Primary Blast Lung Injury: The UK Military Experience.

INTRODUCTION: Primary blast lung injury occurs when an explosive shock wave passes through the thorax and transits through tissues of varying densities. It requires close proximity to an explosion and presents quick with respiratory distress in survivors. MATERIALS AND METHODS: The Joint Theatre Trauma Registry and the Defence Statistics (Health) Database were interrogated for casualties injured as a result of an explosion during the conflict in Afghanistan. The case notes and imaging of casualties meeting the criteria for diagnosis were reviewed. Demographic and clinical data on casualties with primary blast lung injury were analyzed. RESULTS: 848 blast-exposed casualties survived to discharge from intensive care, and 238 blast-exposed casualties were killed in action. Following exclusions, 111 case notes and all postmortem reports were reviewed in detail. About, 25 casualties had isolated primary blast lung injury (2.9% of casualties surviving to discharge from intensive care) and 31 nonsurvivors (13% of nonsurvivors) had the disease documented at postmortem. Severe cases of primary blast lung injury required an estimated average of 4.5 days of conventional mechanical ventilation. CONCLUSIONS: 8.1% of blast exposed casualties suffered primary blast lung injury. It was a less severe disease than other nontraumatic forms of acute lung injury and did not cause deaths once a casualty had reached a combat support hospital. It was well managed with a relatively brief period of conventional mechanical ventilation.

A Health Care Worker with Ebola Virus Disease and Adverse Prognostic Factors Treated in Sierra Leone.

We describe the management of a Sierra Leonean health care worker with severe Ebola virus disease complicated by diarrhea, significant electrolyte disturbances, and falciparum malaria coinfection. With additional resources and staffing, high quality care can be provided to patients with Ebola infection and adverse prognostic factors in west Africa.

Transport and assimilation of inorganic carbon by Lichina pygmaea under emersed and submersed conditions.

Photosynthetic O2 evolution by the upper littoral lichen, Lichina pygmaea (Lightf.) C.Ag., under light-saturated conditions at 5 °C is saturated by the 2 mol m-3 inorganic C found in seawater at pH 8.0. Photosynthesis is not reduced when pH is increased to pH 9.4, and is slightly reduced at pH 10.0, when submersed in seawater with 2 mol m-3 inorganic C. The rate of photosynthesis at pH 10 greatly exceeds the rate of uncatalysed conversion of HCO3 - . It is concluded that HCO3 - is used in photosynthesis. Since extracellular carbonic anhydrase is present, it is possible that CO2 enters the photobiont (Calothrix) cells even during HCO3 use. pH drift experiments support the notion of HCO3 - use. Emersed photosynthesis at 5 °C is more than half-saturated by 35 Pa (normal atmospheric) CO2 ; the light- and CO2 -saturated emersed photosynthetic rate is not significantly different from the light and inorganic C-saturated photosynthetic rate when submersed. Inorganic C diffusion from the thallus surface to the photobiont needs, at least under some conditions, carbonic anhydrase activity which permits HCO3 - fluxes to supplement CO2 movement. The CO2 compensation partial pressure at 5 °C is 0.83 Pa, i.e. at the low range of values found for terrestrial cyanobacterial lichens. Dark 14 C-inorganic C assimilation when submersed is a small fraction of the dark respiratory rate, consistent with the observed absence of diel CAM-like variation in intracellular titratable acidity. The high value (-11.5%) of δ13 C, the low CO2 compensation partial pressure, and the relatively high affinity for inorganic C., are consistent with the operation of an inorganic C concentrating mechanism such as occurs in free-living cyanobacteria and probably occurs in terrestrial cyanobacterial lichens and in most intertidal algae.

The analysis of photosynthesis in air and water of Ascophyllum nodosum (L.) Le Jol.

The photosynthetic characteristics for the intertidal macroalga Ascophyllum nodosum were examined in air and water. Under ambient conditions of temperature (10° C) inorganic carbon concentrations (15.63 mmol CO2 m-3 or 2.0 mol TIC m-3) and light (500 µmol photons m-2 s-1) photosynthesis was slightly greater by the exposed alga than by the submerged alga. In both environments photosynthesis was light saturated at 200 µmol photons m-2 s-1. The relationship between CO2 concentration and photosynthesis in air could be accurately analysed using Michaelis-Menten kinetics, although the range of concentrations used were not saturating. In contrast the application of the Lineweaver-Burk and Woolf plots to aquatic photosynthesis was not suitable as the experimental data was similar to the Blackman type curves and not rectangular hyperbolae. This was reflected by the applicability of the Hill-Whittingham equation to describe the photosynthesis curves. The effect of unstirred layers and other limiting factors is discussed in relation to the kinetic parameters, V max and K m.

Isolation of ammonium-N as 1-sulfonato-iso-indole for measurement of delta15N.

The conversion of ammonium (NH(4) (+)) to 1-sulfonato-iso-indole has been examined as a method for natural abundance measurement of delta(15)N of NH(4) (+). The reaction is complete within 2 h and is based on the derivatisation of NH(4) (+) by o-phthaldialdehyde and sodium sulfite at a high pH, 11.2. The product is readily concentrated from dilute solutions by reverse-phase solid-phase extraction (SPE). The method is compound-specific despite partial derivatisation of potentially interfering amino acids, as their derivatives are not extracted by SPE. delta(15)N values of NH(4) (+) in KCL soil extracts can be measured within 48 h by automated continuous-flow IRMS with a precision of 0.23 per thousand (1 SD). Parallel measurements of NH(4) (+) standards of known delta(15)N are made to allow correction for the isotopic dilution by non-sample NH(4) (+). The practicality of this method is demonstrated by measuring the changes in NH(4) (+) concentration and delta(15)N following the addition of urea as a nitrogen source to inorganic N-depleted soil.

Mechanistic interpretation of carbon isotope discrimination by marine macroalgae and seagrasses.

The literature, and previously unpublished data from the authors' laboratories, shows that the δ13C of organic matter in marine macroalgae and seagrasses collected from the natural environment ranges from -3 to -35‰. While some marine macroalgae have δ13C values ranging over more than 10‰ within the thallus of an individual (some brown macroalgae), in other cases the range within a species collected over a very wide geographical range is only 5‰ (e.g. the red alga Plocamium cartilagineum which has values between -30 and -35‰). The organisms with very negative δ13C (lower than -30‰) are mainly subtidal red algae, with some intertidal red algae and a few green algae; those with very positive δ13C values (higher than -10‰) are mainly green macroalgae and seagrasses, with some red and brown macroalgae. The δ13C value correlates primarily with taxonomy and secondarily with ecology. None of the organisms with δ13C values lower than -30‰ have pyrenoids. Previous work showed a good correlation between δ13C values lower than -30‰ and the lack of CO2 concentrating mechanisms for several species of marine red algae. The extent to which the low δ13C values are confined to organisms with diffusive CO2 entry is discussed. Diffusive CO2 entry could also occur in organisms with higher δ13C values if diffusive conductance was relatively low. The photosynthesis of organisms with δ13C values more positive than -10‰ (i.e. more positive than the δ13C of CO2 in seawater) must involve HCO3- use.

Seaweeds in cold seas: evolution and carbon acquisition.

Much evidence suggests that life originated in hydrothermal habitats, and for much of the time since the origin of cyanobacteria (at least 2.5 Ga ago) and of eukaryotic algae (at least 2.1 Ga ago) the average sea surface and land surface temperatures were higher than they are today. However, there have been at least four significant glacial episodes prior to the Pleistocene glaciations. Two of these (approx. 2.1 and 0.7 Ga ago) may have involved a 'Snowball Earth' with a very great impact on the algae (sensu lato) of the time (cyanobacteria, Chlorophyta and Rhodophyta) and especially those that were adapted to warm habitats. By contrast, it is possible that heterokont, dinophyte and haptophyte phototrophs only evolved after the Carboniferous-Permian ice age (approx. 250 Ma ago) and so did not encounter low (