Comparison of recidivism rates for a teenage trauma prevention program after the addition of high-fidelity patient simulation

Objectives: We evaluated the benefits of adding high-fidelity simulation to a teenage trauma prevention program to decrease recidivism rates and encourage teens to discuss actionable steps toward safe driving.

Methods: A simulated pediatric trauma scenario was integrated into an established trauma prevention program. Participants were recruited because they were court-ordered to attend this program after misdemeanor convictions for moving violations. The teenage participants viewed this simulation from the emergency medical services (EMS) handoff to complete trauma care. Participants completed a postsimulation knowledge assessment and care evaluation, which included narrative data about the experience. Qualitative analysis of color-coded responses identified common themes and experiences in participants' answers. Court records were reviewed 6 years after course completion to determine short- and long-term recidivism rates, which were then compared to our program's historical rate.

Results: One hundred twenty-four students aged 16–20 years participated over a 2-year study period. Narrative responses included general reflection, impressions, and thoughts about what they might change as a result of the course. Participants reported that they would decrease speed (30%), wear seat belts (15%), decrease cell phone use (11%), and increase caution (28%). The recidivism rate was 55% within 6 years. At 6 months it was 8.4%, at 1 year it was 20%, and it increased approximately 5–8% per year after the first year. Compared with our programs, for historical 6-month and 2-year recidivism rates, no significant difference was seen with or without simulation.

Conclusions: Adding simulation is well received by participants and leads to positive reflections regarding changes in risk-taking behaviors but resulted in no changes to the high recidivism rates This may be due to the often ineffectiveness of fear appeals.     

Predictors of urinary bisphenol A and phthalate metabolite concentrations in Mexican children

Exposure to endocrine disrupting chemicals such as bisphenol A (BPA) and phthalates is prevalent among children and adolescents, but little is known regarding important sources of exposure at these sensitive life stages. In this study, we measured urinary concentrations of BPA and nine phthalate metabolites in 108 Mexican children aged 8–13 years. Associations of age, time of day, and questionnaire items on external environment, water use, and food container use with specific gravity-corrected urinary concentrations were assessed, as were questionnaire items concerning the use of 17 personal care products in the past 48-h. As a secondary aim, third trimester urinary concentrations were measured in 99 mothers of these children, and the relationship between specific gravity-corrected urinary concentrations at these two time points was explored. After adjusting for potential confounding by other personal care product use in the past 48-h, there were statistically significant (p < 0.05) positive associations in boys for cologne/perfume use and monoethyl phthalate (MEP), mono(3-carboxypropyl) phthalate (MCPP), mono(2-ethyl-5-hydroxyhexyl) phthalate (MEHHP), and mono(2-ethyl-5-oxohexyl) phthalate (MEOHP), and in girls for colored cosmetics use and mono-n-butyl phthalate (MBP), mono(2-ethylhexyl) phthalate (MEHP), MEHHP, MEOHP, and mono(2-ethyl-5-carboxypentyl) phthalate (MECPP), conditioner use and MEP, deodorant use and MEP, and other hair products use and MBP. There was a statistically significant positive trend for the number of personal care products used in the past 48-h and log-MEP in girls. However, there were no statistically significant associations between the analytes and the other questionnaire items and there were no strong correlations between the analytes measured during the third trimester and at 8–13 years of age. We demonstrated that personal care product use is associated with exposure to multiple phthalates in children. Due to rapid development, children may be susceptible to impacts from exposure to endocrine disrupting chemicals; thus, reduced or delayed use of certain personal care products among children may be warranted.     

Balancing the edge effects budget: bay scallop settlement and loss along a seagrass edge

Edge effects are a dominant subject in landscape ecology literature, yet they are highly variable and poorly understood. Often, the literature suggests simple models for edge effects-positive (enhancement at the edge), negative (enhancement at the interior), or no effect (neutral)--on a variety of metrics, including abundance, diversity, and mortality. In the marine realm, much of this work has focused on fragmented seagrass habitats due to their importance for a variety of commercially important species. In this study, the settlement, recruitment, and survival of bay scallops was investigated across a variety of seagrass patch treatments. By simultaneously collecting settlers (those viable larvae available to settle and metamorphose) and recruits (those settlers that survive some period of time, in this case, 6 weeks) on the same collectors, we were able to demonstrate a "balance" between positive and negative edge effects, resulting in a net neutral effect. Scallop settlement was significantly enhanced along seagrass edges, regardless of patch type while survival was elevated within patch interiors. However, recruitment (the net result of settlement and post-settlement loss) did not vary significantly from edge to center, representing a neutral effect. Further, results suggest that post-settlement loss, most likely due to predation, appears to be the dominant mechanism structuring scallop abundance, not patterns in settlement. These data illustrate the complexity of edge effects, and suggest that the metric used to investigate the effect (be it abundance, survival, or other metrics) can often influence the magnitude and direction of the perceived effect. Traditionally, high predation along a habitat edge would have indicated an "ecological trap" for the species in question; however, this study demonstrates that, at the population level, an ecological trap may not exist.     

A risk assessment of selected phthalate esters in North American and Western European surface waters

Potential risks to aquatic organisms by four commercial phthalate esters, dimethyl (DMP), diethyl (DEP), di-n-butyl (DBP), and butylbenzyl (BBP), were assessed using measured and calculated concentrations in North American and Western European surface waters. Predicted no effect concentrations (PNECs) were calculated using statistical extrapolation procedures and the large aquatic toxicity database. Surface water concentrations of DMP, DEP, DBP, and BBP were calculated using reported emissions to US surface waters from the toxics release inventory (TRI). Monitoring data obtained from the US EPA STORET database and literature surveys from North America and Western Europe show that DMP, DEP, DBP, and BBP are infrequently detected in surface water. Calculated and measured concentrations of DMP, DEP, DBP, and BBP are typically several orders of magnitude below their respective PNECs, indicating that these phthalate esters do not pose a ubiquitous threat to aquatic organisms in North American and Western European surface waters.     

Evaluation of a hospital-based injury surveillance system for monitoring road traffic deaths in Phuket,Thailand

Objectives: The objective of this study was to evaluate and injury surveillance (IS) system’s ability to monitor road traffic deaths and the coverage of road traffic injury and death surveillance in Phuket, Thailand.

Methods: U.S. Centers for Disease Control and Prevention guidelines on surveillance system evaluation were used to qualitatively and quantitatively evaluate IS. Interviews with key stakeholders focused on IS’s usefulness, simplicity, flexibility, acceptability, and stability. Active case finding of 2014 road traffic deaths in all paper and electronic hospital record systems was used to assess system sensitivity, positive predictive value, and data quality. Electronic data matching software was used to determine the implications of combining IS data with other provincial-level data sources (e.g., death certificates, electronic vehicle insurance claim system).

Results: Evaluation results indicated that IS was useful, flexible, acceptable, and stable, with a high positive predictive value (99%). Simplicity was limited due to the burden of collecting data on all injuries and use of paper-based data collection forms. Sensitivity was low, with IS only identifying 55% of hospital road traffic death cases identified during active case finding; however, IS cases were representative of cases identified. Data accuracy and completeness varied across data fields. Combining IS with active case finding, death certificates, and the electronic vehicle insurance claim system more than doubled the number of road traffic death cases identified in Phuket.

Conclusion: An efficient and comprehensive road traffic injury and death surveillance system is critical for monitoring Phuket’s road traffic burden. The hospital-based IS system is a useful system for monitoring road traffic deaths and assessing risk behaviors. However, the complexity of data collection and limited coverage hinders the ability of IS to fully represent road traffic deaths in Phuket Province. Combining data sources could improve coverage and should be considered.     

Using ensemble modeling to predict the impacts of assisted migration on recipient ecosystems

Assisted migration is a controversial conservation measure that aims to protect threatened species by moving part of their population outside its natural range. Although this could save species from extinction, it also introduces a range of risks. The magnitude of the threat to recipient ecosystems has not been investigated quantitatively, despite being the most common criticism leveled at the action. We used an ensemble modeling framework to estimate the risks of assisted migration to existing species within ecosystems. With this approach, we calculated the consequences of an assisted migration project across a very large combination of translocated species and recipient ecosystems. We predicted the probability of a successful assisted migration and the number of local extinctions would result from establishment of the translocated species. Using an ensemble of simulated 15-species recipient ecosystems, we estimated that translocated species will successfully establish in 83% of cases if introduced to stable, high-quality habitats. However, assisted migration projects were estimated to cause an average of 0.6 extinctions and 5% of successful translocations triggered 4 or more local extinctions. Quantifying the impacts to species within recipient ecosystems is critical to help managers weigh the benefits and negative consequences of assisted migration.     

Compensation for “Meaningful Participation” in Climate Change Control: A Modest Proposal and Empirical Analysis

The debate over an international climate change regime has thus far focused primarily on efficiency concerns in developed countries. This paper suggests a means by which equity concerns may be addressed in the ongoing negotiations. A system of transfers is developed that is motivated by the difference between the damage caused by a country and the damage suffered by that country as a result of climate change. Illustrative calculations of the magnitude and direction of these transfers are made. We find that in general transfers flow from temperate to tropical countries but that the degree of uncertainty associated with these calculations is very large.     

Long-term increased bioaccumulation of mercury in largemouth bass follows reduction of waterborne selenium

Average mercury concentrations in largemouth bass from Rogers Quarry in east Tennessee were found to increase steadily following the elimination of selenium-rich discharges of fly ash to the quarry in 1989. From 1990 to 1998, mean mercury concentrations (adjusted to compensate for the covariance between individual fish weight and mercury concentration) in bass rose from 0.02 to 0.61 mg/kg. There was no indication that the rate increase was slowing or that mercury concentrations in fish were approaching a plateau or steady state. Mean selenium concentrations in bass declined from 3 to 1 mg/kg over the first five years of the study, but remained at 1-1.5 mg/kg (about twice typical concentrations in bass from local reference sites) for the last three years of the study. Gross physical abnormalities were common in fish from the site in the first three years after elimination of fly ash discharges but disappeared after two more years. Although it remains possible that other chemical or physical changes related to fly ash disposal in the system were associated with increased mercury bioaccumulation, the most likely explanation is that selenium played a critical role. It appears as though aqueous selenium enrichment was capable of having a profound effect on mercury bioaccumulation in this system but at the cost of causing a high incidence of gross abnormalities in fish. However, it is possible that selenium concentrations between the national ambient water quality criterion for the protection of aquatic life, 5 microg/l, and that now found in Rogers Quarry (<2 microg/l) could reduce mercury bioaccumulation without causing adverse effects on aquatic biota and fish-eating wildlife.