Community resilience has been addressed across multiple disciplines including environmental sciences, engineering, sociology, psychology, and economics. Interest in community resilience gained ...momentum following several key natural and human-caused hazards in the United States and worldwide. To date, a comprehensive community resilience model that encompasses the performance of all the physical and socio-economic components from immediate impact through the recovery phase of a natural disaster has not been available. This paper summarizes a literature review of previous community resilience studies with a focus on natural hazards, which includes primarily models of individual infrastructure systems, their interdependencies, and community economic and social systems. A series of national and international initiatives aimed at community resilience are also summarized in this study. This paper suggests extensions of existing modeling methodologies aimed at developing an improved, integrated understanding of resilience that can be used by policy-makers in preparation for future events.
Kawasaki disease (KD) is one of the most common vasculitides of early childhood. There are no previous studies on KD in Cyprus. The aim of this study was to evaluate the epidemiology of KD in Cyprus, ...risk factors for resistance to treatment and the development of cardiac complications. This is a retrospective multicenter study of pediatric patients with KD hospitalized between January 2000 and-December 2019. The data were collected from medical records. A total of 136 patients with KD were included in the study. 83% of patients were < 5 years of age and 10% were < 6 months. Thirty patients (22%) developed coronary artery lesions. Serum sodium ≤ 133 mmol/L, albumin ≤ 3.2 g/dl, ALT ≥ 80 U/L and neutrophils percentage ≥ 80% at diagnosis, were identified as risk factors for resistance to IVIG. Clinical and epidemiological characteristics of KD in Cyprus population were similar to those reported in the literature. Although the majority of cases received appropriate treatment in time, cardiac complications still occurred.
The community's resilience in the face of natural hazards relies heavily on the rapid and efficient restoration of electric power networks, which plays a critical role in emergency response, economic ...recovery, and the functionality of essential lifeline and social infrastructure systems. Leveraging the recent data revolution, the digital twin (DT) concept emerges as a promising tool to enhance the effectiveness of post-disaster recovery efforts. This paper introduces a novel framework for post-hurricane electric power restoration using a hybrid DT approach that combines physics-based and data-driven models by utilizing a dynamic Bayesian network. By capturing the complexities of power system dynamics and incorporating the road network's influence, the framework offers a comprehensive methodology to guide real-time power restoration efforts in post-disaster scenarios. A discrete event simulation is conducted to demonstrate the proposed framework's efficacy. The study showcases how the electric power restoration DT can be monitored and updated in real-time, reflecting changing conditions and facilitating adaptive decision-making. Furthermore, it demonstrates the framework's flexibility to allow decision-makers to prioritize essential, residential, and business facilities and compare different restoration plans and their potential effect on the community.
A large number of communities are impacted annually by the increasing frequency of tornado hazards resulting in damage to the infrastructure as well as disruption of community functions. The effect ...of the hazard geometry (center and angle of tornado path as well as the tornado width) is studied herein on how it influences the recovery of physical and social systems within the community. Given that pre-disaster preparedness including mitigation strategies (e.g., retrofits) and policies (e.g., insurance) is crucial for increasing the resilience of the community and facilitating a faster recovery process, in this study, the impact of various mitigation strategies and policies on the recovery trajectory and resilience of a typical US community subjected to a tornado is investigated considering different sources of uncertainties. The virtual testbed of Centerville is selected in this paper and is modeled by adopting the Agent-based modeling (ABM) approach which is a powerful tool for conducting community resilience analysis that simulates the behavior of different types of agents and their interactions to capture their interdependencies. The results are presented in the form of recovery time series as well as calculated resilience indices for various community systems (lifeline networks, schools, healthcare, businesses, and households). The results of this study can help deepen our understanding of how to efficiently expedite the recovery process of a community.
The differential diagnosis of multiple unexplained bone fractures in a young infant usually includes child abuse or bone disease such as osteogenesis imperfecta. Bone abnormalities can occur in ...60-80% of cases with congenital syphilis and may be the sole manifestation. However, this frequent manifestation of this rare disease such as congenital syphilis is frequently disregarded. We describe a case of a young infant with multiple long bone fractures diagnosed with congenital syphilis.
This 2-month-old male patient was referred to our hospital because of fractures of the ulna and distal radius bilaterally and noisy breathing with the suspicion of osteogenesis imperfecta. After thorough examination, the infant had anemia and a palpable spleen. We performed a screen for congenital infections among other investigations, which revealed positive non-treponemal and treponemal antibodies for syphilis. Hence the diagnosis for Congenital Syphilis was made. We performed a lumbar puncture (LP) which showed mild pleocytosis. The patient was treated with intravenous aqueous penicillin G 200 000 UI/KG per day for 10 days. In addition, a single dose of intramuscular penicillin G benzathine 50 000 UI/KG was given due to the abnormal result of CSF. On follow up admission 6 months later, the new syphilis serology had much improved and the new LP revealed no abnormal findings.
We present this case report in order to remind of a common manifestation of congenital syphilis, a rare disease which needs to be included in the differential diagnosis of multiple unexplained fractures in early infancy. In our case the fractures were symmetric and bilateral and they were accompanied by anemia and mild hepatosplenomegaly which led to the investigation of congenital syphilis as a possible cause. However, two thirds of infants with congenital syphilis are asymptomatic at birth. All women should have a proper syphilis screening during pregnancy.
The spread of COVID-19 into a global pandemic has negatively affected the mental health of frontline healthcare-workers. This study is a multi-centre, cross-sectional epidemiological study that uses ...nationwide data to assess the prevalence of stress, anxiety, depression and burnout among health care workers managing COVID-19 patients in Cyprus. The study also investigates the mechanism behind the manifestation of these pathologies, as to allow for the design of more effective protective measures. Data on the mental health status of the healthcare workers were collected from healthcare professionals from all over the nation, who worked directly with Covid patients. This was done via the use of 64-item, self-administered questionnaire, which was comprised of the DASS21 questionnaire, the Maslach Burnout Inventory and a number of original questions. Multivariable logistic regression models were used to investigate factors associated with each of the mental health measures. The sample population was comprised of 381 healthcare professionals, out of which 72.7% were nursing staff, 12.9% were medical doctors and 14.4% belonged to other occupations. The prevalence of anxiety, stress and depression among the sample population were 28.6%, 18.11% and 15% respectively. The prevalence of burnout was 12.3%. This was in parallel with several changes in the lives of the healthcare professionals, including; working longer hours, spending time in isolation and being separated from family. This study indicates that the mental health of a significant portion of the nation's workforce is compromised and, therefore, highlights the need for an urgent intervention particularly since many countries, including Cyprus, are suffering a second wave of the pandemic. The identified risk factors should offer guidance for employers aiming to protect their frontline healthcare workers from the negative effects of the COVID-19 pandemic.
Seasonal influenza is a major public health problem. Nosocomial influenza is particularly concerning as it may affect patients at high risk for complications. Unvaccinated health care workers (HCWs) ...are an important source of nosocomial influenza and therefore a priority target group for vaccination. Despite the fact that some European countries have high coverage rates such as UK (76.8% in season 2020/21), others continue to have low coverage rates for influenza vaccines. This study aims to estimate vaccination coverage in HCWs in Cyprus, an island country located in the Eastern Mediterranean region and describe their attitudes towards influenza vaccination.
This is a questionnaire based, nation-wide study assessing flu vaccination coverage in 2019–2020 and attitudes related to vaccination acceptance, of 962 HCWs in both public and private health care facilities. Multivariable logistic regression was used to investigate factors associated with flu vaccination status.
Flu vaccination coverage was estimated as 31.8%. The top two reasons for getting vaccinated were to protect their family (81.4%) and themselves (77.4%). The top two reasons for not getting immunised, besides “no particular reason” (25.7%), included disbelief for vaccine effectiveness (21.5%) and safety (29.3%). The regression model showed that doctors compared to nurses had 10 times the odds of being vaccinated. Other factors positively associated with flu vaccination were encouragement by the supervisor, having sufficient knowledge on flu and flu vaccination and easy access to vaccination. A percentage of 54.8% of participants stated that COVID-19 pandemic strongly or somewhat influenced their decision to get vaccinated.
Flu vaccination coverage in HCWs in Cyprus is rather low, similar to some other European countries. Barriers and facilitators in this study can be considered in strategies to increase flu vaccination uptake. Such questionnaire-based surveys should be repeated in order to evaluate effectiveness of targeted vaccination campaigns.
During the past decades Streptococcus pneumoniae has developed significant resistance to many classes of antimicrobial drugs. Potential risk factors for colonization of the nasopharynx by ...Streptococcus pneumoniae in children and for carriage of drug resistant strains were examined.
Between 2007 and 2008 nasopharyngeal swabs were collected from 402 children 6 months to 5 years old visiting the public sector immunization centers and outpatient departments as well as offices of paediatricians from private practice in Nicosia district in Cyprus. Information on demographic characteristics and potential risk factors of participating children were collected using a standardized questionnaire distributed to parents.
In multivariable analyses we found that attendance at day care center, having siblings in the family and having both parents originating from Cyprus, statistically increased the risk of pneumococcal colonization. Full immunization with PCV7 appears to be a protective factor against colonization by pneumococcus. Previous administration of antimicrobials during the last month prior to specimen collection appeared to be the most consistent risk factor for carrying a non susceptible strain of Streptococcus pneumoniae to either penicillin or erythromycin. Factors such as age, nationality, previous or current breastfeeding, passive exposure to cigarette smoke and attendance in a day care center do not appear as independent risk factors for colonization by non susceptible strains.
Prudent use of antibiotics especially for upper respiratory tract infections in children as well as increased vaccination coverage by the pneumococcal conjugate vaccines could prove effective in reducing levels of colonization by drug resistant pneumococcal strains.
Experience from past earthquakes has demonstrated the need to account for design goals beyond safety, known as functional recovery objectives, in the interest of community resilience. Frameworks have ...been proposed in the literature to assess the post-earthquake functional recovery of a building, but without accounting for utility systems’ disruption, which may be a key contributor to determining when a building is functional. This paper integrates a previously proposed probabilistic method for estimating the post-earthquake restoration of critical utility services with an individual building's functional recovery assessment framework. The integration was performed by incorporating utilities into the building system fault trees embedded into a functional recovery framework for various building occupancies (residential and commercial office buildings). Once incorporated, the results are used to interrogate the functional recovery of a reinforced concrete building, and the recovery time results were presented for seven cases investigating contributing factors in the functional recovery results including the number of crews available for lifeline restoration, the effect of low-quality service on meeting tenant requirements for elevators, heating ventilation and air conditioning (HVAC), plumbing and electrical systems, consideration of fire watch, the effect of building seismic retrofit, as well as different cases of fragility functions for the lifeline systems. Results showed that utility systems’ disruption does not have a significant impact on the recoccupancy of a building because only one utility-dependent building system (fire suppression) is needed for the building's safety. Unlike reoccupancy, utility systems are significant for functional recovery, mainly at moderate hazard levels because, at these levels, lifeline networks could be damaged without significant building damage, such that the lifeline systems restoration governs. Buildings with more restrictive tenant requirements are more sensitive to tenant disruptions.
AbstractPostdisaster community scale recovery and resilience assessments have gained interest in the United States and around the world following natural and human-made disasters. Tornadoes are one ...of the most devastating natural disasters that occur in the United States every year with an annual average of more than 1,200 causing an impactful number of deaths as well as economic losses. The postdisaster recovery planning and process of communities can be enhanced by the use of risk-informed decision-making tools accounting for postdisaster vulnerability and restoration assessment in terms of repair time (functionality) and repair cost (economic losses). In this study, a methodology to probabilistically quantify building functionality through the development of functionality fragilities for use within broader community modeling is introduced. It is important when performing community resilience assessment studies to break down the components making up a community into their most fundamental components. Thus, it is proposed to generate stand-alone functionality fragilities (e.g., for different building types) and thereby not limit the process for optimizing risk-informed decision making, which may include options such as changes in permitting time, or removal of construction constraints. The proposed functionality methodology is composed of four steps while integrating concepts of performance based engineering, where functionality analyses are first performed for each major component in the building including both structural and nonstructural components (subassembly level) and then the results are combined in the form of statistical distributions to quantify the building (system level) functionality. The methodology is illustrated for a suite of 19 building types ranging from residential, schools, and hospitals, representing the building stock in the US communities needed to model a community that is heavily impacted by an extreme wind event (i.e., tornado). The post-tornado building direct economic losses are also probabilistically assessed for the 19 building archetypes. Repair times (functionality) and repair cost distribution curves summarized in this study may be further used in risk-informed decision making for investigation of policy implications, the effect of retrofit programs, and other changes to building codes.
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