Threat awareness training for non-governmental organizations deploying humanitarian aid workers into conflict environments.

INTRODUCTION: The current war in Ukraine and the subsequent deployment of Non-Governmental Organizations (NGOs) from around the world has highlighted the many potential dangers faced by humanitarian aid workers operating in conflict zones. Humanitarian aid workers may face both direct and indirect threats and aggression while on deployment, and given the rising number of global conflicts, the authors postulate a need to incorporate threat awareness training as part of pre-deployment training. METHODS: A list of the top 22 rated NGOs providing international aid was obtained from CharityWatch. All 22 were contacted via their public email addresses or website contact pages to find out if they provide any form of security, tactical or threat awareness training. RESULTS: Of the 13 NGOs that responded, 7 did not deploy staff into recent conflict zones or surroundings. All 6 NGOs who deployed staff into Ukraine or surrounding border countries, provided either security, tactical or threat awareness training to their staff. CONCLUSION: With the rising number of conflicts and disasters around the world, humanitarian aid workers are increasingly exposed to hostile environments and there is a compelling need for NGOs to ensure staff are adequately trained and prepared to handle any dangers and threats they may face. In this study, all 6 of the studied NGOs which deployed staff to the conflict zone confirmed some type of security or threat awareness training ranging from in-house security briefs to extensive, multi-day, commercially run courses such as Hostile Environment Awareness Training course.

The Use of Physical Characteristics to Explain Variation in Ball-Carrying Capability in Elite Rugby Union: A Narrative Review.

ABSTRACT: Hart, AS, Erskine, RM, and Clark, DR. The use of physical characteristics to explain variation in ball-carrying capability in elite rugby union: a narrative review. J Strength Cond Res 37(8): 1718-1727, 2023-The effectiveness of offensive ball carrying has been identified as a key determinant in elite rugby union try-scoring success and subsequent match outcome. Despite this, there is limited research evaluating the physical qualities believed to underpin the ball-carrying capability among elite rugby union players. The aim of this review was to critically appraise the scientific literature that has investigated the use of physical characteristics to explain ball-carrying capability in elite rugby union. Measures of sprint performance, specifically acceleration, maximum sprinting speed, and sprint momentum have presented weak-to-strong correlations with the number of tries scored, line breaks, tackle breaks, defenders beaten, and dominant collisions recorded among international rugby union players. In addition, unilateral and bilateral vertical countermovement jump height, peak power output, and drop jump reactive strength index have each demonstrated meaningful associations with the number of tries scored, line breaks, tackle breaks, and dominant collisions. However, various measures of maximal lower-body strength have presented only trivial correlations with the game statistics associated with ball-carrying capability. These trivial correlations are likely a result of the inconsistent and inaccurate methods used to assess maximal lower-body strength, with methods ranging from a box squat-predicted 1 repetition maximum to a maximal isometric mid-thigh pull. Further investigation is required to assess the contribution of maximal lower-body strength, agility, repeated sprint ability, and aerobic capacity to ball-carrying capability in elite rugby union. Such robust, objective data could be used to inform the specificity of physical preparation and maximize the transfer of these physical qualities to on-field performance.

Using Smartphone Sensor Paradata and Personalized Machine Learning Models to Infer Participants' Well-being: Ecological Momentary Assessment.

BACKGROUND: Sensors embedded in smartphones allow for the passive momentary quantification of people's states in the context of their daily lives in real time. Such data could be useful for alleviating the burden of ecological momentary assessments and increasing utility in clinical assessments. Despite existing research on using passive sensor data to assess participants' moment-to-moment states and activity levels, only limited research has investigated temporally linking sensor assessment and self-reported assessment to further integrate the 2 methodologies. OBJECTIVE: We investigated whether sparse movement-related sensor data can be used to train machine learning models that are able to infer states of individuals' work-related rumination, fatigue, mood, arousal, life engagement, and sleep quality. Sensor data were only collected while the participants filled out the questionnaires on their smartphones. METHODS: We trained personalized machine learning models on data from employees (N=158) who participated in a 3-week ecological momentary assessment study. RESULTS: The results suggested that passive smartphone sensor data paired with personalized machine learning models can be used to infer individuals' self-reported states at later measurement occasions. The mean R2 was approximately 0.31 (SD 0.29), and more than half of the participants (119/158, 75.3%) had an R2 of ≥0.18. Accuracy was only slightly attenuated compared with earlier studies and ranged from 38.41% to 51.38%. CONCLUSIONS: Personalized machine learning models and temporally linked passive sensing data have the capability to infer a sizable proportion of variance in individuals' daily self-reported states. Further research is needed to investigate factors that affect the accuracy and reliability of the inference.

Optimizing Bariatric Surgery outcomes: the impact of preoperative elevated hemoglobin A1c levels on composite perioperative outcome measures.

INTRODUCTION: The use of bariatric surgery in the management of obesity and its related morbidity has significantly increased in the US over the past decade. There is a lack of data on the impact of optimal preoperative glycemic control on the morbidity and mortality following bariatric surgery. The aim of this study was to analyze the impact of hemoglobin (Hb) A1c > 7 on outcomes among patients undergoing Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG). METHODS: Data were extracted from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (2017) and limited to patients undergoing an elective laparoscopic RYGB or SG. Multivariable logistic regression was conducted to adjust for other preoperative variables. RESULTS: A total number of 31,060 (69.3%) patients underwent SG, while 13,754 (30.7%) received RYGB. Patients who were older, male, non-Hispanic, smokers, and those with a higher American Society of Anesthesiologist Classification (ASA) score were more likely to have elevated HbA1c levels. Compared to individuals with normal HbA1c levels, patients with elevated levels had no significant difference in mortality (p = 0.902) but did have a difference in composite morbidity and mortality (p < 0.001). On multivariable analysis, elevated HbA1c, older age, increasing body mass index (BMI), elevated creatinine, longer operations, African American race, receiving RYGB, and having a trainee as surgical assistant were found to increase the odds of having an adverse outcome. No significant difference was found within smoking status, sex, ASA Classification, robotic vs laparoscopic, or if a second attending surgeon was assisting. CONCLUSIONS: HbA1c levels and presence of trainees in the OR are modifiable preoperative risk factors for adverse events following bariatric surgery. Improving preoperative glycemic control may be an effective and achievable quality improvement measure.

Emergency Physician Twitter Use in the COVID-19 Pandemic as a Potential Predictor of Impending Surge: Retrospective Observational Study.

BACKGROUND: The early conversations on social media by emergency physicians offer a window into the ongoing response to the COVID-19 pandemic. OBJECTIVE: This retrospective observational study of emergency physician Twitter use details how the health care crisis has influenced emergency physician discourse online and how this discourse may have use as a harbinger of ensuing surge. METHODS: Followers of the three main emergency physician professional organizations were identified using Twitter's application programming interface. They and their followers were included in the study if they identified explicitly as US-based emergency physicians. Statuses, or tweets, were obtained between January 4, 2020, when the new disease was first reported, and December 14, 2020, when vaccination first began. Original tweets underwent sentiment analysis using the previously validated Valence Aware Dictionary and Sentiment Reasoner (VADER) tool as well as topic modeling using latent Dirichlet allocation unsupervised machine learning. Sentiment and topic trends were then correlated with daily change in new COVID-19 cases and inpatient bed utilization. RESULTS: A total of 3463 emergency physicians produced 334,747 unique English-language tweets during the study period. Out of 3463 participants, 910 (26.3%) stated that they were in training, and 466 of 902 (51.7%) participants who provided their gender identified as men. Overall tweet volume went from a pre-March 2020 mean of 481.9 (SD 72.7) daily tweets to a mean of 1065.5 (SD 257.3) daily tweets thereafter. Parameter and topic number tuning led to 20 tweet topics, with a topic coherence of 0.49. Except for a week in June and 4 days in November, discourse was dominated by the health care system (45,570/334,747, 13.6%). Discussion of pandemic response, epidemiology, and clinical care were jointly found to moderately correlate with COVID-19 hospital bed utilization (Pearson r=0.41), as was the occurrence of "covid," "coronavirus," or "pandemic" in tweet texts (r=0.47). Momentum in COVID-19 tweets, as demonstrated by a sustained crossing of 7- and 28-day moving averages, was found to have occurred on an average of 45.0 (SD 12.7) days before peak COVID-19 hospital bed utilization across the country and in the four most contributory states. CONCLUSIONS: COVID-19 Twitter discussion among emergency physicians correlates with and may precede the rising of hospital burden. This study, therefore, begins to depict the extent to which the ongoing pandemic has affected the field of emergency medicine discourse online and suggests a potential avenue for understanding predictors of surge.

Routine Radiographs After Total Joint Arthroplasty: Is There Clinical Value?

BACKGROUND: Routine radiographs have historically been obtained during routine care after total joint arthroplasty (TJA). However, substantial improvements in surgical technique, biomaterials, and changes in payment models placing greater emphasis on value have occurred. Recently, there has been interest in a transition to performing follow-up visits virtually. The purpose of this study was to assess how frequently patients attend postoperative appointments and the clinical utility of routine radiographs after TJA. METHODS: Patients undergoing primary total hip arthroplasty and total knee arthroplasty at a single tertiary institution in 2018 were included. Patients attending scheduled follow-up at 6 to 12 weeks and 1 year were assessed. Retrospective chart review was conducted to determine whether abnormalities were noted on routine radiographic surveillance by the orthopedic surgeons or radiologist and if any radiographic findings altered clinical management. RESULTS: A total of 938 TJAs were performed, and 885 met inclusion criteria, with 423 (47.8%) total hip arthroplasties and 462 (52.2%) total knee arthroplasties. Eight hundred sixty-five (97.7%) patients attended a follow-up visit at 6 or 12 weeks and 589 (66.6%) attended at 1 year postoperatively. A single radiographic abnormality was detected, occurring at the 6- to 12-week period by the radiologist and interpreted as being an artifact by the surgeon. No additional radiographic abnormalities were detected at 1 year. Information from radiographs did not change clinical management for any patients. CONCLUSION: In a large cohort of patients, routine radiographic surveillance did not detect any true abnormalities during the first year after primary TJA. For patients without symptoms attributable to the TJA prosthesis, conducting virtual care visits without routine radiographs may be considered.

Recurrence after transanal endoscopic microsurgery for benign and malignant rectal tumours: experience of a single New Zealand centre.

BACKGROUND: Transanal endoscopic microsurgery (TEM) is an established technique for the resection of rectal adenomas and selected malignant tumours. It avoids the morbidity of radical resection for tumours not amenable to endoscopic resection. An important marker of quality is the local recurrence rate. The primary objective was to determine local recurrence rates for benign and malignant rectal tumours. METHODS: We identified index TEM excisions of rectal adenomas and adenocarcinomas in patients age 18 and over at Dunedin Hospital, New Zealand, between 2000 and 2020, from a prospective database. Surveillance data were collected via chart review. The primary outcome was recurrence rate for adenomas and adenocarcinomas. Secondary outcomes included time to recurrence, association of recurrence with recognized risk factors, and adverse event rates. RESULTS: We identified 100 patients for analysis. Of 75 benign cases, 11 (14.7%) developed local recurrence, with 63.6% identified within 1 year. Of the 25 malignant cases (19 T1, 5 T2, 1 T3), 9 (36%) developed recurrence, with 77.8% identified within 2 years. Adverse events occurred in 26% of patients, with no reoperations or deaths. CONCLUSION: Our adenoma recurrence rate was at the higher end of the reported range of 2.4-16%. Minor complications were common, but not major morbidity. The propensity for rectal tumours to recur commonly and early reinforces the importance of regular standardized endoscopic surveillance.

Repeatability, reproducibility, and diagnostic accuracy of a commercial large language model (ChatGPT) to perform emergency department triage using the Canadian triage and acuity scale.

PURPOSE: The release of the ChatGPT prototype to the public in November 2022 drastically reduced the barrier to using artificial intelligence by allowing easy access to a large language model with only a simple web interface. One situation where ChatGPT could be useful is in triaging patients arriving to the emergency department. This study aimed to address the research problem: "can emergency physicians use ChatGPT to accurately triage patients using the Canadian Triage and Acuity Scale (CTAS)?". METHODS: Six unique prompts were developed independently by five emergency physicians. An automated script was used to query ChatGPT with each of the 6 prompts combined with 61 validated and previously published patient vignettes. Thirty repetitions of each combination were performed for a total of 10,980 simulated triages. RESULTS: In 99.6% of 10,980 queries, a CTAS score was returned. However, there was considerable variations in results. Repeatability (use of the same prompt repeatedly) was responsible for 21.0% of overall variation. Reproducibility (use of different prompts) was responsible for 4.0% of overall variation. Overall accuracy of ChatGPT to triage simulated patients was 47.5% with a 13.7% under-triage rate and a 38.7% over-triage rate. More extensively detailed text given as a prompt was associated with greater reproducibility, but minimal increase in accuracy. CONCLUSIONS: This study suggests that the current ChatGPT large language model is not sufficient for emergency physicians to triage simulated patients using the Canadian Triage and Acuity Scale due to poor repeatability and accuracy. Medical practitioners should be aware that while ChatGPT can be a valuable tool, it may lack consistency and may frequently provide false information.

ABSTRAIT: OBJECTIF: La sortie du prototype ChatGPT au public en novembre 2022 a considérablement réduit l'obstacle à l'utilisation de l'intelligence artificielle en permettant un accès facile à un grand modèle de langage avec une interface web simple. Une situation où ChatGPT pourrait être utile est de trier les patients qui arrivent au service d'urgence. Cette étude visait à résoudre le problème de la recherche : «Les médecins d'urgence peuvent-ils utiliser ChatGPT pour trier avec précision les patients à l'aide de l'Échelle canadienne de triage et d'acuité (ECTC) ?¼. MéTHODES: Six invites uniques ont été élaborées indépendamment par cinq urgentologues. Un script automatisé a été utilisé pour interroger ChatGPT avec chacune des six invites combinées à 61 vignettes de patients validées et précédemment publiées. Trente répétitions de chaque combinaison ont été réalisées pour un total de 10980 triages simulés. RéSULTATS: Dans 99.6 % des 10980 requêtes, un score CTAS a été obtenu. Cependant, il y a eu des variations considérables dans les résultats. La répétabilité (utilisation répétée de la même invite) était responsable de 21.0 % de la variation globale. La reproductibilité (utilisation de différentes invites) était responsable de 4.0 % de la variation globale. La précision globale de ChatGPT pour le triage des patients simulés était de 47.5 %, avec un taux de sous-triage de 13.7 % et un taux de triage supérieur de 38.7 %. Un texte plus détaillé donné à titre d'invite était associé à une plus grande reproductibilité, mais à une augmentation minimale de la précision. CONCLUSIONS: Cette étude suggère que le modèle actuel de ChatGPT en langage large n'est pas suffisant pour permettre aux médecins d'urgence de trier des patients simulés à l'aide de l'échelle canadienne de triage et d'acuité en raison de la faible répétabilité et de la faible précision. Les médecins doivent être conscients que, bien que ChatGPT puisse être un outil précieux, il peut manquer de cohérence et fournir fréquemment de fausses informations.

Association of Terazosin, Doxazosin, or Alfuzosin Use and Risk of Dementia With Lewy Bodies in Men.

BACKGROUND AND OBJECTIVES: Terazosin, doxazosin, and alfuzosin (Tz/Dz/Az) are α-1 adrenergic receptor antagonists that also bind to and activate a key adenosine triphosphate (ATP)-producing enzyme in glycolysis. It is hypothesized that the increase in energy availability in the brain may slow or prevent neurodegeneration, potentially by reducing the accumulation of alpha-synuclein. Recent work has suggested a potentially neuroprotective effect of the use of Tz/Dz/Az in Parkinson disease in both animal and human studies. We investigated the neuroprotective effects of Tz/Dz/Az in a closely related disease, dementia with Lewy bodies (DLB). METHODS: We used a new-user active comparator design in the Merative Marketscan database to identify men with no history of DLB who were newly started on Tz/Dz/Az or 2 comparator medications. Our comparator medications were other drugs commonly used to treat benign prostatic hyperplasia that do not increase ATP: the α-1 adrenergic receptor antagonist tamsulosin or 5α-reductase inhibitor (5ARI). We matched the cohorts on propensity scores and duration of follow-up. We followed up the matched cohorts forward to estimate the hazard of developing DLB using Cox proportional hazards regression. RESULTS: Men who were newly started on Tz/Dz/Az had a lower hazard of developing DLB than matched men taking tamsulosin (n = 242,716, 728,256 person-years, hazard ratio [HR] 0.60, 95% CI 0.50-0.71) or 5ARI (n = 130,872, 399,316 person-years, HR 0.73, 95% CI 0.57-0.93). while the hazard in men taking tamsulosin was similar to that of men taking 5ARI (n = 159,596, 482,280 person-years, HR 1.17, 95% CI 0.96-1.42). These results were robust to several sensitivity analyses. DISCUSSION: We find an association in men who are taking Tz/Dz/Az and a lower hazard of DLB compared with similar men taking other medications. When combined with the literature of Tz/Dz/Az on Parkinson disease, our findings suggest that glycolysis-enhancing drugs may be broadly protective in neurodegenerative synucleinopathies. A future randomized trial is required to assess these associations for causality. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that Tz/Dz/Az use reduces the rate of developing DLB in adult men.

Rurality modifies the association between symptoms and the diagnosis of amyotrophic lateral sclerosis.

OBJECTIVE: We utilized national claims-based data to identify the change in odds of diagnosis of ALS following possible-ALS-symptoms-and whether the change varies in urban/rural areas. METHODS: Insurance claims were obtained from the Merative MarketScan databases, 2001-2021 in the United States. Individuals with incident ALS were identified and matched on age, sex, and enrollment period to individuals without ALS. For all individuals, claims for 8 possible-ALS-symptoms in the time before any ALS diagnosis were identified. We then used conditional logistic regression to estimate the odds of being diagnosed with ALS following these symptoms and whether the association varied by urban/rural location. RESULTS: 19,226 individuals with ALS were matched to 96,126 controls. Patients with ALS were more likely to live in an urban area (87.0% vs 84.5%). Of those with ALS 84% had 1+ of our 8 possible-ALS-symptom compared to 51% of controls. After adjustment for confounders, having possible-ALS-symptoms increased the odds of a future ALS diagnosis by nearly 5-fold. A dose-response pattern was present with increasing odds as the number of symptoms increased. In all models, urban areas were associated with increased odds of diagnosis with ALS while the effect of having a symptom was smaller in urban places. Urban cases of ALS are diagnosed at younger ages. CONCLUSIONS: These results suggest symptoms may appear and be noted years before the diagnosis of ALS. Additionally, rural patients are diagnosed at later ages with a greater dependence on symptoms than urban patients. These results highlight potential improvements for screening for ALS.

Pediatric disaster preparedness curriculum across emergency medicine residencies.

OBJECTIVE: To assess pediatric disaster medicine (PDM) instruction in emergency medicine (EM) residency programs and to identify barriers to integrating these skills into EM training. METHODS: National survey study of United States EM Residency Program Directors (PDs) and Assistant PDs during the 2021-2022 academic year. RESULTS: Of the 186 EM residency programs identified, a total of 24 responses were recorded with a response rate of 12.9 percent. Importance of training was rated 5.79 (standard deviation 2.51) using the Likert scale ranging from 1 to 10. Out of 24 programs, 17 (70.8 percent) do not have any PDM training as part of residency training. Live drill, simulation, and tabletop were identified as most effective methods to deliver PDM training with the Likert scale score of 4.78, 4.6, and 4.47, respectively. Senior trainees' level of -knowledge/skills with family reunification (Likert 2.09/5; chemical-biological-radiological-nuclear explosive 2.95/5) and mass casualty preparation of the emergency department (3.3/5) as assessed by the respondents. The main barrier to education included logistics, eg, space and costs (Likert 3.7/5), lack of didactic time (3.7/5), and limited faculty knowledge, skill, or experience (3.3/5). CONCLUSION: PDM training is lacking and requires standardization. This study highlights the opportunity for the creation of a model for EM resident education in PDM.

Mass Gathering Event Medical Preparedness and Response: A Review of Canadian Legislation and Guidelines.

INTRODUCTION: The mass gathering event (MGE) industry is growing globally, including in countries such as Canada. MGEs have been associated with a greater prevalence of injury and illness when compared with daily life events, despite most participants having few comorbidities. As such, adequate health, safety, and emergency medical planning is required. However, there is no single entity regulating these concerns for MGEs, resulting in the responsibility for health planning lying with event organizers. This study aims to compare the legislative requirements for MGE medical response systems in the 13 provinces and territories of Canada. METHODS: This study is a cross-sectional descriptive analysis of Canadian legislation. Lists of publicly available legislative requirements were obtained by means of the emergency medical services directors and Health Ministries. Descriptive statistics were performed to compare legislation. RESULTS: Of the 13 provinces and territories, 10 responded. For the missing 3, a law library review confirmed the absence of specific legislation. Most (n = 6; 60%) provinces and territories referred to provisions in their Public Health laws. Four confirmed that MGE medical response was a municipal or local concern to be addressed by the event organizers. CONCLUSIONS: No provinces could list specific legislation guiding safety, health, and medical response for an MGE.

Determining the Impact of Hurricane Dorian and the Covid-19 Pandemic on Moral Distress in Emergency Medical Providers at the Rand Memorial Hospital: Moral distress in emergency medical personnel.

OBJECTIVES: The aim of this work was to determine the impact of Moral Distress (MD) in emergency physicians, nurses, and emergency medical service staff at the Rand Memorial Hospital (RMH) in the Bahamas, and the impact of Hurricane Dorian and the COVID-19 pandemic on Moral Distress. METHOD: A cross-sectional study utilizing a 3-part survey, which collected sociodemographic information, Hurricane Dorian and COVID-19 experiences, as well as responses to a validated modified Moral Distress Scale (MDS). RESULTS: Participants with 2 negatively impactful experiences from COVID-19 had statistically significantly increased MD compared to participants with only 1 negatively impactful experience (40.4 vs. 23.6, P = 0.014). Losing a loved one due to COVID-19 was associated with significantly decreased MD (B = - 0.42, 95% CI -19.70 to -0.88, P = 0.03). Losing a loved one due to Hurricane Dorian had a non-statistically significant trend towards higher MD scores (B = 0.34, 95% CI -1.23 to 28.75, P = 0.07). CONCLUSION: The emergency medical staff at the RMH reported having mild - moderate MD. This is one of the first studies to look at the impact of concurrent disasters on MD in emergency medical providers in the Bahamas.

Heterogeneity in mental health change during the COVID-19 pandemic in Germany: The role of social factors.

The COVID-19 pandemic constitutes a prolonged global crisis, but its effects on mental health seem inconsistent. This inconsistency highlights the importance of considering the differential impact of the pandemic on individuals. There is some evidence that mental health trajectories are heterogeneous and that both sociodemographic and personal characteristics are associated with higher risk for mental health issues. By contrast, information on the role of social factors as potential determinants of initial reactions to the pandemic and on heterogeneous trajectories over time is lacking. We analysed seven assessments of a large-scale (N = 2203) longitudinal study across 1.5 years, beginning in March 2020. Using self-report data on mental health and life satisfaction, we applied latent change models to examine initial reactions and mean changes across the pandemic. In addition, we applied latent class growth analyses to investigate whether there were distinct groups with different patterns of change. Results showed that on average, levels of life satisfaction and anxiety decreased (d = -0.31 and d = -0.11, respectively), levels of depressive symptoms increased (d = 0.13), and stress levels remained unchanged (d = -0.01) during the first year of the pandemic. For each outcome, we identified four distinct mental health trajectories. Between 5% (for anxiety) and 11% (for life satisfaction) of the sample reported consistently high-and even increasing-impairments in mental health and well-being. The trajectories of a sizeable number of people covaried with the course of the pandemic, such that people experienced better mental health when the number of COVID cases was low and when fewer restrictions were placed on public life. Low emotional support, high instrumental support, and the tendency to compare oneself with others were associated with more mental health issues. Findings show that whereas a substantial portion of people were largely unaffected by the pandemic, some individuals experienced consistently high levels of psychological distress. Social factors appear to play a crucial role in the maintenance of well-being.

Virtual Reality Training in Disaster Medicine: A Systematic Review of the Literature.

SUMMARY STATEMENT: Disaster medicine (DM) training aims to recreate stressful, mass casualty scenarios faced by medical professionals in the field with high fidelity. Virtual (VR) and augmented reality (AR) are well suited to disaster training as it can provide a safe, socially distant simulation with a high degree of realism. The purpose of this literature review was to summarize the current use of VR or AR for simulation training of healthcare providers in DM education. A systematic review of peer-reviewed articles was performed from January 1, 2000, to November 21, 2020, on PubMed, Embase, and OVID. Exclusion criteria included non-English articles, computer-generated models without human participants, or articles not relating to DM, VR or AR. Thirty-two articles were included. Triage accuracy was evaluated in 17 studies. Participants reported improved confidence and positive satisfaction after the simulations. The studies suggest VR or AR can be considered for disaster training in addition to other, more traditional simulation methods. More research is needed to create a standardized educational model to incorporate VR and AR into DM training and to understand the relationship between disaster simulation and improved patient care.

Time Series Analysis of Congestive Heart Failure Discharges in Florida (USA) Post Tropical Cyclones.

OBJECTIVES: The aim of this study was to analyze congestive heart failure (CHF) discharges in Florida (USA) post tropical cyclones from 2007 through 2017. METHODS: This was a retrospective longitudinal time series analysis of hospital CHF quarterly discharges across Florida using the Healthcare Cost and Utilization Project (HCUP) database. The autoregressive integrated moving average (ARIMA) model was used with correlated seasonal regressor variables such as cyclone frequency, maximum cyclone wind speed, average temperature, and reports of influenza-like illness (ILI). RESULTS: A total of 3,372,993 patients were identified, with average age in each quarter ranging 72.2 to 73.9 years and overall mortality ranging 4.3% to 6.4%. The CHF discharges within each year peaked from October through December and nadired from April through June with an increasing overall time trend. Significant correlation was found between CHF discharge and the average temperature (P <.001), with approximately 331.8 less CHF discharges (SE = 91.7) per degree of increase in temperature. However, no significant correlation was found between CHF discharges and frequency of cyclones, the maximum wind speed, and reported ILI. CONCLUSIONS: This study suggests that with the current methods and the HCUP dataset, there is no significant increase in overall CHF discharges in Florida as a result of recent previous cyclone occurrences.