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The frequency, social, and economic impacts of natural disasters show exponential increases in recent decades. Cities and countries around the world have begun to realize that these events are no longer "hundred year" storms, but repeat within a few years. As urbanisation continues throughout this century, more and more people and more economic activity will be concentrated in at-risk areas; especially as new arrivals in cities throughout Asia and Africa are likely to be concentrated in the highest risk districts, much as they often are in North America and Europe today. This article reviews recent growth of natural disasters and considers how a systems approach can improve approaches to mitigation and adaptation of these risks and to recovery from such events., (© 2016 Elsevier B.V. All rights reserved.)

Introduction: Limited data suggest mild hypernatremia may be related to lower intracranial pressure (ICP) in patients with traumatic brain injury (TBI). The practice at the study center has been to use hypertonic saline (HTS) to generate a targeted serum sodium of 145 to 155 mEq/l in patients with TBI. The purpose of this study was to determine the relationship between serum sodium values and ICP, and to evaluate the acute effect of HTS on ICP., Methods: A retrospective review of patients who were admitted to the trauma ICU for TBI, had an ICP monitor placed, and received at least one dose of HTS between January 2006 and March 2011 was performed. Data were collected for up to 120 hours after ICP monitor placement. The primary outcome was the relationship between serum sodium and maximum ICP. Secondary outcomes were the relationship between serum sodium and the mean number of daily interventions for ICP control, and the acute effect of HTS on ICP during the 6 hours after each dose. Linear regression was used to analyze the primary outcome. Analysis of variance on ranks and repeated measures analysis of variance were used to evaluate the number of interventions and the acute effect of HTS on ICP, respectively., Results: Eighty-one patients were enrolled with mean ± standard deviation age of 36 ± 15 years and median Glasgow Coma Scale score of 7 (interquartile range, 4 to 7). A total of 1,230 serum sodium values (range, 118 to 174 mEq/l) and 7,483 ICP values (range, 0 to 159 mmHg) were collected. There was no correlation between serum sodium and maximum ICP (R(2) = 0.0052). The overall mean ± standard deviation number of interventions for elevated ICP per day was 4.2 ± 2.9, 2.9 ± 2.0, and 2.6 ± 2.3 for patients with a mean serum sodium of < 145, 145 to 155, and > 155 mEq/l, respectively (P < 0.001). Regarding the acute effect of HTS on ICP, there was no statistical difference in mean ICP compared with baseline during hours 1 through 6 following HTS doses (baseline, 13.7 ± 8.4 mmHg; hour 1, 13.6 ± 8.3 mmHg; hour 2, 13.5 ± 8.8 mmHg; hour 3, 13.3 ± 8.7 mmHg; hour 4, 13.4 ± 8.7 mmHg; hour 5, 13.4 ± 8.3 mmHg; hour 6, 13.5 ± 8.3 mmHg; P = 0.84)., Conclusions: Serum sodium concentrations did not correlate with ICP values. These results warrant further evaluation and possible reassessment of sodium goals for ICP management in patients with TBI.

We analyze the structure and assess the deformation history of the Tierra Caliente Metamorphic Complex (TCMC) of southern Mexico, where Laramide accretion of exotic terranes is in debate. The TCMC consists of a south-plunging antiform fault that is bounded on both its eastern and western flanks. Tierra Caliente Metamorphic Complex rocks show at least two phases of compressional deformation. The first and most prominent records a mean tectonic transport direction of 068 degrees. This phase is responsible for east-verging asymmetrical folding and thrusting of both metamorphic and superjacent sedimentary rocks. The second phase has an average transport direction of 232 degrees and is restricted to the western portion of the TCMC. A third phase is responsible for normal faulting. Lack of discernible deformation before Late Cretaceous time indicates that the main deformation phase is coincident with Laramide orogenesis elsewhere in the North American Cordillera. The stratigraphy, structure, and deformational history of the TCMC do not require accretion of exotic terranes. We explain the Mesozoic tectonostratigraphic evolution of the TCMC in terms of deposition and deformation of Mesozoic volcanic and sedimentary strata over the attenuated continental crust of the North American plate.

The aim of the study was to carry out an audit of 283 hysterectomies performed for menstrual disorders over a one year period, and to determine the satisfaction of the women concerned towards their treatment. The medical records of these patients were examined, and they were each sent a questionnaire, 69% of which were completed and returned. The most common presenting symptoms were menorrhagia and dysmenorrhoea. In 53% of cases no clinical abnormality was postulated and in 31% of cases no pathological abnormality was found. The preoperative clinical and pathological diagnoses were in agreement for 59% of patients. Over 90% of women were satisfied with the management of their case by their GP and the gynaecology outpatient clinic. The use of patient-controlled analgesia systems was associated with better post-operative pain relief than intramuscular injections. Thirteen percent of patients required blood transfusion; 21% suffered some form of postoperative complication, most of which were minor. Ninety-four percent of the women were pleased that they had undergone hysterectomy, and 76% wished that they had had the operation sooner. It was concluded that hysterectomy is perceived positively by patients and should not necessarily be considered as a last resort treatment for menstrual disorders.

It is well established that the spin-lattice magnetic relaxation rate 1/T1 of solvent protons in homogeneous protein solutions increases dramatically as the magnetic field is reduced well below the traditional NMR range. For a 5% solution of protein of 10(5) Daltons, for example, 1/T1 increases from about 50% above the pure solvent rate at 20 MHz to five times the solvent rate at 0.01 MHz. At higher fields, the effect of protein on the relaxation rate decreases progressively toward zero. 1/T1 of solvent in erythrocyte suspension behaves similarly, indicating that extracellular water has ready access to intracellular protein. We now report analogous data for samples of various mammalian tissues: we find that the data can be accommodated within the conceptual framework developed earlier for analyzing homogeneous protein solutions. It appears that tissue water probes the macromolecular composition and structure in a tissue-specific fashion. The variation of 1/T1 with field differs for each tissue, and its magnitude at low fields varies by more than a factor of three, far more than does the water content of the tissues. The relevance to contrast in NMR imaging is discussed.

The Point Spread Function (PSF) in NMR imaging is the result of both the line broadening due to magnet field inhomogeneity and the intrinsic spectrum of the nucleus at resonance. In the case of proton imaging, the line broadening dominates the small chemical shifts and the spectral lines are not resolved. This is not generally the case with other nuclei having strong chemical shifts and the PSF then has a complex structure. During imaging, the complex PSF is convolved with the spatial distribution of the nucleus at resonance and this leads to halo artifacts which are dependent on the imaging technique employed. The images due to the ensemble of spectral lines can be separated in principle by deconvolution of the data with the PSF before reconstruction. In the special case where the complex PSF is spatially independent, it can be obtained from the Free Induction Decay (FID) data produced in the absence of a spatially encoding gradient field. This technique has been successfully applied to in-vivo imaging of exogenous perfluorocarbon material.

In vivo magnetic resonance imaging (MRI) has employed almost exclusively the proton because of its high gyromagnetic ratio and natural abundance relative to other nuclei. Recent research has focused on imaging using nuclei other than 1H, but has been limited by the decreased sensitivity and/or low biologic concentrations of the nuclei. Fluorine (19F), with a gyromagnetic ratio second only to that of hydrogen, is a theoretically attractive nucleus for MRI, but fluorine is present in only minute amounts in most tissues. Perfluorochemical emulsions (PFC), developed as blood replacement agents, appear to be safe vehicles for fluorine administration. We report our initial results of in vivo 19F magnetic resonance imaging of liver, tumor, and abscess in rats given exogenous fluorine.