Key Influencing Factors and Optimization Strategy of Epidemic Resilience in Urban Communities-A Case Study of Nanjing, China.

COVID-19 has posed a significantly severe impact on both people's lives and the global economic development. Increasing the community epidemic resilience will considerably improve the national public health emergency response capacity from bottom to top. This study identifies the influencing factors of community epidemic resilience through systematic literature review under the 4R framework, then obtains the relationships of influencing factors through Interpretive structural model, and finally assesses the performance of epidemic resilience using PROMETHEE II method through empirical cases in Nanjing, China. The results show that: (1) Eight factors influencing the epidemic resilience of community are identified, and the economic level plays the root role; (2) Community epidemic resilience can be improved from robustness, rapidity, redundancy and resourcefulness aspects; (3) Through the empirical analysis, the epidemic resilience ranking of community can be displayed (Community D > T > S > F); (4) Additionally, the performance and sensitivity analysis of influencing factors in each community can be demonstrated. (5) Finally, four implications are proposed, namely, allocating public resources rationally, significantly increasing the economic level, ensuring the accuracy of information delivery and conducting disaster learning.

Respiratory Variations in Peak Peripheral Artery Velocities and Waveforms for Rapid Assessment of Fluid Responsiveness in Traumatic Shock Patients.

BACKGROUND This study aimed to assess the correlation between the variability of the end-inspiratory and end-expiratory blood flow waveform and fluid responsiveness (FR) in traumatic shock patients who underwent mechanical ventilation by evaluating peripheral arterial blood flow parameters. MATERIAL AND METHODS A cohort of 60 patients with traumatic shock requiring mechanical ventilation-controlled breathing received ultrasound examinations to assess the velocity of carotid artery (CA), femoral artery (FA) and brachial artery (BA). A rehydration test was performed in which of 250 mL of 0.9% saline was administered within 30 min between the first and second measurement of cardiac output by echocardiography. Then, all patients were divided into 2 groups, a responsive group (FR+) and a non-responsive group (FR-). The velocity of end-inspiratory and end-expiratory peripheral arterial blood flow of all patients was ultrasonically measured, and the variability were measured between end-inspiratory and end-expiratory. RESULTS The changes in the end-inspiratory and end-expiratory carotid artery blood flow velocity waveforms of the FR+ groups were significantly different from those of the FR- group (P<0.001). A statistically significant difference in ΔVmax (CA), ΔVmax (BA), and ΔVmax (FA) between these 2 groups was found (all P<0.001). The ROC curve showed that DVmax (CA) and ΔVmax (BA) were more sensitive values to predict FR compared to ΔVmax (FA). The sensitivity of ΔVmax (CA), ΔVmax (FA), and ΔVmax (BA) was 70.0%, 86.7%, and 93.3%, respectively. CONCLUSIONS The study showed that periodic velocity waveform changes in the end-inspiratory and end-expiratory peripheral arterial blood flow can be used for quick assessment of fluid responsiveness.