Optimization of Nonambulant Mass Casualty Decontamination Protocols as Part of an Initial or Specialist Operational Response to Chemical Incidents

© 2018 The Author(s). Published with license by Taylor & Francis.© 2018 Robert P. Chilcott, Hannah Mitchell, Hazem Matar. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License (http://creativecommons.org/licenses/by-ncnd/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited, and is not altered, transformed, or built upon in any way.Objective: The UK's Initial Operational Response (IOR) is a new process for improving the survival of multiple casualties following a chemical, biological, radiological or nuclear incident. Whilst the introduction of IOR represents a patient-focused response for ambulant casualties, there is currently no provision for disrobe and dry decontamination of nonambulant casualties. Moreover, the current specialist operational response (SOR) protocol for nonambulant casualty decontamination (also referred to as “clinical decontamination”) has not been subject to rigorous evaluation or development. Therefore, the aim of this study was to confirm the effectiveness of putatively optimized dry (IOR) and wet (SOR) protocols for nonambulant decontamination in human volunteers. Methods: Dry and wet decontamination protocols were objectively evaluated using human volunteers. Decontamination effectiveness was quantified by liquid chromatography–mass spectrometry analysis of the recovery of a chemical warfare agent simulant (methylsalicylate) from skin and hair of volunteers, with whole-body fluorescence imaging to quantify the skin distribution of residual simulant. Results: Both the dry and wet decontamination processes were rapid (3 and 4 min, respectively) and were effective in removing simulant from the hair and skin of volunteers, with no observable adverse effects related to skin surface spreading of contaminant. Conclusions: Further studies are required to assess the combined effectiveness of dry and wet decontamination under more realistic conditions and to develop appropriate operational procedures that ensure the safety of first responders.Peer reviewe

The Importance of Starting a For-Profit Business as Mission to Advance God’s Kingdom

All Christians have a duty to advance the Kingdom of God according to Matthew 28:16-20, which tells Christians to, “go and make disciples of all nations” (New International Version). The gospel has not yet reached many areas of the world that Christians could influence if they started a Business as Mission (BAM). A BAM start-up would provide jobs to the surrounding communities and aid in improving the economy. Assisting others by providing jobs and meeting their physical, spiritual, social, and economic needs will empower individuals and allow communities to flourish. Even non-Christians find helping others important, which is seen through the concept of corporate social responsibility in numerous organizations. All Christians should seek to do everything to the “glory of God,” with excellence according to Colossians 3:23, which can be demonstrated through starting a for-profit Business as Mission

The Implications, Magnitude, and Development of Traumatic Brain Injury for Individuals Undergoing Treatment for Opioid Use Disorder

There is an established bidirectional relation between substance use and traumatic brain injuries (TBIs). Despite the high rate of prescribing opioids for pain management following a TBI and the epidemic of opioid use disorder (OUD) in the United States, scarce research has specifically analyzed the association between TBI and OUD. In a series of three interrelated manuscripts, the present study will first examine the prevalence and features of TBIs among persons seeking treatment for OUD. Next, the present study will evaluate the association between TBI and indicators of risky health behaviors and OUD severity, including the risk of overdose and polysubstance use. The predictive ability of symptoms of posttraumatic stress disorder, anxiety, impulsivity, depression, and chronic pain on odds of having had a TBI will also be calculated. Last, a systematic review will be conducted to provide comprehensive guidelines for effective methods of tailoring OUD treatment to mitigate the effects of TBI on treatment outcomes. Altogether, the findings will aid in the understanding of the development of TBI for persons with OUD, provide insight into common clinical complexities for patients with OUD and TBI, and offer guidance on how best to tailor interventions to increase substance use treatment efficacy for persons with TBI

Gender Differences In Linguistic Indicators Of Communion And Agency: Associations With Caregiver Stress

This study examined gender differences in caregivers\u27 use of agentic and communal words when talking about their care recipients\u27 suffering and how this related to their stress, in terms of cardiovascular reactivity and self-reported negative emotion. Seventy-six older adult caregivers of spouses with chronic pain were recorded while describing an incident of their spouses\u27 suffering. Caregivers\u27 heart rate (HR) was continuously monitored during their speeches, and they reported their emotions (distress and anger) after their speeches. In addition, respiratory sinus arrhythmia (RSA) was calculated using HR. Results indicated that male caregivers were more likely to talk about a relational episode of their partner\u27s suffering than female caregivers. There were no significant gender differences in communal or agentic word use, and type of word use was not associated with stress; however, associations between word use and stress differed significantly by caregiver gender. These differences suggested that acting in gender conforming roles was protective in female caregivers; whereas, acting in gender non-conforming roles was associated with increased stress in male caregivers. We also found that communally focused relationships were beneficial for men. The findings reveal novel characteristics that might influence caregiver emotional regulation capacity and suggest the need to consider caregiver experiences differently for men and women, and to examine couples as whole

Effective national infrastructure: Balancing detail and flexibility – through planning to delivery

A report produced for the National Infrastructure Planning Association on optimising the balance between the level of detail required in the process for consenting national infrastructure projects, with the need for flexibility at the project delivery stage

Clinical interventions for HIV-associated neurocognitive disorder (hand) : a systematic review

Despite the widespread use of antiretroviral therapy, HIV-associated neurocognitive disorder (HAND) continues to be one of the most common central nervous system (CNS) complications of human immunodeficiency virus (HIV), with the prevalence of the disorder remaining stable at pre-cART levels. HAND ranges in severity from mild to severe and can greatly impact the lives of individuals living with the disorder, often leading to morbidity in severe cases. The prevalence and severity of HAND underscores the need for safe, effective therapies to mitigate or eliminate the impacts of the disorder in order to improve the quality of life of infected individuals. While extensive research has been conducted to investigate the effectiveness of various clinical interventions in treating HAND, no comprehensive systematic review of these studies exists. The purpose of the present study was to conduct and present a systematic review of the literature regarding experimental studies of clinical therapeutic interventions for HAND. In total, 4,269 articles were returned in the initial database search, 13 of which met the inclusion criteria and were selected for inclusion in the review. The 13 articles examined in the final review included experimental investigations of both pharmaceutical and cognitive therapies for HAND. This review presents the current evidence that exists regarding empirically investigated interventions for HAND and broadly discusses trends, limitations, and gaps in the literature.Includes bibliographical references (pages 16-18)

IL-17 can be protective or deleterious in murine pneumococcal pneumonia

Streptococcus pneumoniae is the major bacterial cause of community-acquired pneumonia, and the leading agent of childhood pneumonia deaths worldwide. Nasal colonization is an essential step prior to infection. The cytokine IL-17 protects against such colonization and vaccines that enhance IL-17 responses to pneumococcal colonization are being developed. The role of IL-17 in host defence against pneumonia is not known. To address this issue, we have utilized a murine model of pneumococcal pneumonia in which the gene for the IL-17 cytokine family receptor, Il17ra, has been inactivated. Using this model, we show that IL-17 produced predominantly from γδ T cells protects mice against death from the invasive TIGR4 strain (serotype 4) which expresses a relatively thin capsule. However, in pneumonia produced by two heavily encapsulated strains with low invasive potential (serotypes 3 and 6B), IL-17 significantly enhanced mortality. Neutrophil uptake and killing of the serotype 3 strain was significantly impaired compared to the serotype 4 strain and depletion of neutrophils with antibody enhanced survival of mice infected with the highly encapsulated SRL1 strain. These data strongly suggest that IL-17 mediated neutrophil recruitment to the lungs clears infection from the invasive TIGR4 strain but that lung neutrophils exacerbate disease caused by the highly encapsulated pneumococcal strains. Thus, whilst augmenting IL-17 immune responses against pneumococci may decrease nasal colonization, this may worsen outcome during pneumonia caused by some strains