Short-term Missions Research Articles

Intraoperative Anesthesia-Related Critical Events in Low-Resource Hospitals During Short-Term Surgical Missions in Tanzania and Democratic Republic of the Congo: An Observational Study.

Critical incidents and mortality related to anesthesia are more frequently observed in low- and middle-income countries in comparison to high-income countries. The difficulties linked to anesthesia in rural areas of the Democratic Republic of the Congo (DRC) and Tanzania have limited documentation. The aim of this study was to comprehensively document anesthesia-related critical events that occurred during surgical missions organized by the nongovernmental organization 2nd Chance in hospitals in DRC and Tanzania. Data were collected during 6 surgical missions in 3 hospitals in the DRC and 1 in Tanzania. All scheduled surgery patients were included. Anesthesia was administered by a local Non-Physician Anesthesia Provider (NPAP), using local resources, under the supervision of an anesthesiologist from the association. The anesthesiologist reported critical events and collected data. Local teams managed critical events initially, with intervention by the anesthesiologist from 2nd Chance on the local team's request, according to preestablished protocol or if the situation was considered dangerous. Critical incidents associated with anesthesia, including bradycardia, hypoxemia, airway management failure, and equipment problems, were documented from induction of anesthesia until discharge from the recovery room. We recruited 201 patients, of whom 192 were evaluated, with 9 patients dropping out due to protocol noncompliance. All patients were American Society of Anesthesiologists (ASA) I (62%; n = 120) or ASA II (38%; n = 72). Among them, 104 individuals (54%) experienced at least 1 critical event, totaling 202 critical events. Hypoxemia emerged as the most common event, affecting 29% of the patients (n = 55) with at least 1 episode. Equipment problems (oxygen supply and/or anesthesia machine failure) occurred in 24% of cases (n = 46), airway management issues in 23% (n = 44), and bradycardia in 6% (n = 12). Hypotension and hypertension were not documented due to the lack of monitoring. The majority of these events (over 60%) required intervention by the anesthesiologist. The occurrence of critical events related to anesthesia appears to be high in this study. Due to numerous limitations, these results cannot be generalized to all hospitals in Tanzania and the DRC. However, this study underscores the challenges faced by anesthesia teams, encompassing inadequate resources, equipment deficiencies, and varying levels of expertise among anesthesia personnel. The research further stresses the significance of addressing these challenges to enhance patient safety.

A Cosmopolitan Argument for Temporary "Diagonal" Short-Term Surgical Missions as a Component of Surgical Systems Strengthening.

A Cosmopolitan Argument for Temporary "Diagonal" Short-Term Surgical Missions as a Component of Surgical Systems Strengthening.

479 The Impact of Short-term Medical Missions on the Resilience of Healthcare Students and Professionals

479 The Impact of Short-term Medical Missions on the Resilience of Healthcare Students and Professionals

Unveiling the Lasting Impact: A 15-Year Follow-Up of Short-Term Surgical Mission Experiences

IntroductionResident interest in global surgery has increased over recent years. Incorporating short-term surgical missions (STSMs) into training improves Accreditation Council for Graduate Medical Education (ACGME) competencies and aids in understanding of global health infrastructure. We aim to investigate the impact of STSM participation during residency on the desire for participation after residency, and barriers in doing so. MethodsEighteen general surgery residents who participated in STSM with the International Surgical Health Initiative from 2009 to 2017 were surveyed. An 18-question survey encompassing demographics, mission-specific data, ACGME competencies, current perspectives, barriers, and areas for improvement was distributed. ResultsThe group averaged 5.4 y out of residency and 89% (n = 16) completed the survey. Mean age was 38.5 y with a female predominance (62.5%). During residency, 10 (62.5%) participated in ≥ two STSMs and six (37.5%) participated in one STSM. On average, each resident performed 24 cases per mission. All reported that after their resident STSM experience, they were more inclined to participate as an attending. Twenty-five percent (n = 4) participated in STSMs after residency. Vacation, scheduling, and family factors were ranked the highest barriers. All ACGME competencies were felt to be significantly improved by STSMs. ConclusionsThis is the first long-term follow-up study of general surgery residents who participated in STSMs confirming that resident involvement increases desire for continued participation. Although 100% of residents wanted to participate as attendings, only 25% were successful in doing so. While operative experience is salient in surgical residency, there are other valuable experiences to be gained. Further work should focus on enhancing experiences and mitigation of barriers to continued participation in global humanitarian initiatives.

Aggregated planning to solve multi-product multi-period disassembly line balancing problem by considering multi-manned stations: A generic optimization model and solution algorithms

Disassembly lines are crucial in the recovery process of end-of-life (EOL) products, facilitating the systematic extraction of parts to meet predetermined objectives. While previous studies have made significant advancements, they have not addressed the disassembly line planning and balancing problem by focusing on the real-life significance of combining long-term decision-making and short-term operational missions. This study fills this gap by combining multi-product, multi-period, and multi-manned disassembly line concepts into a novel integrated approach. Initially, a generic optimization model is formulated, incorporating the concept of multi-manned stations. Subsequently, genetic algorithm (GA)-based solution approaches are developed to address the problem’s complexity. Three tactical-level policies, including economic disassembly quantity (EDQ), just-in-time (JIT), and random (R) based lot size policies, are explored within the algorithms. Additionally, simulated annealing-based local search algorithms and two crossover operators, CR1 and CR2, are incorporated to enhance solution quality. Through computational analysis, six algorithms are evaluated, with the GACR1-JIT algorithm demonstrating significant cost reductions compared to alternatives. The findings underscore the growing importance of JIT-based lot size policies, particularly with an increasing number of periods. This research bridges theoretical and practical considerations by highlighting the strategic importance of combining long-term disassembly line planning and short-term lot sizing decisions to improve system performance.

Heart Preparation for Short-Term Missions.

Involvement in short-term missions experiences can be most beneficial when intentional personal and group preparation takes place. Learning about the people and history of the destination, identifying one's purpose in making the trip, asking God for direction and affirmation, meditation on Scripture, and prayer for oneself and for those who will be on the receiving end of care or ministry are wise. Willingness to take a servant's mindset and to give time and goods from a biblical perspective shows respect for those to be served.

IPA Analysis: Exploring the Postsurgical Needs of Guatemalan Children & Their Families From Low-SES Communities Using an OT Lens

Abstract Date Presented 03/22/24 This study explores the experiences of children and families from low-socioeconomic status (SES) communities after short-term surgical mission trips in Guatemala. The findings highlight the occupational injustices that challenge recovery experienced by this population. Primary Author and Speaker: Diana Del Carmen Tojin Additional Authors and Speakers: Karen Aranha Contributing Authors: Karen Aranha, Angela Labrie Blackwell

Pediatric anesthesia outreach in low and middle-income countries: Models, motives, and moral misalignments.

A lack of anesthesia and surgical capacity leaves approximately 1.7 billion children per annum without access to surgical and anesthetic care. Over the past 50 years, the predominant strategy to address this lack of access has been to provide surgical capacity primarily from high-income countries (HICs) to low and middle-income countries (LMICs) in the form of short-term surgical missions. More recently, the international medical community has recognized the need to build sustainable surgical capacity in resource-constrained settings. This article reviews three models of surgical aid: the vertical model (short-term surgical missions); the horizontal model (system-wide capacity building); and the diagonal model, which is a hybrid of the first two. At their core, medical aid interventions exist on a spectrum ranging from providing surgical capacity to building surgical capacity. The skills, attitudes, and behaviors that drive success in providing medical capacity are fundamentally different from those that drive success in building medical capacity. The root cause of this difference is a shift in the moral duty of the visiting physician from a duty solely to the patient in front of them (based on the primacy of the doctor-patient relationship) to include a duty to the local physicians and the local medical system, and by extension to the next 10 000 patients in need of care. Failure to address the conflicts engendered by this fundamental moral shift risks undermining capacity-building efforts in all models of medical aid.

Factors Associated With Lack of Long-Term Follow-Up Data After Global Cardiac Surgery Missions.

Background: Humanitarian medical missions attempt to lessen the burden of limited access to cardiac surgery in low- and middle-income countries. While organizations express difficulties obtaining follow-up information, there is currently little evidence to support the various assumptions for lack of data. This study examines the factors influencing long-term patient follow-ups on repeated short-term cardiac surgery missions across nine countries. Methods: A retrospective analysis of CardioStart International's database (RedCap) was conducted to investigate demographic, socioeconomic, and surgical factors associated with follow-ups. Results: A total of 550 pediatric (50%) and adult (50%) cardiac surgery patients displayed a follow-up rate of 14.7%, with no significant difference between populations (P = 1). Mean follow-up time was 1.5 years postoperative. Countries were highly variable, with Dominican Republic and Vietnam showing follow-up rates of 30.4% and 43.2%, respectively, while Brazil, Nepal, and Tanzania had no follow-ups (P < 0.0001). The 11 surrogate factors for socioeconomic status, including home amenities and technology access, were predominantly insignificant, with the exception of phone access showing an unexpectedly decreased follow-up rate (11.6%, P = 0.006). Surgical intervention was a significant factor (P = 0.009). No adult cardiac surgery trends were noted; however, congenital cases demonstrated increased follow-ups in patients with higher Risk Adjusted Congenital Heart Surgery scores, with ventricular septal defects (32.5%) exceeding atrial septal defects (7.3%). Conclusions: Follow-ups correlate with mission factors, including location and types of intervention, more so than previously assumed socioeconomic and technological factors. Thus, certain missions may require more allocation of resources and adapted organizational policies to overcome site-specific barriers to follow-up.

Beyond the Expected: Evaluating Preoperative Predictors of a Difficult Cholecystectomy Aboard the USNS Comfort.

Mini abstract Typical preoperative markers of a difficult laparoscopic cholecystectomy did not apply during the US Naval ShipComfort Deployment in 2019. This prospective study reveals the importance of preparedness for short-term surgical missions, the impact of health care disparities on the severity of disease, and the need for deliberate and thoughtful engagement with host-nation partners.

Long-term space missions' effects on the human organism: what we do know and what requires further research.

Space has always fascinated people. Many years have passed since the first spaceflight, and in addition to the enormous technological progress, the level of understanding of human physiology in space is also increasing. The presented paper aims to summarize the recent research findings on the influence of the space environment (microgravity, pressure differences, cosmic radiation, etc.) on the human body systems during short-term and long-term space missions. The review also presents the biggest challenges and problems that must be solved in order to extend safely the time of human stay in space. In the era of increasing engineering capabilities, plans to colonize other planets, and the growing interest in commercial space flights, the most topical issues of modern medicine seems to be understanding the effects of long-term stay in space, and finding solutions to minimize the harmful effects of the space environment on the human body.

ОЦЕНКА РАДИАЦИОННОЙ ОБСТАНОВКИ ПРИ КРАТКОВРЕМЕННЫХ ПОЛЕТАХ НА ЛУНУ

Background: The issue of assessing the features of factors affecting the formation of radiation doses of astronauts while in orbit of the Moon and on its surface remains insufficiently studied, which is important for ensuring the anti-radiation safety of astronauts on lunar missions. Purpose: To analyze the factors influencing the formation of the radiation dose of astronauts at the stage of finding the spacecraft in orbit of the Moon and the lander on its surface. Material and methods: The features of the dose load levels on astronauts at the stages of the Moon’s orbit and on the Moon’s surface are analyzed and generalized, calculation methods are used taking into account the orbit of the spacecraft around the Moon, the anti-radiation properties of the materials of the lander and spacesuit and the time spent in them during a short-term lunar mission. Results: The total radiation doses of astronauts for 14 days, calculated according to dosimetric measurements during the years of low solar activity (2009 and 2018‒2019), are 19.5‒23.2 mSv for astronauts staying in a spacecraft in lunar orbit, and from 22,7 to 24,0 mSv for astronauts on the Lunar surface, depending on the mass thickness of the protection at the maximum permissible 250 mSv for 1 month. An increase in the mass thickness of the anti-radiation protection of the lander in the equivalent of aluminum from 1.5 to 3-5 g/cm2 and the lunar spacesuit in the equivalent of aluminum from 0.2 to 0.5‒1 g/cm2 will reduce the total radiation dose of astronauts no more than 1.3 times during a 14-day stay on the surface of the moon. The results indicate that in order to minimize the radiation doses that astronauts receive during a lunar mission, it is important to take into account the forecast of solar activity in order to optimize the launch time of the spacecraft in the «windows» with minimal levels of radiation exposure. Conclusion: When predicting radiation hazard levels for astronauts during a short-term lunar mission, it is necessary to assess the levels of exposure to cosmic ionizing radiation both in the orbit of the Moon, depending on the lunar trajectory of the spacecraft, and on the surface of the Moon, taking into account the time spent in the lunar module and in a spacesuit, as well as levels of solar activity. It is important to take into account the analyzed features of the formation of cosmonauts’ radiation doses while orbiting the Moon and on its surface when predicting the time limits of the lunar mission, anti-radiation protection of astronauts and their compliance with the regulatory limits of exposure.

Lesser in Lebanon: Reflections on a Short-Term Mission Experience.

During the aftermath of the Syrian civil war conflict, a short-term mission trip to Lebanon brought insight to this author. Reflection on the ministry of Jesus Christ allowed the author to consider how engagement in a short-term mission affects the individuals one has the intention to serve. Similarities between short-term missions and nursing practice through a biblical lens are considered.

АНАЛИЗ ВОЗМОЖНЫХ УРОВНЕЙ ОБЛУЧЕНИЯ КОСМОНАВТОВ ПРИ КРАТКОСРОЧНОЙ ЛУННОЙ МИССИИ

Probable dose loads to cosmonauts in a short-term lunar mission including the transit and stay on the surface were estimated using actual measurements and model calculations. It was found that doses of radiation received in a 21-day mission with a 14-day stay on the Moon in the period of minimal solar activity will make about 130 mSv; in the period of solar maximum and in case of a solar event radiation doses may reach 9–12 Svwith the maximum admissible dose of 250 mSv over a month. Increase of mass thickness of radiation shield of the command module from 10 to 20 g/cm2 (aluminum equivalent) and of the EVA spacesuit from 0.2 to 0.5-1.0 g/cm2 (aluminum equivalent) can reduce 1.4 times the total dose to cosmonauts in the period of solar minimum. Minimization of crew radiation levels requires a consideration of the solar activity forecast in order to choose the launch "windows" when high-energy electrons flow in the Earth's external radiation belt is minimal, and space weather along the route to the Moon.

ИНДИВИДУАЛЬНЫЕ ОСОБЕННОСТИ И ФАКТОРЫ УСПЕШНОСТИ АДАПТАЦИИ К УСЛОВИЯМ ДВУХНЕДЕЛЬНОЙ ИЗОЛЯЦИИ, МОДЕЛИРУЮЩЕЙ ПОЛЕТ НА ЛУНУ

The investigation is analysis of psychological adaptation to an experimental isolation modeling a short-term space exploration mission. Project Eskiz (Sketch) was designed as a 14-d isolation of 4 male and 2 female subjects in a small chamber including exits on a Lunar surface on days 8 and 9. Dynamics of adaptation to the psychological stress in isolation was analyzed by 4 subsyndromes. For all crewmembers particularly stressful were the first 4 days of isolation, and EVA days. Three coping strategies were stable (reliable), situational (unstable) and asthenic (unbalanced). The favorable factors included previous experience, high motivation, goal-based cohesion of the crew and cultural commonality. Results of the investigation can be of practical implication in optimization of the methods of selection, preparation and consulting spacecrew members in future missions.

Concepts for drone based pipeline leak detection.

The quickly developing drone technology can be used efficiently in the field of pipeline leak detection. The aim of this article is to provide drone mission concepts for detecting releases from pipelines. It provides an overview of the current applications of natural gas pipeline surveys, it considers environmental conditions by plume modelling, it discusses suitable commercially available sensors, and develops concepts for routine monitoring of pipelines and short term missions for localising and identifying a known leakage. Suitable platforms depend on the particular mission and requirements concerning sensors and legislation. As an illustration, a feasibility study during a release experiment is introduced. The main challenge of this study was the variability of wind direction on a time scale of minutes, which produces considerable differences to the plume simulations. Nevertheless, the leakage rates derived from the observations are in the same order of magnitude as the emission rates. Finally the results from the modeling, the release experiment and possible drone scenarios are combined and requirements for future application derived.

Plastic Surgical Outreach to Low- and Middle-income Countries and Global Health Priorities: An Analysis of 96 Nongovernmental Organizations.

Conditions that are treated by surgery constitute a significant portion of the global burden of disease. In low- and middle-income countries (LMICs), allocation of resources toward the most cost-effective surgical procedures (essential surgery) and care delivery platforms is critical. Nongovernmental organizations (NGOs) and the plastic surgeons who work with them play a significant role in plastic surgical outreach to LMICs. However, it is unknown whether their work aligns with existing global public health recommendations. A previously established internet-based methodology was used to identify plastic surgical NGOs. Through direct correspondence with NGOs and publicly available data, plastic surgical NGOs were cataloged with respect to the subspecialty areas of plastic surgery performed, care delivery platforms, and geographic sites. These results were then compared with the existing global public health recommendations. A total of 96 NGOs met inclusion criteria. The most common subspecialty area was cleft surgery (80.3%), followed by pediatric plastic surgery (46.9%). No NGOs used a continuous care delivery platform. Instead, all NGOs used an intermittent model through short-term surgical missions, of which 62.8% used a nonrotating care model and returned to the same site(s) annually, whereas 37.2% used a rotating care model. Most NGOs perform cleft surgery, an area considered essential surgery, and thus, collectively, the work of NGOs largely aligns with global public health priorities. However, there is room for improvement for both the types of procedures performed and the care delivery platforms to provide the most cost-effective and sustainable care.

Exodus of Lebanese doctors in times of crisis: a qualitative study.

Since 2019, Lebanon is experiencing an unprecedented exodus of doctors, seriously threatening the national health system, which is expected to continue without quick and effective solutions. Therefore, this study aimed to understand the factors that push Lebanese doctors to migrate and the factors that retain others in the country. Additionally, this study aims to propose solutions to preserve an adequate supply of medical care amidst the crisis. Qualitative semi-structured interviews and focus group discussions were conducted using pre-developed guides. Purposive and snowball sampling was adopted to recruit physicians who emigrated and physicians staying in Lebanon. Transcripts of interviews and focus groups were coded using Dedoose software and analyzed through a combination of inductive and deductive approaches. Emigration was found to be the result of numerous interconnected factors. The main drivers for emigration were declining income, career problems, reduced quality of care, unhealthy work environment, and the deteriorated political and socio-economic contexts leading to instability and insecurity. As for the retention factors, they included affective attachment and sense of belonging to the professional environment and the country, followed by recognition and valorization at work. Several recommendations were developed to maintain quality of care delivery, including reforms of the health system, development of focused human resource retention strategies based on resource mapping evidence, negotiations with recruiting institutions to endorse the code ethics ending unethical practices draining countries' human resources, provision of financial incentives to doctors, and the recognition and valorization of physicians. Other rapid interventions were suggested, such as short-term medical missions to mitigate shortages in certain specialties, telemedicine, adaptation of recruitment processes to compensate for resources shortages in certain specialties, and adoption of task-shifting approaches to alleviate the workload on overburdened specialists. The findings of this study shed the light on the different factors influencing migration while framing them in the Lebanese context. These findings and recommendations should inform stakeholders and policy makers about the interventions needed to restore the quality of care. The feasibility and sustainability of most formulated recommendations depend on several factors, with political and socio-economic security and stability being the most crucial ones.

Effects of Microgravity on Astronaut Physiology in Long-Term Space Missions and Proposed Countermeasures

The interest in long-term space travel (&gt;6 months) has gained popularity in the space community. This began in the 1970s with multiple short-term missions exploring the Moon and Mars to understand true habitability and early developments of long-term space settlements. With new missions being proposed by major pioneers in aerospace, such as NASA, SpaceX, and JAXA, scientists are concerned with human health, especially the long-term effects. Long-term settlements have been hypothesized to have major short-term and long-term detriments to multiple physiological systems, most notably musculoskeletal, cardiovascular, and neurophysical. This is due to the effects of microgravity; however, more experimentation must be conducted to understand these effects sufficiently. So far, scientists have linked microgravity to decreased osteoblastic differentiation, rapid bone loss, and increased risk of kidney stone formation in the musculoskeletal system. Additionally, the cardiovascular system is impacted by space anemia, which is hypothesized to be reversible but may induce detrimental effects. Finally, microgravity affects the vestibular system significantly, especially spatial recognition. Countermeasures have been proposed to reduce these effects, like inducing artificial gravity, administrating bisphosphonates and other drugs/therapies, and utilizing tactile aids. The long-term effect of microgravity is still an emerging topic of space research, and much more research must be conducted through various programs like the Artificial Gravity Bed Rest Study with the European Space Agency (AGBRESA) to understand long-term results better.

Pediatric Otolaryngology Short-Term Mission Outcomes at a Surgical Mission Hospital in Guatemala.

The frequency of humanitarian surgical mission trips has grown over recent decades. Unfortunately, research on patient outcomes from these trips has not increased proportionately. We aim to analyze the safety and efficacy of surgeries in a low- and middle-income country missions-based surgery center in Guatemala City, Guatemala,and identify factors that influence surgical outcomes. Retrospective cohort study. Guatemalan surgery center is called the Moore Center. Pediatric patients underwent otolaryngology surgery between 2017 and 2019. All patients required follow up. We analyzed the effect of patient, surgical, and geographic factors on follow up and complications with univariate and multivariate analyses. A total of 1094 otolaryngologic surgeries were performed between 2017 to 2019, which comprised 37.4% adenotonsillectomies, 26.8% cleft lip (CL)/cleft palate (CP) repairs, 13.6% otologic, and 20% "other" surgeries. Patients traveled on average 88 km to the center (±164 km). Eighty-nine percent attended their first follow up and 55% attended their second. The 11% who missed their first follow up lived farther from the center (p < .001) and had a higher ASA classification (p < .001) than the 89% who did attend. Sixty-nine (6.3%) patients had 1 or more complications. CL/CP surgery was associated with more complications than other procedures (p < .001). Of 416 tonsillectomies, 4 patients (1%) had a bleeding episode with 2 requiring reoperation. This surgical center models effective surgical care in low-resource areas. Complications and follow-up length vary by diagnosis. Areas to improve include retaining complex patients for follow up and reducing complications for CL/CP repair.