Global emergency medicine: A scoping review of the literature from 2021

OBJECTIVE

The objective was to identify the most important and impactful peer-reviewed global emergency medicine (GEM) articles published in 2021. The top articles are summarized in brief narratives and accompanied by a comprehensive list of all identified articles that address the topic during the year to serve as a reference for clinicians, researchers, and policy makers.

METHODS

A systematic PubMed search was carried out to identify all GEM articles published in 2021. Title and abstract screening was performed by trained reviewers and editors to identify articles in one of three categories based on predefined criteria: disaster and humanitarian response (DHR), emergency care in resource-limited settings (ECRLS), and emergency medicine development (EMD). Included articles were each scored by two reviewers using established rubrics for original (OR) and review (RE) articles. The top 5% of articles overall and the top 5% of articles from each category (DHR, ECRLS, EMD, OR, and RE) were included for narrative summary.

RESULTS

The 2021 search identified 44,839 articles, of which 444 articles screened in for scoring, 25% and 22% increases from 2020, respectively. After removal of duplicates, 23 articles were included for narrative summary. ECRLS constituted the largest category (n = 16, 70%), followed by EMD (n = 4, 17%) and DHR (n = 3, 13%). The majority of top articles were OR (n = 14, 61%) compared to RE (n = 9, 39%).

CONCLUSIONS

The GEM peer-reviewed literature continued to grow at a fast rate in 2021, reflecting the continued expansion and maturation of this subspecialty of emergency medicine. Few high-quality articles focused on DHR and EMD, suggesting a need for further efforts in those fields. Future efforts should focus on improving the diversity of GEM research and equitable representation.

Volumetric quantification of choroid and Haller's sublayer using OCT scans: An accurate and unified approach based on stratified smoothing

BACKGROUND AND OBJECTIVE

The choroid, a dense vascular structure in the posterior segment of the eye, maintains the health of the retina by supplying oxygen and nutrients, and assumes clinical significance in screening ocular diseases including age-related macular degeneration (AMD) and central serous chorioretinopathy (CSCR). As a technological assist, algorithmic estimation of choroidal biomarkers has been suggested based on sectional (B-scan) optical coherence tomography (OCT) images. However, most such 2D estimation techniques are compute-intensive, yet enjoy limited accuracy and have only been validated on OCT image datasets of healthy eyes. Not surprisingly, fine-scale analyses, including those involving Haller's sublayer, remain relatively rare and unsophisticated. Against this backdrop, we propose an efficient algorithm to quantify desired biomarkers with improved accuracy based on volume OCT scans. Specifically, we attempted an accurate, computationally light volumetric segmentation method involving stratified smoothing to detect choroid and Haller's sublayer.

METHODS

For detecting the various boundaries of the choroid and the Haller's sublayer, we propose a common volumetric method that performs suitable exponential enhancement and maintains smooth spatial continuity across 2D B-scans. Further, we achieve suitable volumetric smoothing by primarily deploying light-duty linear regression, and sparingly using compute-intensive tensor voting, and hence significantly reduce overall complexity. The proposed methodology is tested on five health and five diseased OCT volumes considering various metrics including volumetric Dice coefficient and corresponding quotient measures to facilitate comparison vis-à-vis intra-observer repeatability.

RESULTS

On five healthy and five diseased OCT volumes, respectively, the proposed method for choroid segmentation recorded volumetric Dice coefficients of 93.53 % and 93.30 %, which closely approximate the respective reference observer repeatability values of 95.60 % and 95.49 %. In terms of related quotient measures, our method achieved more than 50 % improvement over a recently reported method. In detecting Haller's sublayer as well, our algorithm records statistical performance closely matching that of reference manual method.

CONCLUSION

Advancing the state-of-the-art, the proposed volumetric segmentation, tested on both healthy and diseased datasets, demonstrated close match with the manual reference. Our method assumes significance in accurate screening of chorioretinal diseases including AMD, CSCR and pachychoroid. Further, it enables generating accurate training data for developing deep learning models for improved detection of choroid and Haller's sublayer.

Systematic review on chronic non-communicable disease in disaster settings

BACKGROUND

Non-communicable diseases (NCDs) constitute the leading cause of mortality globally. Low and middle-income countries (LMICs) not only experience the largest burden of humanitarian emergencies but are also disproportionately affected by NCDs, yet primary focus on the topic is lagging. We conducted a systematic review on the effect of humanitarian disasters on NCDs in LMICs assessing epidemiology, interventions, and treatment.

METHODS

A systematic search in MEDLINE, MEDLINE (PubMed, for in-process and non-indexed citations), Social Science Citation Index, and Global Health (EBSCO) for indexed articles published before December 11, 2017 was conducted, and publications reporting on NCDs and humanitarian emergencies in LMICs were included. We extracted and synthesized results using a thematic analysis approach and present the results by disease type. The study is registered at PROSPERO (CRD42018088769).

RESULTS

Of the 85 included publications, most reported on observational research studies and almost half (48.9%) reported on studies in the Eastern Mediterranean Region (EMRO), with scant studies reporting on the African and Americas regions. NCDs represented a significant burden for populations affected by humanitarian crises in our findings, despite a dearth of data from particular regions and disease categories. The majority of studies included in our review presented epidemiologic evidence for the burden of disease, while few studies addressed clinical management or intervention delivery. Commonly cited barriers to healthcare access in all phases of disaster and major disease diagnoses studied included: low levels of education, financial difficulties, displacement, illiteracy, lack of access to medications, affordability of treatment and monitoring devices, and centralized healthcare infrastructure for NCDs. Screening and prevention for NCDs in disaster-prone settings was supported. Refugee status was independently identified both as a risk factor for diagnosis with an NCD and conferring worse morbidity.

CONCLUSIONS

An increased focus on the effects of, and mitigating factors for, NCDs occurring in disaster-afflicted LMICs is needed. While the majority of studies included in our review presented epidemiologic evidence for the burden of disease, research is needed to address contributing factors, interventions, and means of managing disease during humanitarian emergencies in LMICs.

A review of interventions for noncommunicable diseases in humanitarian emergencies in low- and middle-income countries

OBJECTIVE

Noncommunicable diseases (NCDs) are of increasing prevalence in low- and middle-income countries (LMICs), affected by disasters. Humanitarian actors are increasingly confronted with how to effectively manage NCDs, yet primary focus on this topic is lacking. We conducted a systematic review on the effects of disasters on NCDs in LMICs. Key interventions were identified, and their effects on populations in disaster settings were reviewed.

DESIGN

We electronically searched Medline, PubMed, Global Health, and Social Science Citation Index. We followed standard systematic review methodology for the selection, data abstraction, and risk of bias assessment. Eligible articles incorporated core intervention components as defined by the United States Department of Health and Human Services. Key intervention components including target population, phase of crisis, and measured outcomes were extracted and synthesized using a thematic analysis approach. The full systematic review is registered at PROSPERO (CRD42018088769).

RESULTS

Of the 4,430 identified citations, we identified seven eligible studies. Studies reported on the response (n = 4) and recovery (n = 3) phases of disaster, with no studies reporting on the mitigation or preparedness phases. Successful interventions conducted predeployment risk assessments, performed training and capacity building for healthcare workers, worked in close cooperation with local health services, evaluated individual needs of subpopulations, promoted task shifting between humanitarian and development actors, and adopted flexibility in guideline -implementation.

CONCLUSIONS

This review highlights the limited quantity and quality of evidence on interventions designed to address NCDs in humanitarian emergencies, with a particular paucity of studies addressing the mitigation and preparedness phases of disaster. While several challenges to NCD management such as insecurity and fluid movement of refugees create inherent challenges to NCD management in disasters, the lack of knowledge and training in NCD management among healthcare providers and the absence of basic medications and supplies for NCD management highlighted in this review are amenable to further intervention.

Global emergency medicine: A scoping review of the literature from 2020

OBJECTIVE

The objective was to identify, screen, highlight, review, and summarize some of the most rigorously conducted and impactful original research (OR) and review articles (RE) in global emergency medicine (EM) published in 2020 in the peer-reviewed and gray literature.

METHODS

A broad systematic search of peer-reviewed publications related to global EM indexed on PubMed and in the gray literature was conducted. The titles and abstracts of the articles on this list were screened by members of the Global Emergency Medicine Literature Review (GEMLR) Group to identify those that met our criteria of OR or RE in the domains of disaster and humanitarian response (DHR), emergency care in resource-limited settings (ECRLS), and EM development. Those articles that met these screening criteria were then scored using one of three scoring templates appropriate to the article type. Those articles that scored in the top 5% then underwent in-depth narrative summarization.

RESULTS

The 2020 GEMLR search initially identified 35,970 articles, more than 50% more than last year's search. From these, 364 were scored based on their full text. Nearly three-fourths of the scored articles constituted OR, of which nearly three-fourths employed quantitative research methods. Nearly 10% of the articles identified this year were directly related to COVID-19. Research involving ECRLS again constituted most of the articles in this year's review, accounting for more than 60% of the literature scored. A total of 20 articles underwent in-depth narrative critiques.

CONCLUSIONS

The number of studies relevant to global EM identified by our search was very similar to that of last year. Revisions to our methodology to identify a broader range of research were successful in identifying more qualitative research and studies related to DHR. The number of COVID-19-related articles is likely to continue to increase in subsequent years.

Genetic structure and connectivity among Aedes aegypti populations within Madurai city in Southern India

We investigated the genetic variability and differentiation among 12 Ae. aegypti populations collected within the Madurai city in Tamil Nadu state of Southern India. Genotyping of 12 microsatellite markers in 353 individual samples showed moderate levels of genetic diversity among 12 populations. UPGMA tree, hierarchical clustering, Bayesian clustering and Discriminant Analysis on Principal Components roughly divided these populations into two genetic clusters: main city populations and the populations located at the border of the corporation limit. Significant positive correlation between genetic and geographic distance was observed among 12 populations, however, the correlation was non-significant within each genetic cluster. Population assignment and divMigrate graph depicted less migration between two groups. Overall, the findings of this study provided an overview of Ae. aegypti population structure within an urban setting in India that have implications in effective implementation of vector control in the city area.

Global Emergency Medicine: A Review of the Literature From 2019

OBJECTIVE

The annual systematic search of the peer-reviewed and gray literature relevant to global emergency medicine (EM) was conducted by the Global Emergency Medicine Literature Review (GEMLR) to screen, evaluate, and review the most rigorously conducted and relevant research in global EM published in 2019.

METHODS

After a broad search of PubMed and websites of organizations publishing relevant gray literature, all articles that were deemed relevant to the fields of disaster and humanitarian response, emergency care in resource-limited settings, and EM development by at least one reviewer, an editor, and the managing editors were then scored by two different reviewers using a 20-point scoring template relevant to either original research (OR) or review (RE) articles. This scoring system rates articles on their clarity, research design, ethics, importance to global EM, and breadth of impact. Articles that then scored in the top 5% were then critiqued in depth.

RESULTS

A total of 23,321 article titles and abstracts were screened by 22 reviewers with a wide swath of clinical and research experience in global EM. From these, a total of 356 articles underwent full-text review and scoring on the 20-point scale; 26% were categorized as disaster and humanitarian response, 58% as emergency care in resource-limited settings, and 15% as EM development. Of these 356 articles, 276 (77.5%) were OR articles and 80 (22.5%) were RE articles. The 16 articles that scored in the top 5% (>17.5 of 20 points) received full in-depth narrative summaries.

CONCLUSIONS

In 2019, the overall number of studies relevant to global EM that were identified by our search decreased from the prior year, but more high-scoring articles related to the development of EM clinical practice and as a specialty in resource-constrained settings were identified.

Global Emergency Medicine: A Review of the Literature from 2018

OBJECTIVES

The Global Emergency Medicine Literature Review (GEMLR) conducts a systematic annual search of peer-reviewed and gray literature relevant to global emergency medicine (EM) to identify, review, and disseminate the most rigorously conducted and widely relevant research in global EM.

METHODS

An electronic search of PubMed, a comprehensive retrieval of articles from specific journals, and search of the gray literature were conducted. Title and abstracts retrieved by these searches were screened by a total of 22 reviewers based on their relevance to the field of global EM, across the domains of disaster and humanitarian response (DHR), emergency care in resource-limited settings (ECRLS), and emergency medicine development (EMD). All articles that were deemed relevant by at least one reviewer, their editor, and the managing editor underwent formal scoring of overall methodologic quality and importance to global EM. Two independent reviewers scored all articles; editors provided a third score in cases of widely discrepant scores.

RESULTS

A total of 19,102 articles were identified by the searches and, after screening and removal of duplicates, a total of 517 articles underwent full review. Twenty-five percent were categorized as DHR, 61% as ECRLS, and 15% as EMD. Inter-rater reliability testing between the reviewers revealed a Cohen's kappa score of 0.213 when considering the complete score or 0.426 when excluding the more subjective half of the score. A total of 25 articles scored higher than 17.5 of 20; these were selected for a full summary and critique.

CONCLUSIONS

In 2018, the total number of articles relevant to global EM that were identified by our search continued to increase. Studies and reviews focusing on pediatric infections, several new and traditionally underrepresented topics, and landscape reviews that may help guide clinical care in new settings represented the majority of top-scoring articles. A shortage of articles related to the development of EM as a specialty was identified.

Global Emergency Medicine: A Review of the Literature From 2017

OBJECTIVES

The Global Emergency Medicine Literature Review (GEMLR) conducts an annual search of peer-reviewed and gray literature relevant to global emergency medicine (EM) to identify, review, and disseminate the most important new research in this field to a global audience of academics and clinical practitioners.

METHODS

This year, 17,722 articles written in three languages were identified by our electronic search. These articles were distributed among 20 reviewers for initial screening based on their relevance to the field of global EM. Another two reviewers searched the gray literature, yielding an additional 11 articles. All articles that were deemed appropriate by at least one reviewer and approved by their editor underwent formal scoring of overall quality and importance. Two independent reviewers scored all articles.

RESULTS

A total of 848 articles met our inclusion criteria and underwent full review. Sixty-three percent were categorized as emergency care in resource-limited settings, 23% as disaster and humanitarian response, and 14% as EM development. Twenty-one articles received scores of 18.5 or higher out of a maximum score 20 and were selected for formal summary and critique. Inter-rater reliability testing between reviewers revealed a Cohen's kappa of 0.344.

CONCLUSIONS

In 2017, the total number of articles identified by our search continued to increase. Studies and reviews with a focus on infectious diseases, pediatrics, and trauma represented the majority of top-scoring articles.

Three-Dimensional Nanostructured Palladium with Single Diamond Architecture for Enhanced Catalytic Activity

Fuel cells are a key new green technology that have applications in both transport and portable power generation. Carbon-supported platinum (Pt) is used as an anode and cathode electrocatalyst in low-temperature fuel cells fueled with hydrogen or low-molecular-weight alcohols. The cost of Pt and the limited world supply are significant barriers to the widespread use of these types of fuel cells. Comparatively, palladium has a 3 times higher abundance in the Earth's crust. Here, a facile, low-temperature, and scalable synthetic route toward three-dimensional nanostructured palladium (Pd) employing electrochemical templating from inverse lyotropic lipid phases is presented. The obtained single diamond morphology Pd nanostructures exhibited excellent catalytic activity and stability toward methanol, ethanol, and glycerol oxidation compared to commercial Pd black, and the nanostructure was verified by small-angle X-ray scattering, scanning tunneling electron microscopy, and cyclic voltammetry.

Bystander Assistance for Trauma Victims in Low- and Middle-Income Countries: A Systematic Review of Prevalence and Training Interventions

OBJECTIVE

Lack of organized prehospital care may contribute to the disproportionate burden of trauma-related deaths in low- and middle-income countries (LMICs). The World Health Organization (WHO) recommends bystander training in basic principles of first aid and victim transport; however, prevalence of bystander or layperson assistance to trauma victims in LMICs has not been well-described, and organized reviews of existing evidence for bystander training are lacking. This systematic review aims to 1) describe the prevalence of bystander or layperson aid or transport for trauma victims in the prehospital setting in LMICs and 2) ascertain impacts of bystander training interventions in these settings.

METHODS

A systematic search of OVID Medline, Cochrane Library, and relevant gray literature was conducted. We included 1) all studies detailing prevalence of bystander-administered aid or transport for trauma victims in LMICs and 2) all randomized controlled trials and observational studies evaluating bystander training interventions. We extracted study characteristics, interventions, and outcomes data. Study quality was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria.

RESULTS

Sixty-two studies detailed prevalence of bystander transport and aid. Family members, police, and bus or taxi drivers commonly transported patients; a majority of patients, up to >94%, received aid from bystanders. Twenty-four studies examined impacts of training interventions. Only one study looked at transport interventions; the remainder addressed first aid training. Interventions varied in content, duration, and target learners. Evidence was generally of low quality, but all studies demonstrated improvements in layperson knowledge and skills. Five studies reported a mortality reduction.

CONCLUSIONS

Heterogeneity in data reporting and outcomes limited formal meta-analysis. However, this review shows high rates of bystander involvement in prehospital trauma care and transport in LMICs and highlights the need for bystander training. Bystander training in these settings is feasible and may have an important impact on meaningful outcomes such as mortality. Categories of involved bystanders varied by region and training interventions should be targeted at relevant groups. "Train the trainer" models appear promising in securing community engagement and maximizing participation. Further research is needed to examine the value of bystander transport networks in trauma.

Impact of nutrition interventions on pediatric mortality and nutrition outcomes in humanitarian emergencies: A systematic review

OBJECTIVES

Malnutrition contributes to paediatric morbidity and mortality in disasters and complex emergencies, but summary data describing specific nutritional interventions in these settings are lacking. This systematic review aimed to characterise such interventions and their effects on paediatric mortality, anthropometric measures and serum markers of nutrition.

METHODS

A systematic search of OVID MEDLINE, Cochrane Library and relevant grey literature was conducted. We included all randomised controlled trials and observational controlled studies evaluating effectiveness of nutritional intervention(s) on defined health outcomes in children and adolescents (0-18 years) within a disaster or complex emergency. We extracted study characteristics, interventions and outcomes data. Study quality was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria.

RESULTS

A total of 31 studies met inclusion criteria. Most were conducted in Africa (17), during periods of conflict or hunger gaps (14), and evaluated micronutrient supplementation (14) or selective feeding (10). Overall study quality was low, with only two high and four moderate quality studies. High- and medium-quality studies demonstrated positive impact of fortified spreads, ready-to-use therapeutic foods, micronutrient supplementation, and food and cash transfers.

CONCLUSION

In disasters and complex emergencies, high variability and low quality of controlled studies on paediatric malnutrition limit meaningful data aggregation. If existing research gaps are to be addressed, the inherent unpredictability of humanitarian emergencies and ethical considerations regarding controls may warrant a paradigm shift in what constitutes adequate methods. Periodic hunger gaps may offer a generalisable opportunity for robust trials, but consensus on meaningful nutritional endpoints is needed.

Global Emergency Medicine: A Review of the Literature From 2015

OBJECTIVES

The Global Emergency Medicine Literature Review (GEMLR) conducts an annual search of peer-reviewed and gray literature relevant to global emergency medicine (EM) to identify, review, and disseminate the most important new research in this field to a global audience of academics and clinical practitioners.

METHODS

This year 12,435 articles written in six languages were identified by our search. These articles were distributed among 20 reviewers for initial screening based on their relevance to the field of global EM. An additional two reviewers searched the gray literature. A total of 723 articles were deemed appropriate by at least one reviewer and approved by their editor for formal scoring of overall quality and importance. Two independent reviewers scored all articles.

RESULTS

A total of 723 articles met our predetermined inclusion criteria and underwent full review. Sixty percent were categorized as emergency care in resource-limited settings (ECRLS), 17% as EM development (EMD), and 23% as disaster and humanitarian response (DHR). Twenty-four articles received scores of 18.5 or higher out of a maximum score 20 and were selected for formal summary and critique. Inter-rater reliability between reviewers gave an intraclass correlation coefficient of 0.71 (95% confidence interval = 0.66 to 0.75). Studies and reviews with a focus on infectious diseases, trauma, and the diagnosis and treatment of diseases common in resource-limited settings represented the majority of articles selected for final review.

CONCLUSIONS

In 2015, there were almost twice as many articles found by our search compared to the 2014 review. The number of EMD articles increased, while the number ECRLS articles decreased. The number of DHR articles remained stable. As in prior years, the majority of articles focused on infectious diseases.

Influence of fermented tannery solid waste on morphological, biochemical, yield and nutritional responses of tomato plants

The non-tanned proteinaceous tannery solid waste animal fleshing (ANFL), containing high nutritive value, was hydrolyzed using bacteria Selenomonas ruminantium HM000123 through submerged (SmF) and solid-state (SSF) fermentation processes. In addition, the effects of ANFL fermentative hydrolysate on growth, yield and biochemical properties of tomato plants were investigated. The treatments included T1 (SmF-ANFL), T2 (SSF-ANFL), T3 (recommended dose of NPK fertilizers) and a control without any amendment. Hydrolysates of both SmF-ANFL and SSF-ANFL treatments increased the biomass and yield as evidenced by plant height, stem girth, number of leaves and fruit yield when compared with both NPK and control plants. In this 90-day study, significant (p ≤ 0.05) changes were observed in SSF-ANFL treated plants compared to the other treatments. Protein profile analyzed through SDS-PAGE indicates the expression of a high molecular weight protein (205 kDa) and other proteins in the leaves of the SSF-ANFL treated plants. Overall results revealed that SSF-ANFL can be successfully utilized as a fertilizer particularly for cultivating tomato plants.

Hyperferritinemia and markers of inflammation and oxidative stress in the cord blood of HIV-exposed, uninfected (HEU) infants

OBJECTIVES

The purpose of this study was to evaluate markers of iron status and inflammation/oxidative stress in maternal and cord blood (CB) of HIV-infected and HIV-uninfected women as potential mechanisms for poor outcomes among HIV-exposed, uninfected (HEU) infants.

METHODS

Maternal venous blood and CB specimens were obtained from 87 pregnant women (45 HIV-infected and 42 HIV-uninfected) enrolled at Kalafong Hospital, Pretoria, South Africa. Iron status [serum iron, ferritin and transferrin concentrations, transferrin saturation, soluble transferrin receptor (sTfR) concentration and the sTfR/log ferritin (sTfR/F) index], antenatal exposure to inflammation (CB C-reactive protein and interleukin-6 concentrations and haptoglobin switch-on status) and oxidative stress [total radical trapping ability of CB plasma (TRAP) and chronic oxidative stress (soluble receptor of advanced glycation end-products (sRAGE) concentration] were assessed in laboratory studies.

RESULTS

There were no differences between the HIV-infected and HIV-uninfected groups in maternal haematological and iron indices, except that HIV-infected mothers had decreased white blood cell counts (P = 0.048) and increased serum ferritin concentrations (P = 0.032). Ferritin levels were significantly higher in CB than in maternal blood (P < 0.001) in both groups and further elevated in the CB of HEU infants (P = 0.044). There was also an inverse relationship between CB sTfR/F index and sRAGE (r = -0.43; P = 0.003) in the HIV-infected but not in the HIV-uninfected group.

CONCLUSIONS

Our study showed for the first time that ferritin was significantly elevated in CB of HEU infants. The inverse relationship between sTfR/F index and sRAGE in CB suggests that chronic oxidative stress or RAGE axis activation in HIV-infected mothers may play a role in modulating ferritin levels.

Nutrient and enzymatic changes of hydrolysed tannery solid waste treated with epigeic earthworm Eudrilus eugeniae and phytotoxicity assessment on selected commercial crops

Animal fleshing (ANFL) is the predominant proteinaceous solid waste generated during processing of leather and it is confronting disposal problems. The aim of this study was to assess the potential of epigeic earthworm Eudrilus eugeniae to utilize and transform the fermented ANFL in the solid state (SSF) and submerged state (SmF) into a value added product along a low residence period (25 days). A total of six treatment units containing different waste mixture compositions were established. Fifty healthy and non-clitellated earthworms were introduced in three different treatment containers: control, SSF, and SmF (+worm). Another set of treatment mixtures (control, SSF, SmF) was established without earthworms (-worm) to compare the results. The products were characterized for physico-chemical, enzymatic analysis and seedling growth parameters to compare the differences in the process with and without earthworms. The changes observed in the analytical parameters were in the following order: SSF > SmF > control mixtures (p < 0.05). The vermicompost showed a significant reduction in heavy metals, total organic carbon and an increase in total Kjeldhal nitrogen as compared to the product untreated by earthworms. The maximum enzymatic activities were observed after 21 days of vermicomposting. The relative seed germination of vermicompost extracts were in the order of tomato (Lycopersicon esculentum) > green gram (Vigna radiata) > cucumber (Cucumis sativus) > bottle gourd (Lagenaria siceraria (Mol.) Standl.) and showed no phytotoxicity effects. The results indicated that the combination of both ANFL hydrolysis through fermentation and vermicomposting is a good alternative to the management of this kind of waste.

Chest X-ray after tracheostomy is not necessary unless clinically indicated

BACKGROUND

Chest radiography is routinely used post-tracheostomy to evaluate for complications. Often, the chest X-ray findings do not change clinical management. The present study was conducted to evaluate the utility of post-tracheostomy X-rays.

METHOD

This retrospective review of 255 patients was performed at a single-center, university, level I trauma center. All patients underwent tracheostomy and were evaluated for postprocedure complications.

RESULTS

Of the 255 patients, 95.7% had no change in postprocedure chest X-ray findings. New significant chest X-ray findings were found in 4.3% of patients, including subcutaneous emphysema, pneumothorax, and new significant consolidation. Only three of these patients required change in clinical management, and all changes were based on clinical presentation alone.

CONCLUSIONS

Routine chest X-ray following tracheostomy fails to provide additional information beyond clinical examination. Therefore radiographic examination should be performed only after technically difficult procedures or if the patient experiences clinical deterioration. Significant cost savings and minimization of radiation exposure can be achieved when chest radiography after tracheostomy is performed exclusively for clinical indications.

Studies on the distribution of bacterial isolates in rare earth environment

Rare earth soil is precious, but very common across Arabian coast especially in Chavara, (Quilon district, Kerala) south west coast of India. They are widely distributed but usually occur in small amounts and enhance the soil properties. In the present study, 18 different bacterial isolates were identified from three different samples such as soil and biofilm formed on metal surfaces from the rare earth environment of Chavara using 16S rDNA gene sequencing. The accumulation of rare earth elements (REE) by microbes was studied using FT-IR analysis. In the FTIR spectrum of the test system, a peak at 1548 and 1449 cm(-1) indicates the presence of aromatic nuclei (carboxylic acid), while C=C stretch for C-O-C group was noticed at 1237 cm(-1). Thus significant variations in the peak position confirm the presence of carboxyl group and thus it was confirmed that rare earth elements induce the bacteria to produce carboxylic acid and thereby accumulate rare earth elements.

Phytochelatin systhesis and cadmium uptake of Brassica napus

Soil contamination with cadmium (Cd) poses risk to human health. Metal hyperaccumulator plants play an important role in phytoextraction of heavy metals from such contaminated sites. Accumulation of Cd and its influence on the induction of phytochelatins in Brassica napus was investigated. Brassica napus plants were grown in nutrient culture with 1 and 5 microM Cd for 10 days. The biomass negatively correlates with Cd concentration in the nutrient solution and the reduction in dry weight was significantly higher for the root than the shoot. Cadmium accumulation positively correlates with the Cd concentration in the nutrient solution and the Cd accumulation in root is significantly higher than the shoot. High-performance liquid chromatography (HPLC) analysis revealed the induction of PC2, PC3 and PC4 in response to Cd in B. napus and their concentrations vary with the Cd level in the external solution. In 1 microM Cd treated plants; PC2 was the dominant thiol fraction in the root, followed by PC3 and PC4, whereas in the shoot, PC3 is the dominant species followed by PC4 and PC2. In 5 microM Cd treated plants, the concentration of both PC3 and PC4 are higher than that of PC2 in the roots. In the shoot, the concentration of PC3 and PC4 was higher than the PC2 irrespective of the quantity of Cd uptake, implying that the detoxification of Cd involves higher molecular weight thiol complexes in the shoot. Considering the high aboveground biomass and Cd accumulation in the shoot, B. napus can be a potential candidate for the phytoextraction of Cd.

Speciation of heavy metals during co-composting of sewage sludge with lime

During composting the humification of organic matter will have a significant effect on the physicochemical form of existence of heavy metals. Therefore the present study was conducted to investigate the effect of co-composting sewage sludge with lime on heavy metal speciation and the changes in DTPA extractable metals. Metal speciation was conducted to evaluate the redistribution of Cu, Mn, Ni, Pb and Zn in sewage sludge composted with lime. Sewage sludge was mixed with sawdust in 2:1 (w/w fresh weight) and then composted with lime at 0%, 0.63%, 1% or 1.63% (dry weight) for 100 days. The lime addition did not cause any changes in the different forms of Cu and Mn, but the composting process caused transformations of residual form of Cu and Mn into oxidizable and reducible form, respectively. For Ni, the reducible form was mainly transformed into residual form and lime addition decreased this transformation. Major transformation of different forms of Pb was not found, however the residual form of Pb increased with lime addition. The predominant residual form of Zn was mainly transformed into oxidizable form and the lime addition reduced this transformation. Addition of lime to sewage sludge during composting resulted in lower DTPA extractable metal contents. Therefore, lime is a suitable material to co-compost with sewage sludge to reduce the availability of heavy metals.

Phytoremediation and rehabilitation of municipal solid waste landfills and dumpsites: A brief review

Environmental problems posed by municipal solid waste (MSW) are well documented. Scientifically designed landfills and/or open dumpsites are used to dispose MSW in many developed and developing countries. Non-availability of land and need to reuse the dumpsite space, especially in urban areas, call for rehabilitation of these facilities. A variety of options have been tried to achieve the goals of rehabilitation. In the last couple of decades, phytoremediation, collectively referring to all plant-based technologies using green plants to remediate and rehabilitate municipal solid waste landfills and dumpsites, has emerged as a potential candidate. Research and development activities relating to different aspects of phytoremediation are keeping the interest of scientists and engineers alive and enriching the literature. Being a subject of multi-disciplinary interest, findings of phytoremediation research has resulted in generation of enormous data and their publication in a variety of journals and books. Collating data from such diverse sources would help understand the dynamics and dimensions of landfill and dumpsite rehabilitation. This review is an attempt in this direction.

The state of the health care workforce

The shortage of health care workers has emerged as one of the field's biggest long-term challenges. The number of nurses, technicians, pharmacists and even housekeeping staff is on the way down, and worker dissatisfaction is on the way up. The health care workforce is slowly vanishing, and those workers who remain are unhappy. In this special fold-out section, Hospitals & Health Networks looks at this complex problem by analyzing how serious it really is and how bad it's going to get, taking a look at workers' frustration, and offering tips and resources to start to fix it.

Spleno-gonadal fusion. A case report

Examination of a two-year-old boy with bilateral inguinal hernia revealed a firm, smooth, non-tender mass continuous with the upper pole of the testis and extending upwards to the inguinal canal. Histological examination revealed splenic tissue. The article describes the details of this case of splenogonadal fusion and quotes 50 further references from literature.

Leiomyoma of the duodenum presenting as a pyogenic liver abscess

Leiomyoma of the duodenum is a rare condition which is most often diagnosed only as an incidental finding at post-mortem. It may present clinically with pain or haemorrhage. A case is described of degeneration of a leiomyoma of the fourth part of the duodenum giving rise to pyogenic liver abscess. There is no previous report of this association in the literature.

Topical thrombin and control of wound haematoma

The frequency of wound haematoma was investigated in 45 prophylactically heparinised patients undergoing abdominal surgery. Thrombin was applied locally to the wound in 15 patients, and in these patients wound haematoma was significantly less common than in the controls.