Exploring community level multi-agency communication and collaboration during the emergency response to the covid-19 pandemic

Objectives This study assesses multi-agency communication and collaboration during the community emergency response to the covid-19 pandemic. Study design Qualitative case-study research. Methods Semi-structured qualitative interviews were conducted with ten officers from organisations involstved in the community response to the pandemic, at strategic or tactical level, within an English local authority (LA) area. Interviews were thematically analysed. Results Horizontal (local/regional) communication and collaboration between the multi-agencies was found to be effective. Participants felt multi-agency groups had a sense of shared identity, partly from pre-existing relationships and a sense of shared common fate. The unified command model, with incident management co-chaired by the local authority, fire and police was found to support joint working, bolstering response effectiveness. There was frustration with vertical (national) communication and collaboration. Messages to local responders were often delivered via daily Government briefings to the public, meaning local responders had little time to consider and implement appropriate actions. Conclusions The study provides new and impactful insights into the community response in an English MBC area during the Covid-19 pandemic. However, findings apply to any high-or-low-income country if their emergency planning/response considers community level integration with multiple-agencies to improve the public health emergency response. Set against existing international literature, show good command-and-control structures, including leadership, training and positive local culture were important for successful communication and collaboration between the multi-agencies. This study highlights some beneficial practices which support recovery and preparedness for future emergencies

Canadian health emergency management professionals’ perspectives on the prevalence and effectiveness of disaster preparedness activities in response to COVID-19

Emergency management (EM)1 professionals play an integral role in preparing healthcare organizations for disasters but evidence of their pervasiveness in Canadian healthcare is limited. Through an exploratory Canada-wide survey of EM in healthcare organizations, we aim to develop understanding of the prevalence and effectiveness of the disaster preparedness activities enacted in preparation for COVID-19. The online survey generated 161 responses; 150 (93%) had EM responsibility. EM reported that reviewing infectious disease (pandemic) plans and protocols was the most widespread activity (82%), while simulation-based exercises was the least (26%). Organizational incident management response to COVID-19 was led by a sole ‘incident commander’ 61% of the time, while 39% of ‘incident commands’ were led by multiple individuals. Of all those assigned to lead IM, only 68% received training in that role. Overall, the prevalence of disaster preparedness activities in healthcare organizations was positively associated with leaders who received training in incident response and having a dedicated EM resource. Meanwhile, the overall effectiveness of activities was positively correlated with having a sole ‘incident commander’ and was found to improve as the overall prevalence of activities rose. The study provides strong evidence for regional, organizational, and EM resource variation in the delivery of disaster preparedness activities and training for leaders in Canadian healthcare. Hence, we recommend the creation of a national health emergency preparedness system which includes legislated standards and a national training centre to ensure Canadian healthcare is bolstered against future disasters including pandemics

Integrated healthcare and the dilemma of public health emergencies

Traditional healthcare services have demonstrated structural shortcomings in the delivery of patient care and enforced numerous elements of integration in the delivery of healthcare services. Integrated healthcare aims at providing all healthcare that makes humans healthy. However, with mainly chronically ill people and seniors, typically suffering from numerous comorbidities and diseases, being recruited for care, there is a need for a change in the healthcare service structure beyond direct-patient care to be compatible in peacetime and during public health emergencies. This article’s objective is to discuss the opportunities and obstacles for increasing the effectiveness of healthcare through improved integration. A rapid evidence review approach was used by performing a systematic followed by a non-systematic literature review and content analysis. The results confirmed that integrated healthcare systems play an increasingly important role in healthcare system reforms undertaken in European Union countries. The essence of these changes is the transition from the episodic treatment of acute diseases to the provision of coordinated medical services, focused on chronic cases, prevention, and ensuring patient continuity. However, integrated healthcare, at a level not yet fully defined, will be necessary if we are to both define and attain the integrated practice of both global health and global public health emergencies. This paper attains the necessary global challenges to integrate healthcare effectively at every level of society. There is a need for more knowledge to effectively develop, support, and disseminate initiatives related to coordinated healthcare in the individual healthcare systems

Superpotentials for M-theory on a G_2 holonomy manifold and Triality symmetry

For $M$-theory on the $G_2$ holonomy manifold given by the cone on {\bf S^3}\x {\bf S^3} we consider the superpotential generated by membrane instantons and study its transformations properties, especially under monodromy transformations and triality symmetry. We find that the latter symmetry is, essentially, even a symmetry of the superpotential. As in Seiberg/Witten theory, where a flat bundle given by the periods of an universal elliptic curve over the $u$-plane occurs, here a flat bundle related to the Heisenberg group appears and the relevant universal object over the moduli space is related to hyperbolic geometry.Comment: 58 pages, latex; references adde

Genetic architecture of spatial electrical biomarkers for cardiac arrhythmia and relationship with cardiovascular disease

The 3-dimensional spatial and 2-dimensional frontal QRS-T angles are measures derived from the vectorcardiogram. They are independent risk predictors for arrhythmia, but the underlying biology is unknown. Using multi-ancestry genome-wide association studies we identify 61 (58 previously unreported) loci for the spatial QRS-T angle (N = 118,780) and 11 for the frontal QRS-T angle (N = 159,715). Seven out of the 61 spatial QRS-T angle loci have not been reported for other electrocardiographic measures. Enrichments are observed in pathways related to cardiac and vascular development, muscle contraction, and hypertrophy. Pairwise genome-wide association studies with classical ECG traits identify shared genetic influences with PR interval and QRS duration. Phenome-wide scanning indicate associations with atrial fibrillation, atrioventricular block and arterial embolism and genetically determined QRS-T angle measures are associated with fascicular and bundle branch block (and also atrioventricular block for the frontal QRS-T angle). We identify potential biology involved in the QRS-T angle and their genetic relationships with cardiovascular traits and diseases, may inform future research and risk prediction

Neonatal antigen-presenting cells are functionally more quiescent in children born under traditional compared with modern environmental conditions

Background One explanation for the high burden of allergic and autoimmune diseases in industrialized countries is inappropriate immune development under modern environmental conditions. There is increasing evidence that the process of immune deviation already begins in utero, but the underlying immunologic mechanisms are not clear. Objective We sought to identify differences in the function of neonatal antigen-presenting cells (APCs) in children born in settings that are more traditional versus those of modern societies. Methods Cord blood mononuclear cells were collected from newborns from Papua New Guinea (PNG; traditional) and Australia (modern) and compared for differences in APCs and T-cell phenotype and function. Results Australian cord naive T cells (CD4+CD25−CD127+ cells) showed an enhanced and more rapid proliferative response in an autologous, APC-dependent culture system, a result of differences in neonatal APCs rather than T-cell function. This included an increased capacity to process antigen and to upregulate activation markers after stimulation. In contrast, resting PNG APCs exhibited higher baseline levels of activation and inhibitory markers and were less responsive or nonresponsive to stimulation in vitro. Conclusions This study supports the hypothesis that prenatal environments can influence the developing immune system in utero. Children born under modern environmental conditions exhibit increased APC reactivity at birth compared with children born under traditional environmental conditions. The functionally more quiescent nature of PNG neonatal APCs might protect against the development of harmful inflammatory responses in early life