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For thirty years, emergency medical services agencies have emphasized limiting spinal motion during transport of the trauma patient to the emergency department. The long spine board (LSB) has been the mainstay of spinal motion restriction practices, despite the paucity of data to support its use. The purpose of this study was to determine reduction in lateral motion afforded by the LSB in comparison to the stretcher mattress alone. This was a randomized controlled crossover trial where healthy volunteer subjects were randomly assigned to either LSB or stretcher mattress only. All subjects were fitted with a rigid cervical collar, secured to the assigned device (including foam head blocks), and driven on a closed course with prescribed turns at a low speed (<20 mph). Upon completion, the subjects were then secured to the other device and the course was repeated. Each subject was fitted with 3 graduated-paper disks (head, chest, hip). Lasers were affixed to a scaffold attached to the stretcher bridging over the patient and aimed at the center of the concentric graduations on the disks. During transport, the degree of lateral movement was recorded during each turn. Significance was determined by t test. In both groups, the head demonstrated the least motion with 0.46±0.4-cm mattress and 0.97±0.7-cm LSB (P≤ .0001). The chest and hip had lateral movement with chest 1.22±0.9-cm mattress and 2.22±1.4-cm LSB (P≤ .0001), and the hip 1.20±0.9-cm mattress and 1.88±1.2-cm LSB (P≤ .0001), respectively. In addition, lateral movement had a significant direct correlation with body mass index. The stretcher mattress significantly reduced lateral movement during transport.

BackgroundNumerous stroke severity scales have been published, but few have been studied with emergency medical services (EMS) in the prehospital setting. We studied the Vision, Aphasia, Neglect (VAN) stroke assessment scale in the prehospital setting for its simplicity to both teach and perform. This prospective prehospital cohort study was designed to validate the use and efficacy of VAN within our stroke systems of care, which includes multiple comprehensive stroke centers (CSCs) and EMS agencies.MethodsThe performances of VAN and the National Institutes of Health Stroke Scale (NIHSS) ≥6 for the presence of both emergent large vessel occlusion (ELVO) alone and ELVO or any intracranial hemorrhage (ICH) combined were reported with positive predictive value, sensitivity, negative predictive value, specificity, and overall accuracy. For subjects with intraparenchymal hemorrhage, volume was calculated based on the ABC/2 formula and the presence of intraventricular hemorrhage was recorded.ResultsBoth VAN and NIHSS ≥6 were significantly associated with ELVO alone and with ELVO or any ICH combined using χ2 analysis. Overall, hospital NIHSS ≥6 performed better than prehospital VAN based on statistical measures. Of the 34 cases of intraparenchymal hemorrhage, mean±SD hemorrhage volumes were 2.5±4.0 mL for the five VAN-negative cases and 17.5±14.2 mL for the 29 VAN-positive cases.ConclusionsOur VAN study adds to the published evidence that prehospital EMS scales can be effectively taught and implemented in stroke systems with multiple EMS agencies and CSCs. In addition to ELVO, prehospital scales such as VAN may also serve as an effective ICH bypass tool.

Preventive and promotive interventions delivered by schools can support a healthy lifestyle, positive development, and well-being in children and adolescents. The coronavirus disease 2019 (COVID-19) pandemic presented unique challenges to school health and nutrition programmes due to closures and mobility restrictions. We conducted a scoping review to examine how school health and nutrition programmes pivoted during the COVID-19 pandemic, and to provide summative guidance to stakeholders in strategic immediate and long-term response efforts. We searched MEDLINE, Embase, PsycINFO, and grey literature sources for primary (observational, intervention, and programme evaluations) and secondary (reviews, best practices, and recommendations) studies conducted in low- and middle-income countries from January 2020 to June 2023. Programmes that originated in schools, which included children and adolescents (5-19.9 years) were eligible. We included 23 studies in this review. They varied in their adaptation strategy and key programmatic focus, including access to school meals (n = 8), health services, such as immunisations, eye health, and water, sanitation, and hygiene-related activities (n = 4), physical activity curriculum and exercise training (n = 3), mental health counselling and curriculum (n = 3), or were multi-component in nature (n = 5). While school meals, physical activity, and mental health programmes were adapted by out-of-school administration (either in the community, households, or virtually), all health services were suspended indefinitely. Importantly, there was an overwhelming lack of quantitative data regarding modified programme coverage, utilisation, and the impact on children and adolescent health and nutrition. We found limited evidence of successful adaptation of school health and nutrition programme implementation during the pandemic, especially from Asia and Africa. While the adoption of the World Health Organization health-promoting school global standards and indicators is necessary at the national and school level, future research must prioritise the development of a school-based comprehensive monitoring and evaluation framework to track key indicators related to both health and nutrition of school-aged children and adolescents.

This chapter contains sections titled: Hurricane Katrina Fundamentals of Emergency Triage by the Emergency Physician Prehospital Medical Care and the Emergency Physician Emergency Medical Care Specific to Disaster Situations Emergency Management Knowledge, Skills, and Responsibilities Training and Exercise for Disaster Preparedness Conclusion Notes

Microbial communities in the gastrointestinal tract influence many aspects of host health, including metabolism and susceptibility to pathogen colonization. These relationships and the environmental and individual factors that drive them are relatively unexplored for free-living wildlife. We quantified the relationships between urban habitat use, diet, and age with microbiome composition and diversity for 82 American white ibises (Eudocimus albus) captured along an urban gradient in south Florida and tested whether gut microbial diversity was associated with Salmonella enterica prevalence. Shifts in community composition were significantly associated with urban land cover and, to a lesser extent, diets higher in provisioned food. The diversity of genera was negatively associated with community composition associated with urban land cover, positively associated with age class, and negatively associated with Salmonella shedding. Our results suggest that shifts in both habitat use and diet for urban birds significantly alter gut microbial composition and diversity in ways that may influence health and pathogen susceptibility as species adapt to urban habitats.

The 2020 toy and game market is projected to be US $135 billion. To determine if 3D printing could affect these markets if consumers offset purchases by 3D printing free designs, this study investigates the 100 most popular downloaded designs at MyMiniFactory in a month. Savings are quantified for using a Lulzbot Mini 3D printer and three filament types: commercial filament, pellet-extruded filament, and post-consumer waste converted to filament with a recyclebot. Case studies probed the quality of: (1) six common complex toys; (2) Lego blocks; and (3) the customizability of open source board games. All filaments analyzed saved the user over 75% of the cost of commercially available true alternative toys and over 90% for recyclebot filament. Overall, these results indicate a single 3D printing repository among dozens is saving consumers well over $ 60 million/year in offset purchases. The most common savings fell by 40%–90% in total savings, which came with the ability to make novel toys and games. The results of this study show consumers can generate higher value items for less money using the open source distributed manufacturing paradigm. It appears clear that consumer do-it-yourself (DIY) manufacturing is set to have a significant impact on the toy and game markets in the future.

The conservation profession is increasingly seeking effective ways to reduce societal impact on biodiversity, including through targeted behavior change interventions. Multiple conservation behavior change programs exist, but there is also great uncertainty regarding which behaviors are most strategic to target. Behavioral prioritization is a tool that has been used effectively to support behavior change decision‐making in other environmental disciplines and more recently for a small sub‐set of biodiversity behavior change challenges. Here, we use behavioral prioritization to identify individual behaviors that could be modified to achieve biodiversity benefits in the state of Victoria, Australia. We use an adapted nominal group technique method to identify potential biodiversity behaviors and, for each behavior, estimate the corresponding plasticity (or capacity for change) and positive impact on biodiversity outcomes. We elicited 27 behaviors that individuals could undertake to benefit or reduce their negative impact on biodiversity. This list was then used to prioritize 10 behaviors as determined by their likely effect(s) on biodiversity, plasticity, and current prevalence in Victoria. We take a first step in outlining a list of behaviors that can direct Victorian decision‐makers toward increasing positive and reducing negative impacts of society on biodiversity, guide motivated individuals to reduce their own biodiversity footprint, and more broadly, develop a behavior change research agenda for behaviors most likely to benefit biodiversity.

One of the greatest challenges of developmental psychology is figuring out what children are thinking. This is particularly difficult in early childhood, for children who are prelinguistic or are just beginning to speak their first words. In this stage, children's responses are commonly measured by presenting young children with a limited choice between one of a small number of options (e.g., \"Do you want X or Y?\"). A tendency to choose one response in these tasks may be taken as an indication of a child's preference or understanding. Adults' responses are known to exhibit order biases when they are asked questions. The current set of experiments looks into the following question: do children demonstrate response biases? Together, we show that 1) toddlers demonstrate a robust verbal recency bias when asked \"or\" questions in a lab-based task and a naturalistic corpus of caretaker-child speech interactions, 2) the recency bias weakens with age, and 3) the recency bias strengthens as the syllable-length of the choices gets longer. Taken together, these results indicate that children show a different type of response bias than adults, recency instead of primacy. Further, the results may suggest that this bias stems from increased constraints on children's working memory.

Background Adults aged 65 and older have surgery more often than younger people and often live with frailty. The postoperative transition in care from hospital to home after surgey is a challenging time for older adults with frailty as they often experience negative outcomes. Improving postoperative transitions in care for older adults with frailty is a priority. However, little knowledge from the perspective of older adults with frailty is available to support meaningful improvements in postoperative transitions in care. Objective To explore what is important to older adults with frailty during a postoperative transition in care. Methods This qualitative study used an interpretive description methodology. Twelve adults aged ≥ 65 years with frailty (Clinical Frailty Scale score ≥ 4) who had an inpatient elective surgery and could speak in English participated in a telephone-based, semi-structured interview. Audio files were transcribed and analyzed using thematic analysis. Results Five themes were constructed: 1) valuing going home after surgery; 2) feeling empowered through knowledge and resources; 3) focusing on medical and functional recovery; 4) informal caregivers and family members play multiple integral roles; and 5) feeling supported by healthcare providers through continuity of care. Each theme had 3 sub-themes. Conclusion Future programs should focus on supporting patients to return home by empowering patients with resources and clear communication, ensuring continuity of care, creating access to homecare and virtual support, focusing on functional and medical recovery, and recognizing the invaluable role of informal caregivers.