Prime Time or Lyme Time: A Case of Lyme Hepatitis in the Emergency Department.

Lyme disease, a tick-borne illness, is caused by the spirochete Borrelia burgdorferi. Lyme disease commonly presents with the characteristic erythema migrans rash, fever, malaise, headache, and arthralgias. Some patients may have mild liver manifestations, including abnormal liver function tests (LFTs), hyperbilirubinemia, or granulomatous hepatitis. Significant LFT abnormalities and hepatitis in a case of Lyme disease are rare. Here, we present a case of Lyme hepatitis in the emergency department (ED) where the patient presented with classic Lyme symptoms and was also found to have markedly elevated aspartate transaminase (AST) and alanine transaminase (ALT), mild alkaline phosphatase (ALP) elevation, and mild hyperbilirubinemia.

Reexploring the conception of heat-health risk: From the perspectives of dimensionality and spatiality.

Extreme heat events are more frequent and intense as a result of global climate change, thus posing tremendous threats to public health. However, extant literature exploring the multidimensional features of heat-health risks from a spatial perspective is limited. This study revisits extreme heat-health risk and decomposes this concept by integrating multi-sourced datasets, identifying compositional features, examining spatial patterns, and comparing classified characteristics based on local conditions. Using Maryland as the focal point, we found that the components of heat-health risk are different from traditional risk dimensions (i.e., vulnerability, hazards, and exposure). Through a local-level clustering analysis, heat-health risks were compared with areas having similar features, and among those with different features. The findings suggest a new perspective for understanding the socio-environmental and socio-spatial features of heat-health risks. They also offer an apt example of applying cross-disciplinary methods and tools for investigating an ever-changing phenomenon. Moreover, the spatial classification mechanism provides insights about the underlying causes of heat-health risk disparities and offers reference points for decision-makers regarding identification of vulnerable areas, resource allocation, and causal inferences when planning for and managing extreme heat disasters.

An Enhanced IDBO-CNN-BiLSTM Model for Sentiment Analysis of Natural Disaster Tweets.

The Internet's development has prompted social media to become an essential channel for disseminating disaster-related information. Increasing the accuracy of emotional polarity recognition in tweets is conducive to the government or rescue organizations understanding the public's demands and responding appropriately. Existing sentiment analysis models have some limitations of applicability. Therefore, this research proposes an IDBO-CNN-BiLSTM model combining the swarm intelligence optimization algorithm and deep learning methods. First, the Dung Beetle Optimization (DBO) algorithm is improved by adopting the Latin hypercube sampling, integrating the Osprey Optimization Algorithm (OOA), and introducing an adaptive Gaussian-Cauchy mixture mutation disturbance. The improved DBO (IDBO) algorithm is then utilized to optimize the Convolutional Neural Network-Bidirectional Long Short-Term Memory (CNN-BiLSTM) model's hyperparameters. Finally, the IDBO-CNN-BiLSTM model is constructed to classify the emotional tendencies of tweets associated with the Hurricane Harvey event. The empirical analysis indicates that the proposed model achieves an accuracy of 0.8033, outperforming other single and hybrid models. In contrast with the GWO, WOA, and DBO algorithms, the accuracy is enhanced by 2.89%, 2.82%, and 2.72%, respectively. This study proves that the IDBO-CNN-BiLSTM model can be applied to assist emergency decision-making in natural disasters.

A Support Tool for Emergency Management in Smart Campuses: Reference Architecture and Enhanced Web User Interfaces.

In the context of smart campuses, effective emergency management is crucial for ensuring the safety and well-being of students, staff, and visitors. This paper presents a comprehensive support tool designed to enhance emergency management on smart campuses, integrating a low-cost people-counting system based on cameras and Raspberry Pi devices. It introduces a newly designed architecture and user interfaces that enhance the functionality and user experience of a smart campus disaster management system. Finally, a usability evaluation has been carried out to validate the brand-new user interfaces devoted to emergency management.

Cairo Consensus on Accreditation as the Basis for Future-Proofing the ART Laboratory.

An international consensus meeting was convened to discuss globally applicable strategies for 'future-proofing' ART laboratories. The central theme was how the application of the foundational principles of laboratory accreditation enables any centre to create an ethos and framework that will support future-proofing in all regards. Discussions focussed on ART laboratory services from egg retrieval and semen specimen receipt to embryo transfer, as well as pertinent cryobanking activities. Issues related to whether ART treatment should be considered an essential service, overall clinic operations, general patient care, and the provision of clinical treatment, were not included as they fall under the purview of physicians and public health authorities. This report details the 16 core consensus points reached, which are supported by extensive practical recommendations that cover the gamut of ART laboratory operations.

Conflict and fragmented public health emergency management system in Tigray region of Northern Ethiopia: A double burden to accommodate resilient and advanced public health emergency management. A commentary review for policy-makers and a call to action.

An estimated 2.5 million people have been internally and externally displaced in the Tigray region of northern Ethiopia in conflict and post-conflict settings. This induced a loss of access to basic and essential healthcare services. The situation was overwhelming, causing service inaccessibility, inadequate health facilities, unstable security to access the services, shortage of supplies and drugs, and medical equipment's in the region. The regional public health emergency management is one service delivery set up for the critically ill. It is characterized by weak emergency management capacities, poor coordination and integration. In addition, the system falls in to two independent sectors in the Tigray Health Bureau (THB), Tigray Health Research Institute (THRI). This leads to a fragmented system, an unclear leadership and governance role and a poor service delivery setup and tracking mechanism. The situation leads to resource duplication and poor business practice. Indeed, this type of service delivery setup secures personal and professional interest more than community interest. The situation exacerbated the occurrence of recurrent outbreaks in the region, with, for instance, zoonotic diseases (anthrax and rabies), acute watery diarrhoea, measles, malaria, yellow fever, and coronavirus disease 2019 (COVID-19) approaching to their level of epidemic. Moreover, they will spike as an epidemic in the future. All these circumstances made it evident that the system need reform to adhere with legal global, national, and regional frameworks, guidelines and proclamations. The system should have one service delivery set up at regional level. It must fall into regional public health institutes (PHIs) to adhere its service packages to the current advancements. Furthermore, integrated effort need from program implementers, relevant stakeholders and policy-makers should be committed and work together in the review and reform process.

Lessons of the Boom: A Playbook for Crisis Centers to Prevent, Survive, and Respond to Active Assailants, Targeted Violence, and Mass Violence.

Modern crisis centers need to be prepared for mass shootings, active assailant incidents, and related forms of targeted violence. While crisis engagement has traditionally been seen as a "right of boom" or post-incident responder, crisis leaders need to prepare their teams to identify people at risk for violence, use tools like Behavioral Threat Assessment and Management to reduce risk in those persons, and prepare their teams for potential incidents in their community. Evidence suggests that acute stressors are a common proximal risk factor for severe violence implying a potential synergy for using crisis services as a tool for prevention of violence.

Rescue path planning for urban flood: A deep reinforcement learning-based approach.

Urban flooding is among the costliest natural disasters worldwide. Timely and effective rescue path planning is crucial for minimizing loss of life and property. However, current research on path planning often fails to adequately consider the need to assess area risk uncertainties and bypass complex obstacles in flood rescue scenarios, presenting significant challenges for developing optimal rescue paths. This study proposes a deep reinforcement learning (RL) algorithm incorporating four main mechanisms to address these issues. Dual-priority experience replays and backtrack punishment mechanisms enhance the precise estimation of area risks. Concurrently, random noisy networks and dynamic exploration techniques encourage the agent to explore unknown areas in the environment, thereby improving sampling and optimizing strategies for bypassing complex obstacles. The study constructed multiple grid simulation scenarios based on real-world rescue operations in major urban flood disasters. These scenarios included uncertain risk values for all passable areas and an increased presence of complex elements, such as narrow passages, C-shaped barriers, and jagged paths, significantly raising the challenge of path planning. The comparative analysis demonstrated that only the proposed algorithm could bypass all obstacles and plan the optimal rescue path across nine scenarios. This research advances the theoretical progress for urban flood rescue path planning by extending the scale of scenarios to unprecedented levels. It also develops RL mechanisms adaptable to various extremely complex obstacles in path planning. Additionally, it provides methodological insights into artificial intelligence to enhance real-world risk management.

Drivers and collaborative governance of public health emergency response in the context of digital city.

Introduction: With the frequent occurrence of public health events, the government inevitably makes many mistakes in emergency management. In modern emergency management, it is particularly important to promote the diversification of emergency management subjects and improve the government's emergency management ability. Methods: In order to make up for the deficiency of government's participation in public health emergency management, this paper analyzes the driving factors and driving effects of enterprises' participation in public health emergency response under the background of digital city. A fully explained structural model is used to analyze the relationship between the different drivers. In addition, the spatial and temporal distribution characteristics of public health events were analyzed through spatial auto-correlation. On this basis, the government cooperative governance strategy is discussed. Results and discussion: The results show that in the context of digital cities, there are 14 driving factors for enterprises to participate in public health emergency response. The most important factors are the company's own development needs, relative technical advantages and so on. The driving efficiency is mainly concentrated in three aspects: psychology, resources and structure. Public health events have periodicity in time distribution and regional differences in spatial distribution. The significance of this study is to help the government improve the emergency management ability from different angles.

The impact of coronavirus disease 2019 on acute coronary syndrome: Differences between epidemic waves.

Introduction: Since the beginning of the COronaVIrus Disease 2019 (COVID-19) pandemic, poor attention has been paid to the indirect effects of the pandemia on cardiovascular health system, in particular in patients with Acute Coronary Syndrome (ACS). The aims of this study is to compare possible epidemiological, clinical and management differences between the four epidemic waves in groups of patients hospitalized for ACS with a view to highlighting the burden of the pandemic on the management of this syndrome. Materials and methods: In this retrospective observational study we included 98 patients admitted to Coronary Intensive Care Unit (CICU) for ACS between March 2020 and March 2022, who underwent revascularization procedure using percutaneous coronary angioplasty (PCI). The patients examined were divided into four groups representative of the four epidemic waves that affected our country. Results: The rate of hospitalization for ACS increased progressively to a 178 % increase in the third wave compared to the first (p = 0.003), with an increase of 900 % if we consider only Non-ST-Elevation Myocardial Infarction (NSTEMI) (representing 54 % of the ACS diagnoses of the third group against 14.3 % in the first). Longer door-to-balloon times were recorded in the third wave for the increased presence of NSTEMI. The average hospital stay was lower in the third wave with 5 ± 2 days (p = 0.007) as well as mortality (5.1 % in the third wave; the highest in the fourth wave with 9.5 %). Conclusions: The study show that the management of ACS suffered most from the indirect effects of the pandemic during the first wave, both because of the unpreparedness of hospital facilities and because of the fear of infection that has dissuaded people from asking for help.

The impact of a child's inborn error of metabolism: the parents' perspectives on restrictions, discrimination, family planning, and emergency management.

BACKGROUND: To investigate the impact of children's inborn error of metabolism (IEMs) on the children's and their parents' lives from the parents' perspective. We focused on disease-related restrictions in various issues of daily life, experienced discrimination, parental family planning, and management of metabolic emergencies. METHODS: We conducted a questionnaire-based survey with 108 parents of 119 children with IEM who attended a metabolic outpatient clinic. The children were categorized into 4 cohorts, based on increasing disease severity (cohort 1: IEMs with lowest severity, cohort 4: IEMs with highest severity), and compared by using Tobit regressions. RESULTS: The severity of the child's IEM was associated with an increase in the intensity of perceived restrictions from the parents' perspective for themselves and their children in all aspects of life: in general, in contact with friends, in the pursuit of hobbies, in childcare/school/occupation, and due to emotional stress. The highest intensity of restrictions in all cohorts was found for the parents themselves in contact with friends (compared to cohort 1: cohort 2: c. 3.556, p = 0.002; cohort 3: c. 4.159, p = 0.003; cohort 4: c. 7.224, p < 0.001). Parents of 8% of children reported that their children were discriminated against because of IEM, with the highest proportion of affected children (43%) in cohort 4. Parental family planning decisions were influenced in 34% of parents, with fear of recurrence being a predominant aspect. Of the parents of children diagnosed with IEMs associated with metabolic emergencies, 68% stated that they felt well or very well prepared for the occurrence of a metabolic emergency, and 100% of parents were able to name the necessary action steps from memory. Nevertheless, 58% stated that they experienced an occurring emergency as rather or very stressful. CONCLUSIONS: From the parents' perspective, the intensity of restrictions increased with the severity of the child's IEM. The study shows the high impact of IEM on parents of children with IEM and the daily challenges they face. These findings emphasize the importance of comprehensive support for parents of children with IEM.

Survey on health literacy and related factors among firefighters of emergency management departments in Southwest China.

OBJECTIVE: Although health literacy (HL) has emerged as a critical public health concern, research on HL in emergency management departments is limited. This study aimed to investigate the awareness of HL and associated factors among firefighters of emergency management departments in southwest China to provide a basis for carrying out targeted health education. METHODS: A cross-sectional convenience sample of 1,742 firefighters from an emergency management department in southwestern China was surveyed from February to April 2023 using the Chinese Citizen's Health Literacy Questionnaire (2019 version). The chi-square test, linear trend chi-square test, Fisher's test, rank sum test, and multifactorial logistic regression model were used to identify influential factors associated with HL. RESULTS: The HL level of the 1742 respondents was 34.3%. Age, ethnicity, education level, length of service, type of job, smoking status, types of parental jobs, annual household income, time of daily internet use, etc. (P < 0.05). The results of multivariate logistic regression analysis indicate that type of job (OR = 0.648, 95%CI:0.426-0.985), length of service (OR = 0.496, 95%CI:0.251-0.981), household income (OR = 1.900, 95%CI:1.443-2.502), daily internet usage time (OR = 0.726, 95%Cl:0.588-0.896), health status (OR = 0.750, 95%Cl:0.585-0.962) and frequency of organizing HL sessions (OR = 1.603, 95%Cl:1.101-2.330) were influencing factors affecting the HL of the officers and soldiers. CONCLUSION: The health literacy level of firefighters in the Emergency Management Department in Southwest China was 34.3%. Lower levels were found in the health-related skills dimension (HRS, 30.1%) and in infectious disease control (ID, 30.7%). Health information literacy (HI, 34.3%) was lower than the national level. The type of urban and rural areas, literacy level, and household income level may be the factors affecting the level of health literacy among the respondents. Therefore, health education and promotion interventions should target high priority dimensions (HRS, HI, and ID) and should focus on strengthening health literacy levels of firefighters with rural types, low education levels, and low household income to improve their health.

Formal and informal hospital emergency management practices: managing for safety and performance amid crisis.

Although formal preparedness for unexpected crises has long been a concern of health care policy and delivery, many hospitals struggled to manage staff and equipment shortages, precarious finances, and supply chain disruptions among other difficulties during the Coronavirus disease pandemic. Our purpose was to analyze how hospitals used formal and informal emergency management practices to maintain safe and high-quality care while responding to crisis. We conducted a qualitative study based on 26 interviews with hospital leaders and emergency managers from 12 US hospitals, purposively sampled to vary along geographic location, urban/rural delineation, size, resource availability, system membership, teaching status, and performance levels among other characteristics. In order to manage staff, space, supplies, and system- related challenges, hospitals engaged formal and informal practices around planning, teaming, and exchanging resources and information. Relying solely only on formal or informal practices proved inadequate, especially when prespecified plans, the incident command structure, and existing contracts and communication platforms failed to support resilient response. We identified emergent capabilities-imaginative planning, recombinant teaming, and transformational exchange-through which hospitals achieved harmonious interplay between the formal and informal practices of emergency management that supported safe care and resilience amid crisis. Managing emergent challenges for and amid crisis calls for health care delivery organizations to engage creative planning processes, enable motivated workers with diverse skill sets to team up, and establish rich inter- and intra-organizational partnerships that support vital exchange.

"Leading through Crisis": A Systematic Review of Institutional Decision-Makers in Emergency Contexts.

This review aims to map studies on governmental and institutional decision-making processes in emergencies. The literature reveals various approaches used by governments in managing emergencies. Consequently, this article suggests the need for a systematic literature review to outline how institutional decision-makers operate during emergencies. To achieve this goal, the most widely used databases in psychological research were consulted, with a specific focus on selecting scientific articles. Subsequently, these studies were rigorously assessed for their relevance using a structured literature selection process following the PRISMA 2020 guidelines. At the conclusion of the review process, nine studies were identified, each suggesting different methods by which governments manage emergencies. This diversity arises because emergency decision-making processes must account for numerous variables that change depending on the type of crisis and the specific context. However, several critical aspects have emerged, such as the centrality of pre-disaster planning to improve intervention practices and methods, attention to information gaps that inevitably arise during an emergency, and the importance of streamlining and delegating decision-making to emergency responders in the field to counter the phenomenon of centralized decision-making that often hampers crucial interventions during emergencies.

National Athletic Trainers' Association Position Statement: Emergency Action Plan Development and Implementation in Sport.

OBJECTIVE: An emergency action plan (EAP) is a written document detailing the preparations and on-site emergency response of health care professionals and other stakeholders to medical emergencies in the prehospital setting. The EAP is developed to address any type of catastrophic injury response and should not be condition specific. The objective of this National Athletic Trainers' Association position statement is to provide evidence-based and consensus-based recommendations for developing and implementing an EAP for sports settings. METHODS: These recommendations were developed by a multidisciplinary expert panel that performed (1) a comprehensive review of existing EAP evidence, (2) a modified Delphi process to define consensus recommendations, and (3) a strength of recommendation taxonomy determination for each recommendation. RESULTS: An EAP is an essential tool designed to facilitate emergency preparedness and an efficient, coordinated emergency response during an athletic event. A comprehensive EAP should consider modes to optimize patient outcomes, the various stakeholders needed to develop the plan, the factors influencing effective implementation of the EAP, and the roles and responsibilities to ensure a structured response to a catastrophic injury. CONCLUSIONS: These evidence-informed recommendations outline the necessary steps for emergency planning and provide considerations for the immediate management of patients with catastrophic injuries. Increasing knowledge and implementation of the EAP to manage patients with catastrophic injuries improves the overall response and decreases errors during an emergency.

Wildfire risk management in the era of climate change.

The August 8, 2023R Lahaina fire refocused attention on wildfires, public alerts, and emergency management. Wildfire risk is on the rise, precipitated through a combination of climate change, increased development in the wildland-urban interface (WUI), decades of unmitigated biomass accumulation in forests, and a long history of emphasis on fire suppression over hazard mitigation. Stemming the tide of wildfire death and destruction will involve bringing together diverse scientific disciplines into policy. Renewed emphasis is needed on emergency alerts and community evacuations. Land management strategies need to account for the impact of climate change and hazard mitigation on forest ecosystems. Here, we propose a long-term strategy consisting of integrating wildfire risk management in wider-scope forest land management policies and strategies, and we discuss new technologies and possible scientific breakthroughs.

Provincial Intra-Action Review of the COVID-19 Vaccination Programme: Opportunities to Improve Vaccine Response in North Kivu, Democratic Republic of Congo.

Background: Low levels of COVID-19 vaccination coverage in many countries prompted the use of rapid assessments to characterize barriers to vaccination and identify corrective measures. The World Health Organization recommended the use of intra-action reviews (IARs) to identify best practices, gaps, and lessons learned to make real-time improvements to the COVID-19 vaccination response. Objective: The Democratic Republic of the Congo (DRC) implemented a national IAR in July 2021 that was poorly attended by the provincial health level, where vaccination activities are planned and implemented. To bridge this gap, we proposed sub-national IARs focused on COVID-19 vaccine program implementation at the provincial level. Methods: Using the WHO methodology, we organized a four-day provincial IAR workshop and invited national, provincial and health zone Ministry of Health (MoH) representatives and private and non-governmental organizations involved in the provincial COVID-19 vaccination response. Participants were divided into six groups based on their expertise, affiliation, and role within the health system to assess and identify lessons learned, challenges and the solutions within each of the six technical areas: (1) coordination, planning and monitoring; (2) service delivery; (3) risk communication and community engagement; (4) adverse effects following immunization (AEFI); (5) logistics; (6) and data management, monitoring and evaluation. Results: The first provincial COVID-19 IAR was conducted in Goma, North Kivu, from January 19-22, 2022. A total of 56 participants came from provincial and health zone offices, and non-governmental organizations. Through work group discussions, they identified best practices, challenges, and lessons learned, and made recommendations to improve implementation of vaccination activities and reach coverage targets. Activities were proposed to operationalize recommendations and address challenges to improve the provincial response. Conclusion: This provincial IAR was a useful tool for reviewing progress and areas of improvement, while evaluating aspects of the COVID-19 vaccine rollout. It provided a means to share information with vaccination partners on areas of intervention, tailored to the local context.

Reliability and Detectability of Emergency Management Systems in Smart Cities under Common Cause Failures.

Urban areas are undergoing significant changes with the rise of smart cities, with technology transforming how cities develop through enhanced connectivity and data-driven services. However, these advancements also bring new challenges, especially in dealing with urban emergencies that can disrupt city life and infrastructure. The emergency management systems have become crucial elements for enabling cities to better handle urban emergencies, although ensuring the reliability and detectability of such system remains critical. This article introduces a new method to perform reliability and detectability assessments. By using Fault Tree Markov chain models, this article evaluates their performance under extreme conditions, providing valuable insights for designing and operating urban emergency systems. These analyses fill a gap in the existing research, offering a comprehensive understanding of emergency management systems functionality in complex urban settings.

Evolutionary game analysis of multiple subjects in the management of major public health emergencies.

The frequent occurrence of major public health emergencies (MPHEs) significantly challenges national security, economic stability, social operation and the safety of people's lives and property worldwide. Consequently, enhancing the emergency management of MPHEs is critically urgent. This paper constructs a game model involving local government, social organisations, and the public for MPHE management, exploring strategy combinations and influencing factors across various scenarios. Several results were obtained. (1) Local government, social organisations, and the public each have positive and negative strategy choices based on cost-benefit analysis, leading to eight different strategy combinations. Furthermore, all three take positive strategies as the optimal way to achieve the game equilibrium. (2) The transformation of strategy combinations is primarily influenced by the cost-benefit gap and the strategic decisions of local government. (3) Altering a subject's initial strategy value doesn't change its final choice but impacts the time to achieve a stable strategy equilibrium. The severity of local government punishments on social organisations influences their strategic choices and the time to optimal strategy, whereas rewards to the public or social organisations only affect the time to achieve this strategy. The findings of this study can not only help improve the collaborative governance system of MPHEs but also provide scientific guidance on how governments can manage MPHEs.