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Terrorist Attacks against Hospitals: World-Wide Trends and Attack Types
- Nitzan Ulmer, Dennis G. Barten, Harald De Cauwer, Menno I. Gaakeer, Vincent W. Klokman, Monique van der Lugt, Luc J. Mortelmans, Frits H.M. van Osch, Edward C.T.H. Tan, Arjen Boin
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- Journal:
- Prehospital and Disaster Medicine / Volume 37 / Issue 1 / February 2022
- Published online by Cambridge University Press:
- 18 January 2022, pp. 25-32
- Print publication:
- February 2022
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Background:
Analysts have warned on multiple occasions that hospitals are potential soft targets for terrorist attacks. Such attacks will have far-reaching consequences, including decreased accessibility, possible casualties, and fear among people. The extent, incidence, and characteristics of terrorist attacks against hospitals are unknown. Therefore, the objective of this study was to identify and to characterize terrorist attacks against hospitals reported to the Global Terrorism Database (GTD) over a 50-year period.
Methods:The GTD was used to search for all terrorist attacks against hospitals from 1970-2019. Analyses were performed on temporal factors, location, attack and weapon type, and number of casualties or hostages. Chi-square tests were performed to evaluate trends over time and differences in attack types per world region.
Results:In total, 454 terrorist attacks against hospitals were identified in 61 different countries. Of these, 78 attacks targeted a specific person within the hospital, about one-half (52.6%) involved medical personnel. There was an increasing trend in yearly number of attacks from 2008 onwards, with a peak in 2014 (n = 41) and 2015 (n = 41). With 179 incidents, the “Middle East & North Africa” was the most heavily hit region of the world, followed by “South Asia” with 125 attacks. Bombings and explosions were the most common attack type (n = 270), followed by 77 armed assaults. Overall, there were 2,746 people injured and 1,631 fatalities. In three incidents, hospitals were identified as secondary targets (deliberate follow-up attack on a hospital after a primary incident elsewhere).
Conclusion:This analysis of the GTD identified 454 terrorist attacks against hospitals over a 50-year period. It demonstrates that the threat is real, especially in recent years and in world regions where terrorism is prevalent. The findings of this study may help to create or further improve contingency plans for a scenario wherein the hospital becomes a target of terrorism.
Reformulation and priorities for reducing energy density; a survey on fat content in cakes and biscuits sold in British supermarkets
- Roberta Alessandrini, Fengjun He, Kawther M. Hashem, Monique Tan, Graham A MacGregor
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- Journal:
- Proceedings of the Nutrition Society / Volume 79 / Issue OCE2 / 2020
- Published online by Cambridge University Press:
- 10 June 2020, E426
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Cakes and biscuits are widely consumed foods and are important contributors of energy, total and saturated fat and sugar in British diets. So far, the UK government has prompted the food industry to reduce energy density in cakes and biscuits mainly through sugar reformulation. However, a government led evaluation has shown that reducing only sugar has lowered energy density minimally. To assess whether total and saturated fat reformulation could be an additional and more effective mechanism for reducing product energy density we conducted a cross-sectional survey of pre-packed cakes and biscuits available in nine UK supermarkets. We collected nutrition information from product packaging. In cakes (n = 381), the mean total fat content was 17.9 ± 5.2g/100 g (39% of the overall energy); range (1.4–35.6g/100g). The average saturated fat content in cakes was 5.9 ± 3.4g/100 g (13% of the overall energy); range (0.3–20g/100g). The average sugar content in cakes was 36.6 ± 7.6 (34% of the overall energy); range (11.3–62.0g/100g). In biscuits (n = 481) the mean total fat content was 21.8g ± 6.3g/100 g (40% of the overall energy); range (0.7–38.9g/100g) and the average saturated fat content was 11.4 ± 4.9 g/100 g (23% of the overall energy); range (0.3–22.3g/100g). The average sugar content in biscuits was 30.0 ± 9.2 (23% of the overall energy); range (12.0–74.0g/100g). In both cakes and biscuits total and saturated fat, but not sugar content, was positively correlated with energy density. According to the nutrient profiling system used by the government, 57% of cakes and 75% of biscuits would receive a red (high) label for total fats; 54% of cakes and 88% of biscuits and would receive a red label for saturated fat.
Our results show that cakes and biscuits sold in UK supermarkets are high in total and saturated fat, and that fat content contributes substantially to product energy density. We observed a large variation in total and saturated fat content within each product category. This finding indicates that reformulation to reduce total and saturated fat and energy density is possible as some manufacturers are already producing cake and biscuits with a more healthful nutrient composition and lower energy density. Fat reformulation in cakes and biscuits and similar products would effectively reduce energy density and calorie intake and thereby prevent obesity. We recommend that fat reformulation should be implemented simultaneously with sugar reformulation and to be focussed where possible on saturated fat, as this will have the additional and independent beneficial effect of lowering LDL cholesterol.
Chapter 11 - MR imaging of the rectum, 3T vs. 1.5T
- Edited by Ihab R. Kamel, The Johns Hopkins University School of Medicine, Elmar M. Merkle, Duke University School of Medicine, North Carolina
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- Book:
- Body MR Imaging at 3 Tesla
- Published online:
- 05 August 2011
- Print publication:
- 04 August 2011, pp 150-163
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Summary
Background
Colorectal cancer is the third most common cancer in men and the second most common cancer in women, with an age-adjusted incidence rate of 46.1 per 100 000 per year in the United Kingdom [1]. The estimated number of deaths in the United States in 2009 was 49 920 [2]. Therefore, colorectal cancer has a high impact on health and society. Until now the precise etiology of rectal cancer has not been clarified. It is currently believed that the etiology is multifactorial, with genetic factors on the one hand and environmental factors, such as diet, smoking, and exercise, on the other hand. Patients usually present with rectal bleeding, weight loss, or abdominal complaints. Based on these symptoms a colonoscopy with biopsy is performed, where a tumor is found. Patients then undergo local staging with MR imaging, which has been proven to be the most accurate modality for staging of rectal cancer [3]. Distant staging is performed with computed tomography (CT) of the abdomen and thorax or a combination of a chest X-ray and an ultrasound of the liver. After staging, the patient is discussed in a multidisciplinary team (MDT) meeting, where the risk profile for recurrence is evaluated. A colorectal MDT consists of surgeons, radiation oncologists, medical oncologists, pathologists, gastroenterologists, and radiologists. Over the years, the role of the radiologist in the MDT has evolved from a reporting role to a full sparring partner in clinical decision-making. Because the aim of imaging of rectal cancer is to determine the risk profile of the patient, which defines the type of treatment the patient will undergo, the radiologist nowadays has a crucial influence on the treatment of the patient.
Contributors
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- By Mohamed Aboulghar, Mona M. Aboulghar, A. Arnone, Baris Ata, Claire Basille, Ernesto Bosch, Astrid E. P. Cantineau, Robert F. Casper, W. Ciampaglia, G. E. Cognigni, Ben J. Cohlen, C. Coughlan, Alan H DeCherney, Human Mousavi Fatemi, Bart C. J. M. Fauser, M. Filicori, Richard Fleming, Annalise Giallonardo, Shannon Gilmore, Georg Griesinger, Ahmet Helvacioglu, Hananel Holzer, Ziad Rafic Hubayter, Efstratios Kolibianakis, Gabor T. Kovacs, W. Ledger, Dan Levin, David R. Meldrum, Mohamed F. Mitwally, Monique Mochtar, Lamiya Mohiyiddeen, Francesco Morgia, Hany F. Moustafa, Suheil J. Muasher, Luciano G. Nardo, Geeta Nargund, L. Parmegiani, P. Pocognoli, Biljana Popović-Todorović, Botros Rizk, Marco Sbracia, Mauro Schimberni, William B. Schoolcraft, Eric S. Surrey, C. Tabarelli, Seang Lin Tan, George Tolis, Evert J. P. van Santbrink, Madelon van Wely, Paraskevi Xekouki
- Edited by Mohamed Aboulghar, Botros Rizk, University of South Alabama
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- Book:
- Ovarian Stimulation
- Published online:
- 05 August 2011
- Print publication:
- 23 December 2010, pp ix-xii
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