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.     

OSHA职业伤害与疾病记录和报告机制简介

介绍了OSHA《记录和报告职业伤害与疾病》法规的主要内容,分析了中国引入该法规的益处。     

基于人体皮肤热模型的热防护服评价方法研究

在热防护服热防护性能测试装置基础上,用自行研制的新型耐高温模拟皮肤传感器代替铜片热流计测量通过应急热防护服装面料的热流量,将热流量作为热波皮肤模型边界条件,得到人体皮肤表层下80μm处的温度值,从而得到一定条件下人体真实皮肤达到二级烧伤所需时间,用其评价热防护服用织物的热防护性能,并将热波皮肤模型(TWMBT)的测试值与Pennes模型以及铜片热流计的测试结果进行分析比较。采用热波皮肤模型分析织物层下的"皮肤"防热时间更接近实际皮肤达到二级烧伤时间值,可较为精确的量化织物热防护性能,为应急救援热防护服装的热设计提供理论依据。     

Pedestrian fatalities, Atlanta Metropolitan Statistical Area and United States, 2000-2004

Motor vehicle crashes killed almost 5,000 pedestrians in 2005 in the United States. Pedestrian risk may be higher in areas characterized by urban sprawl. From 2000 to 2004, pedestrian fatality rates declined in the United States, but the Atlanta metropolitan statistical area did not experience the same decline. Pedestrian fatality rates for males, Hispanics, and the 15–34 and 35–54 year age groups were higher in Atlanta than in the United States overall. Pedestrian safety interventions should be targeted to high-risk populations and localized pedestrian settings.     

酸雨与镧对大豆幼苗生长的复合伤害效应研究

为探索酸雨与稀土镧对大豆幼苗生长的复合影响及其内在机制,以重要油粮作物大豆(Glycine max)为材料,研究在模拟酸雨pH分别为3.0、3.5、4.5与稀土镧La(Ⅲ)浓度分别为60、100和300mg·L-1处理下大豆幼苗生长及光合作用的变化.结果表明,相对单一酸雨与镧处理,酸雨与La(Ⅲ)复合处理组中大豆幼苗的生长受抑制程度增大,两者呈协同效应,且pH越低,La(Ⅲ)浓度越高,抑制效应越明显.光合参数的变化规律与生长指标近同,相同处理组各光合参数的降幅不一致,其中最大荧光(Fv/Fm)和叶绿素含量(Chl)的降幅范围分别为9.53%～22.75%和9.14%～24.53%,较净光合速率Pn(22.78%～84.7%)、希尔(Hill)反应速率(15.52%～73.38%)和Mg2+-ATPase活性(14.51%～71.54%)小,表明各光合参数对2个胁迫因子的敏感程度存在差异.进一步相关性分析发现,Pn变化主要受Hill反应速率与Mg2+-ATPase活性的影响,而Chl、Fv/Fm次之.表明酸雨与La(Ⅲ)对植物光合过程各环节的作用机制不同,光合作用受阻是影响植物生长的重要因素之一.     

Fun ride or risky transport: Golf cart-related injuries treated in U.S. emergency departments from 2007 through 2017

Introduction: Golf cart-related injuries constitute a substantial source of morbidity, most notably in pediatric populations. Despite the high rate of injuries, there have been no meaningful changes in golf cart design or legislation to reduce the overall burden of these injuries. This study sought to characterize the epidemiology of golf cart-related injuries treated in United States hospital emergency departments. Method: A retrospective analysis was conducted by using data from the National Electronic Injury Surveillance System for patients of all ages who were treated in emergency departments (EDs) (2007–2017) for a golf cart-related injury. Results: From 2007 through 2017, an estimated 156,040 (95% CI = 102,402–209,679) patients were treated in U.S. EDs for golf cart-related injuries. The average rate of traumatic brain injuries (TBIs) in children (1.62 per 100,000 children) was more than three times that of TBIs in adults (0.52 per 100,000 adults; rate ratio = 2.38; 95% CI = 2.36–2.41) and nearly twice that of TBIs in seniors (1.11 per 100,000 seniors; rate ratio = 1.21; 95% CI = 1.19–1.22). The rate of injuries in seniors increased significantly by 67.6% from 4.81 per 100,000 seniors in 2007 to 8.06 per 100,000 seniors in 2017 (slope = 0.096; p = 0.041). Conclusions: Golf cart use remains an important source of injury for people of all ages, especially in children. As use continues to increase, it is unlikely that golf cart-related injuries will decrease without substantial changes to product design, regulation, and/or legislation. Practical Applications: Use of golf carts pose a considerable risk of injury and morbidity; safety recommendations should be followed.     

An LC-MS/MS method for creatine and creatinine analysis in paraquat-intoxicated patients

Abstract

A sudden increase in serum creatinine after paraquat intoxication has been reported in several clinical studies. However, this dramatic change of creatinine may be possibly due to an interconversion of creatine-creatinine in relation to paraquat toxicity. In order to investigate the creatine-creatinine relationship, a liquid chromatography tandem mass spectrometry in combination with electrospray ionization was developed and validated for simultaneous determination of creatine and creatinine in the serum. The chromatographic separation was achieved on a Gemini® C₆-Phenyl column with a gradient elution consisting of 0.1% formic acid in ultrapure water and methanol as the mobile phase. The method yielded suitable levels of specificity and selectivity, and calibration curves of creatine and creatinine in serum were linear over the concentration range of 0.5–200?µg mL^?1. The limit of quantification of both compounds was 0.5?µg mL^?1, and the method was accurate within the recovery range of 96.23–102.75%, indicating the robustness of the method. The method was successfully applied to toxicological samples from paraquat-intoxicated patients, and the concentrations of creatine and creatinine were quantified. High creatine concentrations in serum samples were observed which may lead to high serum creatinine despite normal kidney function as creatine is converted to creatinine in proportion to its concentration.     

Integrated model of simulated occupant injury risk and real medical costs

Introduction

The purpose of this study was to develop an integrated methodology that links occupant injury risk functions, estimated in the laboratory, with real world medical treatment costs by using the abbreviated injury score (AIS). Using our model, the expected medical treatment costs for crash injuries to various body regions and of different severities can be investigated.

Methods

First, the simulation results are compared with NHTSA crash data. We used a modified kinematics simulation model that incorporates an F = E^b function as a supplement to the previous Steffan's model to obtain a more accurate acceleration history a(t). Second, head injury criteria HIC₃₆ can be calculated from a(t), and we use the injury probability P as a function of HIC_36, as proposed by Kuppa, to obtain the injury risk function for various AIS values. Third, medical treatment cost models for various AIS values can be calculated by using a regression cost model with real world data. Finally, the injury risk function and medical treatment cost models are linked through AIS values. We establish an integrated methodology and predict medical costs and car safety data using real world police reports, medical treatment costs, and laboratory simulation results.

Results

Using head injuries in frontal crashes as an example, we focus on simulation parameters for different vehicle models, with and without airbags. We specifically examine impact closing speed, Delta-V, and impact directions.

Conclusion

Simulation results can be used to supplement insufficient real crash data, in particular ΔV, and injury risk results from police crash reports.

Impact on industry

The proposed integrated methodology may provide the vehicle industry with a new safety assessment method. Real crash data coupling provides consumers with more realistic and applicable information.     

Using data linkage to assess the impact of motorized recreational vehicle-related injuries in Ohio

Problem

Motorized recreational vehicle (MRV)-related injuries can result in severe medical and financial consequences. The objective of this study was to describe the epidemiology, and clinical and financial impact of MRV-related injuries in Ohio.

Method

Probabilistically linked statewide Emergency Medical Services (EMS) and hospital (inpatient and emergency department) data for 2003 and 2004 were examined. Record pairs with a MRV-related E-code (E821-E823, E825) were included in this study.

Results

There were 2,893 patients with MRV-related injuries, who had linked EMS and hospital records, resulting in more than $15 million in hospital charges and 1,921 inpatient days of hospitalization. The male-to-female ratio was nearly 4:1, and 19% were younger than 16. Almost 82% of cases were not wearing a helmet; there was a trend of decreasing helmet use with increasing age. Mean (SE) inpatient hospital charges and length of stay (LOS) were $22,218 ($1,290) and 3.8 (0.2) days, respectively. The mean (SE) Injury Severity Score (ISS) for inpatients was 9.2 (0.4). Individuals injured on a street/highway were 3.20 times more likely to sustain an ISS ≥ 16 (95% CI: 1.03, 9.88; p = 0.044) and 3.05 times more likely to sustain a traumatic brain injury (TBI) (95% CI: 1.17, 7.94; p = 0.024) than those who were injured at a place designated for sport or recreation. Children aged 12 to 15 and young adults aged 16 to 25 were 2.47 and 2.14 times more likely, respectively, to sustain a TBI than adults aged 36 or older (aged 12 to 15: 95% CI: 1.13, 5.38; p = 0.024; aged 16 to 25: 95% CI: 1.26, 3.64; p = 0.005). Higher ISS was associated with both higher total charges (p < 0.001) and longer LOS (p < 0.001).

Discussion

This study demonstrates that MRV-related injuries are an important public health problem in Ohio, with a substantial clinical and financial impact.

Impact on Industry

Enactment and enforcement of statewide MRV safety legislation and training of MRV users offer valuable opportunities to prevent these costly injuries.     

基于伤害监测的产品安全监管模式研究

鉴于缺陷产品给消费者造成的人身伤害日渐增多,通过分析产品伤害流行病学的模型,提出采用不同的干预措施,包括预警、召回、完善标准和法律等手段,及时消除由缺陷产品引起的各种伤害,而这有赖于对大量的缺陷信息的收集和分析。国外一些发达国家建立的产品伤害监测系统,通过样本医院收集由产品缺陷导致的伤害事故,被证明是一种有效的信息收集手段。为此,我国有关部门开始着手建立产品伤害监测系统的前期研究工作,并进行试点研究,取得大量一手资料。建议借鉴国外的成功经验,尽快建立适合我国国情的产品伤害监测系统,并开展有关重点产品的伤害监测活动。