Trauma demography and clinical epidemiology of motorcycle crash–related head injury in a neurosurgery practice in an African developing country

Objective: Though motor vehicle crashes (MVCs) were the main cause of head trauma from road traffic injuries (RTIs), motorcycle crashes (MCCs) are now a major cause of RTI-related head injury (HI) in many developing countries.

Methods: Using a prospective database of HIs from a neurosurgical practice in a sub-Saharan African developing country, a cross-sectional survey was conducted for the trauma demography and clinical epidemiology of this MCC-related HI.

Results: Motorcycle crashes accounted for 57% (473/833) of all RTI-related HIs in this registry. The victims, with a mean age of 33.1 years (SD = 18.3), consisted mainly of males (83.1%), those of low socioeconomic status (>90%), and those aged between 20 and 40 years old (56%). MCCs involved only riders in 114 cases (114/473, 32.1%), of which 69% were motorcycle–motorcycle crashes. The HI was moderate–severe in 50.8%; clinical symptomatology of significant HI included loss of consciousness (92%), anisocoria (35%), Abbreviated Injury Scale head (AIS–head) score > 3 (28%), and CT-Rotterdam score > 3 (30%). Extracranial systemic injury involved the limbs most frequently, with an Injury Severity Score (ISS) >25 in 49%. The fatality rate was 24%.

MCC-related HI among pedestrian victims involved more vulnerable age groups (the young and elderly) but have lower mean ISS compared to motorcycle passengers (mean ISS = 23.5 [11.6] vs. 27.4 [13.0]; 95% confidence interval [CI], 1.27–6.49; P = .004). In addition, compared to a contemporary cohort of MVC-related HIs in our registry, MCC victims were older (mean age 34.8 years [18.0] vs. 30.8 [18.4]; P = .002); had higher proportions of certain extracranial trauma like long bone fractures (71 vs. 29%; P = .02); and suffered fewer surgical brain lesions (25.5 vs. 17.2%; P = .004).

Conclusions: Motorcycle crashes are now a significant threat to the heads, limbs, and lives of vulnerable road users in developing countries.     

NUTRIENT CONCENTRATIONS AND YIELDS IN UNDEVELOPED STREAM BASINS OF THE UNITED STATES1

ABSTRACT: Data from 85 sites across the United States were used to estimate concentrations and yields of selected nutrients in streams draining relatively undeveloped basins. Flow‐weighted concentrations during 1990–1995 were generally low with median basin concentrations of 0.020, 0.087, 0.26, 0.010, and 0.022 milligrams per liter (mg/L) for ammonia as N, nitrate as N, total nitrogen, orthophosphate as P, and total phosphorus, respectively. The flow‐weighted concentration of nitrate exceeded 0.6 mg/L in only three basins. Total nitrogen exceeded 1 mg/L in only four basins, and total phosphorus exceeded 0.1 mg/L in only four basins. The median annual basin yield of ammonia as N, nitrate as N, total nitrogen, orthophosphate as P, and total phosphorus was 8.1, 26, 86, 2.8, and 8.5 kilograms per square kilometer, respectively. Concentrations and yields of nitrate tended to be highest in northeastern and mid‐Atlantic coastal states and correlated well with areas of high atmospheric nitrogen deposition. Concentrations and yields of total nitrogen were highest in the southeastern part of the nation and in parts of the upper Midwest. In the northeast, nitrate was generally the predominant form of nitrogen, and in the southeast and parts of the upper Midwest, organic nitrogen was the dominant form. Concentrations of total phosphorus were generally highest in the Rocky Mountain and Central Plain states.     

Resolving conflicting priorities in Ontario agriculture

Changes in global patterns of grain production have affected the profitability of commercial, cash-crop agriculture in North America. The current financial crisis has highlighted a perceived conflict between the priorities of (1) strengthening net farm profit, (2) maintaining the productive potential of the land base, (3) enhancing the health and cohesiveness of the agricultural community, and (4) addressing societal demands for safe foodstuffs. Reducing input costs by reducing the need for privately owned machinery can minimize the scale-dependence of agricultural practices, as illustrated with examples involving silage and intensively managed pasture in Ontario. This approach could improve farming opportunities for nontraditional, part-time farmers, and at the same time, create a niche for professional custom operators and managers. Enhancing the viability of nontraditional farm operations, a historically neglected component of the farming community, as well as commercial farms is viewed as one approach to sustaining and improving both the agricultural land base and the agricultural community. Applying resource-extensive rather than resource-intensive approaches to forage management reveals that these apparently divergent priorities are, in fact, interlocking pieces of the same puzzle.     

Acoustically detected year-round presence of right whales in an urbanized migration corridor

Species' conservation relies on understanding their seasonal habitats and migration routes. North Atlantic right whales (Eubalaena glacialis), listed as endangered under the U.S. Endangered Species Act, migrate from the southeastern U.S. coast to Cape Cod Bay, Massachusetts, a federally designated critical habitat, from February through May to feed. The whales then continue north across the Gulf of Maine to northern waters (e.g., Bay of Fundy). To enter Cape Cod Bay, right whales must traverse an area of dense shipping and fishing activity in Massachusetts Bay, where there are no mandatory regulations for the protection of right whales or management of their habitat. We used passive acoustic recordings of right whales collected in Massachusetts Bay from May 2007 through October 2010 to determine the annual spatial and temporal distribution of the whales and their calling activity. We detected right whales in the bay throughout the year, in contrast to results from visual surveys. Right whales were detected on at least 24% of days in each month, with the exception of June 2007, in which there were no detections. Averaged over all years, right whale calls were most abundant from February through May. During this period, calls were most frequent between 17:00 and 20:00 local time; no diel pattern was apparent in other months. The spatial distribution of the approximate locations of calling whales suggests they may use Massachusetts Bay as a conduit to Cape Cod Bay in the spring and as they move between the Gulf of Maine and waters to the south in September through December. Although it is unclear how dependent right whales are on the bay, the discovery of their widespread presence in Massachusetts Bay throughout the year suggests this region may need to be managed to reduce the probability of collisions with ships and entanglement in fishing gear.     

Mortality in rural locations after severe injuries from motor vehicle crashes

BackgroundMortality from traffic crashes is often higher in rural regions, and this may be attributable to decreased survival probability after severe injury.MethodsData were obtained from the National Automotive Sampling System – General Estimates System (NASS-GES) for 2002–2008. Using weighted survey logistic regression, three injury outcomes were analyzed: (a) Death overall, (b) Severe injury (incapacitating or fatal), and (c) Death, after severe injury. Models controlled for (pre-crash) person, event, and county level factors.ResultsThe sample included 883,473 motorists. Applying weights, this represented a population of 98,411,993. Only 2% of the weighted sample sustained a severe injury, and 9% of these severely injured motorists died. The probability of death overall and the probability of severe injury increased with older age, safety belt nonuse, vehicle damage, high speed, and early morning crashes . Males were less likely to be severely injured, but more likely to die if severely injured. Motorists in southern states were more likely to have severe injuries, but not more likely to die if severely injured. Motorists who crashed in very rural counties were significantly more likely to die overall, and were more likely to die if severely injured.ConclusionsMotorists with severe injury are more likely to die in rural areas, after controlling for person- and event-specific factors.