Direct Physical Injury Research Articles

Imaging Assessment of Nontraumatic Pathologic Conditions at the Craniovertebral Junction: A Comprehensive Review.

Nontraumatic pathologic conditions of the craniovertebral junction encompass a range of conditions affecting the complex anatomy of this region without direct physical injury. These conditions include congenital syndromes that predispose individuals to ligamentous laxity, potentially leading to instability. Additionally, rare but noteworthy cases such as Grisel syndrome, a cause of pediatric torticollis, may arise without a traumatic trigger. Inflammatory diseases, including rheumatoid arthritis, ankylosing spondylitis, and crystal deposition, can lead to cervical instability and spinal cord compression. Infections at the upper cervical spine are dominated by tuberculosis, typically transmitted through hematologic or lymphatic routes with characteristic imaging findings. On the other hand, purulent bacterial infections in this area are rare. Furthermore, although tumors involving the structures of the craniovertebral junction are infrequent, they can lead to significant complications, albeit less frequently through cord compression and more commonly via pathologic fractures or subluxation. The craniocervical junction is a complex anatomic region comprising ligaments, bones, joints, and muscles that support the head's weight and enable its wide range of motion. Accurate recognition and understanding of the complex anatomy and the various nontraumatic pathologic conditions at the craniovertebral junction are pivotal for initiating timely and appropriate treatment strategies. ©RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material.

Mitigation of harm during a novel behavioural response study involving active sonar and wild cetaceans

Some studies of how human activities can affect wild free-ranging animals may be considered to have potential negative outcomes too severe to be ethically studied. This creates a societal dilemma involving choices between continuing risky activities with high uncertainty about their potential effects on wildlife, often with considerable associated precaution or undertaking focused research to reduce uncertainty, but with some risk of harm from either strong response leading to potential stranding or direct physical injury from sound exposure. Recent and ongoing field experiments have measured the conditions in which wild cetaceans respond to military sonar, and provided insight into the nature of responses. Here mitigation measures are reported for one of the first such experiments designed to measure fine-scale behavioural responses to controlled exposures of midfrequency (3–4 kHz) active sonar. The objective was to do so without causing the kinds of physical harm that have been previously observed (e.g. stranding events) and that motivated the study. A critical goal of this experimental study was to identify a response that was safe but that could be used as an indicator of the probability of risk from more extreme or sustained exposure from real military operations. A monitoring and mitigation protocol was developed using a feedback control procedure for real-time mitigation of potential harm. Experimental protocols were modulated relative to indicators of potential risk with the explicit objective of detecting potentially harmful consequences of sound exposure and taking appropriate corrective action. Three categories of mitigation methods were developed and integrated within the experimental protocol incorporating designed, engineered, and operational mitigation measures. Controlled exposure experiments involving free-ranging animals were conducted without any evident harm to the experimental subjects, while successfully eliciting behavioural responses that provided meaningful results to inform management decisions. This approach demonstrates the importance of careful design of protocols in exposure-response experiments, particularly in pioneering studies assessing response where both the potential for harm and level of uncertainty may be high.

Disproportionate Impacts of Wildfires among Elderly and Low-Income Communities in California from 2000-2020.

Wildfires can be detrimental to urban and rural communities, causing impacts in the form of psychological stress, direct physical injury, and smoke-related morbidity and mortality. This study examined the area burned by wildfires over the entire state of California from the years 2000 to 2020 in order to quantify and identify whether burned area and fire frequency differed across Census tracts according to socioeconomic indicators over time. Wildfire data were obtained from the California Fire and Resource Assessment Program (FRAP) and National Interagency Fire Center (NIFC), while demographic data were obtained from the American Community Survey. Results showed a doubling in the number of Census tracts that experienced major wildfires and a near doubling in the number of people residing in wildfire-impacted Census tracts, mostly due to an over 23,000 acre/year increase in the area burned by wildfires over the last two decades. Census tracts with a higher fire frequency and burned area had lower proportions of minority groups on average. However, when considering Native American populations, a greater proportion resided in highly impacted Census tracts. Such Census tracts also had higher proportions of older residents. In general, high-impact Census tracts tended to have higher proportions of low-income residents and lower proportions of high-income residents, as well as lower median household incomes and home values. These findings are important to policymakers and state agencies as it relates to environmental justice and the allocation of resources before, during, and after wildfires in the state of California.

Railway spine: The advent of compensation for concussive symptoms

ABSTRACTThe introduction of railway transportation in Great Britain in the early-nineteenth century saw an increased frequency of trauma cases involving persisting symptoms without objective evidence of injury. In 1866, a prominent surgeon, Sir John Eric Erichsen, attributed such symptoms to concussion of the spine (popularized as “railway spine”) that involved an organic pathology, inflammation of the spinal cord in the absence of spinal fracture, with potential psychological overlay. This was widely accepted within the medico-legal context throughout the 1870s, whereby passengers sought compensation for collision-related injuries. In 1883, a railway surgeon named Herbert William Page countered the assertion that many of Erichsen’s cases likely had sustained direct physical injury to the spine, the cord, and/or the spinal nerves; and in cases without such injury, the symptoms were psychogenic, as in traumatic neurasthenia and/or hysteria. Similarities between Erichsen’s and Page’s medico-legal positions, such as conscious and unconscious forms of symptom exaggeration that would both resolve upon settlement of the case, ushered in the era of medical injury compensation.

Direct and indirect health impacts of climate change on the vulnerable elderly population in East China

The latest scientific advances on the impacts of climate change on the health of the elderly in East China were reviewed consulting peer-reviewed publications from 2000 to 2017. The direct impacts of climate change result from rising temperatures, heat waves, and increases in the frequency of complex extreme weather events such as windstorms, floods, and droughts. The health and social consequences of these events are far reaching, ranging from reduced labour productivity and heat-related deaths through to direct physical injury during extreme weather events, the spread of infectious diseases, and mental health effects following widespread flooding or prolonged drought. Research has indicated that climate change will have the greatest impact on vulnerable groups of people, including the elderly population. However, there is a dearth of empirical evidence, a lack of focus on vulnerable segments of the population (especially elderly), limited understanding of how health status will change in the future, and lack of acknowledgement of how different regions in China vary in terms of the consequences of climate change. The main risk in East China that climate change may exacerbate is flooding (sea level rise, coastal and riverine, flood risk). However in some regions of East China such as in the provinces of Anhui, Jiangsu, Hebei, and Shandong the biggest climate change risk is considered to be drought. Main health risks linked to climate change are evident as cardiovascular and respiratory diseases (heat stroke, exhaustion, and asthma), often caused by interactions between heat wave episodes and concurrent poor air quality.

Radiographers' experience of risks for patient safety incidents in the radiology department.

To describe potential risks for patient safety incidents in the radiology department from a radiographer's perspective. A radiology department is a high-tech environment with high communication activity between different healthcare systems in combination with a large patient flow. Risks for patient safety incidents exist in every phase of a radiological examination. Due to the nature of the activity, a radiology department needs to have its own range of measures to prevent risks linked to radiology. A qualitative descriptive design. Semi-structured interviews were carried out with 17 radiographers during the period September 2015 to February 2016. The data were analysed using conventional content analysis. This study followed the COREQ checklist criteria for the reporting of qualitative research. The analysis yielded 20 different patient safety incidents that could result in the following six types of healthcare-associated harm: Patients could be exposed to unnecessary radiation; patients could receive an inaccurate diagnosis; patients could incur drug-induced damage; patients could suffer direct physical injury; or, their examination and treatment could be delayed or not carried out; or, their general health condition could deteriorate. Lack of communication and knowledge, both internally and externally, can increase risks for patient safety incidents. The study describes a complex chain of activities that represent risks in the radiology department. It needs to be pointed out that it is not always the activities in the radiology department that cause the harm. To carry out preventive patient safety work, a comprehensive analysis of the entire care chain is required. Patient safety work should also focus on improvement in communication both internally, within the radiology department, and externally. Standardised methodological guidelines, consistent prescriptions of method from the radiologist and a good working environment are internal success factors for patient safety at the radiology department.

Cyberstalking: Investigating formal intervention and the role of Corporate Social Responsibility

ContextOnline harassment and stalking have been identified with growing accordance as anti-social behaviours, potentially with extreme consequences including indirect or direct physical injury, emotional distress and/or financial loss. ObjectiveAs part of our ongoing work to research and establish better understanding of cyberstalking, this study aims to investigate the role of Police, Mobile Operators, Internet Service Providers (ISPs) and owners/administrators of online platforms (e.g. websites, chatrooms) in terms of intervention in response to offences. We ask to what different authorities do people report incidents of cyberstalking? Do these authorities provide satisfactory responses or interventions? And how can this be improved? Furthermore, we discuss the role of Corporate Social Responsibility (CSR) to encourage the implementation of cyberstalking-aware schemes by service providers to support victims. In addition, CSR can be used as a means to measure the effects of externality factor in dictating the relationship between the impact of a given individuals’ privacy loss and strategic decisions on investment to security controls in an organisational context. MethodA mixed method design has been used in this study. Data collection took place by means of an online survey made available for three years to record both qualitative and quantitative data. Overall, 305 participants responded from which 274 identified themselves as victims of online harassment. ResultOur results suggest that most offences were communicated through private channels such as emails and/or mobile texts/calls. A significant number of victims did not report this to their service provider because they did not know they could. While Police were recognised as the first-point-of-contact in such cases, 41.6% of our sample did not contact the Police due to reasons such as fear of escalation, guilt/sympathy and self-blaming. Experiences from those who have reported offences to service providers demonstrate that no or very little support was offered. Overall, the majority of participants shared the view that third-party intervention is required on their behalf in order to mitigate risks associated with cyberstalking. An independent specialist anti-stalking organisation was a popular choice to act on their behalf followed by the Police and network providers. ConclusionIncidents are taking place on channels owned and controlled by large, cross-border international companies providing mobile services, webmail and social networking. The lack of support offered to victims in many cases of cyberstalking can be identified as Corporate Social Irresponsibility (CSI). We anticipate that awareness should be raised as regarding service providers’ liability and social responsibility towards adopting better strategies.

Landslide consequence analysis: a region-scale indicator-based methodology

Consequence analysis is, together with hazard evaluation, one of the major steps of landslide risk assessment. However, a significant discrepancy exists between the number of published landslide hazard and landslide consequence studies. While various methodologies for regional-scale hazard assessment have been developed during the last decade, studies for estimating and visualising possible landslide consequences are still limited, and those existing are often difficult to apply in practice mainly because of the lack of data on the historical damage or on landslide damage functions. In this paper, an indicator-based GIS-aided methodology is proposed with an application to regional-scale consequence analysis. The index, called Potential Damage Index, allows describing, quantifying, valuing, totalizing and visualising different types of consequences. The method allows estimating the possible damage caused by landslides by combining weighted indicators reflecting the exposure of the elements at risk. Direct (physical injury, and structural and functional damage) and indirect (socio-economic impacts) consequences are individually analysed and subsequently combined to obtain a map of total consequences due to landsliding. Geographic visualisation of the index allows the delineation of the areas exposed to any type of possible impacts that could be combined with a corresponding map displaying landslide probability of occurrence. The method has been successfully applied to analyse the present consequences in the Barcelonnette Basin (South French Alps). These maps contribute to development of adequate land use and evacuation plans, and thus are important tools for local authorities and insurance companies.

Atrial fibrillation ablation in athletes: an Olympic challenge?

Sports practice is very popular in our Western society as an epitome of a healthy life style, and endurance athletes have been our heroes since the days of the Greek in Olympia. However, aside from direct physical injury, there appear to be more indirect pathophysiological dangers that lurk around the corner. It has been established that individuals participating in regular intense physical exercise for several times a week have a two-fold risk of developing atrial fibrillation (AF). The Arrhythmia Unit of the Hospital Clinic in Barcelona, Spain, was among the first to make such observations in a population of AF patients with long-term sports activity.1 The Barcelona group extends their research by examining the results of ablation in athletes with AF.2 What is it that may distinguish athletes from other individuals? An increased physical demand may lead to structural adaptations of the heart, such as hypertrophy, dilatation, and fibrosis. Also, functional alterations in cellular ion channel expression and electrolyte handling may be evoked. In addition, an increased vagal tone and a lower resting heart rate can be found in well-trained athletes. Such changes may affect the electrophysiological properties of the atria and promote reentry and focal activity, which are established mechanisms for AF. The next question would be whether athletes with AF are any different … *Corresponding author. Tel: +31 30 609 9111, Fax: +31 30 609 2274, Email: l.boersma{at}Antonius.net

Violence and mental health

According to the World Health Organization (WHO, 2002) over 300 000 people died in 2000 as a direct result of violent conflicts. The rates ranged from less than 1 per 100 000 population in high-income countries to 6.2 per 100 000 in low- and middle-income countries. Torture, rape and violation of human rights are also used to terrorise and undermine communities. Violence not only results in death and direct physical injury but also affects mental health and subsequent physical health (WHO, 2002). According to the WHO, an estimated 1.6 million people worldwide lost their lives to violence in 2000. About half of the deaths were attributed to suicide, nearly a third were due to homicide, and about a fifth were casualties of armed conflicts.

Radiation Peak Skin Dose to Risk Stratify Electrophysiological Procedures for Deterministic Skin Damage

Ionising radiation is has the potential to cause harm both by increasing the probability future malignancy (stochastic mechanisms) and by direct physical injury (deterministic mechanisms). Several measures have been developed to quantify radiation exposure during a procedure and cardiologists usually refer to fluoroscopic screening time (FST). FST, however, has limitations for predicting deterministic injury which is directly dependant on peak skin dose (PSD). We compared FST to PSD for a range of interventional cardiac electrophysiology procedures. All patients undergoing electrophysiology procedures during a 2-month period in our institution were studied. Demographic details, nature of procedure, FST and PSD were measured. The FST to PSD ratio was calculated and compared between patient and procedural factors. 67 procedures on patients (23 female) with body mass index (BMI) of 28 (SD 5) Kg/m2 were studied. Screening times ranged from 0.2 to 96.6 min (median 11.2). PSD ranged from <0.1 to 1108 mGy (median 141). There was a positive correlation between PSD to FST ratio and BMI (r = 0.59, p < 0.001). The PSD to FST ratio was higher in cardiac resynchronization therapy (CRT) devices than single or dual chamber ICDs (p = 0.002). FST is not a reliable predictor of deterministic skin injury and in high-risk procedures such as CRT devices and those on individuals of high BMI PSD should be measured.

World report on violence and health: What it means for children and pediatricians

World report on violence and health: What it means for children and pediatricians

Stimulation of systemic bone formation induced by experimental blood loss.

Direct physical injury to bone marrow is associated with a systemic osteogenic response. However, blood loss, a condition that stimulates hemopoietic stem cells, also may activate osteoprogenitor cells in the bone marrow. To determine if bleeding induces a systemic osteogenic response, the mineral appositional rates and osteoblast numbers were determined in the bones of rats that were subjected to controlled cardiac bleeding and compared with those of rats subjected to ablation of their tibial bone marrow. In addition, a study of the kinetics of the osteogenic responses during the first 10 days after operative treatment was performed by quantitating the serum levels of biochemical indices known to be associated with systemic bone formation. The results showed that animals that sustained acute blood loss (1% or 3% body weight) or injury to their tibial bone marrow had statistically significant increases in mineral appositional rate, osteoblast number, and serum levels of osteogenic growth peptide. The kinetics studies showed that osteogenic growth peptide levels peaked on the tenth postoperative day and declined sharply thereafter. An enhancement of serum osteocalcin activity occurred only on the second postoperative day, was increased in all experimental groups when compared with untreated control animals, but immediately declined to baseline levels. Alkaline phosphatase activities increased in the experimental groups, peaking on Day 10 after tibial bone marrow ablation and on Day 12 in the group that underwent bleeding. These findings suggest that bleeding alone, independent of any skeletal trauma, may evoke a systemic osteogenic response. This response is similar in its timing and magnitude to that which has been shown to follow direct physical injury to bone marrow. The observation that systemic bone formation follows bone marrow activation induced by two different stimuli suggests that these responses may be mediated by common regulatory mechanisms. The ability to trigger or control these responses may form the basis for future therapeutic strategies to enhance bone formation.

Kids, cars and conservation: children's ideas about the environmental impact of motor vehicles

The ideas of children about the environmental impact of motor vehicles have been explored using an open‐form questionnaire. The children were from British National Curriculum Years 7 (age 11/12 years), 9 (age 13/14) and 11 (age 15/16). Children appear to think in different ways about the social and environmental costs of motoring. First, children were aware of the danger of direct physical injury from vehicles. Second, many children raised ideas of vehicle emissions, air pollution and human respiratory problems. These ideas were offered more frequently by the older children, suggesting a development of thinking to embrace more abstract, indirect effects of vehicles. Third, children, especially older children, raised ideas about vehicles and global environmental problems. However, the problem with which vehicles were most frequently associated, erroneously, was ozone layer damage. It is suggested that this persistent misconception is a product of more general failure to distinguish between the specific cau...

Pathogenesis of giardiasis

Giardiasis is the most common small intestinal protozoal infection and is found worldwide. The mechanisms by which Giardia duodenalis (= G. lamblia) produces chronic diarrhoea and malabsorption have still not been clearly defined. Many infections are associated with mild to moderate mucosal damage which, in animal models of infection, have functional correlates. Possible mechanisms include direct physical injury, release of parasite products such as proteinases or lectin, and mucosal inflammation associated with T cell activation and cytokine release. Other possible mechanisms of malabsorption include associated bacterial overgrowth and bile salt deconjugation, bile salt uptake by the parasite with depletion of intraluminal bile salts, and inhibition of pancreatic hydrolytic enzymes. Thus, there is no single mechanism to explain the diarrhoea and malabsorption caused by Giardia, which currently should be regarded as a multifactorial process.

MR imaging of patients with intracranial aneurysm clips.

612 T HERE has been a considerable amount of interest regarding safety and the patient and health care worker in magnetic resonance (MR) imaging environments. Much has been written on this issue in the decade since MR imaging was first introduced into the diagnostic clinical arena (1-4). Questions regarding the safety of the timevarying magnetic fields, the carcinogenicity of the static magnetic fields, possible effects on reproductive health, MR-related thermal injuries/burns, and even MR contrast agent reactions are topics that have generated particular interest. While each of these is indeed a legitimate area of research and is certainly worthy of attention, there is no doubt that the static magnetic field of the MR system itself and its effects on ferromagnetic objects and devices that may be exposed to this field should always be of primary concern. Injuries related to the static fields of the MR system seem to be the most numerous of all types of safety incidents reported in MR imaging to date (1,4-7). These result either from the so-called “projectile effect” (direct physical injury secondary to rotational or translational motion of a ferromagnetic object) or from incapacitation of magnetically sensitive devices on which the patient is physiologically dependent. Further, many of these injuties number among the most severe of all that have occurred thus far in clinical MR sites in this country. It is ironic that injuries related to ferromagnetic objects are generally among the most avoidable of all adverse incidents that occur in the MR environment.

Second international conference on wartime medical services

Provision of wartime medical services is influenced by the psychological as well as the immediate physical injuries caused by war. But the psychological trauma of war is much less clearly understood than direct physical injury. The Second International Conference on Wartime Medical Services concentrated on these broader, less tangible effects of war, particularly in children. UNICEF estimates that 80% of the direct and indirect victims of military action are children and women. Other papers at the conference included reports on Israeli parents' fears for their children, combat stress reactions in Israeli soldiers, the physical and psychological responses of 35 Iranian-held American hostages and of Finnish veterans of the Finnish/Soviet war (1941-44), the nature of injuries to Palestinians in the Occupied Territories, and injuries from chemical attack in Iran and medical responses to these.

Adult Interference with Postlarvae in Soft Sediments: The Pontoporeia-Macoma Example

In the Baltic Sea, the presence of dense populations of the deposit-feeding amphipods Pontoporeia affinis and P. femorata has been hypothesized to inhibit recruitment of the bivalve Macoma balthica. Experimental tests with P. affinis and newly settled M. balthica in small, flow- through aquaria corroborated this hypothesis. Survival of small M. balthica spat decreased with increasing density of Pontoporeia affinis. The increase in mortality was strong enough potentially to explain the field observation that M. balthica is generally absent or rare in areas with dense populations of Pontoporeia spp. Three hypotheses as to the mechanism for the decreased M. balthica survival were tested. The results were inconsistent with hypotheses of suffocation after burial or starvation as the mechanism of death, but corroborated the hypothesis of direct physical injury to M. balthica spat following contact with P. afiinis adults. In the presence of P. affinis, spat survival was lower in shallow than in deep sediment; encounters between the two species should be more frequent in shallow sediment. Adult P. affinis were found to crush newly settled M. balthica spat, presumably ingesting the remains. M. balthica spat are not, however, common enough to be an important food source for P. afiinis. It is suggested that while interference with larval recruitment by adults is likely to be an important structuring factor in marine soft bottom communities, it is unlikely to depress community biomass below carrying capacity, as suggested by Peterson (1979). Virtually all communities contain species with brood protection, the young of which are less susceptible to interference by adults. Where such interference is strong, species with brood protection are likely to become dominant, as are Pontoporeia spp. over large areas in the Baltic Sea.

Social stress, mortality and aggression in colonies and burrowing habitats

High mortality was found within six mixed-sex groups of Long-Evans rats living in burrowing habitats with 58% of subordinate males dying within 4 mo. of group formation. By contrast, no subordinate deaths occured during this time in six identical adult groups(3 males and 3 females) housed in similar (1 m square) colony cages without burrows. Although aggression against intruders was also much greater in habitats than colonies --through 400 days postformation--subordinate deaths did not appear to result from direct physical injury. It seems that mimicing key features of the rat's environment enhances intermale conflict and social stress, even while providing partial protection from biting attack. Behav. Proc.:

Aspects neuropathologiques des comas post-traumatiques graves par lésions encéphaliques diffuses

From a review of recent literature, and pathological study of more than 100 personal cases, the authors describe the most interesting of these "diffuse" lesions; they only recall the most common types of lesions (contusions, vascular lesions, edema and its consequences - especially on brain stem); but a more detailed description is given of less known lesions of corpus callosum, brain stem and white matter, which have a more complex pathogeny (direct physical injury, anoxia-ischaemia, edema), and which they consider to be factors which worsen or protract the coma. "Biochemical" lesions (basic myelinic protein, liberated "false" neurotransmitters) are also discussed.