Complementary Phenotyping of Maize Root System Architecture by Root Pulling Force and X-Ray Imaging.

The root system is critical for the survival of nearly all land plants and a key target for improving abiotic stress tolerance, nutrient accumulation, and yield in crop species. Although many methods of root phenotyping exist, within field studies, one of the most popular methods is the extraction and measurement of the upper portion of the root system, known as the root crown, followed by trait quantification based on manual measurements or 2D imaging. However, 2D techniques are inherently limited by the information available from single points of view. Here, we used X-ray computed tomography to generate highly accurate 3D models of maize root crowns and created computational pipelines capable of measuring 71 features from each sample. This approach improves estimates of the genetic contribution to root system architecture and is refined enough to detect various changes in global root system architecture over developmental time as well as more subtle changes in root distributions as a result of environmental differences. We demonstrate that root pulling force, a high-throughput method of root extraction that provides an estimate of root mass, is associated with multiple 3D traits from our pipeline. Our combined methodology can therefore be used to calibrate and interpret root pulling force measurements across a range of experimental contexts or scaled up as a stand-alone approach in large genetic studies of root system architecture.

Refugee camps, fire disasters and burn injuries.

In the past five years, no fewer than 15 conflicts have brought unspeakable tragedy and misery to millions across the world. At present, nearly 20 people are forcibly displaced every minute as a result of conflict or persecution, representing a crisis of historic proportions. Many displaced persons end up in camps generally developing in an impromptu fashion, and are totally dependent on humanitarian aid. The precarious condition of temporary installations puts the nearly 700 refugee camps worldwide at high risk of disease, child soldier and terrorist recruitment, and physical and sexual violence. Poorly planned, densely packed refugee settlements are also one of the most pathogenic environments possible, representing high risk for fires with potential for uncontrolled fire spread and development over sometimes quite large areas. Moreover, providing healthcare to refugees comes with its own unique challenges. Internationally recognized guidelines for minimum standards in shelters and settlements have been set, however they remain largely inapplicable. As for fire risk reduction, and despite the high number of fire incidents, it is not evident that fire safety can justify a higher priority. In that regard, a number of often conflicting influences will need to be considered. The greatest challenge remains in balancing the various risks, such as the need/cost of shelter against the fire risk/cost of fire protection.

Dans les 5 années écoulées, ce ne sont pas moins de 15 conflits armés qui ont propulsé des millions de personnes à travers le monde dans une tragédie et une misère indescriptibles. Actuellement, 20 personnes sont déplacés de force chaque minute en raison d'un tel conflit ou de persécutions, ce qui est une crise historique. Nombre d'entre elles se retrouvent dans des camps de réfugiés de fortune, totalement dépendants de l'aide humanitaire. Les conditions précaires de survie dans ces quelque 700 camps placent ces réfugiés dans une situation de risque non seulement de santé mais aussi de violence physique, sexuelle et mentale (enfants soldats, « recrutement ¼ terroriste). La densité d'habitations installées sans plan est un facteur pathogénique majeur, dans lesquelles les incendies peuvent toucher une superficie très importante. En outre, la dispensation de soins aux réfugiés pose des problèmes spécifiques. Des standard minimums de déploiement ont été édictés au niveau international, mais ils restent largement inapplicables. La prévention des incendies reste une préoccupation secondaire, malgré leur fréquence car il s'agit de trouver une priorité entre la réalisations d'abris sûrs pour dispenser les soins et la prévention des incendies, à coût peu extensible.

The association between severity of King's Obesity Staging Criteria scores and treatment choice in patients with morbid obesity: a retrospective cohort study.

BACKGROUND: The King's Obesity Staging Criteria (KOSC) comprises of a four-graded set of health related domains. We aimed to examine whether, according to KOSC, patients undergoing bariatric surgery differed from those opting for conservative treatment. METHODS: We graded 2142 consecutive patients with morbid obesity attending our centre from 2005-10 into the following KOSC domains: airway/apnoea, body mass index (BMI), cardiovascular risk (CV-risk), diabetes mellitus, economic complications, functional limitations, gonadal dysfunction, and perceived health status/body image. Both patients and physicians agreed upon treatment choice through a shared decision making process. RESULTS: A total of 1329 (62%) patients opted for lifestyle intervention and 813 (37%) for bariatric surgery as their first treatment choice. The patients treated with bariatric surgery were younger (42 vs. 44 years, p < 0.001), had a higher BMI (45.4 vs. 43.8 kg/m2, p < 0.001) and had a lower ten year estimated CV-risk (9.4 vs. 10.7%, p = 0.004) than the lifestyle intervention group. Compared with having BMI < 40 kg/m2, BMI ≥ 40 kg/m2 was associated with 85% increased odds of bariatric surgery (OR 1.85 [95% CI 1.48, 2.30]). Conversely, patients with ≥20% ten year CV-risk, had lower odds of bariatric surgery than patients with <20% CV-risk (0.68 [0.53, 0.87]). CONCLUSION: BMI was the strongest KOSC-domain associated with subsequent bariatric surgery after a shared decision making process. Prospective studies are required to assess whether the use of KOSC can help guide patients and clinicians to identify the most appropriate choice of treatment for morbid obesity.

Essential surgery: the way forward.

INTRODUCTION: Very little surgical care is performed in low- and middle-income countries (LMICs). An estimated two billion people in the world have no access to essential surgical care, and non-surgeons perform much of the surgery in remote and rural areas. Surgical care is as yet not recognized as an integral aspect of primary health care despite its self-demonstrated cost-effectiveness. We aimed to define the parameters of a public health approach to provide surgical care to areas in most need. METHODS: Consensus meetings were held, field experience was collected via targeted interviews, and a literature review on the current state of essential surgical care provision in Sub-Saharan Africa (SSA) was conducted. Comparisons were made across international recommendations for essential surgical interventions and a consensus-driven list was drawn up according to their relative simplicity, resource requirement, and capacity to provide the highest impact in terms of averted mortality or disability. RESULTS: Essential Surgery consists of basic, low-cost surgical interventions, which save lives and prevent life-long disability or life-threatening complications and may be offered in any district hospital. Fifteen essential surgical interventions were deduced from various recommendations from international surgical bodies. Training in the realm of Essential Surgery is narrow and strict enough to be possible for non-physician clinicians (NPCs). This cadre is already active in many SSA countries in providing the bulk of surgical care. CONCLUSION: A basic package of essential surgical care interventions is imperative to provide structure for scaling up training and building essential health services in remote and rural areas of LMICs. NPCs, a health cadre predominant in SSA, require training, mentoring, and monitoring. The cost of such training is vastly more efficient than the expensive training of a few polyvalent or specialist surgeons, who will not be sufficient in numbers within the next few generations. Moreover, these practitioners are used to working in the districts and are much less prone to gravitate elsewhere. The use of these NPCs performing "Essential Surgery" is a feasible route to deal with the almost total lack of primary surgical care in LMICs.

Primary triage of mass burn casualties with associated severe traumatic injuries.

A key aim in any mass disaster event is to avoid diverting resources by overwhelming specialized tertiary centers with minor casualties. The most crucial aspect of an effective disaster response is pre-hospital triage at the scene. Unfortunately, many triage systems have serious shortcomings in their methodologies and no existing triage system has enough scientific evidence to justify its universal adoption. Moreover, it is observed that the optimal approach to planning is by no means clear-cut and that each new incident involving burns appears to produce its own unique problems not all of which were predictable. In most major burns disasters, victims mostly have combined trauma burn injuries and form a heterogeneous group with a broad range of devastating injuries. Are these victims primarily burn patients or trauma patients? Should they be taken care of in a burn center or in a trauma center or only in a combined burns-trauma center? Who makes the decision? The present review is aimed at answering some of these questions.

Un objectif clé après les désastres de masse de tous les types est d'éviter le détournement des ressources submergeant les centres tertiaires spécialisés de patients atteints de lésions mineures. L'aspect le plus crucial d'une réponse efficace aux catastrophes est le triage préhospitalier à la scène de l'accident. Malheureusement, de nombreux systèmes de triage présentent de sérieuses lacunes dans leurs méthodologies et aucun système de triage actuellement utilisé ne démontre de posséder les qualités scientifiques suffisantes pour justifier son adoption universelle. Par ailleurs, on observe que l'approche optimale pour la planification n'est pas nullement claire et que tous les cas de désastre par feu présentent des aspects particuliers non tous prévisibles. Dans la plupart des grands désastres par feu, la majorité des victimes présentent une association de brûlures et d'autres traumatismes et constituent un groupe hétérogène atteint d'une large gamme de lésions dévastatrices. Ces victimes sont-elles principalement des patients brûlés ou des patients traumatisés? Faut-il les prendre en charge dans un centre des brûlés ou un centre des traumatisés ou seulement dans un centre dédié aux soins des deux catégories de patients? Qui prend la décision? Les Auteurs de cette étude mirent à répondre à certaines de ces questions.

Assessment of the antibacterial activity of a triclosan-containing cutting board.

Several studies have shown that consumers may not clean cutting boards properly between preparation of raw and cooked meat. Cutting boards may therefore act as sources for contamination of cooked meat or other ready-to-eat foods with pathogenic and spoilage bacteria. The aim of the work was to investigate if cutting boards containing the antimicrobial compound triclosan can reduce the viability of bacteria, thus acting as a hygiene barrier. Survival and growth of food pathogens and spoilage bacteria on two cutting boards without antimicrobials and a commercial cutting board containing triclosan were tested. No difference in bacterial counts on cutting boards without and with triclosan was found after exposure to naturally contaminated chicken filets for one hour. Pathogenic and spoilage bacteria were inoculated on coupons (6.7-7 log per coupon) of cutting boards and incubated at 25°C at controlled relative humidity for 24 and 72 h. At a relative humidity of 100%, growth of Escherichia coli, Salmonella, Staphylococcus aureus, coagulase-negative staphylococci (CNS) and Serrratia spp. was observed and no antibacterial effect of the triclosan-containing board was found except for against Listeria monocytogenes. At lower humidity (70% RH) less growth was found on the triclosan-containing cutting board than untreated boards after 24h. After 72 h of incubation, cell counts were reduced on triclosan-containing boards, with the most pronounced antibacterial effects observed against Salmonella, S. aureus and CNS. For S. aureus and Salmonella it was found that when a lower initial cell count was applied (3.5 log per coupon), the triclosan-containing board had an antibacterial effect under humid conditions, as well as a more pronounced antibacterial effect under dry conditions. An agar overlay assay showed that triclosan migrated out of the coupons. Repeated washing of the triclosan-containing cutting boards reduced the antibacterial effect, thus the amount of triclosan available on the surface seemed to be limited. In conclusion, using triclosan-containing cutting boards as a hygienic barrier may only work under certain conditions (low humidity, long exposure time, and clean conditions) and not against all genera of bacteria.

Provision of essential surgery in remote and rural areas of developed as well as low and middle income countries.

BACKGROUND: Surgery is increasingly becoming an integral part of public health and health systems development worldwide. Such surgical care should be provided at the same type and level in both urban and rural settings. However, provision of essential surgery in remote and rural areas of developed as well as low and middle income countries remains totally inadequate and poses great challenges. METHODS: Though not intended to be a systematic review, several aspects of primary health care and its surgical aspects in remote and rural areas were reviewed. Search tools included Medline, PubMed and Scopius. Health concerns such as quality health care and limitations, as well as infrastructures, surgical workforce as well as implications for planning, teaching and training for surgical care in remote areas were searched. RESULTS: The dire shortage of surgeons and anesthesiologists in most low and middle income countries means task shifting and training of non-physician clinicians (NPCs) is the only option particularly in most developing poor countries. CONCLUSION: The best means of bringing surgical care to rural dwellers is yet to be clearly determined. However, modern surgical techniques integrated with the strategy as outlined by the World Health Organization can be brought to rural areas through specially organized camps. Sophisticated surgery can thus be performed in a high-volume and cost-effective manner, even in temporary settings. However, provision of essential surgery to rural and remote areas can only partly be met both in developed and in low and middle income countries and it will take years to solve the problem of unmet surgical needs in these areas.

Metabolic implications of severe burn injuries and their management: a systematic review of the literature.

BACKGROUND: Severe burn patients are some of the most challenging critically ill patients, with an extreme state of physiologic stress and an overwhelming systemic metabolic response. A major component of severe burn injury is a hypermetabolic state associated with protein losses and a significant reduction of lean body mass. The second prominent component is hyperglycemia. Reversal of the hypermetabolic response by manipulating the patient's physiologic and biochemical environment through the administration of specific nutrients, growth factors, or other agents, often in pharmacologic doses, is emerging as an essential component of the state of the art in severe burn management. The present review aims at summarizing the new treatment modalities established to reduce the catabolic burden of severe burn injuries, for which there is some evidence-based support. METHODS: A systematic review of the literature was conducted. Search tools included Elsevier ScienceDirect, EMBASE.com, Medline (OVID), MedlinePlus, and PubMed. Topics searched were Nutrition and Burns, Metabolic Response and Burns, Hypermetabolism and Burns, Hyperglycemia and Burns, and several more specific topics when indicated. With a focus on the most recently published articles, abstracts were reviewed and, when found relevant, were included as references. Full text articles, whenever available, were retrieved. RESULTS: Many issues remain unanswered. Unfortunately, the present state of our knowledge does not allow the formulation of clear-cut guidelines. Only general trends can be outlined, and these will certainly have some practical applications but above all will dictate future research in the field.

Nutritional and pharmacological modulation of the metabolic response of severely burned patients: review of the literature (part 1).

Severe burn patients are some of the most challenging critically ill patients, with an extreme state of physiological stress and an overwhelming systemic metabolic response. Increased energy expenditure to cope with this insult necessitates mobilization of large amounts of substrate from fat stores and active muscle for repair and fuel, leading to catabolism. The hypermetabolic response can last for as long as nine months to one year after injury and is associated with impaired wound healing, increased infection risks, erosion of lean body mass, hampered rehabilitation, and delayed reintegration of burn survivors into society. Reversal of the hypermetabolic response by manipulating the patient's physiological and biochemical environment through the administration of specific nutrients, growth factors, or other agents, often in pharmacological doses, is emerging as an essential component of the state of the art in severe burn management. Early enteral nutritional support, control of hyperglycaemia, blockade of catecholamine response, and use of anabolic steroids have all been proposed to attenuate hypermetabolism or to blunt catabolism associated with severe burn injury. The present study is a literature review of the proposed nutritional and metabolic therapeutic measures in order to determine evidence-based best practice. Unfortunately, the present state of our knowledge does not allow the formulation of clear-cut guidelines. Only general trends can be outlined which will certainly have some practical applications but above all will dictate future research in the field.

Nutritional and Pharmacological Modulation of the Metabolic Response of Severely Burned Patients: Review of the Literature (Part II)*.

Severe burn patients are some of the most challenging critically ill patients, with an extreme state of physiological stress and an overwhelming systemic metabolic response. Increased energy expenditure to cope with this insult necessitates mobilization of large amounts of substrate from fat stores and active muscle for repair and fuel, leading to catabolism. The hypermetabolic response can last for as long as nine months to one year after injury and is associated with impaired wound healing, increased infection risks, erosion of lean body mass, hampered rehabilitation, and delayed reintegration of burn survivors into society. Reversal of the hypermetabolic response by manipulating the patient's physiological and biochemical environment through the administration of specific nutrients, growth factors, or other agents, often in pharmacological doses, is emerging as an essential component of the state of the art in severe burn management. Early enteral nutritional support, control of hyperglycaemia, blockade of catecholamine response, and use of anabolic steroids have all been proposed to attenuate hypermetabolism or to blunt catabolism associated with severe burn injury. The present study is a literature review of the proposed nutritional and metabolic therapeutic measures in order to determine evidence-based best practice. Unfortunately, the present state of our knowledge does not allow the formulation of clear-cut guidelines. Only general trends can be outlined which will certainly have some practical applications but above all will dictate future research in the field.

Nutritional and Pharmacological Modulation of the Metabolic Response of Severely Burned Patients: Review of the Literature (Part III)*.

Severe burn patients are some of the most challenging critically ill patients, with an extreme state of physiological stress and an overwhelming systemic metabolic response. Increased energy expenditure to cope with this insult necessitates mobilization of large amounts of substrate from fat stores and active muscle for repair and fuel, leading to catabolism. The hypermetabolic response can last for as long as nine months to one year after injury and is associated with impaired wound healing, increased infection risks, erosion of lean body mass, hampered rehabilitation, and delayed reintegration of burn survivors into society.Reversal of the hypermetabolic response by manipulating the patient's physiological and biochemical environment through the administration of specific nutrients, growth factors, or other agents, often in pharmacological doses, is emerging as an essential component of the state of the art in severe burn management. Early enteral nutritional support, control of hyperglycaemia, blockade of catecholamine response, and use of anabolic steroids have all been proposed to attenuate hypermetabolism or to blunt catabolism associated with severe burn injury. The present study is a literature review of the proposed nutritional and metabolic therapeutic measures in order to determine evidence-based best practice. Unfortunately, the present state of our knowledge does not allow the formulation of clear-cut guidelines. Only general trends can be outlined which will certainly have some practical applications but above all will dictate future research in the field.

Military and civilian burn injuries during armed conflicts.

Burn injury is a ubiquitous threat in the military environment, and war burns have been described for more than 5,000 years of written history. Fire was probably utilized as a weapon long before that. With the ever-increasing destructive power and efficiency of modern weapons, casualties, both fatal and non-fatal, are reaching new highs, particularly among civilians who are becoming the major wartime targets in recent wars, accounting for most of the killed and wounded. Even though medical personnel usually believe that a knowledge of weaponry has little relevance to their ability to effectively treat injuries and that it may in some way be in conflict with their status, accorded under the Geneva and Hague treaties, it is imperative that they know how weapons are used and understand their effects on the human body. The present review explores various categories of weapons of modern warfare that are unfamiliar to most medical and paramedical personnel responsible for burn treatment. The mechanisms and patterns of injury produced by each class of weapons are examined so that a better understanding of burn management in a warfare situation may be achieved.

O3 impacts on plant development: a meta-analysis of root/shoot allocation and growth.

The mechanism of O3 action on plants remains poorly characterized. Symptoms include visible lesions on the leaf surface, reduced growth and a hypothesized reduction in allocation of carbohydrate to roots. The generality of this latter phenomenon has not been demonstrated. Here, a meta-analysis is performed of all available experimental data, to test the hypotheses that O3 exposure of the shoot inhibits biomass allocation below ground (the root/shoot allometric coefficient, k) and inhibits whole-plant growth rate [relative growth rate (RGR)]. Both k and RGR were significantly reduced by O3 (5.6 and 8.2%, respectively). Variability in k was greater than in RGR, and both exhibited some positive as well as mostly negative responses. The effects on k were distinct from the effects on RGR. In some cases, k was reduced while RGR was unaffected. Slow-growing plants (small RGR) exhibited the largest declines in k. These observations may have mechanistic implications regarding O3 phytotoxicity. There were no effects of type of exposure chamber on sensitivity to O3. The analyses indicate that the O3 inhibition of allocation to roots is real and general, but variable. Further experiments are needed for under-represented plant groups, to characterize exceptions to this generalization and to evaluate O3--environment interactions.