An interpretative phenomenological analysis of stress and well-being in Emergency Medical Dispatchers

This study explored the stress and wellbeing of Emergency Medical Dispatchers (EMD) who remotely provide crisis intervention to medical emergencies through telehealth support. Semi-structured interviews with 16 EMDs were conducted and Interpretative Phenomenological Analysis was used to identify themes in the data. These results indicated that despite their physical distance from the crisis scene, EMDs can experience vicarious trauma through acute and cumulative exposure to traumatic incidents and their perceived lack of control which can expound feelings of helplessness. Three superordinate themes of operational stress and trauma, organisational stress, and posttraumatic growth were identified. Practical implications are suggested to enable emergency services organisations to counteract this job related stress and promote more positive mental health outcomes.

Social support, self-efficacy, trauma and well-being in emergency medical dispatchers

Emergency Medical Dispatchers (EMDs) respond to crisis calls for ambulance; they dispatch paramedics and provide emotional and medical assistance to callers. Despite the stressful nature and exposure to potentially traumatising events in this role, there has been no published research specifically investigating well-being or posttraumatic growth among EMDs. Extrapolating from research conducted among other emergency services workers (e. g., paramedics, police), literature attests to the importance of self efficacy and social support in promoting mental health in emergency service workers. Therefore, this study assessed the impact of self efficacy, and giving and receiving social support on psychological well-being, posttraumatic growth (PTG), and symptoms of posttraumatic stress disorder (PTSD). Sixty EMDs (50% response rate) completed an online questionnaire. Three hierarchical multiple regression analyses were conducted to ascertain predictors of well-being, PTG and PTSD. Receiving social support emerged as a significant positive predictor of well-being and PTG, and a significant negative predictor of PTSD. Self efficacy was found to significantly and positively predict well-being, and shift-work was found to significantly and negatively predict PTSD. These results highlight that self efficacy and receiving social support are likely to be important for enhancing well-being within this population, and that receiving social support is also likely to facilitate positive post-trauma responses. Such findings have implications for the way emergency service personnel are educated with reference to aspects of mental health and how best to support personnel in order to achieve optimal mental health outcomes for all.

Growth and meaning from negotiating the complex journey of being an Emergency Medical Dispatcher

Emergency Medical Dispatchers (EMDs) are charged with taking the calls of those who ring the national emergency number for urgent medical assistance, for dispatching paramedical crews, and for providing as much assistance as can be offered remotely until paramedics arrive. In a job role which is filled with vicarious trauma, emergency situations, pressure, abuse, grief and loss, EMDs are often challenged in maintaining their mental health. The seemingly senseless death of a teenager who commits suicide, the devastating loss of a baby to Sudden Infant Death Syndrome, lives lost through natural disasters, and multiple vehicle fatalities are only a few of the types of experiences EMDs are faced with in the course of their work. However, amongst the horror are positive stories such as coaching a caller to negotiate the birth of a baby and saving a life in jeopardy from heart failure. EMD’s need to cope with the daily challenges of the role; make sense of their work and create meaning in order to have a fulfilled and sustainable career. Although some people in this work struggle greatly to withstand the impacts of vicarious trauma, there are also stories of personal growth. In this Chapter we use a case study to explore how meaning is made for those who are an auditory witness to a continual flux of trauma for others and how the traumatic experiences EMDs bear witness to can also be a catalyst for posttraumatic growth.

岷江上游景观可持续管理决策预案研究

岷江上游地区是我国一个重要的大尺度、复合型生态过渡带，也是一个生态系统脆弱区和敏感区，它不但影响当地和岷江下游的农业生产、生活用水和生态环境，而且影响长江上游地区生态环境改善，在长江上游生态安全格局中占有重要地位。近几十年来，在强烈的自然变化与人类活动干扰下，该区域景观发生了巨大变化，综合研究影响景观变化的自然、社会因子，制定以生态系统可持续为目标的景观管理决策，从而为改善区域生态环境，构建生态安全格局具有重要的科学意义和现实需求。本论文通过对岷江上游农、林、草复合景观诸多因子的研究，通过NetWaver和CDP（Criterium DecisionPlus）平台，分别建立基于模糊逻辑的景观评价知识库和基于多目标决策的景观管理决策模型，实现了岷江上游3种不同目标的景观管理决策预案。本论文取得了如下结论： (1). 景观格局分析表明，岷江上游景观以草地为基质，森林以及其他景观类型作为斑块镶嵌其中，草地类型影响到整个景观格局的生态过程，包括物质的传输与能量的流动。 (2). 通过建立人类活动强度这一可定量化测度的指标，分析了研究区森林、草地、耕地三种主要景观类型的格局变化，结果显示，人类活动视为信息熵输入，其强度大小对景观类型所起的作用不同，正确引导和控制一定范围、一定强度的人类活动可以实现景观的恢复。 (3). 基于NetWeaver系统，设计景观评价模糊知识库，对研究区进行了景观综合评价，整个流域除了四个子流域支持程度为低或者非常低外，其余子流域支持程度较好，景观管理的可行性和有效性水平较高。评价的结果为景观管理预案的设计提供了重要的数据支持。 (4). 综合研究区社会、经济和生态发展三个子系统，通过层次分析法，建立三层指标体系对研究区可持续能力进行评价。结果表明，岷江上游可持续发展能力综合评价值为0.22（理想值为1），反映出景观可持续能力差，实施区域生态系统管理，制订可持续管理预案具有重要性和紧迫性。 (5). 通过CDP（Criterium DecisionPlus）平台，综合所有对景观管理有潜在影响的因素，构建景观管理的决策模型，设计了三个基于不同管理目标的决策预案；并对所设计的管理预案进行了模型不确定性分析、灵敏度分析和因子贡献量分析，验证了预案模型的鲁棒性（robustness）；最后，结合生态系统管理系统EMDS（Ecosystem Management Decision System）和ARC/GIS的环境实现预案空间表达，并对决策结果进行了分析与讨论。论文的研究结果是研究区实施景观管理规划的关键性参考依据。

岷江上游景观变化评价

通过NetWeaver设计模糊知识库,利用EMDS模型定量评价了岷江上游1986—2000年景观变化.结果表明:整个流域景观的斑块类型、面积、数量及空间配置均发生了较大变化,且朝着有利于生态恢复的方向变化.森林类型的变化主要发生在北部(松潘县和黑水县).草地类型的变化主要发生在北部(松潘县)和最南部(汶川县).流域景观变化是人类活动强度增大和自然变化共同作用的结果.

岷江上游农林复合景观管理优先度评价

结合前期研究共辨识出10项景观管理影响因子,依据其作用的性质和特点,将其分为4大类参数,通过NetWeaver模型构建了基于模糊逻辑的优先度评价知识库,在EMDS(Ecosystem Management Decision Support system)和ARCGIS9.x环境下,对4类景观管理影响因子的优先度进行了评价。结果显示:1)可行性因子综合优先度评价结果为除ws3、ws6、ws8和ws9 4个子流域的优先度为低外,其余6个子流域优先度居于中等优先水平;2)有效性因子优先度综合评价结果,ws1、ws9和ws10 3个子流域优先度为强,ws8优先度最低,其余子流域为中等优先;3)景观综合结果除ws1~ws33个子流域属于强外,其余子流域优先度为低;4)所有影响因子的综合结果为ws8子流域优先度最低,其余部分优先度居于中等。

Effect of Enamel Matrix Derivative Liquid on Osteoblast and Periodontal Ligament Cell Proliferation and Differentiation.

BACKGROUND Enamel matrix derivatives (EMDs) have been used clinically for more than a decade for the regeneration of periodontal tissues. The aim of the present study is to analyze the effect on cell growth of EMDs in a gel carrier in comparison to EMDs in a liquid carrier. EMDs in a liquid carrier have been shown to adsorb better to bone graft materials. METHODS Primary human osteoblasts and periodontal ligament (PDL) cells were exposed to EMDs in both gel and liquid carriers and compared for their ability to induce cell proliferation and differentiation. Alizarin red staining and real-time polymerase chain reaction for expression of genes encoding collagen 1, osteocalcin, and runt-related transcription factor 2, as well as bone morphogenetic protein 2 (BMP2), transforming growth factor (TGF)-β1, and interleukin (IL)-1β, were assessed. RESULTS EMDs in both carriers significantly increased cell proliferation of both osteoblasts and PDL cells in a similar manner. Both formulations also significantly upregulated the expression of genes encoding BMP2 and TGF-β1 as well as decreased the expression of IL-1β. EMDs in the liquid carrier further retained similar differentiation potential of both osteoblasts and PDL cells by demonstrating increased collagen and osteocalcin gene expression and significantly higher alizarin red staining. CONCLUSIONS The results from the present study indicate that the new formulation of EMDs in a liquid carrier is equally as potent as EMDs in a gel carrier in inducing osteoblast and PDL activity. Future study combining EMDs in a liquid carrier with bone grafting materials is required to further evaluate its potential for combination therapies.