Prehospital characteristics in the North East Department of Haiti: a cross-sectional study from a low-income setting without prehospital systems.

INTRODUCTION: Although prehospital care is recognized as key in health systems development, it has been largely neglected in Haiti. The North East Department is one of the poorest areas of Haiti, and is a region where no data on out-of-hospital health care exists. This research assessed prehospital characteristics in the North East Department with the aim of providing baseline data to inform prehospital systems development. METHODS: In this observational study, data were collected from patients presenting at the Fort Liberté Hospital, the public regional referral health center in the North East Department. Data were accrued from April 2, 2012 through June 5, 2012. All patients accessing acute care at the hospital were eligible for enrollment. After obtaining consent, data on demographics, health needs, and prehospital information were gathered via a standardized questionnaire administered by hospital staff trained in study protocols. RESULTS: Data were collected from 441 patient visits. The median age was 24 years, with 62% of the population being female. Medical complaints comprised 75% of visits, with fever and gastrointestinal complaints being the most common reasons for presentation. Traumatic injuries accounted for 25% of encounters, with an equal distribution of blunt and penetrating events. Extremity injuries were the most common traumatic subclassification. The majority of patients (67.2%) were transported by motorcycle taxi and paid transport fees. Trauma patients were more likely to be transported without charge (OR = 9.10; 95% CI, 2.19-37.76; P < .001). Medical patients were most commonly brought from home (78.5%) and trauma patients from a road/street setting (42.9%). Median time to presentation was 240 minutes (IQR = 120-500) and 65 minutes (IQR = 30-150) for medical and trauma complaints, respectively (P < .001). Eleven percent of patients reported receiving care prior to arrival. As compared with medical patients, trauma victims were less likely to have received prehospital care. CONCLUSIONS: Assessing prehospital care in this low-income setting that lacks surveillance systems was feasible and required minimal resources. Motorcycle taxi drivers function as the primary emergency transport mechanism and may represent an access point for prehospital interventions in the North East Department of Haiti. Out-of-hospital care is nearly nonexistent in the region and its development has the potential to yield public health benefits.

Workplace violence in emergency medicine: current knowledge and future directions.

BACKGROUND: Workplace violence (WPV) has increasingly become commonplace in the United States (US), and particularly in the health care setting. Assaults are the third leading cause of occupational injury-related deaths for all US workers. Among all health care settings, Emergency Departments (EDs) have been identified specifically as high-risk settings for WPV. OBJECTIVE: This article reviews recent epidemiology and research on ED WPV and prevention; discusses practical actions and resources that ED providers and management can utilize to reduce WPV in their ED; and identifies areas for future research. A list of resources for the prevention of WPV is also provided. DISCUSSION: ED staff faces substantially elevated risks of physical assaults compared to other health care settings. As with other forms of violence including elder abuse, child abuse, and domestic violence, WPV in the ED is a preventable public health problem that needs urgent and comprehensive attention. ED clinicians and ED leadership can: 1) obtain hospital commitment to reduce ED WPV; 2) obtain a work-site-specific analysis of their ED; 3) employ site-specific violence prevention interventions at the individual and institutional level; and 4) advocate for policies and programs that reduce risk for ED WPV. CONCLUSION: Violence against ED health care workers is a real problem with significant implications to the victims, patients, and departments/institutions. ED WPV needs to be addressed urgently by stakeholders through continued research on effective interventions specific to Emergency Medicine. Coordination, cooperation, and active commitment to the development of such interventions are critical.

Development and validation of a turbulent-mix model for variable-density and compressible flows.

The modeling of buoyancy driven turbulent flows is considered in conjunction with an advanced statistical turbulence model referred to as the BHR (Besnard-Harlow-Rauenzahn) k-S-a model. The BHR k-S-a model is focused on variable-density and compressible flows such as Rayleigh-Taylor (RT), Richtmyer-Meshkov (RM), and Kelvin-Helmholtz (KH) driven mixing. The BHR k-S-a turbulence mix model has been implemented in the RAGE hydro-code, and model constants are evaluated based on analytical self-similar solutions of the model equations. The results are then compared with a large test database available from experiments and direct numerical simulations (DNS) of RT, RM, and KH driven mixing. Furthermore, we describe research to understand how the BHR k-S-a turbulence model operates over a range of moderate to high Reynolds number buoyancy driven flows, with a goal of placing the modeling of buoyancy driven turbulent flows at the same level of development as that of single phase shear flows.

PACHYCHELES MONILIFER (DANA, 1852): THE DEVELOPMENT IN THE LABORATORY OF LARVAE FROM AN ATLANTIC SPECIMEN WITH A DISCUSSION OF SOME LARVAL CHARACTERS IN THE GENUS (CRUSTACEA: DECAPODA; ANOMURA.

The complete larval development from hatching through megalopal stage is described and illustrated for Pachycheles monilifer, a shallow water porcellanid crab. The development at room temperature (27.8° C) under laboratory conditions consisted of a prezoeal stage of approximately one hour duration, two zoeal stages of approximately five and six days duration, respectively, and a megalopal stage of about eight days duration. The entire larval/postlarval portion of the life cycle is completed under the conditions described herein in approximately three weeks. The zoeal and megalopal stages of P. monilifer were compared with larvae known from two other western Atlantic species, and two species each from the eastern Pacific and Indo-Pacific oceans. As might be expected, larvae of the genus are quite similar in many respects, and difficulty may be encountered in separating them at the specific level. However, certain morphological features are recurrent in the zoeal stages and may be indicative at the generic level; among these are the presence of three spines on the antennal exopodite, four setae on the maxilliulary endopodite, and the hook-like spinules on the first two elongate plumose setae of the telson. A provisional synopsis is provided utilizing the most salient features occurring in all known Pachycheles larvae as an aid in recognizing such larvae, at least at the generic level, in the plankton.

Uptake of modified low-density lipoproteins alters actin distribution and locomotor forces in macrophages.

It is postulated that macrophage-derived foam cells accumulate in the arterial wall because they lose the ability to migrate after excessive ingestion of modified forms of low-density lipoproteins (LDL). To assess changes in locomotor force generating capacity of foam cells, we measured isometric forces in J774A.1 macrophages after cholesterol loading with oxidized (Ox-LDL) or aggregated (Agg-LDL) LDL using a novel magnetic force transducer. Ox-LDL loading reduced the ability of J774A.1 macrophages to generate isometric forces by 50% relative to control cells. Changes in force frequency consistent with reduced motility were detected as well. Agg-LDL loading was also detrimental to J774A.1 motility but to a lesser extent than Ox-LDL. Ox-LDL loading significantly reduced total actin levels and induced changes in the F-actin to G-actin distribution, whereas Agg-LDL loaded cells had significantly increased levels of total actin. These data provide evidence that cholesterol loading and subsequent accumulation decreases macrophage motility by reducing the cells' force generating capacity and that Ox-LDL appears to be more effective than Agg-LDL in disrupting the locomotor machinery.