bluuebunny/crossref_metadata_2025 huggingface dataset:
Gender Attitudes and Fertility Aspirations among Young Men in Five High Fertility East African Countries
Authors: Snow Rachel C. , Winter Rebecca A. , Harlow Siobán D.
Published: March 2013

The relationship between women's attitudes toward gender equality and their fertility aspirations has been researched extensively, but few studies have explored the same associations among men. Using recent Demographic and Health Survey data from five high fertility East African countries, we examine the association between young men's gender attitudes and their ideal family size. Whereas several DHS gender attitude responses were associated with fertility aspirations in select countries, men's greater tolerance of wife beating was consistently associated with higher fertility aspirations across all countries, independent of education, income, or religion. Our findings highlight the overlapping values of male authority within marriage and aspirations for large families among young adult males in East Africa. Total lifetime fertility in East Africa remains among the highest worldwide: thus, governments in the region seeking to reduce fertility may need to explicitly scrutinize and address the reproduction of prevailing masculine values.
Responsiveness to self‐report questions about loneliness: a comparison of mainstream and intellectual disability‐specific instruments
Authors: Stancliffe R. J. , Wilson N. J. , Bigby C. , Balandin S. , Craig D.
Published: March 2013

Background

We compared responsiveness to two self‐report assessments of loneliness: the UCLA Loneliness Scale (UCLALS) designed for the general community, and the Modified Worker Loneliness Questionnaire (MWLQ) designed for people with intellectual disability (ID).

Methods

Participants were 56 older adults with disability – 40 individuals with ID and 16 without ID. They were individually assessed on the MWLQ and the UCLALS. The difficulty of the items in both scales was evaluated in relation to readability, features of question wording, question length and response format.

Results

The UCLALS was more difficult than the MWLQ on each of the difficulty dimensions assessed. There was significantly greater responsiveness to the MWLQ than the UCLALS, especially among people with ID.

Conclusions

To enable as many people with ID as possible express their views on loneliness, the ID‐specific MWLQ is a much better choice. However, this choice comes at the cost of ready comparison to loneliness data for the general community, which is available for widely used assessments such as the UCLALS.
MONETARY POLICY AND ECONOMIC IMBALANCES: AN ETHNOGRAPHIC EXAMINATION OF CENTRAL BANK RITUALS
Authors: Grimes Arthur
Published: March 2013

We apply the ethnographic tools of economic anthropology to analyse a particular ritual performed by the high priest of the Arbee sub‐tribe in the South Pacific island group of Aotearoa. (In other island groups, this high priest is sometimes known as the Governor of the Reserve Bank of New Zealand.) The ritual is considered by many within Aotearoa to be the cause of The Imbalance in The Economy. We analyse this claim and show that it has similarities (and equal validity) to claims of other cargo cults within the South‐West Pacific region.
How Parents Experience the Quality of Support: A Survey in Residential Care
Authors: Luijkx Jorien , Brug Annet ten , Vlaskamp Carla
Published: March 2013

As parents and/or legal guardians are considered to be part of the care system of a person with intellectual disabilities (ID), it is of import to acquire more specific and transparent views from parents and/or legal guardians regarding quality of support. This study examined the views of parents and/or legal guardians on the quality of support provided to clients with an ID in residential care in the Netherlands, in order to improve the partnership between parents/legal guardians and facilities. A questionnaire developed in close cooperation with parents specifically for this aim was sent to 1,785 households (parents and/or legal guardians) of clients in the Netherlands. The questionnaire consists of the following five subsections: daily care, housing, day services, leisure activities, and communication. A multiple regression analysis was performed to determine which factors contributed to the satisfaction of parents and/or legal guardians. The questionnaires returned (n = 1,058) showed that respondents rated the overall quality of support at an average grade of 7.3 out of 10 (SD: 1.2). Small but mostly significant differences were found between the subsections. A significant model for the overall quality of support emerged; nevertheless, the predictor variables accounted for only 4.0% of the explained variance in the data set. Special attention should be paid to the percentage of parents and/or legal guardians who gave unsatisfactory scores (10%) and the substantial percentage (25%) of parents and/or legal guardians that rated the quality of care only marginally satisfactory (grades 6–7). The results of this questionnaire provide opportunities for optimal use of the qualities and knowledge of parents and/or legal guardians, opportunities for mutual communication between the service organization and parents and/or legal guardians, and guidance for policy regarding improvements in support.
Masculinity Studies and Literature
Authors: Hobbs Alex
Published: March 2013

In contrast to feminist theory or women’s studies, masculinity studies is a relatively new approach to analysing literature. This article discusses the state of literary masculinity studies and its relationship to sociological men’s studies and feminism. It highlights the intention of masculinity studies scholarship to expose the damaging impact of patriarchy on men (as well as women), and its aim to celebrate alternative masculinities over hegemonic ideals through an analysis of male protagonists. It also notes the criticisms brought against the theoretical approach: that men are already adequately represented in literary theory; that the approach can be either universalist or too fragmented by sub‐categorisations of masculinity according to class, race, sexuality, etc. Giving an overview of the scholarship in the field, the article notes that while sexuality and ethnicity are becoming more frequent subjects for critics, issues of age – both youth and senescence – are relatively ignored, and suggests that this theme requires further examination in literary masculinity studies and in men’s studies more widely.
Novel regulatory system nemRA–gloA for electrophile reduction in Escherichia coli K‐12
Authors: Lee Changhan , Shin Jongcheol , Park Chankyu
Published: March 2013

Electrophilic compounds such as glyoxals, which are toxic due to their reactive carbonyl group, are generated in vivo through various pathways. In this study, we obtained evidence indicating that the nemRA operon, previously reported to encode a repressor and the N‐ethylmaleimide reductase, respectively, is co‐transcribed with the 3′‐proximal gloA gene encoding glyoxalase I. The operon is not only involved in cytosolic detoxification but is also regulated by electrophiles such as quinones and glyoxals. A gel mobility shift assay revealed that purified NemR repressor bound to DNA was dissociated upon interaction with quinones and glyoxals, while their reduced forms were ineffective. The cysteines of NemR at 21 and 116 were essential in sensing electrophiles in vivo and in vitro. Reversible intermolecular disulphide bonds were observed with a reducing agent as well as with electrophiles. DNA binding affinity reduced by glyoxal was also increased with a reducing agent. The NemA reductase, an FMN‐containing enzyme, exhibited catalytic activity toward various electrophiles including quinones, while GloA played a major role in glyoxal detoxification. Therefore, we propose that cells have a cytosolic system consisting of the nemRA–gloA operon for the reduction of electrophiles, especially quinones and glyoxals, to maintain an appropriate intracellular redox balance.
Peach allergy in spanish children: tolerance to the pulp and molecular sensitization profile
Authors: Boyano‐Martínez Teresa , Pedrosa María , Belver Teresa , Quirce Santiago , García‐Ara Carmen
Published: March 2013

Background

Peach allergy is the main cause of vegetable food allergy in the Mediterranean area. Pru p 3 is the major allergen, and it is mainly found in the peel.

Objective

We sought to calculate the frequency of tolerance to peach pulp in Spanish children suffering from allergic reactions after eating or having contact with peach and to analyze the sensitization pattern to peach allergens.

Methods

Fifty‐seven children (32 boys; median age, 7.4 yr) were included in the study. A systematized questionnaire on allergic reactions to peach was administered. Prick tests with peach peel and pulp, peach lipid transfer protein (LTP), and profilin were performed. Serum‐specific IgE to peach, rPru p 1, rPru p 3, and rPru p 4 was determined by ImmunoCAP. Oral food challenges (OFCs) with peach pulp were performed on all but one child.

Results

Eighty‐eight percent of the children had positive prick tests with peach peel, 35% with peach pulp, 88% with peach LTP, and 9% with profilin. Serum‐specific IgE to peach was demonstrated in 100% of the patients; rPru p 3‐specific IgE in 96%; rPru p 1‐specific IgE in 11%; and rPru p 4‐specific IgE in 10%. Oral food challenge was negative in 52 (93%) children.

Conclusions

More than 90% of the study population tolerated peeled peach. Pru p 3 was the major allergen. Pru p 1 and 4 showed low prevalence.
Testing children for allergies: why, how, who and when
Authors: Eigenmann P. A. , Atanaskovic‐Markovic M. , O'B Hourihane J. , Lack G. , Lau S. , Matricardi P. M. , Muraro A. , Namazova Baranova L. , Nieto A. , Papadopoulos N. G. , Réthy L. A. , Roberts G. , Rudzeviciene O. , Wahn U. , Wickman M. , Høst A.
Published: March 2013

Allergic diseases are common in childhood and can cause a significant morbidity and impaired quality‐of‐life of the children and their families. Adequate allergy testing is the prerequisite for optimal care, including allergen avoidance, pharmacotherapy and immunotherapy. Children with persisting or recurrent or severe symptoms suggestive for allergy should undergo an appropriate diagnostic work‐up, irrespective of their age. Adequate allergy testing may also allow defining allergic trigger in common symptoms. We provide here evidence‐based guidance on when and how to test for allergy in children based on common presenting symptoms suggestive of allergic diseases.
The relationships between psychological mindedness, parental bonding and adult attachment
Authors: Bourne Kathryn , Berry Katherine , Jones Lisa
Published: March 2013

Objectives

The aims of this study were to clarify the relationship between psychological mindedness and attachment relationships in childhood and adulthood.

Design

This analogue study examined associations between psychological mindedness and attachment using a cross‐sectional design.

Method

Participants completed questionnaire measures of psychological mindedness, parental bonding, and adulthood attachment relationships.

Results

As hypothesized, psychological mindedness was strongly, negatively correlated with attachment avoidance in adulthood. Psychological mindedness was also positively correlated with perceived maternal care in childhood, and negatively correlated with perceived paternal over‐protection. However, a regression analysis found that attachment avoidance in adulthood was a more significant predictor of psychological mindedness than parental bonding experiences in childhood.

Conclusions

Further research is needed to replicate associations between attachment and psychological mindedness in clinical samples and to explore additional constructs which influence psychological mindedness.

Practitioner points

High attachment avoidance may be a potential risk factor for poor psychological mindedness.

Helping individuals to develop more secure attachments in their adult relationships may improve their psychological mindedness.
Real Estate Determinants of Firm Relocation in Urban Residential Neighbourhoods
Authors: Risselada Anne , Schutjens Veronique , Van Oort Frank
Published: March 2013

Real estate factors, such as property ownership, size and age, are generally not accounted for in research on revealed relocation decisions of firms. This is remarkable, as entrepreneurs often suggest that real estate characteristics at the property level provide an explanation for firm relocation behaviour in addition to more‐frequently tested drivers of firm relocation. We assess the role of real estate determinants, focusing on firms in urban residential neighbourhoods, differentiating between firms located in residential and commercial properties. We find that property ownership is negatively related to relocation likelihood, while being located in property with multiple users is positively related to relocation likelihood. For firms in residential properties high property age and large property size limits firm relocation. Our findings confirm that real estate characteristics are important determinants for relocation likelihood of firms, suggesting that the structure of neighbourhood housing stocks can be linked to the mobility pattern of local firms.
The Geographical Scope of Industrial Location Determinants: An Alternative Approach
Authors: Martinez Ibañez Oscar , Manjón Antolín Miguel , Arauzo‐Carod Josep-Maria
Published: March 2013

This paper considers the estimation of the geographical scope of industrial location determinants. While previous studies impose strong assumptions on the weighting scheme of the spatial neighbour matrix, we propose a flexible parametrisation that allows for different (distance‐based) definitions of neighbourhood and different weights to the neighbours. In particular, we estimate how far can reach indirect marginal effects and discuss how to report them. We also show that the use of smooth transition functions provides tools for policy analysis that are not available in the traditional threshold modelling.
Simple Resazurin-Based Microplate Assay for Measuring Chlamydia Infections
Authors: Osaka Ichie , Hefty P. Scott
Published: March 2013

The conventional method for quantification of
Chlamydia
infection using fluorescence microscopy typically involves time- and labor-intensive manual enumeration, which is not applicable for a large-scale analysis required for an inhibitory compound screen. In this study, an alamarBlue (resazurin) assay was adopted to measure
Chlamydia
infection by measuring the redox capability of infected host cells in a 96-well format. The assay provided measurements comparable to those of the conventional microscopy method while drastically reducing the time required for analysis.
Cysteine Protease-Binding Protein Family 6 Mediates the Trafficking of Amylases to Phagosomes in the Enteric Protozoan Entamoeba histolytica
Authors: Furukawa Atsushi , Nakada-Tsukui Kumiko , Nozaki Tomoyoshi
Published: March 2013

Phagocytosis plays a pivotal role in nutrient acquisition and evasion from the host defense systems in
Entamoeba histolytica
, the intestinal protozoan parasite that causes amoebiasis. We previously reported that
E. histolytica
possesses a unique class of a hydrolase receptor family, designated the cysteine protease-binding protein family (CPBF), that is involved in trafficking of hydrolases to lysosomes and phagosomes, and we have also reported that CPBF1 and CPBF8 bind to cysteine proteases or β-hexosaminidase α-subunit and lysozymes, respectively. In this study, we showed by immunoprecipitation that CPBF6, one of the most highly expressed CPBF proteins, specifically binds to α-amylase and γ-amylase. We also found that CPBF6 is localized in lysosomes, based on immunofluorescence imaging. Immunoblot and proteome analyses of the isolated phagosomes showed that CPBF6 mediates transport of amylases to phagosomes. We also demonstrated that the carboxyl-terminal cytosolic region of CPBF6 is engaged in the regulation of the trafficking of CPBF6 to phagosomes. Our proteome analysis of phagosomes also revealed new potential phagosomal proteins.
Human Primary Intestinal Epithelial Cells as an Improved
In Vitro
Model for Cryptosporidium parvum Infection
Authors: Castellanos-Gonzalez Alejandro , Cabada Miguel M. , Nichols Joan , Gomez Guillermo , White A. Clinton
Published: March 2013

The study of human intestinal pathogens has been limited by the lack of methods for the long-term culture of primary human intestinal epithelial cells (PECs). The development of infection models with PECs would allow a better understanding of host-parasite interactions. The objective of this study was to develop a novel method for prolonged
in vitro
cultivation of PECs that can be used to study
Cryptosporidium
infection. We isolated intact crypts from human intestines removed during weight loss surgery. The fragments of intestinal layers were cultivated with culture medium supplemented with growth factors and antiapoptotic molecules. After 7 days, the PECs formed self-regenerating cell clusters, forming villi that resemble intestinal epithelium. The PECs proliferated and remained viable for at least 60 days. The cells expressed markers for intestinal stem cells, epithelial cells, and mature enterocytes. The PECs were infected with
Cryptosporidium
. In contrast to older models in which parasite numbers decay, the burden of parasites increased for >120 h. In summary, we describe here a novel method for the cultivation of self-regenerating human epithelial cells from small intestinal crypts, which contain both intestinal stem cells and mature villus cells. We present data that suggest these cells support
Cryptosporidium
better than existing cell lines. PECs should provide an improved tool for studying host-parasite interactions involving
Cryptosporidium
and other intestinal pathogens.
Modulation of the Immune and Inflammatory Responses by Plasmodium falciparum Schizont Extracts: Role of Myeloid Dendritic Cells in Effector and Regulatory Functions of CD4
+
Lymphocytes
Authors: Clemente Ann Maria , Fadigati Giulia , Caporale Roberto , Marchese Damiano G. , Castronovo Giuseppe , Sannella Anna Rosa , Severini Carlo , Verra Federica , Garaci Enrico , Cozzolino Federico , Torcia Maria Gabriella
Published: March 2013

The optimal immune response to malaria infection comprises rapid induction of inflammatory responses promptly counteracted by regulatory mechanisms to prevent immunopathology. To evaluate the role of dendritic cells (DC) in the balance of parasite-induced inflammatory/anti-inflammatory mechanisms, we studied the activity of monocyte-derived dendritic cells (MDDC), previously exposed to soluble extracts of
Plasmodium falciparum
-infected red blood cells (
Pf
SE), in the differentiation of CD4 cells isolated from donors never exposed to malaria infection. We show that MDDC exposed to
Pf
SE are extremely efficient to induce a contemporary differentiation of TH1 effector cells and T regulatory (Treg) cells in CD4 T cells even when exposed to low concentrations of parasitic extracts. Treg cells induced by MDDC infected with
Pf
SE (MDDC-
Pf
SE) produce transforming growth factor beta (TGF-β) and interleukin 10 (IL-10) and are endowed with strong suppressive properties. They also show phenotypical and functional peculiarities, such as the contemporary expression of markers of Treg and TH1 differentiation and higher sensitivity to TLR4 ligands both inducing an increasing production of suppressive cytokines. On the whole, our data indicate that MDDC exposed to
Pf
SE orchestrate a well-balanced immune response with timely differentiation of TH1 and Treg cells in CD4 cells from nonimmune donors and suggest that, during the infection, the role of MDCC could be particularly relevant in low-parasitemia conditions.
Combinations of Monoclonal Antibodies to Anthrax Toxin Manifest New Properties in Neutralization Assays
Authors: Pohl Mary Ann , Rivera Johanna , Nakouzi Antonio , Chow Siu-Kei , Casadevall Arturo
Published: March 2013

Monoclonal antibodies (MAbs) are potential therapeutic agents against
Bacillus anthracis
toxins, since there is no current treatment to counteract the detrimental effects of toxemia. In hopes of isolating new protective MAbs to the toxin component lethal factor (LF), we used a strain of mice (C57BL/6) that had not been used in previous studies, generating MAbs to LF. Six LF-binding MAbs were obtained, representing 3 IgG isotypes and one IgM. One MAb (20C1) provided protection from lethal toxin (LeTx) in an
in vitro
mouse macrophage system but did not provide significant protection
in vivo
. However, the combination of two MAbs to LF (17F1 and 20C1) provided synergistic increases in protection both
in vitro
and
in vivo
. In addition, when these MAbs were mixed with MAbs to protective antigen (PA) previously generated in our laboratory, these MAb combinations produced synergistic toxin neutralization
in vitro
. But when 17F1 was combined with another MAb to LF, 19C9, the combination resulted in enhanced lethal toxicity. While no single MAb to LF provided significant toxin neutralization, LF-immunized mice were completely protected from infection with
B. anthracis
strain Sterne, which suggested that a polyclonal response is required for effective toxin neutralization. In total, these studies show that while a single MAb against LeTx may not be effective, combinations of multiple MAbs may provide the most effective form of passive immunotherapy, with the caveat that these may demonstrate emergent properties with regard to protective efficacy.
Dipterinyl Calcium Pentahydrate Inhibits Intracellular Mycobacterial Growth in Human Monocytes via the C-C Chemokine MIP-1β and Nitric Oxide
Authors: Sakala Isaac G. , Eickhoff Christopher S. , Blazevic Azra , Moheno Phillip , Silver Richard F. , Hoft Daniel F.
Published: March 2013

Tuberculosis remains one of the top three leading causes of morbidity and mortality worldwide, complicated by the emergence of drug-resistantMycobacterium tuberculosisstrains and high rates of HIV coinfection. It is important to develop new antimycobacterial drugs and immunomodulatory therapeutics and compounds that enhance antituberculous immunity. Dipterinyl calcium pentahydrate (DCP), a calcium-complexed pterin compound, has previously been shown to inhibit human breast cancer cells and hepatitis B virus (HBV). DCP inhibitory effects were attributed to induction of apoptosis and/or increased production of interleukin 12 (IL-12) and granulocyte-macrophage colony-stimulating factor (GM-CSF). In this study, we tested the ability of DCP to mediate inhibition of intracellular mycobacteria within human monocytes. DCP treatment of infected monocytes resulted in a significant reduction in viability of intracellular but not extracellularMycobacterium bovisBCG. The antimicrobial activity of DCP was comparable to that of pyrazinamide (PZA), one of the first-line antituberculosis drugs currently used. DCP potentiated monocyte antimycobacterial activity by induction of the cysteine-cysteine (C-C) chemokine macrophage inflammatory protein 1β (MIP-1β) and inducible nitric oxide synthase 2. Addition of human anti-MIP-1β neutralizing antibody or a specific inhibitor of thel-arginase-nitric oxide pathway (NG-monomethyll-arginine [l-NMMA] monoacetate) reversed the inhibitory effects of DCP on intracellular mycobacterial growth. These findings indicate that DCP induced mycobacterial killing via MIP-1β- and nitric oxide-dependent effects. Hence, DCP acts as an immunoregulatory compound enhancing the antimycobacterial activity of human monocytes.
A rare complication of endovenous laser ablation: intravascular laser catheter breakage
Authors: Bozoglan Orhan , Mese Bulent , Inci Mehmet Fatih , Eroglu Erdinc
Published: March 2013

During endovenous laser ablation, which is performed as an alternative to surgery for the treatment of superficial venous insufficiency of lower extremity and associated varicose veins, it was realised that the distal end of the catheter protecting the fibre sheared off; the retained catheter fragment in the saphenous vein was removed by a mini incision. Herein, we aim to present a rare complication of endovenous laser ablation.
Initially unrecognised lunate dislocation as a cause of carpal tunnel syndrome
Authors: Ott Florian , Mattiassich Georg , Kaulfersch Christian , Ortmaier Reinhold
Published: March 2013

A patient was admitted reporting tingling pain and numbness in the right hand. Neurological examination—including nerve conduction studies—diagnosed carpal tunnel syndrome. Operative carpal tunnel release was performed without complications. Four months postoperatively the otherwise healthy patient presented again due to persistent complaints, although preoperative symptoms had improved. On this occasion, the patient reported loss of strength accompanied by rigidity in the wrist. Clinical examination showed some swelling adjacent to the operation wound. A postoperative ganglion cyst was suspected and a conservative treatment option—splinting the wrist—was chosen. Four weeks later the patient presented again with further swelling and increasing rigidity of the wrist. Surgical intervention was planned. Preoperative plain radiographs of the wrist revealed chronic palmar dislocation of the lunate to be the cause of the symptoms in our patient. Radiological signs of scapholunate advanced collapse arthritis (SLAC wrist) were also observed.
Adverse Reactions to Anthrax Immunisation in a Military Field Hospital
Authors: Hayes SC , World MJ
Published: March 2013

Objective

To determine the outcome of anthrax immunisation.

Methods

Adverse reactions (occurrence, nature, severity and incapacity) and immune responses to a voluntary programme of anthrax immunisation at 0, 3, 6, and 24 weeks were monitored by questionnaire and voluntary blood sampling in 129 members, including 24 immunised 7 years previously (immunes), of a military field hospital alerted for possible deployment.

Results

Follow-up was complete in 85%. Ninety-eight (76%) received the first anthrax immunisation. Uptake was greater (p=0.015) in immunes. Initial prevalence of adverse reaction was 63%. Subsequent uptake and adverse reaction dwindled significantly (p<0.001). Only 28 (22%) were immunised at 24 weeks. Proportions reporting adverse reactions following the initial immunisation were greater in immunes (p=0.046) and officers (p=0.02). There was no significant (p=0.36) correlation between uptake of immunisation and prevalence of adverse reaction. Antecedent adverse reaction did not reduce the proportion of participants accepting immunisation subsequently. The nature of adverse reactions (47% local, 24% systemic and 27% both ) and severity were the same throughout. Forty-five percent of adverse reactions caused incapacity. Seventy-four percent of these had pain in the injected arm (± systemic symptoms) which prevented lifting or driving for 48 hours in 63%. Immune responses were greater in immunes.

Conclusions

It was concluded that anthrax immunisation results in a higher than expected prevalence of adverse reaction with initial incapacity of military significance affecting 18%. Greater immune responses may increase adverse reaction but this does not affect acceptance of anthrax immunisation. Poor completion rates necessitate development of a new anthrax immunisation strategy.
Simultaneous Presentation Of Both True And False Aneurysm In The Infrarenal Aorta
Authors: Townend M , Keightley A , Price B A
Published: March 2013

Interventional radiology has resulted in a reduced need for bypass procedures for aorto-occlusive disease. However, there are still indications for surgery of this type, which carries with it a small but significant morbidity and mortality. False aneurysms are well described following such procedures but with the development of inert, strong and non-absorbable materials they are becoming less common. This paper describes the acute presentation of a false aneurysm of the aorta following an aorto-iliac bypass where true aneurysmal change had taken place in the area of the anastomosis.
Occult elbow dislocation: A rare cause of upper limb arterial insufficiency
Authors: McMurtry IA , Bhullar TJ
Published: March 2013

We present a case of vascular injury resulting from occult dislocation of the elbow joint. At last review 46 cases of brachial artery injury with concomitant dislocation have been reported (10), all in small series and case reports. In all the dislocation was clinically or radiologically evident.
Combat Casualties In The First Decade Of The 21st Century - New And Emerging Weapon Systems
Authors: Galbraith KA
Published: March 2013

This paper reviews new and emerging weapons systems targeted directly or indirectly against personnel. It distinguishes emerging technologies that may form the basis of usable weapons in the next 10 years, from the speculations and aspirations of weapons designers, and identifies six groups of weapons systems which will present significant new or changing threats to UK forces. The article combines this information with knowledge of biophysical interactions and clinical effects, to identify possible consequences for the DMS in terms of types, patterns and numbers of casualties. Ballistic threats will continue to be the most common casualty-producing mechanism for servicemen in any environment.
Burns and Military Clothing
Authors: McLean A D
Published: March 2013

Burn injury is a ubiquitous threat in the military environment. The risks during combat are well recognised, but the handling of fuel, oil, munitions and other hot or flammable materials during peacetime deployment and training also imposes an inherent risk of accidental burn injury.

Over the last hundred years, the burn threat in combat has ranged from nuclear weapons to small shoulderlaunched missiles. Materials such as napalm and white phosphorus plainly present a risk of burn, but the threat extends to encompass personnel in vehicles attacked by anti-armour weapons, large missiles, fuel-air explosives and detonations/conflagrations on weapons platforms such as ships. Large numbers of burn casualties were caused at Pearl Harbor, in Hiroshima and Nagasaki, Vietnam, during the Arab/Israeli Wars and in the Falkland Islands conflict.

The threat from burns is unlikely to diminish, indeed new developments in weapons seek to exploit the vulnerability of the serviceman and servicewoman to burns.

Clothing can be a barrier to some types of burn - both inherently in the properties of the material, but also by trapping air between clothing layers. Conversely, ignition of the clothing may exacerbate a burn. There is hearsay that burnt clothing products within a wound may complicate the clinical management, or that materials that melt (thermoplastic materials) should not be worn if there is a burn threat. This paper explores the incidence of burn injury, the mechanisms of heat transfer to bare skin and skin covered by materials, and the published evidence for the complication of wound management by materials.

Even light-weight combat clothing can offer significant protection to skin from short duration flash burns; the most vulnerable areas are the parts of the body not covered - face and hands. Multilayered combat clothing can offer significant protection for short periods from engulfment by flames; lightweight tropical wear with few layers offers little protection. Under high heat loads in the laboratory, combat clothing can ignite, but there is little evidence that clothing ignition is a common occurrence in military burn casualties.

Thermoplastic materials have many benefits in civil and military clothing. There is little objective evidence that they exacerbate burns, or complicate burn management. Their use in military clothing must be based on objective evidence, not hearsay.
Use of simulation technology in Australian Defence Force resuscitation training
Authors: Hendrickse AD , Ellis AM , Morris RW
Published: March 2013

Realistic training of health personnel for the resuscitation of military casualties is problematic. There are few opportunities for personnel to obtain the necessary experience unless working in a busy emergency or trauma environment. Even so, the specific nature of military trauma means that many aspects of casualty management may not be adequately covered in the civilian domain. This paper discusses the use of advanced simulation technology in the training of military resuscitation teams. Such training has been available to members of the Australian Defence Force (ADF) for two years.
Malaria remains a military medical problem
Authors: World MJ
Published: March 2013

Objective

To bring military medical problems concerning malaria to the attention of the Defence Medical Services.

Method

Seven military medical problems related to malaria are illustrated by cases referred for secondary assessment over the past five years. Each is discussed in relation to published data.

Results

The cases of failure of various kinds of chemoprophylaxis, diagnosis and treatment of malaria may represent just a fraction of the magnitude of the overall problem but in the absence of reliable published military medical statistics concerning malaria cases, the situation is unclear.

Conclusion

Present experience suggests there are a number of persisting problems affecting the military population in relation to malaria. Only publication of reliable statistics will define their magnitude. Interim remedies are proposed whose cost-effectiveness remains to be established.
Prospective Evaluation of Handheld Ultrasound in the Diagnosis of Blunt Abdominal Trauma
Authors: Brooks A , Davies B , Connolly J
Published: March 2013

Objectives

To evaluate the Sonosite 180 handheld ultrasound in the diagnosis of haemoperitoneum in blunt abdominal trauma.

Methods

Trauma ultrasound using the Focused Assessment with Sonar for Trauma (FAST) technique was performed using the Sonosite 180 handheld ultrasound during the primary survey of adult patients triaged to the resuscitation room with multiple trauma or suspected abdominal injury. The ultrasound findings were compared against the investigation of choice of the attending surgeon/accident & emergency physician - CT, DPL, laparotomy or clinical observation.

Results

50 patients who had sustained blunt abdominal trauma were evaluated using FAST. Satisfactory images were obtained in 96%. There were 5 true positive scans confirmed by CT, DPL or laparotomy. There were no false negative or false investigations. The sensitivity and specificity of handheld FAST was 100%.

Conclusions

Handheld ultrasound using the Sonosite 180 system can be successfully used by appropriately trained doctors as the primary investigation in the acute evaluation of blunt abdominal trauma.
The Reconnaissance and Siting of Field Hospitals
Authors: Boreham A , Bricknell MCM
Published: March 2013

This paper describes the reconnaissance function for the siting of deployable field hospitals. It reports two levels of reconnaissance, theatre/operational and tactical. The paper describes the factors to be considered when conducting the reconnaissance and the format of the reconnaissance report.
Principles And Problems Underlying Testing The Effectiveness Of Blast Protective Footwear
Authors: Chaloner E J , McMaster J , Hinsley D E
Published: March 2013

Anti-personnel landmines are a continuing threat to soldiers and civilians working overseas in post conflict situations. Several groups of governmental and commercial scientists are currently designing and/or testing footwear to protect the lower leg from the effects of close proximity blast. The general principles surrounding testing of protective footwear are examined together with an assessment of the known progress to date and the strengths and weaknesses of the designs produced.
A Two Year Review Of The Treatment And Complications Of Mandibular Angle Fractures
Authors: Dhariwal D K , Gibbons A J , Murphy M , Llewelyn J , Gregory M C
Published: March 2013

A review of all patients with treated mandibular angle fractures at a district general hospital, over a two year period, was undertaken. Forty one consecutive patients with 43 mandibular angle fractures were identified. Thirty eight fractures were treated by open reduction and internal fixation with miniplates and 5 by intermaxillary fixation (IMF).

Fractures treated with miniplates were reduced under direct vision to give an anatomical reduction without using temporary intermaxillary fixation. The shortened operative time together with the prompt administration of intravenous antibiotics following injury and rapid treatment of fractures after admission resulted in a low complication rate of 7.3% of patients requiring a subsequent surgical procedure. Although IMF has an important role to play in the general treatment of facial fractures, we suggest that there is a place for single miniplate fracture fixation without the use of temporary IMF when treating simple angle fractures. As this technique is quick and has a low complication rate its use in military situations should be considered.
Battlefield Use Of Depleted Uranium And The Health Of Veterans
Authors: Bolton JPG , Foster CRM
Published: March 2013

Depleted uranium munitions have been used in recent military operations in both the Gulf and the Balkans and there have been concerns that exposure to depleted uranium may be a cause of ‘Gulf War Syndrome’ and cancer clusters. We recount the properties of depleted uranium, its military uses and the situations in which personnel may be exposed. Following a review of scientific literature, the health effects of depleted and natural uranium exposure are described and the major outcomes of research into Gulf Veterans’ Illnesses are summarised. We conclude that, although there is the potential for uranium exposures to cause renal damage or lung cancer, the risk of harm following depleted uranium exposure in military settings seems to be low. We advise on the management of casualties exposed to depleted uranium and suggest control measures that may be appropriate to protect personnel who provide casualty care.
The Medical And Surgical Management Of Chronic Anal Fissure
Authors: Garner JP , McFall M , Edwards DP
Published: March 2013

Major advances in our understanding of the mechanisms involved in chronic anal fissure have allowed the introduction of many new medical therapies for this condition. The literature about current treatment modalities licensed for anal fissure and those novel therapies still under evaluation has been reviewed. These new treatments are examined in the context of traditional surgical management of the disease and a future treatment algorithm suggested.
Musculoskeletal Injuries In Female Soldiers: Analysis Of Cause And Type Of Injury
Authors: Strowbridge N F
Published: March 2013

Objectives

To record and analyse those injuries and conditions requiring referral to a military sports injury and rehabilitation centre over a three year period, with special reference to gender, type and site of injury, and the cause of the injury.

Methods

A prospective study in which data on the gender, diagnosis, and cause of injury, of all patients referred to the Colchester Garrison Sports Injury and Rehabilitation Centre was recorded. All subjects were trained, serving soldiers in the British Army referred via their General Practitioner.

Results

Low back pain (OR 2.71, p<0.0001) and injuries to the hip, thigh and lower leg (OR 2.33, p<0.0001) were more frequent in female soldiers. Military training (OR 4.62, p<0.0001), work (OR 2.53, p<0.0001), recreation (OR 2.39, p<0.0001), and pre-existing conditions (OR 4.2, p<0.0001) were the causes most commonly cited by female rather than male soldiers. There was no statistical gender difference for sport related or road traffic accident injuries.

Conclusions

Female soldiers are more likely to sustain an injury than their male counterparts. Specific injuries account for the majority of this difference. Military training, work, and recreation are more likely to be the cause of injury in the female soldier. Conditions existing prior to military service were also more common. There was no gender difference in the injuries caused by sport or road traffic accidents. These results may act as a basis for targeted intervention in order to reduce inequality without reducing overall training standards.
The Pipe Bomb: A Modern Terrorist Weapon
Authors: Gibbons A J , Farrier J N , Key S J
Published: March 2013

The use of pipe bombs by terrorist organisations around the world has risen dramatically. The pipe bomb is simple and easy to make and details of bomb construction are freely available from the Internet. Components can be found in most hardware stores and thus give little forensic information.

Despite the increasing use of pipe bombs, clinicians may be unfamiliar with the type of injuries they cause. This paper describes two incidents of pipe bomb explosions and illustrates the type of injuries sustained by both terrorists and victims.
Command In A Field Hospital
Authors: Bricknell MCM
Published: March 2013

This paper examines the challenges involved in commanding a field hospital. There are frequent, dynamic tensions between the military culture that is based on a task-focussed, hierarchical structure and the clinical culture that is based on flat, process-focussed, multidisciplinary teams. The paper outlines the cultural environment of the field hospital and then examines the deployment sequence whereby a functioning clinical facility may be created from a group of disparate individuals. There are a number of tools that may assist with this including the personality of the Commanding Officer, individual skills, the creation of an organizational identity and the choice of command structure.
Combined UK/US Field Hospital Management Of A Major Incident Arising From A Chinook Helicopter Crash In Afghanistan, 28 Jan 2002
Authors: Vassallo D J , Gerlinger T , Maholtz P , Burlingame B , Shepherd A F I
Published: March 2013

On Monday, 28 January 2002, a US Army Chinook helicopter crashed on landing in Afghanistan. Sixteen casualties were airlifted from the scene for treatment at the US Army 274th Forward Surgical Team and the British 34 Field Hospital Troop at Bagram airfield before aeromedical evacuation out of Afghanistan. This was the largest mass casualty incident to be dealt with in a combined fashion by the British and American medical services in Afghanistan during the initial months of Operation ENDURING FREEDOM. It illustrated how multinational surgical teams can successfully manage such incidents by following common and agreed protocols. The lessons learned are relevant to any combined operations in the near future.
A Case Of Bilateral Manual Eye-Gouging Of A British Soldier
Authors: Clare Gerry , Poole Tom , Govan James
Published: March 2013

Peacetime assault-related injuries amongst soldiers are common. Whilst the majority of incidents of assault do not result in permanent physical incapacity, some may be devastating, ruining careers and lives. Here we describe one such injury. There is no national register of such injuries; they may, therefore, be under-reported.
Medical Confidentiality And Human Immunodeficiency Virus (HIV) Infection: A Hypothetical Case
Authors: Gibson T M , Coker W J
Published: March 2013

This paper describes a hypothetical case of a HIV positive pilot. It explores legal and ethical aspects of medical confidentiality and discusses who, inside and outside military and medical circles, can be told of his condition in the light of the particular circumstances. Disclosure without the patient’s consent is a serious step that should not be undertaken without advice from Service medico-legal departments and medical protection organisations.
A Lesson Not Yet Learned
Authors: Becker GW , Laundy TJ
Published: March 2013

Objectives

Accounts of numerous military campaigns throughout history have shown that casualties from medical illness usually greatly outnumber combat injuries. We aimed to see whether this remained the case in a modern campaign where predominantly surgical facilities were deployed.

Methods

We examined 1511 hospital records of inpatients in the Oman theatre during the last three months of Exercise Saif Sareea II and the initial period of Operation Veritas.

Results

Of the 1399 records included, 1033 (74%) required care from a physician, whereas 366 (26%) were treated by surgeons. However, of patients returning to duty in theatre (total 985), 884 (90%) had been treated by physicians and 101 had been treated by surgeons. Notably, only 23 (2%) of these had undergone a surgical procedure.

Conclusions

Experience in Oman suggests that the lessons of history in respect of casualties in times of conflict are both unlearned and being repeated. The role of the medical specialities in military secondary care should be recognised and deployed facilities should not be defined by surgical capability alone.
Impact Of Deployment Of Personnel With Chronic Conditions To Forward Areas
Authors: Hodgetts TJ , Greasley LA
Published: March 2013

Aim

To identify reasons for inappropriate deployment of soldiers with chronic conditions to an operational environment.

Setting

Two British Army field hospitals in Kuwait, 08 February to 17 March 2003, during the period of troop concentration prior to war-fighting (Operation Telic).

Population

All British military personnel on land during the concentration phase, rising to an estimated 28,000 troops.

Methods

Real-time electronic record maintained of all cases presenting to 22 and 33 Field Hospitals judged to be inappropriately deployed.

Results

50 sequential cases were analysed. 34% were downgraded prior to deployment. Of those who were P2 FE, 85% were judged to have required protection from deployment by downgrading. 20% of all cases had a history of chronic asthma, and of the asthmatics 60% (6/10) were not downgraded. 18% of all cases were deployed while waiting for secondary care investigation or review that should have ensured protection from deployment. No patient had an existing “FT” (forward temperate) or “LT” (lines of communication temperate) grading: but in four cases it was predictable that the patient’s underlying condition would be adversely affected by deployment to a desert environment. In 5 cases it was identified that the inappropriate deployment could be attributed to clinical management within the civilian sector, with a consequent failure to institute the necessary downgrading process.

Conclusions

Review of the medical grading process is needed to protect those soldiers who are awaiting outpatient opinion or definitive diagnosis from investigation, and to provide an employability grading that matches a soldier’s fitness for operational role.
Organisation For The Relief Of Concentration Camps
Authors: Engel HO
Published: March 2013

Objective

To review the essential principles involved in rescue missions for natural and man-made disasters.

Method

A description of the relief of a concentration camp in 1945 as an example of the logistics required in any major disaster or rescue.

Results

The arrival of trained Army rescue teams on the first day and dealing systematically with priorities in salvage, treatment and nursing saved many lives, even of desperately ill patients.

Conclusions

A centralised administration and organisation of supplies is the first priority. Suitable intravenous and very light nutrients, and the prevention and combating of infections are more urgent than the provision of shelter and clothing.
The Psychological Dimension Of Chemical, Biological, Radiological And Nuclear (CBRN) Terrorism
Authors: Palmer Ian
Published: March 2013

Terrorism is an increasing feature of the World Scene. In the UK, our perspective has changed from a largely Ireland focused one to a more international view. The United States of America are, for the first time, seen as major terrorist targets. We are now “at war with terrorism”. The medical aspects of terrorism have been extensively discussed in this journal and elsewhere, this article specifically addresses the psychological consequences of the use of terror weapons.