The implication of a translational triage tool in mass casualty incidents: part three: a multinational study, using validated patient cards.

BACKGROUND: Mass casualty incidents (MCI) pose significant challenges to existing resources, entailing multiagency collaboration. Triage is a critical component in the management of MCIs, but the lack of a universally accepted triage system can hinder collaboration and lead to preventable loss of life. This multinational study uses validated patient cards (cases) based on real MCIs to evaluate the feasibility and effectiveness of a novel Translational Triage Tool (TTT) in primary triage assessment of mass casualty victims. METHODS: Using established triage systems versus TTT, 163 participants (1575 times) triaged five patient cases. The outcomes were statistically compared. RESULTS: TTT demonstrated similar sensitivity to the Sieve primary triage method and higher sensitivity than the START primary triage system. However, the TTT algorithm had a lower specificity compared to Sieve and higher over-triage rates. Nevertheless, the TTT algorithm demonstrated several advantages due to its straightforward design, such as rapid assessment, without the need for additional instrumental interventions, enabling the engagement of non-medical personnel. CONCLUSIONS: The TTT algorithm is a promising and feasible primary triage tool for MCIs. The high number of over-triages potentially impacts resource allocation, but the absence of under-triages eliminates preventable deaths and enables the use of other personal resources. Further research involving larger participant samples, time efficiency assessments, and real-world scenarios is needed to fully assess the TTT algorithm's practicality and effectiveness in diverse multiagency and multinational contexts.

Global, Regional, and National Economic Consequences of Stroke.

BACKGROUND: An understanding of global, regional, and national macroeconomic losses caused by stroke is important for allocation of clinical and research resources. The authors investigated the macroeconomic consequences of stroke disease burden in the year 2019 in 173 countries. METHODS: Disability-adjusted life year data for overall stroke and its subtypes (ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage) were collected from the GBD study (Global Burden of Disease) 2019 database. Gross domestic product (GDP, adjusted for purchasing power parity [PPP]) data were collected from the World Bank; GDP and disability-adjusted life year data were combined to estimate macroeconomic losses using a value of lost welfare (VLW) approach. All results are presented in 2017 international US dollars adjusted for PPP. RESULTS: Globally, in 2019, VLW due to stroke was $2059.67 billion or 1.66% of the global GDP. Global VLW/GDP for stroke subtypes was 0.78% (VLW=$964.51 billion) for ischemic stroke, 0.71% (VLW=$882.81 billion) for intracerebral hemorrhage, and 0.17% (VLW=$212.36 billion) for subarachnoid hemorrhage. The Central European, Eastern European, and Central Asian GBD super-region reported the highest VLW/GDP for stroke overall (3.01%), ischemic stroke (1.86%), and for subarachnoid hemorrhage (0.26%). The Southeast Asian, East Asian, and Oceanian GBD super-region reported the highest VLW/GDP for intracerebral hemorrhage (1.48%). CONCLUSIONS: The global macroeconomic consequences related to stroke are vast even when considering stroke subtypes. The present quantification may be leveraged to help justify increased spending of finite resources on stroke in an effort to improve outcomes for patients with stroke globally.

Analysis of core risk factors and potential policy options for sustainable supply chain: an MCDM analysis of Saudi Arabia's manufacturing industry.

Sustainable supply chain management (SSCM) has been a tough challenge for developing economies like Saudi Arabia. Implementation of SSCM practices in the manufacturing industry has been prone to multiple risk factors that need to be identified, evaluated, and prioritized especially considering the dynamics of the manufacturing industry in a developing economy. Moreover, it is also imperative to trace out feasible and sustainable strategies to overcome the risks to SSCM practices adoption. This study serves this purpose and identifies, evaluates, prioritizes the risk factors, sub-factors, and strategies to overcome these risk factors in the implementation of SSCM practices in the manufacturing industry in Saudi Arabia. An integrated multi-criteria decision analysis approach by combining fuzzy AHP and fuzzy WASPAS methods is employed for the analyses. The fuzzy AHP analysis results show that economic risks are dominant risks followed by the managerial policy risks and environmental risks in implementing SSCM. Industrial emissions are the leading risk factors in the overall ranking of the sustainable supply chain sub-risk factors followed by market dynamics, management policy failures, financial constraints, and credit uncertainty. While evaluating the sustainable supply chain strategies using fuzzy WASPAS, it is concluded that commitment and support of top, middle, and lower level management is the most pivotal strategy to deal with the risks to SSCM in Saudi Arabia followed by establishing environmental policies and goals to adopt SSCM, and provision of the financial resources and subsidies.

The role of multifrequency tympanometry in otitis media.

OBJECTIVE: To evaluate the diagnostic value of multifrequency tympanometry in otitis media with effusion and adhesive otitis media. METHODS: We selected 50 patients with long standing or recurrent attacks of otitis media with effusion from the outpatient clinic of the Ears, Nose and Throat (ENT) Department, Sohag Medical School, Egypt between May 2002 and December 2002. A control group was also selected, consisting of 25 patients with normal hearing levels and with no history of ENT problems. We conducted full audiological investigations in the form of pure tone audiometry, speech audiometry and immittancemetry. Immittancemetry included low probe tone frequency and multifrequency tympanometry. Each subject in the study group had undergone myringotomy and examination under microscope to decide if the case had either otitis media with effusion or adhesive otitis media. RESULTS: Resonant frequency proved to have the best performance in reflecting middle ear pathology. It was lowest in otitis media with effusion with a mean value of 428 +/- 159 Hz and it was highest in adhesive otitis media with a mean of 1336 +/- 230 Hz. CONCLUSION: Multifrequency tympanometry has an efficacy of 100% in the diagnosis of otitis media with effusion and 70% in the diagnosis of adhesive otitis media.