Risk of flood-related mortality in Nepal

In July 1993, severe flooding devastated Sarlahi district in Nepal. The next month, a follow-up study of a large population cohort was undertaken. The study is unique in that a prospective research database was used to verify residency prior to the flood and to confirm vital status afterwards. It evaluated 41,501 children aged between two and nine years and adults aged 15-70 in 7,252 households. Flood-related fatality rates were 13.3 per 1,000 for girls and 9.4 per 1,000 for boys, 6.1 per 1,000 for women and 4.1 per 1,000 for men. Flood-related fatality rates for children were six times higher than mortality rates in the same villages a year before the flood (relative risk (RR) = 5.9, 95 per cent confidence interval (CI) 5.0-6.8). Flood-related fatality was associated with low socio-economic status preflood (RR = 6.4, 95 per cent CI 2.7-20.0), and having a house constructed of thatch (RR = 5.1, 95 per cent CI 1.7-24.5).     

Avian Mortality at Oil Pits in the United States: A Review of the Problem and Efforts for Its Solution

Oil production operations produce waste fluids that may be stored in pits, open tanks, and other sites accessible to wildlife. Birds visit these fluid-filled pits and tanks (“oil pits”), which often resemble water sources, and may become trapped and die. The US Fish and Wildlife Service (USFWS) has a program to reduce these impacts by locating problem pits, documenting mortality of protected wildlife species, and seeking cleanup or corrective action at problem pits with the help of state and federal agencies regulating the oil industry. Species identification and verification of protected status for birds recovered from oil pits are performed at the USFWS National Fish and Wildlife Forensics Laboratory. From 1992 to 2005, a minimum of 2060 individual birds were identified from remains recovered from oil pits, representing 172 species from 44 families. The taxonomic and ecological diversity of these birds indicates that oil pits pose a threat to virtually all species of birds that encounter them. Ninety-two percent of identified bird remains belonged to protected species. Most remains identified at the Forensics Laboratory were from passerines, particularly ground-foraging species. Based on Forensics Laboratory and USFWS field data, oil pits currently cause the deaths of 500,000–1 million birds per year. Although law enforcement and industry efforts have produced genuine progress on this issue, oil pits remain a significant source of mortality for birds in the United States.     

Mortality Risk in Pediatric Motor Vehicle Crash Occupants: Accounting for Developmental Stage and Challenging Abbreviated Injury Scale Metrics

Objective: Survival risk ratios (SRRs) and their probabilistic counterpart, mortality risk ratios (MRRs), have been shown to be at odds with Abbreviated Injury Scale (AIS) severity scores for particular injuries in adults. SRRs have been validated for pediatrics but have not been studied within the context of pediatric age stratifications. We hypothesized that children with similar motor vehicle crash (MVC) injuries may have different mortality risks (MR) based upon developmental stage and that these MRs may not correlate with AIS severity.

Methods: The NASS-CDS 2000–2011 was used to define the top 95% most common AIS 2+ injuries among MVC occupants in 4 age groups: 0–4, 5–9, 10–14, and 15–18 years. Next, the National Trauma Databank 2002–2011 was used to calculate the MR (proportion of those dying with an injury to those sustaining the injury) and the co-injury-adjusted MR (MR_MAIS) for each injury within 6 age groups: 0–4, 5–9, 10–14, 15–18, 0–18, and 19+ years. MR differences were evaluated between age groups aggregately, between age groups based upon anatomic injury patterns and between age groups on an individual injury level using nonparametric Wilcoxon tests and chi-square or Fisher's exact tests as appropriate. Correlation between AIS and MR within each age group was also evaluated.

Results: MR and MR_MAIS distributions of the most common AIS 2+ injuries were right skewed. Aggregate MR of these most common injuries varied between the age groups, with 5- to 9-year-old and 10- to 14-year-old children having the lowest MRs and 0- to 4-year-old and 15- to 18-year-old children and adults having the highest MRs (all P <.05). Head and thoracic injuries imparted the greatest mortality risk in all age groups with median MR_MAIS ranging from 0 to 6% and 0 to 4.5%, respectively. Injuries to particular body regions also varied with respect to MR based upon age. For example, thoracic injuries in adults had significantly higher MR_MAIS than such injuries among 5- to 9-year-olds and 10- to 14-year-olds (P =.04; P <.01). Furthermore, though AIS was positively correlated with MR within each age group, less correlation was seen for children than for adults. Large MR variations were seen within each AIS grade, with some lower AIS severity injuries demonstrating greater MRs than higher AIS severity injuries. As an example, MR_MAIS in 0- to 18-year-olds was 0.4% for an AIS 3 radius fracture versus 1.4% for an AIS 2 vault fracture.

Conclusions: Trauma severity metrics are important for outcome prediction models and can be used in pediatric triage algorithms and other injury research. Trauma severity may vary for similar injuries based upon developmental stage, and this difference should be reflected in severity metrics. The MR-based data-driven determination of injury severity in pediatric occupants of different age cohorts provides a supplement or an alternative to AIS severity classification for pediatric occupants in MVCs.     

Evaluating mortality rates with a novel integrated framework for nonmonogamous species

The conservation of wildlife requires management based on quantitative evidence, and especially for large carnivores, unraveling cause‐specific mortalities and understanding their impact on population dynamics is crucial. Acquiring this knowledge is challenging because it is difficult to obtain robust long‐term data sets on endangered populations and, usually, data are collected through diverse sampling strategies. Integrated population models (IPMs) offer a way to integrate data generated through different processes. However, IPMs are female‐based models that cannot account for mate availability, and this feature limits their applicability to monogamous species only. We extended classical IPMs to a two‐sex framework that allows investigation of population dynamics and quantification of cause‐specific mortality rates in nonmonogamous species. We illustrated our approach by simultaneously modeling different types of data from a reintroduced, unhunted brown bear (Ursus arctos) population living in an area with a dense human population. In a population mainly driven by adult survival, we estimated that on average 11% of cubs and 61% of adults died from human‐related causes. Although the population is currently not at risk, adult survival and thus population dynamics are driven by anthropogenic mortality. Given the recent increase of human‐bear conflicts in the area, removal of individuals for management purposes and through poaching may increase, reversing the positive population growth rate. Our approach can be generalized to other species affected by cause‐specific mortality and will be useful to inform conservation decisions for other nonmonogamous species, such as most large carnivores, for which data are scarce and diverse and thus data integration is highly desirable.     

癌症与土壤环境中Sn元素的关系

利用土壤环境资料中关于锡元素的32335个数据,癌死亡调查资料787080例,研究了胃癌、食管癌、肝癌、宫颈癌、肺癌、大肠癌、白血病、鼻咽癌、乳腺病死亡率与人鲜生活区土壤环境中锡元素的关系,结果表明。食管癌死亡率与生活区土壤中锡元素质量分数的相关性显著,肝癌、宫颈癌、鼻咽癌死亡率与生活区土壤中锻元素质量分数的相关性极显著,而胃癌、肺癌、大肠癌、白血病、乳腺癌死亡率与生活区土壤中锡元素质量分数的相共性下显著。     

鼻咽癌与土壤环境中化学元素的相关性研究

利用土壤元素数据２０６９４４８个,鼻咽癌死亡调查资料２２５６０例,研究了鼻咽癌死亡率与土壤环境中６１个元素质量分数的相关性。结果表明,汞、铅、硒、针、锡、钛、钽、溴、碘元素质量分数与鼻咽癌死亡率呈非常显著的正相关;铪元素质量分数与鼻咽癌死亡率呈显著的正相关;铟、镱、镥、铀、锆、铋、碲元素质量分数与鼻咽癌死亡率呈较显著的正相关。锰、钠、镁、钙、锶元素质量分数与鼻咽癌死亡率呈非常显著的负相关;钾、钡元素质量分数与鼻咽癌死亡率呈较显著的负相关。钒、铷、铯、银、铝、镓、铊、钪、钇、镧、铈、钕、钆、镝、钬、铒、铥、钼、钨、铁、砷、镉、钴、铬、铜、氟、镍、锌、锂、铍、硼、镨、钐、铕、铽、锗、锑元素质量分数与鼻咽癌死亡率无明显的相关性。     

Suicide bombings: process of care of mass casualties in the developing world

In recent times Pakistan's biggest city, Karachi, has witnessed numerous terrorist attacks. The city does not have an emergency response system and only one of the three public sector hospitals has a trauma centre. We describe the pattern of injuries and management of two terror-related mass casualty incidents involving suicide bombers in a developing nation with limited resources. The first incident occurred in May 2002 with 36 casualties, of whom 13 (36%) died immediately and 11 (30.5%) died at the primary receiving hospitals. The second incident was targeted against the local population in May 2004. The blast resulted in 104 casualties, of which 14 (13.46%) died at the site. All patients had their initial assessment and treatment based on Advanced Trauma and Life Support principles and documented on a trauma form.     

Mortality rate and confidence interval estimation in humanitarian emergencies

Surveys are conducted frequently in humanitarian emergencies to assess the health status of the population. Most often, they employ complex sample designs, such as cluster sampling. Mortality is an indicator commonly estimated in such surveys. Confidence limits provide information on the precision of the estimate and it is important to ensure that confidence limits for a mortality rate account for the survey design and utilise an acceptable methodology. This paper describes the calculation of confidence limits for mortality rates from surveys using complex sampling designs and a variety of software programmes and methods. It contains an example that makes use of the SAS, SPSS, and Epi Info software programmes. Of the three confidence interval methods examined—the ratio command approach, the modified rate approach, and the modified proportion approach—the paper recommends the ratio command approach to estimate mortality rates with confidence limits.     

Parental condition, brood sex ratio and differential young survival: an experimental study in gulls (Larus fuscus)

Empirical evidence is growing that the offspring sex ratio in birds can be biased in relation to the body condition of parents during breeding. The sex ratio bias may come about because (1) the actual production of the two sexes may be skewed and/or (2) there may be a sex bias in early nestling mortality contingent on parental condition. By manipulating parental condition and giving them a control brood to rear, thereby eliminating effects operating via the eggs, we examined the extent to which parental condition influences the post-hatching survival of male and female lesser black-backed gulls, Larus fuscus. We found that the pre-fledging survival of male chicks was strongly reduced in all-male broods reared by parents in poor condition. Pre-fledging survival of female chicks was, however, unaffected by parental condition or brood sex composition. Thus, independently of any production biases, sex differences in nestling mortality alone can bias the offspring sex ratio at fledging in relation to the prevailing rearing conditions. In other studies on gulls we have, however, also shown that females in poor condition at laying preferentially produce female eggs. Clearly a bias in fledging sex ratio can occur within the same species due to a combination of differential production and differential post-laying mortality; the latter can involve a differential effect of poor egg quality on male and female offspring, differential effects of brood sex composition on their survival and a difference in the capacity of parents to rear males and females. All of these processes need to be taken into account in attempting to understand offspring sex ratios. Received: 15 February 2000 / Revised: 7 August 2000 / Accepted: 26 August 2000     

Variations in the birth sex ratio and neonatal mortality in a natural herd of horses

Variations in birth sex ratios and sex differences in juvenile mortality occur in a number of mammalian species, and in many cases have been linked to resource availability. Most of these biases in offspring sex ratios concern polygynous species with pronounced sexual dimorphism, and where females only are philopatric. Data on species with unusual life-history strategies, such as slight sexual dimorphism or dispersal by both sexes, are of particular interest. In this study of a natural herd of horses (Equus caballus) which experienced an eruptive cycle, and therefore a period of nutritional stress, male offspring had higher neonatal mortality rates in nutritionally poor years than in good ones, whereas “year quality” had no effect on the mortality of female offspring; year quality could therefore be used by mares as predictor of sex-specific offspring survival. We show that the environmental conditions that predicted lower survival of males were negatively related to their production: the birth sex ratio the following year was female-biased; and mares were less likely to produce a son when they had produced a son the preceding year. There was no significant effect of mother's parity, age or rank, or the timing of conception or birth on offspring sex ratios. The mechanism leading to biases in the birth sex ratio could have been the loss of male embryos by mares that did not foal. As there was no evidence for selective abortion of male foetuses in females that did foal the next year, it is not necessary to invoke maternal adjustment, though this remains a possibility. Finally, there was a suggestion that male offspring were more costly to raise than females, since mothers that reared a son in poor years tended to experience an increase in the interbirth interval between their two subsequent offspring. Received: 28 December 1996 / Accepted after revision: 27 July 1997