Emergency Transport Research Articles

Comparison of emergency transport for acute alcohol intoxication before and after the coronavirus disease 2019 pandemic: A retrospective observational study

The ongoing coronavirus disease 2019 (COVID-19) pandemic has had a broad effect on social, economic, educational, and political systems. We investigated the effect of COVID-19 on emergency transportation due to acute alcohol intoxication in the Kochi Prefecture in Japan, a region with high alcohol consumption. This retrospective observational study was conducted using the data of 62,138 patients from the Kochi-Iryo-Net database, Kochi Prefecture's emergency medical and wide-area disaster information system. Chi-square tests and multiple logistic regression analyses were performed to examine the association between emergency transportation and alcohol intoxication. This analysis compared the monthly number of transportations during 2019 (as reference) with that throughout 2020 and 2021. Approximately 1.5 % of all emergency transportation cases were related to acute alcohol intoxication. The number of emergency transportation cases due to acute alcohol intoxication declined by 0.5 % in 2020 and 0.7 % in 2021 compared with that in 2019. Moreover, compared with that in 2019, the number of cases of emergency transportation due to acute alcohol intoxication significantly decreased in 2020 (incidence rate ratio: 0.78; 95 % confidence interval: 0.67–0.91) and 2021 (incidence rate ratio: 0.73; 95 % confidence interval: 0.63–0.86). Lifestyle changes due to the COVID-19 pandemic affected the number of emergency transports due to acute alcohol intoxication in 2020 and 2021 (during the COVID-19 pandemic) compared to that in 2019 (before the pandemic).

Adverse Events during Intrahospital Transport of Critically Ill Patients: A Multicenter, Prospective, Observational Study (I-TOUCH Study).

Critically ill patients are frequently transported to various locations within the hospital for diagnostic and therapeutic purposes, which increases the risk of adverse events (AEs). This multicenter prospective observational study was undertaken to determine the incidence of AEs related to intrahospital transport, their severity, and their effects on patient outcomes. We included consecutive unstable critically ill patients requiring intrahospital transport, across 15 Indian tertiary care centers over 5 months (October 11, 2022-February 20, 2023). Apart from the demographics and severity of illness, data related to transport itself, such as indications and destination, incidence of AEs, their category and treatment required, and patient outcomes, were recorded in a standard form. Eight hundred and ninety-three patients were transported on 1065 occasions out of the intensive care unit (ICU). The mean (SD) acute physiology and chronic health evaluation II score of the patients was 15.38 (±7.35). One hundred and two AEs occurred, wherein cardiovascular instability was the most common occurrence (31, 30.4%). Two patients had cardiac arrest immediately after transport. Acute physiology and chronic health evaluation II [odds ratio (OR): 1.02, 95% confidence interval (CI) - 1.00-1.05, p = 0.04], emergent transport (OR: 5.11, 95% CI - 3.32-7.88, p = 0.00), and team composition (OR: 5.34, 95% CI - 1.63-17.5, p = 0.00) during transport were found to be independent predictors of AEs. We found a high incidence of AEs during intrahospital transport of critically ill patients. These events were more common during emergent transports and when the patients were transported by doctors. Transport by itself was not related to ICU mortality. We feel that stabilization of the patients before transport and adherence to a standardized protocol may help in minimizing the AEs, thereby enhancing patient safety. Zirpe KG, Tiwari AM, Kulkarni AP, Govil D, Dixit SB, Munjal M, et al. Adverse Events during Intrahospital Transport of Critically Ill Patients: A Multicenter, Prospective, Observational Study (I-TOUCH Study). Indian J Crit Care Med 2023;27(9):635-641.

Community-based transport system in Shinyanga, Tanzania: A local innovation averting delays to access health care for maternal emergencies.

In achieving the sustainable development goal 3.1, Tanzania needs substantial investment to address the three delays which responsible for most of maternal deaths. To this end, the government of Tanzania piloted a community-based emergency transport intervention to address the second delay through m-mama program. This study examined secondary data to determine the cost-effectiveness of this intervention in comparison to the standard ambulance system alone. The m-mama program was implemented in six councils of Shinyanga region. The m-mama program data analyzed included costs of referral services using the Emergency Transportation System (EmTS) compared with the standard ambulance system. Analysis was conducted using Microsoft Excel, whose data was fed into a TreeAge Pro Healthcare 2022 model. The cost and effectiveness data were discounted at 5% to make a fair comparison between the two systems. During m-mama program implementation a total of 989 referrals were completed. Of them, 30.1% used the standard referral system using ambulance, while 69.9% used the EmTS. The Emergency transport system costed USD 170.4 per a completed referral compared to USD 472 per one complete referral using ambulance system alone. The introduction of m-mama emergency transportation system is more cost effective compared to standard ambulance system alone in the context of Shinyanga region. Scaling up of similar intervention to other regions with similar context and burden of maternal mortality may save cost of otherwise normal emergency ambulance system. Through lessons learned while scaling up, the intervention may be improved and tailored to local challenges and further improve its effectiveness.

Emergency fleet scheduling for maritime oil spill accidents considering demand-site dynamic motion under uncertain demand

This paper studies an optimal scheduling method for emergency fleets in maritime oil spill accidents. An oil spill accident has the characteristic of a multipoint distribution of demand sites. Considering the suddenness of the accident and the dynamic motion of oil film at sea, the demand for emergency resources is uncertain and the location of demand sites is time-varying. Through analysis of these characteristics, an emergency fleet scheduling model with multi-centre and multi-demand points was established. The study considered the demand uncertainty of emergency resources and the time-varying location of the demand sites to minimise emergency transportation costs and environmental pollution losses. Accordingly, an improved hybrid metaheuristic algorithm was designed based on a genetic algorithm and a simulated annealing algorithm. Numerical experiments were conducted to verify the effectiveness and practicability of the proposed method. The results can provide decision-making reference for the emergency response to maritime oil spill accidents.

Modeling the Decay in Probability of Receiving Endovascular Thrombectomy on the Basis of Time From Stroke Onset

Background American Heart Association guidelines specify infarct core volume as 1 determinant of eligibility for endovascular thrombectomy. Therefore, it is important to understand how time‐dependent infarct core growth translates to a patient's declining probability of thrombectomy eligibility. Modeling the probability that a patient with suspected large‐vessel occlusion would qualify for thrombectomy on the basis of their expected time from stroke onset to treatment can help inform the optimal prehospital emergency transport protocols, maximizing the likelihood of an excellent patient outcome. Methods We extended a published physiological model of infarct core growth to derive a decay curve of thrombectomy eligibility (based on a given infarct core volume threshold) as a function of time from stroke onset. We then adapted an existing model of the time‐dependent probability of an excellent outcome to incorporate this decay curve. Using the adapted model, we determined the optimal prehospital emergency transport protocols in Alberta, Canada, and compared these with the protocols that assumed all patients were thrombectomy eligible. Results The probability of qualifying for thrombectomy decays exponentially as time elapses from stroke onset. We found that the area where mothership is the optimal transport protocol increased by 18.6% after incorporating our decay curve of thrombectomy eligibility into the underlying optimization model. The benefit of mothership versus drip‐and‐ship also increased in the areas where mothership was favored, and in areas where drip‐and‐ship was favored, the benefit of drip‐and‐ship weakened. We also performed a number of sensitivity analyses to observe how these results change on the basis of our assumptions for model parameters. Conclusion This methodology provides a novel, physiology‐based approach to derive a thrombectomy eligibility curve. These models are necessary to better optimize prehospital transport decisions and consequently improve outcomes of patients with suspected large‐vessel occlusion.

The Experience and the Characteristics of Patients With Tele-ICU Implementation in a Rural Community Hospital.

Background Tele-ICUs are increasingly being used in the US. In Japan, young physicians mainly operate rural community hospitals to manage severely ill patients. However, the introduction of the tele-ICU system in Japan is still uncommon. We introduced a tele-ICU system to a community hospital. The objective of this study is to determine if the newly introduced tele-ICU system is being effectively utilized. Methods This is a single-center, retrospective observational study. We introduced the tele-ICU system to the NachiKatsuura Town Onsen Hospital, Japan, in 2019. Thereafter, we retrospectively explored the characteristics of the consulted cases, the time of consultation, the Sequential Organ Failure Assessment (SOFA) score, and the number of consultations by month from 1st July 2019 to 31st March 2020. The main outcome was the monthly number of consultations, and other measures included the clinical characteristics of the consulted cases. Results A total of 81 cases were referred to the tele-ICU system within nine months. Sixty-two cases, excluding those with missing data, were included in the analysis. The number of consultations was almost constant during the study period and was most frequent during the day. The recommendations from tele-ICU physicians were mostly "advice on the treatment plan." The mean SOFA score was 2.56. Conclusions We introduced a Japanese-type tele-ICU system for Japanese rural community hospitals. Many cases from rural community hospitals that were referred to the tele-ICU systems were moderately severe and did not require urgent transportation. These cases are not indicated for emergency transportation and should be treated in rural community hospitals.

Impact of Heavy Snowfall on Emergency Transport and Prognosis of Out-of-Hospital Cardiac Arrest Patients: A Nation-Wide Cohort Study.

Out-of-hospital cardiac arrest (OHCA) is a significant global cause of mortality, and Emergency Medical Services (EMS) response interval is critical for survival and a neurologically-favorable outcome. Currently, it is unclear whether EMS response interval, neurologically-intact survival, and overall survival differ between snowy and non-snowy periods at heavy snowfall areas. A nation-wide population-based cohort of OHCA patients, registered from 2017 through 2019 in the All-Japan Utstein Registry, was divided into four groups according to areas (heavy snowfall area or other area) and seasons (winter or non-winter): heavy snowfall-winter, heavy snowfall-non-winter, other area-winter, and other area-non-winter. The first coprimary outcome was EMS response interval, and the secondary coprimary outcome was one-month survival and a neurologically-favorable outcome at one month. A total of 337,781 OHCA patients were divided into four groups: heavy snowfall-winter (N = 15,627), heavy snowfall-non-winter (N = 97,441), other area-winter (N = 32,955), and other area-non-winter (N = 191,758). Longer EMS response intervals (>13 minutes) were most likely in the heavy snowfall-winter group (OR = 1.86; 95% CI, 1.76 to 1.97), and also more likely in heavy snowfall areas in non-winter (OR = 1.44; 95% CI, 1.38 to 1.50). One-month survival in winter was worse not only in the heavy snowfall area (OR = 0.86; 95% CI, 0.78 to 0.94) but also in other areas (OR = 0.91; 95% CI, 0.87 to 0.94). One-month neurologically-favorable outcomes were also comparable between heavy snowfall-winter and other area-non-winter groups. This study showed OHCA in heavy snowfall areas in winter resulted in longer EMS response intervals. However, heavy snowfall had little effect on one-month survival or neurologically-favorable outcome at one month.

Snakebite envenomations and access to treatment in communities of two indigenous areas of the Western Brazilian Amazon: A cross-sectional study.

The indigenous populations of Brazil present poor health indicators and a disproportionate prevalence and case-fatality rate of neglected tropical diseases, including snakebite envenomations (SBEs). This study aims to estimate access to medical care for SBEs and analyze the barriers that prevent victims from accessing healthcare in indigenous communities in two health districts located in the Western Brazilian Amazon. This cross-sectional study used semi-structured interviews to collect data from individuals who experienced SBEs in the Upper Rio Solimões and Upper Rio Negro indigenous health districts. Of the 187 participants, 164 (87.7%) reported that they had access to healthcare and received assistance in a hospital in the urban area of the municipalities. Frequency was 95.4% in the Upper Rio Solimões SIHD, and 69.6% in the Upper Rio Negro SIHD (P<0.0001). The study found that the availability of indigenous medicine as the only choice in the village was the main reason for not accessing healthcare (75%), followed by a lack of financial resources and means of transportation (28.1%). Four deaths were reported from SBEs, resulting in a case-fatality rate of 2.1%. In the study areas, there are records of SBE patients who did not receive medical attention. Availability of pre-hospital emergency transport using motorboats, a greater number of hospitals and better navigability of the Solimões River and its tributaries would make access easier for indigenous people living in the region of the Upper Solimões River. The implementation of cross-cultural hospital care needs to be considered in order to reduce the resistance of indigenous populations in relation to seeking treatment for SBEs.

Structured Referral Call Handling Process Improves Neonatal Transport Dispatch Times.

In 2019 the Southern Alberta Neonatal Transport Service adopted a transport call handling process change to expedite transport team mobilization. This study compares the impact of this change on neonatal transport decision to dispatch and mobilization times. This retrospective cohort study was conducted using a historical cohort of neonates referred for transportation between January 2017 and December 2021. The "dispatch time" (DT) was the time from the start of consultation to the time a decision to dispatch the transport team was made, whereas "mobilization time" (MT) referred to the time from start of consultation to the time the team departed the home base. In 2019, a DT target of <3 minutes was implemented to meet a target MT of <15 and <30 minutes for emergent and urgent high-risk transport referral calls, respectively. In 2021 use of the "Situation" component of the SBAR (Situation, Background, Assessment, Recommendation) communication tool was introduced with the transport team asking five questions to determine need for mobilization. Data between 2017 and 2018 represented the preintervention period, 2019, the "washout" period for implementation, and 2020 to 2021, the postintervention period. Data were analyzed to determine trends in DT and MT. The DT was reduced from a median of 5 to 3 minutes following intervention (p < 0.001). DT target goal of 3 minutes was achieved in 67.08% of calls compared with 26.24% in the preintervention period, (p < 0.001). The team achieved MT target goals in 42.71% of urgent and emergent transfers compared with 18.05% prior to intervention (p < 0.001). Introduction of a time-sensitive referral call handling process improved dispatch and mobilization time of the neonatal transport team. · Time-sensitive triaging of neonatal transport referrals improves dispatch and mobilization time.. · A structured referral call handling process improves the efficiency of neonatal transport decision-making.. · Dedicated neonatal transport vehicles are likely to improve neonatal transport mobilization time..

Pre-Hospital Emergency Medical Services Utilization Amid COVID-19 in 2020: Descriptive Study Based on Routinely Collected Dispatch Data in Bavaria, Germany.

The COVID-19 pandemic affected the utilization of health care services and posed organizational challenges. While many previous studies focused on the misuse of pre-hospital EMS for low-urgency health problems, the pandemic has put more emphasis on the avoidance of medically necessary calls. To compare the utilization of pre-hospital emergency medical services before and after specific pandemic periods. This was a retrospective, descriptive analysis of routine data from 26 dispatch centers in Bavaria, Germany. We investigated the number of emergencies per 100,000 population, as well as the relative change in the emergency rates and transport rates in 2020, compared to the two previous years. Boxplots showed the distributions across the Bavarian districts per calendar week. The mean rates and standard deviations as well as the relative changes were presented for the specific periods. A paired samples t-test was used to compare the rates. Compared to the average of the two previous years, the emergency rates in 2020 were lower in 35 out of 52 calendar weeks. The strongest reductions were observed during the first wave, where the average emergency rate declined by 12.9% (SD 6.8, p < 0.001). There was no statistically significant difference in the overall emergency rate during the summer holidays. Lower transport rates were observed throughout the year, especially during the first wave. Utilization of pre-hospital emergency medical services decreased in 2020, especially during the periods with strict measures. This could be due to the lower morbidity from the behavioral changes during the pandemic, but also to the avoidance of medical services for both less urgent and severe conditions. While a reduction in unnecessary care would be beneficial, patients must be encouraged to seek necessary urgent care, even during a pandemic.

Laryngeal mask airway in neonatal stabilization and transport: a retrospective study

Laryngeal mask airway (LMA) may be considered by health caregivers of level I–II hospitals for neonatal resuscitation and stabilization before and during interhospital care, but literature provides little information on this aspect. This study reviewed the use of LMA during stabilization and transport in a large series of neonates. This is a retrospective study evaluating the use of LMA in infants who underwent emergency transport by the Eastern Veneto Neonatal Emergency Transport Service between January 2003 and December 2021. All data were obtained from transport registry, transport forms, and hospital charts. In total, 64/3252 transferred neonates (2%) received positive pressure ventilation with an LMA, with increasing trend over time (p = 0.001). Most of these neonates were transferred after birth (97%), due to a respiratory or neurologic disease (95%). LMA was used before the transport (n = 60), during the transport (n = 1), or both (n = 3). No device-related adverse effects were recorded. Sixty-one neonates (95%) survived and were discharged/transferred from the receiving center. Conclusion: In a large series of transferred neonates, LMA use during stabilization and transport was rare but increasing over time, and showed some heterogeneity among referring centers. In our series, LMA was safe and lifesaving in “cannot intubate, cannot oxygenate” situations. Future prospective, multicenter research may provide detailed insights on LMA use in neonates needing postnatal transport.What is Known:• A supraglottic airway device may be used as an alternative to face mask and endotracheal tube during neonatal resuscitation.• The laryngeal mask may be considered by health caregivers of low-level hospitals with limited exposure on airway management, but literature provides little information on this aspect.What is New:• In a large series of transferred neonates, laryngeal mask use was rare but increasing over time, and showed some heterogeneity among referring centers.• The laryngeal mask was safe and lifesaving in “cannot intubate, cannot oxygenate” situations.

QUANTITATIVE ASSESSMENT OF THE STABILITY OF PORTABLE RADIOGRAPHIC MONITORING TOOLS TO THE FACTORS OF A TRANSPORT ACCIDENT BY THE METHOD OF FINITE ELEMENT CALCULATIONS

A method of quantitative finite-element verification of stability of design and technological solutions of new generation portable radiographic equipment to the factors of transport accident at the stage of automated design of mathematical solid model of the shutter-type radiation head using software packages: "ZENIT-95" and "LS-DYNA" is proposed for consideration. The need for virtual quantitative assessment of stability of developed gamma detector components to emergency transport conditions at the design stage is largely due to the need to reduce costs for full-scale prototyping of technical solutions and test emergency tests. At the same time, production of prototypes equipped with radionuclide emitters without substantiating confirmation of the consistency of design solutions to extreme transportation conditions is certainly risky. Minimization of risk of making incorrect technical decisions at the stage of designing of radiographic control facilities of new generation with confirmation of consistency of design solutions to conditions of emergency transportation can be provided with the use of systems of automated design in 3D format and program-calculating modules "LS-DYNA" and "ZENIT-95" by finite-element calculations method. The object of the quantitative analysis of stability of the main functional unit of portable gamma detector to the transport accident factors by the finite element calculations method is a mathematical solid model of the radiation head conditionally containing radionuclide radiator and virtually exposed to transport accident factors: fall from height onto a target; thermal effects of fire. The 3D model of the WG as the main functional part of the gamma detector represents a logically connected system of elements, the state of which can be described by a set of differential equations, the solution of which using digital technology determines the stresses, strains and zones of thermal effect, allowing a quantitative assessment of mechanical strength and thermal stability of the structural solutions of the product. The results of finite element analysis in the software package "LS-DYNA" with a quantitative assessment of structural and strength stability of the radiation head of a gamma detector when falling from height, as well as the results of stability to thermal influence by the example of a finite element model of the radiation head in the software package "ZENIT-95" are presented.

Human Caring at Different Stages After Disasters

Disasters, including natural disasters and man-made ones, occur rather frequently in recent years. Disasters bring destruction to the resources and expectations of local residents and cause varying degrees of physical and mental damage to the victims, some of whom suffered persistent post-traumatic stress disorder (PTSD). Human caring is the essence and core of nursing. Giving consideration to the needs and wishes of patients, the nursing staff respect the personal values of patients, give patients sincere attention and care, satisfy the reasonable needs of patients, protect the dignity of patients, stimulate patients' positive inner drive, alleviate their physical and mental pain, and facilitate the smooth recovery of patients. However, very few studies have been done to look into the human caring at various stages after a disaster hit and there is little relevant guidance available. Herein, we examined the characteristics and needs of victims of disasters in the post-disaster response stage and recovery stage and elaborated on specific and feasible measures for the implementation of human caring after disasters, including prehospital emergency care, which includes on-the-site emergency care and transportation of patients, in-hospital treatment, which includes an environment of human caring and human caring for patients and their families, especially for the special-needs populations, and post-hospital recovery stage, which includes post-hospital continuing and community-based human caring. We intend to provide guidance and reference for the practice of human caring when major disasters occur.

The ways to overcome the crisis situations in the fuel and energy complex field under martial law (Ukrainian experience)

The article reveals the problems of functioning of the fuel and energy complex of Ukraine under martial law. It was determined that Ukraine faced a crisis in the field of energy security due to Russian terrorist attacks on well infrastructure facilities, as well as the main strategies and mechanisms of response to crisis phenomena in the field of the fuel and energy complex, which are carried out through legislative and regulatory changes, were investigated; analyzed changes aimed at ensuring the security of supply and access of citizens to energy during wartime and preventing humanitarian crises. The article provides an overview of the adopted legislative changes in the field of the Ukrainian fuel and energy complex, defines the role of the Energy Community, which helps Ukraine to restore critical infrastructure objects faster and minimize damage from terrorist missile attacks, and also helps with the logistics of necessary materials to overcome crisis phenomena. It is noted that in order to become more independent in the field of fuel and energy complex in the future, Ukraine needs diversification, energy efficiency and fast renewable energy. From the point of view of diversification, Ukraine needs to increase its purchases of liquefied natural gas (LNG) from such suppliers as the USA, Qatar, Norway, African producers and others. Ukraine was able to pass the heating period 2022/2023. And this result was ensured by the heroic efforts of gas workers, heat workers, electricians, employees of the State Emergency Service, transport and logistics. The power industry held on, albeit at a high cost — unfortunately, there were casualties among repairmen, operating personnel, and engineering staff, not to mention the damaged and destroyed infrastructure At present, the global energy crisis is not over yet, therefore, it is extremely necessary to consolidate the efforts of the entire civilized world to avoid possible negative bifurcations in the further development of the situation, in particular, to prevent options and conditions under which this crisis can turn into a global political crisis Ukraine needs to take into account the energy development trends of the world and Europe and focus on decentralized and distributed "green" energy.

Long-distance transfer of unwell neonates: A case series.

The Northern Territory Neonatal Emergency Transport Service (NETS NT) pilot was created in April 2018 to expedite the transfer of critically unwell neonates to specialised interstate centres. The aim of this paper is to describe long-distance retrievals undertaken during the first 3 years of operation of the service. A case series is described comprising neonates requiring long-distance aeromedical transfer (>2500 km) by NETS NT between April 2018 and June 2021. Data were obtained from hospital and transport service documentation. This was supplemented by four semi-structured interviews with transport staff. Thirty neonates were transferred via NETS NT during the investigation period, including 19 transfers >2500 km. Of these, 18/19 (94.7%) required respiratory support, 8/19 (42.1%) were intubated and 4/19 (21.1%) required inotropic support. The average length of transport was 7.5 h (5.6-8.9). Twelve patients had in-flight documentation available. Eight required increased oxygen administration 8/12 (66.6%). The median change in FiO2 was an increase of 0.02 (-0.05 to 0.45). The NETS NT has been successfully established to transport high-risk neonates to interstate quaternary health services when required. Future recommendations for the service include ongoing implementation of systems and processes to strengthen all aspects of governance and operations using suitably adapted resources from established Australian retrievals services.

Maternal mortality in Bangladesh: Who, when, why, and where? A national survey-based analysis.

Despite a notable decline in recent decades, maternal mortality in Bangladesh remains high. A thorough understanding of causes of maternal deaths is essential for effective policy and programme planning. Here we report the current level and major causes of maternal deaths in Bangladesh, focusing on care-seeking practices, timing, and place of deaths. We analysed data from the 2016 Bangladesh Maternal Mortality and Health Care Survey (BMMS), conducted with nationally representative sample of 298 284 households. We adapted the World Health Organization's 2014 verbal autopsy (VA) questionnaire. Trained physicians reviewed the responses and assigned the cause of death based on the International Classification of Diseases (ICD-10). We included 175 maternal deaths in our analysis. The maternal mortality ratio was 196 (uncertainty range = 159-234) per 100 000 live births. Thirty-eight per cent of maternal deaths occurred on the day of delivery and 6% on one day post-delivery. Nineteen per cent of the maternal deaths occurred at home, another 19% in-transit, almost half (49%) in a public facility, and 13% in a private hospital. Haemorrhage contributed to 31% and eclampsia to 23% of the maternal deaths. Twenty-one per cent of the maternal deaths occurred due to indirect causes. Ninety-two per cent sought care before dying, of which 7% sought care from home. Thirty-three per cent of women who died due to maternal causes sought care from three or more different places, indicating they were substantially shuttled between facilities. Eighty per cent of the deceased women who delivered in a public facility also died in a public facility. Two major causes accounted for around half of all maternal deaths, and almost half occurred during childbirth and by two days of birth. Interventions to address these two causes should be prioritised to improve the provision and experience of care during childbirth. Significant investments are required for facilitating emergency transportation and ensuring accountability in the overall referral practices.

Carrier‐Modulated Anomalous Electron Transport in Electrolyte‐Gated SrTiO3

The anomalous transport phenomena and underlying mechanism of SrTiO3 have been long term concerned, including the Kondo physics and anomalous Hall effects to be discussed herein. Nevertheless, a clarification of the physical origins for these phenomena and their intertransitions upon varying carrier density remain to be an issue, due to the limited modulation of carrier density. Herein, the intriguing transport behaviors of electrolyte‐gated SrTiO3 in the field‐effect transistor geometry are investigated, which allows a relatively wide carrier density window. It is revealed that the remarkable Kondo‐like resistance upturn, identified at relatively low carrier density, becomes gradually disappeared and replaced by the emerging nonlinear Hall resistance with increasing gating voltage, indicating the interesting gating‐controlled transport behaviors. The detailed discussions on the underlying physics suggest that the gating‐controlled transport can be well described by the multiband transport model taking into account magnetic scattering in the channel layer, a comprehensive scenario for the emergent transport effects in carrier‐doped SrTiO3. The present work provides a promising platform for exploring novel quantum materials phenomena in SrTiO3 and analogous systems.

Emergent anomalous transport and non-Gaussianity in a simple mobile–immobile model: the role of advection

We analyse the transport of diffusive particles that switch between mobile and immobile states with finite rates. We focus on the effect of advection on the density functions and mean squared displacements (MSDs). At relevant intermediate time scales we find strong anomalous diffusion with cubic scaling in time of the MSD for high Péclet numbers. The cubic scaling exists for short and long mean residence times in the immobile state . For long the plateau in the MSD at intermediate times, previously found in the absence of advection, also exists for high Péclet numbers. Initially immobile tracers are subject to the newly observed regime of advection induced subdiffusion for short immobilisations and high Péclet numbers. In the long-time limit the effective advection velocity is reduced compared to advection in the mobile phase. In contrast, the MSD is enhanced by advection. We explore physical mechanisms behind the emerging non-Gaussian density functions and the features of the MSD.

Rectal artesunate for severe malaria, implementation research, Zambia.

To determine whether the positive results of a single-district pilot project focused on rectal artesunate administration at the community level in Zambia could be replicated on a larger scale. In partnership with government, in 10 rural districts during 2018-2021 we: (i)trained community health volunteers to administer rectal artesunate to children with suspected severe malaria and refer them to a health facility; (ii)supported communities to establish emergency transport, food banks and emergency savings to reduce referral delays; (iii)ensured adequate drug supplies; (iv)trained health workers to treat severe malaria with injectable artesunate; and (v)monitored severe malaria cases and associated deaths via surveys, health facility data and a community monitoring system. Intervention communities accessed quality-assured rectal artesunate from trained community health volunteers, and follow-on treatment for severe malaria from health workers. Based on formal data from the health management information system, reported deaths from severe malaria reduced significantly from 3.1% (22/699; 95% confidence interval, CI: 2.0-4.2) to 0.5% (2/365; 95% CI: 0.0-1.1) in two demonstration districts, and from 6.2% (14/225; 95% CI: 3.6-8.8) to 0.6% (2/321; 95% CI: 0.0-1.3) in eight scale-up districts. Despite the effects of the coronavirus disease, our results confirmed that pre-referral rectal artesunate administered by community health volunteers can be an effective intervention for severe malaria among young children. Our results strengthen the case for wider expansion of the pre-referral treatment in Zambia and elsewhere when combined with supporting interventions.

Novel application of multi-facility process map analysis for rapid injury care health system assessment in Northern Malawi

ObjectivesWe used the process mapping method and Three Delays framework, to identify and visually represent the relationship between critical actions, decisions and barriers to access to care following injury in...