Childhood leukaemia and ordnance factories in west Cumbria during the Second World War.
Much evidence has accumulated that childhood leukaemia (CL) is a rare response to a common, but unidentified, infection and in particular that situations involving the unusual mixing of urban and rural groups (approximating to, respectively, groups infected with, and susceptible to, the relevant microorganism) can produce localised epidemics with consequent increases of the infrequent leukaemic complication. During the Second World War, explosives production factories were built and operated at Drigg and Sellafield, and a shell filling factory at Bootle, in west Cumbria, England, requiring substantial numbers of construction workers to be brought into this remote and isolated area. Following the design of an earlier study of CL near large (post-war) rural construction sites, mortality from this disease was investigated with the help of the Office of National Statistics, in the area around these Cumbrian factories where local workers largely lived, during the construction period and with particular reference to the overlapping construction and operational phase when the mixing of local and migrant workers would have been greatest. An excess of leukaemia deaths at ages 1-14 was found during the construction period (observed 3; observed/expected (O/E) 2.2, 95% confidence interval (CI): 0.6, 6.0), which was more marked and statistically significant during the overlap with operations (O 3; O/E 4.5, 95% CI: 1.1, 12.2), especially at ages 1-4 (O 2; O/E 7.1, CI: 1.2, 23.6). A previous investigation did not detect this excess because it considered only a small part of west Cumbria that omitted the communities where most of the workforce lived, having incorrectly attributed the post-war expansion of the village of Seascale (situated between Drigg and Sellafield) to the wartime ordnance factories. The present findings are consistent with the results of the earlier study of rural construction projects and with the general evidence that marked rural-urban population mixing increases the risk of CL. (+info
Suicide bombers form a new injury profile.
BACKGROUND: Recent explosions of suicide bombers introduced new and unique profiles of injury. Explosives frequently included small metal parts, increasing severity of injuries, challenging both physicians and healthcare systems. Timely detonation in crowded and confined spaces further increased explosion effect. METHODS: Israel National Trauma Registry data on hospitalized terror casualties between October 1, 2000 and December 31, 2004 were analyzed. RESULTS: A total of 1155 patients injured by explosion were studied. Nearly 30% suffered severe to critical injuries (ISS > or = 16); severe injuries (AIS > or = 3) were more prevalent than in other trauma. Triage has changed as metal parts contained in bombs penetrate the human body with great force and may result in tiny entry wounds easily concealed by hair, clothes etc. A total of 36.6% had a computed tomography (CT), 26.8% had ultrasound scanning, and 53.2% had an x-ray in the emergency department. From the emergency department, 28.3% went directly to the operating room, 10.1% to the intensive care unit, and 58.4% directly to the ward. Injuries were mostly internal, open wounds, and burns, with an excess of injuries to nerves and to blood vessels compared with other trauma mechanisms. A high rate of surgical procedures was recorded, including thoracotomies, laparotomies, craniotomies, and vascular surgery. In certain cases, there were simultaneous multiple injuries that required competing forms of treatment, such as burns and blast lung. CONCLUSIONS: Bombs containing metal fragments detonated by suicide bombers in crowded locations change patterns and severity of injury in a civil population. Specific injuries will require tailored approaches, an open mind, and close collaboration and cooperation between trauma surgeons to share experience, opinions, and ideas. Findings presented have implications for triage, diagnosis, treatment, hospital organization, and the definition of surge capacity. (+info
Managing burn victims of suicide bombing attacks: outcomes, lessons learnt, and changes made from three attacks in Indonesia.
INTRODUCTION: Terror attacks in Southeast Asia were almost nonexistent until the 2002 Bali bomb blast, considered the deadliest attack in Indonesian history. Further attacks in 2003 (Jakarta), 2004 (Jakarta), and 2005 (Bali) have turned terrorist attacks into an ever-present reality. METHODS: The authors reviewed medical charts of victims evacuated to the Singapore General Hospital (SGH) Burns Centre during three suicide attacks involving Bali (2002 and 2005) and the Jakarta Marriott hotel (2003). Problems faced, lessons learnt, and costs incurred are discussed. A burns disaster plan drawing on lessons learnt from these attacks is presented. RESULTS: Thirty-one patients were treated at the SGH Burns Centre in three attacks (2002 Bali attack [n = 15], 2003 Jakarta attack [n = 14], and 2005 Bali attack [n = 2]). For the 2002 Bali attack, median age was 29 years (range 20 to 50 years), median percentage of total burn surface area (TBSA) was 29% (range 5% to 55%), and median abbreviated burn severity index (ABSI) was 6 (range 3 to 10). Eight of 15 patients were admitted to the intensive care unit. For the 2003 Jakarta attack, median age was 35 years (range 24 to 56 years), median percentage of TBSA was 10% (range 2% to 46%), and median ABSI was 4 (range 3 to 9). A large number of patients had other injuries. Problems faced included manpower issues, lack of bed space, shortage of blood products, and lack of cadaver skin. CONCLUSION: The changing nature of terror attacks mandates continued vigilance and disaster preparedness. The multidimensional burns patient, complicated by other injuries, is likely to become increasingly common. A burns disaster plan with emphasis on effective command, control, and communication as well as organisation of health care personnel following a 'team concept' will do much to ensure that the sudden onset of a crisis situation at an unexpected time does not overwhelm hospital manpower and resources. (+info
Military fatality rates (by cause) in Afghanistan and Iraq: a measure of hostilities.
BACKGROUND: Military fatalities occur in clusters, and causes differ between theatres of operation or within-theatre over time. AIM: Based on around 500 coalition deaths, identify major causes in Iraq and Afghanistan. For consecutive periods (1: May 1 to September 17, 2006, 2: September 18, 2006 to February 4, 2007), ascertain UK and others' numbers deployed to compare fatality rates per 1000-personnel years. Take account of clustering: deaths per fatal improvised explosive device (IED) incident, and in making short-term projections for Afghanistan. METHODS: Cause and date of coalition deaths in Iraq and Afghanistan are as listed in http://www.iCasualties.org, where each death is designated as hostile or non-hostile. Numbers deployed in 2006 were available for UK and Canada, and for US to Iraq. FINDINGS: Out of 537 coalition fatalities in Iraq in 2006 to September 17, 2006, 457 (85%) were hostile, but only half were in Afghanistan (October 2001 to September 17, 2006: 52%, 249/478). Air losses accounted for 5% fatalities in Iraq, but 32% in Afghanistan. IEDs claimed three out of five hostile deaths in Iraq, only a quarter in Afghanistan. Deaths per fatal IED incident averaged 1.5. In period 1, 50/117 military deaths in Afghanistan were UK or Canadian from 6750 personnel, a fatality rate of 19/1000/year, nearly four times the US rate of 5/1000/year in Iraq (based on 280 deaths). Sixty out of 117 fatalities in Afghanistan occurred as clusters of two or more deaths. In period 2, fatality rates changed: down by two-thirds in Afghanistan for UK and Canadian forces to 6/1000/year (18 deaths), up by 46% for US troops in Iraq to 7.5/1000/year (416 deaths). INTERPRETATION: Rate, and cause, of military fatalities are capable of abrupt change, as happened in Iraq (rate) and Afghanistan (rate and cause) between consecutive 140-day periods. Forecasts can be wide of the mark. (+info
Cloning, analysis and functional annotation of expressed sequence tags from the Earthworm Eisenia fetida.
BACKGROUND: Eisenia fetida, commonly known as red wiggler or compost worm, belongs to the Lumbricidae family of the Annelida phylum. Little is known about its genome sequence although it has been extensively used as a test organism in terrestrial ecotoxicology. In order to understand its gene expression response to environmental contaminants, we cloned 4032 cDNAs or expressed sequence tags (ESTs) from two E. fetida libraries enriched with genes responsive to ten ordnance related compounds using suppressive subtractive hybridization-PCR. RESULTS: A total of 3144 good quality ESTs (GenBank dbEST accession number EH669363-EH672369 and EL515444-EL515580) were obtained from the raw clone sequences after cleaning. Clustering analysis yielded 2231 unique sequences including 448 contigs (from 1361 ESTs) and 1783 singletons. Comparative genomic analysis showed that 743 or 33% of the unique sequences shared high similarity with existing genes in the GenBank nr database. Provisional function annotation assigned 830 Gene Ontology terms to 517 unique sequences based on their homology with the annotated genomes of four model organisms Drosophila melanogaster, Mus musculus, Saccharomyces cerevisiae, and Caenorhabditis elegans. Seven percent of the unique sequences were further mapped to 99 Kyoto Encyclopedia of Genes and Genomes pathways based on their matching Enzyme Commission numbers. All the information is stored and retrievable at a highly performed, web-based and user-friendly relational database called EST model database or ESTMD version 2. CONCLUSION: The ESTMD containing the sequence and annotation information of 4032 E. fetida ESTs is publicly accessible at http://mcbc.usm.edu/estmd/. (+info
Weapons of war--humanitarian and medical impact.
Most of us have patients who have loved ones living far away, sometimes in conflict zones or in other dangerous locations, and we share in the anxiety and distress that such situations bring to relatives. (+info
Accuracy of assessing the level of impulse sound from distant sources.
Impulse sound events are characterised by ultra high pressures and low frequencies. Lower frequency sounds are generally less attenuated over a given distance in the atmosphere than higher frequencies. Thus, impulse sounds can be heard over greater distances and will be more affected by the environment. To calculate a long-term average immission level it is necessary to apply weighting factors like the probability of the occurrence of each weather condition during the relevant time period. This means that when measuring impulse noise at a long distance it is necessary to follow environmental parameters in many points along the way sound travels and also to have a database of sound transfer functions in the long term. The paper analyses the uncertainty of immission measurement results of impulse sound from cladding and destroying explosive materials. The influence of environmental conditions on the way sound travels is the focus of this paper. (+info
The explosive-degrading cytochrome P450 system is highly conserved among strains of Rhodococcus spp.