Accidental Death Research Articles

Trends in Road Traffic Injuries Mortality in India: An Analysis from the Global Burden of Disease Study 1990-2021.

Road traffic injury (RTI) is one of the most common causes of accidental deaths in India. The study investigates the changes in trends in age-standardised RTI mortality rates in India by sex and age groups, using data from the Global Burden of Disease (GBD) Study 2021. The trend segments are estimated from 1990 to 2021 employing a joinpoint regression model. Additionally, the influence of age, time period, and birth cohort on mortality rate trends was assessed using the age-period-cohort model. Over the past 32 years, the RTI mortality rates have experienced multiple trend segments. RTI mortality rate in the ≤ 14-year-old population has declined remarkably, dropping from 5.71 (4.65 to 6.88) per lakh population in 1990 to 3.66 (3.01 to 4.35) per lakh population in 2010, and further declining to 1.98 (1.65 to 2.37) per lakh population in 2021. The study found a positive correlation between RTI mortality rates and age, with rates consistently lower for women compared to men across all age groups. The variation in RTI mortality rates across Indian states has widened over time, with the coefficient of variation increasing from 30.58% in 1990 to 32.36% in 2010, and further to 35.11% in 2021. Despite efforts, Indian states are unlikely to achieve the goal of halving RTI deaths by 2030, based on 2010 levels. To address this, road conditions and road safety policies aimed at preventing the incidence of RTIs should be further intensified.

Shedding Light on Hidden Methamphetamine Abuse: A Nation-wide 7-year Post-mortem Study in Taiwan.

The number of methamphetamine-related deaths has been increasing in recent decades. However, current data primarily rely on a few large-scale national surveys, highlighting the need for diverse data sources. Post-mortem studies offer advantages that compensate for the limitations of cohort studies. In this study, we aimed to (1) examine mortality rates and years of potential life lost, (2) compare proportionate mortality with previous cohort studies, and (3) quantitatively investigate causes of death as potential risk factors associated with each manner of death. We analyzed 740 cases from 2013 to 2019 in Taiwan. The mean age of cases was 38.4 years, with a notable loss of 30 or more years of potential life, and 79.6% were male. The crude mortality rate was 0.45 per 100,000 person-years. The proportionate mortality indicated that autopsy dataset, compared to cohort studies, provided more accurate estimations for accidental deaths, equivalent suicides, underestimated natural deaths, and overestimated homicides. Accidental deaths were evident in 67% of cases with 80% attributed to drug intoxication. Multiple substances were detected in 61% of cases, with psychiatric medications detected in 43% of cases. Higher methamphetamine concentrations and a greater proportion of multiple substances and benzodiazepines were detected in suicidal deaths. Among accidental deaths, traffic accidents (7.9%) were the second most common cause, particularly motorcycle riders. Using autopsy dataset as a secondary source, we identified that over half of the cases involved drug intoxication-related accidental deaths. The significant proportion of cases involving multiple substances, psychiatric medications, and drug-impaired driving raises concerns.

Bacterial profile of wound site infections and evaluation of risk factors for sepsis among road traffic accident patients from Apex Trauma Centre, Northern India.

Background. Among the most significant yet often ignored health issues worldwide are trauma and accidental injuries. India accounts for 11% of global deaths in road accidents, the highest in the world, according to the World Bank report. There are limited data about the bacterial contamination of road traffic accident (RTA) wounds and their antibiotic susceptibility patterns. Materials and Methods. This prospective study was conducted in a tertiary care centre in northern India from January 2023 to January 2024. Wound deep swabs or aspirates were collected from RTA patients with traumatic injuries at different time intervals. Gram stain and culture were performed, and positive aerobic culture was subjected to antibiotic susceptibility testing. Organism identification was done using MALDI-TOF MS and routine biochemical tests. Blood samples were also collected to rule out bloodstream infections during follow-up if the patient became febrile or showed symptoms of systemic infection. Sepsis was defined in those patients who had two or more scores in the systemic inflammatory response syndrome criteria with a positive microbiological culture. Risk factors were evaluated for sepsis on the basis of the patient's vitals, injury characteristics, procalcitonin, Glasgow Coma Scale (GCS) score, need for mechanical ventilation and complete blood count, which were obtained from the patient's admission file. Results. A total of 189 wound samples were collected, of which 99 (52.38%) samples showed the growth of microorganisms. The aerobic isolates included 69 (69.69%) Gram-negative bacilli, of which the majority were Klebsiella pneumoniae, 28 (28.28%) Gram-positive cocci, of which the majority were Staphylococcus aureus and 2 (2.02%) anaerobic isolates. Among the Gram-negative isolates, none of the isolates were resistant to colistin. All S. aureus isolates were susceptible to vancomycin, teicoplanin and levonadifloxacin. Sepsis developed in 50 (26.45 %) patients. Significant risk factors evaluated for sepsis were a raised procalcitonin level, a low GCS score, a higher injury severity score, the need for mechanical ventilation and a raised quick sequential organ failure assessment score. Conclusion. It is essential to ascertain the profile of microorganisms isolated from RTA wounds in order to reduce antibiotic resistance and deliver efficient treatment.

Современные принципы и методы оказания первой помощи при утоплении

Summary. The aim of the study — to review and analyze the scientific literature and current recommendations on first aid (FA) for drowning; based on the results of the analysis, to develop a draft universal algorithm for providing FA in drowning. Study materials and methods. The material for the study comprised international and national guidelines on FA in drowning and articles on the topic of FA in drowning published in peer-reviewed scientific journals. The information search was carried out in January 2024 using the Google search engine and bibliographic databases Google Scholar, PubMed, and eLIBRARY.RU. Results of the study and their analysis. Being one of the most common causes of accidental death, drowning is a serious public health problem. Timely and correct provision of FA by incident witnesses significantly reduces the risk of death and disability for the victims. At the same time, the topic of providing FA for drowning has been little touched upon in the domestic scientific literature. There are no uniform guidelines for the Russian Federation on the provision of FA in drowning. Improvement of the organizational basis in Russia for effective provision of FA for drowning requires the development and approval of a unified formal procedure for providing FA for drowning and the establishment of the practice of mass training of the population in modern principles and methods of providing FA for drowning. Based on the results of the analysis of current international guidelines on FA, the proposed universal algorithm for providing FA for drowning, after discussion and agreement by the scientific community, may act as a basic element for creating the formal procedure for providing FA and developing appropriate educational and awareness-raising materials on FA for drowning.

Golden Jackal (Canis aureus) death by road accident in rural Bengal-insight the fact: a perception based eco-spatial clarification.

Golden jackal is one of the higher trophic level wild animals in rural Bengal. Their ecological significance is undeniable in regional ecosystems and biodiversity. But gradually they become threatened due to habitat contraction, road killing, poisoning and human persecution. The documentation of jackal death by road accident within the 12-km district highway which is a single lane bituminous road in Patshpur-I Community Development Block under Purba Medinipur district, India, reveals an unpredictable ecological circumstance (n-154). Jackals are killed by road accidents from 2022 to 2023. On behalf of this blameless situation, the present study conducted intensive observations, case studies and spatial-ecological analysis. The study also included stakeholder's perceptions to reach and relates the background of this fact. After observation and analysis, it has been found that the jackal deaths have a spatio-temporal signature and are connected with food and forage ground loss from their habitat-influenced area. Another outcome is that roadside habitat becomes an alternative food source and forage ground for them due to trench construction both alongside of the district highway and illegal dumping of meat wastes and domestic wastes. The seasonal biological activities of the jackals, local weather phenomena and car driver negligence are responsible for the accidental death of jackals along the district highway. Considering all the observed factors, the present study shared some reliable measures to control, protect and conserve this animal for balancing regional ecosystem as well as biodiversity in rural Bengal.

Некоторые особенности осмотра места происшествия по уголовным делам о нарушении правил дорожного движения и эксплуатации транспортных средств

Currently, in conditions of intensive development of infrastructure, the main component of which is transport, one of the main tasks of the state remains to ensure road safety. Decree of the Government of the Russian Federation No. 1-r dated 08.01.2018 approved the Road Safety Strategy in the Russian Federation for 2018-2024, which defines the foundations for the formation and implementation of state policy in the field of road safety at various levels (federal, regional, municipal, intersectoral). Improving road safety and striving to achieve zero deaths in road accidents in 2030 is its goal. For 2024, the social risk indicator has been set as a target – no more than 4 deaths per 100,000 people. The article analyzes some features of the inspection of the scene of an accident in criminal cases of violation of traffic rules and operation.

Review of Local Homeless Mortality Efforts: A Call for Standardized Data and Reporting.

There are currently no national estimates of how many people die while unhoused in the US. Local jurisdictions have developed their own approaches for estimating homeless mortality. We aimed to examine these local approaches, document what is known about homeless mortality, and summarize local methodologies. We reviewed 17 publicly available homeless mortality reports (ie, gray literature). Reports were sought from government, Health Care for the Homeless, coalition to end homelessness, and other advocacy and social service websites. From each report, we extracted the number of homeless deaths, dates of observation, data source(s) used, determination of homeless status, manners and causes of death, and decedent demographics. Data collection and reporting on homeless mortality varied greatly across reports. This variation limits aggregation across reports. Medical examiner data was the most used data source. Manner of death was the most consistently collected field, with accidental deaths reported as the most prevalent manner of homeless deaths. Not all reports listed specific causes of death, but those that did reported toxicity (eg, overdose) and cardiovascular causes as most prevalent. The most granular age category of most homeless decedents was 40 to 60years. On average, 80% of decedents were of male sex. While over half of reports included race and ethnicity information, disparities could not be estimated without suitable denominators. Standardized data collection and reporting guidance is needed for homeless mortality. Health departments can work with local Health Care for the Homeless programs and Continuums of Care to establish data sharing processes. Matching vital statistics with homeless service utilization records may be one opportunity to improve these efforts. Until there is federal or national guidance on these standards, localities can consider adding housing or homelessness variables as optional or mandatory fields in electronic death reporting systems.

Human birth tissue products as a non-opioid medicine to inhibit post-surgical pain.

Pain after surgery causes significant suffering. Opioid analgesics cause severe side effects and accidental death. Therefore, there is an urgent need to develop non-opioid therapies for managing post-surgical pain. Local application of Clarix Flo (FLO), a human amniotic membrane (AM) product, attenuated established post-surgical pain hypersensitivity without exhibiting known side effects of opioid use in mice. This effect was achieved through direct inhibition of nociceptive dorsal root ganglion (DRG) neurons via CD44-dependent pathways. We further purified the major matrix component, the heavy chain-hyaluronic acid/pentraxin 3 (HC-HA/PTX3) from human AM that has greater purity and water solubility than FLO. HC-HA/PTX3 replicated FLO-induced neuronal and pain inhibition. Mechanistically, HC-HA/PTX3 induced cytoskeleton rearrangements to inhibit sodium current and high-voltage activated calcium current on nociceptive neurons, suggesting it is a key bioactive component mediating pain relief. Collectively, our findings highlight the potential of naturally derived biologics from human birth tissues as an effective non-opioid treatment for post-surgical pain. Moreover, we unravel the underlying mechanisms of pain inhibition induced by FLO and HC-HA/PTX3.

Age estimation of Phormia regina pupae based on ATR-FTIR and chemometrics

Accurate postmortem interval estimation is vital in the investigation of homicides, suicides, and accidental deaths. It is key in narrowing suspect lists, improving crime-solving efficiency, and offering solace to bereaved families. The intra-puparial period, comprising about half of a fly’s developmental cycle, presents challenges for morphological age estimation. External changes are limited to color shifts and the appearance of respiratory horns on the puparium only within several hours after pupariation, while detailed internal development analysis often requires invasive methods like removing the puparium, which can be damaging. Additionally, these techniques usually depend on a forensic entomologist’s expertise, which lead to subjective biases. This study employed attenuated total reflection-fourier transform infrared spectroscopy, a rapid, non-destructive method for analyzing proteins, chitosan, and chitin in puparia. Data showed a consistent reduction in the concentration of the amide I band within the puparium during the intra-puparial development at five constant temperatures (19 °C, 22 °C, 25 °C, 28 °C and 31 °C). This trend in the spectral data effectively distinguishes pupae at various stages of intra-puparial development, facilitating precise age estimation, which is critical for the estimation of the minimum postmortem interval (PMImin). Finally, this work combined the total reflection-fourier transform infrared spectroscopy with chemometric analysis and successfully developed a partial least squares discriminant analysis model and a random forest model, with accuracies of 88 % and 81 %, respectively. These models enable the non-invasive age estimation of P. regina in its intra-puparial period, a stage traditionally difficult to assess morphologically, thus laying the groundwork for PMImin estimation using fly pupae.

Text mining of verbal autopsy narratives to extract mortality causes and most prevalent diseases using natural language processing

Verbal autopsy (VA) narratives play a crucial role in understanding and documenting the causes of mortality, especially in regions lacking robust medical infrastructure. In this study, we propose a comprehensive approach to extract mortality causes and identify prevalent diseases from VA narratives utilizing advanced text mining techniques, so as to better understand the underlying health issues leading to mortality. Our methodology integrates n-gram-based language processing, Latent Dirichlet Allocation (LDA), and BERTopic, offering a multi-faceted analysis to enhance the accuracy and depth of information extraction. This is a retrospective study that uses secondary data analysis. We used data from the Agincourt Health and Demographic Surveillance Site (HDSS), which had 16338 observations collected between 1993 and 2015. Our text mining steps entailed data acquisition, pre-processing, feature extraction, topic segmentation, and discovered knowledge. The results suggest that the HDSS population may have died from mortality causes such as vomiting, chest/stomach pain, fever, coughing, loss of weight, low energy, headache. Additionally, we discovered that the most prevalent diseases entailed human immunodeficiency virus (HIV), tuberculosis (TB), diarrhoea, cancer, neurological disorders, malaria, diabetes, high blood pressure, chronic ailments (kidney, heart, lung, liver), maternal and accident related deaths. This study is relevant in that it avails valuable insights regarding mortality causes and most prevalent diseases using novel text mining approaches. These results can be integrated in the diagnosis pipeline for ease of human annotation and interpretation. As such, this will help with effective informed intervention programmes that can improve primary health care systems and chronic based delivery, thus increasing life expectancy.

Significance of Programmed Cell Death Pathways in Neurodegenerative Diseases.

Programmed cell death (PCD) is a form of cell death distinct from accidental cell death (ACD) and is also referred to as regulated cell death (RCD). Typically, PCD signaling events are precisely regulated by various biomolecules in both spatial and temporal contexts to promote neuronal development, establish neural architecture, and shape the central nervous system (CNS), although the role of PCD extends beyond the CNS. Abnormalities in PCD signaling cascades contribute to the irreversible loss of neuronal cells and function, leading to the onset and progression of neurodegenerative diseases. In this review, we summarize the molecular processes and features of different modalities of PCD, including apoptosis, necroptosis, pyroptosis, ferroptosis, cuproptosis, and other novel forms of PCD, and their effects on the pathogenesis of neurodegenerative diseases, such as Alzheimer's disease (AD), Parkinson's disease (PD), Huntington's disease (HD), amyotrophic lateral sclerosis (ALS), spinal muscular atrophy (SMA), multiple sclerosis (MS), traumatic brain injury (TBI), and stroke. Additionally, we examine the key factors involved in these PCD signaling pathways and discuss the potential for their development as therapeutic targets and strategies. Therefore, therapeutic strategies targeting the inhibition or facilitation of PCD signaling pathways offer a promising approach for clinical applications in treating neurodegenerative diseases.

Underlying Polysubstance Classes and Associated Sociodemographic Characteristics and Health Histories among People who Died from Substance-Related Acute Toxicity in Canada: A Latent Class Analysis

AbstractThe aim of this study was to examine underlying patterns of substances detected among accidental acute toxicity deaths in Canada and their associations with sociodemographic characteristics, location, and substance use and health history. Data abstracted from coroner and medical examiner files for all accidental acute toxicity deaths across Canada (2016 to 2017) were analyzed. Six classes emerged from a latent class analysis conducted to characterize detected substance classes: (1) cocaine and alcohol, (2) benzodiazepines and other pharmaceutical substances, (3) pharmaceutical opioids, (4) multiple pharmaceutical and non-pharmaceutical substances, (5) methamphetamine and fentanyl or analogues, and (6) fentanyl or analogues. Differences were identified between latent classes by sex, age, marital status, location of death, place of residence, and substance use and health history. Patterns of detected substances among deaths characterized in this study emphasize the complex nature of substance-related acute toxicity deaths across Canada and can inform future research and public health action.

Deaths in jail: a retrospective analysis of autopsies performed at the Legal Medicine Unit of Pavia (1999-2022).

The high rate of incarceration, now exceeding 11.5 million people worldwide, has raised concerns about the conditions within penal institutions, such as the consequences of incarceration on the person. This retrospective study aims to investigate the issue of death in custody, exploring the relationship between incarceration, health vulnerabilities, and death from the forensic pathologist's point of view. We analyzed, from a forensic, clinical and toxicological perspective, 86 cases of deaths in detention facilities in North-Western Italy from 1999 to 2022. The analysis has shown that suicide, mainly committed by hanging, plastic bag suffocation and butane intoxication, represents the leading type of violent death (52%), followed by accidental deaths (16%). On the other hand, cardiovascular diseases are the leading cause of natural deaths (42%), followed by infectious diseases (especially HIV-related). The present study identifies the most frequent and critical situations and risk factors related to death in custody and the profile of the inmate who is at a higher risk of death, allowing to highlight the issues to be addressed from a public health point of view. On the whole, it calls for comprehensive reforms, aligned with international human rights standards, addressing mental and physical care gaps, improving correctional officers' education, and training, and focusing on rehabilitation with well-being and dignity.

Naloxone vending machines in county jail

IntroductionThe overdose epidemic in the United States has intensified following the introduction of illicitly manufactured fentanyl to drug markets with recent estimates indicating 110,000 deaths in 2022 and longer-term trends adversely impacting national life expectancy. A period of incarceration has been identified as a critical touchpoint for overdose prevention given its strong association with risk of overdose. In this paper we describe efforts funded by the Centers for Disease Control and Prevention (CDC) Overdose Data to Action (OD2A) grant to design and implement naloxone vending machines that provide free naloxone within county jails to returning citizens and those visiting county jail facilities. MethodsThis study utilized three sources of data. First, we describe the results of a pre-implementation survey administered by technical assistance providers to 18 jails across the state of Michigan. Second, among the 6 jail facilities that accepted a naloxone vending machine we examine administrative data from Michigan Department of Health and Human Services on naloxone orders to look at changes 6-months before and after implementation. Third and lastly, we conducted semi-structured interviews (N = 6) with jail administrators (i.e., County Sheriffs) on the barriers and facilitators to implementing a naloxone vending machine. ResultsSix facilities indicated they would accept a vending machine to distribute free naloxone. Overall, the total number of naloxone box orders that were distributed across all jail sites increased by 63.5 % from 4104 boxes pre-naloxone vending machine to 6708 boxes post-naloxone vending machine implementation. Qualitative interviews revealed that prior naloxone distribution efforts and foundational knowledge about opioids, overdose, and naloxone emerged as facilitators for vending machine implementation. ConclusionThis study illustrates the utility of policy-driven funding strategies aimed at mitigating accidental overdose deaths among a high-risk population while building community naloxone saturation efforts.

Risk Factors and Profiles of Falls Among Inpatients in Vietnam: A Multicenter Nested Case-Control Study.

Falls among inpatients represent a significant global health concern and are among the leading causes of accidental death. However, hospital falls are context- and population dependent. This study aimed to investigate the risk factors contributing to falls and the fall profiles among Vietnamese inpatients. A nested case-control study was conducted at nine public hospitals in Ho Chi Minh City. For every fall identified through the medical fall incident reporting system, four controls (ie, nonfall patients) were also selected from medical records within the same department and timeframe. Medical records were extracted, which included detailed information about the falls. Among 101 fall cases and 404 nonfall controls, several risk factors for falls were found, including reduced strength and mobility (OR=3.08, 95% 1.30-7.30), nocturia (OR=9.08, 95% CI 4.04-20.45), having more than two diseases (OR=2.76, 95% CI 1.53-4.98), using walking aids (OR=23.26, 95% CI 10.20-53.03), using medical devices (OR=3.44, 95% CI 1.92-6.15) and using antiepileptics (OR=3.94, 95% CI 1.22-12.77). About 19.8% of the falls occurred within the first 24 hours from admission and the most common time of falls was from 0:00 am to 5:59 am (44.6%). The patient bed and bathroom were the most frequent locations for falls, accounting for 44.55% and 37.62% of the cases, respectively. More than 40% of the falls occurred when the patients were with their personal caregivers. Although intervention programs can use these risk factors to target those who have a high risk of falling, to optimize resources, such programs should consider the fall patterns found in our study.

Fatal traffic accidents involving electric scooters in Poland in 2019–2023

With the introduction of mobile applications that allow short-term rentals, electric scooters (e-scooters) are gaining popularity as a means of micromobility in urban areas. The aim of the study was to assess the circumstances and causes of death in traffic accidents involving electric scooters in Poland. The inclusion criteria for the study were met by 9 cases (7 M,2F; mean age: 40.3 years). Accidents usually occur during working days during the warm months, especially during the morning traffic rush hour. Usually, these accidents involved another vehicle (4/9 cases). In addition, the victim was most often the driver (8/9 cases) and rarely uses a helmet (1/9 cases). In only two cases did the test reveal the presence of alcohol in the blood at the time of the accident. In studied cases, head injuries occurred in every case, and injuries to the limbs and chest occurred in more than half of the cases. Within the head, in addition to minor injuries like bruises and epidermal abrasions, skull fractures, and intracranial bleedings predominated. Similar minor injuries were also observed in the extremities, with significant fractures observed only in the lower extremities. Among chest injuries, lung contusions predominated. The most common cause of death was craniocerebral injury (6/9 cases), but there were two deaths each from chest injuries and polytrauma. To increase the safety of e-scooter users, it is recommended that measures be taken to educate users about the potential risks of using the vehicle and that measures be taken to increase the use of helmets, e.g. through legislative action. Further studies involving larger study groups are needed to assess the correlation between potential risk factors and the fatal outcome of the accident.

Exploring the Influence of the Perceived Neighborhood Built Environment on the Fall Risks among Older Adults in China

Falls are the leading cause of accidental injury-related deaths among older adults, with approximately 50% of them occurring in the neighborhood built environment. This longitudinal study investigated the influence of the perceived built environment (PBE) on fall risks among Chinese older adults residing in neighborhoods. We utilized data from the 2018 and 2020 waves of the China Longitudinal Aging Social Survey (CLASS), comprising a sample size of 8686 respondents. A complementary log–log (cloglog) regression was used to effectively model falls because of their infrequent occurrence. The results revealed a significant U-shaped non-linear relationship between PBE and falls. As the PBE score increased from relatively low levels, there was a decrease in the probability of falls, indicating that enhancing PBE can effectively protect against fall risks. However, once an average PBE score threshold was reached (around a turning point score of 22), this association may slightly reverse. Living alone and living in urban areas are two major factors that increase the vulnerability of older adults to PBE, resulting in higher fall risks within their neighborhoods. The study enhances the understanding of how PBE affects fall risks among older adults.

The Interplay of Fantasy and Physics in King’s The Dark Tower: The Gunslinger: A Physicist’s Perspective

The paper aims to explore the existence of many worlds and their interconnections in Stephen King’s The Dark Tower: The Gunslinger. It draws on theoretical physicist Brian Greene’s concept of parallel universes. It also draws on the theoretical concept of Albert Einstein and Nathan Rosen as they have discussed in ‘Einstein-Rosen Bridge Theory’. This theory is commonly known as wormholes that connect different regions of space-time, enabling the journey from one world to another and back. Greene's theoretical underpinnings, proposing a vast ensemble of universes with distinct properties, find expressions in the narrative. King's narrative, exemplified by, among others, Jake's revival in Mid-World after a presumed death in a New York car accident, explicitly embraces the idea of parallel universes, each with unique physical laws that influence the concepts such as life and death. The narrative unfolds across disparate worlds, echoing Greene’s theoretical mapping of parallel universes, each governed by its unique set of physical laws and realities. In the narrative, the exploration of multiverse concepts employs fiction's imaginative license to investigate interconnected universes and the potential for transcendent journeys through the cosmic fabric. The theoretical backdrop finds resonance in the novel where characters navigate within the four-dimensional continuum, mirroring the speculative nature of multiverse theories. By intertwining the world of fantasy with the hypotheses of physics, the paper discusses the connections between seemingly disparate realms. This perspective bridges literature and theoretical physics, offering a compelling exploration of the speculative landscapes of parallel universes.

Effectiveness of a Community-Based First Aid Education Program on Choking for Laypersons in Surabaya, Indonesia: A Quasi-Experimental Study

Choking is a leading cause of accidental death, particularly among children and the elderly. Prompt first aid, especially the Heimlich maneuver, is crucial in preventing fatalities. This study aimed to evaluate the effectiveness of a community-based first aid education program on choking in Surabaya, Indonesia. A quasi-experimental, pre-post design was implemented in Surabaya. Participants were recruited from various community settings (workplaces and community centers). The intervention group received a comprehensive first aid education program on choking, while the control group received standard health education. Knowledge and skills related to choking first aid were assessed before and after the intervention. A total of 350 participants completed the study (175 per group). The intervention group demonstrated a significant improvement in knowledge (p < 0.001) and skills (p < 0.001) related to choking first aid compared to the control group. Additionally, the intervention group reported increased confidence in their ability to respond to choking emergencies. The community-based first aid education program significantly enhanced knowledge, skills, and confidence in choking first aid among laypersons in Surabaya. Such programs should be considered as a public health strategy to reduce choking-related morbidity and mortality.

An injectable oleogel-based bupivacaine formulation for prolonged non-opioid post-operative analgesia.

Opioid-based medications remain the mainstay of post-operative pain management, even though they are associated with a plethora of adverse effects including addiction, nausea, constipation, cognitive impairment, respiratory depression, and accidental death due to overdose. Local anesthetics are effective at controlling the intense pain after surgery but their short duration of effect limits their clinical utility in post-operative pain management. In this manuscript, an optimized injectable oleogel-based formulation of bupivacaine for multi-day post-operative pain management was characterized on the benchtop and assessed in two clinically-relevant porcine post-operative pain models. Benchtop characterization verified the optimized oleogel-based bupivacaine formulation design, demonstrating a homogenous stable oleogel with sufficient injectability due to shear-thinning properties, high drug loading capacity and first-order drug release kinetics over 5days. In vivo assessment in two pig post-operative pain models demonstrated that the oleogel-based bupivacaine formulation can provide statistically significant multi-day analgesia in two routes of administration: local instillation directly into a surgical site and ultrasound-guided peripheral nerve block injection. Pharmacokinetic assessment of ALX005 found that Cmax values were not statistically different from the bupivacaine HCl control, with no clinical signs of local anesthetic systemic toxicity observed, when administering up to 2.7 and 8.1 times the control dose of bupivacaine HCl. This study demonstrates the pre-clinical safety and efficacy of an injectable oleogel-based bupivacaine formulation and explores its utility as a single-administration long-acting local anesthetic product for post-operative pain management that can be used in both local and regional anesthetic applications.