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In Honduras, as in many settings between 2020 and 2022, food security was affected by the COVID-19 pandemic, climate change, and conflicts-what some refer to as "The Three Cs." These challenges have had overlapping impacts on food supply chains, food assistance programs, food prices, household purchasing power, physical access to food, and food acceptability. This article applies a food system disruption analysis-adapted from a fault tree analysis originally developed for a municipal context in the United States-to the context of Honduras to systematically examine how the Three Cs affected food availability, accessibility, and acceptability. This article demonstrates the value of approaching food security through a disruption analysis, especially for settings impacted by multiple, interconnected, ongoing crises.

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INTRODUCTION: Studies assessing early trauma resuscitation have used long-term endpoints, such as 28- or 30-day mortality or Glasgow Outcomes Scores at 6-months. These endpoints are convenient but may not accurately reflect the effect of early resuscitation. We sought expert opinion and consensus on endpoints and definitions of variables needed to conduct a Department of Defense- (DoD) funded study to epidemiologically assess combat-relevant mortality and morbidity due to timeliness of resuscitation among critically injured civilians internationally. METHODS: We conducted an online modified Delphi process with an international panel of civilian and US military experts. In several iterative rounds, experts reviewed background information, appraised relevant scientific evidence, provided comments, and rendered a vote on each variable. A-priori, we set consensus at ≥80% concordant votes. RESULTS: Twenty panelists participated with a 100% response rate. Eight items were presented, with the following outputs for the epidemiologic study: Assess mortality within 7-days of injury; assess multi-organ failure using SOFA scores measured early (at day 3) and late (at day 7); assess traumatic brain injury mortality early (≤7-days) and late (28-days); hybrid (anatomic and physiologic) injury severity scoring is optimal; capture comorbidities per the US National Trauma Data Standard list with specific additions; assign resuscitative interventions to one of five standardized phases of trauma care; and, use a novel trauma death categorization system. CONCLUSIONS: A modified Delphi process yielded expert-ratified definitions and endpoints of variables necessary to conduct a combat-relevant epidemiologic study assessing outcomes due to early trauma resuscitation. Outputs may also benefit other groups conducting trauma resuscitation research.

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Rhodococcus sp. H-CA8f was isolated from marine sediments obtained from the Comau fjord, located in Northern Chilean Patagonia. Whole-genome sequencing was achieved using PacBio RS II platform, comprising one closed, complete chromosome of 6,19 Mbp with a 62.45% G + C content. The chromosome harbours several metabolic pathways providing a wide catabolic potential, where the upper biphenyl route is described. Also, Rhodococcus sp. H-CA8f bears one linear mega-plasmid of 301 Kbp and 62.34% of G + C content, where genomic analyses demonstrated that it is constituted mostly by putative ORFs with unknown functions, representing a novel genetic feature. These genetic characteristics provide relevant insights regarding Chilean marine actinobacterial strains.

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In developing countries, continuing education for healthcare staff may be limited by staff shortages and lack of sophisticated means of delivery. These limitations have implications for compliance with an important infection control practice, namely good hand hygiene. A comparison was made between the efficacy of two educational tools commonly used in healthcare and practical sanitation settings in developing countries, i.e. videotapes and flipcharts, in delivering hand hygiene education to 67 nurses in a paediatric hospital in El Salvador. Efficacy was measured on the basis of scores obtained in pre- and post-training tests consisting of 10 multiple-choice questions. Half of the nurses received video-based instruction and half received instruction via flipcharts. Both methods of instruction increased participants' knowledge of good hand hygiene, and the extent of knowledge acquisition by the two methods was similar. Feedback obtained from flipchart users six months after training indicated that most of the respondents used the flipchart to teach hand hygiene to patients' families (62.5%), patients (50%) and healthcare workers (43.8%). Flipchart users ranked flipcharts as their favourite educational tool. Flipcharts offer an economical, easy-to-use, non-technological yet effective alternative to videotapes for delivering education in developing countries. Although the use of flipcharts requires a skilled and well-trained instructor, flipcharts could be used more widely to deliver education in resource-poor settings.

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OBJECTIVES: The purpose was to demonstrate that an objective, multivariate case definition of fetal alcohol syndrome (FAS) and partial fetal alcohol syndrome (PFAS) can be derived by means of craniofacial anthropometry. STUDY DESIGN: Craniofacial measurements (n = 21) were taken of 100 individuals who had been exposed to alcohol before birth (41 FAS, 59 PFAS) and 31 members of a control group. Multivariate discriminant analysis was used to identify craniofacial measurements that best differentiated the 3 groups (FAS, PFAS, and control). RESULTS: Both the FAS and PFAS groups had a unique craniofacial phenotype that could be accurately discriminated from that of the control group. Stepwise discriminant analysis identified 6 craniofacial measurements that could differentiate individuals with and without prenatal alcohol exposure with 96% accuracy, 98% sensitivity, and 90% specificity. CONCLUSIONS: Individuals with FAS and PFAS have a distinctive facial phenotype that can be characterized anthropometrically. The phenotypic case definition could be used as a screening tool to identify individuals prenatally exposed to alcohol who do not exhibit a "classic" FAS phenotype but exhibit a more subtle craniofacial dysmorphia.

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The objective of this study was to determine age-specific reference values for urinary calcium/creatinine ratios (UCa/Cr) of children in southern Thailand. Non-fasting urine samples were collected from a random population of 488 healthy children (282 males, 206 females) ranging in age from 17 days to 15 years. Samples were divided into six groups by age. Subjects whose calcium levels exceeded the 95th percentile within each age group were classified as having hypercalciuria. Pyuria, hematuria, proteinuria, urinary sodium, and potassium levels in children with normal UCa/Cr were compared with levels in children with high UCa/Cr. The 95th percentiles for UCa/Cr (mg/mg) by age were: <6 months, 0.75; 6 months to <12 months, 0.64; 12 months to <2 years, 0.40; 2 years to <5 years, 0.38; 5 years to <10 years, 0.29; and 10 years to <15 years, 0.26. Pyuria, hematuria, and proteinuria were no more prevalent in the 22 children with hypercalciuria than in children with normal urinary calcium levels. Urinary sodium/creatinine ratios (UNa/Cr) and urinary sodium/potassium ratios (UNa/K) were correlated with UCa/Cr (r=0.41, P<0.0001 and r=0.24, P<0.0001, respectively). Urinary potassium/creatinine ratios (UK/Cr) were not (r=0.05, P>0.1)). Children with high UCa/Cr ratios also had higher UNa/Cr and UNa/K (5.6+/-7.1 vs. 2.6+/-1.5, P<0.001 and 5.4+/-2.3 vs. 2.5+/-0.23, P<0.05, respectively). The study established reference values for random, non-fasting UCa/Cr for healthy Thai children and indicated that urinalysis is not a good indicator of hypercalciuria.

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The phylogeny of 11 pigmented, aerobic, spore-forming isolates from marine sources was studied. Forty-two biochemical characteristics were examined, and a 16S rDNA sequence was obtained for each isolate. In a phylogenetic tree based on 16S sequencing, four isolates (NRRL B-14850, NRRL B-14904, NRRL B-14907, and NRRL B-14908) clustered with B. subtilis and related organisms; NRRL B-14907 was closely related to B. amyloliquefaciens. NRRL B-14907 and NRRL B-14908 were phenotypically similar to B. amyloliquefaciens and B. pumilus, respectively. Three strains (NRRL B-14906, NRRL B-14910, and NRRL B-14911) clustered in a clade that included B. firmus, B. lentus, and B. megaterium. NRRL B-14910 was closely related phenotypically and phylogenetically to B. megaterium. NRRL B-14905 clustered with the mesophilic round spore-producing species, B. fusiformis and B. sphaericus; the isolate was more closely related to B. fusiformis. NRRL B-14905 displayed characteristics typical of the B. sphaericus-like organisms. NRRL B-14909 and NRRL B-14912 clustered with the Paenibacillus species and displayed characteristics typical of the genus. Only NRRL B-14851, an unusually thin rod that forms very small spores, may represent a new Bacillus species.

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OBJECTIVE: Recognizing the impact of the 1977 San Francisco study of trauma deaths in trauma care, our purpose was to reassess those findings in a contemporary trauma system. DESIGN: Cross-sectional. MATERIAL AND METHODS: All trauma deaths occurring in Denver City and County during 1992 were reviewed; data were obtained by cross-referencing four databases: paramedic trip reports, trauma registries, coroner autopsy reports and police reports. MEASUREMENTS AND MAIN RESULTS: There were 289 postinjury fatalities; mean age was 36.8 +/- 1.2 years and mean Injury Severity Score (ISS) was 35.7 +/- 1.2. Predominant injury mechanisms were gunshot wounds in 121 (42%), motorvehicle accidents in 75 (38%) and falls in 23 (8%) cases. Seven (2%) individuals sustained lethal burns. Ninety eight (34%) deaths occurred in the pre-hospital setting. The remaining 191 (66%) patients were transported to the hospital. Of these, 154 (81%) died in the first 48 hours (acute), 11 (6%) within three to seven days (early) and 26 (14%) after seven days (late). Central nervous system injuries were the most frequent cause of death (42%), followed by exsanguination (39%) and organ failure (7%). While acute and early deaths were mostly due to the first two causes, organ failure was the most common cause of late death (61%). CONCLUSIONS: In comparison with the previous report, we observed similar injury mechanisms, demographics and causes of death. However, in our experience, there was an improved access to the medical system, greater proportion of late deaths due to brain injury and lack of the classic trimodal distribution.

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OBJECTIVE: Bacterial translocation from the gut has been invoked as a common inciting event for postinjury multiple organ failure. We previously showed that gut ischemia/reperfusion induces remote organ injury. The purpose of this study was to ascertain if endotoxin has a pivotal mechanistic role in this process. DESIGN: Prospective, randomized study. SETTING: Animal laboratory. SUBJECTS: Sprague-Dawley rats weighing 300 to 350 g. INTERVENTIONS: Anesthetized animals underwent 45 mins of superior mesenteric artery occlusion and 2 hrs of reperfusion; sham laparotomy served as controls. Endotoxin was eliminated with the murine immunoglobulin (Ig) M antibody E5, 3 mg/kg i.v. before the study. MEASUREMENTS AND MAIN RESULTS: Plasma endotoxin was measured by the limulus amebocyte lysate assay. At 2 hrs of reperfusion, circulating neutrophil priming was determined by the difference in superoxide generation with and without the activating stimulus, N-formyl-Met-Leu-Phe. Neutrophil sequestration in the lung was quantitated by myeloperoxidase activity, and by lung endothelial permeability by 125I albumin lung/blood ratio. Endotoxin concentrations were not significantly (significance determined as p < .05) different between the gut ischemia/reperfusion and laparotomy groups (n = > or = 5) during ischemia or reperfusion. Circulating neutrophil priming, neutrophil accumulation in the lung, and lung injury were provoked by gut ischemia/reperfusion, but not altered by endotoxin elimination. CONCLUSION: Gut ischemia/reperfusion primes circulating neutrophils and produces lung injury by a mechanism independent of endotoxin.

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The triage of all injured children to regional pediatric trauma centers may be impractical and unnecessarily exclude adult level I trauma centers from the care of the acutely injured child. The purpose of this study was to critically evaluate the outcome of injured children treated in an adult level I trauma center by adult trauma surgeons. The records of 410 consecutively treated children (age < or = 15 years) and 188 young adults (age 16 to 18 years) admitted to the trauma service during a 2-year period (ending December 1991) were studied. The probability of survival was calculated using TRISS methodology. Results were analyzed using the Z statistic, permitting objective comparison with national norms (Major Trauma Outcome Study). Severity of injury (RTS and ISS) was equivalent (P > .05) in children and young adults. The observed survival (98.0%) in children compared favorably with the predicted survival (TRISS) of 97.7%. Calculation of the Z statistic showed no difference in outcomes of acutely injured children (+0.47) relative to young adults (+0.45) or national norms (MTOS). The triage of injured children to an adult level I trauma center does not adversely affect outcome. Subset analysis of injured children showed no differences in observed outcome relative to predicted outcome (national control) or outcome in young adults (institutional control). These data support the continued triage of acutely injured children to regional trauma centers regardless of pediatric or adult designation.

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Adult respiratory distress syndrome (ARDS) and multiple organ failure (MOF) occur as a result of an unbridled systemic inflammatory response (i.e., severe systemic inflammatory response syndrome [SIRS]). Early epidemiologic studies concluded that infection with systemic sepsis was the common pathway for the development of ARDS and eventual MOF. As a consequence, research investigation from 1977 to 1987 focused on later clinical events (e.g., immunosuppression, persistent hypercatabolism, and bacterial translocation). Now, it is believed that an initial massive traumatic insult can create severe SIRS independent of infection (one-hit model). Alternatively, a less severe traumatic insult can create an inflammatory environment (i.e., primes the host) such that a later, otherwise innocuous, secondary inflammatory insult precipitates severe SIRS (two-hit model). As a result of these newer inflammatory models, research interest over the last 5 yrs has shifted to investigating earlier clinical events (e.g., unrecognized flow-dependent oxygen consumption, ischemia/reperfusion, and priming/activation of the inflammatory response). The traditional infection models of ARDS and MOF are applicable to current research and patient care efforts. However, the inflammatory models emphasize the pivotal role of the initial traumatic insult. Moreover, while ARDS occurs earlier than other types of overt organ failure, it is now believed that simultaneous organ injury is occurring, presumably via similar inflammatory mechanisms.

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The Steamboat Mountain Ski Patrol incorporates local emergency physicians and a visiting trauma surgeon as a second-tier response to life-threatening mountain events. The case of a 48-year-old man surviving a potentially lethal postinjury tension pneumothorax and a review of the 1989-1990 major trauma experience on this ski mountain underscores the value of this concept.

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The aims of this study were to assess the previously reported hypokalaemia in black Barbadians and investigate relationships between hypertension (diastolic bloodpressue > 90mm Hg and/or systolic bloodpressure > 160mm Hg), diabetes mellitus (DM, fasting plasma glucose > 7.8 mmol/l), diet and potassium (K) status in Barbadians. A stratified random sample by sex and age (40-70 years) was obtained from enumeration registers of a geographically defined area. Of 955 persons invited, 464 (48.6 per cent) responded and they comprised 190 men and 274 women. A general and a food frequency questionnaire for 24-hr. diet recall were administered, and height, weight and bloodpressure (BP) were measured. Fasting plasma glucose, K and sodium levels were measured in blood, and urine volume, sodium and K were determined in a 24-hr. urine collection. The mean plasma of K was 3.8 mmol/l, S.D. 0.44, giving a range (mean ñ 2 S.D.) of 2.9 - 4.7 mmol/l which was almost identical to that previously reported. Both 24-hr. urinary K and sodium showed a weak negative correlation with systolic BP only. K deficiency was not clearly linked to hypertension and neither K deficiency nor current thiazide use was linked to DM. The prevalence of hypertension (25 per cent), DM (11 per cent), obesity, hypokalaemia and moderately low dietary K were high (AU)

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Films from 246 angiograms performed for acute trauma were reviewed for artifacts that mimic arterial pathology. The population studied was young (mean age 31.8 years), and preexisting arterial disease was uncommon. Thirty patients (12%) exhibited 35 artifactual abnormalities. Artifacts included stationary wave formation (15 patients), admixture in the leading edge of the contrast column (7 patients) or streaming from the inside aspect of an arterial curve (13 patients), Mach bands (8 patients), and abnormal densities caused by the mishandling of film (1 patient) or discharge of static electricity (1 patient). These artifacts have typical morphologic appearances and locations that allow differentiation from pathological processes that manifest as intraluminal filling defects or arterial wall irregularity.

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The purpose of this study was to compare the benefit of small volume hypertonic saline/dextran (HSD) versus the risk of obligatory time to administer it on-scene in a model of acute hemorrhagic shock. Dogs were bled to a mean arterial pressure (MAP) of 20 mmHg and then randomized to either: a) direct transport to the emergency department (ED) or b) 10 min delay to insert an iv HSD (4 ml/kg) infusion over 5 min, and then transport. The animals receiving HSD had improved (P less than 0.05) cardiac work and oxygen consumption during transport (MAP = 59 +/- 3 vs 38 +/- 4 mmHg; cardiac index (CI) = 3.2 +/- 0.2 vs 1.3 +/- 0.1 L min-1 M-2; O2CI = 115 +/- 7 vs 104 +/- 7 ml min-1 M-2), paralleled by reduced serum lactate (5.3 +/- 0.8 vs 7.0 +/- 2.3 mmol/L) and decreased metabolic acidosis. The benefits of HSD in attenuating shock-induced oxygen debt were corroborated by lower O2CI (98 +/- 4 vs 112 +/- 5 ml min-1 M-2) and higher pH (7.30 +/- 0.01 vs 7.24 +/- 0.02) in the postresuscitation period.

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The purpose of this study was to compare the benefit of small volume hyperonic saline/dextran (HSD) versus the risk of obligatory time to administer it on-scene in a model of acute hemorrhagic shock. Dogs were bled to a mean arteiral pressure (MAP) of 20 mmHg and the randomized to either: a) direct transport to the emergency department (ED) or b) 10 min delay to insert an iv HSD (4 ml/Kg) infusion over 5 min, and then transport. The animals receiving HSD had improved (P<0.05) cardiac work and oxigen consumption during transport (MAP = 59 ñ 3 vs 38 ñ 4 mmHg; cardiac index (CI) = 3.2 ñ 0.2 vs 1.3 ñ 0.1 L min-1 M-2; O2CI = 115 ñ 7 vs 104 ñ 7 mlmin-1M-2), paralleled by reduced serum lactate (5.3 ñ 0.8 vs 7.0 ñ 2.3 mmol/L) and decreased metabolic acidosis. The benefitsof HSD in attenuating shock-induced oxygen debt were corroborated by lower O2CI(98 ñ 4 vs 112 ñ 5 ml min-1 M-2) and higher pH (7.30 ñ 0.01 vs 7.24 ñ 0.02) in the postresuscitation period

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A rare case of traumatic rupture of a pancreatic pseudocyst is presented. Its unique aspect is definitive pseudocyst drainage via a Roux-en-Y cystjejunostomy at initial laparotomy.

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