On the Development of an Acoustic Image Dataset for Unexploded Ordnance Classification Using Front-Looking Sonar and Transfer Learning Methods.

This research aimed to develop a dataset of acoustic images recorded by a forward-looking sonar mounted on an underwater vehicle, enabling the classification of unexploded ordnances (UXOs) and objects other than unexploded ordnance (nonUXOs). The dataset was obtained using digital twin simulations performed in the Gazebo environment utilizing plugins developed within the DAVE project. It consists of 69,444 sample images of 512 × 399 resolution organized in two classes annotated as UXO and nonUXO. The obtained dataset was then evaluated by state-of-the-art image classification methods using off-the-shelf models and transfer learning techniques. The research included VGG16, ResNet34, ResNet50, ViT, RegNet, and Swin Transformer. Its goal was to define a base rate for the development of other specialized machine learning models. Neural network experiments comprised two stages-pre-training of only the final layers and pre-training of the entire network. The experiments revealed that to obtain high accuracy, it is required to pre-train the entire network, under which condition, all the models achieved comparable performance, reaching 98% balanced accuracy. Surprisingly, the highest accuracy was obtained by the VGG model.

Case study: The downside of using a worst-case approach in occupational safety policy as an interpretation of the precautionary principle: Putting the uncertain UXO occupational safety risk into probabilistic perspective.

Unexploded ordnance (UXO) from the World Wars on the North Sea floor pose an uncertain occupational safety risk for dredging and cable installation. At present mitigation strategies are based on an interpretation of the precautionary principle that uses a worst-case approach, that is, assuming that UXO will be encountered, will explode, and will harm people onboard. We propose a probabilistic framework to estimate the UXO risk. Using this probabilistic framework, we conclude that the UXO risk during cable installation meets the prevailing safety standard in the Netherlands. Furthermore, we demonstrate that the UXO risk is lower than the general maritime risk, that is, the occupational health risk caused by the mitigation is higher than the UXO risk itself. We conclude that even for uncertain occupational risks, such as the UXO risk in the North Sea, a probabilistic analysis can be more instrumental in the decision-making process on accepting and mitigating risks than using worst-case scenario thinking.

What Is Missing in Offshore Explosive Ordnance Disposal Risk Assessment?

Offshore explosive ordnance disposal (EOD) in the marine environment is a high-risk activity. Structured risk assessment (RA) can be a helpful tool to provide EOD experts with decision-making support. This paper hypothesizes that existing RA approaches that address unexploded ordnance (UXO) in the sea do not meet the requirements of EOD RA. To test this hypothesis, the paper proposes a novel categorization tool. It uses five review criteria: study type (qualitative vs. quantitative), level of decision-making (strategic vs. applied), risk component (probability vs. consequence), spatial scale (global vs. local), and temporal scale (long-term vs. short-term). The categorization tool is used to identify the requirements of EOD RA and to test whether nine existing RA methods fulfill these requirements. The study finds that none of the investigated RAs meets the requirements and, hence, concludes that a new method should be developed. However, some aspects of the existing studies should be considered when designing a new method. This includes using risk factors (type and mass of explosive material, type and state of the fuze, and water depth) that are relevant for EOD RA. It also involves setting up a directed graph to assess the complex interdependencies between these risk factors.

In-situ comparison of high-order detonations and low-order deflagration methodologies for underwater unexploded ordnance (UXO) disposal.

The unexploded ordnance (UXO) on the seabed off Northwest Europe poses a hazard to offshore developments such as windfarms. The traditional removal method is through high-order detonation of a donor explosive charge placed adjacent to the UXO, which poses a risk of injury or death to marine mammals and other fauna from the high sound levels produced and is destructive to the seabed. This paper describes a sea-trial in the Danish Great Belt to compare the sound produced by high-order detonations with that produced by deflagration, a low-order disposal method that offers reduced environmental impact from noise. The results demonstrate a substantial reduction over high-order detonation, with the peak sound pressure level and sound exposure level being around 20 dB lower for the deflagration. The damage to the seabed was also considerably reduced for deflagration, although there was some evidence for residues of explosives related chemicals in sediments.

World war munitions as a source of mercury in the southwest Baltic Sea.

Mercury (Hg) fulminate was used as a primary fuse in World War (WW) munitions, and may consequently be a Hg source for impacted environments. Mercury is a conspicuous and persistent pollutant, with methylmercury (MeHg) acting as a notorious neurotoxin. Considerable amounts of munitions were intentionally dumped in the North Sea and Baltic Sea following the First and Second WWs. After more than 70 years on the seafloor many munitions have corroded and likely release explosive compounds, including Hg fulminate. The Germany coastal city of Kiel was a manufacturing centre for submarines, and accordingly a prominent target for bombing and post-war disarmament. We collected water and sediment samples around Kiel Bay to assess regional levels and quantify any Hg contamination. The munition dump site Kolberger Heide (KH) and a former anti-aircraft training center Dänisch-Nienhof are situated in Kiel Bay, and were targeted for sampling. Sediment Hg concentrations around KH were notably elevated. Average Hg concentrations in KH sediments were 125 ± 76 ng/g, compared to 14 ± 18 ng/g at background (control) sites. In contrast, dissolved Hg in the water column exhibited no site variations, all ranging between 0.8 and 2.1 pM. Methylmercury in sediments and waters did not have enhanced concentrations amongst sites (<30 pg/g and <50 fM, respectively). Sediment-water exchange experiments showed elevated Hg and MeHg fluxes (i.e. >400 pmol m-2 d-1 MeHg) at one KH location, however remaining cores had low to no Hg and MeHg output (<0-27 pmol m-2 d-1 MeHg). Thus, sediments in Kiel Bay proximate to WW munitions could harbor and form a source of Hg, however water column mixing and removal processes attenuate any discharge from the seafloor to overlying waters.

On the Development of a Digital Twin for Underwater UXO Detection Using Magnetometer-Based Data in Application for the Training Set Generation for Machine Learning Models.

Scanning underwater areas using magnetometers in search of unexploded ordnance is a difficult challenge, where machine learning methods can find a significant application. However, this requires the creation of a dataset enabling the training of prediction models. Such a task is difficult and costly due to the limited availability of relevant data. To address this challenge in the article, we propose the use of numerical modeling to solve this task. The conducted experiments allow us to conclude that it is possible to obtain high compliance with the numerical model based on the finite element method with the results of physical tests. Additionally, the paper discusses the methodology of simplifying the computational model, allowing for an almost three times reduction in the calculation time without affecting model quality. The article also presents and discusses the methodology for generating a dataset for the discrimination of UXO/non-UXO objects. According to that methodology, a dataset is generated and described in detail including assumptions on objects considered as UXO and nonUXO.

Administración de Oxigenoterapia de Alto Flujo en pacientes pediátricos del Hospital de Niños Santísima Trinidad / Administration of High Flow Oxygen Therapy in pediatric patients of the Santísima Trinidad Children's Hospital

La manera de proveer oxígeno ha sido una idea en permanente evolución que ha gatillado en los médicos la inquietud de implementar distintos dispositivos de soporte, desde la cánula nasal, la máscara de reinhalación y bajo flujo, hasta la presión continua en la vía aérea (CPAP) y la ventilación no invasiva (VNI). Recientemente se ha insertado entre ambos extremos mencionados un nuevo dispositivo que provee oxígeno a alto flujo. El objetivo del presente trabajo fue describir aspectos clínicos y técnicos en la administración de Oxigenoterapia de Alto Flujo (OAF) en pacientes pediátricos del Hospital de Niños de la Santísima Trinidad, en el servicio de UEPE (Unidad estabilización pediátrica en emergencia) 2017 y SIP (sala de internación pediátrica) 500 2018, 2019, en el periodo estival. Se realizó un Estudio descriptivo transversal, retrospectivo. El universo fueron los pacientes pediátricos que recibieron OAF en el Hospital de Niños Santísima Trinidad, en el servicio de UEPE del 2017 y SIP 500 2018, 2019 en el periodo estival. Se utilizó como instrumento la tabla de volcado de datos. Los principales resultados demuestran que se asistieron un total de 697 pacientes. La edad prevalente fue de menores de 6 meses, con un promedio del 60%. Los niños que requerían este tratamiento, en su gran mayoría ingresaban por diagnóstico de bronquiolitis, seguido de BOR (bronquitis obstructiva recurrente).En relación al escore de tal modifcado al ingreso, podemos observar que en el sector de UEPE la media es de 8, mientras que la SIP 500 es de 7. En referente al recurso material, existen varios sistemas de OAF. No hay estudios que demuestren la superioridad de un sistema sobre otro.Por último, se observó que el haber implementado esta técnica en la institución, se logró evitar en gran numero la escalada ventilatoria máxima requerida, ya que en el servicio de UEPE la evolución fue 65% la OAF, mientras que en la SIP 500 en el 2018 fue 72%y en el 2019 fue 79%. Por lo que podemos establecer que la OAF logra una mejoría clínica a través de su impacto en el síndrome funcional respiratorio, así como en el score de Tal modifcado en los niños y permite un tratamiento de estos pacientes en salas de internado general, con mínimos efectos adversos, disminuyendo el ingreso a cuidados intensivos[AU]

Te way to provide oxygen has been an idea in constant evolution that has triggered in doctors the concern to implement different support devices, from the nasal cannula, the rebreathing mask and low flow, to continuous pressure in the airway (CPAP). ) and noninvasive ventilation (NIV). Recently, a new device that provides high-flow oxygen has been inserted between both extremes. Te objective of the present work was to describe clinical and technical aspects in the administration of High Flow Oxygen Terapy (OAF) in pediatric patients of the Santísima Trinidad Children's Hospital, in the UEPE service (Emergency Pediatric Stabilization Unit) 2017 and SIP ( pediatric hospitalization room) 500 2018, 2019, in the summer period. A retrospective cross-sectional descriptive study was carried out. Te universe was the pediatric patients who received HFO at the Santísima Trinidad Children's Hospital, in the UEPE service in 2017 and SIP 500 2018, 2019 in the summer period. Te data dump table was used as an instrument. Te main results show that a total of 697 patients were attended. Te prevalent age was under 6 months, with an average of 60%. Te vast majority of children who required this treatment were admitted due to a diagnosis of bronchiolitis, followed by BOR (recurrent obstructive bronchitis). In relation to the score of such modifed on admission, we can observe that in the UEPE sector the mean is 8, while the SIP 500 is 7. Regarding the material resource, there are several OAF systems. Tere are no studies that demonstrate the superiority of one system over another. Finally, it was observed that having implemented this technique in the institution, the maximum required ventilatory escalation was avoided in large numbers, since in the UEPE service the evolution was 65% of the OAF, while in the SIP 500 in 2018 it was 72% and in 2019 it was 79%. Terefore, we can establish that HFO achieves clinical improvement through its impact on functional respiratory syndrome, as well as on the modifed Tal score in children, and allows treatment of these patients in general hospital wards, with minimal effects. adverse effects, reducing admission to intensive care[AU]

A forma de fornecer oxigênio tem sido uma ideia em constante evolução que desencadeou nos médicos a preocupação em implementar diferentes dispositivos de suporte, desde a cânula nasal, a máscara de reinalação e baixo fluxo, até a pressão contínua nas vias aéreas (CPAP). ) -ventilação invasiva (VNI). Recentemente, um novo dispositivo que fornece oxigênio de alto fluxo foi inserido entre os dois extremos. O objetivo do presente trabalho foi descrever aspectos clínicos e técnicos na administração de Oxigenoterapia de Alto Fluxo (OAF) em pacientes pediátricos do Hospital Infantil Santísima Trinidad, no serviço UEPE (Unidade de Emergência Pediátrica de Estabilização) 2017 e SIP (internação pediátrica quarto) 500 2018, 2019, no período de verão. Foi realizado um estudo descritivo transversal retrospectivo. O universo foram os pacientes pediátricos que receberam HFO no Hospital Infantil Santísima Trinidad, no serviço da UEPE em 2017 e SIP 500 2018, 2019 no período de verão. A tabela de despejo de dados foi utilizada como instrumento. Os principais resultados mostram que foram atendidos um total de 697 pacientes, sendo a idade prevalente inferior a 6 meses, com média de 60%. A grande maioria das crianças que necessitaram desse tratamento foi internada por diagnóstico de bronquiolite, seguido de BOR (bronquite obstrutiva recorrente). Em relação ao escore desta modifcada na admissão, observa-se que no setor da UEPE a média é 8 , enquanto o SIP 500 é 7. Em relação ao recurso material, existem vários sistemas OAF. Não há estudos que demonstrem a superioridade de um sistema sobre o outro. Por fm, observou-se que com a implantação dessa técnica na instituição, evitou-se em grande número o escalonamento ventilatório máximo necessário, pois no serviço da UEPE a evolução foi de 65% de na OAF, enquanto no SIP 500 em 2018 foi de 72% e em 2019 foi de 79%. Portanto, podemos estabelecer que a HFO obtém melhora clínica por meio de seu impacto na síndrome respiratória funcional, bem como no escore de Tal modifcado em crianças, e permite o tratamento desses pacientes em enfermarias de hospital geral, com efeitos mínimos. tratamento intensivo[AU]

Acoustic characterisation of unexploded ordnance disposal in the North Sea using high order detonations.

Results are presented of acoustic measurements made during the disposal of 54 items of unexploded ordnance (UXO) in the North Sea during the pre-construction phase of two offshore windfarms. The disposals were conducted using high-order controlled detonation of donor charges placed on the seabed adjacent to the UXOs. The total charge masses ranged from 2.5 kg to 295 kg TNT equivalent, and acoustic measurements were made at ranges of 1.5 km to 58 km from the UXO. High-order detonations can present a risk of injury or death to marine mammals and other fauna from the high sound levels produced, and these results represent the largest data set of acoustic measurements ever assembled for publication. Acoustic measurements were also made on small scare charges, used as mitigation. The sound pressure pulses are presented with their spectra, and the levels of peak sound pressure and sound exposure are presented as a function of range from the source. Measured levels are compared to data from a shallow-water propagation model, and to widely-adopted exposure level thresholds used for marine mammals, illustrating the potential for injury at distances of several kilometres.

Mobilization of Unexploded Ordnance on the Seabed.

Unexploded ordnance devices (UXO) pose a potential threat to human life and material during offshore construction activities. Extensive survey activities are conducted to locate, identify, and clear these objects as necessary. For the period thereafter, it is necessary to investigate whether areas that have already been cleared, or even objects that remain in place, may be affected by mobilization under tidal currents or waves, and could thus have an impact on operation and maintenance during the lifetime of the offshore installation. In this study, model simulations based on fluid mechanics are described to derive the loads on the objects caused by currents and waves and combined with knowledge of the known burial condition of the objects. Within the model, the hydrodynamic and hydrostatic loads on the object caused by waves and currents are balanced with inertia and rolling resistance. Thus, the critical current velocity and critical wave conditions for the mobilization of different objects are calculated and compared with the environmental conditions prevailing in the North Sea. As a result, a recurrence interval for the potential mobilization of objects on the seafloor is given, which can now be used to optimize route surveys and thus help accelerate offshore construction work. It is shown that currents are not able to mobilize the objects investigated in the study in almost all regions of the North Sea. Waves can mobilize certain objects in very shallow and extreme conditions.

Fast Localization and Characterization of Underground Targets with a Towed Transient Electromagnetic Array System.

A fast inversion algorithm combined with the transient electromagnetic (TEM) detection system has important significance for improving the detection efficiency of unexploded ordnance. The traditional algorithms, such as differential evolution or Gauss-Newton algorithms, usually require tens to thousands of iterations to locate the underground target. A new algorithm with a magnetic gradient tensor and singular value decomposition (SVD) to estimate the target position and characterization quickly and accurately is proposed in this paper. Two modes of magnetic gradient tensor are constructed to accurately locate shallow and deep targets, respectively. The SVD algorithm is applied to the responses to estimate the electromagnetic characteristics of the target quickly and accurately. To verify the performance of the proposed algorithm, a towed TEM sensor is designed, which is constructed with three transmitting coils and nine three-component receiving coils arranged in a 3 × 3 array. Field experiments in survey and cued modes were taken to verify the performance of the proposed algorithm and the towed system. Results show that the magnetic gradient tensor algorithm proposed in this paper can accurately locate a single target within 2.0 m depth, and the error of depth is no more than 8 cm. Even for overlapping response of multi targets, the error of depth is no more than 12 cm. The underground target can be accurately characterized by the SVD algorithm. For targets with depths over 2.0 m, the signal-to-noise ratio of characteristic response estimated by SVD is higher than that of the traditional method. The proposed method needs approximately 40 ms, only 1% of the traditional one, considerably improving detection efficiency and laying a theoretical and experimental foundation for real-time data processing.

Underwater acoustic characterisation of unexploded ordnance disposal using deflagration.

The seabed off North West Europe contains much unexploded ordnance (UXO), posing a hazard to offshore developments such as windfarms. The typical removal method is through high-order detonation of a donor charge placed adjacent to the UXO. This method poses a risk of injury or death to marine mammals and other fauna from the high sound levels produced. This paper describes a controlled field experiment to compare the sound produced by high-order detonations with a low-order disposal method called deflagration, which uses a shaped charge of modest size, is less energetic, and offers reduced environmental impact from lower acoustic output. The results demonstrate a substantial reduction over high order detonation, with the peak sound pressure level and sound exposure level being more than 20 dB lower for the deflagration, and with the acoustic output depending only on the size of the shaped charge (rather than the size of the UXO).

Sea-dumped ammunition as a possible source of mercury to the Baltic Sea sediments.

After World War II, as a move toward Germany demilitarization, up to 385,000 t of munitions were sunk in the Baltic Sea. Munition containing various harmful substances, including chemical warfare agents (CWA) and explosives, that can affect marine biota were dumped on the seafloor. Some of those objects contained mercury, either as elemental mercury or mercury compounds (e.g., mercury fulminate, a common explosive primer), and thus could act as a specific local source of mercury in the dumping areas. Unfortunately, there is a lack of information on how dumped munitions impact the mercury concentrations in the Baltic Sea sediments. This report aims to answer the question how much sedimentary mercury in the dumping areas originates from munitions and to determine to what extent the mercury present in those areas originates from mercury fulminate. Concentrations of total sedimentary mercury- HgTOT in samples collected from conventional (Kolberger Heide) and chemical (Bornholm Deep) munitions dumping sites are characterized by high variability. However, an increase in HgTOT concentrations was observed with a decreasing distance to particular munition objects at both study sites. Moreover, mercury speciation in sediments from Kolberger Heide proves that the mercury there can be traced back directly to mercury fulminate. Results of our study confirm that munitions dumpsites are a local point sources of mercury. Due to the ecosystem constrains, varying transport modes and pathways, and both unknown and varying decomposition rates, these sea-bed mercury concentrations are hard to evaluate quantitatively. Therefore we recommend that further detailed studies should be conducted to assess sedimentary mercury provenience in munitions dumpsites more accurately.

Ammunition detection using high frequency multibeam snippet backscatter information.

The present study reports the evaluation of snippet backscatter information gathered with a high-frequency multibeam echosounder system (200-400 kHz) due to their usability to detect ammunition of different sizes in shallow coastal waters. Besides the feasibility of the snippet backscatter data, it was focused on the attainable horizontal accuracy in comparison to side-scan sonar and autonomous underwater vehicle (AUV) surveys. The data was collected in shallow coastal waters of up to 18 m water depth (Baltic Sea) close to an ammunition dumping site characterized by an almost flat seafloor covered with sand and silt sediments. The analysis of the multibeam compared to sidescan data indicates the snippet backscatter to be a promising prospective method for ammunition detection and being able to improve horizontal position accuracy of up to 0.08 m.

An Impaled Potential Unexploded Device in the Civilian Trauma Setting: A Case Report and Review of the Literature.

BACKGROUND: The management of patients with impaled unexploded devices is rare in the civilian setting. However, as the lines of the traditional battlefield are blurred by modern warfare and terrorist activity, emergency providers should be familiar with facility protocols, plans, and contact information of their local resources for unexploded devices. CASE REPORT: A 44-year-old male sustained a close-proximity blast injury to his lower extremities while manipulating a mortar-type firework. He presented to the regional trauma center with an open, comminuted distal femur fracture and radiographic evidence of a potential explosive device in his thigh. His management was coordinated with the local Explosive Ordinance Disposal and the fire department. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Explosive devices pose a grave threat when encountered. Familiarization with protocols to manage these patients can mitigate disaster. Emergency providers should expect and be prepared to coordinate care for these patients.

A High-Performance Portable Transient Electro-Magnetic Sensor for Unexploded Ordnance Detection.

Portable transient electromagnetic (TEM) systems can be well adapted to various terrains, including mountainous, woodland, and other complex terrains. They are widely used for the detection of unexploded ordnance (UXO). As the core component of the portable TEM system, the sensor is constructed with a transmitting coil and a receiving coil. Based on the primary field of the transmitting coil and internal noise of the receiving coil, the design and testing of such a sensor is described in detail. Results indicate that the primary field of the transmitting coil depends on the diameter, mass, and power of the coil. A higher mass-power product and a larger diameter causes a stronger primary field. Reducing the number of turns and increasing the clamp voltage reduces the switch-off time of the transmitting current effectively. Increasing the cross-section of the wire reduces the power consumption, but greatly increases the coil's weight. The study of the receiving coil shows that the internal noise of the sensor is dominated by the thermal noise of the damping resistor. Reducing the bandwidth of the system and increasing the size of the coil reduces the internal noise effectively. The cross-sectional area and the distance between the sections of the coil have little effect on the internal noise. A less damped state can effectively reduce signal distortion. Finally, a portable TEM sensor with both a transmitting coil (constructed with a diameter, number of turns, and transmitting current of 0.5 m, 30, and 5 A, respectively) and a receiving coil (constructed with a length and resonant frequency of 5.6 cm and 50 kHz, respectively) was built. The agreement between experimental and calculated results confirms the theory used in the sensor design. The responses of an 82 mm mortar shell at different distances were measured and inverted by the differential evolution (DE) algorithm to verify system performance. Results show that the sensor designed in this study can not only detect the 82 mm mortar shell within 1.2 m effectively but also locate the target precisely.

Stratification of risk to the surgical team in removal of small arms ammunition implanted in the craniofacial region: case report.

In cases of penetrating injury with implantation of small arms ammunition, it can often be difficult to tell the difference between simple ballistics and ballistics associated with unexploded ordnances (UXOs). In the operative environment, where highly flammable substances are often close to the surgical site, detonation of UXOs could have catastrophic consequences for both the patient and surgical team. There is a paucity of information in the literature regarding how to evaluate whether an implanted munition contains explosive material. This report describes a patient who presented during Operation Enduring Freedom with an implanted munition suspicious for a UXO and the subsequent workup organized by Explosive Ordnance Disposal (EOD) Company prior to surgical removal. Clinical risk factors for UXOs include assassination attempts and/or wartime settings. Specific radiological features suggestive of a UXO include projectile size greater than 7.62-mm caliber, alterations in density of the tip, as well as radiological evidence of a hollowed-out core. If an implanted UXO is suspected, risks to the surgical and anesthesia teams can be minimized by notifying the nearest military installation with EOD capabilities and following clinical practice guidelines set forth by the Joint Theater Trauma System.

Explaining how unexploded ordnance clearance enhances livelihoods in the Lao PDR.

BACKGROUND: Following violent conflict, the continued presence of landmines and unexploded ordnance pose a barrier to rebuilding livelihoods. Mine action removes these explosive remnants of conflict to enable communities to safely return contaminated land to productive use. There is limited understanding, however, of how, why, in what context and in what respects mine action contributes to livelihoods. Yet, such information is required for effective resource allocation, checking underlying program assumptions, understanding benefits and potential harms. METHODS: The evaluation was undertaken in the Lao People's Democratic Republic. It used an interpretive case study design and applied the principles of realist evaluation. Program staff and local government authorities were interviewed (N=37) and program beneficiaries. In total, 38 individual interviews with program beneficiaries were conducted and eighteen focus group interviews (9 with males, 9 with females), each with 6-9 participants. RESULTS: The evaluation identified two main mechanisms through which the program 'worked': (1) communication pre- and post-clearance and (2) the delivery of the product (cleared land). CONCLUSION: The realist approach helped to refine the program theory, highlighted the role of self- and task-efficacy and community communication, assisted in identifying contextual factors that influence outcomes and suggested a revision of expected outcomes.

Epidemiological Study of Child Casualties of Landmines and Unexploded Ordnances: A National Study from Iran.

BACKGROUND: Despite landmine-risk education programs and extensive demining activities on the Western border of Iran, landmines and unexploded ordnance (UXOs) still cause civilian and child casualties three decades after the Iraq-Iran war (1980-1988). The objective of this study was to understand the epidemiological patterns and risk factors of injury in child casualties of landmines and UXOs in Western and Southwestern Iran. METHODS: Children who were 18 years old or younger at the time of study and who sustained injuries from landmines and UXOs were identified through a search at the Iranian National Veterans Registry. These children participated in a 5-day gathering. The information on socioeconomic status, health-related issues, quality of life, health care utilization, and clinical profiles concerning the landmine and UXO injuries were collected. The method of data collection consisted of three component surveys: health interview, social survey, and medical examinations. Social surveys and health interviews were conducted in a face-to-face method by utilizing a questionnaire consisting of 39 questions addressing household and individual components, including information on time and type of injuries, physical activity, mental health, and quality of life. A comprehensive team of physicians in different subspecialties evaluated and examined children to assess the current medical and psychiatric conditions and physical activity, and recommended and arranged further medical, rehabilitation, or surgical planning. RESULTS: Seventy-eight child casualties were identified and participated in the study. The mean age of the participants at the time of study was 16.11 years old (SD=2 years). The mean age of victims at the time of injury was 8.2 years (SD=3.12 years; ranged from 2 to 15 years old). Sixty-seven (85.9%) of the children were male. Provinces of Kurdistan and Kermanshah had the highest number of casualties, with a total number of 54 children (68.3%). Eighty percent of the injuries were caused by landmines, and UXO explosions were reported in 20% of the cases. Overall, 24 children (30%) had received some landmine-risk education before or after the events. Sixty percent of the explosions had happened in the morning between 9:00 am and 12:00 pm. Playing and grazing livestock were the most prevalent activities/reasons at the time of injury, which were reported in 77% of the subjects. Sixty-three percent of incidents had multiple casualties and in only 13 explosions were the children the only victims of the explosion. The most prevalent injuries were amputations in 41 subjects (52.56%), followed by hearing loss in 23 subjects (29.5%). Amputations were more common in upper extremities (62%) than in lower extremities (38%). CONCLUSION: Landmines and UXOs comprise a significant safety hazard to the children living in the Western border of Iran decades after the Iraq-Iran War. The large number of injuries and lack of risk training among victims suggest that landmine cleanings and landmine-risk education should be age-specifically targeted and expanded substantially.

Prevalence of gallstones in 1,229 patients submitted to surgical laparoscopic treatment of GERD and esophageal achalasia: associated cholecystectomy was a safe procedure / Prevalência de colelitíase em 1.229 pacientes submetidos ao tratamento cirúrgico laparoscópico de DRGE e megaesôfago: a colecistectomia associada mostra-se segura

BACKGROUND: Association between esophageal achalasia/ gastroesophageal reflux disease (GERD) and cholelithiasis is not clear. Epidemiological data are controversial due to different methodologies applied, the regional differences and the number of patients involved. Results of concomitant cholecistectomy associated to surgical treatment of both diseases regarding safety is poorly understood. AIM: To analyze the prevalence of cholelithiasis in patients with esophageal achalasia and gastroesophageal reflux submitted to cardiomyotomy or fundoplication. Also, to evaluate the safety of concomitant cholecistectomy. METHODS: Retrospective analysis of 1410 patients operated from 2000 to 2013. They were divided into two groups: patients with GERD submitted to laparocopic hiatoplasty plus Nissen fundoplication and patients with esophageal achalasia to laparoscopic cardiomyotomy plus partial fundoplication. It was collected epidemiological data, specific diagnosis and subgroups, the presence or absence of gallstones, surgical procedure, operative and clinical complications and mortality. All groups/subgroups were compared. RESULTS: From 1,229 patients with GERD or esophageal achalasia, submitted to laparoscopic cardiomyotomy or fundoplication, 138 (11.43%) had cholelitiasis, occurring more in females (2.38:1) with mean age of 50,27 years old. In 604 patients with GERD, 79 (13,08%) had cholelitiasis. Lower prevalence occurred in Barrett's esophagus patients 7/105 (6.67%) (p=0.037). In 625 with esophageal achalasia, 59 (9.44%) had cholelitiasis, with no difference between chagasic and idiopathic forms (p=0.677). Complications of patients with or without cholecystectomy were similar in fundoplication and cardiomyotomy (p=0.78 and p=1.00).There was no mortality or complications related to cholecystectomy in this series. CONCLUSIONS: Prevalence of cholelithiasis was higher in patients submitted to fundoplication (GERD). Patients with chagasic or idiopatic ...

RACIONAL: São controversas as relações entre megaesôfago e doença do refluxo gastroesofágico (DRGE) com colelitíase, especialmente a forma mais adequada de conduzir pacientes com ambas. Dados epidemiológicos são díspares devido às diversas metodologias aplicadas, às diferenças regionais e à quantidade de pacientes envolvidos. OBJETIVO: Estudar a prevalência de colelitíase em pacientes submetidos às operações de refluxo gastroesofágico e megaesôfago (chagásicos ou não) e a segurança da colecistectomia estar associada. MÉTODO: Análise retrospectiva de 1410 pacientes operados entre 2000 e 2013. Eles foram divididos em dois grupos: os com DRGE e operados por hiatoplastia/fundoplicatura a Nissen laparoscópicas e os com acalásia por cardiomiotomia e fundoplicatura parcial laparoscópicas. Foram coletados dados epidemiológicos, diagnóstico, a presença ou não de litiase biliar, tratamento cirúrgico efetuado, complicações clínicas ou cirúrgicas e mortalidade. Todos os grupos e subgrupos foram comparados. RESULTADOS: Foram estudados 1229 pacientes portadores de megaesôfago e/ou DRGE, operados por fundoplicatura com hiatoplastia, nos casos de DRGE, e cardiomiectomia com fundoplicatura, nos casos de megaesôfago, no período de 2000 a 2013, verificando-se presença de colelítiase ou colecistectomia prévia. A colelítiase ocorreu mais no sexo feminino (2,38:1) e na faixa etária entre os 50 e 70 anos. A prevalência global foi de 11,43%; 13,08% na DRGE, menor nos portadores de esôfago de Barrett (6,67%) sendo a diferença significativa (p=0,037); e 9,44% no megaesôfago, não havendo diferença significativa entre os chagásicos e os idiopáticos (p=0,677). Não houve mortalidade ou complicações relacionadas à colecistectomia nesta série. CONCLUSÕES: A prevalência de colelitíase é maior nos pacientes com DRGE do que nos com megaesôfago. Não há diferenças na prevalência de colelitíase nos pacientes com megaesôfago chagásico e não chagásico. É mais frequente litíase ...