Emergency Route Research Articles

Strategies for Drug Encapsulation and Controlled Delivery Based on Vapor‐Phase Deposited Thin Films

Vapor‐phase deposition methods allow the synthesis and engineering of organic and inorganic thin films, with high control on the chemical composition, physical properties, and conformality. In this review, the recent applications of vapor‐phase deposition methods such as initiated chemical vapor deposition (iCVD), plasma enhanced chemical vapor deposition (PE‐CVD), and atomic layer deposition (ALD), for the encapsulation of active pharmaceutical drugs are reported. The strategies and emergent routes for the application of vapor‐deposited thin films on the drug controlled release and for the engineering of advanced release nanostructured devices are presented.

Multi-Objective Emergency Material Vehicle Dispatching and Routing under Dynamic Constraints in an Earthquake Disaster Environment

Emergency material vehicle dispatching and routing (EMVDR) is an important task in emergency relief after large-scale earthquake disasters. However, EMVDR is subject to dynamic disaster environment, with uncertainty surrounding elements such as the transportation network and relief materials. Accurate and dynamic emergency material dispatching and routing is difficult. This paper proposes an effective and efficient multi-objective multi-dynamic-constraint emergency material vehicle dispatching and routing model. Considering travel time, road capacity, and material supply and demand, the proposed EMVDR model is to deliver emergency materials from multiple emergency material depositories to multiple disaster points while satisfying the objectives of maximizing transport efficiency and minimizing the difference of material urgency degrees among multiple disaster points at any one time. Furthermore, a continuous-time dynamic network flow method is developed to solve this complicated model. The collected data from Ludian earthquake were used to conduct our experiments in the post-quake and the results demonstrate that: (1) the EMVDR model adapts to the dynamic disaster environment very well; (2) considering the difference of material urgency degree, the material loss ratio is −10.7%, but the variance of urgency degree decreases from 2.39 to 0.37; (3) the EMVDR model shows good performance in time and space, which allows for decisions to be made nearly in real time. This paper can provide spatial decision-making support for emergency material relief in large-scale earthquake disasters.

A Dynamic Indoor Field Model for Emergency Evacuation Simulation

Indoor emergency response plays a critically important role in disaster management for cities, which must consider the evacuation of people in a dynamic indoor environment. The spatial model is the foundation for the specific analysis of indoor emergency responses, such as evacuations. The current spatial model for evacuation has three primary pitfalls: (1) it primarily focuses on static spatial information, such as rooms, doors, and windows, and lacks dynamic information, such as events and sensors; (2) it mainly focuses on the horizontal space and the static scene and lacks a multi-story component that considers the different properties of stairs compared to planar areas; and (3) it places emphasis on the indoor navigation calculation with a 2D/3D network, which lacks individual properties that can support more complicated analysis, such as congestion and stagnation. In this paper, we propose a dynamic indoor field model with three typical characteristics. (1) It includes not only static information but also dynamic information, such as outdoor and indoor building geometry, sensors, fire spread, and personnel behavior. (2) It supports multi-story buildings from the macro level (building level and floor level) to the micro level (room level and individual level) based on horizontal and vertical indoor space. (3) It supports spatial calculations based on a three-dimensional space grid and can analyze potential congestion and stagnation during evacuation. We design a corresponding evacuation method that supports individual evacuation route finding and evacuation assessment. We perform a series of analyses of the applicability of the proposed model and the efficiency of the designed evacuation method based on multi-story evacuation studies. The simulation includes a total evacuation population exceeding 7000 individuals, and the analysis suggests that the new model and algorithm are effective in planning indoor emergency routes that avoid potential congestion or stagnation.

PERANCANGAN SARANA PENYELAMAT DIRI DAN KEBUTUHAN APAR PADA DARURAT KEBAKARAN DI KANTOR KESEHATAN PELABUHAN KELAS II BALIKPAPAN

Fire in building could cause human casualties, loss of property, disruption of the activities of the organization, environmental degradation and disturbance of public. In the United State, of 15.300 fire in the rise building are 990 victims and 6,1% of them fatalities. Therefore fire prevention should be done by implementing the emergency response system wherein fire extinguishing system and means of escape. The purpose of this study was to identify and designing needs portable fire extinguisher and means of escape that have not been fulfilled in building Class II Port Health Office (PHO) of Balikpapan. This research was performed by cross sectional design using observational approach. The interviews performed on 2 officials of Class II PHO of Balikpapan which is considered to know about the condition of the building as object of research. The result of this research are no fire emergency policy and means of escape. In these condition it is provided to the Class II PHO of Balikpapan fixed procedure on fire emergency and evacuation route. Portable fire extinguisher installed as many as 10 units, in accordance with the requirements calculated based Permenakertrans number 4 1980. Conclusion of this research is Class II PHO of Balikpapan’s building has not been having fire emergency policy and adequate means of escape. This condition should see the Class II PHO of Balikpapan create procedure regarding fire emergency and evacuation route.Keywords: fire emergency, means of escape, portable fire extinguisher

91: Can the early intervention of the Lung Cancer CNS reduce the length of stay for patients admitted via the emergency route on first presentation?

91: Can the early intervention of the Lung Cancer CNS reduce the length of stay for patients admitted via the emergency route on first presentation?

An integrated Model of Outdoor and Indoor Representation of Geographical Environment for Emergency Rescue Routing

Abstract Construction of smart city needs both macro and micro-spatial structures. This paper proposes a framework for integrated emergency routing system (IERS). This framework consists of an integrated outdoor and indoor Navigation Data Model (INDM) and DD* algorithm of emergency routing based on INDM. INDM is a 3D geometric network model (GNM) that represents pedestrian access or search and rescue route analysis within buildings or urban built-environments. An experimental implementation of scenario-based DD* algorithm analysis is presented in this paper. The result shows that the method developed in this paper is superior to Dijkstra algorithm in emergency rescue routing.

Multi-objective evacuation routing optimization for toxic cloud releases

This paper develops a model for assessing the risks associated with the evacuation process in response to potential chemical accidents, based on which a multi-objective evacuation routing model for toxic cloud releases is proposed taking into account that the travel speed on each arc will be affected by disaster extension. The objectives of the evacuation routing model are to minimize travel time and individual evacuation risk along a path respectively. Two heuristic algorithms are proposed to solve the multi-objective evacuation routing model. Simulation results show the effectiveness and feasibility of the model and algorithms presented in this paper. And, the methodology with appropriate modification is suitable for supporting decisions in assessing emergency route selection in other cases (fires, nuclear accidents).

Place of Death in Patients with Lung Cancer: A Retrospective Cohort Study from 2004-2013.

IntroductionMany patients with cancer die in an acute hospital bed, which has been frequently identified as the least preferred location, with psychological and financial implications. This study looks at place and cause of death in patients with lung cancer and identifies which factors are associated with dying in an acute hospital bed versus at home.Methods and FindingsWe used the National Lung Cancer Audit linked to Hospital Episode Statistics and Office for National Statistics data to determine cause and place of death in those with lung cancer; both overall and by cancer Network. We used multivariate logistic regression to compare features of those who died in an acute hospital versus those who died at home.ResultsOf 143627 patients identified 40% (57678) died in an acute hospital, 29% (41957) died at home and 17% (24108) died in a hospice. Individual factors associated with death in an acute hospital bed compared to home were male sex, increasing age, poor performance status, social deprivation and diagnosis via an emergency route. There was marked variation between cancer Networks in place of death. The proportion of patients dying in an acute hospital ranged from 28% to 48%, with variation most notable in provision of hospice care (9% versus 33%). Cause of death in the majority was lung cancer (86%), with other malignancies, chronic obstructive pulmonary disease (COPD) and ischaemic heart disease (IHD) comprising 9% collectively.ConclusionsA substantial proportion of patients with lung cancer die in acute hospital beds and this is more likely with increasing age, male sex, social deprivation and in those with poor performance status. There is marked variation between Networks, suggesting a need to improve end-of-life planning in those at greatest risk, and to review the allocation of resources to provide more hospice beds, enhanced community support and ensure equal access.

Optimization of Global Convergence Based on Genetic Algorithm for Solving Shortest Emergency Route

Optimization of Global Convergence Based on Genetic Algorithm for Solving Shortest Emergency Route

A decomposition-based heuristic for stochastic emergency routing problems

This paper proposes a decomposition-based heuristic for a network delivery problem in which relief workers acquire valuable emergency supplies from relief warehouses, and transport them to meet the urgent needs of distressed population centres. The problem context dictates that the relief items reach these population centres before critical deadlines. However, co-ordination challenges and random disruptions introduce uncertainty in both network travel times and the destination deadlines. Hence, relief workers have to negotiate the tension between ensuring a high probability of punctual delivery and maximising the combined value of the relief supplies delivered. For an arbitrary routing scheme which guarantees punctual delivery in an uncertainty-free state of nature, the heuristic yields an upper bound on the probability that, under uncertainty, the routing scheme described will lead to tardy delivery. We demonstrate our solution approach on a small numerical example and glean insights from experiments on a realistically sized problem. Overall, our central model and proposed solution approach are useful to managers who need to evaluate routing options and devise effective operational delivery plans in humanitarian crisis situations.

Caregivers' Experiences of Pathways to Care for Seriously Ill Children in Cape Town, South Africa: A Qualitative Investigation.

PurposeUnderstanding caregivers’ experiences of care can identify barriers to timely and good quality care, and support the improvement of services. We aimed to explore caregivers’ experiences and perceptions of pathways to care, from first access through various levels of health service, for seriously ill and injured children in Cape Town, South Africa, in order to identify areas for improvement.MethodsSemi-structured, qualitative interviews were conducted with primary caregivers of children who were admitted to paediatric intensive care or died in the health system prior to intensive care admission. Interviews explored caregivers’ experiences from when their child first became ill, through each level of health care to paediatric intensive care or death. A maximum variation sample of transcripts was purposively sampled from a larger cohort study based on demographic characteristics, child diagnosis, and outcome at 30 days; and analysed using the method of constant comparison.ResultsOf the 282 caregivers who were interviewed in the larger cohort study, 45 interviews were included in this qualitative analysis. Some caregivers employed ‘tactics’ to gain quicker access to care, including bypassing lower levels of care, and negotiating or demanding to see a healthcare professional ahead of other patients. It was sometimes unclear how to access emergency care within facilities; and non-medical personnel informally judged illness severity and helped or hindered quicker access. Caregivers commonly misconceived ambulances to be slow to arrive, and were concerned when ambulance transfers were seemingly not prioritised by illness severity. Communication was often good, but some caregivers experienced language difficulties and/or criticism.ConclusionsInterventions to improve child health care could be based on: reorganising the reception of seriously ill children and making the emergency route within healthcare facilities clear; promoting caregivers’ use of ambulances and prioritising transfers according to illness severity; addressing language barriers, and emphasising the importance of effective communication to healthcare providers.

Integrated Optimization Model for Shelter Allocation and Evacuation Routing with Consideration of Reliability

Efficient evacuation routing and allocation of evacuees to safe shelters can effectively reduce casualties and property losses caused by storm surge disasters. A biobjective model is proposed to tackle shelter allocation and emergency routing problems while simultaneously considering network reliability. The proposed model maximizes the total reliability of routes connecting residential communities and shelters and those connecting shelters. A nondominated sorting genetic algorithm is developed to solve this biobjective model with a specially designed chromosome structure, initialization process, and genetic operators. The mathematical model is validated with a case study using storm surge scenario simulation data and real-world community and infrastructure data from Pingyang County, China. The case study illustrates the effectiveness of the proposed model and its potential application in real-world disaster risk reduction.

VehiHealth: An Emergency Routing Protocol for Vehicular Ad Hoc Network to Support Healthcare System.

Survival of a patient depends on effective data communication in healthcare system. In this paper, an emergency routing protocol for Vehicular Ad hoc Network (VANET) is proposed to quickly forward the current patient status information from the ambulance to the hospital to provide pre-medical treatment. As the ambulance takes time to reach the hospital, ambulance doctor can provide sudden treatment to the patient in emergency by sending patient status information to the hospital through the vehicles using vehicular communication. Secondly, the experienced doctors respond to the information by quickly sending a treatment information to the ambulance. In this protocol, data is forwarded through that path which has less link breakage problem between the vehicles. This is done by calculating an intersection value I v a l u e for the neighboring intersections by using the current traffic information. Then the data is forwarded through that intersection which has minimum I v a l u e . Simulation results show VehiHealth performs better than P-GEDIR, GyTAR, A-STAR and GSR routing protocols in terms of average end-to-end delay, number of link breakage, path length, and average response time.

Multidimensional Data and Model Uncertainties in Comparing Heterogeneous Benefits of Distributed Transportation Projects

AbstractInvestments in transportation projects are typically justified by diverse potential benefits, including safety, environmental, energy savings, congestion mitigation, and others. There is a need for such benefits to be comparable early in transportation programming, to allocate scarce resources to preliminary engineering. This paper discusses quantitative methods to aid in prioritizing locations of future highway projects. The paper adopts 15 quantitative metrics including crash rate, emergency route access, environmental issues, level of service (LOS), volume-to-capacity ratio, traffic flow, intermodal access, heavy truck usage, unemployment rate, right-of-way use, use of alternative transportation modes, bridge sufficiency rating, and cost effectiveness. This effort contributes to real-world transportation programming and priority setting via analysis of the crash avoidance and other benefits and costs that are expected before project designs are available. The innovation of this paper is in two ...

Deployment of Wi‐Fi network as an emergency survival communication network in Wakkanai, Hokkaido

Networks must be safeguarded against disasters. From the network‐management viewpoint, safeguards should be considered during the network design phase. In this study, we surveyed the potential of establishing redundant Wi‐Fi networks in schools in the Soya region of Hokkaido to proactively create a bypass communication network that can be used if a natural disaster occurs. During emergency situations such as earthquakes, tsunamis, and floods, a traditional disaster response may not be able to provide adequate communication services to emergency‐management teams. To explore the potential of establishing an emergency survival communication network in Wakkanai, Hokkaido, we conducted a medium‐scale trace‐driven study of redundant networks to determine how to decrease the disaster risk. We set up wireless nodes at four network locations of different sizes, including an access link between the Wakkanai city office and Wakkanai Hokusei Gakuen University networks. Furthermore, we model the optimal redundant topology and discuss the simulation result. By proactively establishing a redundant wireless network as a detour emergency route using our approach, an organization can rapidly reduce disaster risk. © 2015 Institute of Electrical Engineers of Japan. Published by John Wiley & Sons, Inc.

Routes to diagnosis for sarcoma – Describing the sarcoma patient journey

BackgroundUnderstanding the route to diagnosis for patients with cancer is important to improve the diagnostic pathway and therefore outcomes. We aimed to investigate routes to diagnosis for patients with sarcoma in England. MethodsNational patient level datasets relating to 7716 soft tissue and 1240 bone sarcoma patients diagnosed between 2006 and 2008 were analysed. Routes to diagnosis were defined as: “Two Week Wait Referral”, “GP Referral”, “Other Outpatient”, “Inpatient Elective”, “Emergency Presentation”, “Death Certificate Only” and “Unknown”. ResultsPatients with sarcoma are most likely to be diagnosed after “GP Referral” or “Emergency Presentation” and are less likely to be referred under a two week wait compared with other malignancies. Patients with bone sarcoma under 10 or over 80 years of age were more likely to present by emergency routes, as were patients with vertebral column, pelvis or unspecified site tumours and those with Ewing's sarcoma or sarcoma NOS. Patients with soft tissue sarcoma under 19 or over 80 years of age and patients with GI tract tumours were more likely to present by emergency routes. Patients presenting by emergency routes more often had metastases and had lower 1 year survival. Patients from least deprived quintiles more often presented by unknown routes: those from more deprived quintiles more often presented by emergency routes. ConclusionRoutes to diagnosis for sarcoma patients differ from other cancers. Interventions to improve the diagnostic experience should consider the very young and elderly, tumours in abdominal, pelvic or spinal locations and on reducing emergency presentations.

The effect of emergency presentation on surgery and survival in lung cancer patients in England, 2006–2008

BackgroundA large proportion of lung cancer patients in England are diagnosed through an emergency route, which is associated with poorer outcomes. Here, we investigated the association between emergency presentation and the odds of undergoing surgical resection and subsequent survival among lung cancer patients undergoing surgical resection as well as those who did not. MethodsDetails of 93,783 lung cancers were extracted from the National Cancer Data Repository. For non-small cell lung cancer (NSCLC) patients we calculated odds ratios for undergoing surgical resection. Survival was assessed for resected NSCLC and for all other lung cancer patients in three different time intervals: short-term, intermediate and long-term. ResultsCompared with those who did not, NSCLC patients presenting through an emergency route were less likely to undergo surgical resection (adjusted OR=0.22, 95% CI: 0.20–0.24). Patients who underwent surgical resection after an emergency presentation had lower survival in the intermediate period (adjusted HR=1.27, 95% CI: 1.06–1.54) and long term (adjusted HR=1.20, 95% CI: 0.99–1.45). Among all other lung cancer patients, those diagnosed through an emergency route had lower survival, particularly in the short-term (adjusted HR=3.54, 95% CI: 3.42–3.67), but the association remained in the intermediate (adjusted HR=1.66, 95% CI: 1.63–1.69) and long term (adjusted HR=1.10, 95% CI: 1.05–1.15). ConclusionThe reduced access to surgical resection and lower survival among lung cancer patients who present through an emergency admission, highlights the importance of ensuring symptoms are recognised early so that presentation as an emergency can be reduced.

The Effect of Emergency Presentation on Surgery and Survival in Lung Cancer Patients in England, 2006-2008

A B S T R A C T Background: A large proportion of lung cancer patients in England are diagnosed through an emergency route, which is associated with poorer outcomes. Here, we investigated the association between emergency presentation and the odds of undergoing surgical resection and subsequent survival among lung cancer patients undergoing surgical resection as well as those who did not. Methods: Details of 93,783 lung cancers were extracted from the National Cancer Data Repository. For non-small cell lung cancer (NSCLC) patients we calculated odds ratios for undergoing surgical resection. Survival was assessed for resected NSCLC and for all other lung cancer patients in three different time intervals: short-term, intermediate and long-term. Results: Compared with those who did not, NSCLC patients presenting through an emergency route were less likely to undergo surgical resection (adjusted OR = 0.22, 95% CI: 0.20–0.24). Patients who underwent surgical resection after an emergency presentation had lower survival in the intermediate period (adjusted HR = 1.27, 95% CI: 1.06–1.54) and long term (adjusted HR = 1.20, 95% CI: 0.99–1.45). Among all other lung cancer patients, those diagnosed through an emergency route had lower survival, particularly in the short-term (adjusted HR = 3.54, 95% CI: 3.42–3.67), but the association remained in the intermediate (adjusted HR = 1.66, 95% CI: 1.63–1.69) and long term (adjusted HR = 1.10, 95% CI: 1.05– 1.15).

Cancer-specific variation in emergency presentation by sex, age and deprivation across 27 common and rarer cancers.

Background:Although overall sociodemographic and cancer site variation in the risk of cancer diagnosis through emergency presentation has been previously described, relatively little is known about how this risk may vary differentially by sex, age and deprivation group between patients with a given cancer.Methods:Data from the Routes to Diagnosis project on 749 645 patients (2006–2010) with any of 27 cancers that can occur in either sex were analysed. Crude proportions and crude and adjusted odds ratios were calculated for emergency presentation, and interactions between sex, age and deprivation with cancer were examined.Results:The overall proportion of patients diagnosed through emergency presentation varied greatly by cancer. Compared with men, women were at greater risk for emergency presentation for bladder, brain, rectal, liver, stomach, colon and lung cancer (e.g., bladder cancer-specific odds ratio for women vs men, 1.50; 95% CI 1.39–1.60), whereas the opposite was true for oral/oropharyngeal cancer, lymphomas and melanoma (e.g., oropharyngeal cancer-specific odds ratio for women vs men, 0.49; 95% CI 0.32–0.73). Similarly, younger patients were at higher risk for emergency presentation for acute leukaemia, colon, stomach and oesophageal cancer (e.g., colon cancer-specific odds ratio in 35–44- vs 65–74-year-olds, 2.01; 95% CI 1.76–2.30) and older patients for laryngeal, melanoma, thyroid, oral and Hodgkin's lymphoma (e.g., melanoma specific odds ratio in 35–44- vs 65–74-year-olds, 0.20; 95% CI 0.12–0.33). Inequalities in the risk of emergency presentation by deprivation group were greatest for oral/oropharyngeal, anal, laryngeal and small intestine cancers.Conclusions:Among patients with the same cancer, the risk for emergency presentation varies notably by sex, age and deprivation group. The findings suggest that, beyond tumour biology, diagnosis through an emergency route may be associated both with psychosocial processes, which can delay seeking of medical help, and with difficulties in suspecting the diagnosis of cancer after presentation.

Cannulation techniques in aortic surgery.

Providing an adequate perfusion during aortic surgery is crucial for a satisfactory result. For this purpose, different access routes have been used for arterial cannulation including ascending aorta, innominate artery, aortic arch, carotid artery, femoral artery, subclavian or axillary artery [1–3]. The current report by Misfeld and Bakhtiary [4] clearly demonstrates the technique for direct cannulation of the subclavian and axillary artery for aortic surgery. They recommend the routine use of one of these two sites for arterial cannulation during aortic repairs. Also other possible uses for these sites were described as minimally invasive operations, reoperations and left ventricular assist device support. The use of axillary cannulation is remarked to be easier in the setting of pacemaker devices and obese patients. Femoral artery access, being accepted as a straightforward, time-effective and emergency route, has been the choice of arterial cannulation site for many years especially for aortic dissection operations. However, clinical benefits of antegrade cerebral perfusion with either axillary or subclavian cannulation have been demonstrated since mid-1990s [1]. The initial reports focused on the feasibility, short-term mortality and early neurological functions and showed better outcome [1, 2]. In a recent meta-analysis, Ren et al. [1] demonstrated significantly decreased early mortality (6.7 vs 21.6%) and a lower rate of neurological dysfunction (14.3 vs 26.4%) in axillary cannulation when compared with femoral cannulation. Moreover, in a recent report from Etz et al. [5], retrograde perfusion with femoral artery access was found to be an independent risk factor for late mortality (HR = 2; P = 0.009); antegrade perfusion via the axillary artery or direct aortic cannulation was reported with superior long-term survival compared with retrograde perfusion at 10 years after discharge (71 vs 51%). These data suggest that axillary or subclavian artery cannulation for aortic surgery, especially in acute settings, offers superior clinical results. In accordance with this finding, these cannulation routes are being more frequently used. As reported by De Paulis et al. [3], currently the preferred arterial cannulation site as a first choice for aortic arch operations is the subclavian/axillary artery access (with a rate of 54% for acute and 48% for chronic pathologies) in Europe. However, there is still no randomized trial reported on this subject. Although the current data support the use of axillary/subclavian artery cannulation during aortic surgery, recommendation for a routine practice needs still evidence. Thus, we may conclude that axillary/subclavian route can be the preferred method for arterial cannulation for aortic surgery, and it is reasonable to expect more tendency to use these access sites not only for aortic surgery but also for minimally invasive mitral and aortic valve procedures in the near future. But, currently it may also be acceptable to determine the cannulation strategy according to the patient and institutional characteristics besides surgeons’ experience and preferences.