Epidemiology,aetiology and knowledge,attitudes, and practices relating to burn injuries in Palestine: A community‐level research

The aim of this study was to identify the epidemiology, aetiology as well as the knowledge, attitudes, and practices relating to burn injuries in Palestine. A mixed‐method approach was used. A survey was distributed to a total of 1500 households selected by randomised approach. The survey was standardised based on World Health Organisation''s guidelines for conducting community surveys on injury. Additionally, there were 12 focus group discussions and 10 key informant interviews to collect rich qualitative data. In the West Bank and Gaza, 1.5% of Palestinians had experienced serious burn injuries in the 12 months. The total sample of 1500 yields a margin of error (plus/minus) = 2.5% at a 95% level of confidence and a response distribution (P = 50%) with 3% non‐response rate. Of the 1500 households approached, 184 reported a total of 196 burn injuries, with 87.2% occurring inside the home: 69.4% were females and 39.3% were children. The main source of reported cause of burn was heat and flame (36%), electric current (31.6%), hot liquid (28.6%), and chemicals (2.7%). The most common first aid for burns was pouring water (74.7%). People in rural, refugee, and Bedouin settings had the highest incidence of burns. This study provides the burn prevalence rate, explanatory factors that contribute to the frequency of burns in Palestine. Making burn prevention a higher priority within the national policy is crucial.     

Coexistence of vitreous and crystalline phases of H2O at ambient temperature

Formation of vitreous ice during rapid compression of water at room temperature is important for biology and the study of biological systems. Here, we show that Raman spectra of rapidly compressed water at greater than 1 GPa at room temperature exhibits the signature of high-density amorphous ice, whereas the X-ray diffraction (XRD) pattern is dominated by crystalline ice VI. To resolve this apparent contradiction, we used molecular dynamics simulations to calculate full vibrational spectra and diffraction patterns of mixtures of vitreous ice and ice VI, including embedded interfaces between the two phases. We show quantitatively that Raman spectra, which probe the local polarizability with respect to atomic displacements, are dominated by the vitreous phase, whereas a small amount of the crystalline component is readily apparent by XRD. The results of our combined experimental and theoretical studies have implications for detecting vitreous phases of water, survival of biological systems under extreme conditions, and biological imaging. The results provide additional insight into the stable and metastable phases of H₂O as a function of pressure and temperature, as well as of other materials undergoing pressure-induced amorphization and other metastable transitions.

Life as we know it on Earth depends on water. However, water also poses a critical challenge to life when it freezes at atmospheric pressure and low temperatures. The crystallization of H₂O to form hexagonal ice (ice Ih) under these conditions is accompanied by its well-known expansion, which has a dramatic impact on the structure and function of living cells. This crystallization of H₂O disrupts biological membranes and intracellular organization in living organisms and also displaces and concentrates salts and nutrients in the space between crystals (1). Like many liquids, however, rapid cooling of H₂O at ambient pressure to below its glass-transition temperature results in the formation of an amorphous phase known as low-density amorphous ice. Amorphous solid H₂O provides a chance for biological functions to survive where life otherwise cannot exist. Low-density amorphous ice is not the only amorphous form of H₂O. Ice I_h transforms to high-density amorphous (HDA) ice by application of ∼1 GPa of pressure at temperatures below 130 K (2, 3). In addition, a distinct, very-high-density amorphous state (vHDA) can form by isobaric heating and cooling of the HDA (4). low-density amorphous, high-density amorphous, and very-high-density amorphous state ice thus represent the three dominant, solid amorphous forms of H₂O at low temperatures.Solid amorphous phases of H₂O are broadly important in biology and biological applications. That amorphous H₂O which can exist over a broad range of temperatures, from cryogenic conditions to room temperature, is particularly interesting in the context of biological systems. Managing ice crystals is vital for extremophiles to survive damaging effects of H₂O crystallization. These organisms inhibit the growth of ice crystals and regulate the size and shape of the crystals using special antifreeze proteins (5, 6). Additionally, amorphous phases of H₂O are important in preserving biological samples in cryotomography applications. In cryotomography, the amorphous H₂O at low temperature is utilized routinely for sample preparation (7, 8), and significant efforts have been devoted to increase information obtained from cryotomography techniques. The low-temperature regime of amorphous H₂O routinely accessed in cryotomography creates challenges for light microscopy due to freezing of index-matching medium and objectives, which result in lowering the resolution of light microscopy in these applications. Room-temperature amorphous phases of H₂O are, therefore, advantageous for light microscopy applications and further development of techniques such as correlative light and electron microscopy (9–11).While formation of amorphous phases of H₂O below 200 K has been reported in many studies (2, 3, 12–16), a particularly interesting result is the observation of the Raman signature of HDA ice during fast compression of water at room temperature and moderate pressures (17). On the other hand, independent X-ray diffraction (XRD) measurements of H₂O on fast compression could not verify the formation of amorphous H₂O above 200 K (18). Here, we report high-resolution micro-Raman and synchrotron XRD measurements conducted in parallel in rapidly compressed samples of water in diamond anvil cells (DACs). Our findings, that are supported by molecular dynamics simulations, shed light on the nature of the HDA ice at room temperature and reconciled conflicting previous reports.     

Feasibility of Spotlight Consultations Tool in Routine Care: Real-World Evidence

Background:Burnout in people with diabetes and healthcare professionals (HCPs) is at an all-time high. Spotlight AQ, a novel “smart” adaptive patient questionnaire, is designed to improve consultations by rapidly identifying patient priorities and presenting these in the context of best-practice care pathways to aid consultations. We aimed to determine Spotlight AQ’s feasibility in routine care.Materials and Methods:The Spotlight prototype tool was trialed at three centers: two UK primary care centers and one US specialist center (June-September 2020). Participants with type 1 (T1D) or type 2 diabetes (T2D) completed the questionnaire prior to their routine consultations. Results were immediately available and formed the basis of the clinical discussion and decision-making within the clinic visit.Results:A convenience sample of 49 adults took part, n=31 T1D, (n=18 female); and n=18 T2D (n=10 male, n=4 female, n=4 gender unreported). Each identified two priority concerns. “Psychological burden of diabetes” was the most common priority concern (T1D n = 27, 87.1%) followed by “gaining more skills about particular aspects of diabetes” (T1D n=19, 61.3%), “improving support around me” (n=8, 25.8%) and “diabetes-related treatment issues” (n=8, 25.8%). Burden of diabetes was widespread as was lack of confidence around self-management. Similarly, psychological burden of diabetes was the primary concern for participants with T2D (n=18,100%) followed by “gaining more skills about aspects of diabetes” (n=7, 38.9%), “improving support around me” (n=7, 38.9%) and “diabetes-related treatment issues” (n=4; 22.2%).Conclusions:Spotlight AQ is acceptable and feasible for use in routine care. Gaining more skills and addressing the psychological burden of diabetes are high-priority areas that must be addressed to reduce high levels of distress.     

Comparison of nighttime and daytime operation on outcomes of supracondylar humeral fractures: A prospective observational study

Supracondylar humeral fractures are seen in children and treatment is usually closed reduction and percutaneous pinning (CRPP). This surgery can be performed at night, depending on its urgency. Fatigue and sleep deprivation can impact performance of doctors during night shifts. The purpose of this study is to investigate the association between night shifts postoperative morbidity and mortality of supracondylar fracture operations compared to daytime procedures.This prospective observational study included 94 patients who were aged 5 to 12 years with ASA I to III who had supracondylar humeral fractures, underwent CRPP under general anesthesia. Patients were stratified by the time of surgery using time of induction of anesthesia as the starting time of the procedure, into 2 groups: day (07:30 am–06:29 pm) and night (06:30 pm–07:29 am). In total, 82 patients completed the study: 43 in Group Day and 39 in Group Night.The operation duration in Group Night (114.66 ± 29.46 minutes) was significantly longer than in Group Day (84.32 ± 25.9 minutes) (P = .0001). Operation duration (OR: 0.007; P = .0001) and morbidities (OR: 0.417; P = .035) were independent risk factors in Group Night.Children who had supracondylar humeral fractures, undergoing urgent CRPP surgery, in-hospital mortality was associated with the time of day at which the procedure was performed. Patient safety is critically important for pediatric traumatic patient population. Therefore, we suggested to increase the number of healthcare workers and improve the education and experience of young doctors during night shifts.     

EPIDEMIOLOGIE DE L’HYPERTENSION ARTERIELLE EN TUNISIE.Etude Hammam Sousse/Sahloul Heart Study (HSHS)

Introduction: Tunisia is experiencing a double burden of morbidity, characterized by the explosion of cardiovascular diseases and their risk factors including arterial Hypertension. The objective of this study, based on the HSHS cohort (Hammam Sousse Sahloul Heart Study), was to determine the prevalence of hypertension in the general population and to identify its predisposing factors. Methods: HSHS is a cardiovascular health promotion initiative in the city of Hammam Sousse (Tunisia). The study was conducted via a random sample of households, using the WHO PEV technique, made up of 33 clusters, of 33 households each. All people aged 20 and over, included, benefited from a questionnaire, a physical examination and a biological assessment. The Systolic Blood Pressure (SBP) and the Diastolic Blood Pressure (DBP) were measured from the average of the last two measurements, by an OMRON type tensiometer, of suitable width. These prevalences were adjusted according to sex and age group, by their weighting coefficients in the general population, and they were accompanied by their 95% CIs. Binary logistic regression was conducted to identify independent factors associated with hypertension. Results: The study population was composed of 481 men (33.4%) and 960 women (66.6%), with an average age of 49.6±16.35 years in males (M) and 46.6±16.18 in females (F). In addition to the family history of hypertension, the sufficient weekly consumption of vegetables and fruits was low (M: 32.4%, F: 24.9%). The adjusted rate of hypertension in the adult study population was 32.5%, 95%CI[31.9-33.1] (M: 36.4%, 95%CI[35, 5-37.3]; F: 28.4%; 95% CI[27.6-29.2]), reaching in the age group of 60 years and above: M: 74.6% (95%CI[66.9-82.3], F: 82.7% (95%CI[73.8-83.6]) Multivariate analysis identified five independent factors significantly associated with hypertension: male sex (ORa=1.55 [1.18-2.03]), age over 40 years (ORa=6.54[4.70-9.11]), low level of schooling (ORa=1.80 [1.36-2.38]), low physical activity (ORa=1.42[1.07-1.88]) and high socio-economic level (ORa=1 .84 [1.30-2.63]). Conclusion: The HSHS study confirmed the high prevalence of hypertension, and the extent of its low detection and control. Hence the need for a universal approach to health promotion, oriented towards the general population, piloted by its local organizations, based on the adoption of a healthy lifestyle, and centered on physical activity.     

Omega-9 Modifies Viscoelasticity and Augments Bone Strength and Architecture in a High-Fat Diet-Fed Murine Model

The influence of diet on the development of osteoporosis is significant and not fully understood. This study investigated the effect of diets of varying lipid profiles and ω-3, ω-6 and ω-9 composition on the structural and mechanical properties of bone. The hypothesis studied was that a diet high in saturated fat would induce osteoporosis and produce an overall increased detrimental bony response when compared with a diet high in unsaturated ω-6, or ω-9. Male C57BL/6J mice were fed either a control diet, 50:50 mix (saturated:unsaturated) high in ω-9 (HFD^50:50), a diet high in saturated fat (HSF) or a polyunsaturated fat diet high in ω-6 (PUFA) over an 8-week duration. Tibiae were retrieved and evaluated using DMA, 3-point-bending, histomorphometry, and microCT. Mice fed a HSF diet displayed key features characteristic of osteoporosis. The loss tangent was significantly increased in the HFD^50:50 diet group compared with control (p = 0.016) and PUFA-fed animals (p = 0.049). HFD^50:50-fed mice presented with an increased viscous component, longer tibiae, increased loss modulus (p = 0.009), and ultimate stress, smaller microcracks (p < 0.001), and increased trabecular width (p = 0.002) compared with control animals. A diet high in ω-9 resulted in an overall superior bone response and further analysis of its role in bone health is warranted.