapidly declined to between 0.0024 to 0.03% at distances of 50 to 100 m. At each location, outcrossing frequency was spatially heterogeneous, indicating insects or wind moved pollen asymmetrically. A power analysis assuming a binomial distribution and a range of alpha values (type 1 error) was conducted to estimate an upper and lower confidence interval for the probable transgenic seed frequency in each sample. This facilitated interpretation when large numbers of seeds were screened from the outcrossing experiments and no transgenic seeds were found. This study should aid regulators and the plant molecular farming industry in developing confinement strategies to mitigate pollen mediated gene flow from transgenic to non-transgenic safflower.