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Background: Sri Lanka is a leading nation in healthcare provision in the South Asia. Notably, it recorded amongst the lowest maternal and neonatal mortality rates in the region. However a significant deficit in improving all-cause mortality rates was the absence of a cohesive system of pre-hospital care., Method: This narrative review delves into the evolution of Sri Lanka's Emergency Medical Services (EMS) system over the past decade. It examines the historical context, challenges encountered, and the transformative role of the "1990 Suwa Seriya" ambulance service on all causes of morbidity and mortality rates including out-of-hospital cardiac arrest (OHCA)., Results: The review elucidates the path from no organised pre-hospital system in 2015 to a comprehensive free to public, pre-hospital care emergency ambulance service that effectively serves 22 million people nationa-wide in 6 short years. Collaborations with emergency medicine, novel approaches to training and credentialing, as well as evolving research initiatives illustrate an approach to be emulated in countries with emerging pre-hospital systems. 1990 Suwa Seriya's response during the COVID-19 pandemic and its implications on public perception are discussed in conjunction with efforts to limit morbidity and mortality from OHCA., Conclusion: In conclusion, the article underscores 1990 Suwa Seriya's dedication to continuous improvement and its potential as a model for bolstering emergency healthcare. By addressing challenges, fostering collaborations, and adapting to crises like the COVID-19 pandemic, 1990 Suwa Seriya exemplifies a pathway towards elevating pre-hospital care standards in lower-middle-income countries (LMICs)., Competing Interests: Sri Lal De Silva is the Chief Medical Officer and Sohan de Silva is the Chief Executive Officer of 1990 Suwa Seriya Foundation., (© 2024 The Author(s).)

Zircon double dating (ZDD) of comendite lava reveals an eruption age of 7.0 ± 0.9 ka for the Qixiangzhan eruption (QXZ), Changbaishan-Tianchi volcano, China/DPRK. This age is supported by new 40 Ar/ 39 Ar sanidine experiments and a previous age control from charcoal at the base of the QXZ. The revised age supports correlations with distal ash in Eastern China and Central Japan and establishes a significant (estimated at Volcanic Explosivity Index 5+) eruption that may provide a useful Holocene stratigraphic marker in East Asia. The new age indicates that the QXZ lava does not record a ca. 17 ka Hilina Pali/Tianchi geomagnetic field excursion but rather a heretofore unrecognized younger Holocene excursion at ca. 7-8 ka. Comparison between U-Th zircon crystallization and ZDD as well as 40 Ar/ 39 Ar sanidine ages indicates a protracted period of accumulation of the QXZ magma that extends from ca. 18 ka to the eruption age. This connotes an eruption that mixed remobilized early formed crystals (antecrysts) from prior stages of magma accumulation with crystals formed near the time of eruption. Based on these results, a recurrence rate of ca. 7-8 ka for the Changbaishan-Tianchi magma system is found over the last two major eruption cycles., (© 2022. The Author(s).)

Objective: Ultrasonography remains the initial imaging modality in the management of biliary disease. This study is designed to evaluate the accuracy of transabdominal ultrasonography in diagnosing biliary pathology in patients with choledocholithiasis., Methods: This was a retrospective study of a continuous sample of patients over a period of 3 years ending in January 2016; these patients were referred for endoscopic management of choledocholithiasis to a tertiary care hospital in Colombo, Sri Lanka. Ultrasound reporting was carried out by different consultant radiologists at both the index and the referring hospitals. The findings of endoscopic retrograde cholangiograms were compared with the ultrasound scan (USS) results., Results: A total of 247 patients were included in the study. USS was 97.4% accurate in detecting intrahepatic duct dilatation (IHDD). Stone counts and the location of stone(s) in the USSs correlated strongly with the number of stones delivered during endoscopic removal and their location in cholangiograms ( P < 0.001). The difference in mean diameter of the common bile duct (CBD) of patients with choledochal cysts (CCs) (18.57 mm) and of patients without them (12.39 mm) is statistically significant ( P < 0.001). At 14.5 mm, the negative predictive value for a CC is 99.02%., Conclusion: Ultrasonography is a reliable tool in predicting IHDD, stone count, and the location of stones in the biliary tree, particularly in a resource-poor setting. A CBD diameter of 14.5 mm in transabdominal ultrasound scan can be used as a cutoff for predicting extrahepatic CC., Competing Interests: There are no conflicts of interest.

Large calderas, or supervolcanoes, are sites of the most catastrophic and hazardous events on Earth, yet the temporal details of post-supereruption activity, or resurgence, remain largely unknown, limiting our ability to understand how supervolcanoes work and address their hazards. Toba Caldera, Indonesia, caused the greatest volcanic catastrophe of the last 100 kyr, climactically erupting ∼74 ka. Since the supereruption, Toba has been in a state of resurgence but its magmatic and uplift history has remained unclear. Here we reveal that new 14 C, zircon U-Th crystallization and (U-Th)/He ages show resurgence commenced at 69.7±4.5 ka and continued until at least ∼2.7 ka, progressing westward across the caldera, as reflected by post-caldera effusive lava eruptions and uplifted lake sediment. The major stratovolcano north of Toba, Sinabung, shows strong geochemical kinship with Toba, and zircons from recent eruption products suggest Toba's climactic magma reservoir extends beneath Sinabung and is being tapped during eruptions.

The Altiplano-Puna Magma Body (APMB) in the Central Andes is the largest imaged magma reservoir on Earth, and is located within the second highest orogenic plateau on Earth, the Altiplano-Puna. Although the APMB is a first-order geologic feature similar to the Sierra Nevada batholith, its role in the surface uplift history of the Central Andes remains uncertain. Here we show that a long-wavelength topographic dome overlies the seismically measured extent of the APMB, and gravity data suggest that the uplift is isostatically compensated. Isostatic modelling of the magmatic contribution to dome growth yields melt volumes comparable to those estimated from tomography, and suggests that the APMB growth rate exceeds the peak Cretaceous magmatic flare-up in the Sierran batholith. Our analysis reveals that magmatic addition may provide a contribution to surface uplift on par with lithospheric removal, and illustrates that surface topography may help constrain the magnitude of pluton-scale melt production.

Objective: Infection with hepatitis B (HBV) and hepatitis C (HCV) viruses is relatively common throughout South-East Asia and chronic infection can lead to severe consequences. This study assesses knowledge about HBV and HCV and estimates the seroprevalence of markers for these viruses in immigrants from Laos and Cambodia., Methods: Ninety-five Laotian (aged 18-82 years) and 234 Cambodian (15-92 years) immigrants participated in separate community-based surveys conducted during 1998 and 2002, respectively. Participants completed a questionnaire on health status and level of knowledge about viral hepatitis. Blood samples were collected and tested for the presence of HBV and HCV markers., Results: Nine per cent of Laotian and 8% of Cambodian participants were infected with HBV. While 49% of Laotian and 64% of Cambodian participants showed evidence of previous exposure to HBV, 30% and 9%, respectively, were vulnerable to infection. The seroprevalence of antibodies to HCV was 3% in the Laotian and 8% in the Cambodian participants. Between one-fifth and one-third of the Laotians and Cambodians who had heard of HBV and HCV knew of possible transmission routes for the viruses. Most of those with HBV or HCV infection were unaware they were infected., Conclusions: These findings indicate a significant prevalence of undetected HBV and HCV infections and an urgent need for the provision of culturally relevant information about viral hepatitis in immigrants of South-East Asian origin.