Burn injuries and acute burn management in the rural areas in northern Bangladesh - A household survey.

INTRODUCTION: Burn injuries pose a significant public health challenge, especially in low- and middle-income countries (LMICs). In Bangladesh, burn injuries are prevalent and often result in severe disability or death. However, knowledge regarding the causes of burn injuries, acute burn management, and barriers to seeking burn care in the riverine areas of northern Bangladesh is limited. METHODS: We conducted a questionnaire-based study in eight subunits and five selected districts in northern Bangladesh to determine the prevalence, causes, and management of burn injuries in these areas. A total of 210 individuals from different households were interviewed, which represented a population of 1020 persons. RESULTS: Among the respondents, 55% reported that at least one member of their household suffered from a burn injury in the past. The most common causes of burn injuries were open fire (41%) and hot fluids (30%). More than 40% of burns were not rinsed with water directly after sustaining the injury. Additionally, almost 30% of respondents did not seek medical care immediately after the injury, with financial constraints being the most commonly cited reason. DISCUSSION: We found a low rate of adequate cooling and seeking medical care. The need for basic knowledge on prevention and treatment of burn injuries and improved access to affordable health care services in the region is high.

Recommended centrifuge method: Specific grain size separation in the <63 µm fraction of marine sediments.

The isolation of specific grain size classes of lithogenic samples and biogenic carbonate from the <63 µm fraction (i.e. clay and silt) of marine sediment is often a prerequisite to further pre-treatments and/or analytical measurements for palaeoceanographic studies. Established techniques employed have included sieving, settling and micro-filtration (and/or a combination of these). However, these methods often use significant amounts of bulk sediment (often up to ∼3 g) and/or require considerable amounts of time during sediment processing (ranging from 48 h to 3 weeks) to isolate a size specific class for further analyses. Here, we build on previous approaches to isolate three grain size classes (e.g. <2 µm, clay; 2-10 µm, fine silt; and 10-63 µm, coarse silt) from the <63 µm fraction of marine sediment with the aid of a centrifuge at varying revolutions per minute using Stokes' Law. We show the utility of our approach using two common sediment types dominated by (i) lithogenic and (ii) biogenic carbonate (specifically coccoliths) components of marine sediment cores. Our method reduces the amount of sample material required to 1-2 g to provide an isolated clay fraction (or other targeted size fraction) and decreases the sample processing time (to ∼1 hour) to enable high throughput of analysis, when compared to previous techniques for palaeoceanographic proxy measurements.•We recommend a more straightforward grain size isolation method for lithogenic sediment and biogenic carbonate sediment types•Isolating commonly targeted grain size fractions for palaeoceanographic studies using a centrifuge.

Persistent influence of precession on northern ice sheet variability since the early Pleistocene.

Prior to ~1 million years ago (Ma), variations in global ice volume were dominated by changes in obliquity; however, the role of precession remains unresolved. Using a record of North Atlantic ice rafting spanning the past 1.7 million years, we find that the onset of ice rafting within a given glacial cycle (reflecting ice sheet expansion) consistently occurred during times of decreasing obliquity whereas mass ice wasting (ablation) events were consistently tied to minima in precession. Furthermore, our results suggest that the ubiquitous association between precession-driven mass wasting events and glacial termination is a distinct feature of the mid to late Pleistocene. Before then (increasing), obliquity alone was sufficient to end a glacial cycle, before losing its dominant grip on deglaciation with the southward extension of Northern Hemisphere ice sheets since ~1 Ma.

Home management of mild to moderately severe community-acquired pneumonia: a randomised controlled trial.

OBJECTIVE: To determine whether community management of mild to moderate community-acquired pneumonia (CAP) is as effective and acceptable as standard hospital management of CAP. DESIGN: Randomised controlled trial. SETTING: Christchurch, New Zealand, primary and secondary care. PARTICIPANTS: 55 patients presenting or referred to the emergency department at Christchurch Hospital with mild to moderately severe pneumonia, assessed using a validated pneumonia severity assessment score, from July 2002 to October 2003. INTERVENTIONS: Hospital treatment as usual or comprehensive care in the home delivered by primary care teams. MAIN OUTCOME MEASURES: Primary: days to discharge, days on intravenous (IV) antibiotics, patient-rated symptom scores. Secondary: health status measured using level of functioning at 2 and 6 weeks, patient satisfaction. RESULTS: The median number of days to discharge was higher in the home care group (4 days; range, 1-14) than in the hospital groups (2 days; range, 0-10; P = 0.004). There was no difference in the number of days on IV antibiotics or on subsequent oral antibiotics. Patient-rated symptom scores at 2 and 6 weeks, median change in symptom severity from baseline to 6 weeks, and general functioning at 2 and 6 weeks did not differ between the groups. Patients in both groups were satisfied with their treatment, with a clear preference for community treatment (P < 0.001). CONCLUSIONS: Mild to moderately severe CAP can be managed effectively in the community by primary care teams. This model of comprehensive care at home can be implemented by primary care teams with suitable funding structures.