Firefighter injuries are not just a fireground problem.

PubMed

Frost, D M; Beach, T A C; Crosby, I; McGill, S M

2015-01-01

Linking firefighter injury reporting to general motion patterns may provide insight into potential injury mechanisms and the development of prevention strategies. To characterize the injuries sustained by members of a large Canadian metropolitan fire department over a 5-year span. Data were taken from injury reports filed by career firefighters between 2007 and 2011. Injuries were described by job duty, type, body part affected, and the general motion pattern employed at the time of injury (e.g. lifting). Of the 1311 injuries reported, 64% were categorized as sprains and strains (musculoskeletal disorders -MSDs), the most frequent of which affected the back (32%). Categorized by job duty, 65% of MSDs were sustained while working at the fire station or during physical training-related activities. Only 15% were attributed to fireground operations. Furthermore, the associated job duty could not differentiate the types of injuries sustained; back injuries occurred primarily while lifting, knee injuries while stepping, and shoulder injuries during pushing/pulling-related activities. Firefighter injuries are not just a fireground problem. Injury causation may be better understood by linking the injury location and type with motion patterns rather than job duties. This information could assist in developing general prevention strategies for the fire service.

Tackle-related injury rates and nature of injuries in South African Youth Week tournament rugby union players (under-13 to under-18): an observational cohort study.

PubMed

Burger, Nicholas; Lambert, Mike I; Viljoen, Wayne; Brown, James C; Readhead, Clint; Hendricks, Sharief

2014-08-12

The tackle situation is most often associated with the high injury rates in rugby union. Tackle injury epidemiology in rugby union has previously been focused on senior cohorts but less is known about younger cohorts. The aim of this study was to report on the nature and rates of tackle-related injuries in South African youth rugby union players representing their provinces at national tournaments. Observational cohort study. Four South African Youth Week tournaments (under-13 Craven Week, under-16 Grant Khomo Week, under-18 Academy Week, under-18 Craven Week). Injury data were collected from 3652 youth rugby union players (population at risk) in 2011 and 2012. Tackle-related injury severity ('time-loss' and 'medical attention'), type and location, injury rate per 1000 h (including 95% CIs). Injury rate ratios (IRR) were calculated and modelled using a Poisson regression. A χ(2) analysis was used to detect linear trends between injuries and increasing match quarters. The 2012 under-13 Craven Week had a significantly greater 'time-loss' injury rate when compared with the 2012 under-18 Academy Week (IRR=4.43; 95% CI 2.13 to 9.21, p<0.05) and under-18 Craven Week (IRR=3.52; 95% CI 1.54 to 8.00, p<0.05). The Poisson regression also revealed a higher probability of 'overall' ('time-loss' and 'medical attention' combined) and 'time-loss' tackle-related injuries occurring at the under-13 Craven Week. The proportion of 'overall' and 'time-loss' injuries increased significantly with each quarter of the match when all four tournaments were combined (p<0.05). There was a difference in the tackle-related injury rate between the under-13 tournament and the two under-18 tournaments, and the tackle-related injury rate was higher in the final quarter of matches. Ongoing injury surveillance is required to better interpret these findings. Injury prevention strategies targeting the tackle may only be effective once the rate and nature of injuries have been accurately determined

Penetrating head injuries in children due to BB and pellet guns: a poorly recognized public health risk.

PubMed

Kumar, Ravi; Kumar, Ramesh; Mallory, Grant W; Jacob, Jeffrey T; Daniels, David J; Wetjen, Nicholas M; Foy, Andrew B; O'Neill, Brent R; Clarke, Michelle J

2015-10-23

OBJECT Nonpowder guns, defined as spring- or gas-powered BB or pellet guns, can be dangerous weapons that are often marketed to children. In recent decades, advances in compressed-gas technology have led to a significant increase in the power and muzzle velocity of these weapons. The risk of intracranial injury in children due to nonpowder weapons is poorly documented. METHODS A retrospective review was conducted at 3 institutions studying children 16 years or younger who had intracranial injuries secondary to nonpowder guns. RESULTS The authors reviewed 14 cases of intracranial injury in children from 3 institutions. Eleven (79%) of the 14 children were injured by BB guns, while 3 (21%) were injured by pellet guns. In 10 (71%) children, the injury was accidental. There was 1 recognized assault, but there were no suicide attempts; in the remaining 3 patients, the intention was indeterminate. There were no mortalities among the patients in this series. Ten (71%) of the children required operative intervention, and 6 (43%) were left with permanent neurological injuries, including epilepsy, cognitive deficits, hydrocephalus, diplopia, visual field cut, and blindness. CONCLUSIONS Nonpowder guns are weapons with the ability to penetrate a child's skull and brain. Awareness should be raised among parents, children, and policy makers as to the risk posed by these weapons.

Tackle-related injury rates and nature of injuries in South African Youth Week tournament rugby union players (under-13 to under-18): an observational cohort study

PubMed Central

Burger, Nicholas; Lambert, Mike I; Viljoen, Wayne; Brown, James C; Readhead, Clint; Hendricks, Sharief

2014-01-01

Objectives The tackle situation is most often associated with the high injury rates in rugby union. Tackle injury epidemiology in rugby union has previously been focused on senior cohorts but less is known about younger cohorts. The aim of this study was to report on the nature and rates of tackle-related injuries in South African youth rugby union players representing their provinces at national tournaments. Design Observational cohort study. Setting Four South African Youth Week tournaments (under-13 Craven Week, under-16 Grant Khomo Week, under-18 Academy Week, under-18 Craven Week). Participants Injury data were collected from 3652 youth rugby union players (population at risk) in 2011 and 2012. Outcome measures Tackle-related injury severity (‘time-loss’ and ‘medical attention’), type and location, injury rate per 1000 h (including 95% CIs). Injury rate ratios (IRR) were calculated and modelled using a Poisson regression. A χ2 analysis was used to detect linear trends between injuries and increasing match quarters. Results The 2012 under-13 Craven Week had a significantly greater ‘time-loss’ injury rate when compared with the 2012 under-18 Academy Week (IRR=4.43; 95% CI 2.13 to 9.21, p<0.05) and under-18 Craven Week (IRR=3.52; 95% CI 1.54 to 8.00, p<0.05). The Poisson regression also revealed a higher probability of ‘overall’ (‘time-loss’ and ‘medical attention’ combined) and ‘time-loss’ tackle-related injuries occurring at the under-13 Craven Week. The proportion of ‘overall’ and ‘time-loss’ injuries increased significantly with each quarter of the match when all four tournaments were combined (p<0.05). Conclusions There was a difference in the tackle-related injury rate between the under-13 tournament and the two under-18 tournaments, and the tackle-related injury rate was higher in the final quarter of matches. Ongoing injury surveillance is required to better interpret these findings. Injury prevention strategies

Children at risk of residual physical problems after public road traffic injuries--a 1-year follow-up study.

PubMed

Olofsson, Eva; Bunketorp, Olle; Andersson, Anna-Lena

2012-01-01

To describe the residual physical problems 1 year after traffic injuries in children with respect to age, gender, extraction (Swedish or foreign), type of care, type of accident and use of protective equipment, type of injury, and the impact on daily living activities. Hospital data were analysed for children, aged 15 or under, after road traffic accidents in the Gothenburg region in 2000. Age, gender, type of road user, counterpart, use of protective equipment, type and severity of each injury, and type of care were related to follow-up data obtained by a self-completed questionnaire answered 1 year after the accident. The AIS90 was used for injury classification. Residual physical problems were specified, graded, and mapped on anatomical pictures of the body by the respondents. Logistic regression was used to explore independent factors for residual problems. A total of 341 children (81%) fulfilled the study. Cyclists dominated, 60%, followed by moped users, car occupants and pedestrians. The mean age was 11 years, 61% were boys, 16% were of foreign extraction, 26% were treated as inpatients, and 11% had at least one serious (AIS3+) injury. Residual problems were reported for 16% of the study group (n=53), and of these 31% were located to the lower extremities (mostly knee problems), upper extremities in 20%, face in 14%, neck in 14%, upper trunk in 8%, lower trunk in 8%, and skull/brain in 3%. Significant permanent impairment was reported in one case. Cyclists reported problems significantly less frequently than others. Children reporting problems tended to be older and were most often injured as moped users. Problems to the neck and the upper trunk were reported to a higher rate than the injury rate in these regions. Children with residual problems reported limitations in daily living activities after the accident more often than those without residual physical problems. Residual physical problems were reported in about one sixth of the study group, few with

Symptoms of Persistent Behavior Problems in Children with Mild Traumatic Brain Injury

PubMed Central

Taylor, H. Gerry; Orchinik, Leah J.; Minich, Nori; Dietrich, Ann; Nuss, Kathryn; Wright, Martha; Bangert, Barbara; Rusin, Jerome; Yeates, Keith Owen

2014-01-01

Objective To investigate the effects of mild traumatic brain injury (mTBI) in children on symptom ratings of behavior problems across the first year post injury. Setting Emergency departments of two regional children’s hospitals. Participants Parents of 176 children with mTBI and 90 with orthopedic injury (OI) ages 8–15 years. Design Group comparisons of post-injury parent and teacher ratings of child behavior problems controlling for background factors. Main Measures Child Behavior Checklist (CBCL) and Teacher’s Report Form (TRF). Results For younger but not older children in the sample, children with mTBI compared to those with OI had higher post-injury ratings on the CBCL Total Behavior Problem scale, t (264) = 3.34, p<.001, and higher rates of T-scores ≥ 60 on this scale, OR (CI) = 3.00 (1.33, 6.77), p=.008. For children with mTBI, hospitalization, motor vehicle accidents, loss of consciousness, and MRI abnormality were associated with higher parent or teacher ratings. Conclusions School-age children with mTBI are at risk for persistent symptoms of behavior problems, especially if mTBI is more severe or occurs at a younger age. The findings justify monitoring of behavior long after injury and further research to identify risk factors for these symptoms and their association with clinical disorders. PMID:25629259

Recognizing Faces

ERIC Educational Resources Information Center

Ellis, Hadyn D.

1975-01-01

The proposition that the mechanisms underlying facial recognition are different from those involved in recognizing other classes of pictorial material was assessed following a general review of the literature concerned with recognizing faces. (Author/RK)

[A prospective cohort study on injuries among school-age children with and without behavior problems].

PubMed

Peng, Ying-chun; Ni, Jin-fa; Tao, Fang-biao; Wu, Xi-ke

2003-08-01

To study the annual incidence of injuries and the relationship between behavior problems and injuries among school-age children. A prospective cohort study on injuries for 1-year follow-up period was conducted among 2 005 school-age children selected by cluster sampling from three primary schools in Maanshan city. They subjects were divided into two groups with or without exposure according to behavior problems rated by the Rutter Child Behavior Questionnaire at the beginning of the study. Nonparametric test was performed to analyze the differences in injuries between the two groups of children, and the influential factors for injuries were analyzed with multi-classification ordinal response variable logistic regression model. The overall incidence rate for injuries in school-age children was 42.51%, while among children with and without behavior problems were 64.87% and 38.85%, respectively. There were significant differences between the two groups (u = -6.054, P = 0.000). However, the incidence rates of injuries in school-age children with antisocial (A) behavior, neurotic (N) behavior and mixed (M) behavior were 66.99%, 67.41% and 61.40%, respectively. No significant differences were found among them (u(A,N) = -0.052, P = 0.958; u(A,M) = -0.400, P = 0.689; u(N,M) = -0.364, P = 0.716). Multivariate analysis indicated that injuries in school-age children were associated with children behavior problems, maternal age at childbirth, bad conditions during mother pregnancy, education background of mother, prevention measures for safety at home and the child accompanied to travel between school and home by adults. Behavior problems of children seemed to be the major risk factors for injuries. Children with behavior problems represented a significant risk group for injuries among school-age children. When planning intervention strategies on injuries, behavior problems should be emphasized to ensure optimal effectiveness of intervention.

Under-recording of work-related injuries and illnesses: An OSHA priority.

PubMed

Fagan, Kathleen M; Hodgson, Michael J

2017-02-01

A 2009 Government Accounting Office (GAO) report, along with numerous published studies, documented that many workplace injuries are not recorded on employers' recordkeeping logs required by the Occupational Safety and Health Administration (OSHA) and consequently are under-reported to the Bureau of Labor Statistics (BLS), resulting in a substantial undercount of occupational injuries in the United States. OSHA conducted a Recordkeeping National Emphasis Program (NEP) from 2009 to 2012 to identify the extent and causes of unrecorded and incorrectly recorded occupational injuries and illnesses. OSHA found recordkeeping violations in close to half of all facilities inspected. Employee interviews identified workers' fear of reprisal and employer disciplinary programs as the most important causes of under-reporting. Subsequent inspections in the poultry industry identified employer medical management policies that fostered both under-reporting and under-recording of workplace injuries and illnesses. OSHA corroborated previous research findings and identified onsite medical units as a potential new cause of both under-reporting and under-recording. Research is needed to better characterize and eliminate obstacles to the compilation of accurate occupational injury and illness data. Occupational health professionals who work with high hazard industries where low injury rates are being recorded may wish to scrutinize recordkeeping practices carefully. This work suggests that, although many high-risk establishments manage recordkeeping with integrity, the lower the reported injury rate, the greater the likelihood of under-recording and under-reporting of work-related injuries and illnesses. Published by Elsevier Ltd.

[Stab injuries of the skull and brain].

PubMed

Ritter, C; Adebahr, G

1986-01-01

A few cases of skull and brain stab wounds are described and the clinicodiagnostic problems discussed. The injuries often remain unrecognized because the external wound often appears harmless, there are no neurological symptoms, or the clinical picture is interpreted as drunkenness, blunt injury or as another disease. The importance of a precise physical examination of the whole patient's head is pointed out. The refined methods used in modern radiodiagnostics of the skull are the most helpful in correctly recognizing these injuries; there are reports of patients with severe injuries who recovered when the correct diagnosis had been established.

Self-inflicted injuries. Challenging knowledge, skill, and compassion.

PubMed

Haswell, D E; Graham, M

1996-09-01

Self-inflicted injuries and other serious self-destructive behaviours are common and difficult to recognize, prevent, and manage. Although they have previously been understood as repeated, failed attempts at suicide, they are better understood as maladaptive coping strategies. Women who present repeatedly with self-inflicted injuries need help to control this self-destructive behaviour and substitute more positive coping strategies. Physicians also need help in working with patients who respond to problems in this way. The program is made up of two broad sections. The first section involves understanding the problem and its origins in post-traumatic stress disorders. The second section offers a practical approach to helping patients presenting with injuries inflict upon themselves. A deeper understanding of the etiology and management of repeated self-inflicted injuries will enable physicians to help patients with this difficult problem while minimizing their own anxiety and frustration.

Effect on behavior problems of teen online problem-solving for adolescent traumatic brain injury.

PubMed

Wade, Shari L; Walz, Nicolay C; Carey, Joanne; McMullen, Kendra M; Cass, Jennifer; Mark, Erin; Yeates, Keith Owen

2011-10-01

To report the results of a randomized clinical trial of teen online problem-solving (TOPS) meant to improve behavioral outcomes of adolescents with traumatic brain injury (TBI). A randomized clinical trial was conducted to compare the efficacy of TOPS with access to Internet resources in teenagers with TBI in improving parent and self-reported behavior problems and parent-teen conflicts. Participants included 41 adolescents aged 11 to 18 years (range: 11.47-17.90 years) who had sustained a moderate-to-severe TBI between 3 and 19 months earlier. Teens in the TOPS group received 10 to 14 online sessions that provided training in problem-solving, communication skills, and self-regulation. Outcomes were assessed before treatment and at a follow-up assessment an average of 8 months later. Groups were compared on follow-up scores after we controlled for pretreatment levels. Injury severity and socioeconomic status were examined as potential moderators of treatment efficacy. Forty-one participants provided consent and completed baseline assessments, and follow-up assessments were completed for 35 participants (16 TOPS, 19 Internet resource comparison). The TOPS group reported significantly less parent-teen conflict at follow-up than did the Internet-resource-comparison group. Improvements in teen behavior after TOPS were moderated by injury severity; there were greater improvements in the teens' internalizing symptoms after TOPS among adolescents with severe TBI. Family socioeconomic status also moderated the efficacy of TOPS in improving behavior problems reported by both parents and teens, although the nature of the moderation effects varied. Our findings suggest that TOPS contributes to improvements in parent-teen conflict generally and parent and self-reported teen behavior problems for certain subsets of participants.

Causes and Prevention of Laparoscopic Bile Duct Injuries

PubMed Central

Way, Lawrence W.; Stewart, Lygia; Gantert, Walter; Liu, Kingsway; Lee, Crystine M.; Whang, Karen; Hunter, John G.

2003-01-01

recognize a problem. Even when irregularities were identified, corrective feedback did not occur, which is characteristic of human thinking under firmly held assumptions. These findings illustrate the complexity of human error in surgery while simultaneously providing insights. They demonstrate that automatically attributing technical complications to behavioral factors that rely on the assumption of control is likely to be wrong. Finally, this study shows that there are only a few points within laparoscopic cholecystectomy where the complication-causing errors occur, which suggests that focused training to heighten vigilance might be able to decrease the incidence of bile duct injury. PMID:12677139

Worker substance use, workplace problems and the risk of occupational injury: a matched case-control study.

PubMed

Spicer, Rebecca S; Miller, Ted R; Smith, Gordon S

2003-07-01

This study examines the tendency toward problem behavior as an explanation for the relationship between problem substance use and occupational injury. The authors used a matched case-control study nested in a cohort of 26,413 workers, in which cases (n = 3,994) were workers suffering an occupational injury. Five controls per case (n = 19,970) were selected from the cohort of workers active on the day of the injury and matched on job type. Conditional logistic regression modeled the association of problem substance use with occupational injury, controlling for problem behaviors and worker characteristics. Problem substance use was indicated indirectly if any of the following were alcohol/drug-involved during the comparison period: Employee Assistance Program visit, excused absence or disciplinary action. Discipline records identified minor (absenteeism) and serious (dishonesty, theft, assault, harassment, disrespect) problem behaviors during the comparison period. The odds of injury among workers with an indicator of problem substance use was 1.35 (p = .015) times greater than the odds among workers without an indicator, controlling for job type and demographics as well as adjusting for exposure. This ratio declined to 1.21 (p = .138) when problem behaviors were also controlled for. Minor and serious problem behaviors were significantly associated with occupational injury (odds ratio [OR] = 1.73, p < .001, and OR = 2.19, p < .001, respectively), controlling for demographics and substance use. The relationship of problem substance use with occupational injury was weak when problem behaviors were controlled for, suggesting that this relationship, observed in previous studies, may be explained by a workers tendency toward problem behaviors. Workplace injury prevention programs should address the expression of problem behaviors as a complement to drug and alcohol deterrent programs.

Aerophagia: an uncommon form of self-injury.

PubMed

Holburn, C S

1986-09-01

Aerophagia is a rarely recognized self-injurious behavior that consists of repetitive air swallowing with consequent belching, flatulence, and abdominal distention. The condition causes serious medical problems and can result in death. Possible causes of aerophagia and some attempts to treat it were reviewed briefly.

Effect on Behavior Problems of Teen Online Problem-Solving for Adolescent Traumatic Brain Injury

PubMed Central

Walz, Nicolay C.; Carey, JoAnne; McMullen, Kendra M.; Cass, Jennifer; Mark, Erin; Yeates, Keith Owen

2011-01-01

PURPOSE: To report the results of a randomized clinical trial of teen online problem-solving (TOPS) meant to improve behavioral outcomes of adolescents with traumatic brain injury (TBI). METHODS: A randomized clinical trial was conducted to compare the efficacy of TOPS with access to Internet resources in teenagers with TBI in improving parent and self-reported behavior problems and parent-teen conflicts. Participants included 41 adolescents aged 11 to 18 years (range: 11.47–17.90 years) who had sustained a moderate-to-severe TBI between 3 and 19 months earlier. Teens in the TOPS group received 10 to 14 online sessions that provided training in problem-solving, communication skills, and self-regulation. Outcomes were assessed before treatment and at a follow-up assessment an average of 8 months later. Groups were compared on follow-up scores after we controlled for pretreatment levels. Injury severity and socioeconomic status were examined as potential moderators of treatment efficacy. RESULTS: Forty-one participants provided consent and completed baseline assessments, and follow-up assessments were completed for 35 participants (16 TOPS, 19 Internet resource comparison). The TOPS group reported significantly less parent-teen conflict at follow-up than did the Internet-resource-comparison group. Improvements in teen behavior after TOPS were moderated by injury severity; there were greater improvements in the teens' internalizing symptoms after TOPS among adolescents with severe TBI. Family socioeconomic status also moderated the efficacy of TOPS in improving behavior problems reported by both parents and teens, although the nature of the moderation effects varied. CONCLUSION: Our findings suggest that TOPS contributes to improvements in parent-teen conflict generally and parent and self-reported teen behavior problems for certain subsets of participants. PMID:21890828

Are animal-related injuries in rural areas a social problem? A survey from Poland.

PubMed

Neskoromna-Jędrzejczak, Aneta; Bogusiak, Katarzyna; Kasielska-Trojan, Anna; Antoszewski, Bogusław

2017-09-21

The aim of this study was to analyze the mechanisms of animal-related injuries in Polish rural areas, and to evaluate the effects of such injuries on subjects' health and social life. Data concerning animal-related injuries were collected from 102 patients (45 females and 57 males, mean age 45.01±11.4 years) on the basis of a questionnaire. The study was conducted in the rural area of central Poland. Moreover, to assess the severity of injuries to the head and neck region, the Facial Injury Severity Scale (FISS) was applied. The most commonly affected body areas are the upper and lower limbs, which explains the fact that most subjects do not recognize the injury-related deformity as an aesthetic defect.Statistical correlations were observed in several aspects, amongst others: - women were significantly more likely than men to consider undergoing surgical procedures to eliminate/reduce post-traumatic deformities and scars (p<0.05); - injury-related deterioration in appearance resulted in limitations of patients' social life (p<0.0001).

Symptoms of Persistent Behavior Problems in Children With Mild Traumatic Brain Injury.

PubMed

Taylor, H Gerry; Orchinik, Leah J; Minich, Nori; Dietrich, Ann; Nuss, Kathryn; Wright, Martha; Bangert, Barbara; Rusin, Jerome; Yeates, Keith Owen

2015-01-01

To investigate the effects of mild traumatic brain injury (mTBI) in children on symptom ratings of behavior problems across the first-year postinjury. Emergency departments of 2 regional children's hospitals. Parents of 176 children with mTBI and 90 children with orthopedic injury aged 8 to 15 years. Group comparisons of postinjury parent and teacher ratings of child behavior problems controlling for background factors. Child Behavior Checklist and Teacher's Report Form. For younger but not older children in the sample, children with mTBI compared with children with orthopedic injury had higher postinjury ratings on the Child Behavior Checklist Total Behavior Problem scale (t264 = 3.34, P < .001) and higher rates of T-scores of 60 or more on this scale (odds ratio = 3.00; 95% confidence interval, 1.33-6.77; P = .008). For children with mTBI, hospitalization, motor vehicle accidents, loss of consciousness, and magnetic resonance imaging abnormality were associated with higher parent or teacher ratings. School-aged children with mTBI are at risk for persistent symptoms of behavior problems, especially if mTBI is more severe or occurs at a younger age. The findings justify monitoring of behavior long after injury and further research to identify risk factors for these symptoms and their association with clinical disorders.

Behavior problems in children at time of first recognized seizure and changes over the following 3 years.

PubMed

Austin, J K; Perkins, S M; Johnson, C S; Fastenau, P S; Byars, A W; deGrauw, T J; Dunn, D W

2011-08-01

The purposes of this 36-month study of children with first recognized seizures were: (1) to describe baseline differences in behavior problems between children with and without prior unrecognized seizures; (2) to identify differences over time in behavior problems between children with seizures and their healthy siblings; (3) to identify the proportions of children with seizures and healthy siblings who were consistently at risk for behavior problems for 36 months; and (4) to identify risk factors for behavior problems 36 months following the first recognized seizure. Risk factors explored included demographic (child age and gender, caregiver education), neuropsychological (IQ, processing speed), seizure (epileptic syndrome, use of antiepileptic drug, seizure recurrence), and family (family mastery, satisfaction with family relationships, parent response) variables. Participants were 300 children aged 6 through 14 years with a first recognized seizure and 196 healthy siblings. Data were collected from medical records, structured interviews, self-report questionnaires, and neuropsychological testing. Behavior problems were measured using the Child Behavior Checklist and the Teacher's Report Form. Data analyses included descriptive statistics and linear mixed models. Children with prior unrecognized seizures were at higher risk for behavior problems at baseline. As a group, children with seizures showed a steady reduction in behavior problems over time. Children with seizures were found to have significantly more behavior problems than their siblings over time, and significantly more children with seizures (11.3%) than siblings (4.6%) had consistent behavior problems over time. Key risk factors for child behavior problems based on both caregivers and teachers were: less caregiver education, slower initial processing speed, slowing of processing speed over the first 36 months, and a number of family variables including lower levels of family mastery or child

[Trampoline-related injuries in children: an increasing problem].

PubMed

Königshausen, M; Gothner, M; Kruppa, C; Dudda, M; Godry, H; Schildhauer, T A; Seybold, D

2014-06-01

The sales of recreational trampolines have increased during the past few years. Severe injuries are associated in part with trampoline sport in the domestic setting. Therefore, this study was conducted to confirm the hypothesis of an increase in trampoline-related injuries in conjunction with the increasing sales of recreational trampolines and to find out what kind of injuries are most frequent in this context. Between 01/1999 and 09/2013 all trampoline-related injuries of children (0-16 years of age) were assessed retrospectively. Only those cases were evaluated which described with certainty a trampoline-associated trauma. The fractures were considered separately and assigned to specific localisations. Additionally, accidents at home were differentiated from institutional accidents. Within the past 13 years and 9 months trampoline-related injuries were seen in 195 infants. Fractures were present in 83 cases (42 %). The average age was 10 ± 3.4 years (range: 2-16 years). Within first half of the observed time period (7½ years; 01/1999 to 06/2006) 73 cases were detected with a significantly increasing number of injuries up to 122 cases between 07/2006 and 09/2013 (7 years, 3 months), which corresponds to an increase of 67 % (p = 0,028). The vast majority of these injuries happened in the domestic setting (90 %, n = 175), whereas only 10 % (n = 20) of the traumas occurred in public institutions. In 102 children (52 %) the lower extremity was affected and in 51 patients (26 %) the upper extremity was involved (head/spine/pelvis: n = 42, 22 %). The upper extremity was primarily affected by fractures and dislocations (n = 38, 76 %). At the upper extremity there were more injuries requiring surgery in contrast to the lower extremity (n = 11) or cervical spine (n = 1). The underlying data show a significant increase of trampoline-related injuries within the past years. The upper extremity is the second most affected

Analyzing pedestrian crash injury severity under different weather conditions.

PubMed

Li, Duo; Ranjitkar, Prakash; Zhao, Yifei; Yi, Hui; Rashidi, Soroush

2017-05-19

Pedestrians are the most vulnerable road users due to the lack of mass, speed, and protection compared to other types of road users. Adverse weather conditions may reduce road friction and visibility and thus increase crash risk. There is limited evidence and considerable discrepancy with regard to impacts of weather conditions on injury severity in the literature. This article investigated factors affecting pedestrian injury severity level under different weather conditions based on a publicly available accident database in Great Britain. Accident data from Great Britain that are publicly available through the STATS19 database were analyzed. Factors associated with pedestrian, driver, and environment were investigated using a novel approach that combines a classification and regression tree with random forest approach. Significant severity predictors under fine weather conditions from the models included speed limits, pedestrian age, light conditions, and vehicle maneuver. Under adverse weather conditions, the significant predictors were pedestrian age, vehicle maneuver, and speed limit. Elderly pedestrians are associated with higher pedestrian injury severities. Higher speed limits increase pedestrian injury severity. Based on the research findings, recommendations are provided to improve pedestrian safety.

Pediatric Major Head Injury: Not a Minor Problem.

PubMed

Leetch, Aaron N; Wilson, Bryan

2018-05-01

Traumatic brain injury is a highly prevalent and devastating cause of morbidity and mortality in children. A rapid, stepwise approach to the traumatized child should proceed, addressing life-threatening problems first. Management focuses on preventing secondary injury from physiologic extremes such as hypoxemia, hypotension, prolonged hyperventilation, temperature extremes, and rapid changes in cerebral blood flow. Initial Glasgow Coma Score, hyperglycemia, and imaging are often prognostic of outcome. Surgically amenable lesions should be evacuated promptly. Reduction of intracranial pressure through hyperosmolar therapy, decompressive craniotomy, and seizure prophylaxis may be considered after stabilization. Nonaccidental trauma should be considered when evaluating pediatric trauma patients. Copyright © 2017 Elsevier Inc. All rights reserved.

History of Injury and Violence as public health problems and emergence of the National Center for Injury Prevention and Control at CDC.

PubMed

Sleet, David A; Baldwin, Grant; Marr, Angela; Spivak, Howard; Patterson, Sara; Morrison, Christine; Holmes, Wendy; Peeples, Amy B; Degutis, Linda C

2012-09-01

Injuries and violence are among the oldest health problems facing humans. Only within the past 50 years, however, has the problem been addressed with scientific rigor using public health methods. The field of injury control began as early as 1913, but wasn't approached systematically or epidemiologically until the 1940s and 1950s. It accelerated rapidly between 1960 and 1985. Coupled with active federal and state interest in reducing injuries and violence, this period was marked by important medical, scientific, and public health advances. The National Center for Injury Prevention and Control (NCIPC) was an outgrowth of this progress and in 2012 celebrated its 20th anniversary. NCIPC was created in 1992 after a series of government reports identified injury as one of the most important public health problems facing the nation. Congressional action provided the impetus for the creation of NCIPC as the lead federal agency for non-occupational injury and violence prevention. In subsequent years, NCIPC and its partners fostered many advances and built strong capacity. Because of the tragically high burden and cost of injuries and violence in the United States and around the globe, researchers, practitioners, and decision makers will need to redouble prevention efforts in the next 20 years. This article traces the history of injury and violence prevention as a public health priority-- including the evolution and current structure of the CDC's National Center for Injury Prevention and Control. Published by Elsevier Ltd.

The direct cost burden of 13years of disabling workplace injuries in the U.S. (1998-2010): Findings from the Liberty Mutual Workplace Safety Index.

PubMed

Marucci-Wellman, Helen R; Courtney, Theodore K; Corns, Helen L; Sorock, Gary S; Webster, Barbara S; Wasiak, Radoslaw; Noy, Y Ian; Matz, Simon; Leamon, Tom B

2015-12-01

Although occupational injuries are among the leading causes of death and disability around the world, the burden due to occupational injuries has historically been under-recognized, obscuring the need to address a major public health problem. We established the Liberty Mutual Workplace Safety Index (LMWSI) to provide a reliable annual metric of the leading causes of the most serious workplace injuries in the United States based on direct workers compensation (WC) costs. More than $600 billion in direct WC costs were spent on the most disabling compensable non-fatal injuries and illnesses in the United States from 1998 to 2010. The burden in 2010 remained similar to the burden in 1998 in real terms. The categories of overexertion ($13.6B, 2010) and fall on same level ($8.6B, 2010) were consistently ranked 1st and 2nd. The LMWSI was created to establish the relative burdens of events leading to work-related injury so they could be better recognized and prioritized. Such a ranking might be used to develop research goals and interventions to reduce the burden of workplace injury in the United States. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

Sciatic nerve injury from intramuscular injection: a persistent and global problem.

PubMed

Mishra, P; Stringer, M D

2010-10-01

An intramuscular (i.m.) injection into the buttock risks damaging the sciatic nerve. Safe injection practices need to be understood by doctors and nurses alike. The aims of this study were to determine if sciatic nerve injury because of i.m. injection is a continuing problem and to establish the availability of published guidelines on i.m. injection techniques. Intramuscular injection related sciatic nerve injury claims to the New Zealand Accident Compensation Corporation between July 2005 and September 2008 were reviewed. Nursing organisations were surveyed to enquire about guidelines on i.m. injection. I.m. injection related sciatic nerve injuries in the medical and medicolegal literature (1989-2009) were systematically reviewed. There were eight claims for sciatic nerve injection injury made to the ACC during the 3-year study period; all were in young adults. Only one of the nursing organisations contacted had published guidelines on i.m. injection technique, and these related specifically to immunisation. Seventeen reports of patients with sciatic nerve injury from i.m. injection were identified comprising a total of 1506 patients, at least 80% of which were children. Nine court decisions finding in favour of the plaintiff were identified, all from the North American legal system. A broad range of drugs were implicated in the offending i.m. injections. Sciatic nerve injury from an i.m. injection in the upper outer quadrant of the buttock is an avoidable but persistent global problem, affecting patients in both wealthy and poorer healthcare systems. The consequences of this injury are potentially devastating. Safer alternative sites for i.m. injection exist. These should be promoted more widely by medical and nursing organisations. © 2010 Blackwell Publishing Ltd.

[Child-pedestrian injuries inflicted in the road traffic accidents as a forensic medical problem].

PubMed

Savenkova, E N; Efimov, A A

The road traffic accidents are known to make the greatest contribution to the overall structure of pediatric traumatism with the fatal outcome. The problem of pediatric traumatism remains on top of its relevancy despite numerous administrative, legal, technical, and financial measures taken at the government level in an attempt to reduce the mortality rate associated with the child-pedestrian injuries inflicted in the road traffic accidents. The objective of the present study was to summarize and interpret the results published in the scientific literature concerning child-pedestrian injuries inflicted in the road traffic accidents with special reference to the age of the victims and the type of the injury. The analysis of the publications of the domestic and foreign authors has demonstrated that the available data of interest remain to be systematized and that the forensic medical aspects of the problem in question are poorly represented in these materials. It was shown that forensic medical expertises of child-pedestrian injuries inflicted in the road traffic accidents are frequently carried out without taking into consideration the peculiar anatomical and physiological features of the child's organism. The available data concerning the mechanisms and evaluation of severe injuries inflicted to the children in the road traffic accidents are insufficient for the development of the algorithms for the relevant adequate forensic medical expertise. In the light of these findings, the problem of the child-pedestrian injuries inflicted in the road traffic accidents takes on new significance when considered in the context of pediatric traumatism. There is evidently the growing necessity to formulate the universal database containing systematized objective information for the development of new methods of forensic medical expertise for the elucidation of the mechanisms of road traffic injuries inflicted to the children of different age groups depending on the type of the

Clinically Significant Behavior Problems During the Initial 18 Months Following Early Childhood Traumatic Brain Injury

PubMed Central

Chapman, Leah A.; Wade, Shari L.; Walz, Nicolay C.; Taylor, H. Gerry; Stancin, Terry; Yeates, Keith O.

2014-01-01

The present study looked at the emergence of clinically significant problems in behavior, executive function skills (EF), and social competence during the initial 18 months following TBI in young children relative to a cohort of children with orthopedic injuries (OI) and the environmental factors that predict difficulties postinjury. Children, ages 3-7 years, hospitalized for severe TBI moderate TBI, or OI were seen shortly after their injury (M = 40 days) and again 6 months, 12 months, and 18 months postinjury. Behavioral parent self-reports, demographic data, family functioning reports, and home environment reports were collected at injury baseline and each time point post injury. Results suggest that, compared to the OI group, the severe TBI developed significantly more externalizing behavior problems and EF problems following injury that persisted through the 18-month follow-up. Minimal social competence difficulties appeared at the 18-month follow-up, suggesting a possible pattern of emerging deficits rather than a recovery over time. Predictors of the emergence of clinically significant problems included permissive parenting, family dysfunction, and low SES. The findings are similar to those found in school-aged children. PMID:20175634

Analysis of risk factors affecting driver injury and crash injury with drivers under the influence of alcohol (DUI) and non-DUI.

PubMed

Chen, Huiqin; Chen, Qiang; Chen, Lei; Zhang, Guanjun

2016-11-16

The objective of this research was to study risk factors that significantly influence the severity of crashes for drivers both under and not under the influence of alcohol. Ordinal logistic regression was applied to analyze a crash data set involving drivers under and not under the influence of alcohol in China from January 2011 to December 2014. Four risk factors were found to be significantly associated with the severity of driver injury, including crash partner and intersection type. Age group was found to be significantly associated with the severity of crashes involving drivers under the influence of alcohol. Crash partner, intersection type, lighting conditions, gender, and time of day were found to be significantly associated with severe driver injuries, the last of which was also significantly associated with severe crashes involving drivers not under the influence of alcohol. This study found that pedestrian involvement decreases the odds of severe driver injury when a driver is under the influence of alcohol, with a relative risk of 0.05 compared to the vehicle-to-vehicle group. The odds of severe driver injury at T-intersections were higher than those for traveling along straight roads. Age was shown to be an important factor, with drivers 50-60 years of age having higher odds of being involved in severe crashes compared to 20- to 30-year-olds when the driver was under the influence of alcohol. When the driver was not under the influence of alcohol, drivers suffered more severe injuries between midnight and early morning compared to early nighttime. The vehicle-to-motorcycle and vehicle-to-pedestrian groups experienced less severe driver injuries, and vehicle collisions with fixed objects exhibited higher odds of severe driver injury than did vehicle-to-vehicle impacts. The odds of severe driver injury at cross intersections were 0.29 compared to travel along straight roads. The odds of severe driver injury when street lighting was not available at

Accounting for sampling variability, injury under-reporting, and sensor error in concussion injury risk curves.

PubMed

Elliott, Michael R; Margulies, Susan S; Maltese, Matthew R; Arbogast, Kristy B

2015-09-18

There has been recent dramatic increase in the use of sensors affixed to the heads or helmets of athletes to measure the biomechanics of head impacts that lead to concussion. The relationship between injury and linear or rotational head acceleration measured by such sensors can be quantified with an injury risk curve. The utility of the injury risk curve relies on the accuracy of both the clinical diagnosis and the biomechanical measure. The focus of our analysis was to demonstrate the influence of three sources of error on the shape and interpretation of concussion injury risk curves: sampling variability associated with a rare event, concussion under-reporting, and sensor measurement error. We utilized Bayesian statistical methods to generate synthetic data from previously published concussion injury risk curves developed using data from helmet-based sensors on collegiate football players and assessed the effect of the three sources of error on the risk relationship. Accounting for sampling variability adds uncertainty or width to the injury risk curve. Assuming a variety of rates of unreported concussions in the non-concussed group, we found that accounting for under-reporting lowers the rotational acceleration required for a given concussion risk. Lastly, after accounting for sensor error, we find strengthened relationships between rotational acceleration and injury risk, further lowering the magnitude of rotational acceleration needed for a given risk of concussion. As more accurate sensors are designed and more sensitive and specific clinical diagnostic tools are introduced, our analysis provides guidance for the future development of comprehensive concussion risk curves. Copyright © 2015 Elsevier Ltd. All rights reserved.

Dementia resulting from traumatic brain injury

PubMed Central

Ramalho, Joana; Castillo, Mauricio

2015-01-01

Traumatic brain injury (TBI) represents a significant public health problem in modern societies. It is primarily a consequence of traffic-related accidents and falls. Other recently recognized causes include sports injuries and indirect forces such as shock waves from battlefield explosions. TBI is an important cause of death and lifelong disability and represents the most well-established environmental risk factor for dementia. With the growing recognition that even mild head injury can lead to neurocognitive deficits, imaging of brain injury has assumed greater importance. However, there is no single imaging modality capable of characterizing TBI. Current advances, particularly in MR imaging, enable visualization and quantification of structural and functional brain changes not hitherto possible. In this review, we summarize data linking TBI with dementia, emphasizing the imaging techniques currently available in clinical practice along with some advances in medical knowledge. PMID:29213985

46 CFR 160.077-9 - Recognized laboratory.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 46 Shipping 6 2011-10-01 2011-10-01 false Recognized laboratory. 160.077-9 Section 160.077-9... Recognized laboratory. (a) A manufacturer seeking Coast Guard approval of a product under this subpart shall... to a recognized independent laboratory. The following laboratories are recognized under § 159.010-7...

46 CFR 160.048-8 - Recognized laboratory.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 46 Shipping 6 2011-10-01 2011-10-01 false Recognized laboratory. 160.048-8 Section 160.048-8... Recognized laboratory. (a) A manufacturer seeking Coast Guard approval of a product under this subpart shall... to a recognized independent laboratory. The following laboratories are recognized under § 159.010-7...

46 CFR 160.048-8 - Recognized laboratory.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 6 2010-10-01 2010-10-01 false Recognized laboratory. 160.048-8 Section 160.048-8... Recognized laboratory. (a) A manufacturer seeking Coast Guard approval of a product under this subpart shall... to a recognized independent laboratory. The following laboratories are recognized under § 159.010-7...

46 CFR 160.077-9 - Recognized laboratory.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 6 2010-10-01 2010-10-01 false Recognized laboratory. 160.077-9 Section 160.077-9... Recognized laboratory. (a) A manufacturer seeking Coast Guard approval of a product under this subpart shall... to a recognized independent laboratory. The following laboratories are recognized under § 159.010-7...

[The Abbreviated Injury Scale (AIS). Options and problems in application].

PubMed

Haasper, C; Junge, M; Ernstberger, A; Brehme, H; Hannawald, L; Langer, C; Nehmzow, J; Otte, D; Sander, U; Krettek, C; Zwipp, H

2010-05-01

The new AIS (Abbreviated Injury Scale) was released with an update by the AAAM (Association for the Advancement of Automotive Medicine) in 2008. It is a universal scoring system in the field of trauma applicable in clinic and research. In engineering it is used as a classification system for vehicle safety. The AIS can therefore be considered as an international, interdisciplinary and universal code of injury severity. This review focuses on a historical overview, potential applications and new coding options in the current version and also outlines the associated problems.

The SPLASH/ICPC integrity marathon in Ibadan, Nigeria: incidence and management of injuries and marathon-related health problems.

PubMed

Ogwumike, Omoyemi O; Adeniyi, Ade F

2013-04-15

The growing interest in marathon runners and marathons in Nigeria has not been reflected in reports of injuries and other health problems associated with these events. This study therefore outlines the incidence of injuries, marathon-related health problems and delivery of physiotherapy at the maiden and second editions of the Splash 105.5 FM/ICPC Integrity Marathon in Ibadan city, south-west Nigeria in 2009 and 2010. Using a data entry sheet, demographics and information on running experience, past and present injuries and other health problems reported en route and at the finish line by the runners were documented. The prevalence of injuries and other health problems reported by previous and first-time runners were compared. In both events, 16.3% and 17.2% of the runners respectively reported injuries with significant occurrence in first-time runners (p = 0.003 for 2009; p = 0.002 for 2010) mostly at the finish line. The reported injury type and site were muscle cramps and the thigh (39.7% and 76.4% respectively). Heat exhaustion was reported by 42.8% of runners in 2009 and 56.3% in 2010. Cryotherapy was mostly used in combination with other physiotherapy modalities in both years. Most of the injuries and other health problems were reported by first-time marathon runners mainly at the finish line. The most reported site of injury was the thigh while muscle cramps and heat exhaustions were the most reported types of injuries and health problems. First-time marathon runners should be adequately informed of the predisposition to injury during marathons and adequate body conditioning should be emphasized. Ample preparation and effective involvement of the physiotherapy team is essential for management of injured runners en route and at the finish line in a marathon.

The SPLASH/ICPC integrity marathon in Ibadan, Nigeria: incidence and management of injuries and marathon-related health problems

PubMed Central

2013-01-01

Background The growing interest in marathon runners and marathons in Nigeria has not been reflected in reports of injuries and other health problems associated with these events. This study therefore outlines the incidence of injuries, marathon-related health problems and delivery of physiotherapy at the maiden and second editions of the Splash 105.5 FM/ICPC Integrity Marathon in Ibadan city, south-west Nigeria in 2009 and 2010. Methods Using a data entry sheet, demographics and information on running experience, past and present injuries and other health problems reported en route and at the finish line by the runners were documented. The prevalence of injuries and other health problems reported by previous and first-time runners were compared. Results In both events, 16.3% and 17.2% of the runners respectively reported injuries with significant occurrence in first-time runners (p = 0.003 for 2009; p = 0.002 for 2010) mostly at the finish line. The reported injury type and site were muscle cramps and the thigh (39.7% and 76.4% respectively). Heat exhaustion was reported by 42.8% of runners in 2009 and 56.3% in 2010. Cryotherapy was mostly used in combination with other physiotherapy modalities in both years. Conclusion Most of the injuries and other health problems were reported by first-time marathon runners mainly at the finish line. The most reported site of injury was the thigh while muscle cramps and heat exhaustions were the most reported types of injuries and health problems. First-time marathon runners should be adequately informed of the predisposition to injury during marathons and adequate body conditioning should be emphasized. Ample preparation and effective involvement of the physiotherapy team is essential for management of injured runners en route and at the finish line in a marathon. PMID:24499546

Recognizing the Signs and Symptoms of Youth and Adolescents That Experience Mental Health Problems and/or Crises

ERIC Educational Resources Information Center

Pritchett, Tierra M.

2017-01-01

Health First Aid at the Philadelphia Red Cross completed a survey with information pertaining to knowledge and confidence in recognizing the signs and symptoms of youth/adolescents that may be experiencing a mental health problem and or crisis. Descriptive statistics, independent t-tests, ANOVA, and Tukey tests were conducted to investigate the…

Periodic limb movements and insomnia, a common but under-recognized association

PubMed Central

Varadharajulu, Saravanan; Chandrasekaran, Baskaran

2015-01-01

Periodic limb movements unlike restless leg syndrome is under diagnosed and unrecognized in medical arena. While robust Western trials have elucidated the association between periodic limb movements and sleep disturbances, it is not well received and recognized in India even in well sophisticated tertiary care hospital. We report a chronic insomnia patient who had sleep disturbances for past 30 years due to periodic limb movements alone. This was diagnosed through polysomnography. This case emphasizes monitoring leg movements during sleep study. This report may open new horizons in improving monitoring in sleep study in clinical setting. PMID:26124530

The health consequences of child mental health problems and parenting styles: unintentional injuries among European schoolchildren.

PubMed

Keyes, Katherine M; Susser, Ezra; Pilowsky, Daniel J; Hamilton, Ava; Bitfoi, Adina; Goelitz, Dietmar; Kuijpers, Rowella C W M; Lesinskiene, Sigita; Mihova, Zlatka; Otten, Roy; Kovess, Viviane

2014-10-01

Unintentional injury is the leading cause of death for schoolchildren. We assessed the association between externalizing psychopathology, parenting style, and unintentional injury in European children in the community. Data were drawn from the School Children Mental Health in Europe project and included 4517 schoolchildren across seven diverse European regions. Past-year injuries serious enough to seek medical attention were reported by mothers. Child mental health problems were assessed using validated measures and reported by the mothers, teachers, and children. Parenting styles were based on The Parenting Scale and the Parent Behaviors and Attitudes Questionnaire. Children with attention-deficit/hyperactivity symptoms and oppositional defiant symptoms had a higher risk of injury compared to other children whether based on parent report (OR=1.47, 95% C.I. 1.2-1.9), teacher report (OR=1.36, 95% C.I. 1.1-1.7), or parent and teacher report combined (OR=1.53, 95% C.I. 1.1-2.1). Children who self-reported oppositional symptoms also had higher risk of injury (OR=1.6, 95% C.I. 1.1-2.4). Low-caring behavior of parents increased the risk of injury (OR=1.4, 95% C.I. 1.1-1.9). Unintentional injury is a potential adverse health consequence of child externalizing problems. Interventions to improve parent-child relationships and prevention as well as focused treatment for externalizing problems may reduce the burden of injury. Copyright © 2014 Elsevier Inc. All rights reserved.

Inflammatory Myofibroblastic Tumors of the Female Genital Tract Are Under-recognized

PubMed Central

Pickett, Justine L.; Chou, Angela; Andrici, Juliana A.; Clarkson, Adele; Sioson, Loretta; Sheen, Amy; Reagh, Jessica; Najdawi, Fedaa; Kim, Yoomee; Riley, Denise; Maidens, Jayne; Nevell, David; McIlroy, Kirsten; Valmadre, Susan; Gard, Greg; Hogg, Russell; Turchini, John; Robertson, Gregory; Friedlander, Michael

2017-01-01

Inflammatory myofibroblastic tumor (IMT) of the female genital tract is under-recognized. We investigated the prevalence of ALK-positive IMT in lesions previously diagnosed as gynecologic smooth muscle tumors. Immunohistochemistry (IHC) for ALK was performed on tissue microarrays of unselected tumors resected from 2009 to 2013. Three of 1176 (0.26%) “leiomyomas” and 1 of 44 (2.3%) “leiomyosarcomas” were ALK IHC positive, confirmed translocated by fluorescence in situ hybridization (FISH) and therefore more appropriately classified as IMT. On review significant areas of all 4 tumors closely mimicked smooth muscle tumors morphologically, but all showed at least subtle/focal features suggesting IMT. Recognizing that the distinction between IMT and leiomyoma/leiomyosarcoma can be subtle, we then reviewed 1 hematoxylin and eosin slide from each patient undergoing surgery for “leiomyoma” from 2014 to 2017 and selected cases for ALK IHC with a low threshold. Of these, 30 of 571 (5.3%) underwent IHC. Two were confirmed to be IHC positive and FISH rearranged. Of the 6 IMTs, only 1 tumor with a previous diagnosis of leiomyosarcoma, an infiltrative margin and equivocal necrosis, metastasized. Of note it demonstrated a less aggressive clinical course compared with most metastatic leiomyosarcomas (alive with disease at 6 y). The patient was subsequently offered crizotinib to which she responded rapidly. In conclusion, IMTs may closely mimic gynecologic smooth muscle tumors. IMTs account for at least 5 of 1747 (0.3%) tumors previously diagnosed as leiomyoma and 1 of 44 (2.3%) as leiomyosarcoma. These tumors may be recognized prospectively with awareness of subtle/focal histologic clues, coupled with a low threshold for ALK IHC. PMID:28731868

Stress factors predicting injuries of hospital personnel.

PubMed

Salminen, Simo; Kivimäki, Mika; Elovainio, Marko; Vahtera, Jussi

2003-07-01

Stress at work has long been recognized as a factor in increasing risk for mental and physical health problems. The extent to which work stressors and stress predicted injuries occur in a large population of Finnish hospital workers was studied. A total of 5,111 employees (624 men, 4,487 women) from 10 hospitals participated in this study. Their psychological distress was measured by the General Health Questionnaire, and overload and job control by the Harris scale and the Job Content Questionnaire, respectively. Injuries certified by a physician were followed up for 3 years: injuries in 1997 (n = 213) were used as a measure of baseline and injuries in 1998-1999 (n = 443) were the dependent variables. Psychological distress was not significantly related to injuries. However, low decision latitude (risk ratio = 1.27 (1.04 to 1.54)), low skill discretion only for men (risk ratio = 2.76 (1.78 to 4.30)), and highly monotonous work (risk ratio = 1.26 (1.02 to 1.55)) were stressors predicting injuries. In addition, workers with numerous problems in interpersonal relationships (risk ratio = 1.43 (1.18 to 1.73)) or many conflicts in collaboration at work (risk ratio = 1.40 (1.15 to 1.71)) were more often involved in injuries. This study showed that stressors related to autonomy of work and interpersonal relationship at workplace are predictors of injuries in hospital settings. These factors are potentially amenable to organizational interventions. Copyright 2003 Wiley-Liss, Inc.

Adolescents’ internalizing problems following traumatic brain injury are related to parents’ psychiatric symptoms

PubMed Central

Peterson, Robin L.; Kirkwood, Michael W.; Taylor, H. Gerry; Stancin, Terry; Brown, Tanya M.; Wade, Shari L.

2013-01-01

Background A small body of previous research has demonstrated that pediatric traumatic brain injury increases risk for internalizing problems, but findings have varied regarding their predictors and correlates. Methods We examined the level and correlates of internalizing symptoms in 130 teens who had sustained a complicated mild to severe TBI within the past 1 to 6 months. Internalizing problems were measured via both maternal and paternal report Child Behavior Checklist. We also measured family functioning, parent psychiatric symptoms, and post-injury teen neurocognitive function. Results Mean parental ratings of internalizing problems were within the normal range. Depending on informant, 22–26% of the sample demonstrated clinically elevated internalizing problems. In multiple and binary logistic regression models, only parent psychiatric symptoms consistently provided unique prediction of teen internalizing symptoms. For maternal but not paternal report, female gender was associated with greater internalizing problems. Conclusion Parent and teen emotional problems are associated following adolescent TBI. Possible reasons for this relationship, including the effects of TBI on the family unit, are discussed. PMID:22935574

Injuries to law enforcement officers: the backface signature injury.

PubMed

Wilhelm, Marianne; Bir, Cynthia

2008-01-15

In today's law enforcement community, one of the most vital tools an officer can possess is personal body armor. However, a recent Department of Justice investigation has raised important questions regarding the protection actually afforded officers through the use of personal body armor, and the current test methods used to assess the armor. Test results show that most Zylon-containing vests showed deformations in excess of the 0101.04 Standard's 44 mm backface signature limit. Such increased deformation can lead to serious injuries, including backface signature injuries, which have occurred in the field. Although the vest is successful in containing the round, it is not effectively dissipating the energy enough to prevent large amounts of vest deformation at the area of impact. Therefore, open, penetrating wounds occur even though the bullet did not penetrate the vest. The objective of the current study was to further define the backface signature injury through the use of case studies and laboratory experiments. Following the case study investigation, backface signature testing was conducted using a clay medium based on the NIJ 0101.04 Standard. The final component of this research involved the use of post-mortem human specimens (PMHS) for further investigation of the backface signature injury. Although the underlying cause of backface signature injuries is unknown, energy density is likely to play a role in the mechanism. Energy density (E/a) is defined as the energy per unit area and has been previously used in less lethal skin penetration research. Further research into the underlying causes of backface signature injuries is necessary. In addition to armor testing, the study of law enforcement personnel who have been shot while wearing soft body armor is also a valuable tool for determining the effectiveness of certification standards. Finally, it is important for medical personnel to recognize the backface signature injury and document this as a type of

Laparoscopic hernia repair and bladder injury.

PubMed

Dalessandri, K M; Bhoyrul, S; Mulvihill, S J

2001-01-01

Bladder injury is a complication of laparoscopic surgery with a reported incidence in the general surgery literature of 0.5% and in the gynecology literature of 2%. We describe how to recognize and treat the injury and how to avoid the problem. We report two cases of bladder injury repaired with a General Surgical Interventions (GSI) trocar and a balloon device used for laparoscopic extraperitoneal inguinal hernia repair. One patient had a prior appendectomy; the other had a prior midline incision from a suprapubic prostatectomy. We repaired the bladder injury, and the patients made a good recovery. When using the obturator and balloon device, it is important to stay anterior to the preperitoneal space and bladder. Prior lower abdominal surgery can be considered a relative contraindication to extraperitoneal laparoscopic hernia repair. Signs of gas in the Foley bag or hematuria should alert the surgeon to a bladder injury. A one- or two-layer repair of the bladder injury can be performed either laparoscopically or openly and is recommended for a visible injury. Mesh repair of the hernia can be completed provided no evidence exists of urinary tract infection. A Foley catheter is placed until healing occurs.

Parent Psychological Functioning and Communication Predict Externalizing Behavior Problems After Pediatric Traumatic Brain Injury

PubMed Central

Raj, Stacey P.; Cassedy, Amy; Taylor, H. Gerry; Stancin, Terry; Brown, Tanya M.; Kirkwood, Michael W.

2014-01-01

Objective Adolescents sustaining traumatic brain injury (TBI) show increased prevalence of behavior problems. This study investigated the associations of parent mental health, family functioning, and parent–adolescent interaction with adolescent externalizing behavior problems in the initial months after TBI, and examined whether injury severity moderated these associations. Methods 117 parent–adolescent dyads completed measures of family functioning, adolescent behavior, and parent mental health an average of 108 days post-TBI. Dyads also engaged in a 10-min video-recorded problem-solving activity coded for parent behavior and tone of interaction. Results Overall, higher ratings of effective parent communication were associated with fewer externalizing behavior problems, whereas poorer caregiver psychological functioning was associated with greater adolescent externalizing behaviors. Results failed to reveal moderating effects of TBI severity on the relationship between socio-environmental factors and behavior problems. Conclusions Interventions targeting parent communication and/or improving caregiver psychological health may ameliorate potential externalizing behavior problems after adolescent TBI. PMID:24065551

The development and evaluation of a web-based programme to support problem-solving skills following brain injury.

PubMed

Powell, Laurie Ehlhardt; Wild, Michelle R; Glang, Ann; Ibarra, Summer; Gau, Jeff M; Perez, Amanda; Albin, Richard W; O'Neil-Pirozzi, Therese M; Wade, Shari L; Keating, Tom; Saraceno, Carolyn; Slocumb, Jody

2017-10-24

Cognitive impairments following brain injury, including difficulty with problem solving, can pose significant barriers to successful community reintegration. Problem-solving strategy training is well-supported in the cognitive rehabilitation literature. However, limitations in insurance reimbursement have resulted in fewer services to train such skills to mastery and to support generalization of those skills into everyday environments. The purpose of this project was to develop and evaluate an integrated, web-based programme, ProSolv, which uses a small number of coaching sessions to support problem solving in everyday life following brain injury. We used participatory action research to guide the iterative development, usability testing, and within-subject pilot testing of the ProSolv programme. The finalized programme was then evaluated in a between-subjects group study and a non-experimental single case study. Results were mixed across studies. Participants demonstrated that it was feasible to learn and use the ProSolv programme for support in problem solving. They highly recommended the programme to others and singled out the importance of the coach. Limitations in app design were cited as a major reason for infrequent use of the app outside of coaching sessions. Results provide mixed evidence regarding the utility of web-based mobile apps, such as ProSolv to support problem solving following brain injury. Implications for Rehabilitation People with cognitive impairments following brain injury often struggle with problem solving in everyday contexts. Research supports problem solving skills training following brain injury. Assistive technology for cognition (smartphones, selected apps) offers a means of supporting problem solving for this population. This project demonstrated the feasibility of a web-based programme to address this need.

Problem behaviour and traumatic dental injuries in adolescents.

PubMed

Ramchandani, Damini; Marcenes, Wagner; Stansfeld, Stephen A; Bernabé, Eduardo

2016-02-01

To explore the relationship between problem behaviour and traumatic dental injuries (TDI) among 15- to 16-year-old schoolchildren from East London. This cross-sectional study used data from 794 adolescents who participated in phase III of the Research with East London Adolescents Community Health Survey (RELACHS), a school-based prospective study of a representative sample of adolescents. Participants completed a questionnaire and were clinically examined for TDI, overjet and lip coverage. The Strength and Difficulties Questionnaire (SDQ) was used to assess problem behaviour, which provided a total score and five domain scores (emotional symptoms, conduct problems, hyperactivity, peer problems and pro-social behaviour). The association between problem behaviour and TDI was assessed in unadjusted and adjusted logistic regression models. Adjusted models controlled for demographic (sex, age and ethnicity), socio-economic (parental employment) and clinical factors (overjet and lip coverage). The prevalence of TDI was 17% and the prevalence of problem behaviour, according to the SDQ, was 10%. In the adjusted model, adolescents with problem behaviour were 1.87 (95% confidence interval: 1.03-3.37) times more likely to have TDI than those without problem behaviour. In subsequent analysis by SDQ domains, it was found that only peer problems were associated with TDI (OR = 1.78, 95% CI: 1.01-3.14), even after adjustment for confounders. This study found evidence for a relationship between problem behaviour and TDI among adolescents, which was mainly due to peer relationship problems. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Interventions for attention problems after pediatric traumatic brain injury: what is the evidence?

PubMed

Backeljauw, Barynia; Kurowski, Brad G

2014-09-01

To gain an understanding of the current state of the evidence for management of attention problems after traumatic brain injury (TBI) in children, determine gaps in the literature, and make recommendations for future research. TYPE: Focused systematic review. PubMed/Medline and PsychINFO databases were searched for relevant articles published in English during the last 20 years. Keywords included "attention" "attention deficit and disruptive behavior disorders," and "brain injuries." Studies were limited to children. Titles were examined first and eliminated based on lack of relevancy to attention problems after brain injury in children. This was followed by an abstract and full text review. Article quality was determined based on the US Preventative Services Task Force recommendations for evidence grading. Four pharmacologic and 10 cognitive therapy intervention studies were identified. These studies varied in level of evidence quality but were primarily nonrandomized or cohort studies. There are studies that demonstrate benefits of varying pharmacologic and cognitive therapies for the management of attention problems after TBI. However, there is a paucity of evidence available to definitively guide management of attention problems after pediatric TBI. Larger randomized, controlled trials and multicenter studies are needed to elucidate optimal treatment strategies in this population. Copyright © 2014 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

Caregiver Ratings of Long-term Executive Dysfunction and Attention Problems After Early Childhood Traumatic Brain Injury: Family Functioning Is Important

PubMed Central

Kurowski, Brad G.; Taylor, H. Gerry; Yeates, Keith Owen; Walz, Nicolay C.; Stancin, Terry; Wade, Shari L.

2013-01-01

Objective To evaluate the relationship of family and parenting factors to long-term executive dysfunction and attention problems after early childhood traumatic brain injury (TBI). We hypothesized that the magnitude of executive dysfunction and attention problems would be moderated by family and parenting factors. Design A multicenter, prospective cohort study that included an orthopedic injury (OI) reference group. Setting Three tertiary academic children’s hospital medical centers and one general medical center. Participants Children, ages 3–7 years, hospitalized for OI, moderate TBI, or severe TBI. Methods and Outcome Measurements Parental ratings of family functioning and parenting styles were obtained 18 months after the injury occurred. The main outcome measurements, which were parental ratings of children’s executive function and attention, were performed at least 24 months after the injury occurred (mean, 39 months; range, 25–63 months). Analysis Group comparisons were conducted with use of t-tests, χ2 analysis, analysis of variance, and Pearson and Spearman correlations. Regression analysis was used to examine associations of the outcomes with family functioning and parenting styles and to test moderating effects of these factors on group differences. Results Participants with severe TBI demonstrated increased executive dysfunction and attention problems compared with those who sustained moderate TBI or OI. Lower levels of family dysfunction were associated with better executive function and attention across groups but did not moderate group differences. However, attention deficits after severe TBI were exacerbated under conditions of more permissive parenting relative to attention deficits after OIs. Conclusions Executive function and attention problems persisted on a long-term basis (>24 months) after early childhood TBI, and positive global family functioning and nonpermissive parenting were associated with better outcomes. Better

Caregiver ratings of long-term executive dysfunction and attention problems after early childhood traumatic brain injury: family functioning is important.

PubMed

Kurowski, Brad G; Taylor, H Gerry; Yeates, Keith Owen; Walz, Nicolay C; Stancin, Terry; Wade, Shari L

2011-09-01

To evaluate the relationship of family and parenting factors to long-term executive dysfunction and attention problems after early childhood traumatic brain injury (TBI). We hypothesized that the magnitude of executive dysfunction and attention problems would be moderated by family and parenting factors. A multicenter, prospective cohort study that included an orthopedic injury (OI) reference group. Three tertiary academic children's hospital medical centers and one general medical center. Children, ages 3-7 years, hospitalized for OI, moderate TBI, or severe TBI. METHODS AND OUTCOME MEASUREMENTS: Parental ratings of family functioning and parenting styles were obtained 18 months after the injury occurred. The main outcome measurements, which were parental ratings of children's executive function and attention, were performed at least 24 months after the injury occurred (mean, 39 months; range, 25-63 months). Group comparisons were conducted with use of t-tests, χ(2) analysis, analysis of variance, and Pearson and Spearman correlations. Regression analysis was used to examine associations of the outcomes with family functioning and parenting styles and to test moderating effects of these factors on group differences. Participants with severe TBI demonstrated increased executive dysfunction and attention problems compared with those who sustained moderate TBI or OI. Lower levels of family dysfunction were associated with better executive function and attention across groups but did not moderate group differences. However, attention deficits after severe TBI were exacerbated under conditions of more permissive parenting relative to attention deficits after OIs. Executive function and attention problems persisted on a long-term basis (>24 months) after early childhood TBI, and positive global family functioning and nonpermissive parenting were associated with better outcomes. Better characterization of the optimal family environment for recovery from early childhood

Estimating under-reporting of road crash injuries to police using multiple linked data collections.

PubMed

Watson, Angela; Watson, Barry; Vallmuur, Kirsten

2015-10-01

The reliance on police data for the counting of road crash injuries can be problematic, as it is well known that not all road crash injuries are reported to police which under-estimates the overall burden of road crash injuries. The aim of this study was to use multiple linked data sources to estimate the extent of under-reporting of road crash injuries to police in the Australian state of Queensland. Data from the Queensland Road Crash Database (QRCD), the Queensland Hospital Admitted Patients Data Collection (QHAPDC), Emergency Department Information System (EDIS), and the Queensland Injury Surveillance Unit (QISU) for the year 2009 were linked. The completeness of road crash cases reported to police was examined via discordance rates between the police data (QRCD) and the hospital data collections. In addition, the potential bias of this discordance (under-reporting) was assessed based on gender, age, road user group, and regional location. Results showed that the level of under-reporting varied depending on the data set with which the police data was compared. When all hospital data collections are examined together the estimated population of road crash injuries was approximately 28,000, with around two-thirds not linking to any record in the police data. The results also showed that the under-reporting was more likely for motorcyclists, cyclists, males, young people, and injuries occurring in Remote and Inner Regional areas. These results have important implications for road safety research and policy in terms of: prioritising funding and resources; targeting road safety interventions into areas of higher risk; and estimating the burden of road crash injuries. Copyright © 2015 Elsevier Ltd. All rights reserved.

Causes of Ring-Related Leg Injuries in Birds – Evidence and Recommendations from Four Field Studies

PubMed Central

Griesser, Michael; Schneider, Nicole A.; Collis, Mary-Anne; Overs, Anthony; Guppy, Michael; Guppy, Sarah; Takeuchi, Naoko; Collins, Pete; Peters, Anne; Hall, Michelle L.

2012-01-01

One of the main techniques for recognizing individuals in avian field research is marking birds with plastic and metal leg rings. However, in some species individuals may react negatively to rings, causing leg injuries and, in extreme cases, the loss of a foot or limb. Here, we report problems that arise from ringing and illustrate solutions based on field data from Brown Thornbills (Acanthiza pusilla) (2 populations), Siberian Jays (Perisoreus infaustus) and Purple-crowned Fairy-wrens (Malurus coronatus). We encountered three problems caused by plastic rings: inflammations triggered by material accumulating under the ring (Purple-crowned Fairy-wrens), contact inflammations as a consequence of plastic rings touching the foot or tibio-tarsal joint (Brown Thornbills), and toes or the foot getting trapped in partly unwrapped flat-band colour rings (Siberian Jays). Metal rings caused two problems: the edges of aluminium rings bent inwards if mounted on top of each other (Brown Thornbills), and too small a ring size led to inflammation (Purple-crowned Fairy-wrens). We overcame these problems by changing the ringing technique (using different ring types or larger rings), or using different adhesive. Additionally, we developed and tested a novel, simple technique of gluing plastic rings onto metal rings in Brown Thornbills. A review of studies reporting ring injuries (N = 23) showed that small birds (<55 g body weight) are more prone to leg infections while larger birds (>35 g) tend to get rings stuck over their feet. We give methodological advice on how these problems can be avoided, and suggest a ringing hazard index to compare the impact of ringing in terms of injury on different bird species. Finally, to facilitate improvements in ringing techniques, we encourage online deposition of information regarding ringing injuries of birds at a website hosted by the European Union for Bird Ringing (EURING). PMID:23300574

Video analysis of concussion injury mechanism in under-18 rugby

PubMed Central

Hendricks, Sharief; O'Connor, Sam; Lambert, Michael; Brown, James C; Burger, Nicholas; Mc Fie, Sarah; Readhead, Clint; Viljoen, Wayne

2016-01-01

Background Understanding the mechanism of injury is necessary for the development of effective injury prevention strategies. Video analysis of injuries provides valuable information on the playing situation and athlete-movement patterns, which can be used to formulate these strategies. Therefore, we conducted a video analysis of the mechanism of concussion injury in junior-level rugby union and compared it with a representative and matched non-injury sample. Methods Injury reports for 18 concussion events were collected from the 2011 to 2013 under-18 Craven Week tournaments. Also, video footage was recorded for all 3 years. On the basis of the injury events, a representative ‘control’ sample of matched non-injury events in the same players was identified. The video footage, which had been recorded at each tournament, was then retrospectively analysed and coded. 10 injury events (5 tackle, 4 ruck, 1 aerial collision) and 83 non-injury events were analysed. Results All concussions were a result of contact with an opponent and 60% of players were unaware of the impending contact. For the measurement of head position on contact, 43% had a ‘down’ position, 29% the ‘up and forward’ and 29% the ‘away’ position (n=7). The speed of the injured tackler was observed as ‘slow’ in 60% of injurious tackles (n=5). In 3 of the 4 rucks in which injury occurred (75%), the concussed player was acting defensively either in the capacity of ‘support’ (n=2) or as the ‘jackal’ (n=1). Conclusions Training interventions aimed at improving peripheral vision, strengthening of the cervical muscles, targeted conditioning programmes to reduce the effects of fatigue, and emphasising safe and effective playing techniques have the potential to reduce the risk of sustaining a concussion injury. PMID:27900149

Lysosomal acid lipase deficiency--an under-recognized cause of dyslipidaemia and liver dysfunction.

PubMed

Reiner, Željko; Guardamagna, Ornella; Nair, Devaki; Soran, Handrean; Hovingh, Kees; Bertolini, Stefano; Jones, Simon; Ćorić, Marijana; Calandra, Sebastiano; Hamilton, John; Eagleton, Terence; Ros, Emilio

2014-07-01

Lysosomal acid lipase deficiency (LAL-D) is a rare autosomal recessive lysosomal storage disease caused by deleterious mutations in the LIPA gene. The age at onset and rate of progression vary greatly and this may relate to the nature of the underlying mutations. Patients presenting in infancy have the most rapidly progressive disease, developing signs and symptoms in the first weeks of life and rarely surviving beyond 6 months of age. Children and adults typically present with some combination of dyslipidaemia, hepatomegaly, elevated transaminases, and microvesicular hepatosteatosis on biopsy. Liver damage with progression to fibrosis, cirrhosis and liver failure occurs in a large proportion of patients. Elevated low-density lipoprotein cholesterol levels and decreased high-density lipoprotein cholesterol levels are common features, and cardiovascular disease may manifest as early as childhood. Given that these clinical manifestations are shared with other cardiovascular, liver and metabolic diseases, it is not surprising that LAL-D is under-recognized in clinical practice. This article provides practical guidance to lipidologists, endocrinologists, cardiologists and hepatologists on how to recognize individuals with this life-limiting disease. A diagnostic algorithm is proposed with a view to achieving definitive diagnosis using a recently developed blood test for lysosomal acid lipase. Finally, current management options are reviewed in light of the ongoing development of enzyme replacement therapy with sebelipase alfa (Synageva BioPharma Corp., Lexington, MA, USA), a recombinant human lysosomal acid lipase enzyme. Copyright © 2014 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

The health consequences of child mental health problems and parenting styles: Unintentional injuries among European schoolchildren☆,☆☆

PubMed Central

Keyes, Katherine M.; Susser, Ezra; Pilowsky, Daniel J.; Hamilton, Ava; Bitfoi, Adina; Goelitz, Dietmar; Kuijpers, Rowella C.W.M.; Lesinskiene, Sigita; Mihova, Zlatka; Otten, Roy; Kovess, Viviane

2015-01-01

Objective Unintentional injury is the leading cause of death for schoolchildren. We assessed the association between externalizing psychopathology, parenting style, and unintentional injury in European children in the community. Methods Data were drawn from the School Children Mental Health in Europe project and included 4517 schoolchildren across seven diverse European regions. Past year injuries serious enough to seek medical atten tion were reported by mothers. Child mental health problems were assessed using validated measures and re ported by the mothers, teachers, and children. Parenting styles were based on The Parenting Scale and the Parent Behaviors and Attitudes Questionnaire. Results. Children with attention deficit/hyperactivity symptoms and oppositional defant symptoms had a higher risk of injury compared to other children whether based on parent report (OR = 1.47, 95% C.I. 1.2 1.9), teacher report (OR = 1.36, 95% C.I. 1.1 1.7), or parent- and teacher-report combined (OR = 1.53, 95% C.I. 1.1 2.1). Children who self reported oppositional symptoms also had higher risk of injury (OR = 1.6, 95% C.I. 1.1 2.4). Low caring behavior of parents increased the risk of injury (OR = 1.4, 95% C.I. 1.1-1.9). Conclusion Unintentional injury is a potential adverse health consequence of child externalizing problems. Interventions to improve parent child relationships and prevention as well as focused treatment for externaliz ing problems may reduce the burden of injury. PMID:25073079

Epidemiology of Time-Loss Injuries in Senior and under-18 Portuguese Male Rugby Players

PubMed Central

Cruz-Ferreira, Antonio Miguel; Cruz-Ferreira, Eduardo Miguel; Ribeiro, Pedro Barbosa; Santiago, Luiz Miguel; Taborda-Barata, Luis

2018-01-01

Abstract Rugby union has one of the highest injury incidence rates in team sports, however, most of the available data focus on the epidemiology of injuries in countries where rugby is popular. We aimed to report the incidence rate and relevant epidemiological aspects of injuries occurred in a group of Portuguese male rugby players. A prospective cohort study was conducted with a group of 45 senior and 32 under-18 male players (total of 77 players). Outcome measures included injury incidence, position, type, location and severity of injuries. The match injury incidence for all players was 55.84 per 1000 player match-hours (66.66 for seniors, 42.85 for under-18), while mean time-loss for injury was 20.79 days. No statistical differences were found between groups. Lower limb injuries accounted for 60.5% of all injuries, while joint/ligament injuries were the most prevalent type. Contact events were responsible for 65.1% of injuries. Despite the limitations, the obtained data are consistent with the literature. Time-loss injuries seem highly prevalent in rugby union and the incidence rates found in this Portuguese-based study were lower than the reported for international and senior men’s professional rugby union, but higher than those occurring in community rugby in tier-1 countries. The authors believe these data reinforce the need to develop and implement effective injury surveillance and prevention programs. PMID:29922379

A Survey on Transport Management Practices Associated with Injuries and Health Problems in Horses

PubMed Central

Padalino, Barbara; Raidal, Sharanne L.; Hall, Evelyn; Knight, Peter; Celi, Pietro; Jeffcott, Leo; Muscatello, Gary

2016-01-01

An online survey was conducted to determine associations between transport management and transport-related injuries and diseases in horses in Australia. The survey was composed of three sections: respondents’ demographic information, transport management strategies or procedures (before, during and after transportation) and transport diseases experienced in the previous two year period. Univariate and multivariate modelling was performed exploring associations between variables (respondents’ details and transport management strategies) and the following transport-related diseases as outcomes: traumatic injuries, diarrhoea, heat stroke, muscular problems, laminitis, transport pneumonia and colic. The survey generated 797 responses. Traumatic injuries were the most common transport-related problem, with a reported incidence of 45.0%. Younger respondents (<40 years old) caring for large numbers of horses (>30 in a week) were more likely to report transport-related injuries. Injury risk was also linked to the use of protections and tranquilizers prior to transport, and checking horses after the journey. Diarrhoea (20.0%) and heat stroke (10.5%) were reported more by amateur than professional horse carers. Increased risk of heat stroke was linked to the restriction of hay and water prior to transportation. Muscular problems (13.0%) appeared to be exacerbated when horse health was not assessed before journey; whilst the risk of laminitis (2.9%) was around three fold greater when post transport recovery strategies were not applied. Associations were made between transport pneumonia (9.2%) and duration of journey, and with activity (horses involved in racing at greater risk). No associations were seen between the incidence of colic (10.3%) and the variables examined. Study findings should be interpreted with caution as they represent participant perceptions and recall. Nevertheless, results support many current recommendations for safe transportation of horses. They

Cumulative Injury

PubMed Central

LaDou, Joseph

1978-01-01

A few states, notably California, are experiencing large increases in the number and cost of disability settlements under workers' compensation. Claims of cumulative injury for coronary heart disease, hypertension, stroke, cancer and neuropsychiatric problems have all been interpreted as compensable under workers' compensation, even when these conditions are clearly related to the aging process. Legal precedents for such claims are building rapidly throughout the country. The resultant costs may lead to the demise of the workers' compensation system. The situation in California is discussed in detail including the legal aspects, cumulative injury claims by type of disease and age of claimants, legal costs to the individual and the employer, and the economic outlook for the workers' compensation insurance system. PMID:151986

Observed Parent Behaviors as Time-Varying Moderators of Problem Behaviors Following Traumatic Brain Injury in Young Children

PubMed Central

Treble-Barna, Amery; Zang, Huaiyu; Zhang, Nanhua; Taylor, H. Gerry; Stancin, Terry; Yeates, Keith Owen; Wade, Shari L.

2016-01-01

Parent behaviors moderate the adverse consequences of pediatric traumatic brain injury (TBI); however, it is unknown how these moderating effects change over time. This study examined the moderating effect of observed parent behaviors over time since injury on the relation between TBI and behavioral outcomes. Participants included children, ages 3–7 years, hospitalized for moderate (n = 52) or severe (n = 20) TBI or orthopedic injury (OI; n = 95). Parent–child dyads were videotaped during structured task and free play conditions and parents completed child behavior ratings. Linear mixed models using a lagged, time-varying moderator analysis examined the relationship of observed parent behaviors at the baseline, 6-month, and 12-month assessments to child behavior problems at 6 months, 12 months, and 18 months post injury, after controlling for pre-injury levels of child behavior problems. The effect of TBI on behavior was exacerbated by less favorable parent behaviors, and buffered by more favorable parent behaviors, in children with severe TBI over the first 12 months post injury. By 18 months post injury, however, the moderating effect of parent behaviors diminished such that children with severe TBI showed more behavior problems relative to children with moderate TBI or OI regardless of parent behaviors or in response to parent behaviors that were initially protective. The results suggest that the moderating effects of the family environment are complex and likely vary in relation to both recovery and developmental factors, with potentially important implications for targets and timing of intervention. PMID:27786528

Head injury - first aid

MedlinePlus

... medlineplus.gov/ency/article/000028.htm Head injury - first aid To use the sharing features on this page, ... a concussion can range from mild to severe. First Aid Learning to recognize a serious head injury and ...

Cheerleading injuries: A narrative review of the literature

PubMed Central

Bagnulo, Angela

2012-01-01

Background: With its increase in participation rate and complex stunts and gymnastic-like maneuvers, cheerleading injuries are on the rise. Objective: A structured narrative review of the literature was performed to discover the status of the literature on a growing yet under recognized sport. Cheerleading injuries are described in terms of distribution, etiology, and prevention. Methods: A literature search was conducted. The articles were then reviewed and included based on broad criteria set out by the author. Results: The search produced 87 articles related to cheerleading injuries or articles with a mention of cheerleading. A total of 26 articles were included in this review based on the inclusion criteria. The most common injury experienced by a cheerleader is an ankle ligament sprain. Summary: The recognition of cheerleading as a sport and a mandatory reporting database are needed along with further research for injury prevention strategies to be implemented. PMID:23204573

Respiratory dyskinesia--an under-recognized side-effect of neuroleptic medications.

PubMed

Bhimanil, Mukesh Mohan; Bhimani, Mukesh; Khan, Murad Moosa; Khan, Muhammad Faheem Ashraf; Waris, Muhammad Shiraz

2011-09-01

Respiratory dyskinesia is an under-recognized side effect of neuroleptic administration. There are only few studies that have addressed the prevalence of respiratory dyskinesia in patients with tardive dyskinesia. Our case report highlights the need to regularly examine patients on antipsychotics for any evidence of dyskinetic movements including respiratory musculature. Since RD is underrecognized and misdiagnosed, early detection can improve long term prognosis as treatment options are few and usually of only limited effect. A 62-year-old Asian male, retired civil engineer, had more than 20 years history of depressive illness, developed antidepressant induced hypomania, and was given risperidone upto 1 mg per day. He developed extrapyrmidal side effects as tremors, rigidity and later dyskinetic movements of lips with shortness of breathing, dyspnoea, grunting or gasping. He was referred to the pulmonologist who got the neccessary medical work up done, which was normal. A diagnosis of respiratory dyskinesia was made. Respiratory dyskinesia is an under-recognised and distressing condition that clinicians need to be aware of when treating patients with anti-psychotic medications. And also there is a need to regularly examine patients on antipsychotics for any evidence of dyskinetic movements including respiratory musculature for early diagnosis and better outcome. This case report also is worth reading for professionals of other specialties also because of the presentation of this patient, it can be easily misdiagnosed and result in poor outcome.

Epidemiology of injuries sustained by players during the 16th Under-17 South American Soccer Championship.

PubMed

Pangrazio, O; Forriol, F

2016-01-01

We performed an epidemiological study of the traumatic injuries during the XVI South American U-17 Football Championship, 2015. Observational surveys submitted by the 10 teams medical services of 220 players. Thirty-five games were held and 116 goals (3.31 per game) were recorded. 103 lesions, ie, 2.94 per game or 32.7 injuries per 1,000 min were recorded. Fifty-six were from direct contact and 66 requiring treatment. 36% of the injuries were punished by fault and 26% of the injuries also saw card. Injuries were most common in the ankle (15 cases), Achilles tendon (14 cases) and thigh (14 cases), followed by trauma to the knee and foot (7 cases each), face and the lumbar region (6 cases each), being rare in the upper extremity. Injuries during Soccer World Cup are difficult to predict and prevent, but serious injuries are rare. Is necessary to establish protocols that get adequate health care at all levels to solve problems produce, both in training and during the competition, and be prepared to solve the serious problems that may arise. Copyright © 2015 SECOT. Published by Elsevier Espana. All rights reserved.

Eye injuries in sport: an increasing problem.

PubMed Central

Jones, N P

1987-01-01

A prospective study of ocular injuries sustained during sport, was performed from January to June 1987. A total of 84 eye injuries were seen. Of these, 23 were severe enough to necessitate admission to hospital. These latter accounted for one quarter of all severe eye injuries during this period. Racquet sports caused 42% of the injuries, and 57% of the hospital admissions, including two penetrating injuries. The importance of sport in causing eye trauma is increasing. It is crucial to encourage safer play, including the wearing of adequate eye protection. PMID:3435820

Acute kidney injury in the fetus and neonate

PubMed Central

Nada, Arwa; Bonachea, Elizabeth M.; Askenazi, David

2017-01-01

SUMMARY Acute kidney injury (AKI) is an under-recognized morbidity of neonates; the incidence remains unclear due to the absence of a unified definition of AKI in this population and because previous studies have varied greatly in screening for AKI with serum creatinine and urine output assessments. Premature infants may be born with less than half of the nephrons compared with term neonates, predisposing them to chronic kidney disease (CKD) early on in life and as they age. AKI can also lead to CKD, and premature infants with AKI may be at very high risk for long-term kidney problems. AKI in neonates is often multifactorial and may result from prenatal, perinatal, or postnatal insults as well as any combination thereof. This review focuses on the causes of AKI, the importance of early detection, the management of AKI in neonates, and long-term sequela of AKI in neonates. PMID:28034548

46 CFR 164.019-17 - Recognized laboratory.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 46 Shipping 6 2011-10-01 2011-10-01 false Recognized laboratory. 164.019-17 Section 164.019-17...: SPECIFICATIONS AND APPROVAL MATERIALS Personal Flotation Device Components § 164.019-17 Recognized laboratory. (a) General. A laboratory may be designated as a recognized laboratory under this subpart if it is— (1...

46 CFR 164.019-17 - Recognized laboratory.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 6 2010-10-01 2010-10-01 false Recognized laboratory. 164.019-17 Section 164.019-17...: SPECIFICATIONS AND APPROVAL MATERIALS Personal Flotation Device Components § 164.019-17 Recognized laboratory. (a) General. A laboratory may be designated as a recognized laboratory under this subpart if it is— (1...

Problem identification for Virginia's highway safety plan.

DOT National Transportation Integrated Search

1982-01-01

Problem identification is recognized as an important component of highway safety planning. Under the NHTSA/FHWA concept, problem identification is the first step in program planning and in the development of effective countermeasure programs. The ann...

Accuracy of injury coding under ICD‐9 for New Zealand public hospital discharges

PubMed Central

Langley, J; Stephenson, S; Thorpe, C; Davie, G

2006-01-01

Objective To determine the level of accuracy in coding for injury principal diagnosis and the first external cause code for public hospital discharges in New Zealand and determine how these levels vary by hospital size. Method A simple random sample of 1800 discharges was selected from the period 1996–98 inclusive. Records were obtained from hospitals and an accredited coder coded the discharge independently of the codes already recorded in the national database. Results Five percent of the principal diagnoses, 18% of the first four digits of the E‐codes, and 8% of the location codes (5th digit of the E‐code), were incorrect. There were no substantive differences in the level of incorrect coding between large and small hospitals. Conclusions Users of New Zealand public hospital discharge data can have a high degree of confidence in the injury diagnoses coded under ICD‐9‐CM‐A. A similar degree of confidence is warranted for E‐coding at the group level (for example, fall), but not, in general, at higher levels of specificity (for example, type of fall). For those countries continuing to use ICD‐9 the study provides insight into potential problems of coding and thus guidance on where the focus of coder training should be placed. For those countries that have historical data coded according to ICD‐9 it suggests that some specific injury and external cause incidence estimates may need to be treated with more caution. PMID:16461421

Pediatric Sports Medicine Injuries: Common Problems and Solutions.

PubMed

Huleatt, Joel B; Nissen, Carl W; Milewski, Matthew D

2018-04-01

The treatment of sports injuries in the skeletally immature has a unique set of complications. Growth deformity may occur after anterior cruciate ligament reconstruction; therefore, skeletal age is used to help guide the choice between physeal sparing and transphyseal techniques. Arthrofibrosis after tibial spine fracture fixation can be reduced by initiating immediate range of motion, and should be treated early and cautiously to avoid iatrogenic fracture. Nonunions of medial epicondyle elbow fractures are more common with nonoperative treatment, but seldom lead to clinical problems outside of certain athletes. Risks of OCD fixation are specific to the material of screw used. Copyright © 2017 Elsevier Inc. All rights reserved.

46 CFR 160.064-7 - Recognized laboratory.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 6 2010-10-01 2010-10-01 false Recognized laboratory. 160.064-7 Section 160.064-7...: SPECIFICATIONS AND APPROVAL LIFESAVING EQUIPMENT Marine Buoyant Devices § 160.064-7 Recognized laboratory. (a) A... laboratory. The following laboratories are recognized under § 159.010-7 of this part, to perform testing and...

46 CFR 160.076-19 - Recognized laboratories.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 6 2010-10-01 2010-10-01 false Recognized laboratories. 160.076-19 Section 160.076-19... Recognized laboratories. (a) PFDs. The following laboratories are recognized under § 159.010-9 of this... Laboratories, Inc., 12 Laboratory Drive, P.O. Box 13995, Research Triangle Park, NC 27709-3995, (919) 549-1400...

46 CFR 160.064-7 - Recognized laboratory.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 46 Shipping 6 2011-10-01 2011-10-01 false Recognized laboratory. 160.064-7 Section 160.064-7...: SPECIFICATIONS AND APPROVAL LIFESAVING EQUIPMENT Marine Buoyant Devices § 160.064-7 Recognized laboratory. (a) A... laboratory. The following laboratories are recognized under § 159.010-7 of this part, to perform testing and...

46 CFR 160.076-19 - Recognized laboratories.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 46 Shipping 6 2011-10-01 2011-10-01 false Recognized laboratories. 160.076-19 Section 160.076-19... Recognized laboratories. (a) PFDs. The following laboratories are recognized under § 159.010-9 of this... Laboratories, Inc., 12 Laboratory Drive, P.O. Box 13995, Research Triangle Park, NC 27709-3995, (919) 549-1400...

The determination of effective injury controls for metal-cutting lathe operators.

PubMed

Etherton, J R; Trump, T R; Jensen, R C

1981-01-01

Operators of metal-working lathes are one of the largest manufacturing machine worker populations in the United States. Machines (other than vehicular) account for over 10% of occupational injuries each year. An estimated 3,400 operators of metal-working lathes suffer lost-time injuries annually in the United States. Some of these are fatal. Therefore an investigation was undertaken to determine methods for reducing injuries to lathe operators. Three methods were used: (i) review of injury reports, (ii) human factors analysis, and (iii) fault-tree procedures. The investigation followed the man-machine systems approach of looking for injury-producing dysfunctions between the lathe and the lathe operator. The major sources of injury were found to be chips and workholding devices. Secondary tasks were found to be more hazardous than is generally recognized. The use of three methods for approaching the problem was found to be useful in that injury controls were identified which are likely to be adopted because of their potential for improving safety without adversely affecting productivity.

Abdominal wall dysfunction in adult bladder exstrophy: a treatable but under-recognized problem.

PubMed

Manahan, M A; Campbell, K A; Tufaro, A P

2016-08-01

Bladder exstrophy is defined by urogenital and skeletal abnormalities with cosmetic and functional deformity of the lower anterior abdominal wall. The primary management objectives have historically been establishment of urinary continence with renal function preservation, reconstruction of functional and cosmetically acceptable external genitalia, and abdominal wall closure of some variety. The literature has focused on the challenges of neonatal approaches to abdominal wall closure; however, there has been a paucity of long-term followup to identify the presence and severity of abdominal wall defects in adulthood. Our goal was to characterize the adult disease and determine effective therapy. A retrospective review of a consecutive series of six patients was performed. We report and characterize the presence of severe abdominal wall dysfunction in these adult exstrophy patients treated as children. We tailored an abdominal wall and pelvic floor reconstruction with long-term success to highlight a need for awareness of the magnitude of the problem and its solvability. The natural history of abdominal wall laxity and the long-term consequences of cloacal exstrophy closure have gone unexplored and unreported. Evaluation of our series facilitates understanding in this complex area and may be valuable for patients who are living limited lives thinking that no solution is available.

Aspects of abuse: recognizing and responding to child maltreatment.

PubMed

Jackson, Allison M; Kissoon, Natalie; Greene, Christian

2015-03-01

Child maltreatment is a public health problem and toxic stress impacting at least 1 in 8 children by the age of 18 years. Maltreatment can take the form of physical and sexual abuse, neglect, and emotional maltreatment. While some children may experience only one form of maltreatment, others may survive multiple forms, and in some cases particularly complex forms of maltreatment such as torture and medical child abuse. When considering maltreatment, providers should be adept at obtaining a thorough history not only from the parent but when appropriate also from the patient. The most common form of child maltreatment is neglect, which encompasses nutritional and medical neglect, as well as other forms such as physical and emotional neglect. Talking with caregivers about stressors and barriers to care may give insight into the etiology for neglect and is an opportunity for the provider to offer or refer for needed assistance. Familiarity with injury patterns and distribution in the context of developmental milestones and injury mechanisms is critical to the recognition of physical abuse. While most anogenital exam results of child victims of sexual abuse are normal, knowing the normal variations for the female genitalia, and thereby recognizing abnormal findings, is important not only forensically but also more importantly for patient care. Pattern recognition does not only apply to specific injuries or constellation of injuries but also applies to patterns of behavior. Harmful patterns of behavior include psychological maltreatment and medical child abuse, both of which cause significant harm to patients. As health professionals serving children and families, pediatric providers are in a unique position to identify suspected maltreatment and intervene through the health care system in order to manage the physical and psychological consequences of maltreatment and to promote the safety and well-being of children and youth by making referrals to child protective

Self-affirmation improves problem-solving under stress.

PubMed

Creswell, J David; Dutcher, Janine M; Klein, William M P; Harris, Peter R; Levine, John M

2013-01-01

High levels of acute and chronic stress are known to impair problem-solving and creativity on a broad range of tasks. Despite this evidence, we know little about protective factors for mitigating the deleterious effects of stress on problem-solving. Building on previous research showing that self-affirmation can buffer stress, we tested whether an experimental manipulation of self-affirmation improves problem-solving performance in chronically stressed participants. Eighty undergraduates indicated their perceived chronic stress over the previous month and were randomly assigned to either a self-affirmation or control condition. They then completed 30 difficult remote associate problem-solving items under time pressure in front of an evaluator. Results showed that self-affirmation improved problem-solving performance in underperforming chronically stressed individuals. This research suggests a novel means for boosting problem-solving under stress and may have important implications for understanding how self-affirmation boosts academic achievement in school settings.

Conquering Athletic Injuries.

ERIC Educational Resources Information Center

Taylor, Paul M., Ed.; Taylor, Diane K., Ed.

The purpose of this book is to be a source of complete, reliable, and practical sports medicine information. Experts from the American Running and Fitness Association describe in clear language how overuse injuries occur, how to recognize and self-treat them, when to seek professional help, and how to prevent future injuries. The book also…

Self-Affirmation Improves Problem-Solving under Stress

PubMed Central

Creswell, J. David; Dutcher, Janine M.; Klein, William M. P.; Harris, Peter R.; Levine, John M.

2013-01-01

High levels of acute and chronic stress are known to impair problem-solving and creativity on a broad range of tasks. Despite this evidence, we know little about protective factors for mitigating the deleterious effects of stress on problem-solving. Building on previous research showing that self-affirmation can buffer stress, we tested whether an experimental manipulation of self-affirmation improves problem-solving performance in chronically stressed participants. Eighty undergraduates indicated their perceived chronic stress over the previous month and were randomly assigned to either a self-affirmation or control condition. They then completed 30 difficult remote associate problem-solving items under time pressure in front of an evaluator. Results showed that self-affirmation improved problem-solving performance in underperforming chronically stressed individuals. This research suggests a novel means for boosting problem-solving under stress and may have important implications for understanding how self-affirmation boosts academic achievement in school settings. PMID:23658751

Management of pancreatic and duodenal injuries in pediatric patients.

PubMed

Plancq, M C; Villamizar, J; Ricard, J; Canarelli, J P

2000-01-01

Diagnosis of duodenal and pancreatic injuries is frequently delayed, and optimal treatment is often controversial. Fourteen children with duodenal and/or pancreatic injuries secondary to blunt trauma were treated between 1980 and 1997. The pancreas was injured in all but 1 child. An associated duodenal injury was present in 4. The preoperative diagnosis was suspected in only 6 patients based on clinical signs and ultrasonography. One patient was treated successfully conservatively; all the others required surgical management. At operation, three procedures were used: peripancreatic drainage, suture of the gland or duodenum with drainage, and primary distal pancreatic resection without splenectomy. A duodenal resection with reconstruction by duodeno-duodenostomy was performed in 1 case. The overall complication rate was 14%: 1 fistula and 1 pseudocyst. Pancreatic ductal transection was recognized 3 days after the initial laparotomy by endoscopic retrograde cholangiopancreatography (ERCP). The mortality was 7%; 1 patient died from septic and neurologic complications. When the diagnosis of pancreatic ductal injuries is a major problem, ERCP may be a useful diagnostic procedure. Pancreatic injuries without a transected duct may often be treated conservatively. The surgical or conservative management of duodenal hematomas is still controversial; other duodenal injuries often need surgical treatment.

Fatal and non-fatal injuries from vessels under air pressure in construction.

PubMed

Welch, L S; Weeks, J; Hunting, K L

1999-02-01

Using a surveillance system that captures data on construction workers treated in an urban emergency department, we identified a series of injuries caused by vessels and tools under air pressure. We describe those six cases, as well as similar cases found in the Census of Fatal Occupational Injuries; we also review data from the National Surveillance for Traumatic Occupational Fatalities database and data from the Bureau of Labor Statistics. Among the injuries and deaths for which we had good case descriptions, the majority would have been prevented by adherence to existing Occupational Safety and Health Administration standards in the construction industry.

Recognizing simple polyhedron from a perspective drawing

NASA Astrophysics Data System (ADS)

Zhang, Guimei; Chu, Jun; Miao, Jun

2009-10-01

Existed methods can't be used for recognizing simple polyhedron. In this paper, three problems are researched. First, a method for recognizing triangle and quadrilateral is introduced based on geometry and angle constraint. Then Attribute Relation Graph (ARG) is employed to describe simple polyhedron and line drawing. Last, a new method is presented to recognize simple polyhedron from a line drawing. The method filters the candidate database before matching line drawing and model, thus the recognition efficiency is improved greatly. We introduced the geometrical characteristics and topological characteristics to describe each node of ARG, so the algorithm can not only recognize polyhedrons with different shape but also distinguish between polyhedrons with the same shape but with different sizes and proportions. Computer simulations demonstrate the effectiveness of the method preliminarily.

Firework-related childhood injuries in Greece: a national problem.

PubMed

Vassilia, Konte; Eleni, Petridou; Dimitrios, Trichopoulos

2004-03-01

During a 5-year period, out of 110066 children with injuries recorded in the Greek Emergency Department Injury Surveillance System (EDISS), 91 had firework-related injuries. Descriptive analyses and the Barrell matrix were used to determine risk factors and extrapolated national firework childhood injury figures were calculated. The estimated annual incidence of childhood firework injuries treated in the emergency departments of hospitals countrywide, was 7 per 100000 children years. Seventy percent of injuries concerned older children (10-14 years), mostly boys with self-inflicted injuries, whereas girls suffered injuries as bystanders. A sharp peak in spring was noted, when the Greek Orthodox Easter is celebrated. Illicitly sold fireworks caused most injuries, but in eight instances homemade firecrackers were responsible.

Correlates of self-injurious, aggressive and destructive behaviour in children under five who are at risk of developmental delay.

PubMed

Petty, J L; Bacarese-Hamilton, M; Davies, L E; Oliver, C

2014-01-01

Several behavioural correlates of self-injury, aggression and destructive behaviour have been identified in children and young adults with intellectual disabilities. This cross-sectional study aimed to further explore these correlates in very young children with developmental delay. Parents of 56 children (40 male) under the age of five years (mean age 2 years 10 months) completed a questionnaire about their child's behaviour and the presence of behavioural correlates, including repetitive, over-active or impulsive behaviour and more severe developmental delay. Parents reported very high prevalence of self-injurious, aggressive and destructive behaviour: 51%, 64% and 51%, respectively. A binary logistic regression revealed that a higher score on a measure of overactive and impulsive behaviour significantly predicted the presence of destructive behaviour. A multiple linear regression revealed that both repetitive behaviour and number of health problems approached significance as independent predictors of severe self-injurious behaviour. Despite the very small sample, several factors emerged as potential predictors of self-injurious, aggressive and destructive behaviour. These findings support the need for further investigation in a larger sample. Confirmation in this age group could help guide the development of targeted early intervention for these behaviours by identifying behavioural risk markers. Copyright © 2013 Elsevier Ltd. All rights reserved.

CT characteristics of Morel-Lavallée lesions: an under-recognized but significant finding in acute trauma imaging.

PubMed

McKenzie, Gavin A; Niederhauser, Blake D; Collins, Mark S; Howe, Benjamin M

2016-08-01

To highlight the significance and imaging characteristics of Morel-Lavallée (ML) lesions, which have been well characterized on MRI, but are potentially under-recognized on CT. Twenty-eight Morel-Lavallée lesions were identified in 18 patients and were all clinically or surgically confirmed. Lesions were grouped into acute (<3 days), subacute (3-30 days), and chronic (>30 days) at the time of CT imaging. Charts were reviewed to gather patient characteristics, injury patterns, radiologist interpretation, treatment, and outcomes. Sixteen male and 2 female patients with a mean age of 50 years (range 19-80) at the date of their initial evaluation were identified. All patients had significant trauma that accounted for 28 ML lesions, all of which were in a characteristic subcutaneous location overlying the muscular fascial plane. Lesions on CT went through an evolution from hyperdense, poorly or moderately marginated without a pseudocapsule to being hypodense, with internal fat globules or septations and well marginated with a complete enhancing pseudocapsule. Only 1 (4 %) of the ML lesions was suggested and 7 (25 %) lesions were not commented on at all by the interpreting radiologist. Morel-Lavallée lesions are post-traumatic closed, internal, soft-tissue, degloving lesions that are potentially underrecognized on CT. Most acute ML lesions are nonspecific, resembling simple hematomas or contusions. ML lesions evolve as they age with subacute and chronic lesions demonstrating the known features described on MR imaging that should allow for an accurate imaging diagnosis.

Is clinician refusal to treat an emerging problem in injury compensation systems?

PubMed

Brijnath, Bianca; Mazza, Danielle; Kosny, Agnieszka; Bunzli, Samantha; Singh, Nabita; Ruseckaite, Rasa; Collie, Alex

2016-01-20

The reasons that doctors may refuse or be reluctant to treat have not been widely explored in the medical literature. To understand the ethical implications of reluctance to treat there is a need to recognise the constraints of doctors working in complex systems and to consider how these constraints may influence reluctance. The aim of this paper is to illustrate these constraints using the case of compensable injury in the Australian context. Between September and December 2012, a qualitative investigation involving face-to-face semistructured interviews examined the knowledge, attitudes and practices of general practitioners (GPs) facilitating return to work in people with compensable injuries. Compensable injury management in general practice in Melbourne, Australia. 25 GPs who were treating, or had treated a patient with compensable injury. The practice of clinicians refusing treatment was described by all participants. While most GPs reported refusal to treat among their colleagues in primary and specialist care, many participants also described their own reluctance to treat people with compensable injuries. Reasons offered included time and financial burdens, in addition to the clinical complexities involved in compensable injury management. In the case of compensable injury management, reluctance and refusal to treat is likely to have a domino effect by increasing the time and financial burden of clinically complex patients on the remaining clinicians. This may present a significant challenge to an effective, sustainable compensation system. Urgent research is needed to understand the extent and implications of reluctance and refusal to treat and to identify strategies to engage clinicians in treating people with compensable injuries. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Nonaccidental head injury in children. Historical vignette.

PubMed

Al-Holou, Wajd N; O'Hara, Edward A; Cohen-Gadol, Aaron A; Maher, Cormac O

2009-06-01

Our current understanding of nonaccidental head injury in children is the result of decades of effort and the tireless work of numerous physicians. In 1860 Auguste Ambroise Tardieu, a French forensics expert, recognized important patterns of injury in children and identified nonaccidental trauma as the cause of these injuries. His work was ignored. In the years that followed, physicians continued to report these patterns of injury but were unable to identify the etiology. A fundamental misunderstanding of the usual cause of subdural hematoma (SDH) contributed to the confusion at that time. Early in the 20th century, neurosurgeons such as Wilfred Trotter recognized that SDHs were traumatic in origin. However, even Trotter's efforts to expose faults in the theories that SDHs primarily resulted from inflammatory or infectious processes were not accepted immediately. Eventually, the pattern of injuries in children was again recognized both by neurosurgeons, who began to identify an association between trauma-induced SDHs and retinal hemorrhages, and by radiologists, who began to note SDHs in conjunction with osseous lesions. Not until the 1950s and 1960s, however, did physicians begin to routinely identify nonaccidental trauma as the cause of these injuries. Following the recognition of child abuse, a pattern of injuries in conjunction with shaking was identified and is currently known as shaken baby syndrome. Since its identification, our understanding of this syndrome has been modified as a result of new medical research, legal challenges, and popular media forces.

Erythropoietin protects myocardium against ischemia-reperfusion injury under moderate hyperglycemia.

PubMed

Jun, Ji Hae; Jun, Na-Hyung; Shim, Jae-Kwang; Shin, Eun Jung; Kwak, Young-Lan

2014-12-15

Erythropoietin (EPO), an essential hormone for erythropoiesis, provides protection against myocardial ischemia/reperfusion (I/R) injury. Hyperglycemia during acute myocardial infarction aggravates organ damage and attenuates the efficacies of various protective measures. This study aimed to investigate the protective role of EPO against myocardial I/R injury under a clinically relevant moderate hyperglycemic condition and its associated mechanisms. Eighty-two Sprague-Dawley rats were randomly assigned to six groups: normoglycemia-Sham, normoglycemia-I/R-control-saline (IRC), normoglycemia-I/R-EPO (IRE), hyperglycemia-Sham, hyperglycemia-IRC, and hyperglycemia-IRE. The rats received 1.2 g/kg dextrose or same volume of normal saline depending on the group. I/R was induced by a 30 min period of ischemia followed by reperfusion for 4 h. For 1 h before I/R injury, intravenous 4000 IU/kg of EPO was administered. EPO pretreatment significantly reduced the number of apoptotic cells and the infarct size compared with those of the control groups. EPO increased GATA-4 phosphorylation and acetylation against I/R in hyperglycemic myocardium. It also enhanced ERK induced GATA-4 post-translational modifications such as increased GATA-4 phosphorylation and acetylation, and decreased GATA-4 ubiquitination following hypoxia-reoxygenation in H9c2 cells in hyperglycemic medium. Increased GATA-4 stability by EPO diminished I/R-related down-regulation of Bcl-2 and reduction of caspase-3 activities in hyperglycemic myocardium. In conclusion, EPO pretreatment before I/R injury conveyed significant myocardial protection under moderate hyperglycemic condition through mechanisms involved in reduction of caspase-3 activity and up-regulation of Bcl-2 in association with enhanced ERK-induced GATA-4 stability. Copyright © 2014 Elsevier B.V. All rights reserved.

Cognitive Task Demands and Discourse Performance after Traumatic Brain Injury

ERIC Educational Resources Information Center

Byom, Lindsey; Turkstra, Lyn S.

2017-01-01

Background: Social communication problems are common in adults with traumatic brain injury (TBI), particularly problems in spoken discourse. Social communication problems are thought to reflect underlying cognitive impairments. Aims: To measure the contribution of two cognitive processes, executive functioning (EF) and theory of mind (ToM), to the…

How I Manage Abdominal Injuries.

ERIC Educational Resources Information Center

Haycock, Christine E.

1986-01-01

In sports, abdominal injuries occur most frequently in cycling, horseback riding, and skiing. Most involve children, not adults. Any athlete sustaining a severe blow to the abdomen should be examined. Guidelines are provided for recognizing and treating injuries to the abdominal muscles, kidneys, spleen, and liver. (Author/MT)

Psychosocial outcomes following spinal cord injury in Iran.

PubMed

Khazaeipour, Zahra; Norouzi-Javidan, Abbas; Kaveh, Mahboobeh; Khanzadeh Mehrabani, Fatemeh; Kazazi, Elham; Emami-Razavi, Seyed-Hasan

2014-05-01

Objective/background In patients with spinal cord injury (SCI), SCI causes psychosocial complications that vary based on culture, conditions, and the amenities of each community. Health planners and social services should have full knowledge of these issues in order to plan schedules that address them. In this study, we aimed to understand the psychosocial problems of persons with SCI in Iran and to explore the requirements for minimizing these difficulties. Design This was a descriptive cross-sectional study. Setting Brain and Spinal Cord Injury Research (BASIR) Center, Tehran University of Medical Sciences, Tehran, Iran. Participants One hundred nineteen persons with SCI referred to BASIR clinic to receive outpatient rehabilitation. Methods In this study, trained interviewers administered a questionnaire to the participants. The questionnaire consisted of socio-demographic variables and psychosocial questions about finances, employment, housing, education, and social communication problems. Results Psychosocial problems for persons with SCI are mainly associated with financial hardship due to unemployment and the high cost of living, followed by difficulties with transportation, house modification, education, marriage, social communication, sports, and entertainment. Psychological problems include sadness, depression, irritability/anger, suicidal thoughts, and a lack of self-confidence. The levels of the aforementioned problems differ with respect to sex. Conclusion Persons suffering from SCI can face some serious psychosocial problems that may vary according to sex. For example, transportation difficulties can lead to problems such as unsociability. After recognizing these problems, the next step would be providing services to facilitate a productive lifestyle, enhancing social communication and psychological health, and ultimately creating a higher quality of life.

Recognizing and Fostering Creativity in Technological Design Education

ERIC Educational Resources Information Center

Cropley, David; Cropley, Arthur

2010-01-01

The importance of creativity in technological design education is now clearly recognized, both in everyday understanding and also in formal curriculum guidelines. Design offers special opportunities for creativity because of the "openness" of problems (ill-defined problems, the existence of a variety of pathways to the solution, the absence of…

Sharps and high-pressure injection injuries in veterinary and animal workers.

PubMed

Robertson, Colin E; Ackerman, Nicola A; Burke, Francis D; Reilly, William J

2016-02-01

Needlestick and 'sharps' injuries among those working with animals are a significant, under-reported and often ill-understood problem. Many patients present initially to Emergency Departments, where their potential to cause local and systemic infections and injury, zoonoses, allergic or anaphylactic reactions and death may be unrecognized. Increased awareness of the possibility of adverse effects and the consequences of these specific injuries is essential.

Repetitive Stress Injuries

MedlinePlus

... Safe Videos for Educators Search English Español Repetitive Stress Injuries KidsHealth / For Teens / Repetitive Stress Injuries What's ... t had any problems since. What Are Repetitive Stress Injuries? Repetitive stress injuries (RSIs) are injuries that ...

Recognizing Physical Disability as a Social Problem.

ERIC Educational Resources Information Center

Blake, Charles

Physical disability is an enormous psychosocio-economic-medical problem that affects over 24 million Americans. Public policy endorses a multi-disciplinary approach in analyzing this issue. Legislation has broadened the meaning of physical disability to include persons with mental and emotional disorders. Some of the costs associated with physical…

Injuries as a public health problem in sub-Saharan Africa: epidemiology and prospects for control.

PubMed

Nordberg, E

2000-12-01

Injuries are common and on increase in most developing countries, including sub-Saharan Africa. A large proportion of the injuries are caused by road traffic accidents, falls, burns, assaults, bites, stings and other animal-related injuries, poisonings, drownings/near-drownings and suicide. Globally, injuries are responsible for about five per cent of the total mortality, and the overall global annual costs were estimated in the late 1980s at around 500 billion US dollars. The burden and pattern of injuries in Africa and other developing areas are poorly known and not well studied. The incidence is on the increase, partly due to rapid growth of motorised transport and to expansion of industrial production without adequate safety precautions. This is a review of data on various kinds of injuries in developing countries with a focus on sub-Saharan Africa. A computerised search of the relevant literature published between 1985 and 1998 was conducted and a manual search of journals publishing texts on health in low-income countries and in tropical environments was also done. A few studies on injury prevention policy and on research related to injury epidemiology and prevention have also been identified and included. It is concluded that in a relatively typical East African area with a total mortality rate of 1,300/100,000/year, injuries are likely to cause around 100 of these deaths. The corresponding total rate of significant injuries is estimated at 40,000/100,000/year with a breakdown as tabulated below. [table: see text] Although a few surveys and other investigations of injuries have been conducted over the years, injury epidemiology and control remain under-researched and relatively neglected subject areas. Much needs to be done. Collection and analysis of injury data need to be standardised, for example regarding age groups, gender disaggregation and severity. Injuries and accidents should be subdivided in at least road traffic injury, fall, burn, assault

76 FR 71623 - Agency Information Collection (Spinal Cord Injury Patient Care Survey) Under OMB Review

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-18

... Collection (Spinal Cord Injury Patient Care Survey) Under OMB Review AGENCY: Veterans Benefits Administration... INFORMATION: Title: Spinal Cord Injury Patient Care Survey, VA Form 10-0515. OMB Control Number: OMB Control... 10-0515 will be used to determine spinal cord patients' satisfaction with VA rehabilitation and...

Theory of mind mediates the prospective relationship between abnormal social brain network morphology and chronic behavior problems after pediatric traumatic brain injury

PubMed Central

Ryan, Nicholas P.; Catroppa, Cathy; Beare, Richard; Silk, Timothy J.; Crossley, Louise; Beauchamp, Miriam H.; Yeates, Keith Owen; Anderson, Vicki A.

2016-01-01

Childhood and adolescence coincide with rapid maturation and synaptic reorganization of distributed neural networks that underlie complex cognitive-affective behaviors. These regions, referred to collectively as the ‘social brain network’ (SBN) are commonly vulnerable to disruption from pediatric traumatic brain injury (TBI); however, the mechanisms that link morphological changes in the SBN to behavior problems in this population remain unclear. In 98 children and adolescents with mild to severe TBI, we acquired 3D T1-weighted MRIs at 2–8 weeks post-injury. For comparison, 33 typically developing controls of similar age, sex and education were scanned. All participants were assessed on measures of Theory of Mind (ToM) at 6 months post-injury and parents provided ratings of behavior problems at 24-months post-injury. Severe TBI was associated with volumetric reductions in the overall SBN package, as well as regional gray matter structural change in multiple component regions of the SBN. When compared with TD controls and children with milder injuries, the severe TBI group had significantly poorer ToM, which was associated with more frequent behavior problems and abnormal SBN morphology. Mediation analysis indicated that impaired theory of mind mediated the prospective relationship between abnormal SBN morphology and more frequent chronic behavior problems. Our findings suggest that sub-acute alterations in SBN morphology indirectly contribute to long-term behavior problems via their influence on ToM. Volumetric change in the SBN and its putative hub regions may represent useful imaging biomarkers for prediction of post-acute social cognitive impairment, which may in turn elevate risk for chronic behavior problems. PMID:26796967

Study on incidence of needle stick injury and factors associated with this problem among medical students.

PubMed

Norsayani, Mohamad Yaakob; Noor Hassim, Ismail

2003-05-01

Medical students face the threat of needle stick injury with the consequent risk of acquiring blood-borne infection by pathogens such as HIV, Hepatitis B and Hepatitis C while performing their clinical activities in the hospitals. A cross-sectional study was conducted among 417 final year medical students from Universiti Kebangsaan Malaysia (UKM), University Malaya (UM) and Universiti Putra Malaysia (UPM). The aims of the study were to determine the incidence of cases and episodes of needle stick injury among them in the past year. This study was also done to find out the factors that might be associated with the occurrence of this problem. The factors were sociodemographic factors, duration of exposure, level of knowledge of blood-borne diseases and Universal Precaution, perception of risk of blood-borne diseases and level of practice of Universal Precaution. The incidence of needle stick injury among medical students was 14.1% (59 cases). The total number of episodes of needle stick injury was 87 and the incidence of episodes among respondents was high i.e. 20.9%. The highest incidence of episodes of needle stick injury occurred in Obstetric & Gynaecology postings, followed by Medicine and Surgery. For clinical procedures, venepuncture had the highest incidence followed by setting up drips and giving parenteral injections. The results showed the students who had needle stick injury (cases) had lower scores in the practice of Universal Precautions than non-cases (p<0.05). There was a significant association between the level of practice of Universal Precautions and the number of episodes of needle stick injury, i.e. the higher the score for the practice of Universal Precautions, the lower the number of episodes (beta=-2.03 x 10(-2), p<0.05). This study showed that medical students are at risk of needle stick injury and blood-borne infections during their clinical activities while performing procedures on patients especially for those who were poor at practising

Development and validation of a new method for the registration of overuse injuries in sports injury epidemiology: the Oslo Sports Trauma Research Centre (OSTRC) overuse injury questionnaire.

PubMed

Clarsen, Benjamin; Myklebust, Grethe; Bahr, Roald

2013-05-01

Current methods for injury registration in sports injury epidemiology studies may substantially underestimate the true burden of overuse injuries due to a reliance on time-loss injury definitions. To develop and validate a new method for the registration of overuse injuries in sports. A new method, including a new overuse injury questionnaire, was developed and validated in a 13-week prospective study of injuries among 313 athletes from five different sports, cross-country skiing, floorball, handball, road cycling and volleyball. All athletes completed a questionnaire by email each week to register problems in the knee, lower back and shoulder. Standard injury registration methods were also used to record all time-loss injuries that occurred during the study period. The new method recorded 419 overuse problems in the knee, lower back and shoulder during the 3-month-study period. Of these, 142 were classified as substantial overuse problems, defined as those leading to moderate or severe reductions in sports performance or participation, or time loss. Each week, an average of 39% of athletes reported having overuse problems and 13% reported having substantial problems. In contrast, standard methods of injury registration registered only 40 overuse injuries located in the same anatomical areas, the majority of which were of minimal or mild severity. Standard injury surveillance methods only capture a small percentage of the overuse problems affecting the athletes, largely because few problems led to time loss from training or competition. The new method captured a more complete and nuanced picture of the burden of overuse injuries in this cohort.

Subjective complaints after acquired brain injury: presentation of the Brain Injury Complaint Questionnaire (BICoQ).

PubMed

Vallat-Azouvi, Claire; Paillat, Cyrille; Bercovici, Stéphanie; Morin, Bénédicte; Paquereau, Julie; Charanton, James; Ghout, Idir; Azouvi, Philippe

2018-04-01

The objective of the present study was to present a new complaint questionnaire designed to assess a wide range of difficulties commonly reported by patients with acquired brain injury. Patients (n =  619) had been referred to a community re-entry service at a chronic stage after brain injury, mainly traumatic brain injury (TBI). The Brain Injury Complaint Questionnaire (BICoQ) includes 25 questions in the following domains: cognition, behavior, fatigue and sleep, mood, and somatic problems. A self and a proxy questionnaire were given. An additional question was given to the relative, about the patient's awareness of his difficulties. The questionnaires had a good internal coherence, as measured with Cronbach's alpha. The most frequent complaints were, in decreasing order, mental slowness, memory troubles, fatigue, concentration difficulties, anxiety, and dual tasking problems. Principal component analysis with varimax rotation yielded six underlying factors explaining 50.5% of total variance: somatic concerns, cognition, and lack of drive, lack of control, psycholinguistic disorders, mood, and mental fatigue/slowness. About 52% of patients reported fewer complaints than their proxy, suggesting lack of awareness. The total complaint scores were not significantly correlated with any injury severity measure, but were significantly correlated with disability and poorer quality of life (Note: only factor 2 [cognition/lack of drive] was significantly related to disability.) The BICoQ is a simple scale that can be used in addition to traditional clinical and cognitive assessment measures, and to assess awareness of everyday life problems. © 2017 Wiley Periodicals, Inc.

Extravasation injuries: a review.

PubMed

Goutos, I; Cogswell, L K; Giele, H

2014-10-01

Extravasation injuries are common emergencies in clinical practice. If they are not recognized and treated promptly, they can lead to deleterious functional and cosmetic outcomes. There is a vast range of agents involved in these injuries and marked paucity of evidence to support their specific management. Following an extensive literature review, we outline management principles for clinicians involved in the care of patients with extravasation injuries. Key parameters in deciding appropriate management plans include the volume/toxicity of the agent, the necrosis interval of the injury, patient-related factors, as well as the facilities and expertise available in the setting of individual cases of extravasation. © The Author(s) 2014.

Problem music and self-harming.

PubMed

North, Adrian C; Hargreaves, David J

2006-10-01

Academics and protest groups have claimed that "problem music" (hard rock, hip hop/rap, & punk) causes self-injurious thoughts/behaviors among fans. In this study we investigated whether the relationship is mediated by self-esteem, delinquency, and conservatism; and whether first exposure to problem music preceded self-injurious thoughts. A liking for problem music was associated with four of the five self-injurious measures, although these significant relationships were weakened (into nonsignificance in the case of two self-injurious measures) when the mediating variables were included. Listening to problem music did not precede self-injurious thoughts. Problem music is associated with self-injurious thoughts and behaviors, but this relationship is mediated by other factors and the former does not seem to cause the latter.

Diagnosis of blunt traumatic aortic injury 2007: still a nemesis.

PubMed

Mirvis, Stuart E; Shanmuganathan, K

2007-10-01

In recent years, the use of multidetector computed tomography (MDCT) for the diagnosis of acute thoracic injury in blunt trauma has expanded. MDCT has shown high accuracy for the diagnosis or exclusion of injury to the aorta and its primary branches, decreasing the need for thoracic angiography and allowing earlier treatment of this often rapidly fatal lesion. With increasing use of MDCT, more subtle injuries and variants of vascular anatomy are being recognized that create pitfalls in the diagnosis. Of perhaps more concern is the recognition that aortic injury can occur with little or no associated mediastinal hematoma, the principle chest radiographic finding indicating a need for further imaging. The importance of recognizing unusual sites of aortic injury, congenital variants of mediastinal anatomy, the precise extent of injury, and the anatomic pathology present as key factors in deciding among treatment options is emphasized.

Bathing suit mesh entrapment: an unusual case of penile injury.

PubMed

Hoppa, Eric C; Wiley, James F

2006-12-01

Penile injury is a rare chief complaint in the pediatric emergency department. The most common penile injuries are iatrogenic or postsurgical complications, blunt trauma, tourniquet injuries, fractures, and zipper injuries. We report a series of 3 cases of penile foreskin entrapment within the mesh lining of bathing suits as a new, recognized form of penile injury.

13 CFR 123.602 - When would my business not be eligible to apply for an economic injury disaster loan under this...

Code of Federal Regulations, 2010 CFR

2010-01-01

... eligible to apply for an economic injury disaster loan under this subpart? 123.602 Section 123.602 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION DISASTER LOAN PROGRAM Economic Injury Disaster Loans... eligible to apply for an economic injury disaster loan under this subpart? Your business is not eligible...

13 CFR 123.602 - When would my business not be eligible to apply for an economic injury disaster loan under this...

Code of Federal Regulations, 2011 CFR

2011-01-01

... eligible to apply for an economic injury disaster loan under this subpart? 123.602 Section 123.602 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION DISASTER LOAN PROGRAM Economic Injury Disaster Loans... eligible to apply for an economic injury disaster loan under this subpart? Your business is not eligible...

Theory of mind mediates the prospective relationship between abnormal social brain network morphology and chronic behavior problems after pediatric traumatic brain injury.

PubMed

Ryan, Nicholas P; Catroppa, Cathy; Beare, Richard; Silk, Timothy J; Crossley, Louise; Beauchamp, Miriam H; Yeates, Keith Owen; Anderson, Vicki A

2016-04-01

Childhood and adolescence coincide with rapid maturation and synaptic reorganization of distributed neural networks that underlie complex cognitive-affective behaviors. These regions, referred to collectively as the 'social brain network' (SBN) are commonly vulnerable to disruption from pediatric traumatic brain injury (TBI); however, the mechanisms that link morphological changes in the SBN to behavior problems in this population remain unclear. In 98 children and adolescents with mild to severe TBI, we acquired 3D T1-weighted MRIs at 2-8 weeks post-injury. For comparison, 33 typically developing controls of similar age, sex and education were scanned. All participants were assessed on measures of Theory of Mind (ToM) at 6 months post-injury and parents provided ratings of behavior problems at 24-months post-injury. Severe TBI was associated with volumetric reductions in the overall SBN package, as well as regional gray matter structural change in multiple component regions of the SBN. When compared with TD controls and children with milder injuries, the severe TBI group had significantly poorer ToM, which was associated with more frequent behavior problems and abnormal SBN morphology. Mediation analysis indicated that impaired theory of mind mediated the prospective relationship between abnormal SBN morphology and more frequent chronic behavior problems. Our findings suggest that sub-acute alterations in SBN morphology indirectly contribute to long-term behavior problems via their influence on ToM. Volumetric change in the SBN and its putative hub regions may represent useful imaging biomarkers for prediction of post-acute social cognitive impairment, which may in turn elevate risk for chronic behavior problems. © The Author (2016). Published by Oxford University Press. For Permissions, please email: journals.permissions@oup.com.

[Cruciate ligament injuries under gender aspects].

PubMed

Grabau, D E; Vitzthum, K; Mache, S; Groneberg, D A; Quarcoo, D

2011-12-01

An injury of cruciate ligament is one the most common knee injuries. This accident happens mostly without external impact and towards the end of training and competition sessions. Women, especially athletes playing team sports ball games such as soccer or disciplines such as tennis, are affected 2 to 8 times more often than men. Anatomic, biomechanical and endocrinological differences are currently discussed as potential risk factors. In terms of prevention, biomechanical impact is of greatest importance given its influenceability through various training opportunities. Training programs including endurance aspects, strengthening knee musculature, balance as well as plyometric trainings were most effective. Further studies should focus more on concomitants of course of injuries. © Georg Thieme Verlag KG Stuttgart · New York.

Semi-automated detection of anterior cruciate ligament injury from MRI.

PubMed

Štajduhar, Ivan; Mamula, Mihaela; Miletić, Damir; Ünal, Gözde

2017-03-01

A radiologist's work in detecting various injuries or pathologies from radiological scans can be tiresome, time consuming and prone to errors. The field of computer-aided diagnosis aims to reduce these factors by introducing a level of automation in the process. In this paper, we deal with the problem of detecting the presence of anterior cruciate ligament (ACL) injury in a human knee. We examine the possibility of aiding the diagnosis process by building a decision-support model for detecting the presence of milder ACL injuries (not requiring operative treatment) and complete ACL ruptures (requiring operative treatment) from sagittal plane magnetic resonance (MR) volumes of human knees. Histogram of oriented gradient (HOG) descriptors and gist descriptors are extracted from manually selected rectangular regions of interest enveloping the wider cruciate ligament area. Performance of two machine-learning models is explored, coupled with both feature extraction methods: support vector machine (SVM) and random forests model. Model generalisation properties were determined by performing multiple iterations of stratified 10-fold cross validation whilst observing the area under the curve (AUC) score. Sagittal plane knee joint MR data was retrospectively gathered at the Clinical Hospital Centre Rijeka, Croatia, from 2007 until 2014. Type of ACL injury was established in a double-blind fashion by comparing the retrospectively set diagnosis against the prospective opinion of another radiologist. After clean up, the resulting dataset consisted of 917 usable labelled exam sequences of left or right knees. Experimental results suggest that a linear-kernel SVM learned from HOG descriptors has the best generalisation properties among the experimental models compared, having an area under the curve of 0.894 for the injury-detection problem and 0.943 for the complete-rupture-detection problem. Although the problem of performing semi-automated ACL-injury diagnosis by observing knee

Disparities in Under-Five Child Injury Mortality between Developing and Developed Countries: 1990-2013.

PubMed

Huang, Yun; Wu, Yue; Schwebel, David C; Zhou, Liang; Hu, Guoqing

2016-07-07

Using estimates from the 2013 Global Burden of Disease (GBD) study, we update evidence on disparities in under-five child injury mortality between developing and developed countries from 1990 to 2013. Mortality rates were accessed through the online visualization tool by the GBD study 2013 group. We calculated percent change in child injury mortality rates between 1990 and 2013. Data analysis was conducted separately for <1 year and 1-4 years to specify age differences in rate changes. Between 1990 and 2013, over 3-fold mortality gaps were observed between developing countries and developed countries for both age groups in the study time period. Similar decreases in injury rates were observed for developed and developing countries (<1 year: -50% vs. -50% respectively; 1-4 years: -56% vs. -58%). Differences in injury mortality changes during 1990-2013 between developing and developed nations varied with injury cause. There were greater reductions in mortality from transport injury, falls, poisoning, adverse effects of medical treatment, exposure to forces of nature, and collective violence and legal intervention in developed countries, whereas there were larger decreases in mortality from drowning, exposure to mechanical forces, and animal contact in developing countries. Country-specific analysis showed large variations across countries for both injury mortality and changes in injury mortality between 1990 and 2013. Sustained higher child injury mortality during 1990-2013 for developing countries merits the attention of the global injury prevention community. Countries that have high injury mortality can benefit from the success of other countries.

Electrosurgical injuries during robot assisted surgery: insights from the FDA MAUDE database

NASA Astrophysics Data System (ADS)

Fuller, Andrew; Vilos, George A.; Pautler, Stephen E.

2012-02-01

Introduction: The da Vinci surgical system requires the use of electrosurgical instruments. The re-use of such instruments creates the potential for stray electrical currents from capacitive coupling and/or insulation failure with subsequent injury. The morbidity of such injuries may negate many of the benefits of minimally invasive surgery. We sought to evaluate the rate and nature of electrosurgical injury (ESI) associated with this device. Methods: The Manufacturer and User Facility Device Experience (MAUDE) database is administered by the US Food and Drug Administration (FDA) and reports adverse events related to medical devices in the United States. We analyzed all incidents in the context of robotic surgery between January 2001 and June 2011 to identify those related to the use of electrosurgery. Results: In the past decade, a total of 605 reports have been submitted to the FDA with regard to adverse events related to the da Vinci robotic surgical platform. Of these, 24 (3.9%) were related to potential or actual ESI. Nine out of the 24 cases (37.5%) resulted in additional surgical intervention for repair. There were 6 bowel injuries of which only one was recognized and managed intra-operatively. The remainder required laparotomy between 5 and 8 days after the initial robotic procedure. Additionally, there were 3 skin burns. The remaining cases required conservative management or resulted in no harm. Conclusion: ESI in the context of robotic surgery is uncommon but remains under-recognized and under-reported. Surgeons performing robot assisted surgery should be aware that ESI can occur with robotic instruments and vigilance for intra- and post-operative complications is paramount.

What Is Robustness?: Problem Framing Challenges for Water Systems Planning Under Change

NASA Astrophysics Data System (ADS)

Herman, J. D.; Reed, P. M.; Zeff, H. B.; Characklis, G. W.

2014-12-01

Water systems planners have long recognized the need for robust solutions capable of withstanding deviations from the conditions for which they were designed. Faced with a set of alternatives to choose from—for example, resulting from a multi-objective optimization—existing analysis frameworks offer competing definitions of robustness under change. Robustness analyses have moved from expected utility to exploratory "bottom-up" approaches in which vulnerable scenarios are identified prior to assigning likelihoods; examples include Robust Decision Making (RDM), Decision Scaling, Info-Gap, and Many-Objective Robust Decision Making (MORDM). We propose a taxonomy of robustness frameworks to compare and contrast these approaches, based on their methods of (1) alternative selection, (2) sampling of states of the world, (3) quantification of robustness measures, and (4) identification of key uncertainties using sensitivity analysis. Using model simulations from recent work in multi-objective urban water supply portfolio planning, we illustrate the decision-relevant consequences that emerge from each of these choices. Results indicate that the methodological choices in the taxonomy lead to substantially different planning alternatives, underscoring the importance of an informed definition of robustness. We conclude with a set of recommendations for problem framing: that alternatives should be searched rather than prespecified; dominant uncertainties should be discovered rather than assumed; and that a multivariate satisficing measure of robustness allows stakeholders to achieve their problem-specific performance requirements. This work highlights the importance of careful problem formulation, and provides a common vocabulary to link the robustness frameworks widely used in the field of water systems planning.

The impact of injury definition on injury surveillance in novice runners.

PubMed

Kluitenberg, Bas; van Middelkoop, Marienke; Verhagen, Evert; Hartgens, Fred; Huisstede, Bionka; Diercks, Ron; van der Worp, Henk

2016-06-01

Despite several consensus statements, different injury definitions are used in the literature. This study aimed to identify the impact of different injury definitions on the nature and incidence of complaints captured during a short-term running program for novice runners. Prospective cohort study. 1696 participants completed weekly diaries on running exposure and musculoskeletal complaints during a 6-week running program. These data were used to compare six different injury definitions (presence of running-related pain, training-reduction, time-loss of one day or one week). Injuries were registered under these different definitions. Consequently incidence and the nature of complaints were compared between definitions. The different injury definitions resulted in incidences that varied between 7.5% and 58.0%, or 18.7 and 239.6 injuries per 1000h of running. The median duration of injury complaints was 4-7 days for injuries registered under a 'day definition', while complaints registered under a 'week definition' lasted 20-22 days. For running-related pain injuries the median of the maximum amount of pain was 3.0. In training-reduction and time-loss injuries these median values were scored between 5.0 and 7.0. No significant differences in anatomical locations between injuries that were registered under a 'day definition' or a 'week definition' were found. Injuries registered under a time-loss definition were located relatively more often at the knee, while complaints at the pelvis/sacrum/buttock were captured more often under a running-related pain definition. Injury definitions largely impact injury incidence. Location of injury is also affected by choice of injury definition. This stressed the need for standardized injury registration methods. Copyright © 2015 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

Extracellular Spermine Exacerbates Ischemic Neuronal Injury through Sensitization of ASIC1a Channels to Extracellular Acidosis

PubMed Central

Duan, Bo; Wang, Yi-Zhi; Yang, Tao; Chu, Xiang-Ping; Yu, Ye; Huang, Yu; Cao, Hui; Hansen, Jillian; Simon, Roger P.; Zhu, Michael X.; Xiong, Zhi-Gang; Xu, Tian-Le

2011-01-01

Ischemic brain injury is a major problem associated with stroke. It has been increasingly recognized that acid-sensing ion channels (ASICs) contribute significantly to ischemic neuronal damage, but the underlying mechanism has remained elusive. Here, we show that extracellular spermine, one of the endogenous polyamines, exacerbates ischemic neuronal injury through sensitization of ASIC1a channels to extracellular acidosis. Pharmacological blockade of ASIC1a or deletion of the ASIC1 gene greatly reduces the enhancing effect of spermine in ischemic neuronal damage both in cultures of dissociated neurons and in a mouse model of focal ischemia. Mechanistically, spermine profoundly reduces desensitization of ASIC1a by slowing down desensitization in the open state, shifting steady-state desensitization to more acidic pH, and accelerating recovery between repeated periods of acid stimulation. Spermine-mediated potentiation of ASIC1a activity is occluded by PcTX1 (psalmotoxin 1), a specific ASIC1a inhibitor binding to its extracellular domain. Functionally, the enhanced channel activity is accompanied by increased acid-induced neuronal membrane depolarization and cytoplasmic Ca2+ overload, which may partially explain the exacerbated neuronal damage caused by spermine. More importantly, blocking endogenous spermine synthesis significantly attenuates ischemic brain injury mediated by ASIC1a but not that by NMDA receptors. Thus, extracellular spermine contributes significantly to ischemic neuronal injury through enhancing ASIC1a activity. Our data suggest new neuroprotective strategies for stroke patients via inhibition of polyamine synthesis and subsequent spermine–ASIC interaction. PMID:21307247

13 CFR 123.603 - What is the interest rate on an economic injury disaster loan under this subpart?

Code of Federal Regulations, 2010 CFR

2010-01-01

... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false What is the interest rate on an... September 11, 2001 Terrorist Attacks § 123.603 What is the interest rate on an economic injury disaster loan under this subpart? Your economic injury disaster loan under this subpart will have an interest rate of...

Cumulative injury or disease claims: an attempt to define employers' liability for workers' compensation.

PubMed

LaDou, J; Mulryan, L E; McCarthy, K J

1980-01-01

The workers' compensation systems of several states have been expanded in recent years to include injuries and diseases caused by cumulative injury and occupational stress. This expansion has placed a financial burden on the respective systems, on employers, and on consumers, who ultimately must pay the cost of claims through higher priced products or services. This expansion may not be justified from a social perspective, however; extant medical and sociological evidence is not conclusive as to whether occupational-stress injuries or diseases--such as coronary heart disease, hypertension, stroke, and neuropsychiatric illness--are the direct result of stressful work environments. Using the California workers' compensation system as a model, the authors submit that the underlying premises of liability governing the expanded systems should be reassessed based (1) on economic factors, specifically, the increasing costs of workers' compensation; (2) on the capacity of the system to process an ever-increasing number of claims; and (3) on the principle on which workers' compensation systems were established, that of equity between the employer and the employee. On the basis of these three factors, the authors evaluated three legislative approaches to restructuring the expanded system: presumption of compensability, apportionment of liability, and threshold of compensability. The first recognizes that although certain health problems are related to the workplace, the degree of causation is difficult to prove; under this approach, therefore, causation is presumed, and injury compensated, for all diseases and injuries that the system defines as work related. The second holds that where a causal relationship between the work and the injury can be proved, the employer nevertheless should be responsible only for that portion of the disability actually caused by the workplace. The third directs that the injured employee be compensated only when a direct causal link between the

Immune checkpoint inhibitor (nivolumab)-associated kidney injury and the importance of recognizing concomitant medications known to cause acute tubulointerstitial nephritis: a case report.

PubMed

Koda, Ryo; Watanabe, Hirofumi; Tsuchida, Masafumi; Iino, Noriaki; Suzuki, Kazuo; Hasegawa, Go; Imai, Naofumi; Narita, Ichiei

2018-02-27

Acute tubulointerstitial nephritis (ATIN) has been increasingly recognized as an important manifestation of kidney injury associated with the use of immune checkpoint inhibitors (anti-PD-1 and anti-CTLA-4). While the exact pathophysiology remains unknown, corticosteroids are the mainstay of management. We describe a 67-year-old man with stage IV non-small-cell lung cancer who developed kidney injury during treatment with the anti-PD-1 antibody nivolumab. A kidney biopsy showed ATIN without granuloma formation. Considering their mechanism of action, immune checkpoint inhibitors can alter immunological tolerance to concomitant drugs that have been safely used for a long time. For more than 4 years before the initiation of nivolumab therapy, the patient had been receiving the proton pump inhibitor lansoprazole, known to cause drug-induced ATIN, without significant adverse events including kidney injury. He showed rapid improvement in kidney function in 3 days (creatinine decreased from 2.74 to 1.82 mg/dl) on discontinuation of lansoprazole. He then received 500 mg intravenous methylprednisolone for 3 days followed by 1 mg/kg/day oral prednisolone and his creatinine levels eventually stabilized around 1.7 mg/dl. Drug-induced lymphocyte stimulation test (DLST) for lansoprazole was positive. The rapid improvement of kidney function after discontinuation and DLST positivity indicate that lansoprazole contributed to the development of ATIN during nivolumab therapy. Considering the time course, it is plausible that nivolumab altered the long-lasting immunological tolerance against lansoprazole in this patient. To the best of our knowledge, this is the first case report of DLST positivity for a drug that had been used safely before the initiation of an immune checkpoint inhibitor. Although corticosteroid therapy is recommended, the recognition and discontinuation of concomitant drugs, especially those known to induce ATIN, is necessary for the management of kidney

Emotion recognition impairment in traumatic brain injury compared with schizophrenia spectrum: similar deficits with different origins.

PubMed

Mancuso, Mauro; Magnani, Nadia; Cantagallo, Anna; Rossi, Giulia; Capitani, Donatella; Galletti, Vania; Cardamone, Giuseppe; Robertson, Ian Hamilton

2015-02-01

The aim of our study was to identify the common and separate mechanisms that might underpin emotion recognition impairment in patients with traumatic brain injury (TBI) and schizophrenia (Sz) compared with healthy controls (HCs). We recruited 21 Sz outpatients, 24 severe TBI outpatients, and 38 HCs, and we used eye-tracking to compare facial emotion processing performance. Both Sz and TBI patients were significantly poorer at recognizing facial emotions compared with HC. Sz patients showed a different way of exploring the Pictures of Facial Affects stimuli and were significantly worse in recognition of neutral expressions. Selective or sustained attention deficits in TBI may reduce efficient emotion recognition, whereas in Sz, there is a more strategic deficit underlying the observed problem. There would seem to be scope for adjustment of effective rehabilitative training focused on emotion recognition.

Behavioral Problems in the Classroom and Underlying Language Difficulties

ERIC Educational Resources Information Center

Tommerdahl, Jodi; Semingson, Peggy

2013-01-01

Dealing with the behavioral problems of students is one of many dimensions of most educators' and schools' requirements. While research has repeatedly shown that a large number of children with behavior problems have underlying, unrecognized language difficulties, few schools have implemented programs where children with problem behavior are…

The prevalence of occupational health-related problems in dentistry: A review of the literature.

PubMed

Moodley, Rajeshree; Naidoo, Saloshni; Wyk, Jacqueline van

2018-03-27

The study was conducted to report on the scope and prevalence of occupational health related-problems experienced by dentists, dental therapists, and oral hygienists in their practice of dentistry. Professional practice and dental training have many risk factors, and the dental team should be able to recognize these factors to protect themselves. The prevalence of conditions related to the musculoskeletal system, stress, percutaneous injuries, ears, and eyes are of concern. The dental team should also not forget hepatitis B, hepatitis C, and HIV as risks in practice. Dental practitioners should protect themselves by self-recognizing risk factors and by maintaining proper working conditions. The study targeted all empirical research, case studies, and systematic literature reviews written in English. All articles selected were subjected to a data analysis process. Data were captured on an Excel spreadsheet and reported in a comprehensive table. The literature addressing occupational health among dental practitioners included mainly cross-sectional studies and review papers (2001-2016). Forty-nine studies were included in the review. Musculoskeletal disorders remain the most researched occupational health-related problems in dentistry. Eye protection compliance was low among practitioners. Percutaneous injuries especially among young dentists and students were still a concern. Occupational health-related problems are still prevalent in current dentistry practice, despite changes in equipment and surgery design. The reported prevalence of occupational related-health problems and other findings of investigative studies highlight the need for continuous professional education and a need to improve clinical practice aspects of dentistry curricula.

The prevalence of occupational health-related problems in dentistry: A review of the literature

PubMed Central

Naidoo, Saloshni; van Wyk, Jacqueline

2017-01-01

The study was conducted to report on the scope and prevalence of occupational health related-problems experienced by dentists, dental therapists, and oral hygienists in their practice of dentistry. Background: Professional practice and dental training have many risk factors, and the dental team should be able to recognize these factors to protect themselves. The prevalence of conditions related to the musculoskeletal system, stress, percutaneous injuries, ears, and eyes are of concern. The dental team should also not forget hepatitis B, hepatitis C, and HIV as risks in practice. Dental practitioners should protect themselves by self-recognizing risk factors and by maintaining proper working conditions. Methods: The study targeted all empirical research, case studies, and systematic literature reviews written in English. All articles selected were subjected to a data analysis process. Data were captured on an Excel spreadsheet and reported in a comprehensive table. Results: The literature addressing occupational health among dental practitioners included mainly cross-sectional studies and review papers (2001-2016). Forty-nine studies were included in the review. Musculoskeletal disorders remain the most researched occupational health-related problems in dentistry. Eye protection compliance was low among practitioners. Percutaneous injuries especially among young dentists and students were still a concern. Conclusion: Occupational health-related problems are still prevalent in current dentistry practice, despite changes in equipment and surgery design. The reported prevalence of occupational related-health problems and other findings of investigative studies highlight the need for continuous professional education and a need to improve clinical practice aspects of dentistry curricula. PMID:29213011

Receptor Mincle promotes skin allergies and is capable of recognizing cholesterol sulfate

PubMed Central

Kostarnoy, Alexey V.; Gancheva, Petya G.; Lepenies, Bernd; Tukhvatulin, Amir I.; Dzharullaeva, Alina S.; Polyakov, Nikita B.; Grumov, Daniil A.; Egorova, Daria A.; Kulibin, Andrey Y.; Bobrov, Maxim A.; Malolina, Ekaterina A.; Soloviev, Andrey I.; Maltseva, Diana V.; Sakharov, Dmitry A.; Tonevitsky, Alexander G.; Verkhovskaya, Lyudmila V.; Logunov, Denis Y.; Naroditsky, Boris S.; Gintsburg, Alexander L.

2017-01-01

Sterile (noninfected) inflammation underlies the pathogenesis of many widespread diseases, such as allergies and autoimmune diseases. The evolutionarily conserved innate immune system is considered to play a key role in tissue injury recognition and the subsequent development of sterile inflammation; however, the underlying molecular mechanisms are not yet completely understood. Here, we show that cholesterol sulfate, a molecule present in relatively high concentrations in the epithelial layer of barrier tissues, is selectively recognized by Mincle (Clec4e), a C-type lectin receptor of the innate immune system that is strongly up-regulated in response to skin damage. Mincle activation by cholesterol sulfate causes the secretion of a range of proinflammatory mediators, and s.c. injection of cholesterol sulfate results in a Mincle-mediated induction of a severe local inflammatory response. In addition, our study reveals a role of Mincle as a driving component in the pathogenesis of allergic skin inflammation. In a well-established model of allergic contact dermatitis, the absence of Mincle leads to a significant suppression of the magnitude of the skin inflammatory response as assessed by changes in ear thickness, myeloid cell infiltration, and cytokine and chemokine secretion. Taken together, our results provide a deeper understanding of the fundamental mechanisms underlying sterile inflammation. PMID:28292894

Pituitary dysfunction following traumatic brain injury: clinical perspectives

PubMed Central

Tanriverdi, Fatih; Kelestimur, Fahrettin

2015-01-01

Traumatic brain injury (TBI) is a well recognized public health problem worldwide. TBI has previously been considered as a rare cause of hypopituitarism, but an increased prevalence of neuroendocrine dysfunction in patients with TBI has been reported during the last 15 years in most of the retrospective and prospective studies. Based on data in the current literature, approximately 15%–20% of TBI patients develop chronic hypopituitarism, which clearly suggests that TBI-induced hypopituitarism is frequent in contrast with previous assumptions. This review summarizes the current data on TBI-induced hypopituitarism and briefly discusses some clinical perspectives on post-traumatic anterior pituitary hormone deficiency. PMID:26251600

Diagnosing injury to eastern forest trees

Treesearch

John M. Skelly; Donald D. Davis; William Merrill; E. Alan Cameron; H. Daniel Brown; David B. Drummond; Leon S., eds. Dochinger

1987-01-01

The purpose of this manual is to assist members of the National Vegetation Survey in recognizing air pollutant-induced injury and in identifying disease and insect damage that may be confused with air pollutant-induced injury to forest vegetation in the eastern United States. Ozone, sulfur dioxide, and, to a limited geographic extent, hydrogen fluoride, are all...

Nod-like receptor protein 1 inflammasome mediates neuron injury under high glucose.

PubMed

Meng, Xian-Fang; Wang, Xiao-Lan; Tian, Xiu-Juan; Yang, Zhi-Hua; Chu, Guang-Pin; Zhang, Jing; Li, Man; Shi, Jing; Zhang, Chun

2014-04-01

Diabetic encephalopathy is one of the most common complications of diabetes. Inflammatory events during diabetes may be an important mechanism of diabetic encephalopathy. Inflammasome is a multiprotein complex consisting of Nod-like receptor proteins (NLRPs), apoptosis-associated speck-like protein (ASC), and caspase 1 or 5, which functions to switch on the inflammatory process and the release of inflammatory factors. The present study hypothesized that the formation and activation of NLRP1 inflammasome turns on neuroinflammation and neuron injury during hyperglycemia. The results demonstrated that the levels of interleukin-1 beta (IL-1β) were increased in the cortex of streptozocin (STZ)-induced diabetic rats. The levels of mature IL-1β and IL-18 were also elevated in culture medium of neurons treated with high glucose (50 mM). The expression of three essential components of the NLRP1 inflammasome complex, namely, NLRP1, ASC, and caspase 1, was also upregulated in vivo and in vitro under high glucose. Silencing the ASC gene prevented the caspase-1 activation, and inhibiting caspase 1 activity blocked hyperglycemia-induced release of inflammatory factors and neuron injury. Moreover, we found that pannexin 1 mediated the actvitation of NLRP1 inflammasome under high glucose. These results suggest that hyperglycemia induces neuroinflammation through activation of NLRP1 inflammasome, which represents a novel mechanism of diabetes-associated neuron injury.

Chasing the Mirage: a grounded theory of the clinical reasoning processes that Registered Nurses use to recognize delirium.

PubMed

El Hussein, Mohamed; Hirst, Sandra

2016-02-01

The aim of this study was to construct a grounded theory that explains the clinical reasoning processes that registered nurses use to recognize delirium in older adults in acute care hospitals. Delirium is under-recognized in acute hospital settings, this may stem from underdeveloped clinical reasoning processes. Little is known about registered nurses' (RNs) clinical reasoning processes in complex situations such as delirium recognition. A grounded theory approach was used to analyse interview data about the clinical reasoning processes of RNs in acute hospital settings. Seventeen RNs were recruited. Concurrent data collection and comparative analysis and theoretical sampling were conducted in 2013-2014. The core category to emerge from the data was 'chasing the mirage', which describes RNs' clinical reasoning processes to recognize delirium during their interaction with older adults. Understanding the reasoning that contributes to delirium under-recognition provides a strategy by which, this problem can be brought to the forefront of RNs' awareness and intervention. Delirium recognition will contribute to quality care for older adults. © 2015 John Wiley & Sons Ltd.

[Epidemiology and risk factors in injuries due to fall in infants under one year-old].

PubMed

Jiménez de Domingo, Ana; Rubio García, Elena; Marañon Pardillo, Rafael; Arias Constanti, Vanessa; Frontado Haiek, Luis Alberto; Soriano Arola, Marta; Ripoll Oliveras, Francesc; Remón García, Cristina; Estopiña Ferrer, Gloria; Lorente Romero, Jorge

2017-06-01

To describe the epidemiological characteristics of unintentional injuries due to falls in children under one year and to analyse the risk factors associated with severe injuries. This multicentre, observational and cross-sectional study included all children less than one year treated for unintentional fall in the Emergency Departments of 8 Spanish Hospitals, belonging to the «Unintentional Paediatric Injury Workshop» of the Spanish Paediatric Emergency Society, between March 1st, 2014 and February 28th, 2015. Out of 289,887 emergency department cases, 1,022 were due to unintentional falls. The median age was 8 months and 52.5% were males. Fall injuries were more frequent among children aged 9-12 months (37.6%), and 83.5% occurred at home. The most common mechanism was fall from nursery equipment (69.4%), and 47.8% occurred from a height under 50cm. More than two-thirds (68%) of falls were witnessed, but in half of the cases (329) the caregiver was not in area. Serious injuries were seen in 12% of cases. In this study, a fall height greater than 50cm, falls in the street, from the arms of the carer, and from the stairs were identified as independent risk factors for worse outcomes. The most serious injuries occur in children <3 months and from a height of >50cm, though not related to unwitnessed falls. Because the most common serious injury mechanism is the fall from the arms of the carer, from stairs, and falls in the street, these facts should be highlighted in order to avoid morbidity. Copyright © 2015 Asociación Española de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

Domain 2: Sport Safety and Injury Prevention

ERIC Educational Resources Information Center

Gurchiek, Larry; Mokha, Monique Butcher

2004-01-01

Most coaches recognize the importance of creating a safe environment and preventing injuries of their athletes. Domain 2 is dedicated to this important aspect of coaching, and outlines specific areas within safety and injury prevention that coaches should address. Domain 2 sets the standards for facility, equipment, and environmental safety…

Injuries and noncommunicable diseases: emerging health problems of children in developing countries.

PubMed

Deen, J L; Vos, T; Huttly, S R; Tulloch, J

1999-01-01

The present article identifies, for children living in developing countries, the major causes of ill-health that are inadequately covered by established health programmes. Injuries and noncommunicable diseases, notably asthma, epilepsy, dental caries, diabetes mellitus and rheumatic heart disease, are growing in significance. In countries where resources are scarce it is to be expected that increasing importance will be attached to the development and implementation of measures against these problems. Their control may benefit from the application of elements of programmes directed against infectious, nutritional and perinatal disorders, which continue to predominate.

Problem-Solving After Traumatic Brain Injury in Adolescence: Associations With Functional Outcomes

PubMed Central

Wade, Shari L.; Cassedy, Amy E.; Fulks, Lauren E.; Taylor, H. Gerry; Stancin, Terry; Kirkwood, Michael W.; Yeates, Keith O.; Kurowski, Brad G.

2017-01-01

Objective To examine the association of problem-solving with functioning in youth with traumatic brain injury (TBI). Design Cross-sectional evaluation of pretreatment data from a randomized controlled trial. Setting Four children’s hospitals and 1 general hospital, with level 1 trauma units. Participants Youth, ages 11 to 18 years, who sustained moderate or severe TBI in the last 18 months (N=153). Main Outcome Measures Problem-solving skills were assessed using the Social Problem-Solving Inventory (SPSI) and the Dodge Social Information Processing Short Stories. Everyday functioning was assessed based on a structured clinical interview using the Child and Adolescent Functional Assessment Scale (CAFAS) and via adolescent ratings on the Youth Self Report (YSR). Correlations and multiple regression analyses were used to examine associations among measures. Results The TBI group endorsed lower levels of maladaptive problem-solving (negative problem orientation, careless/impulsive responding, and avoidant style) and lower levels of rational problem-solving, resulting in higher total problem-solving scores for the TBI group compared with a normative sample (P<.001). Dodge Social Information Processing Short Stories dimensions were correlated (r=.23–.37) with SPSI subscales in the anticipated direction. Although both maladaptive (P<.001) and adaptive (P=.006) problem-solving composites were associated with overall functioning on the CAFAS, only maladaptive problem-solving (P<.001) was related to the YSR total when outcomes were continuous. For the both CAFAS and YSR logistic models, maladaptive style was significantly associated with greater risk of impairment (P=.001). Conclusions Problem-solving after TBI differs from normative samples and is associated with functional impairments. The relation of problem-solving deficits after TBI with global functioning merits further investigation, with consideration of the potential effects of problem-solving interventions on

Problem-Solving After Traumatic Brain Injury in Adolescence: Associations With Functional Outcomes.

PubMed

Wade, Shari L; Cassedy, Amy E; Fulks, Lauren E; Taylor, H Gerry; Stancin, Terry; Kirkwood, Michael W; Yeates, Keith O; Kurowski, Brad G

2017-08-01

To examine the association of problem-solving with functioning in youth with traumatic brain injury (TBI). Cross-sectional evaluation of pretreatment data from a randomized controlled trial. Four children's hospitals and 1 general hospital, with level 1 trauma units. Youth, ages 11 to 18 years, who sustained moderate or severe TBI in the last 18 months (N=153). Problem-solving skills were assessed using the Social Problem-Solving Inventory (SPSI) and the Dodge Social Information Processing Short Stories. Everyday functioning was assessed based on a structured clinical interview using the Child and Adolescent Functional Assessment Scale (CAFAS) and via adolescent ratings on the Youth Self Report (YSR). Correlations and multiple regression analyses were used to examine associations among measures. The TBI group endorsed lower levels of maladaptive problem-solving (negative problem orientation, careless/impulsive responding, and avoidant style) and lower levels of rational problem-solving, resulting in higher total problem-solving scores for the TBI group compared with a normative sample (P<.001). Dodge Social Information Processing Short Stories dimensions were correlated (r=.23-.37) with SPSI subscales in the anticipated direction. Although both maladaptive (P<.001) and adaptive (P=.006) problem-solving composites were associated with overall functioning on the CAFAS, only maladaptive problem-solving (P<.001) was related to the YSR total when outcomes were continuous. For the both CAFAS and YSR logistic models, maladaptive style was significantly associated with greater risk of impairment (P=.001). Problem-solving after TBI differs from normative samples and is associated with functional impairments. The relation of problem-solving deficits after TBI with global functioning merits further investigation, with consideration of the potential effects of problem-solving interventions on functional outcomes. Copyright © 2017 American Congress of Rehabilitation Medicine

Do rheumatologists recognize their patients' work-related problems?

PubMed

Gilworth, G; Haigh, R; Tennant, A; Chamberlain, M A; Harvey, A R

2001-11-01

The question addressed in this pilot study was 'Does the addition of an occupational health physiotherapist offering early vocational assessment influence the management of rheumatology patients (clinically and related to the workplace)?' Sequential vocational assessments were offered to 78 subjects with rheumatological complaints of more than 1 yr duration experiencing difficulties in working. The findings from the vocational assessments were fed back to rheumatologists. Where necessary and acceptable, workplace interventions were made and the Employment Service's Access to Work scheme was utilized to address the employment problems found. The intervention vocational assessments trebled the number of subjects seeing a Disability Employment Adviser (17% before the study, a further 37% during it). High levels of satisfaction were reported for interventions made at work. Some important changes to the management of some patients by a few doctors were made, but information from the vocational assessments did not reach them reliably in a number of cases. An unmet need for advice and workplace aids and equipment was identified. Vocational assessment by a practitioner with clinical knowledge, ergonomic and workplace experience proved helpful to patients in this pilot study. Without vocational assessment, the hospital-based team rarely identified what were often remediable, work problems and appeared unaware of the appropriate referral route for this group of patients. Rheumatologists may need to expand their management to include consideration of work issues to ensure that their patients are referred early for appropriate ergonomic intervention when required. Further study is required to help facilitate easy identification in the clinical setting of patients with problems at work.

Genitourinary malformations: an under-recognized feature of ectrodactyly, ectodermal dysplasia and cleft lip/palate syndrome.

PubMed

Hyder, Zerin; Beale, Victoria; O'Connor, Ruth; Clayton-Smith, Jill

2017-04-01

The ectodermal dysplasia and cleft lip/palate (EEC) syndrome describes the association of ectrodactyly, ectodermal dysplasia and orofacial clefting. As with many autosomal dominant disorders, there is variability in expression and not all of these three core features are present in every individual with the condition. Moreover, there may be additional associated features, which are under-recognized. One of these is the presence of genitourinary anomalies, some of which cause significant morbidity. This report details a further two patients with EEC syndrome and genitourinary involvement, including flaccid megacystis with detrusor muscle failure, bilateral hydronephrosis and megaureter, requiring significant renal and urological involvement during their childhood. We go on to review the literature on the diagnosis and management of genitourinary malformations in EEC syndrome.

Wernicke-Korsakoff-syndrome: under-recognized and under-treated.

PubMed

Isenberg-Grzeda, Elie; Kutner, Haley E; Nicolson, Stephen E

2012-01-01

Wernicke-Korsakoff syndrome (WKS) is a well described syndrome of neurological and cognitive problems that comprises both Wernicke's encephalopathy (WE) and Korsakoff syndrome (KS). WE is an acute neuropsychiatric disorder caused by thiamine deficiency. KS is a chronic consequence of thiamine deficiency with prominent impairment in memory formation. The authors review the literature on the pathophysiology, presentation, and treatment of WKS, focusing on the acute identification and treatment of WE. Most cases of WE are missed by clinicians, likely because patients do not present with the classic signs associated with the condition. Attaining high serum levels of thiamine during treatment may be important to restore cognitive function as quickly as possible, though the exact dosing and route needed for effective treatment is unknown. Data indicates that the administration of intravenous (IV) thiamine has little risk. In order to prevent this potentially devastating disease, physicians should have a high index of suspicion for WKS and dose thiamine accordingly. Copyright © 2012 The Academy of Psychosomatic Medicine. Published by Elsevier Inc. All rights reserved.

Right frontal pole cortical thickness and executive functioning in children with traumatic brain injury: the impact on social problems.

PubMed

Levan, Ashley; Black, Garrett; Mietchen, Jonathan; Baxter, Leslie; Brock Kirwan, C; Gale, Shawn D

2016-12-01

Cognitive and social outcomes may be negatively affected in children with a history of traumatic brain injury (TBI). We hypothesized that executive function would mediate the association between right frontal pole cortical thickness and problematic social behaviors. Child participants with a history of TBI were recruited from inpatient admissions for long-term follow-up (n = 23; average age = 12.8, average time post-injury =3.2 years). Three measures of executive function, the Trail Making Test, verbal fluency test, and the Conners' Continuous Performance Test-Second edition (CPT-II), were administered to each participant while caregivers completed the Childhood Behavior Checklist (CBCL). All participants underwent brain magnetic resonance imaging following cognitive testing. Regression analysis demonstrated right frontal pole cortical thickness significantly predicted social problems. Measures of executive functioning also significantly predicted social problems; however, the mediation model testing whether executive function mediated the relationship between cortical thickness and social problems was not statistically significant. Right frontal pole cortical thickness and omission errors on the CPT-II predicted Social Problems on the CBCL. Results did not indicate that the association between cortical thickness and social problems was mediated by executive function.

Parents and teachers reporting on a child's emotional and behavioural problems following severe traumatic brain injury (TBI): the moderating effect of time.

PubMed

Silberg, Tamar; Tal-Jacobi, Dana; Levav, Miriam; Brezner, Amichai; Rassovsky, Yuri

2015-01-01

Gathering information from parents and teachers following paediatric traumatic brain injury (TBI) has substantial clinical value for diagnostic decisions. Yet, a multi-informant approach has rarely been addressed when evaluating children at the chronic stage post-injury. In the current study, the goals were to examine (1) differences between parents' and teachers' reports on a child's emotional and behavioural problems and (2) the effect of time elapsed since injury on each rater's report. A sample of 42 parents and 42 teachers of children following severe TBI completed two standard rating scales. Receiver Operating Characteristic (ROC) curves were used to determine whether time elapsed since injury reliably distinguished children falling above and below clinical levels. Emotional-behavioural scores of children following severe TBI fell within normal range, according to both teachers and parents. Significant differences were found between parents' reports relatively close to the time of injury and 2 years post-injury. However, no such differences were observed in teachers' ratings. Parents and teachers of children following severe TBI differ in their reports on a child's emotional and behavioural problems. The present study not only underscores the importance of multiple informants, but also highlights, for the first time, the possibility that informants' perceptions may vary across time.

[Arthroscopic repair of meniscus injury with Fast-fix under local anesthesia].

PubMed

Wang, Jiang-tao; Liu, Yu-jie; Wang, Jun-liang; Qu, Feng; Yuan, Bang-tuo; Zhao, Gang; Shen, Xue-zhen; Zhu, Juan-li; Liu, Yang

2014-08-01

To evaluate the clinical outcome of arthroscopic repair method of meniscus injury with Fast-fix under local anesthesia. From October 2005 to September 2012,106 patients with meniscus injuries admitted into our - hospital were studied, including 74 males and 32 females, ranging in age from 13 to 71 years old, averaged 27.6 years old. The duration of the disease ranged from 15 days to 5 years. The main clinical manifestations included knee joint pain after exercise, joint locking, pressing pain of knee joint and positive McMurray signs. The MRI showed meniscus tear or degeneration. Arthroscopic repairing surgeries were performed with Fast-fix under local anesthesia. Each patient was assessed with VAS pain evaluation and Lysholm knee-joint score system before and after operation. All the patients were followed up more than 1 year. One hundred and 2 patients were followed up by recording subjective symptoms, clinical examinations and questions naires for an average of 2.6 years (ranged, 1.1 to 8 years), and 4 patients lost follow-up. All the 102 patients had no anesthetic complications. Ninety-six patients had normal subjective symptom and clinical examinations. Four patients had a mild ache with activities,2 patients had moderate pain after activities with joint space pressing pain. VAS pain evaluation and Lysholm knee-joint score after operation both were much better than that before operation. onclusion: Local anesthesia can provide nice circumstances for surgeries. Arthroscopic repair using Fast-fix is an idea method for meniscus injury, especially for the posterior horn tear of medial meniscus, which is simple and convenient with less complications, and satisfactory results.

Community Reintegration Problems Among Veterans and Active Duty Service Members With Traumatic Brain Injury.

PubMed

McGarity, Suzanne; Barnett, Scott D; Lamberty, Greg; Kretzmer, Tracy; Powell-Cope, Gail; Patel, Nitin; Nakase-Richardson, Risa

To examine community reintegration problems among Veterans and military service members with mild or moderate/severe traumatic brain injury (TBI) at 1 year postinjury and to identify unique predictors that may contribute to these difficulties. VA Polytrauma Rehabilitation Centers. Participants were 154 inpatients enrolled in the VA TBI Model Systems Program with available injury severity data (mild = 28.6%; moderate/severe = 71.4%) and 1-year postinjury outcome data. Prospective, longitudinal cohort. Community reintegration outcomes included independent driving, employability, and general community participation. Additional measures assessed depression, posttraumatic stress, and cognitive and motor functioning. In the mild TBI (mTBI) group, posttraumatic stress disorder and depressive symptoms were associated with lower levels of various community reintegration outcomes. In the moderate/severe TBI group, cognition and motor skills were significantly associated with lower levels of community participation, independent driving, and employability. Community reintegration is problematic for Veterans and active duty service members with a history of TBI. Unique comorbidities across injury severity groups inhibit full reintegration into the community. These findings highlight the ongoing rehabilitation needs of persons with TBI, specifically evidence-based mental healthcare, in comprehensive rehabilitation programs consistent with a chronic disease management model.

13 CFR 123.604 - How can my business spend my economic injury disaster loan under this subpart?

Code of Federal Regulations, 2010 CFR

2010-01-01

... 13 Business Credit and Assistance 1 2010-01-01 2010-01-01 false How can my business spend my economic injury disaster loan under this subpart? 123.604 Section 123.604 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION DISASTER LOAN PROGRAM Economic Injury Disaster Loans as a Result of the...

Online problem-solving therapy for executive dysfunction after child traumatic brain injury.

PubMed

Kurowski, Brad G; Wade, Shari L; Kirkwood, Michael W; Brown, Tanya M; Stancin, Terry; Taylor, H Gerry

2013-07-01

Executive dysfunction after traumatic brain injury (TBI) in children is common and leads to significant problems in functioning across multiple settings. The objective of this study was to evaluate the efficacy of a web-based counselor-assisted problem solving (CAPS) intervention compared with an Internet resource comparison (IRC) for treatment of executive dysfunction within 12 months after complicated mild to severe TBI in adolescents. We hypothesized that CAPS would significantly improve parent ratings of executive dysfunction compared with an IRC. Participants included 132 adolescents aged 12 to 17 years who sustained a complicated mild to severe TBI within 1 to 6 months before study enrollment. Study design was a multisite, assessor-blinded, randomized controlled trial. Study sites included 3 tertiary pediatric hospitals and 2 tertiary general medical centers. The main outcome measure was primary caregiver Behavioral Rating Inventory of Executive Function Global Executive Composite at baseline and 6-month follow-up. Generalized linear models that controlled for baseline scores were used to compare the CAPS and IRC scores. In older teens, the CAPS group showed significant improvement in executive function behaviors at 6-month follow-up compared with the IRC group (F = 6.74, P = .01, Cohen's d = 0.63). Findings indicate that web-based CAPS improves primary caregiver-rated executive functioning within the first 12 months after TBI in older adolescents. Future research needs to define the optimal timing after injury for delivery of CAPS and characteristics of individuals and families who are most likely to benefit from CAPS.

The effects of monitoring environment on problem-solving performance.

PubMed

Laird, Brian K; Bailey, Charles D; Hester, Kim

2018-01-01

While effective and efficient solving of everyday problems is important in business domains, little is known about the effects of workplace monitoring on problem-solving performance. In a laboratory experiment, we explored the monitoring environment's effects on an individual's propensity to (1) establish pattern solutions to problems, (2) recognize when pattern solutions are no longer efficient, and (3) solve complex problems. Under three work monitoring regimes-no monitoring, human monitoring, and electronic monitoring-114 participants solved puzzles for monetary rewards. Based on research related to worker autonomy and theory of social facilitation, we hypothesized that monitored (versus non-monitored) participants would (1) have more difficulty finding a pattern solution, (2) more often fail to recognize when the pattern solution is no longer efficient, and (3) solve fewer complex problems. Our results support the first two hypotheses, but in complex problem solving, an interaction was found between self-assessed ability and the monitoring environment.

Significant Acute Kidney Injury Due to Non-steroidal Anti-inflammatory Drugs: Inpatient Setting.

PubMed

Dixit, Mehul; Doan, Thuy; Kirschner, Rebecca; Dixit, Naznin

2010-04-26

In the United States non-steroidal anti-inflammatory drugs (NSAID) are freely available over-the-counter. Because of the adverse effects on the kidneys and the popularity of these drugs, unregulated use of NSAIDs is an under recognized and potentially dangerous problem. Fifteen inpatients, mean age of 15.2 ± 2.3 years (five males, 10 females), were referred to nephrology for acute kidney injury. All patients admitted to taking ibuprofen and six also consumed naproxen. None of the patients had underlying renal diseases at the time of admission. Nine patients had proteinuria and 12 had hematuria (including one with gross hematuria). One patient had nephrotic syndrome but the condition resolved spontaneously without steroids and has remained in remission for four years. Two patients required dialysis. Only one of the dialyzed patients required steroid therapy for recovery of renal function. The mean duration of hospitalization was 7.4 ± 5.5 days. The serum creatinine peaked at 4.09 ± 4.24 (range 1.2-15.3) mg/dL. All patients recovered renal function with normalization of serum creatinine to 0.71 ± 0.15 mg/dL. The estimated GFR (glomerular filtration rate) at peak of renal failure was 38.2 ± 20.5 mL/min but did improve to a baseline of 134 ± 26.2 mL/min (range 89-177, p < 0.01). However, the duration from onset to normalization of serum creatinine was 37 ± 42 days indicating that majority of patients had abnormal renal function for a prolonged period. In conclusion, NSAIDs pose a significant risk of renal failure for significant duration and as an entity may be under recognized.

[Cyclothymic obsessive-compulsive disorder. Clinical characteristics of a neglected and under-recognized entity].

PubMed

Hantouche, E G; Demonfaucon, C; Angst, J; Perugi, G; Allilaire, J F; Akiskal, H S

2002-04-13

Clinical research is largely focused on depressive comorbidity in obsessional compulsive disorder (OCD). However some recent publications have suggested that bipolar comorbidity occurs in authentic OCD and its presence has a differential impact on the clinical picture and course of OCD. Recent data from the collaborative survey conducted with AFTOC (French Association of patients suffering from OCD) have revealed a high rate of bipolar comorbidity in OCD: 30% for hypomania and 50% for cyclothymia. The present paper presents further comparative analyses between OCD with (n = 302) versus without cyclothymia (n = 272). The sub-group "Cyclothymic OCD" is characterized by a different clinical picture (higher frequency of aggressive, impulsive, religious and sexual obsessions, and compulsions of control, hoarding, repetition), episodic course, higher rate of major depressive episodes (with more intensity and recurrence) associated with higher rates of suicide attempts and psychiatric admissions, and less favorable response to anti-OCD treatments. These data suggested that cyclothymic OCD could represent a specific distinct variant form of OCD. More vigilance is needed toward this entity which is largely under-recognized in clinical practice.

Trends in Hospitalizations for Acute Kidney Injury - United States, 2000-2014.

PubMed

Pavkov, Meda E; Harding, Jessica L; Burrows, Nilka R

2018-03-16

Acute kidney injury is a sudden decrease in kidney function with or without kidney damage, occurring over a few hours or days. Diabetes, hypertension, and advanced age are primary risk factors for acute kidney injury. It is increasingly recognized as an in-hospital complication of sepsis, heart conditions, and surgery (1,2). Its most severe stage requires treatment with dialysis. Acute kidney injury is also associated with higher likelihood of long-term care, incidence of chronic kidney disease and hospital mortality, and health care costs (1,2). Although a number of U.S. studies have indicated an increasing incidence of dialysis-treated acute kidney injury since the late 1990s (3), no data are available on national trends in diabetes-related acute kidney injury. To estimate diabetes- and nondiabetes-related acute kidney injury trends, CDC analyzed 2000-2014 data from the National Inpatient Sample (NIS) (4) and the National Health Interview Survey (NHIS) (5). Age-standardized rates of acute kidney injury hospitalizations increased by 139% (from 23.1 to 55.3 per 1,000 persons) among adults with diagnosed diabetes, and by 230% (from 3.5 to 11.7 per 1,000 persons) among those without diabetes. Improving both patient and provider awareness that diabetes, hypertension, and advancing age are frequently associated with acute kidney injury might reduce its occurrence and improve management of the underlying diseases in an aging population.

The MD Blues: Under-Recognized Depression and Anxiety in Medical Trainees.

PubMed

Mousa, Omar Y; Dhamoon, Mandip S; Lander, Sarah; Dhamoon, Amit S

2016-01-01

Mental health disease is under recognized in medical professionals. To screen medical students (MS), residents and fellows for major depressive disorder (MDD) and generalized anxiety disorder (GAD) under the new era of work hour reform with age-matched controls from a large representative cross-sectional survey. We conducted an anonymous online survey at a medical university in 2013-2014. We incorporated the Patient Health Questionnaire 2 (PHQ-2) to screen for MDD and the generalized anxiety disorder scale (GAD-7) to screen for GAD, along with additional questions on life stressors and academic performance. We compared these results to age-matched controls from the National Health and Nutrition Examination Survey (NHANES) database. 126 residents/fellows and 336 medical students participated voluntarily. 15.1% and 15.9% of postgraduates as well as 16.4% and 20.3% of MS screened positive for MDD and GAD, respectively. When compared to national estimates, the prevalence of a positive screen for MDD was over five-fold higher in medical trainees compared to age-matched controls (16% vs. 2.8%, p<0.0001). Similarly, the prevalence of a positive screen for GAD was over eight-fold higher in medical trainees (19% vs. 2.3%, p<0.0001).The prevalence was consistently higher within age strata. 33.3% of postgraduates and 32% of MS believe there is a significant impact of depression or anxiety on their academic performance. For stress relief, one fifth of residents/fellows as well as MS reported alcohol use. The stresses of medical education and practice may predispose trainees to psychopathological consequences that can affect their academic performance and patient care. The current study showed a significantly higher rate of MDD and GAD positive screens in medical trainees than the prevalence in an age-matched U.S. population, despite significant work hour reform for medical trainees. Increased awareness and support services are required at all levels of medical training. We

Catecholamines and cognition after traumatic brain injury

PubMed Central

Jenkins, Peter O.; Mehta, Mitul A.

2016-01-01

Abstract Cognitive problems are one of the main causes of ongoing disability after traumatic brain injury. The heterogeneity of the injuries sustained and the variability of the resulting cognitive deficits makes treating these problems difficult. Identifying the underlying pathology allows a targeted treatment approach aimed at cognitive enhancement. For example, damage to neuromodulatory neurotransmitter systems is common after traumatic brain injury and is an important cause of cognitive impairment. Here, we discuss the evidence implicating disruption of the catecholamines (dopamine and noradrenaline) and review the efficacy of catecholaminergic drugs in treating post-traumatic brain injury cognitive impairments. The response to these therapies is often variable, a likely consequence of the heterogeneous patterns of injury as well as a non-linear relationship between catecholamine levels and cognitive functions. This individual variability means that measuring the structure and function of a person’s catecholaminergic systems is likely to allow more refined therapy. Advanced structural and molecular imaging techniques offer the potential to identify disruption to the catecholaminergic systems and to provide a direct measure of catecholamine levels. In addition, measures of structural and functional connectivity can be used to identify common patterns of injury and to measure the functioning of brain ‘networks’ that are important for normal cognitive functioning. As the catecholamine systems modulate these cognitive networks, these measures could potentially be used to stratify treatment selection and monitor response to treatment in a more sophisticated manner. PMID:27256296

Example-Based Learning: Exploring the Use of Matrices and Problem Variability

ERIC Educational Resources Information Center

Hancock-Niemic, Mary A.; Lin, Lijia; Atkinson, Robert K.; Renkl, Alexander; Wittwer, Joerg

2016-01-01

The purpose of the study was to investigate the efficacy of using faded worked examples presented in matrices with problem structure variability to enhance learners' ability to recognize the underlying structure of the problems. Specifically, this study compared the effects of matrix-format versus linear-format faded worked examples combined with…

Tackle technique and tackle-related injuries in high-level South African Rugby Union under-18 players: real-match video analysis.

PubMed

Burger, Nicholas; Lambert, Michael I; Viljoen, Wayne; Brown, James C; Readhead, Clint; Hendricks, Sharief

2016-08-01

The high injury rate associated with rugby union is primarily due to the tackle, and poor contact technique has been identified as a risk factor for injury. We aimed to determine whether the tackle technique proficiency scores were different in injurious tackles versus tackles that did not result in injury using real-match scenarios in high-level youth rugby union. Injury surveillance was conducted at the under-18 Craven Week tournaments (2011-2013). Tackle-related injury information was used to identify injury events in the match video footage and non-injury events were identified for the injured player cohort. Injury and non-injury events were scored for technique proficiency and Cohen's effect sizes were calculated and the Student t test (p<0.05) was performed to compare injury versus non-injury scores. The overall mean score for front-on ball-carrier proficiency was 7.17±1.90 and 9.02±2.15 for injury and non-injury tackle events, respectively (effect size=moderate; p<0.05). The overall mean score for side/behind ball-carrier proficiency was 4.09±2.12 and 7.68±1.72 for injury and non-injury tackle events, respectively (effect size=large; p<0.01). The overall mean score for front-on tackler proficiency was 7.00±1.95 and 9.35±2.56 for injury and non-injury tackle events, respectively (effect size=moderate; p<0.05). The overall mean score for side/behind tackler proficiency was 5.47±1.60 and 8.14±1.75 for injury and non-injury tackle events, respectively (effect size=large; p<0.01). Higher overall mean and criterion-specific tackle-related technique scores were associated with a non-injury outcome. The ability to perform well during tackle events may decrease the risk of injury and may manifest in superior performance. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Neck injury tolerance under inertial loads in side impacts.

PubMed

McIntosh, Andrew S; Kallieris, Dimitrios; Frechede, Bertrand

2007-03-01

Neck injury remains a major issue in road safety. Current side impact dummies and side impact crashworthiness assessments do not assess the risk of neck injury. These assessments are limited by biofidelity and knowledge regarding neck injury criteria and tolerance levels in side impacts. Side impact tests with PMHS were performed at the Heidelberg University in the 1980s and 1990s to improve primarily the understanding of trunk dynamics, injury mechanisms and criteria. In order to contribute to the definition of human tolerances at neck level, this study presents an analysis of the head/neck biomechanical parameters that were measured in these tests and their relationship to neck injury severity. Data from 15 impact tests were analysed. Head accelerations, and neck forces and moments were calculated from 9-accelerometer array head data, X-rays and anthropometric data. Statistically significant relationships were observed between resultant head acceleration and neck force and neck injury severity. The average resultant head acceleration for AIS 2 neck injuries was 112 g, while resultant neck force was 4925 N and moment 241 Nm. The data compared well to other test data on cadavers and volunteers. It is hoped that the paper will assist in the understanding of neck injuries and the development of tolerance criteria.

Factors affecting drug-induced liver injury: antithyroid drugs as instances

PubMed Central

Niknahad, Hossein; Jamshidzadeh, Akram; Abdoli, Narges

2014-01-01

Methimazole and propylthiouracil have been used in the management of hyperthyroidism for more than half a century. However, hepatotoxicity is one of the most deleterious side effects associated with these medications. The mechanism(s) of hepatic injury induced by antithyroid agents is not fully recognized yet. Furthermore, there are no specific tools for predicting the occurrence of hepatotoxicity induced by these drugs. The purpose of this article is to give an overview on possible susceptibility factors in liver injury induced by antithyroid agents. Age, gender, metabolism characteristics, alcohol consumption, underlying diseases, immunologic mechanisms, and drug interactions are involved in enhancing antithyroid drugs-induced hepatic damage. An outline on the clinically used treatments for antithyroid drugs-induced hepatotoxicity and the potential therapeutic strategies found to be effective against this complication are also discussed. PMID:25320726

Posttraumatic stress following pediatric injury: update on diagnosis, risk factors, and intervention.

PubMed

Kassam-Adams, Nancy; Marsac, Meghan L; Hildenbrand, Aimee; Winston, Flaura

2013-12-01

After pediatric injury, transient traumatic stress reactions are common, and about 1 in 6 children and their parents develop persistent posttraumatic stress (PTS) symptoms that are linked to poorer physical and functional recovery. Meta-analytic studies identify risk factors for persistent PTS, including preinjury psychological problems, peritrauma fear and perceived life threat, and posttrauma factors such as low social support, maladaptive coping strategies, and parent PTS symptoms. There is growing prospective data indicating that children's subjective appraisals of the injury and its aftermath influence PTS development. Secondary prevention of injury-related PTS often involves parents and focuses on promoting adaptive child appraisals and coping strategies. Web-based psychoeducation and targeted brief early intervention for injured children and their parents have shown a modest effect, but additional research is needed to refine preventive approaches. There is a strong evidence base for effective psychological treatment of severe and persistent PTS via trauma-focused cognitive behavioral therapy; evidence is lacking for psychopharmacological treatment. Pediatric clinicians play a key role in preventing injury-related PTS by providing "trauma-informed" pediatric care (ie, recognizing preexisting trauma, addressing acute traumatic stress reactions associated with the injury event, minimizing potentially traumatic aspects of treatment, and identifying children who need additional monitoring or referral).

Calcineurin Dysregulation Underlies Spinal Cord Injury-Induced K+ Channel Dysfunction in DRG Neurons

PubMed Central

Zemel, Benjamin M.; Brown, Eric V.; Urban, Mark W.; Tymanskyj, Stephen R.; Lepore, Angelo C.

2017-01-01

Dysfunction of the fast-inactivating Kv3.4 potassium current in dorsal root ganglion (DRG) neurons contributes to the hyperexcitability associated with persistent pain induced by spinal cord injury (SCI). However, the underlying mechanism is not known. In light of our previous work demonstrating modulation of the Kv3.4 channel by phosphorylation, we investigated the role of the phosphatase calcineurin (CaN) using electrophysiological, molecular, and imaging approaches in adult female Sprague Dawley rats. Pharmacological inhibition of CaN in small-diameter DRG neurons slowed repolarization of the somatic action potential (AP) and attenuated the Kv3.4 current. Attenuated Kv3.4 currents also exhibited slowed inactivation. We observed similar effects on the recombinant Kv3.4 channel heterologously expressed in Chinese hamster ovary cells, supporting our findings in DRG neurons. Elucidating the molecular basis of these effects, mutation of four previously characterized serines within the Kv3.4 N-terminal inactivation domain eliminated the effects of CaN inhibition on the Kv3.4 current. SCI similarly induced concurrent Kv3.4 current attenuation and slowing of inactivation. Although there was little change in CaN expression and localization after injury, SCI induced upregulation of the native regulator of CaN 1 (RCAN1) in the DRG at the transcript and protein levels. Consistent with CaN inhibition resulting from RCAN1 upregulation, overexpression of RCAN1 in naive DRG neurons recapitulated the effects of pharmacological CaN inhibition on the Kv3.4 current and the AP. Overall, these results demonstrate a novel regulatory pathway that links CaN, RCAN1, and Kv3.4 in DRG neurons. Dysregulation of this pathway might underlie a peripheral mechanism of pain sensitization induced by SCI. SIGNIFICANCE STATEMENT Pain sensitization associated with spinal cord injury (SCI) involves poorly understood maladaptive modulation of neuronal excitability. Although central mechanisms have

Calcineurin Dysregulation Underlies Spinal Cord Injury-Induced K+ Channel Dysfunction in DRG Neurons.

PubMed

Zemel, Benjamin M; Muqeem, Tanziyah; Brown, Eric V; Goulão, Miguel; Urban, Mark W; Tymanskyj, Stephen R; Lepore, Angelo C; Covarrubias, Manuel

2017-08-23

Dysfunction of the fast-inactivating Kv3.4 potassium current in dorsal root ganglion (DRG) neurons contributes to the hyperexcitability associated with persistent pain induced by spinal cord injury (SCI). However, the underlying mechanism is not known. In light of our previous work demonstrating modulation of the Kv3.4 channel by phosphorylation, we investigated the role of the phosphatase calcineurin (CaN) using electrophysiological, molecular, and imaging approaches in adult female Sprague Dawley rats. Pharmacological inhibition of CaN in small-diameter DRG neurons slowed repolarization of the somatic action potential (AP) and attenuated the Kv3.4 current. Attenuated Kv3.4 currents also exhibited slowed inactivation. We observed similar effects on the recombinant Kv3.4 channel heterologously expressed in Chinese hamster ovary cells, supporting our findings in DRG neurons. Elucidating the molecular basis of these effects, mutation of four previously characterized serines within the Kv3.4 N-terminal inactivation domain eliminated the effects of CaN inhibition on the Kv3.4 current. SCI similarly induced concurrent Kv3.4 current attenuation and slowing of inactivation. Although there was little change in CaN expression and localization after injury, SCI induced upregulation of the native regulator of CaN 1 (RCAN1) in the DRG at the transcript and protein levels. Consistent with CaN inhibition resulting from RCAN1 upregulation, overexpression of RCAN1 in naive DRG neurons recapitulated the effects of pharmacological CaN inhibition on the Kv3.4 current and the AP. Overall, these results demonstrate a novel regulatory pathway that links CaN, RCAN1, and Kv3.4 in DRG neurons. Dysregulation of this pathway might underlie a peripheral mechanism of pain sensitization induced by SCI. SIGNIFICANCE STATEMENT Pain sensitization associated with spinal cord injury (SCI) involves poorly understood maladaptive modulation of neuronal excitability. Although central mechanisms have

A randomized problem-solving trial for adolescent brain injury: Changes in social competence.

PubMed

Tlustos, Sarah J; Kirkwood, Michael W; Taylor, H Gerry; Stancin, Terry; Brown, Tanya M; Wade, Shari L

2016-11-01

Traumatic brain injury (TBI) in adolescence has well documented effects on social competence. Few studies have examined the effects of behavioral interventions on social competence or identified factors associated with changes in social competence after injury. Research Method/Design: Adolescents with moderate to severe TBI ages 12-17 years were randomized within 6 months of injury to either a problem solving and communication (CAPS) group that received online counseling (n = 65) or an Internet resources comparison (IRC) group (n = 67) for a comparative effectiveness trial. Parent-report measures of social competence (Child Behavior Checklist, CBCL; Home and Community Social Behavior Scales, HCSBS; Behavioral and Emotional Rating Scale, BERS-2) were administered at baseline (preintervention) and approximately 6 months later. Analyses examined these measures in relation to treatment group, TBI severity, and age. Regression analyses were also conducted to examine baseline measures of cognition as predictors of social competence after TBI. CAPS had a more positive effect than the comparison condition on the HCSBS and BERS-2 for younger teens with moderate TBI and older teens with severe TBI. More parent-rated executive dysfunction at baseline was related to both lower concurrent levels of social competence and less positive gains in competence over time, whereas higher baseline IQ predicted greater gains in competence. CAPS may be effective for improving social competence for teens after TBI, with benefits dependent on the teen's age and injury severity. Parent-rated executive dysfunction, moreover, has utility in predicting both lower concurrent levels of social competence and subsequent postinjury gains in competence. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Clinical Trials in Head Injury

PubMed Central

NARAYAN, RAJ K.; MICHEL, MARY ELLEN; Ansell, Beth; Baethmann, Alex; Biegon, Anat; Bracken, Michael B.; Bullock, M. Ross; Choi, Sung C.; Clifton, Guy L.; Contant, Charles F.; Coplin, William M.; Dietrich, W. Dalton; Ghajar, Jamshid; Grady, Sean M.; Grossman, Robert G.; Hall, Edward D.; Heetderks, William; Hovda, David A.; Jallo, Jack; Katz, Russell L.; Knoller, Nachshon; Kochanek, Patrick M.; Maas, Andrew I.; Majde, Jeannine; Marion, Donald W.; Marmarou, Anthony; Marshall, Lawrence F.; McIntosh, Tracy K.; Miller, Emmy; Mohberg, Noel; Muizelaar, J. Paul; Pitts, Lawrence H.; Quinn, Peter; Riesenfeld, Gad; Robertson, Claudia S.; Strauss, Kenneth I.; Teasdale, Graham; Temkin, Nancy; Tuma, Ronald; Wade, Charles; Walker, Michael D.; Weinrich, Michael; Whyte, John; Wilberger, Jack; Young, A. Byron; Yurkewicz, Lorraine

2006-01-01

Traumatic brain injury (TBI) remains a major public health problem globally. In the United States the incidence of closed head injuries admitted to hospitals is conservatively estimated to be 200 per 100,000 population, and the incidence of penetrating head injury is estimated to be 12 per 100,000, the highest of any developed country in the world. This yields an approximate number of 500,000 new cases each year, a sizeable proportion of which demonstrate signficant long-term disabilities. Unfortunately, there is a paucity of proven therapies for this disease. For a variety of reasons, clinical trials for this condition have been difficult to design and perform. Despite promising pre-clinical data, most of the trials that have been performed in recent years have failed to demonstrate any significant improvement in outcomes. The reasons for these failures have not always been apparent and any insights gained were not always shared. It was therefore feared that we were running the risk of repeating our mistakes. Recognizing the importance of TBI, the National Institute of Neurological Disorders and Stroke (NINDS) sponsored a workshop that brought together experts from clinical, research, and pharmaceutical backgrounds. This workshop proved to be very informative and yielded many insights into previous and future TBI trials. This paper is an attempt to summarize the key points made at the workshop. It is hoped that these lessons will enhance the planning and design of future efforts in this important field of research. PMID:12042091

An Old Problem: Aging and Skeletal-Muscle-Strain Injury.

PubMed

Baker, Brent A

2017-04-01

Clinical Scenario: Even though chronological aging is an inevitable phenomenological consequence occurring in every living organism, it is biological aging that may be the most significant factor challenging our quality of life. Development of functional limitations, resulting from improper maintenance and restoration of various organ systems, ultimately leads to reduced health and independence. Skeletal muscle is an organ system that, when challenged, is often injured in response to varying stimuli. Overt muscle-strain injury can be traumatic, clinically diagnosable, properly managed, and a remarkably common event, yet our contemporary understanding of how age and environmental stressors affect the initial and subsequent induction of injury and how the biological processes resulting from this event are modifiable and, eventually, lead to functional restoration and healing of skeletal muscle and adjacent tissues is presently unclear. Even though the secondary injury response to and recovery from "contraction-induced" skeletal-muscle injury are impaired with aging, there is no scientific consensus as to the exact mechanism responsible for this event. Given the multitude of investigative approaches, particular consideration given to the appropriateness of the muscle-injury model, or research paradigm, is critical so that outcomes may be physiologically relevant and translational. In this case, methods implementing stretch-shortening contractions, the most common form of muscle movements used by all mammals during physical movement, work, and activity, are highlighted. Understanding the fundamental evidence regarding how aging influences the responsivity of skeletal muscle to strain injury is vital for informing how clinicians approach and implement preventive strategies, as well as therapeutic interventions. From a practical perspective, maintaining or improving the overall health and tissue quality of skeletal muscle as one ages will positively affect skeletal

Weight-training injuries. Common injuries and preventative methods.

PubMed

Mazur, L J; Yetman, R J; Risser, W L

1993-07-01

The use of weights is an increasingly popular conditioning technique, competitive sport and recreational activity among children, adolescents and young adults. Weight-training can cause significant musculoskeletal injuries such as fractures, dislocations, spondylolysis, spondylolisthesis, intervertebral disk herniation, and meniscal injuries of the knee. Although injuries can occur during the use of weight machines, most apparently happen during the aggressive use of free weights. Prepubescent and older athletes who are well trained and supervised appear to have low injury rates in strength training programmes. Good coaching and proper weightlifting techniques and other injury prevention methods are likely to minimise the number of musculoskeletal problems caused by weight-training.

Ongoing daytime behavioural problems in university students following childhood mild traumatic brain injury.

PubMed

Albicini, Michelle S; Lee, James; McKinlay, Audrey

2016-03-01

Sleep is often disrupted in traumatic brain injury (TBI) and may be related to persistent behaviour problems; however, little is known about this relationship in young adults. This study explored associations between TBI, behavioural problems and sleep disturbances in 247 university students (197 non-TBI, 47 mild TBI, two moderate TBI, one severe TBI) aged 18-25 years, who completed validated measures for behaviour, sleep quality and history of TBI. Because of small group numbers, participants reporting moderate to severe TBI were excluded from the analyses. Results indicated that students with mild TBI reported higher levels of daytime dysfunction, somatic complaints, withdrawal, other behavioural complaints and internalizing behaviours compared with students with no TBI history. A correlational analysis indicated a moderate relationship between the above significant variables. Our results suggest that university students with a history of mild TBI are more likely to experience certain ongoing daytime behavioural problems, which are likely to negatively influence their academic functioning in tertiary education. This study highlights the importance of research on long-term problems following mild TBI in young adults aged 18-25 years--an age group often overlooked within the literature.

Chronic health problems and risk of accidental injury in the workplace: A systematic literature review

PubMed Central

PALMER, K T; HARRIS, E C; COGGON, D

2013-01-01

Objectives To investigate whether common important health conditions and their treatments increase risks of occupational injury. Methods A systematic search was conducted of Medline, Embase and PsycINFO databases from inception to November 2006 employing terms for occupational injury, medications, and a broad range of diseases and impairments. Papers related solely to driving, alcohol, or substance abuse were excluded, as were studies that did not allow analysis of injury risk. For each paper that was retrieved we abstracted standard information on the population, design, exposure(s), outcome(s), response rates, confounders and effect estimates; and rated the quality of information provided. Results We found 38 relevant papers (33 study populations): 16 studies were of cross-sectional design, 13 were case-control and four were prospective. The overall quality was rated as excellent for only two studies. Most commonly investigated were problems of hearing (15 studies), mental health (11 studies) and vision (10 studies). For impaired hearing, neurotic illness, diabetes, epilepsy and use of sedating medication there were moderate positive associations with occupational injury (ORs 1.5–2.0), but there were major gaps in the evidence base. Studies on vision did not present risks by category of eye disease; no evidence was found on psychotic illness; for diabetes, epilepsy and cardiovascular disease there were remarkably few papers; studies seldom distinguished risks by sub-category of external cause or anatomical site and nature of injury; and exposures and outcomes were mostly ascertained by self-report at a single time point, with a lack of clarity about exposure timings. Conclusion Improved research is needed to define the risks of occupational injury arising from common health complaints and treatments. Such research should delineate exposures and outcomes in more detail, and ensure by design that the former precede the latter. PMID:18417559

Racism and Psychological and Emotional Injury: Recognizing and Assessing Race-Based Traumatic Stress

ERIC Educational Resources Information Center

Carter, Robert T.

2007-01-01

The purpose of this article is to discuss the psychological and emotional effects of racism on people of Color. Psychological models and research on racism, discrimination, stress, and trauma will be integrated to promote a model to be used to understand, recognize, and assess race-based traumatic stress to aid counseling and psychological…

Blast injury research models

PubMed Central

Kirkman, E.; Watts, S.; Cooper, G.

2011-01-01

Blast injuries are an increasing problem in both military and civilian practice. Primary blast injury to the lungs (blast lung) is found in a clinically significant proportion of casualties from explosions even in an open environment, and in a high proportion of severely injured casualties following explosions in confined spaces. Blast casualties also commonly suffer secondary and tertiary blast injuries resulting in significant blood loss. The presence of hypoxaemia owing to blast lung complicates the process of fluid resuscitation. Consequently, prolonged hypotensive resuscitation was found to be incompatible with survival after combined blast lung and haemorrhage. This article describes studies addressing new forward resuscitation strategies involving a hybrid blood pressure profile (initially hypotensive followed later by normotensive resuscitation) and the use of supplemental oxygen to increase survival and reduce physiological deterioration during prolonged resuscitation. Surprisingly, hypertonic saline dextran was found to be inferior to normal saline after combined blast injury and haemorrhage. New strategies have therefore been developed to address the needs of blast-injured casualties and are likely to be particularly useful under circumstances of enforced delayed evacuation to surgical care. PMID:21149352

Extensor tendon injury during cesarean delivery.

PubMed

Rinker, Brian

2011-01-01

Fetal laceration is a recognized complication of cesarean delivery; however, major injuries are rare. The case of a healthy newborn who sustained an injury to the extensor pollicis longus tendon during cesarean delivery is reported. The tendon was repaired surgically on the sixth day of life with good recovery of function. Copyright © 2011 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Transcriptome changes in apple peel tissues during CO2 injury symptom development under controlled atmosphere storage regimens

PubMed Central

Johnson, Franklin T; Zhu, Yanmin

2015-01-01

Apple (Malus × domestica Borkh.) is one of the most widely cultivated tree crops, and fruit storability is vital to the profitability of the apple fruit industry. Fruit of many apple cultivars can be stored for an extended period due to the introduction of advanced storage technologies, such as controlled atmosphere (CA) and 1-methylcyclopropane (1-MCP). However, CA storage can cause external CO2 injury for some apple cultivars. The molecular changes associated with the development of CO2 injury are not well elucidated. In this study, the global transcriptional regulations were investigated under different storage conditions and during development of CO2 injury symptoms on ‘Golden Delicious’ fruit. Fruit peel tissues under three different storage regimens, regular cold atmosphere, CA and CA storage and 1-MCP application were sampled at four storage durations over a 12-week period. Fruit physiological changes were affected differently under these storage regimens, and CO2 injury symptoms were detectable 2 weeks after CA storage. Identification of the differentially expressed genes and a gene ontology enrichment analysis revealed the specific transcriptome changes associated with each storage regimen. Overall, a profound transcriptome change was associated with CA storage regimen as indicated by the large number of differentially expressed genes. The lighter symptom was accompanied by reduced transcriptome changes under the CA storage and 1-MCP application regimen. Furthermore, the higher enrichment levels in the functional categories of oxidative stress response, glycolysis and protein post-translational modification were only associated with CA storage regime; therefore, these processes potentially contribute to the development of external CO2 injury or its symptom in apple. PMID:27087982

Rehabilitative, psychiatric, functional and aesthetic problems in patients treated for burn injuries--a preliminary follow-up study.

PubMed

Jonsson, C E; Schüldt, K; Linder, J; Björnhagen, V; Ekholm, J

1997-01-01

Patients consecutively treated for burn injuries for four or more days during 1994 were examined one year after admission by a plastic surgeon, a specialist in rehabilitation medicine and a psychiatrist. Of thirty-nine such patients treated, two were dead, 11 did not present and six thought they had no remaining problems. Aesthetic and functional problems were present in 16 patients, in 11 reconstructive surgery given in one or more sessions was judged to have improved the condition. Of eighteen patients referred to a rehabilitation medicine specialist, 14 were assessed. Nine of these had functional impairments in the burn-injured body regions. A majority had functional impairments, persistent decrease in range of upper extremity motion, reduced muscle force, altered sensibility and itch. One patient suffered from pain. Three patients had occupational handicaps. Work disability occurred in two patients and further two were in need of vocational counselling due to the burn injury. In a subgroup of 11 patients four fulfilled criteria for one or more personality disorders, and two of these also suffered from major depression. Quality of life assessed with the SF-36 was lower than in a normal population. Some of the patients had psychiatric disease and personality disorders. Although rehabilitation started early in the acute phase of treatment, rehabilitation medicine function-increasing measures were needed in several cases. Individual rehabilitation programmes based on the patient's particular features and needs are recommended. The findings support the idea of a multidisciplinary approach for patients with burn injury and indicate that a subgroup of burn injury patients have functional impairments and/or disabilities which can probably be improved with reconstructive surgery and rehabilitation.

Preventable in-hospital medical injury under the "no fault" system in New Zealand

PubMed Central

Davis, P; Lay-Yee, R; Briant, R; Scott, A

2003-01-01

Objectives: To describe the pattern of preventable in-hospital medical injury under the "no fault" system and to assess the level of serious preventable patient harm. Design: Cross sectional survey using a two stage retrospective assessment of medical records conducted by structured implicit review. Setting: General hospitals with over 100 beds providing acute care in New Zealand. Participants: A sample of 6579 patients admitted in 1998 to 13 hospitals selected by stratified systematic list sample. Main outcome measures: Occurrence, preventability, and impact of adverse events. Results: Over 5% of admissions were associated with a preventable in-hospital event, of which nearly half had an element of systems failure. The elderly, ethnic minority groups, and particular clinical areas were at higher risk. The chances of a patient experiencing a serious preventable adverse event subsequent to hospital admission were just under 1%, a figure close to published results from comparable studies under tort. On average, these events required an additional 4 weeks in hospital. System related issues of protocol use and development, communication, and organisation, as well as requirements for consultation and education, were pre-eminent. Conclusions: The risk of serious preventable in-hospital medical injury for patients in New Zealand, a well established "no fault" jurisdiction, is within the range reported in comparable investigations under tort. PMID:12897357

Rehabilitation Treatment and Progress of Traumatic Brain Injury Dysfunction

PubMed Central

Dang, Baoqi; Chen, Wenli; He, Weichun

2017-01-01

Traumatic brain injury (TBI) is a major cause of chronic disability. Worldwide, it is the leading cause of disability in the under 40s. Behavioral problems, mood, cognition, particularly memory, attention, and executive function are commonly impaired by TBI. Spending to assist, TBI survivors with disabilities are estimated to be costly per year. Such impaired functional outcomes following TBI can be improved via various rehabilitative approaches. The objective of the present paper is to review the current rehabilitation treatment of traumatic brain injury in adults. PMID:28491478

Injuries due to human and animal aggression in humans.

PubMed

Łabęcka, Marzena; Lorkiewicz-Muszyńska, Dorota E; Przystańska, Agnieszka; Kondrusiewicz, Krzysztof

2013-01-01

People breed animals, professionally take care of them, and work with them. To live with animals, however, it is necessary to know their behaviour and habits, as well as fears. Ignorance of this knowledge may lead to tragedy for the victim (a person), as well as for the beast (animal). Then, nobody cares whether the animal behaved itself or not in accordance with its nature. The aim of the presented study is to compare the rate of animal aggression in relation to cases of documented aggression towards humans. The victims were investigated according to the age, gender and types of injuries caused by animal bites. The protocols of autopsies (2,218) and medical-legal examinations (4,569) performed from 2004-2009 in the Department of Forensic Sciences in Poznań were analyzed. The selected data was studied using Microsoft Office Excel 2007 for Windows. Analysis revealed the presence of animal bite injuries in less than 1% of the deceased victims of aggression. The number of individuals who died as a result of animal bites varied from 1-4 a year, and in all cases these were postmortem injuries. Analysis of injuries among surviving victims of aggression showed animal bite injuries were present in 41 out of 4,569 victims, almost equally among males and females. Moreover, in 25 victims the bite injuries recognized as human were found. The majority of animal bites occurred in adults. The medium injuries were the most frequent in the animal bite victims. Animal aggression is a marginal problem considering all cases of aggression towards humans. In contrast to the aggression of humans towards other humans, this is a very rare cause of human death or even major injury.

Thyroid functional disease: an under-recognized cardiovascular risk factor in kidney disease patients

PubMed Central

Rhee, Connie M.; Brent, Gregory A.; Kovesdy, Csaba P.; Soldin, Offie P.; Nguyen, Danh; Budoff, Matthew J.; Brunelli, Steven M.; Kalantar-Zadeh, Kamyar

2015-01-01

Thyroid functional disease, and in particular hypothyroidism, is highly prevalent among chronic kidney disease (CKD) and end-stage renal disease (ESRD) patients. In the general population, hypothyroidism is associated with impaired cardiac contractility, endothelial dysfunction, atherosclerosis and possibly higher cardiovascular mortality. It has been hypothesized that hypothyroidism is an under-recognized, modifiable risk factor for the enormous burden of cardiovascular disease and death in CKD and ESRD, but this has been difficult to test due to the challenge of accurate thyroid functional assessment in uremia. Low thyroid hormone levels (i.e. triiodothyronine) have been associated with adverse cardiovascular sequelae in CKD and ESRD patients, but these metrics are confounded by malnutrition, inflammation and comorbid states, and hence may signify nonthyroidal illness (i.e. thyroid functional test derangements associated with underlying ill health in the absence of thyroid pathology). Thyrotropin is considered a sensitive and specific thyroid function measure that may more accurately classify hypothyroidism, but few studies have examined the clinical significance of thyrotropin-defined hypothyroidism in CKD and ESRD. Of even greater uncertainty are the risks and benefits of thyroid hormone replacement, which bear a narrow therapeutic-to-toxic window and are frequently prescribed to CKD and ESRD patients. In this review, we discuss mechanisms by which hypothyroidism adversely affects cardiovascular health; examine the prognostic implications of hypothyroidism, thyroid hormone alterations and exogenous thyroid hormone replacement in CKD and ESRD; and identify areas of uncertainty related to the interplay between hypothyroidism, cardiovascular disease and kidney disease requiring further investigation. PMID:24574542

Recognizing and managing sapstreak disease of sugar maple

Treesearch

David R. Houston; David R. Houston

1993-01-01

Sapstreak disease, a potentially serious problem of sugarbushes and forest stands, occurs when the causal fungus, Ceratocystis virescens, invades the sapwood of roots and bases of stems through wounds inflicted during logging, saphauling, or other activities. Describes how to recognize the disease, the factors that affect its occurrence and development, and management...

Disseminating treatment for anxiety disorders: step 1: recognizing the problem as a precursor to seeking help.

PubMed

Coles, Meredith E; Schubert, Jessica R; Heimberg, Richard G; Weiss, Barry D

2014-12-01

Untreated mental illness is a substantial public health issue in the United States, with only approximately 1/3 of the estimated 46 million adults in the US with mental illness receiving treatment. Many of the individuals with mental illness suffer from excessive anxiety, as over 25% of Americans experience an anxiety disorder during their lifetime and most of these individuals remain untreated. Building from the premise that recognizing one's symptoms precedes requests for help, the current paper presents data from 577 adults (50% Caucasian, 50% African American) in the US regarding their ability to recognize anxiety disorders. Findings from a national survey showed that when presented with detailed vignettes portraying symptoms and their impact, 50% of respondents correctly recognized depression, whereas less than 20% correctly recognized the anxiety disorders. Recognition that the symptoms were a cause for concern was much more common, with 75% or more of the sample noting concern. Responses were surprisingly similar across the two races, and few consistent moderators were found. In conclusion, increasing recognition of anxiety disorders may be a useful first step toward increasing service utilization. Copyright © 2014 Elsevier Ltd. All rights reserved.

Treatment for Sleep Problems in Children with Autism and Caregiver Spillover Effects

ERIC Educational Resources Information Center

Tilford, J. Mick; Payakachat, Nalin; Kuhlthau, Karen A.; Pyne, Jeffrey M.; Kovacs, Erica; Bellando, Jayne; Williams, D. Keith; Brouwer, Werner B. F.; Frye, Richard E.

2015-01-01

Sleep problems in children with autism spectrum disorders (ASD) are under-recognized and under-treated. Identifying treatment value accounting for health effects on family members (spillovers) could improve the perceived cost-effectiveness of interventions to improve child sleep habits. A prospective cohort study (N = 224) was conducted with…

Learning to recognize objects on the fly: a neurally based dynamic field approach.

PubMed

Faubel, Christian; Schöner, Gregor

2008-05-01

Autonomous robots interacting with human users need to build and continuously update scene representations. This entails the problem of rapidly learning to recognize new objects under user guidance. Based on analogies with human visual working memory, we propose a dynamical field architecture, in which localized peaks of activation represent objects over a small number of simple feature dimensions. Learning consists of laying down memory traces of such peaks. We implement the dynamical field model on a service robot and demonstrate how it learns 30 objects from a very small number of views (about 5 per object are sufficient). We also illustrate how properties of feature binding emerge from this framework.

Comparing Data from the Poisons Information Centre with Employers' Accident Reports Reveal Under-Recognized Hazards at the Workplace.

PubMed

Schenk, Linda; Öberg, Mattias

2018-05-28

Records of injuries and incidents provide an important basis for injury prevention related to hazardous substances at the workplace. The present study aimed to review available data on injuries and incidents involving hazardous substances and investigate how data from the Poisons Information Centre could complement the records of the Swedish Work Environment Authority. We found two major obstacles for using injury/incident data based on employers' mandatory reporting. First, it was not possible to quickly and reliably identify injuries caused by hazardous substances, and second, data identifying substances or products are not systematically included. For two out of five investigated injuries with lost working days likely due to chemical injuries, we could not identify substances and/or products involved. The records based on calls to the Poisons Information Centre allow better understanding of chemical hazards and products. Besides the large share of unidentified chemical hazards in the injury statistics, the most striking difference was found for cleaning agents. Cleaning agents were implicated in one-third of the occupational cases that the consulting Poisons Information Centre expert judged to pose a major risk and in need of immediate healthcare. Only one in 10 injuries with lost days reported by employers was related to this type of product. The identification of exposures and symptoms by the Poisons Information Centre allow recognition of chemicals with problematic occupational uses. Hence, these records may serve as an important complement to official injury statistics related to incidents with hazardous substances at work.

Effects of traumatic brain injury on a virtual reality social problem solving task and relations to cortical thickness in adolescence.

PubMed

Hanten, Gerri; Cook, Lori; Orsten, Kimberley; Chapman, Sandra B; Li, Xiaoqi; Wilde, Elisabeth A; Schnelle, Kathleen P; Levin, Harvey S

2011-02-01

Social problem solving was assessed in 28 youth ages 12-19 years (15 with moderate to severe traumatic brain injury (TBI), 13 uninjured) using a naturalistic, computerized virtual reality (VR) version of the Interpersonal Negotiations Strategy interview (Yeates, Schultz, & Selman, 1991). In each scenario, processing load condition was varied in terms of number of characters and amount of information. Adolescents viewed animated scenarios depicting social conflict in a virtual microworld environment from an avatar's viewpoint, and were questioned on four problem solving steps: defining the problem, generating solutions, selecting solutions, and evaluating the likely outcome. Scoring was based on a developmental scale in which responses were judged as impulsive, unilateral, reciprocal, or collaborative, in order of increasing score. Adolescents with TBI were significantly impaired on the summary VR-Social Problem Solving (VR-SPS) score in Condition A (2 speakers, no irrelevant information), p=0.005; in Condition B (2 speakers+irrelevant information), p=0.035; and Condition C (4 speakers+irrelevant information), p=0.008. Effect sizes (Cohen's D) were large (A=1.40, B=0.96, C=1.23). Significant group differences were strongest and most consistent for defining the problems and evaluating outcomes. The relation of task performance to cortical thickness of specific brain regions was also explored, with significant relations found with orbitofrontal regions, the frontal pole, the cuneus, and the temporal pole. Results are discussed in the context of specific cognitive and neural mechanisms underlying social problem solving deficits after childhood TBI. Copyright © 2010 Elsevier Ltd. All rights reserved.

Effects of Traumatic Brain Injury on a Virtual Reality Social Problem Solving Task and Relations to Cortical Thickness in Adolescence

PubMed Central

Hanten, Gerri; Cook, Lori; Orsten, Kimberley; Chapman, Sandra B.; Li, Xiaoqi; Wilde, Elisabeth A.; Schnelle, Kathleen P.; Levin, Harvey S.

2011-01-01

Social problem solving was assessed in 28 youth ages 12–19 years (15 with moderate to severe traumatic brain injury (TBI), 13 uninjured) using a naturalistic, computerized virtual reality (VR) version of the Interpersonal Negotiations Strategy interview (Yeates, Schultz, & Selman, 1991). In each scenario, processing load condition was varied in terms of number of characters and amount of information. Adolescents viewed animated scenarios depicting social conflict in a virtual microworld environment from an avatar’s viewpoint, and were questioned on four problem solving steps: defining the problem, generating solutions, selecting solutions, and evaluating the likely outcome. Scoring was based on a developmental scale in which responses were judged as impulsive, unilateral, reciprocal, or collaborative, in order of increasing score. Adolescents with TBI were significantly impaired on the summary VR-Social Problem Solving (VR-SPS) score in Condition A (2 speakers, no irrelevant information), p = 0.005; in Condition B (2 speakers + irrelevant information), p = 0.035; and Condition C (4 speakers + irrelevant information), p = 0.008. Effect sizes (Cohen’s d) were large (A = 1.40, B = 0.96, C = 1.23). Significant group differences were strongest and most consistent for defining the problems and evaluating outcomes. The relation of task performance to cortical thickness of specific brain regions was also explored, with significant relations found with orbitofrontal regions, the frontal pole, the cuneus, and the temporal pole. Results are discussed in the context of specific cognitive and neural mechanisms underlying social problem solving deficits after childhood TBI. PMID:21147137

What is the evidence for retrieval problems in the elderly?

PubMed

White, N; Cunningham, W R

1982-01-01

To determine whether older adults experience particular problems with retrieval, groups of young and elderly adults were given free recall and recognition tests of supraspan lists of unrelated words. Analysis of number of words correctly recalled and recognized yielded a significant age by retention test interaction: greater age differences were observed for recall than for recognition. In a second analysis of words recalled and recognized, corrected for guessing, the interaction disappeared. It was concluded that previous interpretations that age by retention test interactions are indicative of retrieval problems of the elderly may have been confounded by methodological problems. Furthermore, it was suggested that researchers in aging and memory need to be explicit in identifying their underlying models of error processes when analyzing recognition scores: different error models may lead to different results and interpretations.

Comparison of patient centeredness of visits to emergency departments, physicians, and dentists for dental problems and injuries.

PubMed

Cohen, Leonard A; Bonito, Arthur J; Eicheldinger, Celia; Manski, Richard J; Macek, Mark D; Edwards, Robert R; Khanna, Niharika

2010-01-01

Patient-centered care has a positive impact on patient health status. This report compares patient assessments of patient centeredness during treatment in hospital emergency departments (EDs) and physician and dentist offices for dental problems and injuries. Participants included low-income White, Black, and Hispanic adults who had experienced a dental problem or injury during the previous 12 months and who visited an emergency department, physician, or dentist for treatment. A stratified random sample of Maryland households participated in a cross-sectional telephone survey. Interviews were completed with 94.8% (401/423) of eligible individuals. Multivariable logistic regression analyses were performed. The measure of predictive power, the pseudo-R2s, calculated for the logistic regression models ranged from 12% to 18% for the analyses of responses to the measures of patient centeredness (satisfaction with treatment, careful listening, thorough explaining, spending enough time, and treated with courtesy and respect). EDs were less likely than dentists to treat patients with great courtesy and respect. Further research is needed to identify factors that support patient-centered care.

Development of a Website for Educators Addressing How to Understand, Recognize, and Respond to Student Self-Injury

ERIC Educational Resources Information Center

Dorko, Laura A.

2010-01-01

Self-injury (SI) is defined as the act of deliberately destroying one's own body tissue without suicidal intent in a way that is not widely socially acceptable and is not as a result of mental retardation, autism, or other developmental delays. The review of the self-injury literature focused on the definition, prevalence, and other basic aspects…

Sport injuries in adolescents

PubMed Central

Habelt, Susanne; Hasler, Carol Claudius; Steinbrück, Klaus; Majewski, Martin

2011-01-01

In spite of the wide range of injuries in adolescents during sports activities, there are only a few studies investigating the type and frequency of sport injuries in puberty. However, this information may help to prevent, diagnose and treat sports injuries among teens. 4468 injuries in adolescent patients were treated over a ten year period of time: 66,97% were boys and 32.88% girls. The most frequent sports injuries were football (31.13%) followed by handball (8.89%) and sports during school (8.77%). The lower extremity was involved in 68.71% of the cases. Knee problems were seen in 29.79% of the patients; 2.57% spine and 1.99% head injuries. Injuries consisted primarily of distortions (35.34%) and ligament tears (18.76%); 9,00% of all injuries were fractures. We found more skin wounds (6:1) and fractures (7:2) in male patients compared to females. The risk of ligament tears was highest during skiing. Three of four ski injuries led to knee problems. Spine injuries were observed most often during horse riding (1:6). Head injuries were seen in bicycle accidents (1:3). Head injuries were seen in male patients much more often then in female patients (21:1). Fractures were noted during football (1:9), skiing (1:9), inline (2:3), and during school sports (1:11). Many adolescents participate in various sports. Notwithstanding the methodological problems with epidemiological data, there is no doubt about the large number of athletes sustain musculoskeletal injuries, sometimes serious. In most instances, the accident does not happened during professional sports and training. Therefore, school teachers and low league trainer play an important role preventing further accidence based on knowledge of individual risk patterns of different sports. It is imperative to provide preventive medical check-ups, to monitor the sport-specific needs for each individual sports, to observe the training skills as well as physical fitness needed and to evaluation coaches education. PMID

Blood-based diagnostics of traumatic brain injuries

PubMed Central

Mondello, Stefania; Muller, Uwe; Jeromin, Andreas; Streeter, Jackson; Hayes, Ronald L; Wang, Kevin KW

2011-01-01

Traumatic brain injury is a major health and socioeconomic problem that affects all societies. However, traditional approaches to the classification of clinical severity are the subject of debate and are being supplemented with structural and functional neuroimaging, as the need for biomarkers that reflect elements of the pathogenetic process is widely recognized. Basic science research and developments in the field of proteomics have greatly advanced our knowledge of the mechanisms involved in damage and have led to the discovery and rapid detection of new biomarkers that were not available previously. However, translating this research for patients' benefits remains a challenge. In this article, we summarize new developments, current knowledge and controversies, focusing on the potential role of these biomarkers as diagnostic, prognostic and monitoring tools of brain-injured patients. PMID:21171922

Angiogenin Mediates Cell-Autonomous Translational Control under Endoplasmic Reticulum Stress and Attenuates Kidney Injury

PubMed Central

Mami, Iadh; Bouvier, Nicolas; El Karoui, Khalil; Gallazzini, Morgan; Rabant, Marion; Laurent-Puig, Pierre; Li, Shuping; Tharaux, Pierre-Louis; Beaune, Philippe; Thervet, Eric; Chevet, Eric; Hu, Guo-Fu

2016-01-01

Endoplasmic reticulum (ER) stress is involved in the pathophysiology of kidney disease and aging, but the molecular bases underlying the biologic outcomes on the evolution of renal disease remain mostly unknown. Angiogenin (ANG) is a ribonuclease that promotes cellular adaptation under stress but its contribution to ER stress signaling remains elusive. In this study, we investigated the ANG-mediated contribution to the signaling and biologic outcomes of ER stress in kidney injury. ANG expression was significantly higher in samples from injured human kidneys than in samples from normal human kidneys, and in mouse and rat kidneys, ANG expression was specifically induced under ER stress. In human renal epithelial cells, ER stress induced ANG expression in a manner dependent on the activity of transcription factor XBP1, and ANG promoted cellular adaptation to ER stress through induction of stress granules and inhibition of translation. Moreover, the severity of renal lesions induced by ER stress was dramatically greater in ANG knockout mice (Ang−/−) mice than in wild-type mice. These results indicate that ANG is a critical mediator of tissue adaptation to kidney injury and reveal a physiologically relevant ER stress-mediated adaptive translational control mechanism. PMID:26195817

Ultrasound of skeletal muscle injury.

PubMed

Koh, Eamon Su Chun; McNally, Eugene G

2007-06-01

The professional and recreational demands of modern society make the treatment of muscle injury an increasingly important clinical problem, particularly in the athletic population. In the elite athlete, significant financial and professional pressures may also exist that emphasize the need for accurate diagnosis and treatment. With new advances in ultrasound technology, images of exquisite detail allow diagnosis of muscle injury that matches the accuracy of magnetic resonance imaging (MRI). Furthermore, the benefits of real-time and Doppler imaging, ability to perform interventional procedures, and relative cost benefits compared with MRI place ultrasound at the forefront for investigation for these injuries in many circumstances. Muscle injury may be divided into acute and chronic pathology, with muscle strain injury the most common clinical problem presenting to sports physicians. This article reviews the spectrum of acute and chronic muscle injuries, with particular attention to clinical features and some common or important muscle strain injuries.

From Poor Performance to Success under Stress: Working Memory, Strategy Selection, and Mathematical Problem Solving under Pressure

ERIC Educational Resources Information Center

Beilock, Sian L.; DeCaro, Marci S.

2007-01-01

Two experiments demonstrate how individual differences in working memory (WM) impact the strategies used to solve complex math problems and how consequential testing situations alter strategy use. In Experiment 1, individuals performed multistep math problems under low- or high-pressure conditions and reported their problem-solving strategies.…

A national program for injury prevention in children and adolescents: the injury free coalition for kids.

PubMed

Pressley, Joyce C; Barlow, Barbara; Durkin, Maureen; Jacko, Sally A; Dominguez, DiLenny Roca; Johnson, Lenita

2005-09-01

Injury is the leading cause of death and a major source of preventable disability in children. Mechanisms of injury are rooted in a complex web of social, economic, environmental, criminal, and behavioral factors that necessitate a multifaceted, systematic injury prevention approach. This article describes the injury burden and the way physicians, community coalitions, and a private foundation teamed to impact the problem first in an urban minority community and then through a national program. Through our injury prevention work in a resource-limited neighborhood, a national model evolved that provides a systematic framework through which education and other interventions are implemented. Interventions are aimed at changing the community and home environments physically (safe play areas and elimination of community and home hazards) and socially (education and supervised extracurricular activities with mentors). This program, based on physician-community partnerships and private foundation financial support, expanded to 40 sites in 37 cities, representing all 10 US trauma regions. Each site is a local adaptation of the Injury Free Coalition model also referred to as the ABC's of injury prevention: A, "analyze injury data through local injury surveillance"; B, "build a local coalition"; C, "communicate the problem and raise awareness that injuries are a preventable public health problem"; D, "develop interventions and injury prevention activities to create safer environments and activities for children"; and E, "evaluate the interventions with ongoing surveillance." It is feasible to develop a comprehensive injury prevention program of national scope using a voluntary coalition of trauma centers, private foundation financial and technical support, and a local injury prevention model with a well-established record of reducing and sustaining lower injury rates for inner-city children and adolescents.

Serious injury prediction algorithm based on large-scale data and under-triage control.

PubMed

Nishimoto, Tetsuya; Mukaigawa, Kosuke; Tominaga, Shigeru; Lubbe, Nils; Kiuchi, Toru; Motomura, Tomokazu; Matsumoto, Hisashi

2017-01-01

The present study was undertaken to construct an algorithm for an advanced automatic collision notification system based on national traffic accident data compiled by Japanese police. While US research into the development of a serious-injury prediction algorithm is based on a logistic regression algorithm using the National Automotive Sampling System/Crashworthiness Data System, the present injury prediction algorithm was based on comprehensive police data covering all accidents that occurred across Japan. The particular focus of this research is to improve the rescue of injured vehicle occupants in traffic accidents, and the present algorithm assumes the use of an onboard event data recorder data from which risk factors such as pseudo delta-V, vehicle impact location, seatbelt wearing or non-wearing, involvement in a single impact or multiple impact crash and the occupant's age can be derived. As a result, a simple and handy algorithm suited for onboard vehicle installation was constructed from a sample of half of the available police data. The other half of the police data was applied to the validation testing of this new algorithm using receiver operating characteristic analysis. An additional validation was conducted using in-depth investigation of accident injuries in collaboration with prospective host emergency care institutes. The validated algorithm, named the TOYOTA-Nihon University algorithm, proved to be as useful as the US URGENCY and other existing algorithms. Furthermore, an under-triage control analysis found that the present algorithm could achieve an under-triage rate of less than 10% by setting a threshold of 8.3%. Copyright © 2016 Elsevier Ltd. All rights reserved.

Wii have a problem: a review of self-reported Wii related injuries.

PubMed

Sparks, Dorothy; Chase, Daniel; Coughlin, Lisa

2009-01-01

The increasing popularity of the Wii video game console has been associated with a number of gameplay related traumas. We sought to investigate if there were any identifiable injury patterns associated with Wii use. Utilising a database of self-reported Wii related injuries, the data was categorised by type of injury and game title being played at the time of injury. We found that of 39 reported Wii related injuries over a two-year span, 46% occurred while playing the Wii Sports Tennis software. Further, we identified 14 distinct injury patterns sustained during gameplay. Of these injuries, hand lacerations were the most common, accounting for 44% of the total number of reported cases. Injury associated with video game play is not unique to the Wii, nor is it a new phenomenon. However, the Wii console appears to have a higher rate of associated injuries than traditional game consoles because of its unique user interface. We review the literature and discuss some of the medical complications associated with the Wii and other video game consoles.

Deciphering the underlying mechanisms of Diesun Miaofang in traumatic injury from a systems pharmacology perspective

PubMed Central

ZHENG, CHUN-SONG; FU, CHANG-LONG; PAN, CAI-BIN; BAO, HONG-JUAN; CHEN, XING-QIANG; YE, HONG-ZHI; YE, JIN-XIA; WU, GUANG-WEN; LI, XI-HAI; XU, HUI-FENG; XU, XIAO-JIE; LIU, XIAN-XIANG

2015-01-01

Diesun Miaofang (DSMF) is a traditional herbal formula, which has been reported to activate blood, remove stasis, promote qi circulation and relieve pain. DSMF holds a great promise for the treatment of traumatic injury in an integrative and holistic manner. However, its underlying mechanisms remain to be elucidated. In the present study, a systems pharmacology model, which integrated cluster ligands, human intestinal absorption and aqueous solution prediction, chemical space mapping, molecular docking and network pharmacology techniques were used. The compounds from DSMF were diverse in the clusters and chemical space. The majority of the compounds exhibited drug-like properties. A total of 59 compounds were identified to interact with 16 potential targets. In the herb-compound-target network, the majority of compounds acted on only one target; however, a small number of compounds acted on a large number of targets, up to a maximum of 12. The comparison of key topological properties in compound-target networks associated with the above efficacy intuitively demonstrated that potential active compounds possessed diverse functions. These results successfully explained the polypharmcological mechanism underlying the efficiency of DSMF for the treatment of traumatic injury as well as provided insight into potential novel therapeutic strategies for traumatic injury from herbal medicine. PMID:25891262

[Interdisciplinary cooperation in rehabilitation--problem solving following severe craniocerebral injury].

PubMed

Hackspacher, J; Dern, W; Jeschke, H A

1991-05-01

Therapy and rehabilitation of patients with craniocerebral trauma is particularly difficult to programme on account of the neuropsychological defects and personality changes found in this population. The Ulm rehabilitation hospital seeks to face up to this fact by intense interdisciplinary cooperation in the nursing and medical sector, the fields of logopaedics, Occupational Therapy, physiotherapy, immediate post-acute therapy including cerebral training, as well as the entire field of vocational rehabilitation. A dense time schedule has been established for graded introduction of the necessary therapeutic interventions in the sense of a therapy chain, with intense information flows among the therapists involved, thus ensuring a continuous process and joint adjustment of programming to the individual course, to new problems that may arise. The implementation of this concept is set out on the example of a young patient with craniocerebral injury, who had received treatment in various of our departments for a total of 12 months, finally bringing him up to the conclusion of his vocational education.

Moral injury: A new challenge for complementary and alternative medicine.

PubMed

Kopacz, Marek S; Connery, April L; Bishop, Todd M; Bryan, Craig J; Drescher, Kent D; Currier, Joseph M; Pigeon, Wilfred R

2016-02-01

Moral injury represents an emerging clinical construct recognized as a source of morbidity in current and former military personnel. Finding effective ways to support those affected by moral injury remains a challenge for both biomedical and complementary and alternative medicine. This paper introduces the concept of moral injury and suggests two complementary and alternative medicine, pastoral care and mindfulness, which may prove useful in supporting military personnel thought to be dealing with moral injury. Research strategies for developing an evidence-base for applying these, and other, complementary and alternative medicine modalities to moral injury are discussed. Published by Elsevier Ltd.

Compensating Injury to Autonomy in English Negligence Law: Inconsistent Recognition.

PubMed

Keren-Paz, Tsachi

2018-04-10

Recently in Shaw v Kovac, the Court of Appeal seemed to have rejected a standalone injury to autonomy (ITA) as actionable in negligence, in an informed consent case. In this article, I argue that Shaw can be explained away, and that English law recognizes ITA as actionable in a series of cases, some of which-Bhamra, Tracey, and Yearworth-were not hitherto understood to do so. However, the under-theorization in the cases leads to inconsistencies. Like cases (Rees/Yearworth; Chester/Tracey) are not treated alike; ITA is misunderstood to be about 'religious offence' (Bhamra) and property loss (Yearworth) and worse still, the more serious type 2 ITA (Rees) gives rise to a weaker remedy (of exceptional nature aside) than the less serious type 1 injury (Chester). A better understanding of the different manifestations of ITA will lead to results which are both more consistent and more justified on the merit.

Association between the Number of Injuries Sustained and 12-Month Disability Outcomes: Evidence from the Injury-VIBES Study

PubMed Central

Gabbe, Belinda J.; Simpson, Pam M.; Lyons, Ronan A.; Ameratunga, Shanthi; Harrison, James E.; Derrett, Sarah; Polinder, Suzanne; Davie, Gabrielle; Rivara, Frederick P.

2014-01-01

Objective To determine associations between the number of injuries sustained and three measures of disability 12-months post-injury for hospitalised patients. Methods Data from 27,840 adult (18+ years) participants, hospitalised for injury, were extracted for analysis from the Validating and Improving injury Burden Estimates (Injury-VIBES) Study. Modified Poisson and linear regression analyses were used to estimate relative risks and mean differences, respectively, for a range of outcomes (Glasgow Outcome Scale-Extended, GOS-E; EQ-5D and 12-item Short Form health survey physical and mental component summary scores, PCS-12 and MCS-12) according to the number of injuries sustained, adjusted for age, sex and contributing study. Findings More than half (54%) of patients had an injury to more than one ICD-10 body region and 62% had sustained more than one Global Burden of Disease injury type. The adjusted relative risk of a poor functional recovery (GOS-E<7) and of reporting problems on each of the items of the EQ-5D increased by 5–10% for each additional injury type, or body region, injured. Adjusted mean PCS-12 and MCS-12 scores worsened with each additional injury type, or body region, injured by 1.3–1.5 points and 0.5 points, respectively. Conclusions Consistent and strong relationships exist between the number of injury types and body regions injured and 12-month functional and health status outcomes. Existing composite measures of anatomical injury severity such as the NISS or ISS, which use up to three diagnoses only, may be insufficient for characterising or accounting for multiple injuries in disability studies. Future studies should consider the impact of multiple injuries to avoid under-estimation of injury burden. PMID:25501651

Postdeployment symptom changes and traumatic brain injury and/or posttraumatic stress disorder in men.

PubMed

Macera, Caroline A; Aralis, Hilary J; Macgregor, Andrew J; Rauh, Mitchell J; Galarneau, Michael R

2012-01-01

In Operation Iraqi Freedom and Operation Enduring Freedom, blast-related injuries associated with combat are frequent and can result in traumatic brain injury (TBI) symptoms that may be difficult to distinguish from psychological problems. Using data from the Post-Deployment Health Assessment and Reassessment, we identified 12,046 male U.S. Navy sailors and Marines with reported combat exposure from 2008 to 2009. Symptoms potentially associated with blast-related TBI and posttraumatic stress disorder (PTSD) that were reported immediately after deployment were compared with symptoms present several months later. Our study supports others that have found that subjects with blast-related injuries may experience the development or worsening of symptoms during the months following deployment. Additionally, our study found that those who screened positive for PTSD and TBI formed a unique group, with the presence of TBI exacerbating development of PTSD symptoms at reassessment. Providers should recognize the late development of symptoms, consider the possibility of comorbidity, and be prepared to treat multiple symptoms rather than a specific diagnostic category.

Pelvic fracture injuries of the female urethra.

PubMed

Venn, S N; Greenwell, T J; Mundy, A R

1999-04-01

To review pelvic fracture urethral injuries in women, generally regarded as rare and thus discussed infrequently. Twelve patients (age range 7-51 years) with such injuries were reviewed; most had associated injuries, generally more severe than seen in males with urethral injuries. Patients with milder injuries, perhaps damaging just the innervation of the urethra, presented with incontinence; more severe injuries seemed to cause a longitudinal tear in the urethra but again patients presented mainly with incontinence problems. The most severe injuries were associated with complete rupture of the urethra and a distraction defect suggesting an avulsion injury. These problems were difficult to treat both reconstructively and in providing continence. Pelvic fracture urethral injuries occur in females, but less often than in males. The female urethra seems relatively resistant to injury; differing degrees of severity of pelvic trauma cause different types of urethral injury but in general, a more severe injury is needed to damage it than is necessary in males.

Recognizing and Preventing Adolescent Eating Disorders and Muscularity Problems

ERIC Educational Resources Information Center

Smolak, Linda; Levine, Michael P.

2007-01-01

It is important for adults who work with youth to know how to address the issues of eating disorders and steroid use. This article provides signs and symptoms for both, and then gives practical suggestions for talking with youth about a potential problem. It ends with prevention strategies for adults who work with youth. (Contains 3 tables.)

Danish translation and validation of the Oslo Sports Trauma Research Centre questionnaires on overuse injuries and health problems.

PubMed

Jorgensen, J E; Rathleff, C R; Rathleff, M S; Andreasen, J

2016-12-01

The Oslo Sports Trauma Research Centre Overuse Injury Questionnaire (OSTRC-O) and the Oslo Sports Trauma Research Centre questionnaire on Health Problems (The OSTRC-H) make it possible to monitor illness and injury at regular intervals capturing prevalence and incidence of acute injury, overuse injury, and illnesses. The aim of this study was to translate, culturally adapt, and establish the face validity of the OSTRC-O and the OSTRC-H into a Danish context (DK) through cognitive interviews and the assessment of test-retest reliability. The OSTRC-O.DK was distributed to 57 heterogenous respondents; response rate was 89%. The OSTRC-H was distributed to 58 heterogenous respondents; response rate was 86%. No major disagreements were observed between the original and translated versions of the questionnaires. The OSTRC-O had high internal consistency (Cronbach's alpha 0.80-0.93). The primary reliability analyses including all participants, showed reliability ICC: 0.62 (95% CI: 0.42-0.77. The secondary reliability analyses that only included subjects who did not change injury region from the test to the retest showed an ICC of 0.86 (95% CI: 0.77-0.92).The questionnaires were found to be valid, reliable, and acceptable for use in a Danish population. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Prevention and Management of Nerve Injuries in Thoracic Surgery.

PubMed

Auchincloss, Hugh G; Donahue, Dean M

2015-11-01

Nerve injuries can cause substantial morbidity after thoracic surgical procedures. These injuries are preventable, provided that the surgeon has a thorough understanding of the anatomy and follows important surgical principles. When nerve injuries occur, it is important to recognize the options available in the immediate and postoperative settings, including expectant management, immediate nerve reconstruction, or auxiliary procedures. This article covers the basic anatomy and physiology of nerves and nerve injuries, an overview of techniques in nerve reconstruction, and a guide to the nerves most commonly involved in thoracic operative procedures. Copyright © 2015 Elsevier Inc. All rights reserved.

Recognizing medical emergencies

MedlinePlus

... persistent vomiting Sudden injury due to a motor vehicle accident, burns or smoke inhalation, near drowning, deep ... in case of a neck injury or motor vehicle accident) The person needs the skills or equipment ...

Spinal cord injury - Symptoms and causes

MedlinePlus

... are the leading cause of spinal cord injuries, accounting for almost half of new spinal cord injuries ... address these problems if they affect you. Respiratory system. Your injury may make it more difficult to ...

Pontomedullary lacerations and concomitant head and neck injuries: their underlying mechanism. A prospective autopsy study.

PubMed

Živković, Vladimir; Nikolić, Slobodan; Strajina, Veljko; Babić, Dragan; Djonić, Danijela; Djurić, Marija

2012-09-01

It is a well-documented fact that pontomedullary lacerations (PML) occur as a result of severe craniocervical injury, but their underlying mechanism has yet to be fully clarified. The aim of this prospective study has been to give greater insight into the underlying mechanism of PML through determining the site of blunt head-impact, as well as the presence of concomitant head and neck injuries in cases of brainstem PML. A total of 56 cases with partial PML have been analysed for this study. The case group was composed of 40 men and 16 women, averaging in age 44.2 ± 19.2 years and consisting of 7 motorcyclists, 4 bicyclists, 18 car occupants, 16 pedestrians, and 10 victims of falls from a height, as well as 1 victim of a fall from standing height. The presented study has shown that there are several possible mechanisms of PML. Impact to the chin, with or without a skull base fracture, most often leads to this fatal injury, due to the impact force transmission either through the jawbone or vertebral column; most likely in combination with a fronto-posterior hyperextension of the head. Additionally, lateral head-impacts with subsequent hinge fractures and PML may also be a possible mechanism. The jawbone and other facial bones are able to act as shock absorbers, and their fracture may diminish the energy transfer towards the skull and protect the brain and brainstem from injury. The upper cervical spine can act as damper and energy absorber as well, and may prevent any occurrence of fracture to the base of the skull.

Does tinnitus, hearing asymmetry, or hearing loss predispose to occupational injury risk?

PubMed

Cantley, Linda F; Galusha, Deron; Cullen, Mark R; Dixon-Ernst, Christine; Tessier-Sherman, Baylah; Slade, Martin D; Rabinowitz, Peter M; Neitzel, Richard L

2015-02-01

To determine the relative contributions of tinnitus, asymmetrical hearing loss, low frequency hearing loss (pure tone average of 0.5, 1, 2, 3 kHz; PTA.5123), or high frequency hearing loss (pure tone average of 4, 6 kHz; PTA46), to acute injury risk among a cohort of production and maintenance workers at six aluminum manufacturing plants, adjusting for ambient noise exposure and other recognized predictors of injury risk. Retrospective analysis. The study considered 9920 workers employed during 2003 to 2008. The cohort consisted of 8818 workers (89%) whose complete records were available. Adjusting for noise exposure and other recognized injury predictors, a 25% increased acute injury risk was observed among workers with a history of tinnitus in conjunction with high-frequency hearing loss (PTA46). Low frequency hearing loss may be associated with minor, yet less serious, injury risk. We did not find evidence that asymmetry contributes to injury risk. These results provide evidence that tinnitus, combined with high-frequency hearing loss, may pose an important safety threat to workers, especially those who work in high-noise exposed environments. These at risk workers may require careful examination of their communication and hearing protection needs.

Road safety: serious injuries remain a major unsolved problem.

PubMed

Beck, Ben; Cameron, Peter A; Fitzgerald, Mark C; Judson, Rodney T; Teague, Warwick; Lyons, Ronan A; Gabbe, Belinda J

2017-09-18

To investigate temporal trends in the incidence, mortality, disability-adjusted life-years (DALYs), and costs of health loss caused by serious road traffic injury. A retrospective review of data from the population-based Victorian State Trauma Registry and the National Coronial Information System on road traffic-related deaths (pre- and in-hospital) and major trauma (Injury Severity Score > 12) during 2007-2015.Main outcomes and measures: Temporal trends in the incidence of road traffic-related major trauma, mortality, DALYs, and costs of health loss, by road user type. There were 8066 hospitalised road traffic major trauma cases and 2588 road traffic fatalities in Victoria over the 9-year study period. There was no change in the incidence of hospitalised major trauma for motor vehicle occupants (incidence rate ratio [IRR] per year, 1.00; 95% CI, 0.99-1.01; P = 0.70), motorcyclists (IRR, 0.99; 95% CI, 0.97-1.01; P = 0.45) or pedestrians (IRR, 1.00; 95% CI, 0.97-1.02; P = 0.73), but the incidence for pedal cyclists increased 8% per year (IRR, 1.08; 95% CI; 1.05-1.10; P < 0.001). While DALYs declined for motor vehicle occupants (by 13% between 2007 and 2015), motorcyclists (32%), and pedestrians (5%), there was a 56% increase in DALYs for pedal cyclists. The estimated costs of health loss associated with road traffic injuries exceeded $14 billion during 2007-2015, although the cost per patient declined for all road user groups. As serious injury rates have not declined, current road safety targets will be difficult to meet. Greater attention to preventing serious injury is needed, as is further investment in road safety, particularly for pedal cyclists.

The Development of Emotion and Empathy Skills after Childhood Brain Injury

ERIC Educational Resources Information Center

Tonks, James; Slater, Alan; Frampton, Ian; Wall, Sarah E.; Yates, Phil; Williams, W. Huw

2009-01-01

Lasting socio-emotional behaviour difficulties are common among children who have suffered brain injuries. A proportion of difficulties may be attributed to impaired cognitive and/or executive skills after injury. A recent and rapidly accruing body of literature indicates that deficits in recognizing and responding to the emotions of others are…

Shoulder Acromioclavicular and Coracoclavicular Ligament Injuries: Common Problems and Solutions.

PubMed

Wylie, James D; Johnson, Jeremiah D; DiVenere, Jessica; Mazzocca, Augustus D

2018-04-01

Injuries to the acromioclavicular joint and coracoclavicular ligaments are common. Many of these injuries heal with nonoperative management. However, more severe injuries may lead to continued pain and shoulder dysfunction. In these patients, surgical techniques have been described to reconstruct the function of the coracoclavicular ligaments to provide stable relationship between the clavicle and scapula. These surgeries have been fraught with high complication rates including clavicle and coracoid fractures, infection, loss of reduction and fixation, hardware migration, and osteolysis. This article reviews common acromioclavicular and coracoclavicular repair and reconstruction techniques and associated complications, and provides recommendations for prevention and management. Copyright © 2018 Elsevier Inc. All rights reserved.

Experiences and Attitudes of Collegiate Athletic Trainers Regarding Alcohol-Related Unintentional Injury in Athletes

PubMed Central

Brenner, James W.; Metz, Stacie M.; Entriken, Jack; Brenner, Christina J.

2014-01-01

Context: Alcohol-related unintentional injury (ARUI) has been an unexamined consequence of alcohol consumption by collegiate athletes. It has a potentially devastating effect on their athletic performances and careers. Awareness of this problem in athletes could have a huge effect on what athletic trainers (ATs) do to recognize, treat, and prevent it in a collegiate athlete population. Objective: To examine the experiences and attitudes among collegiate and university ATs about ARUI in the athletes in their care. Design: Cross-sectional study. Setting: Web-based survey. Patients or Other Participants: A total of 1767 e-mail addresses for collegiate and university ATs within National Athletic Trainers' Association Districts 1, 2, 3, and 9. Main Outcome Measure(s): We calculated frequencies, percentages, and attitudes of ATs regarding ARUI in collegiate athletes during the 2010–2011 academic year. Results: The resulting sample size for the analysis was 459 (26.0%) participants of the initial total sample. More than 56% (n = 260) of the ATs reported that they had evaluated, treated, or referred if needed at least 1 ARUI in a collegiate athlete. On average, these ATs had evaluated, treated, or referred if needed 3 alcohol-related unintentional injuries within the 2010–2011academic year. About 73% (n = 331) of ATs agreed that ARUI is a serious problem. Nearly 80% (n = 358) indicated they believe ATs should receive more training to identify student–athletes with alcohol-related problems. Conclusions: Alcohol-related unintentional injury is a common and serious consequence of alcohol use among collegiate athletes. Many ATs also view it as a serious problem yet would like more training in how to address it. Alcohol-related unintentional injury may have important negative effects on the careers and athletic performances of athletes. Researchers need to determine how prevalent ARUI is in the collegiate athlete population and what ATs can do to address it. PMID:24377956

Behavioral avoidance as evidence of injury to fishery resources: Applications to natural resource damage assessment

USGS Publications Warehouse

Delonay, Aaron J.; Little, Edward E.; Lipton, J.; Woodward, D.F.; Hansen, J.A.

1996-01-01

Natural Resource Damage Assessment (NRDA) provisions enacted under Comprehensive Environmental Response Compensation and Liability Act (CERCLA) and the Oil Pollution Act (OPA) empower natural resource trustees to seek compensation for environmental injury resulting from the release of oil or hazardous substances. Under NRDA regulations promulgated under CERCLA, fish avoidance behavior is recognized as an accepted injury, and may be used to support damage claims. In support of an ongoing damage assessment, tests were conducted to determine if avoidance of ambient metals concentrations may contribute to reductions in local salmonid populations. In laboratory tests, rainbow trout (Oncorhynchus mykiss) and brown trout (Salmo trutta) avoided mixtures of metals (Cd, Cu, Pb, and Zn) at concentrations that occur in impacted river reaches at a contaminated site (Clark Fork River, MT). Avoidance of metal contamination may contribute to population reductions and preclude restoration of instream populations by prohibiting movement of fish into contaminated areas of the river from uncontaminated tributaries. Laboratory avoidance tests were performed at two testing facilities. The similar avoidance responses observed at the two laboratories demonstrated the reproducibility of avoidance measures.

The relationship between neurobehavioural problems of severe traumatic brain injury (TBI), family functioning and the psychological well-being of the spouse/caregiver: path model analysis.

PubMed

Anderson, Malcolm I; Parmenter, Trevor R; Mok, Magdalena

2002-09-01

This study used a modern theory of stress as a framework to strengthen the understanding of the relationship between neurobehavioural problems of TBI, family functioning and psychological distress in spouse/caregivers. The research was an ex post facto design utilising a cross-sectional methodology. Path analysis was used to determine the structural effect of neurobehavioural problems on family functioning and psychological distress. Forty-seven female and 17 male spouse/caregivers of partners with severe TBI were recruited. Spouse/caregivers who reported partners with TBI as having high levels of behavioural and cognitive problems experienced high levels of unhealthy family functioning. High levels of unhealthy family functioning were related to high levels of distress in spouse/caregivers, as family functioning had a moderate influence on psychological distress. Furthermore, indirect effects of behavioural and cognitive problems operating through family functioning intensified the level of psychological distress experienced by spouse/caregivers. Additionally, spouse/caregivers who reported high levels of behavioural, communication and social problems in their partners also experienced high levels of psychological distress. This study was significant because the impact of TBI on the spouse/caregiver from a multidimensional perspective is an important and under-researched area in the brain injury and disability field.

Co-Occurring Non-Suicidal Self-Injury and Firesetting Among At-Risk Adolescents: Experiences of Negative Life Events, Mental Health Problems, Substance Use, and Suicidality.

PubMed

Tanner, Alicia; Hasking, Penelope; Martin, Graham

2016-01-01

Co-occurring internalizing and externalizing problem behaviors in adolescence typically marks more severe psychopathology and poorer psychosocial functioning than engagement in a single problem behavior. We examined the negative life events, emotional and behavioral problems, substance use, and suicidality of school-based adolescents reporting both non-suicidal self-injury (NSSI) and repetitive firesetting, compared to those engaging in either behavior alone. Differences in NSSI characteristics among self-injurers who set fires, compared to those who did not, were also assessed. A total of 384 at-risk adolescents aged 12-18 years (58.8% female) completed self-report questionnaires measuring NSSI, firesetting, and key variables of interest. Results suggest that adolescents who both self-injure and deliberately set fires represent a low-prevalence but distinct high-risk subgroup, characterized by increased rates of interpersonal difficulties, mental health problems and substance use, more severe self-injury, and suicidal behavior. Implications for prevention and early intervention initiatives are discussed.

Do Sleep Problems Mediate the Relationship between Traumatic Brain Injury and Development of Mental Health Symptoms after Deployment?

PubMed Central

Macera, Caroline A.; Aralis, Hilary J.; Rauh, Mitchell J.; MacGregor, Andrew J.

2013-01-01

Study Objectives: Military members screening positive for blast-related traumatic brain injury (TBI) may subsequently screen positive for posttraumatic stress disorder (PTSD) or depression. The role of sleep as a mediating factor in the development of mental health symptoms was explored. Design: Prospective study with symptoms evaluated at two time points. Setting: Postdeployment service in Iraq, Afghanistan, or Kuwait during 2008 and 2009. Participants: There were 29,640 US Navy and Marine Corps men (29,019 who did not screen positive for PTSD at baseline, 27,702 who did not screen positive for depression at baseline, and 27,320 who did not screen positive at baseline for either condition). Measurements and Results: After controlling for sleep problems, the adjusted odds of receiving a positive PTSD screening at follow-up decreased from 1.61 (95% confidence interval [CI] 1.21–2.14) to 1.32 (95% CI 0.99–1.77) for a subject screening positive for TBI relative to a subject screening negative, suggesting that sleep problems mediated 26% of TBI's effect on development of PTSD. Likewise, after controlling for sleep problems, the adjusted odds of receiving a positive depression screening decreased from 1.41 (95% CI 1.11–1.80) to 1.15 (95% CI 0.90–1.47), suggesting that sleep problems mediated 41% of TBI's effect on development of depression. Results were similar for those with either PTSD or depression (37% mediated). Conclusions: These results suggest that sleep problems mediate the effect of a positive TBI screening on the development of mental health disorders, and sleep problems may be an early indicator of risk for PTSD or depression. Citation: Macera CA; Aralis HJ; Rauh MJ; MacGregor AJ. Do sleep problems mediate the relationship between traumatic brain injury and development of mental health symptoms after deployment? SLEEP 2013;36(1):83–90. PMID:23288974

Self-reported occupational health problems among Libyan dentists.

PubMed

Arheiam, Arheiam; Ingafou, Mohamed

2015-01-01

To investigate the prevalence of the most common occupation-related health problems as well as factors associated with their incidence among dental practitioners. A cross-sectional, questionnaire-based survey of Libyan dental practitioners. Participants provided information regarding their experience of occupationally related problems they encountered over the past 12 months which included inquiries about musculoskeletal pain, percutaneous injuries, allergy, eye and sight problems, and hearing problems. Musculoskeletal problems were the most frequently reported (48.2%), followed by percutaneous injuries (35%), eye problems (22%), allergy (11%) and hearing problems (7.6%). Musculoskeletal problems were significantly higher among dentists who work in private sector, full timer as well as those who prefer to work in a sitting position (p=0.021, 0.027 and 0.008, respectively). Practitioners with less than 5 years in service reported significantly higher percentage of percutaneous injuries (p=0.027) than their senior counterparts, whereas practitioners who spent more than 10 years in service were more likely to suffer from visual disturbances (p=0.033). The findings of this study indicate that musculoskeletal problems and percutaneous injuries are the most commonly reported occupational health problems among dentists, whereas allergic reactions and hearing problems are the least reported ones. Dentists should use alternate working positions to minimise musculoskeletal problems and adopt more effective strategies to prevent percutaneous injuries particularly among novices.

Strategic and non-strategic problem gamblers differ on decision-making under risk and ambiguity.

PubMed

Lorains, Felicity K; Dowling, Nicki A; Enticott, Peter G; Bradshaw, John L; Trueblood, Jennifer S; Stout, Julie C

2014-07-01

To analyse problem gamblers' decision-making under conditions of risk and ambiguity, investigate underlying psychological factors associated with their choice behaviour and examine whether decision-making differed in strategic (e.g., sports betting) and non-strategic (e.g., electronic gaming machine) problem gamblers. Cross-sectional study. Out-patient treatment centres and university testing facilities in Victoria, Australia. Thirty-nine problem gamblers and 41 age, gender and estimated IQ-matched controls. Decision-making tasks included the Iowa Gambling Task (IGT) and a loss aversion task. The Prospect Valence Learning (PVL) model was used to provide an explanation of cognitive, motivational and response style factors involved in IGT performance. Overall, problem gamblers performed more poorly than controls on both the IGT (P = 0.04) and the loss aversion task (P = 0.01), and their IGT decisions were associated with heightened attention to gains (P = 0.003) and less consistency (P = 0.002). Strategic problem gamblers did not differ from matched controls on either decision-making task, but non-strategic problem gamblers performed worse on both the IGT (P = 0.006) and the loss aversion task (P = 0.02). Furthermore, we found differences in the PVL model parameters underlying strategic and non-strategic problem gamblers' choices on the IGT. Problem gamblers demonstrated poor decision-making under conditions of risk and ambiguity. Strategic (e.g. sports betting, poker) and non-strategic (e.g. electronic gaming machines) problem gamblers differed in decision-making and the underlying psychological processes associated with their decisions. © 2014 Society for the Study of Addiction.

76 FR 28954 - International Conservation and Management Measures Recognized by the United States

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-19

... concluded under the framework of the Convention on the Conservation of Migratory Species of Wild Animals... International Conservation and Management Measures Recognized by the United States AGENCY: National Marine... international conservation and management measures recognized by the United States. To fulfill this requirement...

Propeller injuries.

PubMed

Mann, R J

1976-05-01

Water skiing, boat racing, skin and scuba diving, and pleasure boat cruising are increasing in popularity. As a result the incidence of injuries secondary to motor propellers is becoming more frequent. In a ten-year period from 1963 to 1973, I collected a total of nine cases. In some amputations were necessary, and in other cases amputations occurred at the time of injury. Problems with bacterial flora occurring in open sea water versus salt water enclosed near docks and fresh lake water are discussed. A review of the orthopedic literature revealed sparse information regarding propeller injuries.

The prevention of selected and imposed posture-caused injury.

PubMed

Kemp, D

1977-09-01

It has been recognized for centuries that posture and health are interrelated. Poor health and injuries impose their own specific postures, and poor posture can contribute towards injury and poor health. The correlation between posture and health is not absolute. We can say that a certain posture will increase the probability of injury. Individual differences of age, sex, somatype, fitness, fatigue, load and frequency of posture adoption will dictate if injury will occur, or not, with any individual. There is no doubt that some postures are more stressful than others. The individual factors mentioned dictate whether the resulting strain is above or below the critical amount required for injury. Copyright © 1977 Australian Physiotherapy Association. Published by . All rights reserved.

Emergency Department Presentations for Injuries in Older Adults Independently Known to be Victims of Elder Abuse

PubMed Central

Rosen, Tony; Bloemen, Elizabeth M.; LoFaso, Veronica M.; Clark, Sunday; Flomenbaum, Neal; Lachs, Mark S.

2015-01-01

Background Elder abuse is under-recognized by Emergency Department (ED) providers, largely due to challenges distinguishing between abuse and accidental trauma. Objective To describe patterns and circumstances surrounding elder abuse-related and potentially abuse-related injuries in ED patients independently known to be physical elder abuse victims. Methods ED utilization of community-dwelling victims of physical elder abuse in New Haven, CT from 1981-1994 was analyzed previously. Cases were identified using Elderly Protective Services data matched to ED records. 66 ED visits were judged to have high probability of being related to elder abuse and 244 of indeterminate probability. We re-examined these visits to assess whether they occurred due to injury. We identified and analyzed in detail 31 injury-associated ED visits from 26 patients with high probability of being related to elder abuse and 108 visits from 57 patients with intermediate probability and accidental injury. Results Abuse-related injuries were most common on upper extremities (45% of visits) and lower extremities (32%), with injuries on head or neck noted in 13 visits (42%). Bruising was observed in 39% of visits, most commonly on upper extremities. 42% of purportedly accidental injuries had suspicious characteristics, with the most common suspicious circumstance being injury occurring >1 day prior to presentation and the most common suspicious injury pattern being maxillofacial injuries. Conclusion Victims of physical elder abuse commonly have injuries on upper extremities, head, and neck. Suspicious circumstances and injury patterns may be identified and are commonly present when victims of physical elder abuse present with purportedly accidental injuries. PMID:26810019

A randomized trial of teen online problem solving: efficacy in improving caregiver outcomes after brain injury.

PubMed

Wade, Shari L; Walz, Nicolay C; Carey, JoAnne; McMullen, Kendra M; Cass, Jennifer; Mark, Erin; Yeates, Keith Owen

2012-11-01

To examine the results of a randomized clinical trial (RCT) of Teen Online Problem Solving (TOPS), an online problem solving therapy model, in increasing problem-solving skills and decreasing depressive symptoms and global distress for caregivers of adolescents with traumatic brain injury (TBI). Families of adolescents aged 11-18 who sustained a moderate to severe TBI between 3 and 19 months earlier were recruited from hospital trauma registries. Participants were assigned to receive a web-based, problem-solving intervention (TOPS, n = 20), or access to online resources pertaining to TBI (Internet Resource Comparison; IRC; n = 21). Parent report of problem solving skills, depressive symptoms, global distress, utilization, and satisfaction were assessed pre- and posttreatment. Groups were compared on follow-up scores after controlling for pretreatment levels. Family income was examined as a potential moderator of treatment efficacy. Improvement in problem solving was examined as a mediator of reductions in depression and distress. Forty-one participants provided consent and completed baseline assessments, with follow-up assessments completed on 35 participants (16 TOPS and 19 IRC). Parents in both groups reported a high level of satisfaction with both interventions. Improvements in problem solving skills and depression were moderated by family income, with caregivers of lower income in TOPS reporting greater improvements. Increases in problem solving partially mediated reductions in global distress. Findings suggest that TOPS may be effective in improving problem solving skills and reducing depressive symptoms for certain subsets of caregivers in families of adolescents with TBI.

Acute kidney injury as the presenting manifestation of sarcoidosis: A case series and review of literature.

PubMed

Rajkumar, Theepika; Lea-Henry, Tom; Chacko, Bobby

2018-06-01

Acute kidney injury is rarely the presenting feature of sarcoidosis. We present a case series of patients whose diagnosis of sarcoidosis was only brought to light by the development of renal impairment. Concurrent hypercalcaemia was noted, prompting further investigation. The patients discussed experienced a significant and rapid improvement in both renal function and hypercalcaemia in response to therapy with prednisolone. This is out of keeping with previous reports of sarcoidosis-induced renal impairment. Our case series highlights the importance of testing for hypercalcaemia in the context of acute kidney injury. Sarcoidosis is primarily a disease of the lungs and reticuloendothelial system; however, the prevalence of renal involvement with sarcoidosis may be under-recognized. The renal manifestations of sarcoidosis are discussed in the context of the current literature. Furthermore, from our experience, we postulate that in the context of sarcoidosis-induced renal injury, concurrent hypercalcaemia may present prior to the development of chronic renal injury and therefore these patients may be more likely to recover renal function. © 2017 Asian Pacific Society of Nephrology.

Rapid assessment procedures in injury control.

PubMed

Klevens, Joanne; Anderson, Mark

2004-03-01

Injuries are among the leading causes of death and disability worldwide. The burden caused by injuries is even greater among the poorer nations and is projected to increase. Very often the lack of technical and financial resources, as well as the urgency of the problem, preclude applying sophisticated surveillance and research methods for generating relevant information to develop effective interventions. In these settings, it is necessary to consider more rapid and less costly methods in applying the public health approach to the problem of injury prevention and control. Rapid Assessment Procedures (RAP), developed within the fields of epidemiology, anthropology and health administration, can provide valid information in a manner that is quicker, simpler, and less costly than standard data collection methods. RAP have been applied widely and successfully to infectious and chronic disease issues, but have not been used extensively, if at all, as tools in injury control. This paper describes Rapid Assessment Procedures that (1) are useful for understanding the scope of the problem and for identifying potential risk factors, (2) can assist practitioners in determining intervention priorities, (3) can provide in-depth knowledge about a specific injury-related problem, and (4) can be used in surveillance systems to monitor outcomes. Finally, the paper describes some of the caveats in using RAP.

Quantifying Risk Factors for Long-Term Sleep Problems After Burn Injury in Young Adults.

PubMed

Lee, Austin F; Ryan, Colleen M; Schneider, Jeffrey C; Kazis, Lewis E; Li, Nien Chen; Rose, Mary; Liang, Matthew H; Wang, Chao; Palmieri, Tina; Meyer, Walter J; Pidcock, Frank S; Reilly, Debra; Sheridan, Robert L; Tompkins, Ronald G

Restorative sleep is an important component of quality of life. Disturbances in sleep after burn injury were reported but all based on uncontrolled or nonstandardized data. The occurrence and the effect of long-term sleep problems in young adult burn survivors have not been well defined. This 5-year (2003-2008) prospective multicenter longitudinal study included adults with burn injuries ages 19 to 30 years who completed the Young Adult Burn Outcome Questionnaire (YABOQ) up to 36 months after injury. The items measured 15 patient-reported outcomes including physical, psychological, and social statuses and symptoms such as itch and pain. Scores of these 15 YABOQ outcome domains were standardized to a mean of 50 and a SD of 10 based on an age-matched nonburned reference group of young adults. Sleep quality was assessed using the item 'How satisfied are you now with your sleep,' rated by a 5-point Likert scale. Patients responding with very and somewhat dissatisfied were classified as having sleep dissatisfaction and the remaining as less or not dissatisfied. The associations between sleep dissatisfaction (yes/no) and YABOQ outcome domains were analyzed longitudinally using mixed-effect generalized linear models, adjusted for %TBSA burned, age, gender, and race. Generalized estimating equations were used to take into account correlated error resulting from repeated surveys on each patient over time. One hundred and fifty-two burn survivors participated in the YABOQ survey at baseline and during the follow-up who had at least one survey with a response to the sleep item. Among them, sleep dissatisfaction was twice as prevalent (76/152, 50%) when compared with the nonburned reference group (29/112, 26%). The likelihood of a burn survivor being dissatisfied with sleep was reduced over time after the burn injury. Sleep dissatisfaction following burns was significantly associated, in a dose-dependent manner, with increasing burn size (P = .001). Better sleep was associated

Work-Related Injury Surveillance in Vietnam: A National Reporting System Model

PubMed Central

Marucci-Wellman, Helen; Wegman, David H.; Leamon, Tom B.; Tuyet Binh, Ta Thi; Diep, Nguyen Bich; Kriebel, David

2013-01-01

Developing nations bear a substantial portion of the global burden of injury. Public health surveillance models in developing countries should recognize injury risks for all levels of society and all causes and should incorporate various groups of workers and industries, including subsistence agriculture. However, many developing nations do not have an injury registration system; current data collection methods result in gross national undercounts of injuries, failing to distinguish injuries that occur during work. In 2006, we established an active surveillance system in Vietnam’s Xuan Tien commune and investigated potential methods for surveillance of work-related injuries. On the basis of our findings, we recommend a national model for work-related injury surveillance in Vietnam that builds on the existing health surveillance system. PMID:24028255

Three-player quantum Kolkata restaurant problem under decoherence

NASA Astrophysics Data System (ADS)

Ramzan, M.

2013-01-01

Effect of quantum decoherence in a three-player quantum Kolkata restaurant problem is investigated using tripartite entangled qutrit states. Different qutrit channels such as, amplitude damping, depolarizing, phase damping, trit-phase flip and phase flip channels are considered to analyze the behaviour of players payoffs. It is seen that Alice's payoff is heavily influenced by the amplitude damping channel as compared to the depolarizing and flipping channels. However, for higher level of decoherence, Alice's payoff is strongly affected by depolarizing noise. Whereas the behaviour of phase damping channel is symmetrical around 50% decoherence. It is also seen that for maximum decoherence ( p = 1), the influence of amplitude damping channel dominates over depolarizing and flipping channels. Whereas, phase damping channel has no effect on the Alice's payoff. Therefore, the problem becomes noiseless at maximum decoherence in case of phase damping channel. Furthermore, the Nash equilibrium of the problem does not change under decoherence.

Work-related injuries in minors.

PubMed

Schober, S E; Handke, J L; Halperin, W E; Moll, M B; Thun, M J

1988-01-01

Since 1938, federal child labor laws have restricted employment of persons under 18 years old, in part to protect them from hazardous occupations. Workers' compensation claims reported to the Supplementary Data System of the Bureau of Labor Statistics were examined to define the current status of occupational injuries among minors. Data tapes from 1980 to 1983 were searched to identify all current claims for injuries and illnesses occurring in 1980 in persons under age 18. Injury rates were calculated using information about employment in 1979 available from the 1980 census. In the 24 states included in this study, 23,823 claims were reported for persons less than 18 years old. Of these claims, approximately 10% were from persons under age 16. Rates of injuries in 16- and 17 year olds were 12.6 per 100 full-time male workers and 6.6 per 100 full-time female workers. Serious injuries included fractures, dislocations, and amputations, accounting for 5.8%, 0.7%, and 0.6% of cases, respectively. California, the only state that coded whether injuries resulted in fatalities, reported 12 deaths in this age group. Machines and vehicles, many of which are restricted under child labor laws, accounted for 8.3% and 5.8% of claims. These data suggest that persons under age 18 years are not adequately protected from occupational injury. Further attention and, possibly, new preventive strategies are needed.

Cartilage Injuries in the Adult Knee

PubMed Central

Moyad, Thomas F.

2011-01-01

Cartilage injuries are frequently recognized as a source of significant morbidity and pain in patients with previous knee injuries. The majority of patients who undergo routine knee arthroscopy have evidence of a chondral defect. These injuries represent a continuum of pathology from small, asymptomatic lesions to large, disabling defects affecting a major portion of one or more compartments within the knee joint. In comparison to patients with osteoarthritis, individuals with isolated chondral surface damage are often younger, significantly more active, and usually less willing to accept limitations in activities that require higher impact. At the present time, a variety of surgical procedures exist, each with their unique indications. This heterogeneity of treatment options frequently leads to uncertainty regarding which techniques, if any, are most appropriate for patients. The purpose of this review is to describe the workup and discuss the management techniques for cartilage injuries within the adult knee. PMID:26069581

Assessment of Musculoskeletal Injuries from Domestic Violence in the Emergency Department

PubMed Central

Giannakopoulos, Georgios F.; Reijnders, Udo J. L.

2015-01-01

Domestic violence is one of the most common causes of nonfatal injury in women, with musculoskeletal injuries representing the second most prevalent manifestation of this form of violence. It is therefore of great importance that healthcare providers such as emergency department (ED) physicians and surgeons are able to recognize and assess these kinds of injuries. In this case report, a woman is described visiting an ED with injuries caused by a fall. Thanks to the knowledge and attention of the ED physician, the real cause of the injury was discovered. What appeared to be an unsuspicious accident was actually the result of intimate partner violence. PMID:26064703

Extravasation injuries.

PubMed

Hannon, Michael G; Lee, Steve K

2011-12-01

Extravasation injuries occur under a wide variety of circumstances in the inpatient setting. Prevention remains the ideal treatment for these iatrogenic injuries. When extravasation injuries do occur, they must be diagnosed and treated promptly to minimize the amount of soft tissue injury. Initial management is similar among vesicant extravasates. Although evidence is limited to guide management for specific extravasates, it is paramount to be aware of the described treatments and principles. Copyright © 2011 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

A different approach to missile induced head injuries.

PubMed

Pabuscu, Yüksel; Bulakbasi, Nail; Kocaoglu, Murat; Ustünsöz, Bahri; Tayfun, Cem

2003-01-01

Missile induced head injuries can be influenced by the anatomical location of the injury, i.e. type of tissue and by the ballistic properties such as the design of the weapon and the mass, shape and construction of the projectile, as well as its velocity characteristics and trajectory angle. In the diagnostic work up of the patients with missile induced head injuries, every available modality can be used. It is important, however, to recognize that CT scan is the primary and most efficacious diagnostic tool in such patients. In this article we have identified risk factors for both morbidity and mortality in patients with missile induced head injury with excluding the patients who had also extracranial serious trauma and systemic disease.

Does Tinnitus, Hearing Asymmetry or Hearing Loss Predispose to Occupational Injury Risk?

PubMed Central

Cantley, Linda F; Galusha, Deron; Cullen, Mark R; Dixon-Ernst, Christine; Tessier-Sherman, Baylah; Slade, Martin D; Rabinowitz, Peter M; Neitzel, Richard L

2015-01-01

Objective To determine the relative contributions of tinnitus, asymmetrical hearing loss, low frequency hearing loss (pure tone average of .5, 1, 2, 3 kHz, PTA.5123), or high frequency hearing loss (pure tone average of 4, 6 kHz, PTA46), to acute injury risk among a cohort of production and maintenance workers at six aluminum manufacturing plants, adjusting for ambient noise exposure and other recognized predictors of injury risk. Design and Study Sample This retrospective analysis considered 9,920 workers employed during 2003 to 2008. The cohort consisted of 8,818 workers (89%) whose complete records were available. Results Adjusting for noise exposure and other recognized injury predictors, a 25% increased acute injury risk was observed among workers with a history of tinnitus in conjunction with high-frequency hearing loss (PTA46). Low frequency hearing loss may be associated with minor, yet less serious, injury risk. We did not find evidence that asymmetry contributes to injury risk. Conclusion These results provide evidence that tinnitus, combined with high-frequency hearing loss, may pose an important safety threat to workers, especially those who work in high-noise exposed environments. These at risk workers may require careful examination of their communication and hearing protection needs. PMID:25549168

Preventing running injuries. Practical approach for family doctors.

PubMed Central

Johnston, C. A. M.; Taunton, J. E.; Lloyd-Smith, D. R.; McKenzie, D. C.

2003-01-01

OBJECTIVE: To present a practical approach for preventing running injuries. QUALITY OF EVIDENCE: Much of the research on running injuries is in the form of expert opinion and comparison trials. Recent systematic reviews have summarized research in orthotics, stretching before running, and interventions to prevent soft tissue injuries. MAIN MESSAGE: The most common factors implicated in running injuries are errors in training methods, inappropriate training surfaces and running shoes, malalignment of the leg, and muscle weakness and inflexibility. Runners can reduce risk of injury by using established training programs that gradually increase distance or time of running and provide appropriate rest. Orthoses and heel lifts can correct malalignments of the leg. Running shoes appropriate for runners' foot types should be selected. Lower-extremity strength and flexibility programs should be added to training. Select appropriate surfaces for training and introduce changes gradually. CONCLUSION: Prevention addresses factors proven to cause running injuries. Unfortunately, injury is often the first sign of fault in running programs, so patients should be taught to recognize early symptoms of injury. PMID:14526862

Prospective monitoring of health problems among recreational runners preparing for a half marathon

PubMed Central

Baumann, Antje; Zech, Astrid; Verhagen, Evert

2018-01-01

Objectives While the health benefits of running are legitimately advocated, participation in running can also lead to health problems. There is a high range of reported prevalence rates especially of running-related overuse injuries in high-level athletes and during competition. Little consensus exists for acute injuries and illnesses especially in recreational runners. Therefore, the aim of this study was to record the prevalence of health problems in recreational long-distance runners preparing for an event. Methods Recreational runners aged 18–65 years who were registered 13 weeks prior to a half-marathon running event were invited to take part in this study. Participants were prospectively monitored weekly over 13 weeks by applying a standardised surveillance system for injuries and illnesses (Oslo Sports Trauma Research Center questionnaire). From this, prevalence and severity of acute and overuse injuries, as well as illnesses, were calculated. Results We received 3213 fully answered questionnaires from 327 participants (40.7% female, 40.9±11.7 years of age, 31.5±21.1 km weekly mileage, 8.3±7.8 years of running experience). At any point in time over the preparation phase, 37.3% of the participants had health problems. Overuse injuries were the major burden (18%). They were followed by illnesses (14.1%) and acute injuries (7.9%). The median weekly severity score was 56.5 (IQR 37.0–58.0). Conclusion The high prevalence of health problems in our cohort suggests that future efforts are needed to further specify the underlying mechanism and develop adequate prevention strategies for recreational runners. PMID:29387447

[Medical problems of musicians].

PubMed

van de Wiel, Albert; Rietveld, Boni

2010-01-01

Most individuals enjoy making music, but pleasure may be diminished by physical complaints. The most common complaints in musicians include injuries of the upper part of the body including the shoulder and spine, skin disorders and hearing problems. Injuries are not so much related to the extent of rehearsing and playing but are mostly the result of a wrong position and misuse of the instrument. Adequate preparation before playing and professional coaching to avoid injuries or to detect problems at an early stage are exceptions rather than the rule. Because of the large number of amateur and professional musicians in the Netherlands, music medicine deserves a more prominent role.

Traumatic penile injuries: Mechanisms and problems of treatment in a tertiary institution in Nigeria.

PubMed

Oranusi, C K; Nwofor, Ame

2014-01-01

Penile injuries are uncommon. The more severe injuries are often difficult to manage. We report our experience with penile injuries from different causes and treatment options available. We analyzed retrospectively 23 cases of penile injuries presenting to the Urology Unit of a tertiary hospital in the Southeastern part of Nigeria from January 2007 to December 2012. The management for each patient varied depending on the nature and extent of the injury. The mean age of the patients was 28.9 ± 14.4 years (range 3 weeks to 43 years). The mean duration before presentation was 22.7 ± 17.8 h (range 1-168 h). The causes of penile injuries were categorized as follows: Postcircumcision 3 (13.0%), genital mutilation (self-inflicted injury/attacks by assailants) 6 (26.1%), accident 4 (17.4%), penile fracture 8 (34.8%), and gunshot injury 2 (8.6%). Isolated blunt injuries to the corporal tissues as occurs in penile fractures was managed successfully with early exploration and closure of the tunical tear, while injuries to the penile skin was managed with dressing and secondary closure. Severe penile injuries resulting in partial or total phallic loss presented the most challenge to treatment. Traumatic penile injuries are not common. Severe penile injuries could be challenging because of the nature of the injuries, delayed presentation and unavailability of modern technological tools and experience required for the treatment of such severe injuries. Expertise in the use of flaps for a neophallus are still been developed, and penile prosthetic devices are not readily available in our setting.

Non food foreign body injuries.

PubMed

Slapak, Ivo; Passali, Francesco Maria; Gulati, Achal

2012-05-14

of a FB may result in significant morbidity. Particularly, long-standing or hazardous foreign bodies can cause extensive damage. Some objects, because of their composition, contour, or location, are particularly hazardous: for instance, objects with sharp edges pose a significant risk of laceration and perforation, while fragments of toys have been found only in 2 cases. Parents are frequently unconscious of hazard related with some objects and they are not adequately able to promptly recognize dangerous objects and risky situations. Moreover, also clinicians seem to pay little attention to adult role in the dynamic of the accident: in fact in case series descriptions, data regarding adult presence are often under-reported. On the contrary, since many injuries to children cannot be prevented without some degree of active behavior on the part of parents, the dissemination of information regarding safe behaviors and the implementation of educational strategies aiming to improve parent's attention toward this issue could be fundamental in preventing injuries and need to be promoted by family pediatricians and health practitioners. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Doxycycline-induced gastrointestinal injury.

PubMed

Affolter, Kajsa; Samowitz, Wade; Boynton, Kathleen; Kelly, Erinn Downs

2017-08-01

Doxycycline-induced gastric injury is a rarely recognized adverse effect of a common medication. Only 2 cases have previously described the distinctive capillary degeneration identified in gastric mucosa. We expanded on this by describing additional involved sites, endoscopic findings, and patient characteristics. Gastrointestinal biopsy materials for cases indexed with the word doxycycline were retrieved and the histology reviewed. The medical record was used to obtain clinical details. Three cases with biopsy materials were identified from the search, and doxycycline ingestion was confirmed. All patients' gastric biopsies had small vessel injury with fibrinoid material around the vessel, and 1 patient had similar changes in the duodenum. Endoscopic findings included fundic and pyloric erosions and ulcers. One patient had a normal endoscopy on follow-up after drug cessation. Confirmation and increased understanding of this drug-specific injury pattern are important for patient management, as cessation appears to result in symptom improvement and healing. Copyright © 2017 Elsevier Inc. All rights reserved.

Dog bite injuries in children: a preliminary survey.

PubMed

Gandhi, R R; Liebman, M A; Stafford, B L; Stafford, P W

1999-09-01

Dog bite injuries in children are a preventable health problem. To characterize this type of injury, we have undertaken to define demographic criteria and patterns of injury inflicted by dogs in our pediatric population. A retrospective chart review was conducted of pediatric patients with dog bite injuries admitted to a Level I pediatric trauma center from January 1986 through June 1998. Patient demographics, canine characteristics, and hospital patient data were collected and analyzed using the Excel program and appropriate statistical methodology. There were 67 patient records reviewed. Thirty-eight (57%) of the patients were male, and 29 (43%) were female. There were 43 (64%) white children, 22 (33%) African-American children, and 2 (3%) Hispanic children. The average age of the children was 6.2 +/- 4.2 years, with an average weight of 23.3 +/- 13.7 kg. More than half the attacks occurred in the afternoon and 55 per cent of these attacks were documented as "unprovoked" attacks. Thirty-one (46%) of these attacks involved family pets, and 30 (45%) dogs were known to the attacked child. The head and neck was involved in greater than 67 per cent of these injuries. Pit bulls caused 25 per cent of the bite injuries. Large dogs were responsible for 88 per cent of the attacks. Forty-four (66%) patients required operative intervention. Twenty-eight of these patients had multiple anatomical areas injured. There were 44 procedures involving the head and neck, 21 involving extremities, and 6 involving other areas of the body. All patients 5 years of age and under had head and neck injuries. Dog bite injuries requiring admission occur more in male children. Caucasian and African American children were the majority of children affected. The children under 5 years of age suffered the most devastating injuries. More than half of these attacks were not provoked. More than two-thirds of the injuries to these children involved the head and neck. We conclude that effective

Changing interdigestive migrating motor complex in rats under acute liver injury.

PubMed

Liu, Mei; Zheng, Su-Jun; Xu, Weihong; Zhang, Jianying; Chen, Yu; Duan, Zhongping

2014-01-01

Gastrointestinal motility disorder is a major clinical manifestation of acute liver injury, and interdigestive migrating motor complex (MMC) is an important indicator. We investigated the changes and characteristics of MMC in rats with acute liver injury. Acute liver injury was created by d-galactosamine, and we recorded the interdigestive MMC using a multichannel physiological recorder and compared the indexes of interdigestive MMC. Compared with normal controls, antral MMC Phase I duration was significantly prolonged and MMC Phase III duration was significantly shortened in the rats with acute liver injury. The duodenal MMC cycle and MMC Phases I and IV duration were significantly prolonged and MMC Phase III duration was significantly shortened in the rats with acute liver injury. The jejunal MMC cycle and MMC Phases I and IV duration were significantly prolonged and MMC Phase III duration was significantly shortened in the rats with acute liver injury compared with normal controls. Compared with the normal controls, rats with acute liver injury had a significantly prolonged interdigestive MMC cycle, related mainly to longer MMC Phases I and IV, shortened MMC Phase III, and MMC Phase II characterized by increased migrating clustered contractions, which were probably major contributors to the gastrointestinal motility disorders.

Recognizing the Signs: What School Mental Health Professionals Can Do about Suicide and Self-Injury

ERIC Educational Resources Information Center

Collins, Christina

2009-01-01

In the everyday bustle of high school life, a student can have wounds--physical or emotional--that often go unnoticed. A lot of issues affect adolescents of all backgrounds. Two particularly serious issues among U.S. high school students are suicide and self-injury. This article discusses what school mental health professionals can do about…

[Burn injuries in children].

PubMed

Brudvik, Christina; Hoem, Eli Leirdal; Luggenes, Brita; Vindenes, Hallvard

2011-01-07

Burn injuries in children may cause permanent harm. This study reports data on incidence, injury mechanisms and products that cause burn injuries (in the period 01.01.07-31.12.07) and compares findings with those from previous studies (in 1989 and 1998). Semi-structured questionnaires were filled in by patients or next-of-kin and health workers at Bergen Accident and Emergency Department, casualty centres in three municipalities in western Norway (Fana, Åsane and Loddefjord) and at the National Burns Centre, Haukeland University Hospital. Missing data were retrieved retrospectively from medical records. We recorded 142 children with burn injuries; 35% were boys under two years of age. The annual incidence was the same as earlier; 6.6 per 1,000 under five years and 3.1 per 1,000 children under 15 years living in the community of Bergen. Contact injuries and scalds were most common and were caused by contact with ovens, stoves and hot food or liquids. Most children (93%) had less severe burns; 6% (9) were hospitalized (four of them had a non-western background). Almost 95% were given first aid by cooling. Children under two years, especially boys, are most at risk of burn injuries. Ovens were the cause more often now than before. The incidence has been the same the last 20 years and is the same as that in Trondheim ten years ago. The fact that the small city, Harstad, (northern Norway) attained substantially less injuries after the introduction of preventive actions indicates that such actions are needed to reduce the number of burn injuries among children.

Is clinician refusal to treat an emerging problem in injury compensation systems?

PubMed Central

Brijnath, Bianca; Mazza, Danielle; Kosny, Agnieszka; Bunzli, Samantha; Singh, Nabita; Ruseckaite, Rasa; Collie, Alex

2016-01-01

Objective The reasons that doctors may refuse or be reluctant to treat have not been widely explored in the medical literature. To understand the ethical implications of reluctance to treat there is a need to recognise the constraints of doctors working in complex systems and to consider how these constraints may influence reluctance. The aim of this paper is to illustrate these constraints using the case of compensable injury in the Australian context. Design Between September and December 2012, a qualitative investigation involving face-to-face semistructured interviews examined the knowledge, attitudes and practices of general practitioners (GPs) facilitating return to work in people with compensable injuries. Setting Compensable injury management in general practice in Melbourne, Australia. Participants 25 GPs who were treating, or had treated a patient with compensable injury. Results The practice of clinicians refusing treatment was described by all participants. While most GPs reported refusal to treat among their colleagues in primary and specialist care, many participants also described their own reluctance to treat people with compensable injuries. Reasons offered included time and financial burdens, in addition to the clinical complexities involved in compensable injury management. Conclusions In the case of compensable injury management, reluctance and refusal to treat is likely to have a domino effect by increasing the time and financial burden of clinically complex patients on the remaining clinicians. This may present a significant challenge to an effective, sustainable compensation system. Urgent research is needed to understand the extent and implications of reluctance and refusal to treat and to identify strategies to engage clinicians in treating people with compensable injuries. PMID:26792215

Repair of a mal-repaired biliary injury: a case report.

PubMed

Aldumour, Awad; Aseni, Paolo; Alkofahi, Mohmmad; Lamperti, Luca; Aldumour, Elias; Girotti, Paolo; De Carlis, Luciano-Gregorio

2009-05-14

Iatrogenic bile-duct injury post-laparoscopic cholecystectomy remains a major serious complication with unpredictable long-term results. We present a patient who underwent laparoscopic cholecystectomy for gallstones, in which the biliary injury was recognized intraoperatively. The surgical procedure was converted to an open one. The first surgeon repaired the injury over a T-tube without recognizing the anatomy and type of the biliary lesion, which led to an unusual biliary mal-repair. Immediately postoperatively, the abdominal drain brought a large amount of bile. A T-tube cholangiogram was performed. Despite the contrast medium leaking through the abdominal drain, the mal-repair was unrecognized. The patient was referred to our hospital for biliary leak. Ultrasound and cholangiography was repeated, which showed an unanatomical repair (right to left hepatic duct anastomosis over the T-tube), with evidence of contrast medium coming out through the abdominal drain. Eventually the patient was subjected to a definitive surgical treatment. The biliary continuity was re-established by a Roux-en-Y hepatico-jejunostomy, over transanastomotic external biliary stents. The patient is now doing well 4 years after the second surgical procedure. In reviewing the literature, we found a similar type of injury but we did not find a similar surgical mal-repair. We propose an algorithm for the treatment of early and late biliary injuries.

Repair of a mal-repaired biliary injury: A case report

PubMed Central

Aldumour, Awad; Aseni, Paolo; Alkofahi, Mohmmad; Lamperti, Luca; Aldumour, Elias; Girotti, Paolo; Carlis, Luciano Gregorio De

2009-01-01

Iatrogenic bile-duct injury post-laparoscopic cholecystectomy remains a major serious complication with unpredictable long-term results. We present a patient who underwent laparoscopic cholecystectomy for gallstones, in which the biliary injury was recognized intraoperatively. The surgical procedure was converted to an open one. The first surgeon repaired the injury over a T-tube without recognizing the anatomy and type of the biliary lesion, which led to an unusual biliary mal-repair. Immediately postoperatively, the abdominal drain brought a large amount of bile. A T-tube cholangiogram was performed. Despite the contrast medium leaking through the abdominal drain, the mal-repair was unrecognized. The patient was referred to our hospital for biliary leak. Ultrasound and cholangiography was repeated, which showed an unanatomical repair (right to left hepatic duct anastomosis over the T-tube), with evidence of contrast medium coming out through the abdominal drain. Eventually the patient was subjected to a definitive surgical treatment. The biliary continuity was re-established by a Roux-en-Y hepatico-jejunostomy, over transanastomotic external biliary stents. The patient is now doing well 4 years after the second surgical procedure. In reviewing the literature, we found a similar type of injury but we did not find a similar surgical mal-repair. We propose an algorithm for the treatment of early and late biliary injuries. PMID:19437572

Ophthalmic manifestations of head injury.

PubMed

Kowal, L

1992-02-01

Head injuries are frequently associated with ophthalmic problems. The commonest problems seen in this series of 161 patients with head injury were problems with poor accommodation (16% of patients; 58% of these persisted), convergence (14% of patients; 35% of these persisted), pseudomyopia (19%; 55% persisted) and optic atrophy (26% of the patients; 78% of these were mild and easily missed on routine testing, and 22% were severe). Motility disorders were common, especially cranial nerve palsies. Other less frequent motility disturbances included apparent inferior oblique palsy, comitant esotropia, and exotropia which was often of the convergence insufficiency type.

Injury prevention and other international public health initiatives.

PubMed

Razzak, Junaid A; Sasser, Scott M; Kellermann, Arthur L

2005-02-01

Injuries, whether caused by unintentional or intentional events, area significant public health problem. The burden of injury is greatest in low-and middle-income countries and among individuals of low socioeconomic status living in high-income countries. Most of these injuries are prevent-able. Emergency physicians can play an important role in reducing the global burden of injuries by providing expert care and by identifying, implementing, and evaluating population-based countermeasures to prevent and control injuries. The strategy used in a particular country depends in large part on the nature of the local problem, the concerns of the population, the availability of resources, and competing demands. Even simple countermeasures may have a big impact in reducing the global burden of death and disability due to injury.

Drug-induced Liver Injury

PubMed Central

David, Stefan; Hamilton, James P

2011-01-01

Drug-induced liver injury (DILI) is common and nearly all classes of medications can cause liver disease. Most cases of DILI are benign, and improve after drug withdrawal. It is important to recognize and remove the offending agent as quickly as possible to prevent the progression to chronic liver disease and/or acute liver failure. There are no definite risk factors for DILI, but pre-existing liver disease and genetic susceptibility may predispose certain individuals. Although most patients have clinical symptoms that are identical to other liver diseases, some patients may present with symptoms of systemic hypersensitivity. Treatment of drug and herbal-induced liver injury consists of rapid drug discontinuation and supportive care targeted to alleviate unwanted symptoms. PMID:21874146

Bile duct injury repair: when? what? who?

PubMed

Kapoor, Vinay K

2007-01-01

Laparoscopic cholecystectomy is associated with a two-to-four times higher risk of bile duct injury (BDI) than open cholecystectomy. BDI can lead to significant morbidity and even mortality. The first priority in BDI is to control peritoneal and biliary sepsis and to convert an acute BDI to a controlled external biliary fistula (EBF) - this can be achieved by endoscopic and/ or radiological intervention in most cases. This should be followed by assessment of the extent of injury - both biliary and vascular. Immediate management of BDI recognized during cholecystectomy depends on the type of injury, the condition of the patient, and the experience of the surgeon. For BDI recognized after cholecystectomy, early repair is not recommended, as the results are poor. The EBF may evolve into a benign biliary stricture (BBS), which should be electively repaired by a Roux-en-Y hepatico-jejunostomy. The use of an endoscopic stent as definitive management of BDI is not recommended. Long-term follow-up is essential after the repair of a BBS, as recurrence can occur several years after repair. Recurrent BBS is best treated with endoscopic balloon dilatation. Excellent early and long-term results can be obtained in specialized units at tertiary care referral centers.

Fetal laceration injury at cesarean delivery.

PubMed

Smith, J F; Hernandez, C; Wax, J R

1997-09-01

To investigate the incidence of fetal laceration injury in cesarean delivery. A retrospective review was conducted using a computer-based data coding system. All neonatal records were reviewed for infants delivered by cesarean during a 2-year period. Maternal records were reviewed in those cases of documented fetal laceration injury. The Fisher exact test was used when indicated. There were 904 cesarean deliveries performed during the study period; of these, 896 neonatal records (98.4%) were available for review. Seventeen laceration injuries were recorded (1.9%). The incidence of laceration appeared higher when the indication for cesarean was nonvertex (6.0% versus 1.4%, P = .02). One of 17 (5.9%) maternal records indicated the presence of the laceration of the fetus. Fetal laceration injury at cesarean delivery is not rare, especially when it is performed for nonvertex presentation. The minority of obstetric records show documentation of such lacerations, suggesting that this complication often may not be recognized by obstetricians.

Rugby injuries.

PubMed

McIntosh, Andrew S

2005-01-01

The purpose of this chapter is to review critically the existing studies on the epidemiology of pediatric rugby injuries and discuss suggestions for injury prevention and further research. Data were sourced from the sports medicine and science literature mainly since 1990, and from a prospective injury surveillance project in rugby undertaken by the University of New South Wales (UNSW) in Sydney during 2002. Literature searches were performed using Medline and SportsDiscus. Reported injury rates were between 7 and 18 injuries per 1,000 hours played, with the rate of injuries resulting in loss of playing or training time measured at 6.5-10.6 per 1,000 hours played. Injury rates increased with age and level of qualification. Head injury and concussion accounted for 10-40% of all injuries. In the UNSW study, concussion accounted for 25% of injuries resulting in loss of playing or training time in the under 13 year age group. Upper and lower extremity injuries were equally apportioned, with musculoskeletal injuries being the main type of injury. Fractures were observed in the upper extremity and ankle, and joint/ligament injuries affected the shoulder, knee and ankle. The tackle was associated with around 50% of all injuries. The scrum produced fewer injuries, but is historically associated with spinal cord injury. Rugby is a contact sport with injury risks related to physical contact, primarily in the tackle. Most injuries affect the musculoskeletal system, with the exception of concussion. Spinal cord injury is rare, but catastrophic. Research is required to understand better injury risks and to reduce the incidence of shoulder, knee and ankle joint injuries, concussion and spinal injury.

Emergency Department Presentations for Injuries in Older Adults Independently Known to be Victims of Elder Abuse.

PubMed

Rosen, Tony; Bloemen, Elizabeth M; LoFaso, Veronica M; Clark, Sunday; Flomenbaum, Neal E; Lachs, Mark S

2016-03-01

Elder abuse is under-recognized by emergency department (ED) providers, largely due to challenges distinguishing between abuse and accidental trauma. To describe patterns and circumstances surrounding elder abuse-related and potentially abuse-related injuries in ED patients independently known to be physical elder abuse victims. ED utilization of community-dwelling victims of physical elder abuse in New Haven, CT from 1981-1994 was analyzed previously. Cases were identified using Elderly Protective Services data matched to ED records. Sixty-six ED visits were judged to have high probability of being related to elder abuse and 244 were of indeterminate probability. We re-examined these visits to assess whether they occurred due to injury. We identified and analyzed in detail 31 injury-associated ED visits from 26 patients with high probability of being related to elder abuse and 108 visits from 57 patients with intermediate probability and accidental injury. Abuse-related injuries were most common on upper extremities (45% of visits) and lower extremities (32%), with injuries on head or neck noted in 13 visits (42%). Bruising was observed in 39% of visits, most commonly on upper extremities. Forty-two percent of purportedly accidental injuries had suspicious characteristics, with the most common suspicious circumstance being injury occurring more than 1 day prior to presentation, and the most common suspicious injury pattern being maxillofacial injuries. Victims of physical elder abuse commonly have injuries on the upper extremities, head, and neck. Suspicious circumstances and injury patterns may be identified and are commonly present when victims of physical elder abuse present with purportedly accidental injuries. Copyright © 2016 Elsevier Inc. All rights reserved.

Injury surveillance in New York City jails.

PubMed

Ludwig, Ariel; Cohen, Louise; Parsons, Amanda; Venters, Homer

2012-06-01

To characterize injuries occurring in jails, we analyzed injury report forms from the New York City jail system. We abstracted data from 4695 injury report forms representing 3863 patients. Of the injuries reported, 66% were classified as intentional. The 2 leading causes of injuries were inmate-on-inmate aggression (40%) and slips and falls (27%). Injuries place a considerable burden on jail health care systems, and there is a need for more studies on this problem and development of injury prevention programs.

Telephone Problem Solving for Service Members with Mild Traumatic Brain Injury: A Randomized, Clinical Trial.

PubMed

Bell, Kathleen R; Fann, Jesse R; Brockway, Jo Ann; Cole, Wesley R; Bush, Nigel E; Dikmen, Sureyya; Hart, Tessa; Lang, Ariel J; Grant, Gerald; Gahm, Gregory; Reger, Mark A; St De Lore, Jef; Machamer, Joan; Ernstrom, Karin; Raman, Rema; Jain, Sonia; Stein, Murray B; Temkin, Nancy

2017-01-15

Mild traumatic brain injury (mTBI) is a common injury for service members in recent military conflicts. There is insufficient evidence of how best to treat the consequences of mTBI. In a randomized, clinical trial, we evaluated the efficacy of telephone-delivered problem-solving treatment (PST) on psychological and physical symptoms in 356 post-deployment active duty service members from Joint Base Lewis McChord, Washington, and Fort Bragg, North Carolina. Members with medically confirmed mTBI sustained during deployment to Iraq and Afghanistan within the previous 24 months received PST or education-only (EO) interventions. The PST group received up to 12 biweekly telephone calls from a counselor for subject-selected problems. Both groups received 12 educational brochures describing common mTBI and post-deployment problems, with follow-up for all at 6 months (end of PST), and at 12 months. At 6 months, the PST group significantly improved on a measure of psychological distress (Brief Symptom Inventory; BSI-18) compared to the EO group (p = 0.005), but not on post-concussion symptoms (Rivermead Post-Concussion Symptoms Questionnaire [RPQ]; p = 0.19), the two primary endpoints. However, these effects did not persist at 12-month follow-up (BSI, p = 0.54; RPQ, p = 0.45). The PST group also had significant short-term improvement on secondary endpoints, including sleep (p = 0.01), depression (p = 0.03), post-traumatic stress disorder (p = 0.04), and physical functioning (p = 0.03). Participants preferred PST over EO (p < 0.001). Telephone-delivered PST appears to be a well-accepted treatment that offers promise for reducing psychological distress after combat-related mTBI and could be a useful adjunct treatment post-mTBI. Further studies are required to determine how to sustain its effects. (Trial registration: ClinicalTrials.gov Identifier: NCT01387490 https://clinicaltrials.gov ).

Laparoscopic bile duct injury: understanding the psychology and heuristics of the error.

PubMed

Dekker, Sidney W A; Hugh, Thomas B

2008-12-01

Bile duct injury is an important unsolved problem of laparoscopic cholecystectomy, occurring with unacceptable frequency even in the hands of experienced surgeons. This suggests that a systemic predisposition to the injury is intrinsic to cholecystectomy and indicates that an analysis of the psychology and heuristics of surgical decision-making in relation to duct identification may be a guide to prevention. Review of published reports on laparoscopic bile duct injury from 1997 to 2007 was carried out. An analysis was also carried out of the circumstances of the injuries in 49 patients who had transection of an extrahepatic bile duct and who were referred for reconstruction or were assessed in a medicolegal context. Special emphasis was placed on identifying the possible psychological aspects of duct misidentification. Review of published work showed an emphasis on the technical aspects of correct identification of the cystic duct, with few papers addressing the heuristics and psychology of surgical decision-making during cholecystectomy. Duct misidentification was the cause of injury in 42 out of the 49 reviewed patients (86%). The injury was not recognized at operation in 70% and delay in recognition persisted into the postoperative period in 57%. Underestimation of risk, cue ambiguity and visual misperception ('seeing what you believe') were important factors in misidentification. Delay in recognition of the injury is a feature consistent with cognitive fixation and plan continuation, which help construct and sustain the duct misidentification during the operation and beyond. Changing the 'culture' of cholecystectomy is probably the most effective strategy for preventing laparoscopic bile duct injury, especially if combined with new technical approaches and an understanding of the heuristics and psychology of the duct misidentification error. Training of surgeons for laparoscopic cholecystectomy should emphasize the need to be alert for cues that the incorrect

Urinary Tract Injury in Gynecologic Laparoscopy for Benign Indication: A Systematic Review.

PubMed

Wong, Jacqueline M K; Bortoletto, Pietro; Tolentino, Jocelyn; Jung, Michael J; Milad, Magdy P

2018-01-01

To perform a comprehensive literature review of the incidence, location, etiology, timing, management, and long-term sequelae of urinary tract injury in gynecologic laparoscopy for benign indication. A systematic review of PubMed, EMBASE, Cochrane Library, and ClinicalTrials.gov was conducted. Four hundred thirty-three studies were screened for inclusion with 136 full-text articles reviewed. Ninety studies published between 1975 and 2015 met inclusion criteria, representing 140,444 surgeries. Articles reporting the incidence of urinary tract injury in gynecologic laparoscopy for benign indication were included. Exclusion criteria comprised malignancy, surgery by urogynecologists, research not in English, and insufficient data. A total of 458 lower urinary tract injuries were reported with an incidence of 0.33% (95% CI 0.30-0.36). Bladder injury (0.24%, 95% CI 0.22-0.27) was overall three times more frequent than ureteral injury (0.08%, 95% CI 0.07-0.10). Laparoscopic hysterectomy not otherwise specified (1.8%, 95% CI 1.2-2.6) and laparoscopically assisted vaginal hysterectomy (1.0%, 95% CI 0.9-1.2) had the highest rates of injury. Most ureteral injuries resulted from electrosurgery (33.3%, 95% CI 24.3-45.8), whereas most bladder injuries resulted from lysis of adhesions (23.3%, 95% CI 18.7-29.0). Ureteral injuries were most often recognized postoperatively (60%, 95% CI 47-76) and were repaired by open ureteral anastomosis (47.4%, 95% CI 36.3-61.9). In contrast, bladder injuries were most often recognized intraoperatively (85%, 95% CI 75-95) and were repaired by laparoscopic suturing (34.9%, 95% CI 29.2-41.7). The incidence of lower urinary tract injury in gynecologic laparoscopy for benign indication remains low at 0.33%. Bladder injury was three times more common than ureteral injury, although ureteral injuries were more often unrecognized intraoperatively and underwent open surgical repair. These risk estimates can assist gynecologic surgeons in effectively

Behavioral avoidance as evidence of injury to fishery resources: Applications to natural resource damage assessment

DOE Office of Scientific and Technical Information (OSTI.GOV)

DeLonay, A.J.; Little, E.E.; Lipton, J.

1996-12-31

Natural Resource Damage Assessment (NRDA) provisions enacted under the Comprehensive Environmental Response Compensation and Liability Act (CERCLA) and the Oil Pollution Act (OPA) empower natural resource trustees to seek compensation for environmental injury resulting from the release of oil or hazardous substances. Under NRDA regulations promulgated under CERCLA, fish avoidance behavior is recognized as an accepted injury, and may be used to support damage claims. In support of an ongoing damage assessment, tests were conducted to determine if avoidance of ambient metals concentrations may contribute to reductions in local salmonid populations. In laboratory tests, rainbow trout (Oncorhynchus mykiss) and brownmore » trout (Salmo trutta) avoided mixtures of metals (Cd, Cu, Pb, and Zn) at concentrations that occur in impacted river reaches at a contaminated site (Clark Fork River, MT). Avoidance of metal contamination may contribute to population reductions and preclude restoration of instream populations by prohibiting movement of fish into contaminated areas of the river from uncontaminated tributaries. Laboratory avoidance tests were performed at two testing facilities. The similar avoidance responses observed at the two laboratories demonstrated the reproducibility of avoidance measures.« less

Farm-related injury event, social consequences and injury reporting in the Land Lantbruk newspaper in Sweden: a retrospective study of farm-related injury reporting during 2000-2005.

PubMed

Lundälv, Jörgen

2006-12-01

The aim of the present study was to detect how a leading news paper, the Land Lantbruk in Stockholm, Sweden, informs the public and specifically the rural sector in Sweden and the Scandinavian countries concerning injury events (farm-related injury event) and the use of injury prevention and control. Injury reporting in the Land Lantbruk has been studied from the point of injury prevention and control. A study of injury prevention and rural health and safety in Australia shows that the newspaper The Land that serves Australia's rural community should 'be an under-utilised vehicle for news and commentary on rural health and safety issues'. The study period was from January 2000 to February 2005. A total of 178 articles were reviewed and analysed. The articles were available on a newspaper database in the Land Lantbruk newspaper. Articles that addressed farm-related injury event and rural health and safety were chosen and organised into subgroups. Tractor and motor vehicle safety (35%) was most common among the injury reporting. Although the newspaper Land Lantbruk provided excellent coverage of the causes of these events, the reports tended to focus on circumstances and did not provide information on injury prevention or the advantages of also coverage of the social and psychosocial long-term consequences of accidents. In the prevention work of reducing farm-related injuries in the rural sector in the Scandinavian countries and decreasing the human suffering represented by this health problem, rural politicians, insurance companies, rural authorities and also handicap organisations should listen more to the injured individuals and their own experiences relative to the difficulty of life after an accident. The reaction of family and relatives, and experiences of the long-term social consequences, have not been included in the media coverage. Journalists at the Land Lantbruk could also share experiences of the Swedish coverage of rural health and safety from

Applying an Evidence-Based Assessment Model to Identify Students at Risk for Perceived Academic Problems following Concussion.

PubMed

Ransom, Danielle M; Burns, Alison R; Youngstrom, Eric A; Vaughan, Christopher G; Sady, Maegan D; Gioia, Gerard A

2016-11-01

The aim of this study was to demonstrate the utility of an evidence-based assessment (EBA) model to establish a multimodal set of tools for identifying students at risk for perceived post-injury academic problems. Participants included 142 students diagnosed with concussion (age: M=14.95; SD=1.80; 59% male), evaluated within 4 weeks of injury (median=16 days). Demographics, pre-injury history, self- and parent-report measures assessing symptom severity and executive functions, and cognitive test performance were examined as predictors of self-reported post-injury academic problems. Latent class analysis categorized participants into "high" (44%) and "low" (56%) levels of self-reported academic problems. Receiver operating characteristic analyses revealed significant discriminative validity for self- and parent-reported symptom severity and executive dysfunction and self-reported exertional response for identifying students reporting low versus high academic problems. Parent-reported symptom ratings [area under the receiver operating characteristic curve (AUC)=.79] and executive dysfunction (AUC=.74), and self-reported ratings of executive dysfunction (AUC=.84), symptoms (AUC=.80), and exertional response (AUC=.70) each classified students significantly better than chance (ps<.001). Hierarchical logistic regression indicated that, of the above, self-reported symptoms and executive dysfunction accounted for the most variance in the prediction of self-reported academic problems. Post-concussion symptom severity and executive dysfunction significantly predict perceived post-injury academic problems. EBA modeling identified the strongest set of predictors of academic challenges, offering an important perspective in the management of concussion by applying traditional strengths of neuropsychological assessment to clinical decision making. (JINS, 2016, 22, 1038-1049).

Epidemiology, pathomechanics, and prevention of athletic injuries to the cervical spine.

PubMed

Torg, J S

1985-06-01

Athletic injuries to the cervical spine associated with quadriplegia most commonly occur as a result of axial loading. Whether it be a football player striking an opponent with the top or crown of his helmet, a poorly executed dive into a shallow body of water where the subject strikes his head on the bottom, or a hockey player pushed into the boards head first, the fragile cervical spine is compressed between the rapidly decelerated head and the continued momentum of the body. Appropriate rule changes recognizing this mechanism have resulted in a reduction of football quadriplegia by two-thirds. Presumably, educational efforts designed to inform the public of the dangers of diving would have a similar effect. The predominance of the axial loading mechanism is not as clearly defined in trampoline and minitrampoline injuries. However, both of these devices are dangerous when used in the best of circumstances, and their use has no place in recreational, educational, or competitive gymnastics. The emergence of severe cervical spine injuries resulting from ice hockey is recognized. Methods, based on sound scientific evidence, to modify the games so as to prevent these injuries are lacking.

Occupational injuries in Bahrain.

PubMed

al-Arrayed, A; Hamza, A

1995-10-01

A study was conducted to show the problem of occupational injuries in Bahrain and try to highlight some solutions that may help to prevent or reduce workplace hazards. The data for occupational injuries between 1988 to 1991 from the social insurance records were reviewed and analysed. The data were summarized, grouped and tabulated according to age, sex, nationality, work place, type of injuries, cause and site of injury. Data were analysed statistically, frequencies were computed and results represented graphically. The study shows that there was a decline in the number of injuries in 1990 and 1991 due to a slow-down of economic activities in general in the Arabian Gulf region during the Gulf War. It also shows that Asian workers are at a high risk of occupational injuries.

Injury Surveillance in New York City Jails

PubMed Central

Ludwig, Ariel; Cohen, Louise; Parsons, Amanda

2012-01-01

To characterize injuries occurring in jails, we analyzed injury report forms from the New York City jail system. We abstracted data from 4695 injury report forms representing 3863 patients. Of the injuries reported, 66% were classified as intentional. The 2 leading causes of injuries were inmate-on-inmate aggression (40%) and slips and falls (27%). Injuries place a considerable burden on jail health care systems, and there is a need for more studies on this problem and development of injury prevention programs. PMID:22515857

Nonoperative Management of Splenic Injury in Combat: 2002-2012

DTIC Science & Technology

2015-03-01

recognized as the defini- tive treatment for splenic injury when Dr. Johnston reported 150 splenectomies for trauma in 1908.4 However, in 1968, Upadhyaya...management safe and effective for all splenic blunt trauma ? A systematic review. Crit Care 2013; 17(5): R185. 6. Joint Theater Trauma System Clinical Practice...2014. 7. Zonies D, Eastridge B: Combat management of splenic injury: trends during a decade of conflict. J Trauma Acute Care Surg 2012; 73(2 Suppl 1

Splenic Injury During Percutaneous Nephrolithotomy

PubMed Central

Thomas, Anil A.; Pierce, Gregory; Walsh, R. Matthew; Sands, Mark

2009-01-01

Background: Injury to the spleen is a recognized complication during percutaneous renal access due to the close anatomical relationship of the spleen and the left kidney. However, transsplenic renal access is a rare complication of percutaneous nephrolithotomy and can also result in considerable morbidity, often requiring emergent splenectomy. Methods: We present our experience with splenic injury during percutaneous nephrolithotomy managed conservatively with the use of a collagen-thrombin hemostatic sealant (D-Stat; Vascular Solutions, Inc., Minneapolis, MN) after delayed removal of the nephrostomy tubes. Results: The patient had an uneventful recovery and was discharged home on postoperative day 6. Conclusion: In select hemodynamically stable patients, nonoperative management with the adjunctive use of hemostatic sealants may be considered. PMID:19660224

Splenic injury during percutaneous nephrolithotomy.

PubMed

Thomas, Anil A; Pierce, Gregory; Walsh, R Matthew; Sands, Mark; Noble, Mark

2009-01-01

Injury to the spleen is a recognized complication during percutaneous renal access due to the close anatomical relationship of the spleen and the left kidney. However, transsplenic renal access is a rare complication of percutaneous nephrolithotomy and can also result in considerable morbidity, often requiring emergent splenectomy. We present our experience with splenic injury during percutaneous nephrolithotomy managed conservatively with the use of a collagen-thrombin hemostatic sealant (D-Stat; Vascular Solutions, Inc., Minneapolis, MN) after delayed removal of the nephrostomy tubes. The patient had an uneventful recovery and was discharged home on postoperative day 6. In select hemodynamically stable patients, nonoperative management with the adjunctive use of hemostatic sealants may be considered.

Injury Control for Children and Youth.

ERIC Educational Resources Information Center

American Academy of Pediatrics, Elk Grove Village, IL.

This book begins with a progress report on preventing childhood injuries. Settings for pediatric care are discussed as well as The Injury Prevention Program (TIPP). Child abuse is also addressed in the first section. In section two, specific childhood injuries and interventions are discussed. Each chapter begins with an overview of the problem,…

Benchmark dataset for undirected and Mixed Capacitated Arc Routing Problems under Time restrictions with Intermediate Facilities.

PubMed

Willemse, Elias J; Joubert, Johan W

2016-09-01

In this article we present benchmark datasets for the Mixed Capacitated Arc Routing Problem under Time restrictions with Intermediate Facilities (MCARPTIF). The problem is a generalisation of the Capacitated Arc Routing Problem (CARP), and closely represents waste collection routing. Four different test sets are presented, each consisting of multiple instance files, and which can be used to benchmark different solution approaches for the MCARPTIF. An in-depth description of the datasets can be found in "Constructive heuristics for the Mixed Capacity Arc Routing Problem under Time Restrictions with Intermediate Facilities" (Willemseand Joubert, 2016) [2] and "Splitting procedures for the Mixed Capacitated Arc Routing Problem under Time restrictions with Intermediate Facilities" (Willemseand Joubert, in press) [4]. The datasets are publicly available from "Library of benchmark test sets for variants of the Capacitated Arc Routing Problem under Time restrictions with Intermediate Facilities" (Willemse and Joubert, 2016) [3].

The association between body-built and injury occurrence in pre-professional ballet dancers - Separated analysis for the injured body-locations.

PubMed

Zaletel, Petra; Sekulić, Damir; Zenić, Nataša; Esco, Michael R; Šajber, Dorica; Kondrič, Miran

2017-02-21

This study has aimed at identifying prevalence of injury-occurrence in 24 pre-professional-ballet-dancers (females, 16-18 years of age), and identifying the associations between the body-built and prevalence of injuries. The sample of variables included: body mass, body height, and 3 somatotype characteristics (mesomorph, ectomorph and endomorph) and data on injuries over the preceding year. Dancers were mostly ectomorphic-mesomorph (endomorphy: 2.6±0.54, mesomorphy: 3.99±0.77, ectomorphy: 3.23±0.54). The most commonly injured locations were the foot (17% of all injuries) and ankle (17%). Majority of the injuries occurred while practising but 37% of hip-injuries occurred while performing. Ankle-injuries resulted in longest absence from ballet. Endomorphy was related to ankle-injury (odds ratio (OR) = 1.9, 95% confidence interval (CI): 1.4-2.3), ectomorphy to foot injury (OR = 1.7, 95% CI: 1.1-2.9), and body-mass to injury to the toes (OR = 1.7, 95% CI: 1.4-3.1). The results of this study allow for recognizing those dancers who are particularly vulnerable to injuries of certain body location. A more profound analysis of the possible mechanisms that lead to hip-injury during performance is needed. Int J Occup Med Environ Health 2017;30(1):151-159. This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.

Effects of an explicit problem-solving skills training program using a metacomponential approach for outpatients with acquired brain injury.

PubMed

Fong, Kenneth N K; Howie, Dorothy R

2009-01-01

We investigated the effects of an explicit problem-solving skills training program using a metacomponential approach with 33 outpatients with moderate acquired brain injury, in the Hong Kong context. We compared an experimental training intervention with this explicit problem-solving approach, which taught metacomponential strategies, with a conventional cognitive training approach that did not have this explicit metacognitive training. We found significant advantages for the experimental group on the Metacomponential Interview measure in association with the explicit metacomponential training, but transfer to the real-life problem-solving measures was not evidenced in statistically significant findings. Small sample size, limited time of intervention, and some limitations with these tools may have been contributing factors to these results. The training program was demonstrated to have a significantly greater effect than the conventional training approach on metacomponential functioning and the component of problem representation. However, these benefits were not transferable to real-life situations.

Update on the Epidemiology of Concussion/Mild Traumatic Brain Injury.

PubMed

Voss, Jameson D; Connolly, Joseph; Schwab, Karen A; Scher, Ann I

2015-07-01

Mild traumatic injuries to the brain (e.g., concussion) are common and have been recognized since antiquity, although definitions have varied historically. Nonetheless, studying the epidemiology of concussion helps clarify the overall importance, risk factors, and at-risk populations for this injury. The present review will focus on recent findings related to the epidemiology of concussion including definition controversies, incidence, and patterns in the population overall and in the military and athlete populations specifically. Finally, as this is an area of active research, we will discuss how future epidemiologic observations hold promise for gaining greater clarity about concussion and mild traumatic brain injury.

Pediatric musculoskeletal injuries: role of ultrasound and magnetic resonance imaging.

PubMed

Piccolo, C L; Galluzzo, M; Ianniello, S; Trinci, M; Russo, A; Rossi, E; Zeccolini, M; Laporta, A; Guglielmi, G; Miele, V

2017-03-01

Pediatric musculoskeletal system is particularly prone to traumatic and sports-related injuries, both acute and chronic, i.e., overuse injuries, because of inherent conditions of weakness, such as the open physis, representing the weakest aspect within the bone, the ligamentous supports and changing biomechanics. Being aware that a quick diagnosis is essential to preserve the good functionality of the limb involved, it is mandatory for the radiologist to recognize the most common patterns of these injuries, identifying those requiring a prompt surgery, as well as be confident with the technique performed, and be supported by an important background experience and knowledge skills.

Rate and pattern of unintentional injuries among 9-12 grades schoolchildren in Yemen and their associated factors.

PubMed

Alshahethi, Ahmed; Al Serouri, Abdulwahed; Khader, Yousef S

2018-03-11

The burden and pattern of unintentional child injuries in Yemen are not yet studied. This study aimed to determine the rate of unintentional injuries and their associated factors and describe the pattern of these injuries among schoolchildren in Sana'a city, Yemen. A cross-sectional school-based study was conducted among students in grades 9-12 in Sana'a Capital City. A total of 10 schools were selected using multistage sampling technique. A self-administered questionnaire was used to collect the data. A total of 1140 students (558 girls and 582 boys) participated in the study. Of all students, 550 (48.2%) students reported unintentional injuries during the last 12-months. In the multivariate analysis, boys were more likely to be injured compared to girls (OR = 1.6) and being a child of divorced or widowed parents was significantly associated with increased odds of injury (OR = 1.7). Age of the household head ≤ 45 years was associated with deceased odds of injuries (OR = 0.76). Fall was the leading cause of injury. More than half of girls (58.9%) and 30.9% of boys were injured at home. About two thirds (64.9%) of injuries affected the lower or upper extremities. One quarter of students (24.5%) received care for their injuries in outpatient clinics and 15.3% were hospitalized because of the injury. About 26.0% of injured students missed schools for one week or more. The vast majority of students (98.4%) recovered the injury while 1.6% of injuries resulted in disability. Schoolchildren in Yemen had a high rate of unintentional injuries being higher in boys and in children of divorced or widowed parents. These injuries should be recognized as a public health problem in Yemen and should be included in the Ministry of Education and Ministry of Health agenda. The reported injury mechanisms and activities posing injury risks should have implications for future interventions and awareness programs.

Ischemic Preconditioning Produces Comparable Protection Against Hepatic Ischemia/Reperfusion Injury Under Isoflurane and Sevoflurane Anesthesia in Rats.

PubMed

Jeong, J S; Kim, D; Kim, K Y; Ryu, S; Han, S; Shin, B S; Kim, G S; Gwak, M S; Ko, J S

2017-11-01

Various volatile anesthetics and ischemic preconditioning (IP) have been demonstrated to exert protective effect against ischemia/reperfusion (I/R) injury in liver. We aimed to determine whether application of IP under isoflurane and sevoflurane anesthesia would confer protection against hepatic I/R injury in rats. Thirty-eight rats weighing 270 to 300 grams were randomly divided into 2 groups: isoflurane (1.5%) and sevoflurane (2.5%) anesthesia groups. Each group was subdivided into sham (n = 3), non-IP (n = 8; 45 minutes of hepatic ischemia), and IP (n = 8, IP consisting of 10-minute ischemia plus 15-minute reperfusion before prolonged ischemia) groups. The degree of hepatic injury and expressions of B-cell lymphoma 2 (Bcl-2) and caspase 3 were compared at 2 hours after reperfusion. Hepatic ischemia induced significant degree of I/R injuries in both isoflurane and sevoflurane non-IP groups. In both anesthetic groups, introduction of IP dramatically attenuated I/R injuries as marked by significantly lower aspartate aminotransferase and aminotransferase levels and better histologic grades compared with corresponding non-IP groups. There were 2.3- and 1.7-fold increases in Bcl-2 mRNA levels in isoflurane and sevoflurane IP groups, respectively, compared with corresponding non-IP groups (both P < .05). Caspase 3 level was significantly high in the isoflurane non-IP group compared with the sham group; however, there were no differences among the sevoflurane groups. The degree of hepatic I/R injury was significantly high in both isoflurane and sevoflurane groups in rats. However, application of IP significantly protected against I/R injury in both volatile anesthetic groups to similar degrees, and upregulation of Bcl-2 might be an important mechanism. Copyright © 2017 Elsevier Inc. All rights reserved.

Veterinary Forensics: Firearms and Investigation of Projectile Injury.

PubMed

Bradley-Siemens, N; Brower, A I

2016-09-01

Projectile injury represents an estimated 14% of reported animal cruelty cases in the United States. Cases involving projectiles are complicated by gross similarities to other common types of injury, including bite wounds and motor vehicle injuries, by weapons and ammunition not commonly recognized or understood by veterinary medical professionals, and by required expertise beyond that employed in routine postmortem examination. This review describes the common types of projectile injuries encountered within the United States, as well as firearms and ammunition associated with this form of injury. The 3 stages of ballistics-internal, external, and terminal-and wounding capacity are discussed. A general understanding of firearms, ammunition, and ballistics is necessary before pursuing forensic projectile cases. The forensic necropsy is described, including gunshot wound examination, projectile trajectories, different imaging procedures, collection and storage of projectile evidence, and potential advanced techniques for gunpowder analysis. This review presents aspects of projectile injury investigation that must be considered in tandem with standard postmortem practices and procedures to ensure reliable conclusions are reached for medicolegal as well as diagnostic purposes. © The Author(s) 2016.

Getting back to work after injury: the UK Burden of Injury multicentre longitudinal study

PubMed Central

2012-01-01

Background Injuries to working age adults are common and place a considerable burden on health services accounting for more than 10% of GP sick notes and 14% of those claiming benefits because they are unable to work in the UK. General practitioners (GPs) currently assess fitness to work and provide care and referral to other services to facilitate return to work (RTW). Recent UK recommendations suggest replacing GP sickness certification with independent assessments of fitness to work after four weeks sick leave. The impact of a wide range of injuries on RTW and subsequent need for independent fitness to work assessments has not been well studied in the UK. The aim of this study was to quantify RTW and factors predicting RTW following a wide range of injuries. Methods We used a multicentre longitudinal study, set in four acute NHS Trusts in the UK which recruited emergency department (ED) attenders and hospital admissions for injury and included those aged 16–65years that were employed or self-employed before the injury. Participants were followed up by postal questionnaire at 1, 4 and 12 months post injury to measure health status (EQ-5D), recovery, use of health and social services, time off work in the preceding month and work problems amongst those who had RTW. Multivariable Poisson regression with a robust variance estimator was used to estimate relative risks for factors associated with RTW. Results One month after injury 35% of ED attenders had fully RTW. The self employed were more likely (RR 1.70, 95% CI 1.17 to 2.47 compared with employed) and the moderate/severely injured less likely to RTW (RR 0.48, 95% CI 0.32 to 0.72 compared with minor injuries). At four months, 83% of ED attenders had RTW and self employment and injury severity remained significant predictors of RTW (self employment RR 1.15, 95% CI 1.03 to 1.30; moderate/severe injury RR 0.79, 95% CI 0.68 to 0.92). At four months 57% of hospital admissions had RTW. Men were more likely than women

Brain injury, neuroinflammation and Alzheimer's disease.

PubMed

Breunig, Joshua J; Guillot-Sestier, Marie-Victoire; Town, Terrence

2013-01-01

With as many as 300,000 United States troops in Iraq and Afghanistan having suffered head injuries (Miller, 2012), traumatic brain injury (TBI) has garnered much recent attention. While the cause and severity of these injuries is variable, severe cases can lead to lifelong disability or even death. While aging is the greatest risk factor for Alzheimer's disease (AD), it is now becoming clear that a history of TBI predisposes the individual to AD later in life (Sivanandam and Thakur, 2012). In this review article, we begin by defining hallmark pathological features of AD and the various forms of TBI. Putative mechanisms underlying the risk relationship between these two neurological disorders are then critically considered. Such mechanisms include precipitation and 'spreading' of cerebral amyloid pathology and the role of neuroinflammation. The combined problems of TBI and AD represent significant burdens to public health. A thorough, mechanistic understanding of the precise relationship between TBI and AD is of utmost importance in order to illuminate new therapeutic targets. Mechanistic investigations and the development of preclinical therapeutics are reliant upon a clearer understanding of these human diseases and accurate modeling of pathological hallmarks in animal systems.

Injuries of the head from backface deformation of ballistic protective helmets under ballistic impact.

PubMed

Rafaels, Karin A; Cutcliffe, Hattie C; Salzar, Robert S; Davis, Martin; Boggess, Brian; Bush, Bryan; Harris, Robert; Rountree, Mark Steve; Sanderson, Ellory; Campman, Steven; Koch, Spencer; Dale Bass, Cameron R

2015-01-01

Modern ballistic helmets defeat penetrating bullets by energy transfer from the projectile to the helmet, producing helmet deformation. This deformation may cause severe injuries without completely perforating the helmet, termed "behind armor blunt trauma" (BABT). As helmets become lighter, the likelihood of larger helmet backface deformation under ballistic impact increases. To characterize the potential for BABT, seven postmortem human head/neck specimens wearing a ballistic protective helmet were exposed to nonperforating impact, using a 9 mm, full metal jacket, 124 grain bullet with velocities of 400-460 m/s. An increasing trend of injury severity was observed, ranging from simple linear fractures to combinations of linear and depressed fractures. Overall, the ability to identify skull fractures resulting from BABT can be used in forensic investigations. Our results demonstrate a high risk of skull fracture due to BABT and necessitate the prevention of BABT as a design factor in future generations of protective gear. © 2014 American Academy of Forensic Sciences.

Evaluation and treatment of biking and running injuries.

PubMed

Oser, Sean M; Oser, Tamara K; Silvis, Matthew L

2013-12-01

Exercise is universally recognized as a key feature for maintaining good health. Likewise, lack of physical activity is a major risk factor for chronic disease and disability, an especially important fact considering our rapidly aging population. Biking and running are frequently recommended as forms of exercise. As more individuals participate in running-related and cycling-related activities, physicians must be increasingly aware of the common injuries encountered in these pursuits. This review focuses on the evaluation and management of common running-related and cycling-related injuries. Copyright © 2013 Elsevier Inc. All rights reserved.

Canary in the coal mine-Initial reports of thermal injury secondary to electronic cigarettes.

PubMed

Bauman, Zachary M; Roman, Jordan; Singer, Matthew; Vercruysse, Gary A

2017-05-01

The use of electronic cigarettes has become increasingly popular with claims suggesting healthier alternatives to tobacco cigarettes. However, research regarding the safety of such devices has been limited to an analysis of the inhaled vapor and the short and long-term effects on the body. A lesser recognized risk of electronic cigarette use is that of lithium-ion battery failure causing ignition, leading to severe thermal injury. Such incidents have been reported in the media but with inconsistencies from a lack of focus on the injuries sustained and a cause of ignition. The cases presented here are among the first recognized thermal injuries sustained from electronic cigarette lithium-ion battery failure, the potential rationale for these failures, and a need for increased awareness of the safety hazards of these devices. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

Brain Injury Association of America

MedlinePlus

... Only) 1-800-444-6443 Welcome to the Brain Injury Association of America (BIAA) Brain injury is not an event or an outcome. ... misunderstood, under-funded neurological disease. People who sustain brain injuries must have timely access to expert trauma ...

Interpersonal violence: an important risk factor for disease and injury in South Africa.

PubMed

Norman, Rosana; Schneider, Michelle; Bradshaw, Debbie; Jewkes, Rachel; Abrahams, Naeemah; Matzopoulos, Richard; Vos, Theo

2010-12-01

Burden of disease estimates for South Africa have highlighted the particularly high rates of injuries related to interpersonal violence compared with other regions of the world, but these figures tell only part of the story. In addition to direct physical injury, violence survivors are at an increased risk of a wide range of psychological and behavioral problems. This study aimed to comprehensively quantify the excess disease burden attributable to exposure to interpersonal violence as a risk factor for disease and injury in South Africa. The World Health Organization framework of interpersonal violence was adapted. Physical injury mortality and disability were categorically attributed to interpersonal violence. In addition, exposure to child sexual abuse and intimate partner violence, subcategories of interpersonal violence, were treated as risk factors for disease and injury using counterfactual estimation and comparative risk assessment methods. Adjustments were made to account for the combined exposure state of having experienced both child sexual abuse and intimate partner violence. Of the 17 risk factors included in the South African Comparative Risk Assessment study, interpersonal violence was the second leading cause of healthy years of life lost, after unsafe sex, accounting for 1.7 million disability-adjusted life years (DALYs) or 10.5% of all DALYs (95% uncertainty interval: 8.5%-12.5%) in 2000. In women, intimate partner violence accounted for 50% and child sexual abuse for 32% of the total attributable DALYs. The implications of our findings are that estimates that include only the direct injury burden seriously underrepresent the full health impact of interpersonal violence. Violence is an important direct and indirect cause of health loss and should be recognized as a priority health problem as well as a human rights and social issue. This study highlights the difficulties in measuring the disease burden from interpersonal violence as a risk factor

Cervical spine injuries in suicidal hanging without a long-drop--patterns and possible underlying mechanisms of injury: an autopsy study.

PubMed

Nikolić, Slobodan; Zivković, Vladimir

2014-06-01

The incidence of cervical spine injuries in suicidal hangings with a short-drop has been reported to be extremely low or non-existent. The aim of this study was to determine the frequency and pattern of cervical spine injuries in suicidal hanging. A retrospective autopsy study was performed and short-drop suicidal hanging cases with documented cervical spine injuries were identified. This group was further analyzed with regard to the gender and age of the deceased, the position of the ligature knot, the presence of hyoid-laryngeal fractures, and the level of cervical spine injury. Cervical spine injuries were present in 25 of the 766 cases, with an average age of 71.9 ± 10.7 years (range 39-88 years). In 16 of these 25 cases, the ligature knot was in the anterior position. The most common pattern of cervical spine injury included partial or complete disruption of the anterior longitudinal ligament and widening of the lower cervical spine disk spaces, associated with absence of hyoid-laryngeal fractures. Cervical spine injuries are not commonly found in short-drop suicidal hanging, occurring in only 3.3 % of all observed cases. Cervical spine injury may be occurring in 80 % of subjects aged 66.5 years and above. The most common pattern of cervical spine injury included anterior longitudinal ligament disruption of the lower cervical spine, disk space widening, and no vertebral body displacement. These injuries were mainly associated with an anterior knot position, and may be a consequence of loop pressure to the posterior neck and cervical spine hyperextension.

Burn injury pain: the continuing challenge.

PubMed

Summer, Gretchen J; Puntillo, Kathleen A; Miaskowski, Christine; Green, Paul G; Levine, Jon D

2007-07-01

The development of more effective methods of relieving pain associated with burn injury is a major unmet medical need. Not only is acute burn injury pain a source of immense suffering, but it has been linked to debilitating chronic pain and stress-related disorders. Although pain management guidelines and protocols have been developed and implemented, unrelieved moderate-to-severe pain continues to be reported after burn injury. One reason for this is that the intensity of pain associated with wound care and rehabilitation therapy, the major source of severe pain in this patient population, varies widely over the 3 phases of burn recovery, making it difficult to estimate analgesic requirements. The effects of opioids, the most commonly administered analgesics for burn injury procedural pain, are difficult to gauge over the course of burn recovery because the need for an opioid may change rapidly, resulting in the overmedication or undermedication of burn-injured patients. Understanding the mechanisms that contribute to the intensity and variability of burn injury pain over time is crucial to its proper management. We provide an overview of the types of pain associated with a burn injury, describe how these different types of pain interfere with the phases of burn recovery, and summarize pharmacologic pain management strategies across the continuum of burn care. We conclude with a discussion and suggestions for improvement. Rational management, based on the underlying mechanisms that contribute to the intensity and variability of burn injury pain, is in its infancy. The paucity of information highlights the need for research that explores and advances the identification of mechanisms of acute and chronic burn injury pain. Researchers continue to report that burn pain is undertreated. This review examines burn injury pain management across the phases of burn recovery, emphasizing 3 types of pain that require separate assessment and management. It provides insights

Early detection of acute kidney injury after pediatric cardiac surgery

PubMed Central

Jefferies, John Lynn; Devarajan, Prasad

2016-01-01

Acute kidney injury (AKI) is increasingly recognized as a common problem in children undergoing cardiac surgery, with well documented increases in morbidity and mortality in both the short and the long term. Traditional approaches to the identification of AKI such as changes in serum creatinine have revealed a large incidence in this population with significant negative impact on clinical outcomes. However, the traditional diagnostic approaches to AKI diagnosis have inherent limitations that may lead to under-diagnosis of this pathologic process. There is a dearth of randomized controlled trials for the prevention and treatment of AKI associated with cardiac surgery, at least in part due to the paucity of early predictive biomarkers. Novel non-invasive biomarkers have ushered in a new era that allows for earlier detection of AKI. With these new diagnostic tools, a more consistent approach can be employed across centers that may facilitate a more accurate representation of the actual prevalence of AKI and more importantly, clinical investigation that may minimize the occurrence of AKI following pediatric cardiac surgery. A thoughtful management approach is necessary to mitigate the effects of AKI after cardiac surgery, which is best accomplished in close collaboration with pediatric nephrologists. Long-term surveillance for improvement in kidney function and potential development of chronic kidney disease should also be a part of the comprehensive management strategy. PMID:27429538

Musculoskeletal injuries in construction: a review of the literature.

PubMed

Schneider, S P

2001-11-01

The first step in addressing any problem is recognition of the problem and a measure of its size and scope. There have been few reviews to date of the evidence of a musculoskeletal disorders problem in construction, particularly in the United States. Construction contractors in the United States have questioned the existence of a musculoskeletal disorders problem in construction, so a review of the evidence is warranted. The types of evidence reviewed include: 1) historical evidence, 2) injury data, 3) workers' compensation data, 4) medical exam data, 5) survey data, and 6) exposure data. Injury data generally represent injuries that the employers have identified as work-related and recorded or reported. Workers' compensation data are from cases that have been filed by workers for compensation and quite often represent only "closed" cases where compensation has been awarded. Medical exam data are from physical examinations of workers. Symptom survey data are the most inclusive and show the number of workers who self-report musculoskeletal problems. Exposure data include measurements made of exposure to musculoskeletal risk factors. The existing data show construction workers to be at significant risk of musculoskeletal injury, specifically related to the work they do. Their risk of musculoskeletal injury is much higher than that of other workers who have less heavy work, about 50 percent higher than all other workers. Several trades have been extensively studied, while others have been studied to a lesser extent. While the exact relationship between exposures and injuries is complex and often multifaceted, it would be difficult to deny the existence of the problem and the fact that these injuries are, to a great extent, related to the work that construction workers perform.

Assessment of Injuries During Brazilian Jiu-Jitsu Competition.

PubMed

Scoggin, James F; Brusovanik, Georgiy; Izuka, Byron H; Zandee van Rilland, Eddy; Geling, Olga; Tokumura, Seren

2014-02-01

Brazilian jiu-jitsu (BJJ) is a unique style of martial arts with rapid growth in the United States and internationally. Although studies have examined injuries in other martial arts and combat sports, to date, no published medical study has examined injuries in BJJ competitions. (1) To estimate the incidence of injuries in BJJ competitions and (2) to identify and describe the types and mechanisms of injuries associated with competitive BJJ. Descriptive epidemiology study. Injury data were obtained from records of on-site medical coverage at 8 statewide BJJ tournaments in Hawaii, USA, between 2005 and 2011. The identified injury incidence on the day of matches was 9.2 per 1000 exposures (46 injuries out of 5022 exposures, ie, match participations). Orthopaedic injuries were the most common and accounted for 78% of all injuries (n = 36), followed by costochondral or rib injuries (n = 7) and lacerations requiring medical care (n = 3). The elbow was found to be the joint most commonly injured during BJJ competitions, with the arm bar being the most common mechanism. We propose that this BJJ-specific injury mechanism, the "arm bar," be recognized as another mechanism of hyperextension injury to the elbow in sports. Comparison of the BJJ injury data with injury data reported for judo, taekwondo, wrestling, and mixed martial arts showed that BJJ competitors were at substantially lower risk of injury compared with these other sports. With orthopaedic injuries being most common and the elbow being the area most vulnerable to injury in BJJ, it is important that participants, referees, and physicians be properly educated about the unique mechanisms of injury that can occur, particularly to the elbow.

Gasoline immersion injury

DOE Office of Scientific and Technical Information (OSTI.GOV)

Simpson, L.A.; Cruse, C.W.

1981-01-01

Chemical burns and pulmonary complications are the most common problems encountered in the patient immersed in gasoline. Our patient demonstrated a 46-percent total-body-surface area, partial-thickness chemical burn. Although he did not develop bronchitis or pneumonitis, he did display persistent atelectasis, laryngeal edema, and subsequent upper airway obstruction. This had not previously been reported in gasoline inhalation injuries. Hydrocarbon hepatitis secondary to the vascular endothelial damage is apparently a reversible lesion with no reported long-term sequelae. Gasoline immersion injuries may be a series multisystem injury and require the burn surgeon to take a multisystem approach to its diagnosis and treatment.

Review of adult electrical burn injury outcomes worldwide: An analysis of low- voltage versus high-voltage electrical injury

PubMed Central

Shih, Jessica G; Shahrokhi, Shahriar; Jeschke, Marc G

2016-01-01

Objective To review low-voltage versus high-voltage electrical burn complications in adults, and to identify novel areas that are not recognized to improve outcomes. Methods An extensive literature search on electrical burn injuries was performed using OVID Medline, PubMed and EMBASE databases from 1946–2015. Studies relating to outcomes of electrical injury in the adult population (≥18 years of age) were included in the study. Results Forty-one single-institution publications with a total of 5485 electrical injury patients were identified and included in the present study. 18.0% of these patients were low-voltage injuries (LVI), 38.3% high-voltage injuries (HVI) and 43.7% with voltage not otherwise specified (NOS). Forty-four percent of studies did not characterize outcomes according to low versus high-voltage injuries. Reported outcomes include surgical, medical, post-traumatic, and other (long-term/psychological/rehabilitative), all of which report greater incidence rates in HVI compared to LVI. Only two studies report on psychological outcomes such as post-traumatic stress disorder. Mortality from electrical injuries are 2.6% in LVI, 5.2% in HVI and 3.7% in NOS. Coroner’s reports reveal a ratio of 2.4:1 for deaths caused by low-voltage injury compared to high voltage-injury. Conclusions High-voltage injuries lead to greater morbidity and mortality than low-voltage injuries. However, the results of the coroner’s reports suggest that immediate mortality from low-voltage injury may be underestimated. Furthermore, based on the data of this analysis we conclude that the majority of studies report electrical injury outcomes, however, the majority of them do not analyze complications by low versus high voltage and often lack long-term psychological and rehabilitation outcomes post-electrical injury indicating that a variety of central aspects are not being evaluated or assessed. PMID:27359191

Rehabilitation of spinal cord injuries

PubMed Central

Nas, Kemal; Yazmalar, Levent; Şah, Volkan; Aydın, Abdulkadir; Öneş, Kadriye

2015-01-01

Spinal cord injury (SCI) is the injury of the spinal cord from the foramen magnum to the cauda equina which occurs as a result of compulsion, incision or contusion. The most common causes of SCI in the world are traffic accidents, gunshot injuries, knife injuries, falls and sports injuries. There is a strong relationship between functional status and whether the injury is complete or not complete, as well as the level of the injury. The results of SCI bring not only damage to independence and physical function, but also include many complications from the injury. Neurogenic bladder and bowel, urinary tract infections, pressure ulcers, orthostatic hypotension, fractures, deep vein thrombosis, spasticity, autonomic dysreflexia, pulmonary and cardiovascular problems, and depressive disorders are frequent complications after SCI. SCI leads to serious disability in the patient resulting in the loss of work, which brings psychosocial and economic problems. The treatment and rehabilitation period is long, expensive and exhausting in SCI. Whether complete or incomplete, SCI rehabilitation is a long process that requires patience and motivation of the patient and relatives. Early rehabilitation is important to prevent joint contractures and the loss of muscle strength, conservation of bone density, and to ensure normal functioning of the respiratory and digestive system. An interdisciplinary approach is essential in rehabilitation in SCI, as in the other types of rehabilitation. The team is led by a physiatrist and consists of the patients’ family, physiotherapist, occupational therapist, dietician, psychologist, speech therapist, social worker and other consultant specialists as necessary. PMID:25621206

Safe communities in China as a strategy for injury prevention and safety promotion programmes in the era of rapid economic growth.

PubMed

Wang, Shu-Mei; Dalal, Koustuv

2013-02-01

Due to its rapid economic development, China is facing a huge health, social, and economic burden resulting from injuries. The study's objective was to examine Safe Communities in China as a strategy for injury prevention and safety promotion programmes in the era of rapid economic growth. Literature searches in English and Chinese, which included grey literature, were performed on the Chinese Journal Full-text Search System and Medline, using the words "Safe Community", "injury", "economics", and "prevention". The results showed that the existing 35 recognized members of the International Safe Community Network have not placed due emphasis on suicide prevention, which is one of the leading problems in both rural and urban China. A few groups, such as children, the elderly, cyclists, and pedestrians, have received due emphasis, while other vulnerable groups, such as migrant workers, motorcyclists, students, players, and farmers have not received the necessary attention from the Safe Community perspective. As the evidence describes, Safe Communities in China can be a very effective strategy for injury prevention, but four aspects need to be strengthened in the future: (1) establish and strengthen the policy and regulations in terms of injury prevention at the national level; (2) create a system to involve professional organizations and personnel in projects; (3) consider the economic development status of different parts of China; and (4) intentional injury prevention should receive greater attention.

Long-term remote organ consequences following acute kidney injury.

PubMed

Shiao, Chih-Chung; Wu, Pei-Chen; Huang, Tao-Min; Lai, Tai-Shuan; Yang, Wei-Shun; Wu, Che-Hsiung; Lai, Chun-Fu; Wu, Vin-Cent; Chu, Tzong-Shinn; Wu, Kwan-Dun

2015-12-28

Acute kidney injury (AKI) has been a global health epidemic problem with soaring incidence, increased long-term risks for multiple comorbidities and mortality, as well as elevated medical costs. Despite the improvement of patient outcomes following the advancements in preventive and therapeutic strategies, the mortality rates among critically ill patients with AKI remain as high as 40-60 %. The distant organ injury, a direct consequence of deleterious systemic effects, following AKI is an important explanation for this phenomenon. To date, most evidence of remote organ injury in AKI is obtained from animal models. Whereas the observations in humans are from a limited number of participants in a relatively short follow-up period, or just focusing on the cytokine levels rather than clinical solid outcomes. The remote organ injury is caused with four underlying mechanisms: (1) "classical" pattern of acute uremic state; (2) inflammatory nature of the injured kidneys; (3) modulating effect of AKI of the underlying disease process; and (4) healthcare dilemma. While cytokines/chemokines, leukocyte extravasation, oxidative stress, and certain channel dysregulation are the pathways involving in the remote organ damage. In the current review, we summarized the data from experimental studies to clinical outcome studies in the field of organ crosstalk following AKI. Further, the long-term consequences of distant organ-system, including liver, heart, brain, lung, gut, bone, immune system, and malignancy following AKI with temporary dialysis were reviewed and discussed.

Health problems in adolescents with alcohol use disorders: self-report, liver injury, and physical examination findings and correlates.

PubMed

Clark, D B; Lynch, K G; Donovan, J E; Block, G D

2001-09-01

Although adolescent alcohol consumption has been found to be positively correlated with self-reported health problems, few studies have examined other health indicators. This study compared adolescents with alcohol use disorders (AUDs) and a community reference group on self-reported health problems, serum liver enzymes, and physical examination findings. The relevance of negative emotionality to understanding these health problems was also investigated. The subjects were adolescents with AUDs recruited from clinical programs and classified as having DSM-IV alcohol dependence (n = 71) or alcohol abuse (n = 57) and reference adolescents without AUDs recruited from community sources (n = 131). The assessment of health status included self-reported health problems in 15 areas; serum liver enzyme assays, including gamma-glutamyl transpeptidase, alanine aminotransferase, and aspartate aminotransferase; and physical examination findings. Negative emotionality was determined by systematically combining scores from the Hamilton Anxiety Rating Scale, the Beck Depression Inventory, the Child Behavior Checklist, and the Multidimensional Personality Questionnaire. Adolescent AUDs were associated with more self-reported health problems, higher gamma-glutamyl transpeptidase and alanine aminotransferase levels, and more physical examination abnormalities. Negative emotionality was highly correlated with self-reported health problems, mediated the relationship between AUDs and self-reported health problems, and was not correlated with serum liver enzyme levels or physical examination abnormalities. These results indicated that AUDs during adolescence were associated with health problems, including modest but demonstrable liver injury. Self-reported health problems were probably best understood, in this context, as a negative emotionality manifestation.

Microglia and Inflammation: Impact on Developmental Brain Injuries

ERIC Educational Resources Information Center

Chew, Li-Jin; Takanohashi, Asako; Bell, Michael

2006-01-01

Inflammation during the perinatal period has become a recognized risk factor for developmental brain injuries over the past decade or more. To fully understand the relationship between inflammation and brain development, a comprehensive knowledge about the immune system within the brain is essential. Microglia are resident immune cells within the…

The effectiveness of artificial intelligent 3-D virtual reality vocational problem-solving training in enhancing employment opportunities for people with traumatic brain injury.

PubMed

Man, David Wai Kwong; Poon, Wai Sang; Lam, Chow

2013-01-01

People with traumatic brain injury (TBI) often experience cognitive deficits in attention, memory, executive functioning and problem-solving. The purpose of the present research study was to examine the effectiveness of an artificial intelligent virtual reality (VR)-based vocational problem-solving skill training programme designed to enhance employment opportunities for people with TBI. This was a prospective randomized controlled trial (RCT) comparing the effectiveness of the above programme with that of the conventional psycho-educational approach. Forty participants with mild (n = 20) or moderate (n = 20) brain injury were randomly assigned to each training programme. Comparisons of problem-solving skills were performed with the Wisconsin Card Sorting Test, the Tower of London Test and the Vocational Cognitive Rating Scale. Improvement in selective memory processes and perception of memory function were found. Across-group comparison showed that the VR group performed more favourably than the therapist-led one in terms of objective and subjective outcome measures and better vocational outcomes. These results support the potential use of a VR-based approach in memory training in people with MCI. Further VR applications, limitations and future research are described.

Yachters in Korea suffer considerable injuries

PubMed Central

Ham, Do-Woong; Jee, Yong-Seok

2016-01-01

Although there is a limited amount of data regarding injuries incurred from yachting, identifying important trends can assist clinicians and yachters in the successful evaluation, treatment, and rehabilitation of injuries. Similar to other research studies related to sailing, the majority of injuries consist of orthopedic problems, with the highest rate of injury occurring in the lower legs and trunk. The most prevalent causes of injury were due to ‘over-action,’ followed by ‘insufficient practice,’ and lastly, ‘insufficient skill’ according to the responses among yachters. Gaining a better understanding of the causes of injury and the affected sites of injury will assist in developing a fitness training program for injury prevention and creating a rehabilitation program to ensure optimal conditions and safety for yachters. PMID:27419119

[Underlying Mechanisms of Methamphetamine-Induced Self-Injurious Behavior and Lethal Effects in Mice].

PubMed

Mori, Tomohisa; Sawaguchi, Toshiko

2018-01-01

Relatively high doses of psychostimulants induce neurotoxicity on the dopaminergic system and self-injurious behavior (SIB) in rodents. However the underlying neuronal mechanisms of SIB remains unclear. Dopamine receptor antagonists, N-methyl-D-aspartic acid (NMDA) receptor antagonists, Nitric Oxide Synthase (NOS) inhibitors and free radical scavengers significantly attenuate methamphetamine-induced SIB. These findings indicate that activation of dopamine as well as NMDA receptors followed by radical formation and oxidative stress, especially when mediated by NOS activation, is associated with methamphetamine-induced SIB. On the other hand, an increase in the incidence of polydrug abuse is a major problem worldwide. Coadministered methamphetamine and morphine induced lethality in more than 80% in mice, accompanied by an increase in the number of poly (ADP-ribose) polymerase (PARP)-immunoreactive cells in the heart, kidney and liver. The lethal effect and the increase in the incidence of rupture or PARP-immunoreactive cells induced by the coadministration of methamphetamine and morphine were significantly attenuated by pretreatment with a phospholipase A2 inhibitor or a radical scavenger, or by cooling of body from 30 to 90 min after drug administration. These results suggest that free radicals play an important role in the increased lethality induced by the coadministration of methamphetamine and morphine. Therefore, free radical scavengers and cooling are beneficial for preventing death that is induced by the coadministration of methamphetamine and morphine. These findings may help us better understand for masochistic behavior, which is a clinical phenomenon on SIB, as well as polydrug-abuse-induced acute toxicity.

Postcholecystectomy bile duct injuries: experience with 49 cases managed by different therapeutic modalities.

PubMed

Abdel Wahab, M; el-Ebiedy, G; Sultan, A; el-Ghawalby, N; Fathy, O; Gad el-Hak, N; Abo Elenin, A; Abo Zid, M; Ezzat, F

1996-01-01

In this study we present our experience in the management of iatrogenic biliary injuries. Forty-nine cases with iatrogenic biliary injuries were managed in our center during the period from 1984 to 1995. Forty patients were referred from other hospitals after cholecystectomy, and 9 cases underwent the original operation in our center. Four (0.3%) of our patients after 1300 conventional cholecystectomy, and 5 (0.9%) cases after 550 laparoscopic cholecystectomy. The injuries were recognized intraoperatively in 5 (10%) cases and were immediately repaired, 3 cases by axial anastomosis and T-tube drainage, 2 cases by hepatico-jejunostomy (Roux-en-Y). The injuries were detected in the remaining 44 patients postoperatively from one week up to 2 months, the mode of presentation was jaundice in 39 (89%) cases, biliary fistula with or without jaundice and biliary peritonitis were detected in 13 (30%) and in 4 (9%) cases respectively. Eleven (25%) cases were treated endoscopically by sphincterotomy, stent in 8 cases, dilatation and double stent in two cases, and dilatation using rigid dilators and stent in one case. The remaining 33 (75%) cases were treated surgically by hepatico-jejunostomy in 21 (64%) cases, and hepatico-duodenostomy in 12 (36%) cases. No hospital mortality occurred, but late mortality occurred in two (5%) patients after surgery due to biliary restricture with progressive cirrhosis in one case, and due to advanced colon cancer in the other case, an din one (9%) case after endoscopic treatment. We achieved 87% excellent surgical results during the period of follow-up (36 months), while 80% excellent results were achieved after endoscopic treatment. Good final results (95%, 83%) were achieved after hepatico-jejunostomy and after hepatico-duodenostomy respectively. Postcholecystectomy biliary injuries present a surgical problem needing extra efforts and careful management. Hepatico-jejunostomy appears to be the procedure of choice in repairing these injuries

Firearm injuries in the United States.

PubMed

Fowler, Katherine A; Dahlberg, Linda L; Haileyesus, Tadesse; Annest, Joseph L

2015-10-01

This paper examines the epidemiology of fatal and nonfatal firearm violence in the United States. Trends over two decades in homicide, assault, self-directed and unintentional firearm injuries are described along with current demographic characteristics of victimization and health impact. Fatal firearm injury data were obtained from the National Vital Statistics System (NVSS). Nonfatal firearm injury data were obtained from the National Electronic Injury Surveillance System (NEISS). Trends were tested using Joinpoint regression analyses. CDC Cost of Injury modules were used to estimate costs associated with firearm deaths and injuries. More than 32,000 persons die and over 67,000 persons are injured by firearms each year. Case fatality rates are highest for self-harm related firearm injuries, followed by assault-related injuries. Males, racial/ethnic minority populations, and young Americans (with the exception of firearm suicide) are disproportionately affected. The severity of such injuries is distributed relatively evenly across outcomes from outpatient treatment to hospitalization to death. Firearm injuries result in over $48 billion in medical and work loss costs annually, particularly fatal firearm injuries. From 1993 to 1999, rates of firearm violence declined significantly. Declines were seen in both fatal and nonfatal firearm violence and across all types of intent. While unintentional firearm deaths continued to decline from 2000 to 2012, firearm suicides increased and nonfatal firearm assaults increased to their highest level since 1995. Firearm injuries are an important public health problem in the United States, contributing substantially each year to premature death, illness, and disability. Understanding the nature and impact of the problem is only a first step toward preventing firearm violence. A science-driven approach to understand risk and protective factors and identify effective solutions is key to achieving measurable reductions in firearm

Firearm injuries in the United States

PubMed Central

Fowler, Katherine A.; Dahlberg, Linda L.; Haileyesus, Tadesse; Annest, Joseph L.

2015-01-01

Objective This paper examines the epidemiology of fatal and nonfatal firearm violence in the United States. Trends over two decades in homicide, assault, self-directed and unintentional firearm injuries are described along with current demographic characteristics of victimization and health impact. Method Fatal firearm injury data were obtained from the National Vital Statistics System (NVSS). Nonfatal firearm injury data were obtained from the National Electronic Injury Surveillance System (NEISS). Trends were tested using Joinpoint regression analyses. CDC Cost of Injury modules were used to estimate costs associated with firearm deaths and injuries. Results More than 32,000 persons die and over 67,000 persons are injured by firearms each year. Case fatality rates are highest for self-harm related firearm injuries, followed by assault-related injuries. Males, racial/ethnic minority populations, and young Americans (with the exception of firearm suicide) are disproportionately affected. The severity of such injuries is distributed relatively evenly across outcomes from outpatient treatment to hospitalization to death. Firearm injuries result in over $48 billion in medical and work loss costs annually, particularly fatal firearm injuries. From 1993 to 1999, rates of firearm violence declined significantly. Declines were seen in both fatal and nonfatal firearm violence and across all types of intent. While unintentional firearm deaths continued to decline from 2000 to 2012, firearm suicides increased and nonfatal firearm assaults increased to their highest level since 1995. Conclusion Firearm injuries are an important public health problem in the United States, contributing substantially each year to premature death, illness, and disability. Understanding the nature and impact of the problem is only a first step toward preventing firearm violence. A science-driven approach to understand risk and protective factors and identify effective solutions is key to achieving

Traumatic intrathoracic tracheobronchial injuries: a study of 78 cases.

PubMed

Alassal, Mohamed A; Ibrahim, Bedir M; Elsadeck, Nabil

2014-09-01

Tracheobronchial injuries are encountered with increasing frequency because of improvements in pre-hospital care. We reviewed our experience of these injuries to determine how to better recognize them and facilitate their correct management. Patients with traumatic non-iatrogenic intrathoracic tracheobronchial injuries managed in 2 tertiary centers in Saudi Arabia between 2000 and 2012, were studied. Clinical presentation, diagnostic evaluation, management, and outcome were reviewed. 78 patients with tracheobronchial injuries were included in this study. They were divided into 2 groups according to the management strategy. Forty-seven patients who were managed conservatively, and 31 underwent surgery. Surgery allowed shorter intensive care unit and hospital stays; otherwise, the results were comparable between the two groups. Early recognition and expedient appropriate management are essential in these potentially lethal injuries. Operative management can be achieved with acceptable mortality, and conservative treatment should be considered as a valuable alternative to the well-established surgical treatment. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

System for face recognition under expression variations of neutral-sampled individuals using recognized expression warping and a virtual expression-face database

NASA Astrophysics Data System (ADS)

Petpairote, Chayanut; Madarasmi, Suthep; Chamnongthai, Kosin

2018-01-01

The practical identification of individuals using facial recognition techniques requires the matching of faces with specific expressions to faces from a neutral face database. A method for facial recognition under varied expressions against neutral face samples of individuals via recognition of expression warping and the use of a virtual expression-face database is proposed. In this method, facial expressions are recognized and the input expression faces are classified into facial expression groups. To aid facial recognition, the virtual expression-face database is sorted into average facial-expression shapes and by coarse- and fine-featured facial textures. Wrinkle information is also employed in classification by using a process of masking to adjust input faces to match the expression-face database. We evaluate the performance of the proposed method using the CMU multi-PIE, Cohn-Kanade, and AR expression-face databases, and we find that it provides significantly improved results in terms of face recognition accuracy compared to conventional methods and is acceptable for facial recognition under expression variation.

Perceptions of occupational injury and illness costs by size of organization.

PubMed

Haslam, C; Haefeli, K; Haslam, R

2010-09-01

Little is known about how organizations perceive and monitor occupational injury and illness costs. To explore perceptions of injury and illness costs, the extent to which organizations monitor their impact, attitudes towards this practice and views on using cost information in health and safety campaigns. Interviews were conducted with 212 representatives from 49 small- and medium-sized enterprises (SMEs) and 80 large organizations from a range of industry sectors. Health and safety investments were driven by a range of factors, of which cost reduction was only one. Human costs were also considered important. Injuries were perceived to represent a substantial business cost by 10% of respondents from SMEs and 56% of those from large organizations. Most were uncertain about the financial impact of work-related illness. No organizations had attempted to monitor occupational illness costs. Injury costs had been assessed within 3 SMEs and 30 large organizations. Only 12% of SME representatives recognized the benefits of costing health and safety failures and around half were unreceptive to the use of cost information in health and safety promotions. Two-thirds of those from large organizations recognized some benefit in measuring costs, and over three-quarters welcomed the provision of industry-specific information. Provision of information that focuses solely on the economic implications of occupational injury and illness may be of limited value and agencies involved in the promotion of health and safety should incorporate a range of information, taking into account the needs and concerns of different sectors.

The impact of sharps injuries on student nurses: a systematic review.

PubMed

Hambridge, Kevin; Nichols, Andrew; Endacott, Ruth

2016-10-27

The purpose of this review was to discover the impact of sharps injuries in the student nurse population. Much is known and reported about sharps injuries in registered nurses, but there has been a lack of published evidence regarding sharps injuries within the student nurse population. A systematic review of nursing, health and psychology databases was conducted. The limits set were publications between 1980 and 2014 in the English language. Studies were identified then, following a rigorous critical and quality appraisal with validated tools, were selected for the systematic review. A total of 40 articles met the inclusion criteria, reporting studies conducted in 18 countries. Psychological and physical impacts of sharps injuries in student nurses were reported, such as fear, anxiety and depression, although these impacts were not quantified using a validated instrument. The impact of sharps injuries can be severe, both psychological and physical. This systematic review shows that further research is needed into this, especially in under-researched areas such as the UK, to establish the impact of sharps injuries within this population. Further research would also aid the education and prevention of this harmful problem. The review also emphasises the psychological issues relating to sharps injuries, the impact these can have on individuals and the support and counselling that student nurses require after injury. These findings highlight the potential psychological issues that can result from sharps injuries in this population.

Contribution of neutrophils to acute lung injury.

PubMed

Grommes, Jochen; Soehnlein, Oliver

2011-01-01

Treatment of acute lung injury (ALI) and its most severe form, acute respiratory distress syndrome (ARDS), remain unsolved problems of intensive care medicine. ALI/ARDS are characterized by lung edema due to increased permeability of the alveolar-capillary barrier and subsequent impairment of arterial oxygenation. Lung edema, endothelial and epithelial injury are accompanied by an influx of neutrophils into the interstitium and broncheoalveolar space. Hence, activation and recruitment of neutrophils are regarded to play a key role in progression of ALI/ARDS. Neutrophils are the first cells to be recruited to the site of inflammation and have a potent antimicrobial armour that includes oxidants, proteinases and cationic peptides. Under pathological circumstances, however, unregulated release of these microbicidal compounds into the extracellular space paradoxically can damage host tissues. This review focuses on the mechanisms of neutrophil recruitment into the lung and on the contribution of neutrophils to tissue damage in ALI.

View Problems with Driving the YPR-765 Under Armour (Uitzichtproblemen bij onderluiks besturen van de YPR-765).

DTIC Science & Technology

1996-04-17

Through interviews with drivers and instructors of the YPR-765, an inventory was made of view problems with driving under armour . Problems with...beginning drivers was worse if executed under armour . Suggestions for improvement are given. The problems signalled appear to conflict with the

Factor Structure and Item Level Psychometrics of the Social Problem Solving Inventory Revised-Short Form in Traumatic Brain Injury

PubMed Central

Li, Chih-Ying; Waid-Ebbs, Julia; Velozo, Craig A.; Heaton, Shelley C.

2016-01-01

Primary Objective Social problem solving deficits characterize individuals with traumatic brain injury (TBI). Poor social problem solving interferes with daily functioning and productive lifestyles. Therefore, it is of vital importance to use the appropriate instrument to identify deficits in social problem solving for individuals with TBI. This study investigates factor structure and item-level psychometrics of the Social Problem Solving Inventory-Revised Short Form (SPSI-R:S), for adults with moderate and severe TBI. Research Design Secondary analysis of 90 adults with moderate and severe TBI who completed the SPSI-R:S. Methods and Procedures An exploratory factor analysis (EFA), principal components analysis (PCA) and Rasch analysis examined the factor structure and item-level psychometrics of the SPSI-R:S. Main Outcomes and Results The EFA showed three dominant factors, with positively worded items represented as the most definite factor. The other two factors are negative problem solving orientation and skills; and negative problem solving emotion. Rasch analyses confirmed the three factors are each unidimensional constructs. Conclusions The total score interpretability of the SPSI-R:S may be challenging due to the multidimensional structure of the total measure. Instead, we propose using three separate SPSI-R:S subscores to measure social problem solving for the TBI population. PMID:26052731

Factor structure and item level psychometrics of the Social Problem Solving Inventory-Revised: Short Form in traumatic brain injury.

PubMed

Li, Chih-Ying; Waid-Ebbs, Julia; Velozo, Craig A; Heaton, Shelley C

2016-01-01

Social problem-solving deficits characterise individuals with traumatic brain injury (TBI), and poor social problem solving interferes with daily functioning and productive lifestyles. Therefore, it is of vital importance to use the appropriate instrument to identify deficits in social problem solving for individuals with TBI. This study investigates factor structure and item-level psychometrics of the Social Problem Solving Inventory-Revised: Short Form (SPSI-R:S), for adults with moderate and severe TBI. Secondary analysis of 90 adults with moderate and severe TBI who completed the SPSI-R:S was performed. An exploratory factor analysis (EFA), principal components analysis (PCA) and Rasch analysis examined the factor structure and item-level psychometrics of the SPSI-R:S. The EFA showed three dominant factors, with positively worded items represented as the most definite factor. The other two factors are negative problem-solving orientation and skills; and negative problem-solving emotion. Rasch analyses confirmed the three factors are each unidimensional constructs. It was concluded that the total score interpretability of the SPSI-R:S may be challenging due to the multidimensional structure of the total measure. Instead, we propose using three separate SPSI-R:S subscores to measure social problem solving for the TBI population.

Motor vehicle driver injury severity study under various traffic control at highway-rail grade crossings in the United States.

PubMed

Hao, Wei; Daniel, Janice

2014-12-01

Based on the Federal Railway Administration (FRA) database, approximately 62% of the collisions at highway-rail crossings occurred at locations with active controls (gate and flashing lights), followed by passive controls (cross bucks and stop signs) with approximately 28% of accidents. The study applied an ordered probit model to explore the determinants of driver injury severity under various control measures at highway-rail grade crossing in the United States. The analysis found that schedule factor (peak hour), visibility, motor vehicle speed, train speed, driver's age, area type, traffic volume and highway pavement impact driver injury severity at both active and passive highway-rail crossings. For both active and passive control highway-rail grade crossings, speed control for both trains and vehicles will significantly reduce driver injury severity. However, the level of influence by vehicle speed and train speed at passive control is higher compared with active control. Paving highways at highway-rail grade crossings will also help to reduce driver injury severity at highway-rail crossing accidents. Published by Elsevier Ltd.

Assessment of Injuries During Brazilian Jiu-Jitsu Competition

PubMed Central

Scoggin, James F.; Brusovanik, Georgiy; Izuka, Byron H.; Zandee van Rilland, Eddy; Geling, Olga; Tokumura, Seren

2014-01-01

Background: Brazilian jiu-jitsu (BJJ) is a unique style of martial arts with rapid growth in the United States and internationally. Although studies have examined injuries in other martial arts and combat sports, to date, no published medical study has examined injuries in BJJ competitions. Purpose: (1) To estimate the incidence of injuries in BJJ competitions and (2) to identify and describe the types and mechanisms of injuries associated with competitive BJJ. Study Design: Descriptive epidemiology study. Methods: Injury data were obtained from records of on-site medical coverage at 8 statewide BJJ tournaments in Hawaii, USA, between 2005 and 2011. Results: The identified injury incidence on the day of matches was 9.2 per 1000 exposures (46 injuries out of 5022 exposures, ie, match participations). Orthopaedic injuries were the most common and accounted for 78% of all injuries (n = 36), followed by costochondral or rib injuries (n = 7) and lacerations requiring medical care (n = 3). The elbow was found to be the joint most commonly injured during BJJ competitions, with the arm bar being the most common mechanism. We propose that this BJJ-specific injury mechanism, the “arm bar,” be recognized as another mechanism of hyperextension injury to the elbow in sports. Conclusion: Comparison of the BJJ injury data with injury data reported for judo, taekwondo, wrestling, and mixed martial arts showed that BJJ competitors were at substantially lower risk of injury compared with these other sports. With orthopaedic injuries being most common and the elbow being the area most vulnerable to injury in BJJ, it is important that participants, referees, and physicians be properly educated about the unique mechanisms of injury that can occur, particularly to the elbow. PMID:26535299

Stochastic reduced order models for inverse problems under uncertainty

PubMed Central

Warner, James E.; Aquino, Wilkins; Grigoriu, Mircea D.

2014-01-01

This work presents a novel methodology for solving inverse problems under uncertainty using stochastic reduced order models (SROMs). Given statistical information about an observed state variable in a system, unknown parameters are estimated probabilistically through the solution of a model-constrained, stochastic optimization problem. The point of departure and crux of the proposed framework is the representation of a random quantity using a SROM - a low dimensional, discrete approximation to a continuous random element that permits e cient and non-intrusive stochastic computations. Characterizing the uncertainties with SROMs transforms the stochastic optimization problem into a deterministic one. The non-intrusive nature of SROMs facilitates e cient gradient computations for random vector unknowns and relies entirely on calls to existing deterministic solvers. Furthermore, the method is naturally extended to handle multiple sources of uncertainty in cases where state variable data, system parameters, and boundary conditions are all considered random. The new and widely-applicable SROM framework is formulated for a general stochastic optimization problem in terms of an abstract objective function and constraining model. For demonstration purposes, however, we study its performance in the specific case of inverse identification of random material parameters in elastodynamics. We demonstrate the ability to efficiently recover random shear moduli given material displacement statistics as input data. We also show that the approach remains effective for the case where the loading in the problem is random as well. PMID:25558115

Fatal laryngeal oedema in an adult from an air rifle injury, and related ballistics.

PubMed

Radojevic, Nemanja; Cukic, Dragana; Curovic, Ivana; Golubovic, Mileta

2015-01-01

Air guns (air pistols and rifles) are already recognized as being potentially lethal. The diabolo pellet has a calibre of .177 (4.5 mm), a 1250 fps velocity, is high energetic, and is most commonly used in such weapons. In the presented case, the victim sustained an air rifle injury to the neck. The pellet passed through the thyroid cartilage, subsequently causing the extensive laryngeal swelling with haematoma around the pellet channel which fatally obstructed the airway. It is estimated microscopically that at least a number of hours must have passed from the injury to the time of death. For this case, a shooting distance was estimated by using experimental shooting values compared to physics formulas for accelerated motion. The case under question has confirmed an applicable legal approach that can be utilized by countries to classify air rifles as being as harmful as other firearms, especially those with high muzzle velocities. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Neuropsychology of traumatic brain injury: An expert overview.

PubMed

Azouvi, P; Arnould, A; Dromer, E; Vallat-Azouvi, C

Traumatic brain injury (TBI) is a serious healthcare problem, and this report is a selective review of recent findings on the epidemiology, pathophysiology and neuropsychological impairments following TBI. Patients who survive moderate-to-severe TBI frequently suffer from a wide range of cognitive deficits and behavioral changes due to diffuse axonal injury. These deficits include slowed information-processing and impaired long-term memory, attention, working memory, executive function, social cognition and self-awareness. Mental fatigue is frequently also associated and can exacerbate the consequences of neuropsychological deficits. Personality and behavioral changes can include combinations of impulsivity and apathy. Even mild TBI raises specific problems: while most patients recover within a few weeks or months, a minority of patients may suffer from long-lasting symptoms (post-concussion syndrome). The pathophysiology of such persistent problems remains a subject of debate, but seems to be due to both injury-related and non-injury-related factors. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Psychological predictors of problem mobile phone use.

PubMed

Bianchi, Adriana; Phillips, James G

2005-02-01

Mobile phone use is banned or illegal under certain circumstances and in some jurisdictions. Nevertheless, some people still use their mobile phones despite recognized safety concerns, legislation, and informal bans. Drawing potential predictors from the addiction literature, this study sought to predict usage and, specifically, problematic mobile phone use from extraversion, self-esteem, neuroticism, gender, and age. To measure problem use, the Mobile Phone Problem Use Scale was devised and validated as a reliable self-report instrument, against the Addiction Potential Scale and overall mobile phone usage levels. Problem use was a function of age, extraversion, and low self-esteem, but not neuroticism. As extraverts are more likely to take risks, and young drivers feature prominently in automobile accidents, this study supports community concerns about mobile phone use, and identifies groups that should be targeted in any intervention campaigns.

Athletic Hip Injuries.

PubMed

Lynch, T Sean; Bedi, Asheesh; Larson, Christopher M

2017-04-01

Historically, athletic hip injuries have garnered little attention; however, these injuries account for approximately 6% of all sports injuries and their prevalence is increasing. At times, the diagnosis and management of hip injuries can be challenging and elusive for the team physician. Hip injuries are seen in high-level athletes who participate in cutting and pivoting sports that require rapid acceleration and deceleration. Described previously as the "sports hip triad," these injuries consist of adductor strains, osteitis pubis, athletic pubalgia, or core muscle injury, often with underlying range-of-motion limitations secondary to femoroacetabular impingement. These disorders can happen in isolation but frequently occur in combination. To add to the diagnostic challenge, numerous intra-articular disorders and extra-articular soft-tissue restraints about the hip can serve as pain generators, in addition to referred pain from the lumbar spine, bowel, bladder, and reproductive organs. Athletic hip conditions can be debilitating and often require a timely diagnosis to provide appropriate intervention.

Prevention of non-contact anterior cruciate ligament injuries in soccer players. Part 1: Mechanisms of injury and underlying risk factors.

PubMed

Alentorn-Geli, Eduard; Myer, Gregory D; Silvers, Holly J; Samitier, Gonzalo; Romero, Daniel; Lázaro-Haro, Cristina; Cugat, Ramón

2009-07-01

Soccer is the most commonly played sport in the world, with an estimated 265 million active soccer players by 2006. Inherent to this sport is the higher risk of injury to the anterior cruciate ligament (ACL) relative to other sports. ACL injury causes the most time lost from competition in soccer which has influenced a strong research focus to determine the risk factors for injury. This research emphasis has afforded a rapid influx of literature defining potential modifiable and non-modifiable risk factors that increase the risk of injury. The purpose of the current review is to sequence the most recent literature that reports potential mechanisms and risk factors for non-contact ACL injury in soccer players. Most ACL tears in soccer players are non-contact in nature. Common playing situations precluding a non-contact ACL injury include: change of direction or cutting maneuvers combined with deceleration, landing from a jump in or near full extension, and pivoting with knee near full extension and a planted foot. The most common non-contact ACL injury mechanism include a deceleration task with high knee internal extension torque (with or without perturbation) combined with dynamic valgus rotation with the body weight shifted over the injured leg and the plantar surface of the foot fixed flat on the playing surface. Potential extrinsic non-contact ACL injury risk factors include: dry weather and surface, and artificial surface instead of natural grass. Commonly purported intrinsic risk factors include: generalized and specific knee joint laxity, small and narrow intercondylar notch width (ratio of notch width to the diameter and cross sectional area of the ACL), pre-ovulatory phase of menstrual cycle in females not using oral contraceptives, decreased relative (to quadriceps) hamstring strength and recruitment, muscular fatigue by altering neuromuscular control, decreased "core" strength and proprioception, low trunk, hip, and knee flexion angles, and high

Pediatric falls from buildings: defining the burden of injury in Hawai'i.

PubMed

Sarkar, Joy; Wolfe, Stacey Q; Speck, Cora; Woods, Elizabeth; Lustik, Michael B; Edwards, Kurt D; Edwards, Mary J

2014-05-01

Falls from buildings, including houses, are an important cause of childhood injury in the United States; however, no study has previously examined the impact of this problem in Hawai'i. The objective of this study is to categorize the demographics and injury circumstances of pediatric falls from buildings in Hawai'i and compare to other US cities. Patients age 10 and under who were injured in nonfatal accidental falls from buildings in Hawai'i between 2005 and 2011 were identified retrospectively from a statewide repository of hospital billing data. The Hawai'i death certificate database was searched separately for deaths in children age 10 and under due to falls from buildings, with data available from 1991 through 2011. Data was reviewed for demographics, circumstances surrounding the injury, and level of hospital treatment. During the 7-year period for nonfatal injuries, 416 fall-related injuries were identified in children age 10 and younger. Of these, 86 required hospitalization. The rate of nonfatal injury in Hawai'i County was twice that of Honolulu and Maui Counties, and three times that of Kaua'i County. There were 9 fatal falls over a 21-year period. The population based incidence for nonfatal injuries was three-fold higher than that reported in the city of Dallas. The rate of hospitalizations following building falls was more than twice as high as the national average, and that of New York City, but similar to that of California. Strategies for education and environmental modification are reviewed, which may be helpful in reducing the incidence of pediatric falls from buildings in Hawai'i.

Sex Differences in Common Sports Injuries.

PubMed

Lin, Cindy; Casey, Ellen; Herman, Daniel; Katz, Nicole; Tenforde, Adam

2018-03-14

Common sports injuries include bone stress injuries (BSIs), anterior cruciate ligament (ACL) injuries, and concussions. Less commonly recognized are the specific sex differences in epidemiology, risk factors, and outcomes of these conditions by sex. An understanding of these factors can improve their clinical management, from prescribing appropriate prehabilitation to guiding postinjury rehabilitation and return to play. This narrative review summarizes the sex differences in the diagnosis and management of BSIs, ACL injuries, and concussions. Although BSIs are more common in female athletes, risk factors for both sexes include prior injury and relative energy deficiency in sport (RED-S). Risk factors in female athletes include smaller calf girth, femoral adduction, and higher rates of loading. Female athletes are also at greater risk for developing ACL injuries in high school and college, but their injury rate is similar in professional sports. Increased lateral tibial slope, smaller ACL size, and suboptimal landing mechanics are additional risk factors more often present in female athletes. Male athletes are more likely to have ACL surgery and have a higher rate of return to sport. Concussions occur more commonly in female athletes; however, female athletes are also more likely to report concussions. Male athletes more commonly sustain concussion through contact with another player. Female athletes more commonly sustain injury from contact with playing equipment. Managing post-concussion symptoms is important, and female athletes may have prolonged symptoms. An understanding of the sex-specific differences in these common sports injuries can help optimize their prehabilitation and rehabilitation. Copyright © 2018 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

Injury case-control studies using "other injuries" as controls.

PubMed

Marshall, Stephen W

2008-03-01

Studies of event-related (or "event-phase") interventions (such as ski helmets) can address injury at a specific body site (such as the head) by using as controls a group of people who experienced the same event (fall) and suffered injuries at other body sites (other than the head). The research question addressed by this type of study is the effect of an exposure or intervention (helmet) during the event phase (fall) of the causal chain. However, this is a valid case-control design only if the controls (skiers with other injuries) provide a reasonable proxy for the prevalence of exposure (helmet-wearing) in the underlying event-phase source population (skiers who fell). This assumption needs to be carefully assessed. Factors associated with both helmet-wearing and injury given a fall (eg, previous injury history, skiing inexperience, or risk-taking behavior) have considerable potential to create bias.

Injury prevention in Australian Indigenous communities.

PubMed

Ivers, Rebecca; Clapham, Kathleen; Senserrick, Teresa; Lyford, Marilyn; Stevenson, Mark

2008-12-01

Injury prevention in Indigenous communities in Australia is a continuing national challenge, with Indigenous fatality rates due to injury three times higher than the general population. Suicide and transport are the leading causes of injury mortality, and assault, transport and falls the primary causes of injury morbidity. Addressing the complex range of injury problems in disadvantaged Indigenous communities requires considerable work in building or enhancing existing capacity of communities to address local safety issues. Poor data, lack of funding and absence of targeted programs are some of the issues that impede injury prevention activities. Traditional approaches to injury prevention can be used to highlight key areas of need, however adaptations are needed in keeping with Indigenous peoples' holistic approach to health, linked to land and linked to community in order to address the complex spiritual, emotional and social determinants of Indigenous injury.

Cost-appropriateness of whole body vs limited bone imaging for suspected focal sports injuries

DOE Office of Scientific and Technical Information (OSTI.GOV)

Nagle, C.E.

Bone imaging has been recognized as a useful diagnostic tool in detecting the presence of focal musculoskeletal injury when radiographs are normal. A retrospective review of bone images in a small number of amateur athletes indicates that secondary injuries were commonly detected at sites different from the site of musculoskeletal pain being evaluated for injury. While a larger study will be necessary to confirm the data, this review suggests that it is medically justified and cost-appropriate to perform imaging of the entire skeleton as opposed to imaging limited to the anatomic site of pain and suspected injury.

The time has come to eliminate the gaps in the under-recognized burden of elder mistreatment: A community-based, cross-sectional study from rural eastern Nepal.

PubMed

Yadav, Uday Narayan; Tamang, Man Kumar; Paudel, Grish; Kafle, Bharat; Mehta, Suresh; Chandra Sekaran, Varalakshmi; Gruiskens, Jeroen R J H

2018-01-01

Elder mistreatment is a well-recognized public health issue with complex underlying factors. The current study hypothesized that there is no effect of any of the following factors on any type of elder mistreatment: ethnicity, age group, education status, gender, living arrangement, concentration problems, medication for any disease, income level of caregiver, use of alcohol and tobacco products, and dependence on family or caregivers for daily activities. We conducted a cross-sectional study of 339 elders adults aged 60 or above residing in a rural part of eastern Nepal between August and November 2016. Multi-stage cluster sampling was adopted to select the study subjects. Information was collected using semi-structured questionnaires administered to elderly people by a designated interviewer. Factors associated with elder mistreatment were analyzed using logistic regression. Our findings revealed that 61.7% of 60+-year-olds experienced some form of mistreatment (physical 2.4%, psychological 22.4%, caregiver neglect 57.5%, financial 12.1% and stranger-inflicted 8.3%). Elder mistreatment was associated with the following characteristics of elders: dependent on family for daily living activities, illiterate, experiencing concentration problems, residing in a living arrangement with their son(s)/daughter(s)-in-law, taking regular medications, belonging to the Dalit community according to the Hindu traditional caste system, and residing with a caregiver having a monthly family income of less than NRs. 20,000 (193USD). Our data show that elder mistreatment is prevalent in a rural community of Nepal. Addressing the lower socio-economic or socio-cultural classes of caregivers and elders via community-focused development programs might have significant implications for improving the well-being of elders.

Cerebellar injury in preterm infants.

PubMed

Tam, Emily W Y

2018-01-01

Although preterm birth is best known to result in adverse neurodevelopmental outcomes through injury of the supratentorial structures, including intraventricular hemorrhage and periventricular leukomalacia, the cerebellum has become increasingly recognized as an important target for injury and adverse motor and cognitive outcomes. Undergoing the most dramatic growth during the preterm period, the cerebellum is vulnerable to large and small hemorrhages, as well as hypoplasia resulting from a number of potentially modifiable risk factors. These factors include contact with intraventricular blood, crossed cerebrocerebellar diaschisis, postnatal glucocorticoid exposure, pain and opioid exposure, nutrition and somatic growth, cardiorespiratory factors, and socioeconomic status. Strategies targeting these factors may result in prevention of the motor and cognitive deficits seen after cerebellar hemorrhage or hypoplasia. Copyright © 2018 Elsevier B.V. All rights reserved.

Online Problem Solving for Adolescent Brain Injury: A Randomized Trial of 2 Approaches.

PubMed

Wade, Shari L; Taylor, Hudson Gerry; Yeates, Keith Owen; Kirkwood, Michael; Zang, Huaiyu; McNally, Kelly; Stacin, Terry; Zhang, Nanhua

Adolescent traumatic brain injury (TBI) contributes to deficits in executive functioning and behavior, but few evidence-based treatments exist. We conducted a randomized clinical trial comparing Teen Online Problem Solving with Family (TOPS-Family) with Teen Online Problem Solving with Teen Only (TOPS-TO) or the access to Internet Resources Comparison (IRC) group. Children, aged 11 to 18 years, who sustained a complicated mild-to-severe TBI in the previous 18 months were randomly assigned to the TOPS-Family (49), TOPS-TO (51), or IRC group (52). Parent and self-report measures of externalizing behaviors and executive functioning were completed before treatment and 6 months later. Treatment effects were examined using linear regression models, adjusting for baseline symptom levels. Age, maternal education, and family stresses were examined as moderators. The TOPS-Family group had lower levels of parent-reported executive dysfunction at follow-up than the TOPS-TO group, and differences between the TOPS-Family and IRC groups approached significance. Maternal education moderated improvements in parent-reported externalizing behaviors, with less educated parents in the TOPS-Family group reporting fewer symptoms. On the self-report Behavior Rating Inventory of Executive Functions, treatment efficacy varied with the level of parental stresses. The TOPS-Family group reported greater improvements at low stress levels, whereas the TOPS-TO group reported greater improvement at high-stress levels. The TOPS-TO group did not have significantly lower symptoms than the IRC group on any comparison. Findings support the efficacy of online family problem solving to address executive dysfunction and improve externalizing behaviors among youth with TBI from less advantaged households. Treatment with the teen alone may be indicated in high-stress families.

Lip and tooth injuries at public swimming pools in Austria.

PubMed

Lechner, Katharina; Connert, Thomas; Kühl, Sebastian; Filippi, Andreas

2017-06-01

There is an increased risk of orofacial injuries in swimming pool facilities. Nevertheless, only a few studies have addressed this issue. The aim of this study was to identify the frequency of lip and tooth injuries at public swimming pools in Austria. A further aim was to examine which gender and age groups were affected, where and why these injuries occurred, and whether pool attendants had sufficient knowledge of dental first-aid measures. A total of 764 pool attendants in Austria were contacted by telephone and 689 participated in the study (90.2%). The attendants were interviewed retrospectively about accident occurrences in 2014 by a standardized questionnaire. Responses to the provision of first aid and choice of storage medium for avulsed teeth were subsequently evaluated. The frequency of lip injuries was 19.0%, and tooth injuries were 11.3%. Male bathers (P < .05) and children under 12 years (P < .001) most frequently suffered injuries. The waterslide was the most common accident site. The most common cause of lip injuries was slipping on wet surfaces (39.0%), and for tooth injuries it was collisions with other persons or objects (each 28.1%). The pool attendants' responses were predominantly good or sufficient on first aid, with the exception of what storage medium to choose. Tooth rescue boxes were available in only 8.6% of all pool facilities. Orofacial injuries are a frequently occurring problem in swimming pool facilities. The pool attendants' knowledge on first-aid care of tooth injuries could still be improved. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Predictors of injury among adult recreational in-line skaters: a multicity study.

PubMed Central

Seldes, R M; Grisso, J A; Pavell, J R; Berlin, J A; Tan, V; Bowman, B; Kinman, J L; Fitzgerald, R H

1999-01-01

OBJECTIVES: This study examined risk factors for injury, injury prevalence, safety gear use, and skating habits of adult recreational in-line skaters. METHODS: Randomly selected in-line skaters in 6 major US cities were interviewed. RESULTS: Only 6% of skaters consistently wore all 4 recommended types of safety gear. Skaters with greater skating experience were more likely to perform tricks, wear less safety gear, and sustain an injury. CONCLUSION: More experienced adult recreational in-line skaters are at increased risk for injury. Safety gear use in alarmingly low in adult recreational in-line skaters, especially experienced skaters. Safe skating education programs should consider targeting this newly recognized at-risk skating population. PMID:9949756

The crack-contact and the free-end problem for a strip under residual stress

NASA Technical Reports Server (NTRS)

Bakioglu, M.; Erdogan, F.

1977-01-01

The plane problem for an infinite strip with two edge cracks under a given state of residual stress is considered. The residual stress is compressive near and at the surfaces and tensile in the interior of the strip. If the crack is deep enough to penetrate into the tensile zone, then the problem is one of crack-contact where the depth of the contact area is an unknown which depends on the crack depth and the residual stress profile. The problem has applications to the static fatigue of glass plates and is solved for three typical residual-stress profiles. In the limiting case of the crack's crossing the entire plate thickness, the problem becomes a stressfree end problem for a semiinfinite strip under a given residual-stress state away from the end. This is a typical stress diffusion problem in which decay behavior of the residual stress near and the nature of the normal displacement at the end of the semiinfinite strip are of special interest. For two typical residual-stress states the solution is obtained, and some numerical results are given.

Pediatric Traumatic Brain Injury. Special Topic Report #3.

ERIC Educational Resources Information Center

Waaland, Pamela K.; Cockrell, Janice L.

This brief report summarizes what is known about pediatric traumatic brain injury, including the following: risk factors (e.g., males especially those ages 5 to 25, youth with preexisting problems including previous head injury victims, and children receiving inadequate supervision); life after injury; physical and neurological consequences (e.g.,…

Traumatic brain injury produced by exposure to blasts, a critical problem in current wars: biomarkers, clinical studies, and animal models

NASA Astrophysics Data System (ADS)

Dixon, C. Edward

2011-06-01

Traumatic brain injury (TBI) resulting from exposure to blast energy released by Improvised Explosive Devices (IEDs) has been recognized as the "signature injury" of Operation Iraqi Freedom and Operation Enduring Freedom. Repeated exposure to mild blasts may produce subtle deficits that are difficult to detect and quantify. Several techniques have been used to detect subtle brain dysfunction including neuropsychological assessments, computerized function testing and neuroimaging. Another approach is based on measurement of biologic substances (e.g. proteins) that are released into the body after a TBI. Recent studies measuring biomarkers in CSF and serum from patients with severe TBI have demonstrated the diagnostic, prognostic, and monitoring potential. Advancement of the field will require 1) biochemical mining for new biomarker candidates, 2) clinical validation of utility, 3) technical advances for more sensitive, portable detectors, 4) novel statistical approach to evaluate multiple biomarkers, and 5) commercialization. Animal models have been developed to simulate elements of blast-relevant TBI including gas-driven shock tubes to generate pressure waves similar to those produced by explosives. These models can reproduce hallmark clinical neuropathological responses such as neuronal degeneration and inflammation, as well as behavioral impairments. An important application of these models is to screen novel therapies and conduct proteomic, genomic, and lipodomic studies to mine for new biomarker candidates specific to blast relevant TBI.

The Crack-contact and the Free End Problem for a Strip Under Residual Stress

NASA Technical Reports Server (NTRS)

Bakioglu, M.; Erdogan, F.

1976-01-01

The plane problem for an infinite strip with two edge cracks under a given state of residual stress is considered. The residual stress is compressive near and at the surfaces and tensile in the interior of the strip. If the crack is deep enough to penetrate into the tensile zone, then the problem is one of crack-contact problem in which the depth of the contact area is an unknown which depends on the crack depth and the residual stress profile. The problem has applications to the static fatigue of glass plates and is solved for three typical residual stress profiles. In the limiting case of the crack crossing the entire plate thickness, the problem becomes a stress-free end problem for a semi-infinite strip under a given residual stress state away from the end. This is a typical stress diffusion problem in which decay behavior of the residual stress near and the nature of the normal displacement at the end of the semi-infinite strip are of special interest. For two typical residual stress states the solution is obtained, and some numerical results are given.

Facilitating students' application of the integral and the area under the curve concepts in physics problems

NASA Astrophysics Data System (ADS)

Nguyen, Dong-Hai

This research project investigates the difficulties students encounter when solving physics problems involving the integral and the area under the curve concepts and the strategies to facilitate students learning to solve those types of problems. The research contexts of this project are calculus-based physics courses covering mechanics and electromagnetism. In phase I of the project, individual teaching/learning interviews were conducted with 20 students in mechanics and 15 students from the same cohort in electromagnetism. The students were asked to solve problems on several topics of mechanics and electromagnetism. These problems involved calculating physical quantities (e.g. velocity, acceleration, work, electric field, electric resistance, electric current) by integrating or finding the area under the curve of functions of related quantities (e.g. position, velocity, force, charge density, resistivity, current density). Verbal hints were provided when students made an error or were unable to proceed. A total number of 140 one-hour interviews were conducted in this phase, which provided insights into students' difficulties when solving the problems involving the integral and the area under the curve concepts and the hints to help students overcome those difficulties. In phase II of the project, tutorials were created to facilitate students' learning to solve physics problems involving the integral and the area under the curve concepts. Each tutorial consisted of a set of exercises and a protocol that incorporated the helpful hints to target the difficulties that students expressed in phase I of the project. Focus group learning interviews were conducted to test the effectiveness of the tutorials in comparison with standard learning materials (i.e. textbook problems and solutions). Overall results indicated that students learning with our tutorials outperformed students learning with standard materials in applying the integral and the area under the curve

Dirt bikes injuries in children.

PubMed

Abdelgawad, A A; Maxfield, D; Tran, S; Mclean, S; Kanlic, E M

2013-12-01

Dirt bike riding is becoming a more popular recreational activity among children. Injuries associated with this recreational activity did not gain attention in the medical literature. The purpose of this study is to assess orthopedic injuries associated with dirt bike riding. We retrospectively studied injuries occurring in children less than 18 years old, while riding dirt bikes, that required admission to the trauma department in our level one trauma center during the period 2000-2010. There were 24 admissions (23 patients). The mean age was 13. Fourteen patients had brain injuries. Six patients had abdominal injuries. One patient died shortly after arriving to the emergency department. Fourteen patients had face and neck injuries. The average injury severity score was 8.5. Thirteen patients' admissions (54 %) had orthopedic fractures. Five of 13 patients (38 %) suffered more than one fracture. Eight patients needed orthopedic intervention (seven of these were in operating room under general anesthesia and one in the emergency department under conscious sedation). Femur fracture was the most common cause for performing surgery in this group of patients. Riding dirt bikes is not a safe recreational activity. Orthopedic injuries constitute a major component of the injuries affecting children riding dirt bikes. Orthopedic surgeons (being responsible for treating most of these children) have the obligation to warn the community against the possible dangers facing children who ride dirt bikes.

Preventing sports injuries: opportunities for intervention in youth athletics.

PubMed

Weaver, Nancy L; Marshall, Stephen W; Miller, Mark D

2002-03-01

Participation in youth sports has steadily grown over the past 30 years and continues to rise. During the 1998-1999 school year over 360,000 collegiate athletes and almost 6.5 million high school athletes participated in sports. This expansion has been accompanied by an increased awareness of the injury problem associated with participation in youth sports. Estimates are that one-third of high school athletes will sustain an injury during a sports season serious enough to result in time lost from participation. While there may always be some risk associated with sports participation, health professionals can actively encourage injury prevention. In this paper, we describe the benefits of sport participation, the injury problem associated with sports, injury prevention frameworks, and conclude by discussing the changing role of the team physician in youth sports.

Recognizing the professionals who help to solve "the population problem".

PubMed

Miro, C A

1984-12-01

It is the population professionals who belong to the "developing" world who have helped to create and expand the basic information which makes it possible to describe the demographic situation of countries and social groups more adequately. These professionals have developed, promoted, and applied analytical techniques which have enriched understanding of the components of demographic change. It is these professionals who have managed to make major contributions towards explaining the relationship between demographic and socioeconomic factors. The professionals are insisting on developing applied, theoretical, and methodological population research, the results of which will serve essentially to propose alternatives for action. This group of professionals participates daily in the training of technical staff and professionals and academics, specialists who will continue to promote the development of demography as a discipline. Finally, these professionals, through various publications, keep population topics at the center of the attention of those who are concerned with studying them. Groups of countries in Africa, Asia, and Latin America suffer, although to a different extent and in different ways, from the problems created by the rapid growth of certain cities, particularly capital cities. In addition to the problems which may arise from the operation of the specific population dynamics in different countries and between different social groups within those countries, there are those arising from the unequal distribution of agricultural land, foodstuffs, and wealth in general, those arising from the unjust organization of the international economy and from the obsolete international financial structure, and those deriving from the irrational use of resources for military spending and the manufacture and stockpiling of vast nuclear arsenals.

Pediatric lower extremity mower injuries.

PubMed

Hill, Sean M; Elwood, Eric T

2011-09-01

Lawn mower injuries in children represent an unfortunate common problem to the plastic reconstructive surgeon. There are approximately 68,000 per year reported in the United States. Compounding this problem is the fact that a standard treatment algorithm does not exist. This study follows a series of 7 pediatric patients treated for lower extremity mower injuries by a single plastic surgeon. The extent of soft tissue injury varied. All patients were treated with negative pressure wound therapy as a bridge to definitive closure. Of the 7 patients, 4 required skin grafts, 1 required primary closure, 1 underwent a lower extremity amputation secondary to wounds, and 1 was repaired using a cross-leg flap. Function limitations were minimal for all of our patients after reconstruction. Our basic treatment algorithm is presented with initial debridement followed by the simplest method possible for wound closure using negative pressure wound therapy, if necessary.

Severe Self-Injurious Behavior: The Problem of Clinical Control

ERIC Educational Resources Information Center

Romanczyk, Raymond G.; Goren, Elizabeth R.

1975-01-01

The long-term treatment program and follow-up of a case of chronic, severe, multiple self-injurious behavior is presented. Contingent electric shock and differential reinforcement of other behavior were the primary techniques utilized. Total suppression was achieved in the laboratory setting, but extending control to the natural environment proved…

29 CFR 100.401 - Claims under the Federal Tort Claims Act for loss of or damage to property or for personal injury...

Code of Federal Regulations, 2010 CFR

2010-07-01

... 29 Labor 2 2010-07-01 2010-07-01 false Claims under the Federal Tort Claims Act for loss of or damage to property or for personal injury or death. 100.401 Section 100.401 Labor Regulations Relating to Labor NATIONAL LABOR RELATIONS BOARD ADMINISTRATIVE REGULATIONS Claims Under the Federal Tort Claims Act § 100.401 Claims under the Federal Tort...

The Effect of Learning Environments Based on Problem Solving on Students' Achievements of Problem Solving

ERIC Educational Resources Information Center

Karatas, Ilhan; Baki, Adnan

2013-01-01

Problem solving is recognized as an important life skill involving a range of processes including analyzing, interpreting, reasoning, predicting, evaluating and reflecting. For that reason educating students as efficient problem solvers is an important role of mathematics education. Problem solving skill is the centre of mathematics curriculum.…

A deep convolutional neural network for recognizing foods

NASA Astrophysics Data System (ADS)

Jahani Heravi, Elnaz; Habibi Aghdam, Hamed; Puig, Domenec

2015-12-01

Controlling the food intake is an efficient way that each person can undertake to tackle the obesity problem in countries worldwide. This is achievable by developing a smartphone application that is able to recognize foods and compute their calories. State-of-art methods are chiefly based on hand-crafted feature extraction methods such as HOG and Gabor. Recent advances in large-scale object recognition datasets such as ImageNet have revealed that deep Convolutional Neural Networks (CNN) possess more representation power than the hand-crafted features. The main challenge with CNNs is to find the appropriate architecture for each problem. In this paper, we propose a deep CNN which consists of 769; 988 parameters. Our experiments show that the proposed CNN outperforms the state-of-art methods and improves the best result of traditional methods 17%. Moreover, using an ensemble of two CNNs that have been trained two different times, we are able to improve the classification performance 21:5%.

The AIS-2005 Revision in Severe Traumatic Brain Injury: Mission Accomplished or Problems for Future Research?

PubMed Central

Carroll, Christopher P.; Cochran, Joseph A.; Price, Janet P.; Guse, Clare E.; Wang, Marjorie C.

2010-01-01

The Abbreviated Injury Scale (AIS) is commonly used to score injury severity and describe types of injuries. In 2005, the AIS-Head section was revised to capture more detailed information about head injuries and to better reflect their clinical severity, but the impact of these changes is largely unknown. The purpose of this study was to compare AIS-1998 and AIS-2005 coding of traumatic brain injuries (TBI) using medical records at a single Level I trauma center. We included patients with severe TBI (Glasgow Coma Scale 3–8) after blunt injury, excluding those who were missing medical records. Detailed descriptions of injuries were collected, then manually coded into AIS-1998 and AIS-2005 by the same Certified AIS Specialist. Compared to AIS-1998, AIS-2005 coded the same injuries with lower severity scores [p<0.01] and with decreased mean and maximum AIS-Head scores [p<0.01]. Of the types of traumatic brain injuries, most of the changes occurred among cerebellar and cerebral injuries. Traumatic hypoxic brain injury secondary to systemic dysfunction was captured by AIS-2005 but not by AIS-1998. However, AIS-2005 captured fewer loss of consciousness cases due to changes in criteria for coding concussive injury. In conclusion, changes from AIS-1998 to AIS-2005 result in significant differences in severity scores and types of injuries captured. This may complicate future TBI research by precluding direct comparison to datasets using AIS-1998. TBIs should be coded into the same AIS-version for comparison or evaluation of trends, and specify which AIS-version is used. PMID:21050606

The AIS-2005 Revision in Severe Traumatic Brain Injury: Mission Accomplished or Problems for Future Research?

PubMed

Carroll, Christopher P; Cochran, Joseph A; Price, Janet P; Guse, Clare E; Wang, Marjorie C

2010-01-01

The Abbreviated Injury Scale (AIS) is commonly used to score injury severity and describe types of injuries. In 2005, the AIS-Head section was revised to capture more detailed information about head injuries and to better reflect their clinical severity, but the impact of these changes is largely unknown. The purpose of this study was to compare AIS-1998 and AIS-2005 coding of traumatic brain injuries (TBI) using medical records at a single Level I trauma center. We included patients with severe TBI (Glasgow Coma Scale 3-8) after blunt injury, excluding those who were missing medical records. Detailed descriptions of injuries were collected, then manually coded into AIS-1998 and AIS-2005 by the same Certified AIS Specialist. Compared to AIS-1998, AIS-2005 coded the same injuries with lower severity scores [p<0.01] and with decreased mean and maximum AIS-Head scores [p<0.01]. Of the types of traumatic brain injuries, most of the changes occurred among cerebellar and cerebral injuries. Traumatic hypoxic brain injury secondary to systemic dysfunction was captured by AIS-2005 but not by AIS-1998. However, AIS-2005 captured fewer loss of consciousness cases due to changes in criteria for coding concussive injury. In conclusion, changes from AIS-1998 to AIS-2005 result in significant differences in severity scores and types of injuries captured. This may complicate future TBI research by precluding direct comparison to datasets using AIS-1998. TBIs should be coded into the same AIS-version for comparison or evaluation of trends, and specify which AIS-version is used.

Telephone-delivered problem-solving training after mild traumatic brain injury: Qualitative analysis of service members' perceptions.

PubMed

Brockway, Jo Ann; St De Lore, Jef; Fann, Jesse R; Hart, Tessa; Hurst, Samantha; Fey-Hinckley, Sara; Savage, Jocelyn; Warren, Michael; Bell, Kathleen R

2016-08-01

The purpose of this study was to identify the specific reasons for service members' satisfaction or dissatisfaction with problem-solving training (PST), telephone delivery, and other aspects of a telephone-delivered PST intervention in order to determine what might enhance this approach for future clinical use. Standard qualitative methods were employed, using a "process" coding strategy to explore the conceptual perceptions of the intervention experience as suggested by the data recorded from final telephone interviews of 80 service members who participated in a randomized controlled trial evaluating the efficacy of telephone-delivered PST after having sustained concussions or mild traumatic brain injuries during recent (PsycINFO Database Record (c) 2016 APA, all rights reserved).

[Impact of acquired brain injury towards the community integration: employment outcome, disability and dependence two years after injury].

PubMed

Luna-Lario, P; Ojeda, N; Tirapu-Ustarroz, J; Pena, J

2016-06-16

To analyze the impact of acquired brain injury towards the community integration (professional career, disability, and dependence) in a sample of people affected by vascular, traumatic and tumor etiology acquired brain damage, over a two year time period after the original injury, and also to examine what sociodemographic variables, premorbid and injury related clinical data can predict the level of the person's integration into the community. 106 adults sample suffering from acquired brain injury who were attended by the Neuropsychology and Neuropsychiatry Department at Hospital of Navarra (Spain) affected by memory deficit as their main sequel. Differences among groups have been analyzed by using t by Student, chi squared and U by Mann-Whitney tests. 19% and 29% of the participants who were actively working before the injury got back their previous status within one and two years time respectively. 45% of the total sample were recognized disabled and 17% dependant. No relationship between sociodemographic and clinical variables and functional parameters observed were found. Acquired brain damage presents a high intensity impact on affected person's life trajectory. Nevertheless, in Spain, its consequences at sociolaboral adjustment over the the two years following the damage through functional parameters analyzed with official governmental means over a vascular, traumatic and tumor etiology sample had never been studied before.

Muscle injury is the principal injury type and hamstring muscle injury is the first injury diagnosis during top-level international athletics championships between 2007 and 2015.

PubMed

Edouard, Pascal; Branco, Pedro; Alonso, Juan-Manuel

2016-05-01

During top-level international athletics championships, muscle injuries are frequent. To analyse the incidence and characteristics of muscle injuries and hamstring muscle injuries (hamstring injuries) occurring during top-level international athletics championships. During 16 international championships held between 2007 and 2015, national medical team and local organising committee physicians reported daily all injuries on a standardised injury report form. Only muscle injuries (muscle tears and muscle cramps) and hamstring injuries have been analysed. 40.9% of all recorded injuries (n=720) were muscle injuries, with 57.5% of them resulting in time loss. The overall incidence of muscle injuries was higher in male athletes than female athletes (51.9±6.0 vs 30.3±5.0 injuries per 1000 registered athletes, respectively; RR=1.71; 95% CI 1.45 to 2.01). Muscle injuries mainly affected the thigh (52.9%) and lower leg (20.1%), and were mostly caused by overuse with sudden onset (38.2%) and non-contact trauma (24.6%). Muscle injury risk varied according to the event groups. Hamstring injuries represented 17.1% of all injuries, with a higher risk in male compared to female athletes (22.4±3.4 vs 11.5±2.6 injuries per 1000 registered athletes, respectively; RR=1.94; 95% CI 1.42 to 2.66). During international athletics championships, muscle injury is the principal type of injury, and among those, the hamstring is the most commonly affected, with a two times higher risk in male than female athletes. Athletes in explosive power events, male athletes and older male athletes, in specific were more at risk of muscle injuries and hamstring injuries. Injury prevention strategies should be sex-specific. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Longboard and skateboard injuries.

PubMed

Keays, Glenn; Dumas, Alex

2014-08-01

The causes and events related to skateboarding injuries have been widely documented. However, little is known about longboard-related injuries. With five deaths linked to longboarding in the United States and Canada in 2012, some cities are already considering banning the practice. This study compared the types and causes of longboarding-related injuries to those associated with skateboarding. We conducted a retrospective cohort study, using an emergency-based surveillance system, on patients under the age of 18 who had been injured while longboarding or skateboarding between 2006 and 2010. A total of 287 longboarding and 4198 skateboarding cases were identified. There were more females in the longboarding group (18.8%) than in the skateboarding one (10.7%, p < 0.002). All the injured longboarders were older than 10 years of age while a fifth of the injured skateboarders were under the age of 11. Longboarders' injuries occurred mainly on streets and roads (75.3% vs. 34.3% in skateboarders, p < 0.000) and rarely in skate parks (1.4% vs. 26.4% in skateboarders, p < 0.000). Longboarders suffered twice as many injuries to their heads and necks (23.3% vs. 13.1%, p < 0.000) and twice as many severe neurological traumas (8.6 vs. 3.7%, p < 0.000) while skateboarders suffered more injuries to their lower extremities (33.7% vs. 24.7%, p < 0.002). Longboarding is associated with a different pattern of injuries than skateboarding. Because longboarders suffer more intracranial injuries, the importance of helmet use should be especially strongly reinforced. Copyright © 2014 Elsevier Ltd. All rights reserved.

Problem Solving Under Time-Constraints.

ERIC Educational Resources Information Center

Richardson, Michael; Hunt, Earl

A model of how automated and controlled processing can be mixed in computer simulations of problem solving is proposed. It is based on previous work by Hunt and Lansman (1983), who developed a model of problem solving that could reproduce the data obtained with several attention and performance paradigms, extending production-system notation to…

Category cued recall evokes a generate-recognize retrieval process.

PubMed

Hunt, R Reed; Smith, Rebekah E; Toth, Jeffrey P

2016-03-01

The experiments reported here were designed to replicate and extend McCabe, Roediger, and Karpicke's (2011) finding that retrieval in category cued recall involves both controlled and automatic processes. The extension entailed identifying whether distinctive encoding affected 1 or both of these 2 processes. The first experiment successfully replicated McCabe et al., but the second, which added a critical baseline condition, produced data inconsistent with a 2 independent process model of recall. The third experiment provided evidence that retrieval in category cued recall reflects a generate-recognize strategy, with the effect of distinctive processing being localized to recognition. Overall, the data suggest that category cued recall evokes a generate-recognize retrieval strategy and that the subprocesses underlying this strategy can be dissociated as a function of distinctive versus relational encoding processes. (c) 2016 APA, all rights reserved).

Category Cued Recall Evokes a Generate-Recognize Retrieval Process

PubMed Central

Hunt, R. Reed; Smith, Rebekah E.; Toth, Jeffrey P.

2015-01-01

The experiments reported here were designed to replicate and extend McCabe, Roediger, and Karpicke’s (2011) finding that retrieval in category cued recall involves both controlled and automatic processes. The extension entailed identifying whether distinctive encoding affected one or both of these two processes. The first experiment successfully replicated McCabe et al., but the second, which added a critical baseline condition, produced data inconsistent with a two independent process model of recall. The third experiment provided evidence that retrieval in category cued recall reflects a generate-recognize strategy, with the effect of distinctive processing being localized to recognition. Overall, the data suggest that category cued recall evokes a generate-recognize retrieval strategy and that the sub-processes underlying this strategy can be dissociated as a function of distinctive versus relational encoding processes. PMID:26280355

An Unsolved Mystery: The Target-Recognizing RNA Species of MicroRNA Genes

PubMed Central

Chen, Chang-Zheng

2013-01-01

MicroRNAs (miRNAs) are an abundant class of endogenous ~ 21-nucleotide (nt) RNAs. These small RNAs are produced from long primary miRNA transcripts — pri-miRNAs — through sequential endonucleolytic maturation steps that yield precursor miRNA (pre-miRNA) intermediates and then the mature miRNAs. The mature miRNAs are loaded into the RNA-induced silencing complexes (RISC), and guide RISC to target mRNAs for cleavage and/or translational repression. This paradigm, which represents one of major discoveries of modern molecular biology, is built on the assumption that mature miRNAs are the only species produced from miRNA genes that recognize targets. This assumption has guided the miRNA field for more than a decade and has led to our current understanding of the mechanisms of target recognition and repression by miRNAs. Although progress has been made, fundamental questions remain unanswered with regard to the principles of target recognition and mechanisms of repression. Here I raise questions about the assumption that mature miRNAs are the only target-recognizing species produced from miRNA genes and discuss the consequences of working under an incomplete or incorrect assumption. Moreover, I present evolution-based and experimental evidence that support the roles of pri-/pre-miRNAs in target recognition and repression. Finally, I propose a conceptual framework that integrates the functions of pri-/pre-miRNAs and mature miRNAs in target recognition and repression. The integrated framework opens experimental enquiry and permits interpretation of fundamental problems that have so far been precluded. PMID:23685275

Under pressure: progressively enlarging facial mass following high-pressure paint injection injury.

PubMed

Mushtaq, Jameel; Walker, Abigail; Hunter, Ben

2016-01-19

High-pressure paint injection injuries are relatively rare industrial accidents and almost exclusively occur on the non-dominant hand. A rarely documented complication of these injuries is the formation of a foreign body granuloma. We report a case of a 33-year-old man presenting with extensive facial scarring and progressive right paranasal swelling 7 years after a high-pressure paint injury. After imaging investigations, an excision of the mass and revision of scarring was performed. Access to the mass was gained indirectly through existing scarring over the nose to ensure an aesthetic result. Histological analysis revealed a florid granulomatous foreign body reaction to retained paint. To the best of our knowledge, this is the first reported case of a facial high-pressure paint injury with consequent formation of a foreign body granuloma. 2016 BMJ Publishing Group Ltd.

Ultrasports Are In--In Spite of Injuries.

ERIC Educational Resources Information Center

Murphy, Patrick

1986-01-01

Participation in ultraendurance sports events is up. Ultraendurance athletes are pushing their bodies to limits that haven't been achieved before. Overuse injuries are the most common complaint, but other medical problems occur with frequency. Events are described, as are injuries associated with them. (MT)

Review of liver injury associated with dietary supplements.

PubMed

Stickel, Felix; Kessebohm, Kerstin; Weimann, Rosemarie; Seitz, Helmut K

2011-05-01

Dietary supplements (DS) are easily available and increasingly used, and adverse hepatic reactions have been reported following their intake. To critically review the literature on liver injury because of DSs, delineating patterns and mechanisms of injury and to increase the awareness towards this cause of acute and chronic liver damage. Studies and case reports on liver injury specifically because of DSs published between 1990 and 2010 were searched in the PubMed and EMBASE data bases using the terms 'dietary/nutritional supplements', 'adverse hepatic reactions', 'liver injury'; 'hepatitis', 'liver failure', 'vitamin A' and 'retinoids', and reviewed for yet unidentified publications. Significant liver injury was reported after intake of Herbalife and Hydroxycut products, tea extracts from Camellia sinensis, products containing usnic acid and high contents of vitamin A, anabolic steroids and others. No uniform pattern of hepatotoxicity has been identified and severity may range from asymptomatic elevations of serum liver enzymes to hepatic failure and death. Exact estimates on how frequent adverse hepatic reactions occur as a result of DSs cannot be provided. Liver injury from DSs mimicking other liver diseases is increasingly recognized. Measures to reduce risk include tighter regulation of their production and distribution and increased awareness of users and professionals of the potential risks. © 2011 John Wiley & Sons A/S.

Teaching Unmotivated and Under-Motivated College Students: Problems, Challenges, and Considerations

ERIC Educational Resources Information Center

McFarlane, Donovan A.

2010-01-01

This essay addresses a critical problem in today's college classroom: dealing with unmotivated and under-motivated students whose inclination toward learning stems from both academic and social factors that the faculty must effectively address to meet teaching-learning goals, meet course requirements, and his or her responsibility in contributing…

48 CFR 31.107 - Contracts with State, local, and federally recognized Indian tribal governments.

Code of Federal Regulations, 2011 CFR

2011-10-01

... to contracts with State, local, and federally recognized Indian tribal governments. They provide the basis for a uniform approach to the problem of determining costs and to promote efficiency and better... requirements promulgated by the sponsoring Government agencies. (b) The Office of Management and Budget will...

Traumatic injuries to the urethra.

PubMed

McAninch, J W

1981-04-01

Major urethral injuries from external trauma are complex problems of diagnosis and treatment. Complications resulting from injury, failed diagnosis, and inappropriate therapy include stricture, impotent, and incontinence. Opinions differ as to whether immediate suprapubic cystostomy followed by later reconstruction is preferable to immediate direct urethral realignment. A review of 30 patients with urethral injuries is presented, 27 male and three female, 29 from blunt trauma and one gunshot. Initial suprapubic cystostomy alone was used in 26 male patients, 21 with prostatomembranous disruption and five with straddle injury. Prostatomembranous reconstruction in 14 complete urethral transections resulted in one residual stricture, two impotent patients, and no incontinence. Partial prostatomembranous disruption and straddle injuries had insignificant residual stricture, none requiring dilation or reconstruction. The results of this management approach appear superior to those of immediate urethral realignment. Advantages of immediate suprapubic cystostomy are: 1) simplified early approach in management, and 2) successful elective reconstruction of major prostatomembranous injuries with low incidence of stricture, impotence, and incontinence.

[Jellyfish sting injuries].

PubMed

Mebs, D

2014-10-01

Jellyfish are distributed worldwide; they cause local skin injuries upon contact which are often followed by systemic signs of envenoming. Which jellyfish species are of medical importance, which skin reactions and systemic symptoms occur, which first-aid measures and treatment options exist? Review of the medical literature and discussion of first-aid and therapeutic options. Jellyfish capable of causing skin injuries occur in almost all oceans. Several jellyfish species may cause severe, potentially lethal, systemic symptoms; they include the Portuguese man-of-war (Physalia physalis) and box jellyfish (Chironex fleckeri, Carukia barnesi, Chiropsalmus quadrigatus). Among the injuries and envenoming symptoms caused by marine organisms, jellyfish dermatitis should not be underestimated. Skin reactions may not only a dermatological problem, but also be accompanied by complex systemic toxic symptoms which are a challenge for internists.

Padova Charter on personal injury and damage under civil-tort law : Medico-legal guidelines on methods of ascertainment and criteria of evaluation.

PubMed

Ferrara, Santo Davide; Baccino, Eric; Boscolo-Berto, Rafael; Comandè, Giovanni; Domenici, Ranieri; Hernandez-Cueto, Claudio; Gulmen, Mete Korkut; Mendelson, George; Montisci, Massimo; Norelli, Gian Aristide; Pinchi, Vilma; Ranavaya, Mohammed; Shokry, Dina A; Sterzik, Vera; Vermylen, Yvo; Vieira, Duarte Nuno; Viel, Guido; Zoja, Riccardo

2016-01-01

Compensation for personal damage, defined as any pecuniary or non-pecuniary loss causally related to a personal injury under civil-tort law, is strictly based on the local jurisdiction and therefore varies significantly across the world. This manuscript presents the first "International Guidelines on Medico-Legal Methods of Ascertainment and Criteria of Evaluation of Personal Injury and Damage under Civil-Tort Law". This consensus document, which includes a step-by-step illustrated explanation of flow charts articulated in eight sequential steps and a comprehensive description of the ascertainment methodology and the criteria of evaluation, has been developed by an International Working Group composed of juridical and medico-legal experts and adopted as Guidelines by the International Academy of Legal Medicine (IALM).

Localization of sclerotic-type chronic graft-vs-host disease to sites of skin injury: potential insight into the mechanism of isomorphic and isotopic responses.

PubMed

Martires, Kathryn J; Baird, Kristin; Citrin, Deborah E; Hakim, Fran T; Pavletic, Steven Z; Cowen, Edward W

2011-09-01

The mechanisms responsible for the variable manifestations of chronic cutaneous graft-vs-host disease (cGVHD) are poorly understood. Localization of sclerotic-type chronic graft-vs-host disease to sites of skin injury (isomorphic and isotopic responses), a recognized phenomenon in morphea, suggests a potential common pathway between cGVHD and other sclerotic skin conditions. Four cases of sclerotic-type cGVHD developed at the site of disparate skin injuries (ionizing radiotherapy, repeated needle sticks, central catheter site, and varicella-zoster virus infection). We review the spectrum of previously reported cases of sclerotic and nonsclerotic cGVHD relating to external forces on the skin. Localization of sclerotic-type cGVHD may occur after many types of skin injury, including UV and ionizing radiotherapy, needle sticks, viral infection, and pressure or friction. Recognition of this phenomenon may be helpful for the early diagnosis of sclerotic disease. Recent insights into the immunological consequences of minor skin injury may provide important clues to the underlying pathogenesis of cGVHD-mediated skin disease.

Core Muscle Injury/Sports Hernia/Athletic Pubalgia, and Femoroacetabular Impingement.

PubMed

Ross, James R; Stone, Rebecca M; Larson, Christopher M

2015-12-01

Core muscle injury/sports hernia/athletic pubalgia is an increasingly recognized source of pain, disability, and time lost from athletics. Groin pain among athletes, however, may be secondary to various etiologies. A thorough history and comprehensive physical examination, coupled with appropriate diagnostic imaging, may improve the diagnostic accuracy for patients who present with core muscular injuries. Outcomes of nonoperative management have not been well delineated, and multiple operative procedures have been discussed with varying return-to-athletic activity rates. In this review, we outline the clinical entity and treatment of core muscle injury and athletic pubalgia. In addition, we describe the relationship between athletic pubalgia and femoroacetabular impingement along with recent studies that have investigated the treatment of these related disorders.

Combat injury coding: a review and reconfiguration.

PubMed

Lawnick, Mary M; Champion, Howard R; Gennarelli, Thomas; Galarneau, Michael R; D'Souza, Edwin; Vickers, Ross R; Wing, Vern; Eastridge, Brian J; Young, Lee Ann; Dye, Judy; Spott, Mary Ann; Jenkins, Donald H; Holcomb, John; Blackbourne, Lorne H; Ficke, James R; Kalin, Ellen J; Flaherty, Stephen

2013-10-01

The current civilian Abbreviated Injury Scale (AIS), designed for automobile crash injuries, yields important information about civilian injuries. It has been recognized for some time, however, that both the AIS and AIS-based scores such as the Injury Severity Score (ISS) are inadequate for describing penetrating injuries, especially those sustained in combat. Existing injury coding systems do not adequately describe (they actually exclude) combat injuries such as the devastating multi-mechanistic injuries resulting from attacks with improvised explosive devices (IEDs). After quantifying the inapplicability of current coding systems, the Military Combat Injury Scale (MCIS), which includes injury descriptors that accurately characterize combat anatomic injury, and the Military Functional Incapacity Scale (MFIS), which indicates immediate tactical functional impairment, were developed by a large tri-service military and civilian group of combat trauma subject-matter experts. Assignment of MCIS severity levels was based on urgency, level of care needed, and risk of death from each individual injury. The MFIS was developed based on the casualty's ability to shoot, move, and communicate, and comprises four levels ranging from "Able to continue mission" to "Lost to military." Separate functional impairments were identified for injuries aboard ship. Preliminary evaluation of MCIS discrimination, calibration, and casualty disposition was performed on 992 combat-injured patients using two modeling processes. Based on combat casualty data, the MCIS is a new, simpler, comprehensive severity scale with 269 codes (vs. 1999 in AIS) that specifically characterize and distinguish the many unique injuries encountered in combat. The MCIS integrates with the MFIS, which associates immediate combat functional impairment with minor and moderate-severity injuries. Predictive validation on combat datasets shows improved performance over AIS-based tools in addition to improved face

Interpersonal processes and self-injury: a qualitative study using Bricolage.

PubMed

Rayner, G; Warne, T

2016-02-01

Literature on self-injury has recognized the impact on the relationship between clients and staff. There is an absence of a detailed account of interpersonal processes surrounding self-injury. A Bricolage qualitative research approach was carried out in the United Kingdom that explored the interpersonal processes surrounding self-injury. Three pairs of clients and staff were interviewed about an incident of self-injury. The interviews were thematically analysed and then synthesized producing a deeper exploration of the relationship between the client and staff. An interpersonal trigger followed by anger and shame, resulted in self-injury to 'numb' these experiences. Self-injury is conceptualized as a safety behaviour to avoid shame and anger and then as a maintenance cycle that traps the client in a reinforcing and rejecting relationship. Staff interviewed were able to reflect with the clients and help them reframe these experiences. Mental Health Nurses can work with clients to understand their own interpersonal cycles of self-injury. They can then reflect on their own roles in this process and avoid reinforcing the clients' negative beliefs. WHAT THE STUDY ADDS TO INTERNATIONAL EVIDENCE: This is the first international paper to explore the interconnection between the client and a professional helper in their lived experiences of self-injury. © 2015 John Wiley & Sons Ltd.

Peripheral nerve injuries secondary to missiles.

PubMed

Katzman, B M; Bozentka, D J

1999-05-01

Peripheral nerve injuries secondary to missiles can present some of the most challenging problems faced by hand surgeons. This article reviews the pertinent neural anatomy, injury classifications, and repair techniques. Options in the management of nerve gaps are presented including the use of vascularized nerve grafts. The results are discussed and a treatment algorithm is presented.

Putative Brain Networks Underlying Repetitive Negative Thinking and Comorbid Internalizing Problems in Autism

PubMed Central

Burrows, Catherine A.; Timpano, Kiara R.; Uddin, Lucina Q.

2016-01-01

Many high-functioning individuals with autism spectrum disorder (ASD) also experience depression and anxiety, yet little is known about mechanisms underlying this comorbidity. Repetitive negative thinking (RNT) about self-referential information is a transdiagnostic cognitive vulnerability factor that may account for the relationship between these two classes of symptoms. We propose a model where self-referential processing and cognitive inflexibility interact to increase risk for RNT, leading to internalizing problems in ASD. Examination of interactions within and between two well-characterized large-scale brain networks, the default mode network and the salience network, may provide insights into neurobiological mechanisms underlying RNT in ASD. We summarize previous literature supporting this model, emphasizing moving towards understanding RNT as a factor accounting for the high rates of internalizing problems in ASD. Future research avenues include understanding heterogeneity in clinical presentation, and promise for identifying and treating cognitive flexibility and RNT to reduce comorbid internalizing problems in ASD. PMID:28603665

Analysis of injuries in taekwondo athletes.

PubMed

Ji, MinJoon

2016-01-01

[Purpose] The present study aims to provide fundamental information on injuries in taekwondo by investigating the categories of injuries that occur in taekwondo and determining the locations of these injuries. [Subjects and Methods] The data of 512 taekwondo athletes were collected. The sampling method was convenience sampling along with non-probability sampling extraction methods. Questionnaire forms were used to obtain the data. [Results] The foot, knee, ankle, thigh, and head were most frequently injured while practicing taekwondo, and contusions, strains, and sprains were the main injuries diagnosed. [Conclusion] It is desirable to decrease the possibility of injuries to the lower extremities for extending participation in taekwondo. Other than the lower extremities, injuries of other specific body parts including the head or neck could be important factors limiting the duration of participation. Therefore, it is necessary to cope with these problems before practicing taekwondo.

Welding related occupational eye injuries: a narrative analysis.

PubMed

Lombardi, D A; Pannala, R; Sorock, G S; Wellman, H; Courtney, T K; Verma, S; Smith, G S

2005-06-01

To determine the activities and circumstances proximal to a welding related occupational eye injury, a hybrid narrative coding approach derived from two well developed classification systems was developed to categorize and describe the activity, initiating process, mechanism of injury, object and/or substance, and the use of protective eyewear from the narrative text data reported for each injury. Routinely collected workers' compensation claims over a one year period (2000) were analyzed from a large US insurance provider. An index term search algorithm of occupation, incident, and injury description fields identified 2209 potential welding related eye injury claims. After detailed review of these claims, 1353 welders and 822 non-welders were analyzed. During 2000, eye(s) as the primary injured body part accounted for 5% (n = 26 413) of all compensation claims. Eye injuries accounted for 25% of all claims for welders. Subjects were mainly male (97.1%) and from manufacturing (70.4%), service (11.8%), or construction (8.4%) related industries. Most injuries were foreign body (71.7%) or burn (22.2%) and 17.6% were bilateral. Common activities include welding (31.9%) and/or grinding (22.5%). Being struck by an airborne object occurred in 56.3% of cases. Non-welders showed similar patterns except that burns (43.8%) were more frequent and more often initiated by another worker (13.9%). Narrative injury text provides valuable data to supplement traditional epidemiologic analyses. Workers performing welding tasks or working nearby welders should be trained to recognize potential hazards and the effective use of proper safety equipment to prevent ocular injury.

Elevated troponin I levels in acute liver failure: is myocardial injury an integral part of acute liver failure?

PubMed

Parekh, Nimisha K; Hynan, Linda S; De Lemos, James; Lee, William M

2007-06-01

Although rare instances of cardiac injury or arrhythmias have been reported in acute liver failure (ALF), overall, the heart is considered to be spared in this condition. Troponin I, a sensitive and specific marker of myocardial injury, may be elevated in patients with sepsis and acute stroke without underlying acute coronary syndrome, indicating unrecognized cardiac injury in these settings. We sought to determine whether subclinical cardiac injury might also occur in acute liver failure. Serum troponin I levels were measured in 187 patients enrolled in the US Acute Liver Failure Study Group registry, and correlated with clinical variables and outcomes. Diagnoses were representative of the larger group of >1000 patients thus far enrolled and included 80 with acetaminophen-related injury, 26 with viral hepatitis, 19 with ischemic injury, and 62 others. Overall, 74% of patients had elevated troponin I levels (>0.1 ng/ml). Patients with elevated troponin I levels were more likely to have advanced hepatic coma (grades III or IV) or to die (for troponin I levels >0.1 ng/ml, odds ratio 3.88 and 4.69 for advanced coma or death, respectively). In acute liver failure, subclinical myocardial injury appears to occur more commonly than has been recognized, and its pathogenesis in the context of acute liver failure is unclear. Elevated troponin levels are associated with a significant increase in morbidity and mortality. Measurement of troponin I levels may be helpful in patients with acute liver failure, to detect unrecognized myocardial damage and as a marker of unfavorable outcome.

Rheumatic diseases presenting as sports-related injuries.

PubMed

Jennings, Fabio; Lambert, Elaine; Fredericson, Michael

2008-01-01

, gout and pseudogout. Effective management of athletes presenting with musculoskeletal complaints requires a structured history, physical examination, and definitive diagnosis to distinguish soft tissue problems from joint problems and an inflammatory syndrome from a non-inflammatory syndrome. Clues to a systemic inflammatory aetiology may include constitutional symptoms, morning stiffness, elevated acute-phase reactants and progressive symptoms despite modification of physical activity. The mechanism of injury or lack thereof is also a clue to any underlying disease. In these circumstances, more complete workup is reasonable, including radiographs, magnetic resonance imaging and laboratory testing for autoantibodies.

Recognizing the Incestuous Family

PubMed Central

Johnson, Mark S.

1983-01-01

Family physicians are in the best position to diagnose incest because of the nature of their practice. Yet many cases of incest are not recognized by the medical community and many incest victims are thus untreated. There are several behavioral and medical clues to incest, which the family physician needs to know in order to recognize incest early and improve the prognosis. Treatment is directed at the whole family, rather than just the active participants. Further research is needed to improve the application of various treatment modalities. PMID:6631984

Injury prevention for children with disabilities.

PubMed

Gaebler-Spira, Deborah; Thornton, Lisa S

2002-11-01

Little injury data exists for children who have disabilities. There is an urgent need to address injury prevention and to improve safety standards for this group. Understanding the epidemiology of injuries will allow clinicians to accurately advise patients and their families on individual risks and counsel them in steps to take to reduce those risks. Safety information must be tailored to consider each child's functional impairments. All children who have disabilities are at risk for maltreatment. Open discussion of this problem is warranted given the immensity of the problem. Identifying parental concerns and supporting parents in the use of respite resources are appropriate. For children who have problems in mobility, falls are the number one concern. Collaboration with reliable vendors and therapists that adhere to standards for safe seating is essential for reducing the risk of wheelchair tips and falls. In addition, therapists should be directed to provide mobility training for activities from safe transfers to street crossing in a community setting. Parents should be counseled to approach their child's injury risk based on the child's cognitive and behavioral level rather than their chronological level. Knowledge of the child's developmental quotient or intelligence quotient will also allow the clinician to accurately formulate an injury prevention plan. Many children will always need supervision for tasks that put them in situations of injury risk (i.e., swimming, street crossing, bathing). Sensorineural deficits such as blindness or deafness create significant alterations in negotiating the environment and an increased risk of injury. Awareness of the special needs for fire risk reduction and street safety are critical in this population. The collection of injury data is critical to define the scope of the problem and to influence changes in policy and the development of technical standards. Educational efforts focused on safety should include

Radiation injury to the nervous system

DOE Office of Scientific and Technical Information (OSTI.GOV)

Gutin, P.H.; Leibel, S.A.; Sneline, G.E.

1991-01-01

This book is designed to describe to the radiation biologist, radiation oncologist, neurologist, neurosurgeon, medical oncologist, and neuro-oncologist, the current state of knowledge about the tolerance of the nervous system to various kinds of radiation, the mechanisms of radiation injury, and how nervous system tolerance and injury are related to the more general problem of radiation damage to normal tissue of all types. The information collected here should stimulate interest in and facilitate the growing research effort into radiation injury to the nervous system.

Perception of Health Problems Among Competitive Runners

PubMed Central

Jelvegård, Sara; Timpka, Toomas; Bargoria, Victor; Gauffin, Håkan; Jacobsson, Jenny

2016-01-01

Background: Approximately 2 of every 3 competitive runners sustain at least 1 health problem each season. Most of these problems are nontraumatic injuries with gradual onset. The main known risk indicator for sustaining a new running-related injury episode is a history of a previous injury, suggesting that behavioral habits are part of the causal mechanisms. Purpose: Identification of elements associated with purposeful interpretations of body perceptions and balanced behavioral responses may supply vital information for prevention of health problems in runners. This study set out to explore competitive runners’ cognitive appraisals of perceived symptoms on injury and illness and how these appraisals are transformed into behavior. Study Design: Cross-sectional study; Level of evidence, 3. Methods: The study population consisted of Swedish middle- and long-distance runners from the national top 15 list. Qualitative research methods were used to categorize interview data and perform a thematic analysis. The categories resulting from the analysis were used to construct an explanatory model. Results: Saturation of the thematic classification required that data from 8 male and 6 female runners (age range, 20-36 years) were collected. Symptoms interpreted to be caused by illness or injury with a sudden onset were found to lead to immediate action and changes to training and competition programs (activity pacing). In contrast, perceptions interpreted to be due to injuries with gradual onset led to varied behavioral reactions. These behavioral responses were planned with regard to short-term consequences and were characterized by indifference and neglect of long-term implications, consistent with an overactivity behavioral pattern. The latter pattern was consistent with a psychological adaptation to stimuli that is presented progressively to the athlete. Conclusion: Competitive runners appraise whether a health problem requires immediate withdrawal from training based on

Injuries in synchronized skating.

PubMed

Dubravcic-Simunjak, S; Kuipers, H; Moran, J; Simunjak, B; Pecina, M

2006-06-01

Synchronized skating is a relatively new competitive sport and data about injuries in this discipline are lacking. Therefore the purpose of this study was to investigate the frequency and pattern of acute and overuse injuries in synchronized skaters. Before and during the World Synchronized Skating Championship 2004, a questionnaire inquiring about the frequency of injuries in this skating discipline was given to 23 participating teams. A total of 514 women and 14 men senior skaters completed the questionnaires (100 % response). Two hundred and eighteen (42.4 %) female and 6 (42.9 %) male skaters had suffered from acute injuries during their synchronized skating career. As some skaters had suffered from more than one injury, the total number of acute injuries in females was 398 and in males 14. In female skaters 19.8 % of acute injuries were head injuries, 7.1 % trunk, 33.2 % upper, and 39.9 % lower extremity injuries. In male skaters 14.3 % were head injuries, 28.6 % upper, and 57.1 % lower extremity injuries, with no report of trunk injuries. Sixty-nine female and 2 male skaters had low back problems and 112 female and 2 male skaters had one or more overuse syndromes during their skating career. Of 155 overuse injuries in female skaters, 102 (65.8 %) occurred during their figure skating career, while 53 injuries (34.2 %) only occurred when they skated in synchronized skating teams. In male skaters, out of 5 overuse injuries, 4 (80 %) occurred in their figure skating career, while 1 (20 %) occurred during their synchronized skating career. Out of the total of 412 injuries, 338 (82 %) occurred during on-ice practice, while 74 (18 %) happened during off-ice training. Ninety-one (26.9 %) acute injures occurred while practicing individual elements, and 247 (73.1 %) on-ice injuries occurred while practicing different team elements. We conclude that injuries in synchronized skating should be of medical concern due to an increasing number of acute injuries, especially

Distinct features of trampoline-related orthopedic injuries in children aged under 6 years.

PubMed

Choi, Eun Seok; Hong, Jin Heon; Sim, Jae Ang

2018-02-01

Concern has been growing about trampoline-related injuries among young children. Several published policy statements have repeatedly recommended that children younger than 6 years should not use trampolines. However, few studies have investigated the injuries caused by trampoline-related accidents among young children. This study aimed to identify the distinct features of trampoline-related orthopedic injuries in children younger than 6 years. We retrospectively reviewed the medical records of pediatric patients aged between 0 and 16 years who visited our regional emergency center due to trampoline-related orthopedic injuries between 2012 and 2015. Patients were divided into two groups: a preschool group (younger than 6 years) and a school group (older than 6 years). We compared the features of the injuries in the two groups. Among 208 patients, 108 (52%) were male and 100 (48%) were female. The mean age was 5.4 years. The preschool group accounted for 66%. There were no seasonal variations. Fractures were sustained in 96 patients (46%). The anatomical locations of injuries differed significantly between the two age groups. Proximal tibia fractures were more frequent in the preschool group than the school group (34% and 6%, respectively). Distal tibia fractures were more prevalent in the school group than the preschool group (44% vs. 13%, respectively). Surgical treatment was needed more frequently in the school group (p = 0.035, hazard ratio 2.52, 95% confidence interval: 1.03-6.17). Most of the injuries (82%) occurred at trampoline parks. The anatomical locations of trampoline-related orthopedic injuries differed significantly between age groups. Fractures were more common around the knee in younger children and the ankle in older children. Copyright © 2017 Elsevier Ltd. All rights reserved.

Apathy following traumatic brain injury.

PubMed

Starkstein, Sergio E; Pahissa, Jaime

2014-03-01

Traumatic brain injury (TBI) may result in significant emotional and behavioral changes, such as depression, impulsivity, anxiety, aggressive behavior, and posttraumatic stress disorder. Apathy has been increasingly recognized as a relevant sequela of TBI, with a negative impact on the patients' quality of life as well as their participation in rehabilitation activities. This article reviews the nosologic and phenomenological aspects of apathy in TBI, diagnostic issues, frequency and prevalence, relevant comorbid conditions, potential mechanisms, and treatment. Crown Copyright © 2014. Published by Elsevier Inc. All rights reserved.

Major and Minor League Baseball Hamstring Injuries: Epidemiologic Findings From the Major League Baseball Injury Surveillance System.

PubMed

Ahmad, Christopher S; Dick, Randall W; Snell, Edward; Kenney, Nick D; Curriero, Frank C; Pollack, Keshia; Albright, John P; Mandelbaum, Bert R

2014-06-01

Hamstring strains are a recognized cause of disability for athletes in many sports, but no study exists that reports the incidence and circumstances surrounding these injuries in professional baseball. Professional baseball players have a high incidence of hamstring strains, and these injuries are influenced by multiple factors including history of hamstring injury, time period within the season, and activity of base running. Descriptive epidemiologic study. For the 2011 season, injury data were prospectively collected for every Major League Baseball (MLB) major and minor league team and recorded in the MLB's Injury Surveillance System. Data collected for this study included date of injury, activity in which the player was engaged at the time of injury, and time loss. Injury rates were reported in injuries per athlete-exposure (A-E). Athlete-exposures were defined as the average number of players on a team who were participating in a game multiplied by the number of games. In the major leagues, 50 hamstring strains were reported for an injury rate (IR) of 0.7 per 1000 A-Es and averaged 24 days missed. In the minor leagues, 218 hamstring strains were reported for an IR of 0.7 per 1000 A-Es and averaged 27 days missed. Base running, specifically running to first base, was the top activity for sustaining a hamstring strain in both major and minor leagues, associated with almost two-thirds of hamstring strains. Approximately two-thirds of these injuries in both the major and minor leagues resulted in more than 7 days of time loss. Approximately 25% of these injuries kept the player out for 1 month or longer. History of a previous hamstring strain in the prior year, 2010, was found in 20% of the major league players and 8% of the minor league players. In the major leagues, the month of May had a statistically significant higher frequency of hamstring injuries than any other month in the season (P = .0153). Hamstring strains are a considerable cause of disability in

Transmission of Insult in Out-of-Position Subjects: I. Shoulder Injury

NASA Astrophysics Data System (ADS)

Shaibani, Saami J.

2002-03-01

The dynamic response of vehicle occupants in impact events is quite well understood when initial boundary conditions have simple values. However, departure from regular seated postures can present considerable analytical challenges in identifying possible causes of injury. Research grounded in physics[1] can facilitate the latter to promote diagnosis, and enhance treatment, for injuries that might not otherwise be recognized. This is confoundingly true in some low-severity impacts, three of which are explored as separate studies because they are so different. The first involves the upper extremity of a passenger who was bent fully forward at the time of impact, and correct use of physics established an unusual injury mechanism when lesser approaches failed. Subsequent papers deal with other parts of the body.[2-3] 1. Proper Treatment of Complex Human Structures, Announcer 27 (4), 100 (1997); 2. Transmission of Insult in Out-of-Position Subjects: II. Lumbosacral Injury, Bull. Am. Phys. Soc. in press (2002); 3. ibid: III. Thoracic Spine Injury.

Newsvendor problem under complete uncertainty: a case of innovative products.

PubMed

Gaspars-Wieloch, Helena

2017-01-01

The paper presents a new scenario-based decision rule for the classical version of the newsvendor problem (NP) under complete uncertainty (i.e. uncertainty with unknown probabilities). So far, NP has been analyzed under uncertainty with known probabilities or under uncertainty with partial information (probabilities known incompletely). The novel approach is designed for the sale of new, innovative products, where it is quite complicated to define probabilities or even probability-like quantities, because there are no data available for forecasting the upcoming demand via statistical analysis. The new procedure described in the contribution is based on a hybrid of Hurwicz and Bayes decision rules. It takes into account the decision maker's attitude towards risk (measured by coefficients of optimism and pessimism) and the dispersion (asymmetry, range, frequency of extremes values) of payoffs connected with particular order quantities. It does not require any information about the probability distribution.

Influences to ADHD Problem Recognition: Mixed-Method Investigation and Recommendations to Reduce Disparities for Latino Youth.

PubMed

Haack, Lauren M; Meza, Jocelyn; Jiang, Yuanyuan; Araujo, Eva Jimenez; Pfiffner, Linda

2018-05-16

ADHD problem recognition serves as the first step of help seeking for ethnic minority families, such as Latinos, who underutilize ADHD services. The current mixed-method study explores underlying factors influencing recognition of ADHD problems in a sample of 159 school-aged youth. Parent-teacher informant discrepancy results suggest that parent ethnicity, problem domain, and child age influence ADHD problem recognition. Emerging themes from semi-structured qualitative interviews/focus groups conducted with eighteen Spanish-speaking Latino parents receiving school-based services for attention and behavior concerns support a range of recognized ADHD problems, beliefs about causes, and reactions to ADHD identification. Findings provide recommendations for reducing disparities in ADHD problem recognition and subsequent help seeking.

Recognizing and Treating Eye Injuries

MedlinePlus

... Plastic Surgery Center Laser Surgery Education Center Redmond Ethics Center Global Ophthalmology Guide Academy Publications EyeNet Ophthalmology ... Plastic Surgery Center Laser Surgery Education Center Redmond Ethics Center Global Ophthalmology Guide Find an Ophthalmologist Advanced ...

Alpine skiing injuries. A nine-year study.

PubMed Central

Davidson, T M; Laliotis, A T

1996-01-01

Injury patterns in alpine skiing have changed over time as ski, boot, binding, and slope-grooming technologies have evolved. We retrospectively examined injury patterns in alpine skiers over a 9-year period at the Mammoth and June mountains (California) ski area. A total of 24,340 injuries were reported for the 9 seasons studied, and total lift tickets sold numbered 9,201,486. The overall injury rate was 2.6 injuries per 1,000 skier days and increased slowly over the period studied. The knee was the most frequently injured area at 35% of all injuries. Increasing trends (P < .05) were noted for the rates of lower extremity injuries (37%) and knee injuries (45%). A decreasing trend was noted for the rate of lacerations (31% decrease). Slight increases were noted in upper extremity and axial injury rates. Skiing injuries continue to be a worrisome recreational problem despite improvements in ski equipment and slope-grooming techniques. The increasing trend in lower extremity, particularly knee, injury rates highlights the need for continued skier education and equipment innovation. PMID:8732730

Problem Solving in Electricity.

ERIC Educational Resources Information Center

Caillot, Michel; Chalouhi, Elias

Two studies were conducted to describe how students perform direct current (D-C) circuit problems. It was hypothesized that problem solving in the electricity domain depends largely on good visual processing of the circuit diagram and that this processing depends on the ability to recognize when two or more electrical components are in series or…

Management of unilateral recurrent laryngeal nerve injury after thyroid surgery: A review.

PubMed

Lynch, Jeremy; Parameswaran, Rajeev

2017-07-01

Recurrent laryngeal nerve (RLN) damage because of thyroid and parathyroid surgery has been recognized for over a century. Injury rates have been slowly decreasing in this period while effective treatment strategies have been increasing. Recent literature was evaluated on the topics of anatomy, pathophysiology, avoidance, and conservative and surgical treatment of RLN injury. Data for this literature review were identified by PubMed and references from relevant articles using the search terms "thyroid," "laryngeal nerve," and "injury." Only articles published in English between 1990 and 2015 were included. Advances in technique and equipment have made injury less likely. The evidence and role for neuromonitoring is discussed. Treatment strategies may include speech therapy, vocal cord augmentation using injection, laryngeal framework surgery techniques (including laryngoplasty and arytenoid adduction), and reinnervation. Injury rates in specialist centers are very low. Good to excellent results may be obtained in most cases. © 2017 Wiley Periodicals, Inc.

The Animal Model of Spinal Cord Injury as an Experimental Pain Model

PubMed Central

Nakae, Aya; Nakai, Kunihiro; Yano, Kenji; Hosokawa, Ko; Shibata, Masahiko; Mashimo, Takashi

2011-01-01

Pain, which remains largely unsolved, is one of the most crucial problems for spinal cord injury patients. Due to sensory problems, as well as motor dysfunctions, spinal cord injury research has proven to be complex and difficult. Furthermore, many types of pain are associated with spinal cord injury, such as neuropathic, visceral, and musculoskeletal pain. Many animal models of spinal cord injury exist to emulate clinical situations, which could help to determine common mechanisms of pathology. However, results can be easily misunderstood and falsely interpreted. Therefore, it is important to fully understand the symptoms of human spinal cord injury, as well as the various spinal cord injury models and the possible pathologies. The present paper summarizes results from animal models of spinal cord injury, as well as the most effective use of these models. PMID:21436995

Rationalizing vaccine injury compensation.

PubMed

Mello, Michelle M

2008-01-01

Legislation recently adopted by the United States Congress provides producers of pandemic vaccines with near-total immunity from civil lawsuits without making individuals injured by those vaccines eligible for compensation through the Vaccine Injury Compensation Program. The unusual decision not to provide an alternative mechanism for compensation is indicative of a broader problem of inconsistency in the American approach to vaccine-injury compensation policy. Compensation policies have tended to reflect political pressures and economic considerations more than any cognizable set of principles. This article identifies a set of ethical principles bearing on the circumstances in which vaccine injuries should be compensated, both inside and outside public health emergencies. A series of possible bases for compensation rules, some grounded in utilitarianism and some nonconsequentialist, are discussed and evaluated. Principles of fairness and reasonableness are found to constitute the strongest bases. An ethically defensible compensation policy grounded in these principles would make a compensation fund available to all individuals with severe injuries and to individuals with less-severe injuries whenever the vaccination was required by law or professional duty.

13 CFR 123.601 - Is my business eligible to apply for an economic injury disaster loan under this subpart?

Code of Federal Regulations, 2010 CFR

2010-01-01

... the September 11, 2001 Terrorist Attacks § 123.601 Is my business eligible to apply for an economic... September 11, 2001, or as a direct result of any related federal action taken between September 11, 2001 and October 22, 2001, you are eligible to apply for an economic injury disaster loan under this subpart. (1...

Current Concepts in Sports Injury Rehabilitation

PubMed Central

Dhillon, Himmat; Dhilllon, Sidak; Dhillon, Mandeep S

2017-01-01

In the modern era, rehabilitation after sports injury has become a domain for specialists, and its evolution has necessarily brought together the sports physiotherapist, the sports physician, and the orthopedic surgeon. The changing profile of sports related injury, as well as limited availability of facilities for rehabilitation in many areas of India, is a matter of concern. Elite sportspersons have some protection, but the average athlete is often left to fend for himself. Key factors in successful sports injury rehabilitation protocols are the application of modern rehabilitation protocols under appropriate supervision, appropriate and well timed surgical interventions, and judicious and need based use of pharmaceutical agents. Modern rehabilitation protocols emphasize teamwork and proper rehabilitation planning, and the rehabilitation team has to be lead by a trained sports physiotherapist, with an understanding of the protocols and interventions required at various stages. Injury specific rehabilitation protocols are being practiced worldwide but need to be introduced according to the nature of the sport as well as available facilities. Even in India, sports physicians are increasingly joining specialist rehabilitation teams, and they can help with medication, nutritional supplements, and specialized tests that could improve injury understanding. Inputs from surgeons are mandatory if surgical interventions have been performed. What is often missing in the underdeveloped world is psychological support and a clear understanding by the athlete of his/her rehabilitation protocols. World over, the primary aims are safe return to sports and minimizing reinjury on return to sport; this involves rehabilitation in stages, and current methodology clearly demarcates acute and chronic phases of injury. Close coordination with trainers and coaches is mandatory, and all need to understand that the reconditioning phase is crucial; skill assessment before progression has now

Arabic word recognizer for mobile applications

NASA Astrophysics Data System (ADS)

Khanna, Nitin; Abdollahian, Golnaz; Brame, Ben; Boutin, Mireille; Delp, Edward J.

2011-03-01

When traveling in a region where the local language is not written using a "Roman alphabet," translating written text (e.g., documents, road signs, or placards) is a particularly difficult problem since the text cannot be easily entered into a translation device or searched using a dictionary. To address this problem, we are developing the "Rosetta Phone," a handheld device (e.g., PDA or mobile telephone) capable of acquiring an image of the text, locating the region (word) of interest within the image, and producing both an audio and a visual English interpretation of the text. This paper presents a system targeted for interpreting words written in Arabic script. The goal of this work is to develop an autonomous, segmentation-free Arabic phrase recognizer, with computational complexity low enough to deploy on a mobile device. A prototype of the proposed system has been deployed on an iPhone with a suitable user interface. The system was tested on a number of noisy images, in addition to the images acquired from the iPhone's camera. It identifies Arabic words or phrases by extracting appropriate features and assigning "codewords" to each word or phrase. On a dictionary of 5,000 words, the system uniquely mapped (word-image to codeword) 99.9% of the words. The system has a 82% recognition accuracy on images of words captured using the iPhone's built-in camera.

Burden of motorcycle-related injury in Malaysia.

PubMed

Rahman, Nik Hisamuddin Na; Baharuddin, Kamarul A; Mohamad, Syarifah Mastura S

2015-01-01

Road traffic injury (RTI) contributes to major morbidity and mortality in both developed and developing countries. Most of the injuries are caused by road-related injuries that specifically relate to motorcycle crash. We attempted to conduct a short survey to determine the magnitude of burden related to motorcycle-related RTIs in Malaysia. We hypothesize that motorcycle-related RTI in Malaysia contributes significantly to the health burden in the country. The cross-sectional survey involves data searching related to RTI in Malaysia from the relevant agencies such as the Ministry of Health Malaysia, Royal Police Force, and Malaysia Institute of Road Safety Research (MIROS) through their official websites and PubMed search. The three agencies are well established and recognized by the Malaysian government in dealing with data collection for the injury nationwide. The primary aim is to determine the prevalence of motorcycle-related RTI, and secondary outcomes are the overall mortality and the contributing factors. Of the cause of trauma, 80 % is due to RTI, and the most vulnerable road users such as pedestrians and motorcyclists are affected the most. Of all RTI, 70 % is contributed by the motorcycle crash, and there are a significant number of deaths for both rider and pillion rider of the motorcycle than for other types of vehicles. Human error is the main reason to be blamed, specifically the attitude of the riders on the road. Trauma is one of the common reasons for death and hospitalization in Malaysia. Motorcycle-related RTI in Malaysia contributes significantly to the health burden in Malaysia. The Malaysian government and non-government agencies have worked together seriously in implementing a preventive measure to reduce the incidence and aftermath of motorcycle-related RTI. However, data is still lacking, and every effort is made to increase the amount of research in the field. Strengths of the article are as follows:Latest alarming data on motorcycle

Traumatic injury to the portal vein.

PubMed Central

Mattox, K L; Espada, R; Beall, A R

1975-01-01

Traumatic injuries to the upper abdominal vasculature pose difficult management problems related to both exposure and associated injuries. Among those injuries that are more difficult to manage are those involving the portal vein. While occurring rarely, portal vein injuries require specific therapeutic considerations. Between January, 1968, and July, 1974, over 2000 patients were treated operatively for abdominal trauma at the Ben Taub General Hospital. Among these patients, 22 had injury to the portal vein. Seventeen portal vein injuries were secondary to gunshot wounds, 3 to stab wounds, and 2 to blunt trauma. Associated injuries to the inferior vena cava, pancreas, liver and bile ducts were common. Three patients had associated abdominal aortic injuries, two with acute aorto-caval fistulae. Nine patients died from from failure to control hemorrhage. Eleven were long-term survivors, including two who required pancreataico-duodenectomy as well as portal venorrhaphy. Late complications were rare. The operative approach to patients with traumatic injuries to multiple organs in the upper abdomen, including the portal vein, requires aggressive management and predetermined sequential methods of repair. In spite of innumerable associated injuries, portal vein injuries can be successfully managed in a significant number of patients using generally available surgical techniques and several adjunctive maneuvers. PMID:1130870