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Purpose Médecins sans Frontières (MSF) is one of the main providers of orthopaedic surgery in natural disaster and conflict settings and strictly imposes a minimum set of contextspecific standards before any surgery can be performed. Based on MSF's experience of performing orthopaedic surgery in a number of such settings, we describe: (a) whether it was possible to implement the minimum standards for one of the more rigorous orthopaedic procedures-internal fixation-and when possible, the time frame, (b) the volume and type of interventions performed and (c) the intra-operative mortality rates and postoperative infection rates. Methods We conducted a retrospective review of routine programme data collected between 2007 and 2014 from three MSF emergency surgical interventions in Haiti (following the 2010 earthquake) and three ongoing MSF projects in Kunduz (Afghanistan), Masisi (Democratic Republic of the Congo) and Tabarre (Haiti). ResultsThe minimum standards for internal fixation were achieved in one emergency intervention site in Haiti, and in Kunduz and Tabarre, taking up to 18 months to implement in Kunduz. All sites achieved the minimum standards to perform amputations, reductions and external fixations, with a total of 9,409 orthopaedic procedures performed during the study period. Intraoperative mortality rates ranged from 0.6 to 1.9 % and postoperative infection rates from 2.4 to 3.5 %. Conclusions In settings affected by natural disaster or conflict, a high volume and wide repertoire of orthopaedic surgical procedures can be performed with good outcomes when minimum standards are in place. More demanding procedures like internal fixation may not always be feasible.

Sarcophyton glaucum is one of the most abundant and chemically studied soft corals with over 100 natural products reported in the literature, primarily cembrane diterpenoids. Yet, wide variation in the chemistry observed from S. glaucum over the past 50 years has led to its reputation as a capricious producer of bioactive metabolites. Recent molecular phylogenetic analysis revealed that S. glaucum is not a single species but a complex of at least seven genetically distinct species not distinguishable using traditional taxonomic criteria. We hypothesized that perceived intraspecific chemical variation observed in S. glaucum was actually due to differences between cryptic species (interspecific variation). To test this hypothesis, we collected Sarcophyton samples in Palau, performed molecular phylogenetic analysis, and prepared chemical profiles of sample extracts using gas chromatography-flame ionization detection. Both unsupervised (principal component analysis) and supervised (linear discriminant analysis) statistical analyses of these profiles revealed a strong relationship between cryptic species membership and chemical profiles. Liquid chromatography with tandem mass spectrometry-based analysis using feature-based molecular networking permitted identification of the chemical drivers of this difference between clades, including cembranoid diterpenes (2R,11R,12R)-isosarcophytoxide (5), (2S,11R,12R)-isosarcophytoxide (6), and isosarcophine (7). Our results suggest that early chemical studies of Sarcophyton may have unknowingly conflated different cryptic species of S. glaucum, leading to apparently idiosyncratic chemical variation.

Pillared clays have shown to effectively catalyze the photo-Fenton process without the necessity of acidic conditions, which is a very attractive feature from the perspective of environmentally friendly processes, especially when high natural abundance of chemical elements are incorporated. In this work, the catalytic activity of Al/Cu interlayered pillared clays for the degradation and mineralization of paracetamol through a photo-Fenton-like process was investigated. Al/Cu-pillared clays were prepared by adding ane Al/Cu pillaring solution to a bentonite suspension. X-ray diffraction (XRD) confirmed the enlargement of the interlayer space of the clay provoked by the pillaring process and Al and Cu species in the prepared samples were verified by atomic absorption spectroscopy (AAS). The specific surface area of pure bentonite was 2-fold increased after the Al/Cu pillaring process. A synthetic paracetamol solution with an initial concentration of 100 ppm was prepared for the assessment of the activity of the prepared materials. Different catalyst concentrations were tested (0.2, 0.5, 0.75, and 1 g L –1 ) and the complete removal of paracetamol was achieved in all cases, but the highest mineralization rate (69.8 mg total organic carbon (TOC) g cat –1 h –1 ) corresponds to the catalyst loading of 0.5 g L –1 . An ultraviolet-C (UVC) light source was employed, and no adjustment of the pH to acidic conditions was needed to achieve these results. Liquid chromatography coupled to mass spectroscopy (LC-MS) was employed to identify the reaction intermediates of paracetamol degradation. A proposed pathway for the oxidation of paracetamol molecule is presented. The effect of Cu content in the pillared clay and the stability and reusability of the catalyst were also assessed. The kinetic constants of paracetamol removal were 0.2318 and 0.0698 min –1 , under photo-Fenton and UV + H 2 O 2 processes, respectively.

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