Red Cross Hospital

Abstract. In this paper, we explore five core challenges that need to be addressed in order to move towards the Comprehensive Disaster and Climate Risk Management approach, which has been proposed within the newly emerging paradigm of a more holistic approach to managing the risks associated with climatic and/or non-climatic hazards and non-climatic risk drivers across varied time scales and levels. These five challenges relate to the following points. First, we have a lack of comprehensive and high quality data for observing how society is impacted by, prepares for, and responds to multi-risks. Second, as a result we have a limited understanding of why individuals, communities, and other decision-makers (fail to) prepare for complex multi-risks in the way they do, and how that affects their responses. Third, our capacity to simulate how current and future risk could be effectively reduced is hampered by the aforementioned lack and fragmentation of observations and understanding of multi-risk dynamics. Fourth, current governance structures often reinforce data and knowledge silos. Fifth, the high complexity and wicked nature of the multi-risk problem results in barriers in knowledge exchange at the science, policy and practice interface. In this paper, we elaborate on each of these challenges, discuss why they matter for comprehensive disaster risk management, and provide ideas of how to overcome these challenges. We end the paper with a brief outlook.

Small Island Developing States (SIDS) in the Eastern Caribbean face escalating hurricane risk under climate change, with impacts driven by compound hazards including extreme wind, rainfall, and storm surge. Anticipatory Action (AA) mechanisms—where predefined actions are activated based on forecast thresholds—offer a means to translate advances in climate and weather prediction into timely, risk-reducing interventions. However, designing robust, decision-relevant trigger models that balance forecast skill, uncertainty, and operational feasibility remains a key challenge, particularly in multi-country contexts.We studied the feasibility of a sub-regional Early Action Protocol (EAP) covering Saint Kitts and Nevis, Dominica, and Antigua and Barbuda, and focused specifically on how to design a sub-regional trigger model. Using stakeholder consultations, analysis of national disaster management systems, analysis of historical and synthetic events by modelling wind, surge, and rainfall, and review of existing forecasting products, we assessed trigger options across temporal scales, compound hazard components, and impact relevance.Results show that the wind and track forecasts from the US National Hurricane Centre demonstrated substantial improvements in accuracy over recent decades. The NHC’s 48-hour track error now averages about 90 km, meaning that areas at risk can be identified with an acceptable uncertainty in terms of storm size and asymmetry. Early actions possible within this lead time can include mobilizing communities, cash distributions, and prepositioning stock. Also, the NHC forecast is the official source, widely adopted by the respective national agencies in the three countries. In the future, the trigger model could be improved by, for example, ECMWF’s AIFS, Google DeepMinds GraphCast, or Microsoft Research’s Aurora, as these have demonstrated the ability to deliver medium-range forecasts with skill comparable to or surpassing traditional numerical models. While these AI models are not yet operational tools at national centres, they are available for experimental use and could be incorporated through the Caribbean Institute for Meteorology and Hydrology (CIMH) as complementary resources for rapid local updates and scenario planning within a newly developed anticipatory framework. In that case, a layered trigger architecture could be designed, containing: (i) probabilistic tropical cyclone track and intensity forecasts; (ii) impact-oriented thresholds linked to rainfall accumulation, wind exposure, and storm surge; and (iii) contextual readiness criteria reflecting response capacities.Our study highlights key design principles for anticipatory trigger models in SIDS now and in the future: transparency, simplicity, tolerance to forecast uncertainty, and alignment with decision timelines for early action. By articulating how forecast information can be operationalised across borders, this contribution advances the integration of climate services and anticipatory humanitarian action in highly exposed island regions. A sub-regional trigger model can leverage shared meteorological information and pooled technical expertise, while allowing country-specific activation thresholds to account for differing exposure and coping capacities. A future initiative will focus on scaling up to Barbados and Belize.

The population-related incidence of pediatric battery ingestion is 1.18 episodes per 100,000 children per year in the Netherlands with 17% complications. Battery swallowing in young children is a life-threatening emergency-urgent action and increased awareness among politicians, industry and healthcare professionals are essential to prevent serious harm. • Battery ingestion can lead to severe complications and mortality. • Young children are prone to accidental button battery ingestion due to oral exploration. • Esophageal impaction and related complications are more common in children compared to adults due to small anatomy. • The incidence rate of pediatric battery ingestion is rarely described worldwide. In the Netherlands, the incidence is 1.18 per 100,000 children per year. • Unfortunately, complications are relatively often after ingestion (17%).

Abstract Taxi service quality is traditionally assessed using objective metrics like waiting time, cost, and comfort. However, contemporary research confirms that subjective psychological factors significantly influence service perception. This study aims to proactively determine the relationship between passenger-driver interaction and the psycho-emotional factors of trust, empathy, and control using a fuzzy logic approach. The empirical basis for the research was a survey of 118 respondents from Ukraine and 101 respondents from Poland. The survey results were converted into percentage distributions for the factors of trust, empathy, and control, which served as the input parameters for a new fuzzy model developed in MATLAB. For model validation, a case study of 10 pilot trips was conducted, comparing the model's predictions with actual passenger ratings. The new fuzzy model predicted interaction levels in the range of 56.05–94.86%, which in most cases aligned with the actual passenger ratings for each trip. The average deviation between the model's predictions and the actual ratings was less than 6.67% according to the Relative Error metric. Analysis of the error revealed that accounting for individual trip circumstances enhances prediction accuracy. The novelty of this research lies in translating a passenger’s subjective psycho-emotional perceptions into quantitative indicators, which increases the reliability of taxi service quality assessment. The results are significant for taxi services and the logistics of their operations, providing a deeper understanding of the psychological factors that influence ratings. Furthermore, this approach can be used by digital taxi platforms for more effective service management. The work demonstrates the potential of fuzzy logic to improve predictive accuracy, develop personalized strategies, and create a foundation for intelligent decision support systems to enhance taxi services in European cities.

Introduction: Patient-facing websites operated by medical societies are crucial for disseminating reliable health information; however, their real-world usage and effectiveness are often unquantified. This study investigated the user engagement and demographics of "Scoliosis Town," a patient education website developed by the Japanese Scoliosis Society, to evaluate its performance.

Abstract Background Postpartum hemorrhage (PPH) is a leading cause of maternal morbidity and mortality. Early risk stratification is vital, especially for vaginal deliveries without specific predictive tools. This study aimed to develop and validate a user-friendly nomogram to predict PPH risk in this group. The goal is to enhance clinical decision-making. Methods We conducted a retrospective cohort study of 6,386 women who had vaginal deliveries at a single center in China from January 2024 to June 2025. The cohort was randomly divided into a training set (n = 4470) and an external validation set (n = 1916). We used multivariate logistic regression to identify independent risk factors. We then created a predictive nomogram. The model was validated internally with bootstrap resampling and externally. We assessed its discrimination, calibration, and clinical utility. Results The nomogram included twelve independent risk factors, such as placental abruption, battledore or velamentous placenta, and history of uterine surgery. The model had excellent discrimination, with AUCs of 0.878 (95% CI: 0.850–0.905) for the training set and 0.882 (95% CI: 0.841–0.923) for the validation set. Calibration was good. Decision curve analysis showed high net clinical benefit. Conclusions We developed and validated a highly accurate, practical nomogram to predict PPH after vaginal delivery. This tool helps clinicians and midwives identify high-risk women early. It enables timely interventions and supports proactive management to improve maternal safety.

Abstract Background Dent disease is a hereditary renal tubular disorder caused by pathogenic variants in either the CLCN5 (Dent disease 1) or OCRL1 (Dent disease 2) gene. As a rare genetic disorder, Dent disease often presents with variable clinical manifestations, leading to frequent misdiagnosis or underdiagnosis, especially in milder cases. Consequently, limited research has addressed the long-term clinical outcomes of Dent disease. Methods This retrospective multicenter cohort study was conducted at 9 hospitals in Korea. A total of 48 male patients from 44 unrelated families with genetically confirmed Dent disease were enrolled, and their clinical phenotypes, and genetic backgrounds were assessed. Result The median age at diagnosis for Dent disease was 6.8 years, and 42 patients were diagnosed with Dent disease 1. At diagnosis, 17 patients (37.0%) demonstrated the classic triad of Dent disease features, whereas 12 patients (26.1%) presented solely with isolated low-molecular-weight proteinuria. During follow-up, whereas all patients maintained low-molecular-weight proteinuria, hypercalciuria, nephrocalcinosis, and nephrolithiasis occurred in 82.6%, 56.5%, and 8.3% of patients, respectively. The cases with Dent disease 2 had a higher rate of hypophosphatemia and significantly elevated proteinuria compared to Dent disease 1. A negative correlation was identified between hypercalciuria and age. The decline rate of annual estimated glomerular filtration rate was 0.6 mL/min/1.73 m², without the case of kidney failure. At last follow-up, kidney dysfunction was present in 36.8% of cases. Conclusions Over a third of Dent disease patients developed chronic kidney disease. Accordingly, clinicians should carefully monitor kidney function through the childhood.

ABSTRACTThis study aimed to determine if skin types can be accurately assessed via melanin scores measured with a colormeter, and whether scar characteristics of people with different skin types are different at various stages of healing. Melanin scores of a Cortex DSM Colormeter were validated against the Fitzpatrick skin type questionnaire in healthy volunteers and unaffected skin of burn and scar patients (N = 137) to determine melanin index cut‐offs per skin type. Scar quality in children and adults at 3, 6, and 12 months post‐burn using DSM Colormeter and the Patient and Observer Scar Assessment Scale (POSAS) was analysed in a cohort of > 1000 patients. Data from 137 individuals showed good correlation between melanin index and Fitzpatrick skin types (Spearman's rho: 0.72 Dermaspectrometer, 0.69 DSM II; p < 0.0001). Scar characteristics varied by skin type for erythema, pigmentation, vascularization, and overall POSAS scores. Children had significantly thicker scars than adults, regardless of skin type, varying from 0.3 to 1.4 points difference on the observer scale at 12 months post burn. We conclude that skin type can be objectively classified using the melanin index, showing a strong correlation with the Fitzpatrick questionnaire. Skin type influences scar outcomes, especially pigmentation and vascularization. Children, particularly those with lighter skin, tend to develop thicker scars than adults. Recognising these differences can improve scar management and patient education.

Abstract Background Wild-type amyloid transthyretin cardiomyopathy (ATTRwt-CM) is an infiltrative disease caused by the progressive deposits of transthyretin amyloid in the myocardium by aging and thus currently considered a more common cause of heart failure in the elderly. Amyloid fibril accumulation increases resistance in coronary microcirculation and results in the high prevalence of coronary microvascular dysfunction (CMD) in cardiac amyloidosis. However, the prevalence and determinants of CMD among patients with ATTRwt-CM using invasive modality remains unknown. Purpose We aimed to investigate the prevalence and determinants of CMD in patients with ATTRwt-CM using intracoronary temperature-pressure wire. Methods Patients with cardiac hypertrophy, defined as interventricular septum thickness ≥12 mm, undergoing invasive CMD assessment were prospectively enrolled. Patients with renal failure (eGFR&amp;lt;30), decompensated heart failure, or significant coronary artery disease (visual stenosis &amp;gt;90%) were excluded. ATTRwt-CM was diagnosed by endomyocardial biopsy and genetic testing. CMD was invasively assessed by bolus intracoronary thermodilution using PressureWire X and Coroventis CoroFlow Cardiovascular System and was defined as coronary flow reserve (CFR) &amp;lt;2.0 or index of microvascular resistance (IMR) ≥25. Results A total of 50 patients (ATTRwt-CM: n=21, non-ATTR-CM: n=29 [hypertrophic cardiomyopathy: n=16, hypertensive heart disease: n=13]) were analyzed. Among patients with ATTRwt-CM, the mean age was 79 years and 86% were male. Overall, 62% of the study population had CMD, with a similar prevalence between the 2 groups (57% in ATTRwt-CM and 66% in non-ATTR-CM, P=0.547) (Abstract Picture 1). Among 31 patients with CMD, IMR ≥25 was more dominant in the ATTRwt-CM group (91.7%, n=11/12), whereas CFR &amp;lt;2.0 was more common in the non-ATTR-CM group (78.9%, n=15/19). In patients with ATTRwt-CM, IMR was significantly correlated with BNP (r=0.479, p=0.028) and troponin T (r=0.460, p=0.041), while there were no significant correlations between IMR and brain natriuretic peptide (BNP) (r=0.095, p=0.630), and IMR and troponin T (r=-0.180, p=0.390) in patients with non-ATTR-CM (Abstract Picture 2). Conclusions CMD was highly prevalent in patients with ATTRwt-CM. Significant association between IMR and cardiac biomarkers such as troponin T and BNP observed only in patients with ATTRwt-CM may suggest the pathophysiological role of CMD in myocardial injury among patients with ATTRwt-CM.