The role of military forces in emergency management (civil-military interaction).

Those involved in emergency response and recovery, including the military, require an acute level of awareness of livelihoods that rely on livestock and their associated implications for human security. Emergencies cause injury and death and devastate livestock-based livelihoods, a key characteristic of the lives of many of the world's rural poor. The role for military forces in emergency management is expanding, and this can cause friction during an emergency due to competing agendas and objectives. Opportunities exist to make greater use of the military, such as providing support to livestock-based livelihoods, but there are challenges and barriers that must be overcome. A common framework for civil-military interaction may help to coordinate response efforts and enhance local and international responses to emergencies. The Livestock Emergency Guidelines and Standards and the proposed livelihood security model are constructs that can help to develop a shared understanding of the security environment during a livestock emergency response. Examples from the Philippines' response to Typhoons Sarika and Haima and Sri Lankan military agricultural engagements provide context for a proposed common operational framework.

Les intervenants dans la réponse et le redressement suite à une situation d'urgence, forces armées incluses, doivent avoir une conscience aiguë du fait que les moyens d'existence des populations affectées sont souvent tributaires du bétail, ce qui a des conséquences en termes de sécurité humaine. Les urgences humanitaires font des blessés et des morts mais elles ont aussi un effet dévastateur sur les moyens d'existence basés sur l'élevage, qui constituent une caractéristique essentielle d'une grande partie des populations rurales pauvres de la planète. Le rôle croissant des forces armées dans la gestion des situations d'urgence peut donner lieu à des frictions pendant les interventions en raison des priorités et des objectifs concurrentiels des différents intervenants. Des perspectives existent pour une utilisation accrue des forces militaires, par exemple pour soutenir les moyens d'existence basés sur l'élevage, mais pour cela il faut résoudre un certain nombre de difficultés et lever certains obstacles. Un cadre commun d'interactions civilo-militaires peut contribuer à coordonner les interventions et améliorer ainsi les réponses tant locales qu'internationales aux situations d'urgence. Les Normes et directives pour l'aide d'urgence à l'élevage (LEGS) et le modèle qu'il propose pour sécuriser les moyens d'existence sont des outils conceptuels qui visent à forger une vision commune du contexte sécuritaire pendant les interventions d'urgence auprès des éleveurs. La réponse des Philippines suite aux typhons Sarika et Haima et l'aide apportée aux agriculteurs par les forces armées sri-lankaises offrent des exemples qui pourraient inspirer un tel cadre opérationnel commun.

Todas las partes que intervienen en la respuesta a situaciones de emergencia y en la recuperación tras ellas, incluidos los cuerpos militares, deben conocer a fondo los medios de sustento que dependen de la ganadería y la forma en que estas actividades repercuten en la seguridad humana. Las emergencias no solo hieren y matan, sino que también devastan los medios de sustento basados en la actividad ganadera, que son una característica básica de la vida de muchos de los pobladores pobres de zonas rurales del mundo. Las fuerzas armadas intervienen cada vez más en la gestión de emergencias, hecho que durante estos episodios puede generar fricciones por la existencia de planes y objetivos discordantes. Existe margen para aprovechar en mayor medida la intervención de los cuerpos militares, por ejemplo para respaldar los medios de vida de quienes dependen de la ganadería, pero para ello hay dificultades y barreras que salvar. La existencia de un marco común que encuadre la interacción de civiles con militares puede ser útil para coordinar las actividades de respuesta a situaciones de emergencia y mejorar esta labor a escala local e internacional. Las directrices y normas para emergencias ganaderas [Livestock Emergency Guidelines and Standards, LEGS], así como la propuesta de un modelo para la seguridad de los medios de sustento, son creaciones teóricas que pueden ayudar a llegar a una concepción común de lo que deben ser las condiciones de seguridad durante la respuesta a una emergencia ganadera. Los ejemplos de la respuesta de Filipinas a los huracanes Sarika y Haima y de la participación de militares esrilanqueses en tareas agropecuarias sirven para contextualizar una propuesta de marco operativo común.

A prospective study of the prevalence of undiagnosed coeliac disease in laboratory defined iron and folate deficiency.

AIMS: To determine the prevalence of coeliac disease in a group of patients in the community who have been shown in the laboratory to have iron and/or folate deficiency. To assess the cost efficiency of this laboratory based case finding strategy. METHODS: The study was undertaken in a large general hospital in the UK serving a population of 300 000. Three hundred and thirty three eligible patients with iron and/or folate deficiency were identified and contacted over an 18 month period. Case finding was by testing for coeliac disease using serological methods and subsequent histological confirmation. RESULTS: Of the 333 eligible and contactable patients with iron and/or folate deficiency, 258 (77%) consented to coeliac disease antibody testing. Twenty eight patients (10.9%) were positive for coeliac disease antibodies. Of these, 24 patients proceeded to endoscopy and biopsy, resulting in 12 cases of histologically confirmed coeliac disease (4.7% (95% confidence interval, 2.1% to 6.8%) of patients tested for coeliac disease antibodies). CONCLUSIONS: This laboratory based methodology detected a considerable number of new coeliac disease cases in the community. Many of these patients did not present with clinical findings suggestive of malabsorption and might not otherwise have been diagnosed. Laboratory based methodologies should be considered in conjunction with other strategies for the early identification and treatment of coeliac disease.

Combined laparoscopic incarcerated herniorrhaphy and small bowel resection.

Laparoscopic femoral herniorrhaphy using a preperitoneal plug and patch appears to be a feasible laparoscopic approach to femoral hernia. A modified preperitoneal femoral hernia repair with mesh and resection of incarcerated small bowel has been successfully completed under laparoscopic guidance in a 64-year-old patient with incarcerated femoral hernia. To our knowledge, this is the first such case reported in the United States. With further experience, laparoscopic femoral herniorrhaphy could provide a viable alternative to the standard treatment of femoral hernia.

Gastric teratoma with gastrointestinal bleeding.

Gastric teratoma is a rare lesion seen most often in infant males. This case report and review of the literature indicate that an endophytic subtype can be associated with gastrointestinal (GI) bleeding. Neither the age of the patient, the gross appearance of the tumor, nor the presence of intestinal bleeding is evidence of malignancy in this benign condition and simple excision of the lesion is satisfactory treatment.

Chronic intestinal ischemia: diagnosis and therapy.

Splanchnic arteriosclerosis is common among the elderly population, but intestinal angina is distinctly a rare entity. Extensive and efficient mesenteric collateral pathways make development of intestinal angina unlikely unless at least two major vessels exhibit hemodynamically important stenoses. Herein we describe the surgical management of 17 patients with chronic intestinal ischemia. The patients most commonly had postprandial pain and lost significant weight; angiography, including lateral aortography, confirmed the diagnosis. An average of 2.5 vessels in these 17 patients were arteriosclerotically involved. These 17 patients underwent 20 major splanchnic artery reconstructions altogether (average, 1.2 vessels per patient) for relief of symptomatic intestinal ischemia. Arterial reconstructions (16 bypass procedures and 4 endarterectomies) were undertaken with either autogenous saphenous vein (10 vessels) or Dacron prosthetics (6 vessels). Revascularizations involved the superior mesenteric artery (six patients), hepatic artery (three patients), splenic artery (seven patients), and inferior mesenteric artery (four patients). Five deaths occurred after operation, two early and three late, all from myocardial infarctions. All patients who survived have been relieved of their pain, and there has been no recurrence. The average length of follow-up has been 60.9 months and repeat angiography in six patients at intervals of up to 5 years has shown no evidence of revascularization occlusion.