Influential Factors on Urban and Rural Response Times for Emergency Ambulances in Qatar

Introduction: Ambulance response times are affected by several factors and play a critical role in the outcome of patients requiring urgent treatment. This article aims to highlight the response time differences within and outside Doha (Capital city of Qatar), identify causal trends in slower response times observed, and explore related technological advances. Methods: High-priority response times were collected for a two-day period in three-hour time slots and categorised as urban or rural. The average response time within each time slot was analysed to determine trends and identify the worst peaks so communication logs between dispatchers and ambulance crews could be played back to determine the cause of the “delayed” response. Results: Over the period analysed, 394 high-priority calls were received with an overall median average response time of five minutes 32 seconds. The average urban and rural setting response times were respectively five minutes 15 seconds (n=311) and six minutes 22 seconds (n = 83). Radio communications of the highest median response time peaks for urban and rural response calls were analysed (n = 11): three with dispatchers giving directions, one crew reporting a physical obstruction preventing them from approaching the scene, and seven others containing no indication for the delayed response time. Discussion: Over the period analysed, high-priority response time targets were met 100%. As expected, rural setting response times were usually longer than in the urban setting. The average response times appear longer on the second day (Tuesday) particularly in the afternoon in the urban setting, but there is otherwise no apparent trend between the two days over the different time slots. Ambulance crew familiarity with their environment and clear information by the caller play an important role in an ambulance reaching the scene quickly but new navigation and information sharing technology is expected to alleviate challenges faced at the time of the pilot study.Peer reviewedFinal Published versio

Implementation of a drive-through testing clinic in Qatar for residents having recently returned from a country with a Covid-19 travel warning

© 2020 Alinier, Morris, Abu, Shaikh, Owen, licensee HBKU Press. This is an open access article distributed under the terms of the Creative Commons Attribution license CC BY 4.0, which permits unrestricted use, distribution and reproduction in any medium, provided the original work is properly cited.INTRODUCTION: The spread of the SARS-CoV-2 virus has caused chaos around the world. At the onset of the virus' detection in the State of Qatar, a free-testing system was rapidly established to invite individuals who had recently returned from countries with a COVID-19 disease travel warning to avoid putting other people at risk. The testing site needed to be accessible to individuals without requiring them to enter the hospital and congregate in a waiting area. The aim of this article is to share our experience with the early implementation of a drive-through testing clinic using the invited person's vehicle as an isolation compartment during screening to minimize person-to-person contamination. METHODS: A Hamad Medical Corporation site was selected to stage a drive-through testing facility to avoid congestion and offer space to facilitate the process. A process was rapidly agreed upon, and staff received the required training regarding infection control measures and documentation. At the testing site, individuals were subjected to the following steps: registration and history taking, temperature measurement, swabbing, and receipt of a sick leave certificate and a flyer about self-quarantine. RESULTS: Over the first six days of implementation, the relevant authorities determined that 687 individuals had to be contacted, 103 attended their testing appointment in that period, and an additional 327 people (close relations of the individuals contacted or individuals contacted but without a health card) also subjected themselves to the testing process, which took a median time of 11 minutes 39 seconds. No individual exhibited symptoms that warranted immediate isolation while they were at the drive-through testing clinic. However, four individuals were diagnosed with COVID-19 following laboratory analysis of the swab taken and followed up. The median time between swab collection and laboratory testing was 13 hours 41 minutes 59 seconds. CONCLUSIONS: Collaboration among various key health, governmental, and travel industry partners was essential to the successful and rapid implementation of a COVID-19 drive-through testing clinic in the early days of the pandemic in Qatar. The general public reacted well to this process. Communication, coordination, and planning were identified as critical factors at every step of the process. It started from the initial call to the travelers who had recently returned from a country with a newly instituted travel warning and concluded by them leaving with their sick leave certificate and an information flyer with reminders about preventative infection control measures and encouraging them to self-quarantine after having been swabbed.Peer reviewe

We\u27re All We Have : Envisioning the Future of Mutual Aid from Queer and Trans Perspectives

Mutual aid has prevailed for as long as humans have existed. However, the concept of mutual aid became popularized in 2020 as a result of the COVID-19 pandemic, the racial uprisings in response to the continued police brutality toward Black people, and an increase in global climate crises. Mutual aid spread as a way of survival and collective care when formal systems, such as federal and local governments within the U.S., were failing to meet people\u27s needs. Using a subset of data from semi-structured interviews, the current study relied on a desire-based research framework and foresight lens to capture the perspectives of queer and trans individuals (n=10) and how they envision mutual aid in the future. Findings show how queer and trans participants of mutual aid envision the structure of the future of mutual aid and the need for a system overhaul to world build. Implications for social work practice and education will be discussed

Food insecurity is associated with mild cognitive impairment among middle-aged and older adults in South Africa: findings from a nationally representative survey

There are no studies on the association between food insecurity and mild cognitive impairment (MCI). Thus, cross-sectional, community-based data on individuals aged ≥50 years from the World Health Organization’s Study on Global AGEing and Adult Health (SAGE) conducted in South Africa (2007-2008) were analyzed to assess this association. The definition of MCI was based on the National Institute on Ageing-Alzheimer’s Association criteria. Past 12-month food insecurity was assessed with two questions on frequency of eating less and hunger due to lack of food. Multivariable logistic regression analysis was conducted. The sample consisted of 3,672 individuals aged ≥50 years [mean (SD) age 61.4 (18.3); 56% females]. The prevalence of MCI was 8.5%, while 11.0% and 20.8% experienced moderate and severe food insecurity, respectively. After adjustment for potential confounders, moderate and severe food insecurity were associated with 2.82 (95%CI=1.65-4.84) and 2.51 (95%CI=1.63-3.87) times higher odds for MCI, compared with no food insecurity, respectively. The OR for those aged ≥65 years with severe food insecurity was particularly high (OR=3.87; 95%CI=2.20-6.81). In conclusion, food insecurity was strongly associated with MCI among South African older adults. Future longitudinal research is required to assess whether addressing food insecurity may reduce risk for MCI and subsequent dementia

Pain and the risk for falls in community-dwelling older adults: systematic review and meta-analysis

Objective: To conduct a systematic review and meta-analysis to establish the association between pain and falls in community dwelling older adults. Data Sources: Electronic databases from inception until 1st March 2013 including Cochrane Library, CINAHL, EBSCO, EMBASE, PubMed and PsycINFO. Study Selection: Two reviewers independently conducted the searches and completed methodological assessment of all included studies. Studies were included that (a) focussed on older adults over 60 years old, (b) recorded falls over 6 or more months, (c) identified a group with and without pain. Studies were excluded that (d) included participants with dementia, a neurological condition (e.g. stroke), (e) participants whose pain was caused by a previous fall, (f) individuals with surgery/ fractures in the past 6 months. Data extraction: One author extracted all data and this was independently validated by another author. Data synthesis: 1,334 articles were screened and 21 studies met the eligibility criteria. 50.5% of older adults with pain reported one or more fall over 12 months compared to 25.7% of controls (p<0.001). A global meta-analysis with 14 studies (n=17,926) demonstrated that pain was associated with an increased odds of falling (OR: 1.56, 95% Confidence Interval (CI): 1.36 to 1.79, I2=53%). A subgroup meta-analysis incorporating studies that monitored falls prospectively established that the odds of falling was significantly higher in those with pain (n=4,674; OR: 1.71, CI: 1.48 to 1.98, I2=0%). Foot pain was strongly associated with falls (n=691; OR: 2.38, CI: 1.62 to 3.48, I2=8%) as was chronic pain (n= 5,367; OR 1.80, CI: 1.56 to 2.09, I2=0%). Conclusion: Community dwelling older adults with pain were more likely to have fallen in the past 12 months and fall again in the future. Foot and chronic pain were particularly strong risk factors for falls and clinicians should routinely enquire about these when completing falls risk assessments

Imaging genetics paradigms in depression research: Systematic review and meta-analysis

Imaging genetics studies involving participants with major depressive disorder (MDD) have expanded. Nevertheless, findings have been inconsistent. Thus, we conducted a systematic review and meta-analysis of imaging genetics studies that enrolled MDD participants across major databases through June 30th, 2017. Sixty-five studies met eligibility criteria (N = 4034 MDD participants and 3293 controls), and there was substantial between-study variability in the methodological quality of included studies. However, few replicated findings emerged from this literature with only 22 studies providing data for meta-analyses (882 participants with MDD and 616 controls). Total hippocampal volumes did not significantly vary in MDD participants or controls carrying either the BDNF Val66Met ‘Met’ (386 participants with MDD and 376 controls) or the 5-HTTLPR short ‘S’ (310 participants with MDD and 230 controls) risk alleles compared to non-carriers. Heterogeneity across studies was explored through meta-regression and subgroup analyses. Gender distribution, the use of medications, segmentation methods used to measure the hippocampus, and age emerged as potential sources of heterogeneity across studies that assessed the association of 5-HTTLPR short ‘S’ alleles and hippocampal volumes. Our data also suggest that the methodological quality of included studies, publication year, and the inclusion of brain volume as a covariate contributed to the heterogeneity of studies that assessed the association of the BDNF Val66Met ‘Met’ risk allele and hippocampal volumes. In exploratory voxel-wise meta-analyses, MDD participants carrying the 5-HTTLPR short ‘S’ allele had white matter microstructural abnormalities predominantly in the corpus callosum, while carriers of the BDNF Val66Met ‘Met’ allele had larger gray matter volumes and hyperactivation of the right middle frontal gyrus compared to non-carriers. In conclusion, few replicated findings emerged from imaging genetics studies that included participants with MDD. Nevertheless, we explored and identified specific sources of heterogeneity across studies, which could provide insights to enhance the reproducibility of this emerging field

Medical resources deployed for the 2019 World Athletics Championships in Doha, Qatar

Background: International sporting events such as the World Athletics (WA) competition require proper medical coverage to ensure the wellbeing of athletes, support teams, and spectators 1 . Several factors may have an impact on people's requirements for medical attention such as the climate, altitude, and intensity of the sporting competition on the athletes 2,3 . The International Association of Athletics Federations (IAAF) held its 2019 competition in Doha, Qatar, and this study reports on the medical resources deployed to cover the event based on risk assessment. Case presentation: Although the competition was held for 10 days across two venues. The medical cover started 3 days earlier and also encompassed warm-up/training venues and official hotels (Table 1). It involved multiple healthcare organizations providing equipment, manpower, medical tents/clinics, and vehicles in case of transportation to the hospital was required. Results: Resources were allocated to various locations based on the risk assessment (Table 1) and depending on the number of people competing, training, or attending, and the size of the venue. Environmental factors were accounted for with the provision of cold-water immersion recovery baths at multiple locations and ample manpower with rostering of clinical staff from various relevant healthcare professions (Table 2). All resources were deployed on a rotational shift basis in the official locations well ahead of the start of each event until an hour or two after the completion of the event. Conclusion: Proper planning, communication, and collaboration among organizers, hosts, medical services providers, and other authorities play a vital role in the safety of athletes, support team members, and spectators. Such large events impose huge strain on the resources which can impact aspects of daily healthcare delivery to the rest of the community and hence need to be carefully considered. It is worth noting that the medical coverage provided was not overwhelmed by patient demand, hence; the medical coverage was appropriate

Perspectives on Preparedness for Chemical, Biological, Radiological, and Nuclear Threats in the Middle East and North Africa Region: Application of Artificial Intelligence Techniques

Over the past 3 decades, the diversity of ethnic, religious, and political backgrounds worldwide, particularly in countries of the Middle East and North Africa (MENA), has led to an increase in the number of intercountry conflicts and terrorist attacks, sometimes involving chemical and biological agents. This warrants moving toward a collaborative approach to strengthening preparedness in the region. In disaster medicine, artificial intelligence techniques have been increasingly utilized to allow a thorough analysis by revealing unseen patterns. In this study, the authors used text mining and machine learning techniques to analyze open-ended feedback from multidisciplinary experts in disaster medicine regarding the MENA region's preparedness for chemical, biological, radiological, and nuclear (CBRN) risks. Open-ended feedback from 29 international experts in disaster medicine, selected based on their organizational roles and contributions to the academic field, was collected using a modified interview method between October and December 2022. Machine learning clustering algorithms, natural language processing, and sentiment analysis were used to analyze the data gathered using R language accessed through the RStudio environment. Findings revealed negative and fearful sentiments about a lack of accessibility to preparedness information, as well as positive sentiments toward CBRN preparedness concepts raised by the modified interview method. The artificial intelligence analysis techniques revealed a common consensus among experts about the importance of having accessible and effective plans and improved health sector preparedness in MENA, especially for potential chemical and biological incidents. Findings from this study can inform policymakers in the region to converge their efforts to build collaborative initiatives to strengthen CBRN preparedness capabilities in the healthcare sector

Depression in Cancer: the many biobehavioural pathways driving tumor progression

Major Depressive Disorder (MDD) is common among cancer patients, with prevalence rates up to four-times higher than the general population. Depression confers worse outcomes, including non-adherence to treatment and increased mortality in the oncology setting. Advances in the understanding of neurobiological underpinnings of depression have revealed shared biobehavioral mechanisms may contribute to cancer progression. Moreover, psychosocial stressors in cancer promote: (1) inflammation and oxidative/nitrosative stress; (2) a decreased immunosurveillance; and (3) a dysfunctional activation of the autonomic nervous system and of the hypothalamic-pituitary-adrenal axis. Consequently, the prompt recognition of depression among patients with cancer who may benefit of treatment strategies targeting depressive symptoms, cognitive dysfunction, fatigue and sleep disturbances, is a public health priority. Moreover, behavioral strategies aiming at reducing psychological distress and depressive symptoms, including addressing unhealthy diet and life-style choices, as well as physical inactivity and sleep dysfunction, may represent important strategies not only to treat depression, but also to improve wider cancer-related outcomes. Herein, we provide a comprehensive review of the intertwined biobehavioural pathways linking depression to cancer progression. In addition, the clinical implications of these findings are critically reviewed

The Endoplasmic Reticulum Stress Response in Neuroprogressive Diseases: Emerging Pathophysiological Role and Translational Implications

The endoplasmic reticulum (ER) is the main cellular organelle involved in protein synthesis, assembly and secretion. Accumulating evidence shows that across several neurodegenerative and neuroprogressive diseases, ER stress ensues, which is accompanied by over-activation of the unfolded protein response (UPR). Although the UPR could initially serve adaptive purposes in conditions associated with higher cellular demands and after exposure to a range of pathophysiological insults, over time the UPR may become detrimental, thus contributing to neuroprogression. Herein, we propose that immune-inflammatory, neuro-oxidative, neuro-nitrosative, as well as mitochondrial pathways may reciprocally interact with aberrations in UPR pathways. Furthermore, ER stress may contribute to a deregulation in calcium homoeostasis. The common denominator of these pathways is a decrease in neuronal resilience, synaptic dysfunction and even cell death. This review also discusses how mechanisms related to ER stress could be explored as a source for novel therapeutic targets for neurodegenerative and neuroprogressive diseases. The design of randomised controlled trials testing compounds that target aberrant UPR-related pathways within the emerging framework of precision psychiatry is warranted