Utilization profile of the trauma intensive care unit at the Role 3 Multinational Medical Unit at Kandahar Airfield between May 1 and Oct. 15, 2009

Background: In the war against the Taliban, Canada was the lead North Atlantic Treaty Organization (NATO) nation to provide medical and surgical care to NATO soldiers, Afghanistan National Army soldiers, Afghanistan Nation Police, civilians working in and outside Kandahar Airfield and Afghanistan civilians at the Role 3 Multinational Medical Unit (R3MMU) from February 2006 to October 2009. Methods: We obtained data from the Joint Theatre Trauma Registry between May 1 and Oct. 15, 2009; 188 patients were admitted to the R3MMU intensive care unit (ICU). We analyzed the ICU data according to types and causes of trauma, mechanical ventilation prevalence, ICU medical and surgical complications, blood products utilization, length of stay in the ICU and mortality. Results: The admitting services were general surgery (35%), neurosurgery (29%), orthopedic surgery (18%) and internal medicine (3%). Improvised explosive devices (46%) and gunshot wounds (26%) were the main causes of ICU admissions. The mean injury severity score for all patients admitted to the ICU was 37, and 81% of ICU patients required mechanical ventilation for a mean duration of 3 days. The main ICU complications were coagulopathy (6.4%), aspiration pneumonia (4.3%), pneumothorax (3.7%) and wound infection (2.7%). The following blood products were most used: packed red blood cells (55%), fresh frozen plasma (54%), platelets (29%) and cryoprecipitate (23%). The average length of stay in the ICU was 4.3 days, and the survival rate was 93%. Conclusion: The high survival rate suggests that ICU care is a necessary and vital resource for a trauma hospital in a war zone

The global burden of cancer attributable to risk factors, 2010–19: a systematic analysis for the Global Burden of Disease Study 2019

BACKGROUND: Understanding the magnitude of cancer burden attributable to potentially modifiable risk factors is crucial for development of effective prevention and mitigation strategies. We analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to inform cancer control planning efforts globally. METHODS: The GBD 2019 comparative risk assessment framework was used to estimate cancer burden attributable to behavioural, environmental and occupational, and metabolic risk factors. A total of 82 risk–outcome pairs were included on the basis of the World Cancer Research Fund criteria. Estimated cancer deaths and disability-adjusted life-years (DALYs) in 2019 and change in these measures between 2010 and 2019 are presented. FINDINGS: Globally, in 2019, the risk factors included in this analysis accounted for 4·45 million (95% uncertainty interval 4·01–4·94) deaths and 105 million (95·0–116) DALYs for both sexes combined, representing 44·4% (41·3–48·4) of all cancer deaths and 42·0% (39·1–45·6) of all DALYs. There were 2·88 million (2·60–3·18) risk-attributable cancer deaths in males (50·6% [47·8–54·1] of all male cancer deaths) and 1·58 million (1·36–1·84) risk-attributable cancer deaths in females (36·3% [32·5–41·3] of all female cancer deaths). The leading risk factors at the most detailed level globally for risk-attributable cancer deaths and DALYs in 2019 for both sexes combined were smoking, followed by alcohol use and high BMI. Risk-attributable cancer burden varied by world region and Socio-demographic Index (SDI), with smoking, unsafe sex, and alcohol use being the three leading risk factors for risk-attributable cancer DALYs in low SDI locations in 2019, whereas DALYs in high SDI locations mirrored the top three global risk factor rankings. From 2010 to 2019, global risk-attributable cancer deaths increased by 20·4% (12·6–28·4) and DALYs by 16·8% (8·8–25·0), with the greatest percentage increase in metabolic risks (34·7% [27·9–42·8] and 33·3% [25·8–42·0]). INTERPRETATION: The leading risk factors contributing to global cancer burden in 2019 were behavioural, whereas metabolic risk factors saw the largest increases between 2010 and 2019. Reducing exposure to these modifiable risk factors would decrease cancer mortality and DALY rates worldwide, and policies should be tailored appropriately to local cancer risk factor burden

Epilepsy care in the southern Caribbean

Very little has been reported about the health resources available for patients with epilepsy in the five English-speaking southern Caribbean countries of Trinidad and Tobago, Barbados, Grenada, Saint Vincent and the Grenadines, and Saint Lucia. There is no comprehensive resource describing their health systems, access to specialty care, antiepileptic drug (AED) use, and availability of brain imaging and EEG. The purpose of this study was to profile epilepsy care in these countries as an initial step toward improving the standard of care and identifying gaps in care to guide future policy changes. In each southern Caribbean country, we conducted study visits and interviewed health-care providers, government health ministers, pharmacy directors, hospital medical directors, pharmacists, clinic staff, radiologists, and radiology and EEG technicians. Health-care providers completed extensive epilepsy care surveys. The five countries all have integrated government health systems with clinics and hospitals that provide free or heavily subsidized care and AEDs for patients with epilepsy. Only Trinidad and Tobago and Barbados, however, have neurology specialists. The three smaller countries lack government imaging and EEG facilities. Trinidad had up to one-year waits for public MRI/EEG. Government formularies in Grenada, Saint Vincent and the Grenadines, and Saint Lucia are limited to first-generation AEDs. One or more second-line agents are formulary in Trinidad and Barbados. Nonformulary drugs may be obtained for individual patients in Barbados. Grenada, Saint Lucia, and Saint Vincent and the Grenadines participate in an Organization of Eastern Caribbean States formulary purchasing system, which added levetiracetam following the survey. Newer generic AED formulations with the lowest risks for pregnancy malformation were not in use. In conclusion, patients with epilepsy in the southern Caribbean have excellent access to government clinics and hospitals, but AED choices are limited. Local medical providers reported that the major limitations in care were lack of specialty care, lack of imaging and EEG services, financial barriers to care, long wait times for care, and limited access to additional AEDs

Breed and season influence on milk quality parameters and in mastitis occurrence

The aims of the present study were to evaluate the performance of Jersey and Holstein cows under different rainfall conditions (dry and rainy seasons) by monitoring aspects related to subclinical mastitis (somatic cell count, microbiological isolation, type of isolated pathogen), milk quality (lactose, protein, fat, total solids) and production (mean milk production) of both breeds. The study was carried out in a dairy farm located in the state of São Paulo, Brazil. Eight visitations were done to the farm, four in a period of high rainfall and four in a period of low rainfall. Milk samples were collected from 79 Holstein cows and 37 Jersey cows for electronic somatic cell count and determination of the main milk components (protein, fat, total solids, lactose). Milk fat, protein, total solids and production were influenced by breed and the season, with similar tendencies for both breeds in both seasons. Somatic cell count (SCC) showed similar results for both breeds. Holstein cows with intramammary infections (IMI) presented a higher increase in SCC when compared to Jersey cows (P<0.001). In the dry season, 53 animals had IMI in at least one month during the study, which 32 were Holstein and 21 were Jersey cows. In the rainy season, 65 animals had intramammary infection, being 43 Holstein and 22 Jersey cows. The frequency of IMI cases was larger in the rainy season than in the dry season. Jersey cows had a lower chance of showing IMI signs and symptoms than Holstein cows in the rainy season (odds ratio=0.52). The larger number of IMI cases in the rainy season may have led to a lower milk lactose rate for both breeds, thus milk lactose rate can be considered an indicator of IMI status. There was prevalence of contagious pathogens overall in the study. The applied model showed that environmental pathogens were more frequently isolated from the breed Jersey, regardless of the study season. There seems to be differences in the immune response of Jersey and Holstein breeds

Improvement of graphene oxide characteristics depending on base washing

Graphene oxide (GO) has been synthesized using Hummer’s method. This oxidation process decorates the graphene sheets by different types of functional groups, yet the harsh oxidation condition leads to introduce many of carbonaceous fragments, which decreasing GO efficiency in many faces, touched its applications. The synthesized GO has been washed by 10 M NaOH to produce (GOn). Thereafter quality enhancement of GO has been studied by several analyses; the introduced hydroxyl and carboxyl groups into few-layer graphene (FLG) surface have been determined by Fourier transform infrared spectra (FTIR). Raman spectroscopy analysis identified the defect degree and the transition of graphite from a crystalline to an amorphous structure and vice versa. The interlayer spacings of FLG and GOn were investigated by Xray diffraction (XRD) and the thermal stability of as-received and modified materials were examined by thermal gravimetric analysis (TGA). The morphological structure was characterized by scanning electron microscopy (SEM) and high resolution transmission electron microscopy (HRTEM). The various investigations confirmed that the properties of GO were improved by neutralization impact, which may pave the way to new developments in the GO-based applications.Методом Хаммера синтезувано оксид графену (ОГ). Цей процес окислення декорує площини графена різними типами функціональних груп, жорсткі умови окислення призводять також до появи великої кількості вуглецевовмісних фрагментів, які зменшують ефективність ОГ в багатьох областях його застосування. Синтезований ОГ промивали розчином 10 М NaOH для отримання (ОГ)n. Якість ОГ досліджено кількома методами: введені в малошаровий графен гідроксильні та карбоксильні групи визначали Фур’є-інфрачервоною спектроскопією, ступінь дефектності та перехід графіту з кристалічної структури в аморфну і навпаки ідентифікували Раманівською спектроскопією, відстань між шарами у малошаровому графені і (ОГ)n досліджували з використанням рентгенівської дифракції, а термостабільність вихідних і модифікованих матеріалів – термогравіметричним аналізом, морфологію структури характеризували за допомогою скануючої електронної мікроскопії і просвічуючої електронної мікроскопії високої роздільної здатності. Різні дослідження підтвердили, що властивості ОГ поліпшувалися під дією нейтралізації, що може прокласти шлях новим розробкам щодо його застосування.Методом Хаммера синтезировали оксид графена (ОГ). Этот процесс окисления декорирует плоскости графена различными типами функциональных групп, жесткие условия окисления приводят также к появлению большого количества углеродсодержащих фрагментов, которые уменьшают эффективность ОГ во многих областях его применения. Синтезированный ОГ промывали раствором 10 М NaOH для получения ОГn. Затем качество ОГ исследовали несколькими методами: введенные в малослойный графен гидроксильные и карбоксильные группы определяли Фурье-инфракрасной спектроскопией; степень дефектности и переход графита из кристаллической структуру в аморфную и наоборот идентифицировали Рамановской спектроскопией, расстояние между слоями в малослойном графене и ОГn исследовали с использованием рентгеновской дифракции, а термостабильность исходных и модифицированных материалов – термогравиметрическим анализом, морфологию структуры характеризовали c помощью сканирующей электронной микроскопии и просвечивающей электронной микроскопии высокого разрешения. Различные исследования подтвердили, что свойства ОГ улучшались под действием нейтрализации, что может проложить путь новым разработкам по его применению