Austere Conditions Research Articles

Place, Strengths and Assets: A Case Study of How Local Area Coordination is Supporting Individuals and Families Under Conditions of Austerity

We report findings of a mixed-method evaluation of Local Area Coordination (LAC) in one English Local Authority—an approach that draws on principles of earlier intervention, and place-, asset- and strengths-based activity. We drew on documentary materials, unstructured observation and qualitative interviews. In total, fifty-five qualitative interviews were conducted with professional stakeholders (including Coordinators, statutory agencies and community organisations), and a purposive sample of individuals supported by LAC. Positively, LAC is operating as intended. It is a flexible and agile approach, and one that is less constrained by the expectations and methods associated with traditional service delivery. Reported impacts include: tackling isolation and loneliness; building a positive vision of the future; identifying non-service solutions and being heard. We discuss the ongoing conceptual and methodological challenges to building the LAC evidence base, fostering professional support and understanding, and managing expectations of individuals and communities in furthering development. Resolving these would allow LAC to move beyond being a promising, local and small-scale transformative development for individuals and families. Its future trajectory is enmeshed in the implications of COVID-19 for individuals, families and communities: rising poverty and widening inequality, a fragile Third Sector, and concerns about community fatigue and erosion of trust.

Physicochemical properties of wet-glycated soy proteins

On a lab-scale, glycation is generally a lengthy process that would be costly if replicated on an industrial scale. In this study, a simplified method for glycating soy protein isolate has been developed. Soy proteins were glycated with allulose, fructose, and glucose in the presence of water. Free amino group content, protein solubility, browning index, and reducing sugar concentration were measured for the glycated proteins. Fourier Transform Infrared (FT-IR) spectroscopy was used to examine structural changes, and hydration behavior was evaluated using Time Domain Nuclear Magnetic Resonance (TD-NMR) relaxometry through T2 relaxation time measurements. The results showed that proteins could be glycated under these austere conditions and with minimal control. It was found that high temperatures were not favorable for glycation, and lower temperatures could be preferred. At high temperatures, proteins become more denatured and less soluble, as shown through the Lowry method for protein solubility and TD-NMR results. Higher browning was observed at a higher temperature, primarily when allulose and fructose were used for glycation. The highest glycation was obtained with glucose, while allulose and fructose showed the lowest reactivity under the proposed conditions. Proteins with low solubility had longer T2 relaxation times, indicating more free water and weaker water-binding capability.

Responding to Socioeconomic Diversity in the European Union (and to Steven Klein’s Essay) with Democracy-Enhancing Conflicts Law

Responding to Socioeconomic Diversity in the European Union (and to Steven Klein’s Essay) with Democracy-Enhancing Conflicts Law

Fragile alliances: culture, funding and sustainability in police–academic partnerships

Background Police–academic partnerships have developed significantly over the past decade or so, spurred on by the expansion of the evidence-based policing movement, the increasing value attached to impactful research in the academy, the ascendance of the professionalisation agenda in the police, and the growing necessity of cross-sectoral collaborations under conditions of post-financial crisis austerity. This trend has given rise to a burgeoning literature in the discipline of criminology which is concerned with charting the progress of these partnerships and setting out the ideal conditions for their future expansion. Aims and objectives we advance a sympathetic critique of this literature, adding a note of caution to its largely optimistic outlook. Methods we do this by combining a narrative review of the literature on police–academic partnerships with insights from elsewhere in the social sciences and observations from our experience of running the International Strand of the N8 Policing Research Partnership. Findings and discussion while we recognise that police–academic partnerships have certainly come a long way, and have the capacity to make important contributions to police work, we argue that they remain ‘fragile’ alliances, beset with fractious occupational cultures, unreliable funding streams and unsustainable inter-institutional relationships. We also reason that the structures underpinning this ‘fragility’ do not represent problems to be overcome, for they help to protect the integrity of the two professions. Conclusion we conclude by offering pragmatic measures for sustaining police–academic partnerships during those difficult periods characterised by cultural dissonance, a paucity of funding and the turnover of key personnel.

Rapid Deployment of National Guard Alternative Healthcare Facility With Isolation Unit Capabilities in Response to COVID-19.

ABSTRACTAt the direction of Governor Phil Scott, the Vermont National Guard rapidly erected a 400-bed alternative healthcare facility field hospital to increase the state’s medical capacity early in the COVID-19 pandemic when information was limited and cases were rapidly rising across the country. This case study reviews the preparation and management of the alternative healthcare facility’s first COVID-19-positive patient assigned to the 50-bed COVID-19 isolation ward. Despite austere conditions with rudimentary improvements to a nonstandard facility, the ad hoc team composed entirely of members of the Vermont National Guard successfully oversaw patient care from admission to discharge while maintaining a zero-percent transmission rate to staff. While the local civilian medical infrastructure was never overwhelmed and patient census at the facility remained low, this case study highlights the capability of the National Guard enterprise as a community response to pandemic crises.

Reframing Regulation: ‘Privatisation’, De-democratisation and the End of Social Protection?

This paper considers how the re-framing of regulation, in ways that have allowed an inter-penetration of private sector mentalities and actors with state regulators, have combined in the UK to produce both a de-democratisation and the erosion of social protection. It does so through an exploration of the enforcement of law designed to regulate business. In particular, I examine enforcement and regulatory policy at Local Authority level under the guise of the Better Regulation initiative and, then, conditions of austerity. These contexts have produced the opportunities for reframed – that is, specifically, marketised – forms of regulation which prioritise the interests of business over social protection. The paper also argues that they have been crucial in producing conditions whereby the fire at Grenfell Tower must be partly understood – conditions of de-democratisation and the decline of social protection.

Effectiveness of Short Training in Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) by Emergency Physicians: The Applied Course for Internal Aortic Clamping on Field Mission.

Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a technique that uses internal clamping of the aorta to control abdominal, pelvic, or junctional bleeding. We created a course to train military physicians in both civilian prehospital use and battlefield use. To determine the effectiveness of this training, we conducted REBOA training for French military emergency physicians. We trained 15 military physicians, organizing the training as follows: a half-day of theoretical training, a half-day of training on mannequins, a half-day on human corpses, and a half-day on a living pig. The primary endpoint was the success rate after training. We defined success as the balloon being inflated in zone 1 of a PryTime mannequin. The secondary endpoints were the progression of each trainee during the training, the difference between the median completion duration before and after training, the median post-training duration, and the median duration for the placement of the sheath introducer before and after training. Fourteen of the physicians (93%) correctly placed the balloon in the mannequin at the end of the training period. During the training, the success rate increased from 73% to 93% (p = .33). The median time for REBOA after training was only 222 seconds (interquartile range [IQR] 194-278), significantly faster than before training (330 seconds, IQR 260-360.5; p = .0033). We also found significantly faster sheath introducer placement (148 seconds, IQR 126-203 versus 145 seconds, IQR 115.5 - 192.5; p = .426). The training can be performed successfully and paves the way for the use of REBOA by emergency physicians in austere conditions.

Beyond “Legal Equality” vs. “Difference” Feminism: Leah F. Vosko Interviews Eileen Boris on Women and the ILO

Beyond “Legal Equality” vs. “Difference” Feminism: Leah F. Vosko Interviews Eileen Boris on Women and the ILO

災害時危機的状況下における診療基準(Standards of care under austere conditions in the catastrophic disaster setting: formation process and development of Crisis Standards of Care)

要旨【目的および対象】米国で発生，進展してきたCrisis Standards of Careについて，その形成過程を追うとともに，災害医療におけるその必要性を検討する。【結果】2001年9.11同時多発テロ発生以来，米国では通常の災害規模を超えたcatastrophic disasterに際し，圧倒的な需要と供給の不均衡のもと，いかに限られた医療資源を分配するか，という問題がCrisis Standards of Care（CSC）という言葉とともに議論され続けている。いかに判断を下すか，日常診療での判断基準や経験では困難で，その結果生じた不利益に法的制裁を科される可能性もありうる。連邦政府機関からその計画作成のための予算が供出され，現在まで様々な州，自治体でそのプロトコールが作成されている。【結語】CSCは災害医療において極めて重要な概念であり，我が国においてもその導入を検討すべきである。

Single Lumen Alternating Micro-Batch Hemodiafiltration (SLAMB-HDF): A Device for Minimally Invasive Renal Replacement Therapy

Blood-based RRT, such as hemodialysis, requires access to the bloodstream and adequate blood flow to enable the requisite clearance. As such, nearly all RRT systems require two lumens, enabling a blood circuit that pulls blood from one lumen or needle and returns it via another lumen or needle. The proposed single lumen alternating micro-batch (SLAMB) technique uses a small single lumen to draw a "micro" batch of blood into a single reservoir. In the reservoir, the "batch" of blood is circulated at a high blood flow rate through a hemofilter or hemodialyzer, enabling efficient small- and middle-molecule clearance. Thereafter, the "purified" blood is returned to the patient and the cycle is repeated. Each batch comprises 20-300 ml of blood, which is adjusted to the vascular access, hemodynamic status, and size of the patient. Up to 15 cycles can be done per hour, allowing this system to achieve a blood clearance level comparable to modern continuous RRT systems. Because the system can function with a small-bore single lumen, this device can work with existing central lines, thus allowing for less invasive vascular access. Because of their size and relative simplicity, SLAMB-based systems are less expensive, smaller, and have improved portability. Lastly, a similar, manual SLAMB-hemofiltration kit, which requires no electricity or battery, can be developed at low cost (<$25) for use in austere medical conditions, thus expanding the availability of RRT for patients with AKI.

A Centrally Acting Antihypertensive, Clonidine, Sedates Patients Presenting With Acute Respiratory Distress Syndrome Evoked by Severe Acute Respiratory Syndrome-Coronavirus 2.

A Centrally Acting Antihypertensive, Clonidine, Sedates Patients Presenting With Acute Respiratory Distress Syndrome Evoked by Severe Acute Respiratory Syndrome-Coronavirus 2.

Protocol Improvement for RNA Extraction From Compromised Frozen Specimens Generated in Austere Conditions: A Path Forward to Transcriptomics-Pathology Systems Integration.

At the heart of the phenome-to-genome approach is high throughput assays, which are liable to produce false results. This risk can be mitigated by minimizing the sample bias, specifically, recycling the same tissue specimen for both phenotypic and genotypic investigations. Therefore, our aim is to suggest a methodology of obtaining robust results from frozen specimens of compromised quality, particularly if the sample is produced in conditions with limited resources. For example, generating samples at the International Space Station (ISS) is challenging because the time and laboratory footprint allotted to a project can get expensive. In an effort to be economical with available resources, snap-frozen euthanized mice are the straightforward solution; however, this method increases the risk of temperature abuse during the thawing process at the beginning of the tissue collection. We found that prolonged immersion of snap frozen mouse carcass in 10% neutral buffered formalin at 4°C yielded minimal microscopic signs of ice crystallization and delivered tissues with histomorphology that is optimal for hematoxylin and eosin (H&E) staining and fixation on glass slides. We further optimized a method to sequester the tissue specimen from the H&E slides using an incubator shaker. Using this method, we were able to recover an optimal amount of RNA that could be used for downstream transcriptomics assays. Overall, we demonstrated a protocol that enables us to maximize scientific values from tissues collected in austere condition. Furthermore, our protocol can suggest an improvement in the spatial resolution of transcriptomic assays.

Enzymatic Debridement of Porcine Burn Wounds via a Novel Protease, SN514.

Necrotic tissue generated by a thermal injury is typically removed via surgical debridement. However, this procedure is commonly associated with blood loss and the removal of viable healthy tissue. For some patients and contexts such as extended care on the battlefield, it would be preferable to remove devitalized tissue with a nonsurgical debridement agent. In this paper, a proprietary debridement gel (SN514) was evaluated for the ability to debride both deep-partial thickness (DPT) and full-thickness burn wounds using an established porcine thermal injury model. Burn wounds were treated daily for 4 days and visualized with both digital imaging and laser speckle imaging. Strip biopsies were taken at the end of the procedure. Histological analyses confirmed a greater debridement of the porcine burn wounds by SN514 than the vehicle-treated controls. Laser speckle imaging detected significant increases in the perfusion status after 4 days of SN514 treatment on DPT wounds. Importantly, histological analyses and clinical observations suggest that SN514 gel treatment did not damage uninjured tissue as no edema, erythema, or inflammation was observed on intact skin surrounding the treated wounds. A blinded evaluation of the digital images by a burn surgeon indicated that SN514 debrided more necrotic tissue than the control groups after 1, 2, and 3 days of treatment. Additionally, SN514 gel was evaluated using an in vitro burn model that used human discarded skin. Treatment of human burned tissue with SN514 gel resulted in greater than 80% weight reduction compared with untreated samples. Together, these data demonstrate that SN514 gel is capable of debriding necrotic tissue and suggest that SN514 gel could be a useful option for austere conditions, such as military multi-domain operations and prolonged field care scenarios.

Planning for historic urban environments under austerity conditions: Insights from post-crash Ireland

In this paper, we examine how conservation-planning and local regeneration in historic urban cores have been re-shaped under austerity conditions and how local planners and local government more generally have negotiated or navigated this emerging austerity terrain. We seek to contribute to wider debates on ‘austerity urbanism’, by examining the impacts of austerity on local planning and how planning officials have attempted to moderate austerity largely imposed by central government (entrenched roll-back neoliberalism) but often through the further roll-out of neoliberalism in local growth strategies. Drawing on the experience of three Irish urban centres, we examine efforts to ‘sell’ the historic city. Both nationally and within the three case study areas, a common overarching theme was evident in the initial post-crisis response to urban development: an emphasis on utilising heritage as a potential economic regeneration pathway. However, while drawing on intangible heritage and heritage narratives for place-branding, the actual protection of tangible built heritage assets was undermined through a greater emphasis on ‘flexible’ planning responses to managing heritage, which seek to minimise barriers to development.

Developing family support services: A comparison of national reforms and challenges in England, Ireland and Spain

A major aspect of contemporary European family policies has been substantial developments in ‘family and parenting support services’ albeit under challenging conditions of austerity in recent years. This article compares and reviews national reforms in family support, child welfare and positive parenting services in England, Ireland and Spain. The analysis critically compares national ‘system-wide’ reforms and frontline service-based innovations; and situates these within broader national and European policy contexts. The article examines the degrees and ways in which children’s and family services reforms across all three countries have been shaped by family support, children’s rights and social investment policy orientations; and deliberates national differences in the scope, timing and longevity of reforms. It raises critical issues from rights-based perspectives and reflects on cross-national insights.

Going up or getting out? Professional insecurity and austerity in the South African health sector

AbstractAs a precondition of belonging, professionalism is often a taken-for-granted feature of being middle-class. Yet ethnographic attention to experiences of work reveals that professional identity can be fragile. Drawing on ethnographic research among nurses in KwaZulu-Natal, this article traces the feelings of precarity about work and the ambivalence that pervades ideas of professionalism. This ambiguity arises partly out of a peculiarly South African story in which histories of professionalism are entwined with the repressive apartheid project of separate development. Many of the professionals working as teachers, nurses, lawyers and administrators today were trained in the former ‘homelands’. Practices of professionalism are entangled with those of clientelism inherited from this earlier period of homeland politics. These local histories combine with wider processes of neoliberalism, as conditions of austerity produce structural shifts towards casualization. The article traces these dynamics in the stories of two nurses and considers what may be at stake politically as middle-class trajectories are threatened. Moving away from a view of the middle classes as either democratic or anti-democratic, feelings of ambivalence about work make questions of political allegiance an ambiguous and fraught matter.

Noninvasive SpO2/FiO2 ratio as surrogate for PaO2/FiO2 ratio during simulated prolonged field care and ground and high-altitude evacuation.

Diagnosis of lung injury requires invasive blood draws to measure oxygen tension in blood. This capability is nonexistent in austere settings and during prolonged field care (PFC), that is, medical care characterized by inability to evacuate casualties from the point of injury for up to 72 hours. We analyzed pulse-oximeter-derived noninvasive SpO2 and assessed the SpO2/FiO2 ratio (SFR) as a surrogate for the PaO2/FiO2 ratio (PFR), an accepted marker of lung function. We hypothesized that SFR is a suitable surrogate for PFR in a data set from animal models of combat-relevant trauma, PFC, and aeromedical evacuation. Data from anesthetized swine (N = 30) subjected to combat relevant trauma, resuscitation, and critical care interventions were analyzed. Pairwise correlations and Bland-Altman and regression analyses were performed to compare PFR and SFR, based on averaged SpO2 values obtained from two monitoring devices. We performed 683 pairwise correlations. SpO2/FiO2 ratio was numerically higher than PFR with a 313 cutoff values for acute respiratory distress syndrome (ARDS) (PFR ≥300). Sensitivity/specificity for detection of mild ARDS was 75%/73% with a 200 to 300 PFR range corresponding to 252 to 312 SFR range. For moderate ARDS, sensitivity/specificity was 61%/93% with a 100 to 200 PFR range corresponding to 191 to 251 SFR range. For severe ARDS, sensitivity/specificity was 49%/97% with a 0 to 100 PFR range corresponding to 0 to 190 SFR range. For all groups, areas under the receiver operating characteristic curves ranged from 0.76 to 0.98. SpO2/FiO2 ratio is a useful surrogate for PFR when arterial blood gas testing is not available during dynamically changing physiologic conditions, for example, during austere conditions, PFC, or aeromedical evacuation, and may permit early detection of casualties in need of lung-specific life-saving interventions. Studies in critically ill humans are warranted.

Исследование проблем формирования региональной потребительской корзины

The article touches upon the problem of forming the consumer goods basket, which is an important social factor determining the living cost of the population. Analysis of the methods of calculating the consumer goods basket in the Russian Federation and in the Astrakhan region has shown that food products make up 50% of it, which is 2.5 times higher than their share in consumer goods baskets of economically developed countries. In terms of the variety of products and services, the consumer goods basket in Russia is a clear outsider: it contains 156 items against &#x0D; 350 - 475 items in Western Europe and the United States. It can be considered a consumer goods basket of the poor, because it only provides an opportunity to survive in conditions of austerity. The comparative analysis of food products included in the basket of the Astrakhan region and recommended by the Ministry of health of the Russian Federation revealed significant deviations from the rational consumption standards. Their observance will increase the living cost of different categories of population in the region from 4.5% to 20% and require an increase in regional budget expenditures for providing social support measures by 15%. It has been inferred that the dual role &#x0D; of the food basket in the economy is explained by two opposite goals: social and budgetary. The goals of social development dictate the establishment of the volume of food consumption in accordance with scientific recommendations. The goals of budget savings lead to underestimation &#x0D; of the basket cost due to using a limited number of cheap products and an incomplete list of goods and services for normal human life. It is necessary to review the composition of the consumer goods basket in favor of a healthier and more useful set of products, expanding the range of non-food items and the list of services. The expansion of the consumer basket can become an effective factor in the growth of consumption volumes, the growth of business income, taxes and the state budget, reach the higher living standards in accordance with the requirements of the social market economy

Making do on not much: High Energy Striving, Femininity and Friendship in Broad City

In the years following the 2008 global financial crisis (“GFC”), feminist media scholarship has drawn attention to the gendered calls in Western media culture to remake subjectivity in line with imperatives of thrift required in conditions of austerity. In the shared symbolic environments that “gender the recession” (Negra &amp; Tasker, 2014), media ranging from news, reality television, and film have placed further, intensified demands on women’s domestic, affective, paid and unpaid labour, requiring attitudinal orientations combining future-oriented enthusiasm, positivity, entrepreneurialism, a continued faith in (budget-conscious) consumption and investment in the home and the family. This article considers the US comedy Broad City as an articulation of how young women are critically grappling with such shifts in gendered social relations and labour markets in the cosmopolitan setting of New York City. We suggest, in the depiction of the central female friendship between Abbi Abrams (Abbi Jacobson) and Ilana Wexler (Ilana Glazer) in Broad City, the show foregrounds the necessity of young women’s “high energy striving” but produces an alternative configuration of the normative relation between femininity and labour. In the show, contra the “retreatism” Negra and Tasker document idealising women’s work in the home as a means of combatting an austere future, the thrifty fun, care, support, and love Abbi and Ilana strive to create together spills across public spaces, spanning the streets of the city, outdoors in parks and on stoops. Abbi and Ilana are continually depicted labouring in some way, though such labour does not generally result in financial or career-based reward, but rather, produces psychic and emotional sustenance for the women’s friendship and a means of affectively investing in each other. Thus, in Broad City’s acknowledgement of the high energy striving required to survive, the show critically questions the relation of such feminine striving to the promise of career, financial success, and the idealised direction of such striving towards the domestic and hetero-patriarchal family. Instead, the show emphasises the material importance of such striving in relation to the bonds of women’s friendship in conditions of material and social hardship, suggesting a different orientation to women’s work and its place in recessional culture.

The Prehospital Evaluation and Care of Moderate/Severe TBI in the Austere Environment.

Increased resource constraints secondary to a smaller medical footprint, prolonged evacuation times, or overwhelming casualty volumes all increase the challenges of effective management of traumatic brain injury (TBI) in the austere environment. Prehospital providers are responsible for the battlefield recognition and initial management of TBI. As such, targeted education is critical to efficient injury recognition, promoting both provider readiness and improved patient outcomes. When austere conditions limit or prevent definitive treatment, a comprehensive understanding of TBI pathophysiology can help inform acute care and enhance prevention of secondary brain injury. Field deployable, noninvasive TBI assessment and monitoring devices are urgently needed and are currently undergoing clinical evaluation. Evidence shows that the assessment, monitoring, and treatment in the first few hours and days after injury should focus on the preservation of cerebral perfusion and oxygenation. For cases where medical management is inadequate (eg, evidence of an enlarging intracranial hematoma), guidelines have been developed for the performance of cranial surgery by nonneurosurgeons. TBI management in the austere environment will continue to be a challenge, but research focused on improving evidence-based monitoring and therapeutic interventions can help to mitigate some of these challenges and improve patient outcomes.