Community Emergency Research Articles

A model of co-creation: strengthening primary health care (PHC) in Ghana through an innovative “Nyansapo” partnership

The Africa Health Collaborative (AHC) initiative embarked on a transformative ten-year collaboration with Kwame Nkrumah University of Science and Technology (KNUST) and the University of Toronto (U of T) to co-create continuing education programs geared toward augmenting the proficiency of primary care practitioners in Ghana. While upholding core principles within the AHC framework, emphasizing respect, inclusivity, equity, reciprocity, ethics, dynamism, and stewardship, seven teams of U of T and KNUST faculty engaged in collaborative efforts to design, administer, and evaluate five in-person “short courses” in Ghana on Palliative Care, Quality Improvement for Health Professionals, Prehospital Emergency Care, Community Emergency Care, and Emergency Preparedness and Response to Epidemic-Prone Diseases to approximately 100 Ghanaian primary care professionals. This paper describes a model of co-creation, highlights lessons learned from a robust evaluation process, and proposes that this co-creation model can strengthen primary health care in Ghana and ultimately transform health systems in Africa.

A chromosomal mutation is superior to a plasmid-encoded mutation for plasmid fitness cost compensation.

Plasmids are important vectors of horizontal gene transfer in microbial communities but can impose a burden on the bacteria that carry them. Such plasmid fitness costs are thought to arise principally from conflicts between chromosomal- and plasmid-encoded molecular machineries, and thus can be ameliorated by compensatory mutations (CMs) that reduce or resolve the underlying causes. CMs can arise on plasmids (i.e., plaCM) or on chromosomes (i.e., chrCM), with contrasting predicted effects upon plasmid success and subsequent gene transfer because plaCM can also reduce fitness costs in plasmid recipients, whereas chrCM can potentially ameliorate multiple distinct plasmids. Here, we develop theory and a novel experimental system to directly compare the ecological effects of plaCM and chrCM that arose during evolution experiments between Pseudomonas fluorescens SBW25 and its sympatric mercury resistance megaplasmid pQBR57. We show that while plaCM was predicted to succeed under a broader range of parameters in mathematical models, chrCM dominated in our experiments, including conditions with numerous recipients, due to a more efficacious mechanism of compensation, and advantages arising from transmission of costly plasmids to competitors (plasmid "weaponisation"). We show analytically the presence of a mixed Rock-Paper-Scissors (RPS) regime for CMs, driven by trade-offs with horizontal transmission, that offers one possible explanation for the observed failure of plaCM to dominate even in competition against an uncompensated plasmid. Our results reveal broader implications of plasmid-bacterial evolution for plasmid ecology, demonstrating the importance of specific compensatory mutations for resistance gene spread. One consequence of the superiority of chrCM over plaCM is the likely emergence in microbial communities of compensated bacteria that can act as "hubs" for plasmid accumulation and dissemination.

Apocalyptic Becoming: Virus, Borders and Symbiosis in Butler’s Clay’s Ark

In Octavia E. Butler’s 1984 novel Clay’s Ark, an extraterrestrial microorganism causes transformative effects on human bodies and societies. Set against the backdrop of an impending large-scale infection, the novel deconstructs societal hierarchies faced by marginalized people. By employing Deleuze and Guattari’s generative thoughts, this paper examines different communities like enclaves, car family, and ranch to highlight how viral outbreaks catalyze significant changes. The Clayark virus functions as a vector of escape, breaking away from conventional norms and structures, and fostering the emergence of more rhizomatic communities. Haraway’s concept of “companion species” is employed to investigate the symbiotic relationship between humans and viruses, envisioning a brighter posthuman society. Butler’s writings challenge conventional science fiction clichés, examining how individuals on the margins navigate and resist systemic oppression, and presenting a symbiotic solution to transcend barriers in the apocalyptic setting.

Why Veterans Choose VA Versus non-VA Emergency Care: A Qualitative Study.

In ensuring the timely delivery of emergency care to Veterans, Veterans Affairs (VA) offers both emergency care services in its own facilities and, increasingly, purchases care for Veterans in non-VA (community) emergency department (ED) settings. Although in recent years emergency care coverage has become the single largest contributor to VA community care spending, no study to date has examined Veteran decision-making as it relates to ED setting choice. The purpose of this study is to identify and describe reasons why Veterans choose VA versus non-VA emergency care settings. Veterans Health Administration data were used to identify geographically diverse Veterans who recently used emergency care. We conducted semi-structured telephone interviews from December 2018 through March 2020 with 50 Veterans to understand the factors Veterans consider when deciding where to obtain ED care. Interviews were audio-recorded and transcribed verbatim. We conducted a directed content analysis of interview transcripts and developed a matrix to summarize and categorize each Veteran's decision-making process to compare participants and to identify common patterns. When choosing between VA and non-VA-EDs, Veterans described 3 distinct patterns of decision-making: (1) choosing the closest ED (often community) for acute conditions; (2) traveling farther for VA care due to preference and financial coverage; and (3) selecting VA when both types of ED care were equidistant. Perceptions of community resources, condition-specific needs, financial considerations, and personal preferences dominated the decision-making. For example, most Veterans (74%) rated their acuity as high, and self-perceived severity/urgency of their condition was the most cited factor influencing where Veterans decided to go for ED care. Our qualitative results help provide insight into how and why Veterans choose to seek emergency care. As the number of Veterans treated in non-VA EDs continues to rise, VA and non-VA ED providers as well as policy makers may benefit from understanding the challenges Veterans face when making this decision.

Comparing the Push–Pull Technique to Pressure Bag for Administration of Blood Products: A Prospective Nonblinded Observation Simulation-based Study (CoPP toP Study)

Abstract Introduction: Shock is defined as inadequate delivery of oxygen to meet the tissue’s demands. There are four main types of shock: cardiogenic, obstructive, distributive, and hypovolemic. Hypovolemic shock causes include hemorrhage, dehydration, and burns. Blood loss results in inadequate oxygen delivery to the cells resulting in tissue death if not reversed. Rapid infusers allow for the rapid administration of blood and crystalloid products to patients in shock; however, many community emergency departments do not have these devices. The aim of our study is to determine the fastest way to administer blood when the viscosity of the fluid is taken into consideration in a simulated setting. Methods: Volunteers were assigned to one of two arms: either the push–pull technique or pressure bag technique. The push–pull technique involved using a 50 cc syringe connected to a 3-way stop-cock to withdraw and infuse the fluid. The pressure bag technique involved pumping a pressure bag up to the maximum to infuse the fluids. The speed of infusing 250 mL of intravenous fluids was recorded. The time for the subjects to collect the materials throughout the emergency department was also recorded. Results: A total of three trials were conducted. On average, the push–pull technique took 228 s and the pressure bag technique took 340 s. The push–pull technique took an average of 112 s less than the pressure bag technique. Subjects took 62 s to find the materials for the pressure bag technique. It took 133 s to find the material for the push–pull technique. Conclusion: This prospective nonblinded observation simulation-based study demonstrated that the push–pull technique was significantly faster than the pressure bag technique.

Languages of lesser diffusion and French public service interpreting: a matter of terminology and strategy

Since the 1970s in France, public service interpreting has become a major branch of the professional translating sector. Today, the non-profit organizations that provide interpreting services are now able to provide interpreters in nearly all the languages spoken by new immigrants, languages that often have unexpected shifts and changes as a result of geopolitical changes. However, despite the resources that have been provided and an outstanding ability to adapt, the market for translating and interpreting in the context of migration is under constant linguistic pressure, which in part determines the status of these associations in the market. This has consequently led to new challenges for everyone involved in the sector, both for interpreting organizations and for the institutions that benefit from their services. Managing the language portfolio has therefore become a crucial issue, requiring a variety of short-, medium- and long-term strategies. After briefly outlining the history of the emergence of community interpreting in France and the issues involved, we will look at the designation of ‘rare’ languages or languages of lesser diffusion in the context of the language market for interpreting and translating. We will then consider the strategies currently implemented to meet demands for rare or even very rare languages. We will finally investigate new opportunities for developing and/or rapidly creating a pool of interpreters.

Lusophone Commonwealth Starts or the Emergence of Community of Lusofone Countries in 1996

Lusophone Commonwealth Starts or the Emergence of Community of Lusofone Countries in 1996

Research Status and Evolutionary Trends of Digitally Empowered Community Emergency Management: Knowledge Graph Analysis Based on CiteSpace

(1) Background: With the acceleration of globalization, various risks are intertwined and coupled, and community emergency management is facing greater pressure than before. The continuous development of digital technology has made it possible to empower community emergency management with digital technology. Therefore, it is urgent to have a clear understanding of the research status and future development direction of digital empowering community emergency management. (2) Methods: This study is based on the Web of Science database and utilizes the CiteSpace knowledge graph visualization method to analyze the research progress of community digital emergency management. (3) Results: The results indicate that from 2000 to 2024, the amount of research on community digital emergency management has been on the rise, involving multiple disciplines, but there has not been a close and mature cooperation network between different countries, institutions, and authors. The research topic has shifted from early single-emergency management to integration with emerging science and technology, with a greater emphasis on the role of communities. Big data, machine learning, technological innovation, digital healthcare, and community resilience are important research directions for the future. (4) Conclusions: In the future, we should strengthen cooperation in this field, overcome issues such as the digital divide and digital security, and promote further development of community digital emergency management.

Microbial interactions impact stress tolerance in a model oral community.

Microbial interactions are critical modulators of the emergence of microbial communities and their functions. However, how these interactions impact the fitness of microbes in established communities upon exposure to environmental stresses is poorly understood. Here, we utilized a two-species community consisting of Aggregatibacter actinomycetemcomitans and Streptococcus gordonii to examine the impact of synergistic and antagonistic interactions on microbial resilience to environmental fluctuations and susceptibility to microbial invasion. We focused on the S. gordonii-produced extracellular molecules, L-lactate and H2O2, which have been shown to mediate interactions between these two microbes. We discovered that seemingly beneficial functions, such as A. actinomycetemcomitans cross-feeding on S. gordonii-produced L-Lactate, can paradoxically exacerbate vulnerabilities, such as susceptibility to antibiotics. Moreover, our data highlight the context-dependent nature of microbial interactions, emphasizing that a seemingly potent antimicrobial, such as H2O2, can have both synergistic and antagonistic effects on a microbial community dependent on the environment.

How online inhibition fuels incivility through moral disengagement

This study aimed to investigate the mediating role of moral disengagement in the link between online disinhibition and cyber incivility, against the backdrop of digital technology’s profound impact on human communication and the emergence of online communities. This transformation has highlighted a range of behaviors, including the negative spectrum of cyber incivility, necessitating an exploration of its underlying dynamics. Utilizing a mediation analysis approach, the research examined the interplay among online disinhibition, moral disengagement, and cyber incivility. The participant consisted of 780 Indonesian students, with an average age of 20.3 years, who reported spending 4-7 hours daily on social media. The study was conducted via an online survey distributed to participants. Moral disengagement was assessed using a Moral Disengagement Scale, cyber incivility was measured with a purpose-built scale, and online disinhibition was evaluated using the Online Disinhibition Scale to measure levels of online disinhibition. Findings indicated a significant correlation among the variables, with a substantial portion of participants exhibiting moderate to high levels of online disinhibition, moral disengagement, and cyber incivility. Mediation analysis further revealed that online disinhibition mediated the relationship between moral disengagement and cyber incivility, suggesting that the lowering of inhibitions online facilitates the manifestation of uncivil behavior, influenced by moral disengagement. This study underscores the complex mechanisms driving cyber incivility, highlighting the crucial mediating role of online disinhibition between moral disengagement and cyber incivility. These insights contribute to the broader understanding of digital communication’s impact on behavior, emphasizing the need to address online disinhibition and moral disengagement to mitigate cyber incivility.

Assessing variations in care delivered to rural out of hospital cardiac arrest patients in the interfacility transfer setting.

There is significant variation in out-of-hospital cardiac arrest (OHCA) outcomes between different regions. We sought to evaluate outcomes of OHCA patients in the interfacility transfer (IFT) setting, between critical care transport (LifeFlight) and community Emergency Medical Services (EMS), in the state of Maine. This was a retrospective analysis of our institution's electronic medical record and the Maine EMS database. Data were collected from January 1, 2019, to December 31, 2021. Only adult OHCA encounters requiring an IFT for definitive post-cardiac-arrest care were included. Demographics, EMS agency, IFT vital signs, targeted temperature management (TTM) medications, cerebral performance category (CPC) scores, survival to discharge, and other descriptive variables were collected. Ninety-three patients met inclusion criteria, with LifeFlight transferring 30 of them (32.3%). LifeFlight was more likely to initiate TTM compared to other EMS agencies (p=0.012), have run-sheets reported (p=0.001), and serve rural areas (p=0.036). LifeFlight was associated with more epinephrine (0.034) and norepinephrine (<0.001) use. Only 37% of IFTs had physician orders, with none (0.0%) of them defining vital sign targets. No difference in survival to discharge or CPC scores was observed between LifeFlight and other EMS agencies. No significant variation in comorbidities or vital signs was observed. There was no difference in survival to discharge or CPC scores between LifeFlight and ad hoc EMS agency. LifeFlight was associated with more TTM and vasopressor utilization during IFT. Most IFT encounters did not have dedicated physician orders, and none of the orders included vital sign targets.

Doctrine of Hijrah and Emergence of Muslim Communities in the West

The presence of Muslims in the West is not recent; their existence in the West dates back centuries. Like other minority groups, Muslims, as a religious minority, have been influenced by their circumstances. Human migration has impacted the culture, lifestyle, and habits of indigenous peoples, as migrants bring their faiths and religious traditions with them. Historically, migration occurred from the East to the West and vice versa for centuries. However, in the last two centuries, this migration has primarily been from developing to developed countries in search of a better future and employment opportunities. The doctrine of hijrah (migration) in Muslim legal thought, along with the emergence of Muslim communities in non-Muslim regions and their interactions with non-Muslims, has long been a subject of discussion among Muslim jurists. This research explores the formation of Muslim communities in non-Muslim countries and assesses the current situation in light of historical and contemporary discourses. Therefore, discussing classical concepts related to migration and the past and present emergence of Muslims in the West is appropriate. This article analyses various writings of classical and contemporary Muslim scholars on the issues of hijrah and Muslims’ settlement in the West.

Paediatric Knee Injuries: A Narrative Review.

The prevalence of paediatric knee injuries is increasing due to higher participation in competitive sports, larger build and more use of imaging in diagnosis. A thorough history of injury (including mechanism and symptoms of pain and instability), together with a comprehensive examination (presence of an effusion, tender areas, range of movement and joint laxity) will dictate the need for radiological investigations. Magnetic Resonance Imaging (MRI) is indicated in most paediatric patients with a history of injury and an acute knee effusion, which indicates damage to an intra-articular structure. Red flags requiring onward referral to a specialist include diagnosed fractures, traumatic knee effusion, instability, or persistent unexplained nocturnal pain or lump. Correct identification and management of injuries will help reduce long-term morbidity. The aim of this review is to provide the reader with an understanding of the management of paediatric knee injuries at primary presentation in the community setting or emergency department.

Study on the construction and application of a community emergency capacity evaluation model based on a combined weighting-discrete Hopfield neural network

To accurately evaluate community emergency capability and solve the problems with the existing index system, which has been declared unreasonable with respect to components, unclear in meaning and unreliable in terms of empowerment results caused by a single algorithm, a triangle model of community safety and resilience is introduced to construct an emergency capability index system suitable for communities with frequent geological disasters in Yunnan Province. Additionally, a combined empowerment model is constructed to improve the accuracy of the empowerment results. First, according to the relevant information and the results of expert consultations and field investigations, the index system is determined. Second, three weighting methods, the G1-entropy weight, G1-CRITIC and G1-coefficient of variation, are used to calculate the index weight and perform a comparative analysis, after which the best weighting method is selected and combined with the discrete Hopfield neural network model to construct a weighting-evaluation model. Finally, the model is applied to evaluate the emergency capability of a community with frequent geological disasters in Yunnan Province. The results show that the index of monitoring and early warning ability of geological disasters is added, which makes the index more targeted, and thus, the result obtained using the G1-CRITIC combination weighting model is more accurate. The evaluation model constructed in this paper accurately evaluates community emergency capacity and is further popularized and applied in communities with frequent geological disasters in Yunnan Province.

Iatrogenic Irreducible Pediatric Salter-Harris II Middle Phalanx Base Fracture With Dorsal Dislocation of the Proximal Interphalangeal Joint: A Case Report.

Pediatric phalangeal Salter-Harris (SH)-type fracture dislocations are rare injuries that often require open reduction and stabilization. We present a case of a 14-year-old male who sustained an iatrogenic irreducible SH II dorsal fracture dislocation of the small-finger proximal interphalangeal joint (PIPJ) after an attempted closed reduction of a small-finger PIPJ dislocation by a community emergency medicine physician. Following the reduction attempt, the epiphysis was noted on radiographs to be rotated approximately 90° with persistent dorsal dislocation and an associated SH II fracture of the base of the middle phalanx. The patient was sent to our trauma center for further evaluation by our on-call hand surgeon and required open reduction and pinning of the fracture dislocation. To our knowledge, this pattern of iatrogenic PIPJ fracture dislocation has not been previously described in the literature. We outline the case presentation, treatment method, and learning points for both the on-call hand surgeon as well as the community emergency medicine physicians in this report.

The Emergence of Chinese Popular Music in Vietnamese Lyrics (nhc Hoa li Vit), 1979-1995

This paper studies the cultural phenomenon of nhc Hoa li Vit, a (sub)genre of nhc Vng music that blends Chinese melodies with Vietnamese lyrics which first gained prominence among the Vietnamese diaspora in the 1980s. The paper traces the historical and cultural origins of nhc Hoa li Vit in translations and adaptations of Chinese popular music, outlining three major historical periods. The first period spanning from 1979-1986, encompasses the genres emergence in Vietnamese refugee communities following the Sino-Vietnamese War, influenced by the popularity of Cantonese wuxia TV dramas. The second period from 1986-1995 marks the genres commercial flourishing due to the i mi policy. The final period after 1995 marks the fundamental transformation of the genre following the normalization of relations between the United States and Vietnam, when, energized by the possibility of returning to Vietnam, nhc Hoa li Vit shed the final vestiges of the melancholic and sentimental style it inherited from wartime nhc Vng and became its own genre. This paper examines the importance of nhc Hoa li Vit in shaping the Vietnamese exiled identity and analyzes how the practice of translation allowed the diasporic community to give expression to its refugee experience. The paper helps uncover a new kind of musical fusion that developed from an exiled culture in a transpacific context.

The Emergence of Chinese Popular Music in Vietnamese Lyrics (nhc Hoa li Vit), 1979-1995

This paper studies the cultural phenomenon of nhc Hoa li Vit, a (sub)genre of nhc Vng music that blends Chinese melodies with Vietnamese lyrics which first gained prominence among the Vietnamese diaspora in the 1980s. The paper traces the historical and cultural origins of nhc Hoa li Vit in translations and adaptations of Chinese popular music, outlining three major historical periods. The first period spanning from 1979-1986, encompasses the genres emergence in Vietnamese refugee communities following the Sino-Vietnamese War, influenced by the popularity of Cantonese wuxia TV dramas. The second period from 1986-1995 marks the genres commercial flourishing due to the i mi policy. The final period after 1995 marks the fundamental transformation of the genre following the normalization of relations between the United States and Vietnam, when, energized by the possibility of returning to Vietnam, nhc Hoa li Vit shed the final vestiges of the melancholic and sentimental style it inherited from wartime nhc Vng and became its own genre. This paper examines the importance of nhc Hoa li Vit in shaping the Vietnamese exiled identity and analyzes how the practice of translation allowed the diasporic community to give expression to its refugee experience. The paper helps uncover a new kind of musical fusion that developed from an exiled culture in a transpacific context.

Locating Anglo-Italian Communities in Bevis and the Naples Manuscript

This article contextualises the Anglo-Italian aspects of Naples, Biblioteca Nazionale, MS XIII.B.29. This fifteenth-century paper miscellany contains Bevis of Hampton, Chaucer’s Clerk’s Tale, St Alexius, Libeaus Desconus, as well as a recipe collection, a section of Lydgate’s “Doublenesse”, and a fragment of Sir Isumbras. The book is among a very select number of codices containing Middle English texts that are presently preserved in an Italian institution. Previous research has demonstrated XIII.B.29 must have travelled to the Italian peninsula at a relatively early date, but the exact reason behind its compilation and the method by which it arrived in Italy remain uncertain. This article reviews the manuscript’s design, provenance, and contents, arguing the book is not just an English manuscript in Italy, but also to some degree an English manuscript about Italy and Italian experiences. Specifically, the article contends that an episode in the manuscript’s Bevis, which describes a street fight near Lombard Street in London, benefits from a reading that acknowledges late medieval developments in finance and long-distance Anglo-Italian commerce, as well as the emergence of Italian communities in Southampton and the capital.

Enhancing methane yield and shifting microbial communities in anaerobic reactors treating lipid-rich dairy wastewater through exogenous lipase addition

This study explores a novel enzymatic pretreatment approach in anaerobic reactors for dairy wastewater, using lipase AY Amano to enhance methane production and modify microbial and archaeal community composition. Batch and semi-batch reactors with a total volume of 2000 mL were used to treat dairy wastewater with initial COD of 2000 and 15,000 mg L−1, respectively. In a new novel approach, the semi-batch reactors underwent a three-phase operation: 30 days of acclimation, 30 days of rest, and 30 days of active operation. Adding lipase (0.05% wv−1) as a pretreatment significantly increased methane yield over the 90 days by 135–138% compared with the control (without enzyme addition). The organic loading rate reached 0.22 g COD day−1 L−1. Furthermore, 30 days after the end of the semi-batch reactor approach (120 days from the start), reusing sludge in batch reactors increased methane yield by 114–122% compared to the control. This increase was linked to the emergence and shift of new methanogenic communities within the sludge. Integrating hydrolytic enzymes into the anaerobic treatment enhances performance and sustainability by fostering methanogen-enriched microbial communities. This is crucial for maximizing methane production but may increase costs, requiring further economic feasibility research.

Research on the Factors Influencing the Epidemic Resilience of Urban Communities in China in the Post-Epidemic Era

In the aftermath of the COVID-19 pandemic, people are gradually realizing that urban community resilience is pivotal for effectively managing public health emergencies. This study employed grounded theory to establish a theoretical framework for epidemic resilience of urban communities (ERUC) in the post-pandemic era. Subsequently, the decision-making trial and evaluation laboratory (DEMATEL)-interpretive structural modeling (ISM) method is utilized to discern the significance and hierarchical interrelations among influencing factors. The findings delineate that 14 determinants shaping ERUC are organized into five distinct tiers. Notably, nine determinants emerge as principal: vulnerable group; educational attainment; risk perception; medical insurance coverage; communal norms; community emergency response; community services; resident participation; and government efficacy. Among these, the vulnerable group and government efficiency are identified as foundational factors, while medical insurance coverage, resident participation, and community infrastructure are identified as direct influences.