Pain relief for neonates in Australian hospitals: A need to improve evidence-based practice

Objective: To ascertain the extent to which neonatal analgesia was used in Australia for minor invasive procedures as an indicator of evidence-based practice in neonatology. Methods: A cross-sectional telephone survey of hospitals in all Australian states and territories with more than 200 deliveries per year was carried out. Questions were asked regarding awareness of the benefits and the use of analgesia for minor invasive procedures in term and near term neonates. Analysis was undertaken according to state and territory, annual birth numbers and the level of neonatal nursery care available. Results: Data were available from 212 of 214 eligible hospitals. Of the total respondents, 51% and 70% respectively were aware of the benefits of sucrose and breast-feeding for neonatal analgesia. Eleven per cent of units administered sucrose before venepuncture and 25% of units used breast-feeding. Ten per cent of units used sucrose before heel prick with 49% utilizing breast-feeding. Expressed breast milk was used in 10% of units. Analgesia was given less frequently before intravenous cannulation compared to venepuncture and heel prick. Awareness and implementation of neonatal analgesia varied widely in the states and territories. There was a trend for hospitals providing a higher level of neonatal care to have a greater awareness of sucrose as an analgesic (P < 0.0001) and the use of sucrose for venepuncture (P = 0.029), heel prick (P = 0.025) and intravenous catheter insertion (P = 0.013). Similar trends were found on analysis according to birth number of the maternity units. Smaller units had a greater usage of breast-feeding as an analgesic for heel prick (P = 0.017). Conclusion: Despite good evidence for the administration of sucrose and breast milk in providing effective analgesia for newborn infants, it is not widely used in Australia. It is imperative that the gap between research findings and clinical practice with regard to neonatal analgesia be addressed.

The role of texture in shape from shading: are humans biased towards seeing relief textures?

When a textured surface is modulated in depth and illuminated, the level of illumination varies across the surface, producing coarse-scale luminance modulations (LM) and amplitude modulation (AM) of the fine-scale texture. If the surface has an albedo texture (reflectance variation) then the LM and AM components are always in-phase, but if the surface has a relief texture the phase relation between LM and AM varies with the direction and nature of the illuminant. We showed observers sinusoidal luminance and amplitude modulations of a binary noise texture, in various phase relationships, in a paired-comparisons design. In the first experiment, the combinations under test were presented in different temporal intervals. Observers indicated which interval contained the more depthy stimulus. LM and AM in-phase were seen as more depthy than LM alone which was in turn more depthy than LM and AM in anti-phase, but the differences were weak. In the second experiment the combinations under test were presented in a single interval on opposite obliques of a plaid pattern. Observers were asked to indicate the more depthy oblique. Observers produced the same depth rankings as before, but now the effects were more robust and significant. Intermediate LM/AM phase relationships were also tested: phase differences less than 90 deg were seen as more depthy than LM-only, while those greater than 90 deg were seen as less depthy. We conjecture that the visual system construes phase offsets between LM and AM as indicating relief texture and thus perceives these combinations as depthy even when their phase relationship is other than zero. However, when different LM/AM pairs are combined in a plaid, the signals on the obliques are unlikely to indicate corrugations of the same texture, and in this case the out-of-phase pairing is seen as flat. [Supported by the Engineering and Physical Sciences Research Council (EPSRC)].

Logistical framework for last mile relief distribution in humanitarian supply chains:considerations from the field

Recent years large scale natural disasters: (e.g. 2004 Tsunami, 2005 Earthquake in South Asia, 2010 Earthquake in Haiti, 2010 flood in Pakistan, 2011 Earthquake in Japan etc.) have captured international attention and led to the advance of research of disaster management. To cope with these huge impact disasters, the involved stakeholders have to learn how quickly and efficiently the relief organisations are able to respond. After a disaster strikes, it is necessary to get the relief aid to the affected people by the prompt action of relief organisations. This supply chain process has to be very fast and efficient. The purpose of this paper is to define the last mile relief distribution in humanitarian supply chain and develop a logistical framework by identifying the factors that affect this process. Seventeen interviews were conducted with field officers and the data analysed to identify which are the critical factors for last mile relief distribution of disaster relief operation. A framework is presented classifying these factors according to the ability to implement them in an optimisation model of humanitarian logistics.

The impact of coordination on the effectiveness of last mile relief distribution

Last mile relief distribution is the final stage of humanitarian logistics. It refers to the supply of relief items from local distribution centers to the disaster affected people (Balcik et al., 2008). In the last mile relief distribution literature, researchers have focused on the use of optimisation techniques for determining the exact optimal solution (Liberatore et al., 2014), but there is a need to include behavioural factors with those optimisation techniques in order to obtain better predictive results. This paper will explain how improving the coordination factor increases the effectiveness of the last mile relief distribution process. There are two stages of methodology used to achieve the goal: Interviews: The authors conducted interviews with the Indian Government and with South Asian NGOs to identify the critical factors for final relief distribution. After thematic and content analysis of the interviews and the reports, the authors found some behavioural factors which affect the final relief distribution. Model building: Last mile relief distribution in India follows a specific framework described in the Indian Government disaster management handbook. We modelled this framework using agent based simulation and investigated the impact of coordination on effectiveness. We define effectiveness as the speed and accuracy with which aid is delivered to affected people. We tested through simulation modelling whether coordination improves effectiveness.

A multi-organisational approach for disaster preparedness and response:the use of optimisation and GIS for facility location, stock pre-positioning, resource allocation and relief distribution

From 1992 to 2012 4.4 billion people were affected by disasters with almost 2 trillion USD in damages and 1.3 million people killed worldwide. The increasing threat of disasters stresses the need to provide solutions for the challenges faced by disaster managers, such as the logistical deployment of resources required to provide relief to victims. The location of emergency facilities, stock prepositioning, evacuation, inventory management, resource allocation, and relief distribution have been identified to directly impact the relief provided to victims during the disaster. Managing appropriately these factors is critical to reduce suffering. Disaster management commonly attracts several organisations working alongside each other and sharing resources to cope with the emergency. Coordinating these agencies is a complex task but there is little research considering multiple organisations, and none actually optimising the number of actors required to avoid shortages and convergence. The aim of the this research is to develop a system for disaster management based on a combination of optimisation techniques and geographical information systems (GIS) to aid multi-organisational decision-making. An integrated decision system was created comprising a cartographic model implemented in GIS to discard floodable facilities, combined with two models focused on optimising the decisions regarding location of emergency facilities, stock prepositioning, the allocation of resources and relief distribution, along with the number of actors required to perform these activities. Three in-depth case studies in Mexico were studied gathering information from different organisations. The cartographic model proved to reduce the risk to select unsuitable facilities. The preparedness and response models showed the capacity to optimise the decisions and the number of organisations required for logistical activities, pointing towards an excess of actors involved in all cases. The system as a whole demonstrated its capacity to provide integrated support for disaster preparedness and response, along with the existence of room for improvement for Mexican organisations in flood management.

A Markov chain location-allocation meta-model for hurricane relief

An emergency is a deviation from a planned course of events that endangers people, properties, or the environment. It can be described as an unexpected event that causes economic damage, destruction, and human suffering. When a disaster happens, Emergency Managers are expected to have a response plan to most likely disaster scenarios. Unlike earthquakes and terrorist attacks, a hurricane response plan can be activated ahead of time, since a hurricane is predicted at least five days before it makes landfall. This research looked into the logistics aspects of the problem, in an attempt to develop a hurricane relief distribution network model. We addressed the problem of how to efficiently and effectively deliver basic relief goods to victims of a hurricane disaster. Specifically, where to preposition State Staging Areas (SSA), which Points of Distributions (PODs) to activate, and the allocation of commodities to each POD. Previous research has addressed several of these issues, but not with the incorporation of the random behavior of the hurricane's intensity and path. This research presents a stochastic meta-model that deals with the location of SSAs and the allocation of commodities. The novelty of the model is that it treats the strength and path of the hurricane as stochastic processes, and models them as Discrete Markov Chains. The demand is also treated as stochastic parameter because it depends on the stochastic behavior of the hurricane. However, for the meta-model, the demand is an input that is determined using Hazards United States (HAZUS), a software developed by the Federal Emergency Management Agency (FEMA) that estimates losses due to hurricanes and floods. A solution heuristic has been developed based on simulated annealing. Since the meta-model is a multi-objective problem, the heuristic is a multi-objective simulated annealing (MOSA), in which the initial solution and the cooling rate were determined via a Design of Experiments. The experiment showed that the initial temperature (T0) is irrelevant, but temperature reduction (δ) must be very gradual. Assessment of the meta-model indicates that the Markov Chains performed as well or better than forecasts made by the National Hurricane Center (NHC). Tests of the MOSA showed that it provides solutions in an efficient manner. Thus, an illustrative example shows that the meta-model is practical.

Managua Relief

Bob del Toro, Dianne Haley and Others with Toys for Managuan Relief. On December 23, 12:29 a.m. local time in Managua, Nicaragua, a magnitude 6.2 earthquake occurred. The earth caused widespread damage among Managua, the capital city. In Managua, 5,000 residents were killed, 20,000 were injured and over 250,000 were left homeless. In Miami, residents and relief organizations focused on helping children. Wife of General Arturo Somoza pleaded on efforts on gathering sporting goods and toys for Managua’s young people. Relief committees purchased 230 dozen balls – basketball, rubber, and volley, soccer, and others. Nearly $500 came from students in Hialeah High School. Jump ropes and jacks were donated from a sorority at Florida International University. Arrangements were made to bring 44,000 pounds of baby formula and canned meat and 13,000 pounds of medicine. Many of Miami’s corporations, associations, and residents contributed to the Managuan Relief effort. Source: The Miami News, March 19, 1973 by Lynn Feigenbaum 887-3400. april 30, 1973. Cutlines: More than 350 dozens of various balls, skate boards and games were recently purchased by the Student Governance Committee of Florida International University for the young people of Managua, Nicaragua who not only do not have enough toys but are unable to attend schools which are closed. Left to right are, Bob del Toro, Dianne Haley, Chairman of the Student Governance Committee, Hialeah Councilman Jack Weaver of the Hialeah-Managua Sister City Committee, Barbara O'Nan and Margaret Klein.

Managua Relief

On December 23, 12:29 a.m. local time in Managua, Nicaragua, a magnitude 6.2 earthquake occurred. The earth caused widespread damage among Managua, the capital city. In Managua, 5,000 residents were killed, 20,000 were injured and over 250,000 were left homeless. In Miami, residents and relief organizations focused on helping children. Wife of General Arturo Somoza pleaded on efforts on gathering sporting goods and toys for Managua’s young people. Relief committees purchased 230 dozen balls – basketball, rubber, and volley, soccer, and others. Nearly $500 came from students in Hialeah High School. Jump ropes and jacks were donated from a sorority at Florida International University. Arrangements were made to bring 44,000 pounds of baby formula and canned meat and 13,000 pounds of medicine. Many of Miami’s corporations, associations, and residents contributed to the Managuan Relief effort. Source: The Miami News, March 19, 1973 by Lynn Feigenbaum From: City of Hialeah Publicity Bureu. 401 1/2 East 1st Ave. Hialeah, Fla. 887-3400. april 30, 1973. Cutlines: Florida International University students recently raised more than $ 1,000 for more than 300 dozens toys and balls for the youngsters of Managua, Nicaragua. With the balls above are shown student Committee members and oficials of the Hialeah-Managua Sister City Committee, left to rigth: Bob del Toro, Sister City Committe president Raymond R. Schultz, Student Governance Committee chairman Dianne Haley and Hialeah City councilman Jack Weaver.

Managua Relief

On December 23, 12:29 a.m. local time in Managua, Nicaragua, a magnitude 6.2 earthquake occurred. The earth caused widespread damage among Managua, the capital city. In Managua, 5,000 residents were killed, 20,000 were injured and over 250,000 were left homeless. In Miami, residents and relief organizations focused on helping children. Wife of General Arturo Somoza pleaded on efforts on gathering sporting goods and toys for Managua’s young people. Relief committees purchased 230 dozen balls – basketball, rubber, and volley, soccer, and others. Nearly $500 came from students in Hialeah High School. Jump ropes and jacks were donated from a sorority at Florida International University. Arrangements by organizations were made to bring 44,000 pounds of baby formula and canned meat and 13,000 pounds of medicine. Many of Miami’s corporations, associations, and residents contributed to the Managuan Relief effort. Source: The Miami News, March 19, 1973 by Lynn Feigenbaum From: City of Hialeah Publicity Bureu. 401 1/2 East 1st Ave. Hialeah, Fla. 887-3400. april 30, 1973. Cutlines: Skate boards, paddle balls and flying saucers were among the big shipment of toys which was recently dispatched to Managua, Nicaragua by students of Florida International University through the Hialeah-Managua Sister Committee. Examining the toys above are, left to right: Margaret Klein, Hialeah councilman Jack Weaver and Barbara O'Nan.