Functional outcomes of motor vehicle crash thoracic injuries in pediatric and adult occupants

Objective: Characterization of the severity of injury should account for both mortality and disability. The objective of this study was to develop a disability metric for thoracic injuries in motor vehicle crashes (MVCs) and compare the functional outcomes between the pediatric and adult populations.

Methods: Disability risk (DR) was quantified using Functional Independence Measure (FIM) scores within the National Trauma Data Bank for the most frequently occurring Abbreviated Injury Scale (AIS) 2–5 thoracic injuries. Occupants with thoracic injury were classified as disabled or not disabled based on the FIM scale, and comparisons were made between the following age groups: pediatric, adult, middle-aged, and older occupants (ages 7–18, 19–45, 46–65, and 66+, respectively). For each age group, DR was calculated by dividing the number of patients who were disabled and sustained a given injury by the number of patients who sustained a given injury. To account for the effect of higher severity co-injuries, a maximum AIS adjusted DR (DR_MAIS) was also calculated for each injury. DR and DR_MAIS could range from 0 to 100% disability risk.

Results: The mean DR_MAIS for MVC thoracic injuries was 20% for pediatric occupants, 22% for adults, 29% for middle-aged adults, and 43% for older adults. Older adults possessed higher DR_MAIS values for diaphragm laceration/rupture, heart laceration, hemo/pneumothorax, lung contusion/laceration, and rib and sternum fracture compared to the other age groups. The pediatric population possessed a higher DR_MAIS value for flail chest compared to the other age groups.

Conclusion: Older adults had significantly greater overall disability than each of the other age groups for thoracic injuries. The developed disability metrics are important in quantifying the significant burden of injuries and loss of quality life years. Such metrics can be used to better characterize severity of injury and further the understanding of age-related differences in injury outcomes, which can influence future age-specific modifications to AIS.     

A Framework for Fully Integrating Environmental Assessment

A new framework for environmental assessment is needed because no existing framework explicitly includes all types of environmental assessments. We propose a framework that focuses on resolving environmental problems by integrating different types of assessments. Four general types of assessments are included: (1) condition assessments to detect chemical, physical, and biological impairments; (2) causal pathway assessments to determine causes and identify their sources; (3) predictive assessments to estimate environmental, economic, and societal risks, and benefits associated with different possible management actions; and (4) outcome assessments to evaluate the results of the decisions of an integrative assessment. The four types of assessments can be neatly arrayed in a two-by-two matrix based on the direction of analysis of causal relationships (rows) and whether the assessment identifies problems or solves them (columns). We suggest that all assessments have a common structure of planning, analysis, and synthesis, thus simplifying terminology and facilitating communication between types of assessments and environmental programs. The linkage between assessments is based on intermediate decisions that initiate another assessment or a final decision signaling the resolution of the problem. The framework is applied to three cases: management of a biologically impaired river, remediation of a contaminated site, and reregistration of a pesticide. We believe that this framework clarifies the relationships among the various types of assessment processes and their links to specific decisions.     

ANALYZIIG RIPARIAN SITE CAPABILITY AND MANAGEMENT OPTIONS1

ABSTRACT: Riparian areas interact with aquatic and upland conditions and therefore help determine the degree of functionality (streambank stability, shade, sediment, and debris filtering) found in a watershed or catchment. Thus, conditions in riparian areas exert significant influence on water quality. Physical and biological factors (biophysical determinants) that influence these conditions and determine long‐term site ecology include topographic variables, geology, climate, soil texture, and others. These conditions are further modified by management infrastructure (roads, dikes, etc.). Our objective was to develop a system for evaluating site condition in relation to site capability. Since biophysical determinants and infrastructure interact with water quality, our first task was to acquire data concerning the spatial distribution of biophysical determinants and infrastructure constraints and to import them into a GIS system where they could be managed and processed. To expedite analysis, determinants and infrastructure constraints were placed into a hierarchy capable of isolating various site capability types. The hierarchy was designed to incorporate multiscale effects. Site capability areas are georeferenced in this process thereby enabling efficient monitoring and providing a way to focus management on those areas needing improvement. Study tasks included: (1) landscape characterization and hierarchy selection, (2) field assessment, (3) information management and data mining, and (4) information interpretation and adaptive management. This approach appears to be an effective way to isolate general ripananstandardsmaycon site conditions, to provide indications about water quality, and to create strategies necessary for alleviating water quality problems.     

Psychological consequences of prenatal diagnosis in a case of familial Angelman Syndrome

Angelman Syndrome (AS), characterized by mental retardation, absence of speech, seizures and motor dysfunction, is caused by genetic defects leading to loss of expression of the maternal copy of the chromosome 15q11–13 imprinted region. Most cases are sporadic, being caused by de novo deletion of maternal chromosome 15q11–13 (75%) or by paternal uniparental disomy (3–4%). Familial cases can occur, due to mutations in the UBE3A gene or in the imprinting center. We describe the case of a pregnant woman having two nephews with AS caused by a UBE3A mutation; lack of communication within the family led the woman to be completely unaware of the risk of disease recurrence until 15 weeks of gestation. UBE3A genetic testing revealed she carried the familial mutation 892–893delCT. Prenatal diagnosis was performed on amniotic fluid and demonstrated that the fetus had inherited the mutation. The unexpected diagnosis and the subsequent termination of the pregnancy caused the woman to undergo acute psychological distress showing relevant psychopathological symptoms. Nevertheless, at 2-year follow-up, adverse consequences were minimized, and the couple was planning a new pregnancy. Factors affecting the psychological outcome of abortion and the role of psychological support in reducing the risk of long-term unfavorable consequences are discussed. Copyright © 2006 John Wiley & Sons, Ltd.