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Introduction. The complexity and power of a natural phenomenon with hazardous and dangerous properties, which is lightning, should be adequately evaluated and prevented at the most accessible organizational and technical level of a particular society. According to the principle of ALARA (as low as reasonably achievable) applied in post-industrial countries, this risk, like others, should be reduced to the extent that is achievable. Neglecting to take a high risk of a hazardous event leads to excessive damage and large irreparable losses that a person or community cannot achieve sustainable development. Therefore, it is the complex, systematic approach in achieving safety, from the stage of assessment, to take into account both the characteristics of hazards, including fire in the relevant facilities, as well as personal, individual risk of death or injury. Purpose. Concerning to the situation with the systematic approach to technical regulation in Ukraine of such a safety sector as lightning protection, it is precisely this neglect that does not correspond to the current potential of the industrial, scientific, regulatory and social development levels. The purpose of this article is to analyze this problem in several areas. The state of technical regulation shows the priority of bringing normative documents into compliance with the legislation. Methods. Application of various methods of calculation, estimation, design and layout of the system allows realizing lightning protection system of buildings, equipment and people. To this aim, comparative characteristics of the passive and active lightning protection systems offered on the market are given; protective angle, rolling sphere, geometric methods of direct impact intercepting are compared. Results. Lightning is an unpredictable natural event; no one in the world is fully understand the mechanism of lightning, it is impossible for any standardization to provide 100% protection in all circumstances. In this view no liability shall attach to IEC and any other ...

BACKGROUND: Concurrent chemoradiotherapy is an established component of the nonoperative management of locally advanced head and neck squamous cell carcinoma (HNSCC), but the standard dose of 100 mg/m(2) cisplatin every 3 weeks is associated with clinically significant toxicity. Interest in a more tolerable regimen has led to the widespread use of weekly lower dose cisplatin, but few randomized trials have compared these approaches. METHODS: We examined outcomes of patients with stage III–IVb HNSCC treated with definitive intent chemoradiotherapy using either high-dose cisplatin (HDC) or low-dose cisplatin (LDC), using population-based Veterans Affairs data. In an intent-to-treat analysis, patients were assigned to the HDC vs LDC group according to the dose of their first cycle. Variables potentially influencing treatment decisions including cancer site, stage, smoking/alcohol use, and comorbidities were used to generate propensity scores (PS) for the use of HDC. We compared overall survival (OS) by treatment group using Cox regression, adjusting for PS. We then determined the risk of toxicities using PS-adjusted logistic regression. RESULTS: A total of 2901 patients were included in the analysis; 2200 received HDC (mean initial dose 100 mg/m(2)). The mean initial dose of LDC was 40 mg/m(2). After PS adjustment, HDC was not associated with improved OS over LDC (hazard ratio = 0.94, 95% confidence interval = 0.80 to 1.04). Adjusting for PS, HDC was associated with an increased risk of acute kidney injury, neutropenia, dehydration/electrolyte disturbance, and hearing loss. CONCLUSION: In this large, population-based study of US military veterans, LDC was associated with similar survival to HDC in the nonoperative definitive management of locally advanced HNSCC of the oral cavity, oropharynx, and hypopharynx/larynx. HDC was associated with statistically significantly more toxicity than LDC. Adoption of LDC may reduce toxicity burden while maintaining OS.

Neuromonitoring is performed to prevent further (secondary) brain damage by detecting low brain blood flow following a head injury, stroke or neurosurgery. This comparative neuromonitoring study is part of an ongoing investigation of brain bioimpedance (rheoencephalography-REG) as a measuring modality for use in both civilian and military medical settings, such as patient transport, emergency care and neurosurgery intensive care. In a previous animal study, we validated that REG detects cerebral blood flow autoregulation (CBF AR), the body's physiological mechanism that protects the brain from adverse effects of low brain blood flow (hypoxia/ischemia). In the current descriptive pig study, the primary goal was to compare measurements of CBF AR made with REG to measurements made with other neuromonitoring modalities: laser Doppler flow (LDF); intracranial pressure (ICP); absolute CBF; carotid flow (CF); and systemic arterial pressure (SAP). Challenges administered to anesthetized pigs were severe induced hemorrhage (bleeding) and resuscitation; CO(2) inhalation; and positive end expiratory pressure (PEEP). Data were stored on a computer and processed offline. After hemorrhage, the loss of CBF AR was detected by REG, ICP, and CF, all of which passively followed systemic arterial SAP after bleeding. Loss of CBF AR was the earliest indicator of low brain blood flow: loss of CBF AR occurred before a decrease in cardiac output, which is the cardiovascular response to hemorrhage. A secondary goal of this study was to validate the usefulness of new automated data processing software developed to detect the status of CBF AR. Both the new automated software and the traditional (observational) evaluation indicated the status of CBF AR. REG indicates the earliest breakdown of CBF AR; cessation of EEG for 2 seconds and respiration would be used as additional indicators of loss of CBF AR. The clinical significance of this animal study is that REG shows potential for use as a noninvasive, continuous and non-operator dependent ...

The Myanmar Snakebite Project is an Australian government (Department of Foreign Affairs and Trade) supported foreign aid project in collaboration with the Myanmar government with the aim of improving outcomes for snakebite patients in Myanmar. As part of the project a case record database was established to document prospective cases of snakebite presenting to Mandalay General Hospital, in Upper Myanmar. The study period was 12 months (1-2-2016 to 31-1-2017). Snake identity was based on a mixture of identified dead snakes brought with patients, doctor's clinical opinion and patient identification. 965 patients were enrolled during the 12 month period, of whom 948 were included for analysis. The male: female ratio was 1.58:1. Most cases involved bites to the lower limbs (82.5%) and adults involved in farm work, confirming snakebite as an occupational disease in this community. Motorised transport was by far the most common form of transport to health care and most patients sought care from the health system (87.7%), not traditional healers (11.5%) as their first point of contact. The officially promoted application of a pressure pad, bandage and immobilisation as first aid for snakebite was almost never used, while most patients used some form of tourniquet (92.0%). 85.4% of cases where a snake ID was listed were bitten by Russell's vipers. Russell's viper bites were responsible for all fatalities (9.8% of cases) and all cases of Acute Kidney Injury (AKI). For all cases, clinical features included local swelling (76.5%), local pain (62.6%), AKI (59.8%), incoagulable blood (57.9%), regional lymphadenopathy (39.8%), nausea/vomiting (40.4%), thrombocytopenia (53.6%), abdominal pain (28.8%), shock (11.8%), secondary infection (8.6%), panhypopituitarism (2.1%). AKI required renal replacement therapy (RRT) in 23.9% of cases, all ascribed to Russell's viper bite. Green pit viper bites were the next most common cause of bites (7.6%) and were associated with incoagulable blood (29%) and occasionally shock (5%) and local ...

This study deals with the legality of measures for the prevention of sexually transmitted diseases, targeted to the show and shed light on legitimate measures developed by street wise for the prevention of sexual diseases, as well as reducing the spread of infection after them. Which it has examined the leading causes of these diseases, as well as the size of the spread in communities, and found that there are many reasons leading to these diseases which are related to individuals, including those relating to governments, and I realized that these diseases spread dramatically, especially AIDS ones, which continues to grow, where the state is not free from this deadly epidemic. And it suffered through the study of the most important general preventive measures for the prevention of these diseases ranging from the promotion of legitimate marriage process, and a medical examination before marriage, and the statement of the impact of these tests in the prevention, as well as bridging the excuses leading to weight, and the necessity of activating the awareness of religious and morals among members of society and activating the role of educational and penal institutions, and monitor blood banks and their donors. It also addressed the most important preventive measures that can put an end to the spread of these diseases after the injury out, from abstinence mating between the patient and a healthy person, avoid women for pregnancy and childbirth, and avoid patient to donate blood or organs, as well as the establishment of legitimate border on the corrupt, and the statement of its impact in the reduction of the spread of sexually transmitted diseases. Thus, the study has included the most legitimate measures for the prevention of sexually transmitted diseases.

The existence of the principle of proportionality as a norm is undisputed, and military commanders in armed conflicts around the world apply it continuously. As the principle is formulated in general terms--prohibiting attacks that may be expected to cause incidental loss of civilian life, injury to civilians, or damage to civilian objects, or a combination thereof, that would be excessive in relation to the military advantage anticipated--it is also clear that interpreting and applying the different elements of the principle is no simple task. This Article shall consider four select issues regarding different elements of the principle of proportionality. First is how to determine "excessive" (Part II). International law does not elaborate on how one must determine what is "excessive." What is generally accepted, however, is that proportionality is assessed inter alia on the basis of subjective considerations and values. The Final Report to the Prosecutor Reviewing the NATO Bombing Campaign in the Federal Republic of Yugoslavia (FRY), for example, has espoused for this purpose the standard of a "reasonable military commander." How should this standard be understood and applied? Second is interpreting "military advantage" (Part III). Here, should the military context in which the attack or operation is taking place matter, and if so, to what extent? Third is the impact of defensive systems on determining" military advantage" (Part IV). Many parties to conflicts have some sort of defensive measures to protect civilians from attack (from passive systems, such as shelters and air raid warnings systems, to active defensive systems, such as aerial defense facilities or rocket interception mechanisms). Should the apparent reduced lethality of enemy capabilities as a result of these systems be taken into account when assessing military advantage in attacks against the enemy? Fourth is the impact of "force preservation" on determining "military advantage" (Part V). It is axiomatic that in conflict, preserving one's ...

In the present, we like to conceive of peace as the absence of its perceived opposite: we imagine it to be the normal, permanent state of society, which is only occasionally (and hopefully extremely rarely) interrupted by an abnormal, different state, that of war. Peace, in this context, we imagine as the near-complete absence of violent conflicts. War, on the other hand, we see as characterised by a significantly increased occurrence or even dominance of violent means of resolving conflicts. This conception, we also like to transfer onto the (close and more distant) past, in which we seem to mostly be interested in war (which sometimes is even referred to as the 'father of all things'). The reason for this, particularly in prehistory, seems to be that war seems to have left more archaeologically identifiable material traces than peace. Starting with weapons and other instruments of warfare via direct traces – whether anthropologically identifiable as trauma on skeletal remains, or archaeologically by stray finds of weapons on 'battlefields' – to defensive and offensive architecture; war seems to be relatively easily traceable by archaeological means. Peace, on the other hand, seems only identifiable negatively, through the absence of evidence for war. As understandable as this conception may be, so misleading it is: peace is not a natural state, occurring automatically if nobody goes to war. Rather, much like war, it requires social organisation and also enforcement, often with violent means. An executioner's sword is not a weapon of war, nor the head severed by it an injury of war, but rather a trace of the violent enforcement or re-establishment of peace. It is thus argued in this contribution that much of what we, as yet, have understood to be the 'archaeology of warfare' might as well be an 'archaeology of peace', since war and peace can hardly be distinguished from each other by archaeological means.

Daijun Zhou,1–3 Ruijia Yang,4 Tao Yang,1–3 Malcolm Xing,1–4 Gaoxing Luo1–3 1Institute of Burn Research, 2State Key Laboratory of Trauma, Burn and Combined Injury, 3Key Laboratory of Proteomics of Chongqing, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China; 4Department of Mechanical Engineering, University of Manitoba, Winnipeg, MB, Canada Objective: This study aimed to prepare an eco-friendly dressing using a chitin-derived membrane with amphipathic anion/quaternary ammonium salt designed for antibacterial purposes.Methods: Four dressings were prepared and group A was chitin, group B was chitin + amphiphilic ion, group C was chitin + quaternary ammonium salt, group D was chitin + amphiphilic ion + quaternary ammonium salt. Results: In the group D material, precipitation of adherent composite ions was observed. The contact angle test showed that the material was hydrophilic. The drug loading rate in groups B, C, and D was 40–50 (ug:mg), the entrapment efficiency was 70%–75% (P>0.05), and the cumulative release percentages were 87.3%, 88.7%, and 90.2% after 72h for group B, C, and D, respectively. The anti-bacterial activity in vitro was in the order D>C>B>A> control (P>0.05). The anti-pollution activity in vitro was in the order D>B>C>A (PC> commercial chitin dressing >B>A> control (P<0.05), and the length of the neonatal epithelium also showed the same trend. Additionally, PCNA and CD31 expression indicated that cell proliferation and angiogenesis were enhanced when skin defects were covered with the D group material (P<0.05).Conclusion: chitin-amphiphilic ion/quaternary ammonium salt dressing was successfully prepared. The antibacterial and antipollution effects of the prepared material (group D) were both very good, acting to promote wound healing. Keywords: chitin, amphipathic anion, quaternary ammonium salt, wound healing, anti-infective dressingCorrigendum for this paper has been published.

Sinkholes can cause property damage, injury to people and harm to the environment. It is therefore not surprising that myriad legal issues arise in the context of sinkholes and the actual and potential harms they present. This paper will focus on those legal issues and will include a discussion of potential causes of action (i.e., legal claims), both under statutory laws (e.g., state laws like in Pennsylvania under which sinkholes can be deemed a nuisance) and common law (i.e., claims derived from longstanding judicial precedent), and available damages (i.e., monetary compensation) and other remedies. Mining activities and water supply wells for industrial, commercial and residential uses, which pump groundwater in karst and other sinkhole prone areas, are often a direct cause of sinkholes. Yet most government agencies regulating mining and other related industries are ill-equipped, either technically or politically, to manage the potential, and in some cases, inevitable damage. Few, in fact, recognize the direct relationship between activities they typically permit, the formation of sinkholes, and the resulting harms. This paper will also discuss both bringing a case for sinkhole remediation (direct lawsuits and mining permit appeals) and defending sinkhole-related claims. Because cases involving karst terrain and sinkholes tend to turn on the presentation of highly technical scientific principles, educating the court is critical, as is the experience and expertise of a top-notch expert witness. This paper will discuss the ways to effectively present such cases in court, including the presentation of technical witnesses/experts. Two case studies will be examined. One case involves a school and a neighboring quarry, in which the court found that a quarry was the direct cause of sinkholes opening in the surrounding area. As a result, the court held that the quarry constituted a nuisance, and therefore denied a permit extension allowing further mining. Another case study will examine sinkholes opening near a major roadway in an area where no mining is known to have occurred.

To the best of our knowledge, cyanobacterial strains from the Arabian Gulf have never been investigated with respect to their potential for nanoparticle production. Lyngbya majuscula was isolated from the AlOqair area, Al-Ahsa Government, Eastern Province, Kingdom of Saudi Arabia. The cyanobacterium was initially incubated with 1500 mg/mL of HAuCl4 for two days. The blue-green strain turned purple, which indicated the intracellular formation of gold nanoparticles. Prolonged incubation for over two months triggered the extracellular production of nanogold particles. UV-visible spectroscopy measurements indicated the presence of a resonance plasmon band at ~535 nm, whereas electron microscopy scanning indicated the presence of gold nanoparticles with an average diameter of 41.7 ± 0.2 nm. The antioxidant and anti-myocardial infarction activities of the cyanobacterial extract, the gold nanoparticle solution, and a combination of both were investigated in animal models. Isoproterenol (100 mg/kg, SC (sub cutaneous)) was injected into experimental rats for three days to induce a state of myocardial infarction; then the animals were given cyanobacterial extract (200 mg/kg/day, IP (intra peritoneal)), gold nanoparticles (200 mg/kg/day, IP), ora mixture of both for 14 days. Cardiac biomarkers, electrocardiogram (ECG), blood pressure, and antioxidant enzymes were determined as indicators of myocardial infarction. The results showed that isoproterenol elevates ST and QT segments and increases heart rate and serum activities of creatine phosphokinase (CPK), creatine kinase-myocardial bound (CP-MB), and cardiac troponin T (cTnT). It also reduces heart tissue content of glutathione peroxidase (GRx) and superoxide dismutase (SOD), and the arterial pressure indices of systolic arterial pressure (SAP), diastolic arterial pressure (DAP), and mean arterial pressure (MAP). Gold nanoparticles alone or in combination with cyanobacterial extract produced an inhibitory effect on isoproterenol-induced changes in serum cardiac injury ...

Since 2001, well over 2.1 million U.S. military personnel have served during Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND) (Elder, 2015). During the OEF/OIF/OND era, traumatic brain injuries (TBI) have become a hallmark injury of returning veterans in addition to posttraumatic stress disorder (PTSD) and chronic pain (Mott, Mondragon, Hundt, Beason-Smith, Grady, & Teng, 2014). Approximately 20% of OEF/OIF/OND veterans meet the criteria for having polytrauma and estimates of 6-8% have what is known as the polytrauma clinical triad (PCT) which is co-occurring PTSD, TBI, and chronic pain (Cifu, Taylor, Carne, Bidelspach, Sayer, Scholten, & Campbell, 2013). Numerous randomized clinical trials have shown that cognitive processing therapy (CPT) and prolonged exposure (PE), two evidence-based treatments for posttraumatic stress disorder (PTSD), are equally effective at improving PTSD symptoms. The present study aims to shed light on predicting clinical outcomes for OEF/OIF/OND veterans with PCT who have engaged in CPT or PE. Whether or not CPT and PE are effective treatments, for veterans with PCT, at reducing self-reported PTSD, depression, anxiety, alcohol use, and pain symptoms is measured using changes in total scores on the PTSD Checklist Military Version (PCL-M), Beck Depression Inventory-II (BDI-II), Beck Anxiety Inventory (BAI), Alcohol Use Disorders Identification Test (AUDIT-C), and the Defense and Veterans Pain Rating Scale (DVPRS) scores. This study was completed via retrospective review of approximately 2,100 electronic medical record charts. The final cohort included in this study was comprised of 140 veterans in individual therapy utilizing CPT or PE through the Veterans Health Administration. Two-way RM-ANOVAs and RM-MANOVA were used to analyze the data in SPSS. Consistent with previous findings, this study found that both CPT and PE are effective treatments for PTSD although treatment outcomes varied within and between groups when race/ethnicity ...

Introduction: burn injuries on duty are frequent and affect attrition rate of military personnel. Nevertheless French data on this topic remains scarce. The purpose of the study was to describe epidemiological characteristics and the management of burn injuries on duty in the French Armed Forces. Methods: a retrospective observational study was performed of French casualties with burns, transported to Percy Burn Center (R4 Medical Treatment Facility) between January 1, 2001, and December 31, 2017. Results: 67 patients were included. 54% of burns analyzed were non-operational injuries, mainly due to mishaps occurring with the burning of waste and the use of fuel. Operational burns (n=31/67) were mostly explosions related (improvised explosive devices and ammunition handle). The median total body surface area burned was 12% [7; 23,5]. Major anatomical regions affected were upper limbs (85%), head/neck (75%) and hands (69%). 7 patients (10%) had smoke inhalation injuries. The combination of burn injury and multiple trauma occurred in 22% (n=15/67). Operational burns resulted in more blast injuries and multiple trauma, more MASCAL procedures, in higher median Injured Severity Score (ISS) and Abbreviated Burn Severity Index (ABSI), more patients under mechanical ventilation, more blood transfusions and surgeries (p <0.001). The case fatality rate was 3% (n=2/67). Discussion: more than half of casualties occur in a non-operational setting. Non-operational burn injuries are less severe and accessible to prevention. Further efforts are needed to expand the spectrum of effective preventive and educational interventions and to improve their effectiveness. The higher severity score of operational burn injuries are due to the associated trauma and mechanism. Burn injuries on duty require a multidisciplinary team approach with highly specialized personnel together in a dedicated trauma and burn center. A French trauma registry is a critical need. Only patients with burns that required hospitalizations have been included. ...

Australian government and organizational age-management policies continue to target employment participation among older workers in light of an aging population. Typically, efforts to reduce early retirement among older workers have focused on well-established factors, including the promotion of worker health, reducing injury, supporting caregivers, reducing age discrimination and enhancing skill development. This research extends on the former approach by examining established factors along with important emerging factors, namely work-life conflict, work centrality and person-job fit. Additionally, the research analyses the effects of gender and financial pressure on older workers' employment participation and preferences. Logistic regression analysis of cross-sectional survey data involving 1,504 Australians aged 45-65, revealed that two established factors, physical health and caregiving, and all three emerging factors were associated with employment participation and preferences to be employed. However, important variations on the basis of gender and financial pressure were also identified. Caregiving was more strongly associated with the preference to remain employed for men (OR = 0.2.54, p < 0.01) than women (OR = 1.03, ns) and person-job fit was more strongly associated with the preference to remain employed for women (OR = 1.64, p < 0.001) than men (OR = 0.91, ns). Work-life conflict was more strongly associated with the preference to leave employment for those reporting limited financial pressure (OR = 0.60, p < 0.001) compared to those in poorer financial circumstances (OR = 0.87, ns). These findings suggest that organizational age management policies should focus on both established and emerging factors, particularly the provision of flexible working conditions and improving the psychosocial work environment. However, such efforts should carefully consider the different needs of men and women, and those under varying levels of financial stress. With respect to government policy to promote employment participation, the findings support a stronger focus on improving physical and psychosocial work conditions rather than increasing the pension eligibility age. This may require further collaboration between government and employers.

Background Female Genital Mutilation (FGM) is all practices involving cutting, alteration or injury to the female genitalia for non-medical reasons. It is a form of violence against women and children, with no benefits and many harms. In 2014, the UK Government committed to working to eliminate FGM. Steps taken towards this aim included creation of educational and safeguarding resources for professionals, and legislative changes including a mandatory reporting duty for professionals in England and Wales (where if a girl under 18 discloses or is found on examination to have FGM then the professional is mandated to report this to the police), and an FGM Enhanced Dataset applicable to NHS organisations in England requiring the submission of personal data about women and girls who have had FGM to NHS Digital. To date, compliance with dataset returns from primary care services have been low. This report describes using patient and public involvement (PPI) to identify research and service priorities to support communities affected by FGM. Methods We held a series of PPI events (4 focus groups, and a multi-agency seminar) in 2015–2016, following the introduction of these legislative changes, speaking to community members, and professionals involved in their care. We asked participants to consider what they identified as research, knowledge and service priorities to support communities affected by FGM. Results The impact of these legislative and reporting requirements on the trust needed for community members to seek to consult health services was identified as important for further research. Priorities for service development were holistic services, that met a woman's needs throughout her lifecourse. Participants emphasised the importance of understanding how to listen, involve and utilise community voices in developing education for professionals, designing services, and developing policy. Conclusions There was a desire for change to develop from within affected communities; any learning and resources need to be ...

The article raises the question of women's dysfunctional mechanisms of adaptation as a consequence of pathological relationships with the mother. Particular attention is paid to such of them: interpersonal dependence, depression, anxiety, frustration, aggression, rigidity. The Hirschfeld Interpersonal Dependency Inventory, the Zung Self-Rating Depression Scale and the Eysenck Personality Questionnaire were used for an empirical study. In order to achieve these goals, a sample of 40 women aged 20 to 25 years was formed. A sample of this age allows you to look at a woman as an already established personality, and highlights the trends and characteristics of her interactions with others. The result of the study proved that the representatives of single-parent families have a greater degree of severity for all the indicators were given (interpersonal dependence, depression, anxiety, frustration, aggression, rigidity). This means that the absence of a permanent mother's partner (along with other factors covered in the article) catalyzes and promotes the process of forming the pathological relationship between a daughter and mother, which in turn becomes the basis for the formation of dysfunctional mechanisms of adaptation to the daughter as an expression of maternal injury. Maternal trauma or a mother complex is defined as the collective concept of a daughter and mother pathological relationship negative consequences. This is explained by the fact that the daughter in these conditions becomes the only one object of the projections of mother's fears, desires and dissatisfied needs, besides, she becomes the only source of love. A harmonious relationship with the mother is the basis for a full-fledged personality formation, while a natural interaction violation in the form of a fierce struggle for similarity and difference leads to an inadequate perception of the world and oneself, which is transferred to all subsequent generations in a closed circle.