Injured Population Research Articles

103 Participants in Clinical Trials for Traumatic Brain Injury Are Not Representative of the Injured Population

INTRODUCTION: Traumatic brain injury (TBI) has higher mortality in minority populations, but these individuals are less likely to participate in TBI trials than non-minorities due to reasons ranging from historical abuse to socioeconomic status. Therefore, it is imperative barriers to minority inclusion in TBI trials are overcome. METHODS: 350 out of 592 TBI studies with published results were compared to the general population statistics on race/ethnicity and sex from the U.S. census and TBI statistics from the CDC. RESULTS: Trials with a completed status compared to withdrawn status were 128 times more likely to publish their findings. While sex was frequently reported (males- 68% of the study participants), the majority of studies did not report race/ethnicity. 9.9% of enrolled subjects are Black even though they represent 12.3% and 19% of TBI cases and mortalities, respectively. This same trend is seen in all other populations, except White people, who were found to be overrepresented in trials as 65.3% of participants are White even though they account for 63.1% and 52.0% of TBI cases and mortalities, respectively. Black patients were 1.9 more times likely to die from head injuries compared to White patients. The average number of days/sessions involved in TBI trials was 12 and the average trial duration was 6.3 years. 14 (29%) trials required phone calls for follow up visits and 14 trials specifically excluded non English speakers. CONCLUSION: The majority of TBI clinical trials reported sex, but not report race/ethnicity. Factors that may influence participation include trial duration and effort commitment. Our results demonstrate the need for demographic reporting to ensure the population being studied accurately reflects the population suffering from the burden of disease.

SARS-CoV-2 Infection and Lung Regeneration.

SUMMARYThe lung is the primary site of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-induced immunopathology whereby the virus enters the host cells by binding to angiotensin-converting enzyme 2 (ACE2). Sophisticated regeneration and repair programs exist in the lungs to replenish injured cell populations. However, known resident stem/progenitor cells have been demonstrated to express ACE2, raising a substantial concern regarding the long-term consequences of impaired lung regeneration after SARS-CoV-2 infection. Moreover, clinical treatments may also affect lung repair from antiviral drug candidates to mechanical ventilation. In this review, we highlight how SARS-CoV-2 disrupts a program that governs lung homeostasis. We also summarize the current efforts of targeted therapy and supportive treatments for COVID-19 patients. In addition, we discuss the pros and cons of cell therapy with mesenchymal stem cells or resident lung epithelial stem/progenitor cells in preventing post-acute sequelae of COVID-19. We propose that, in addition to symptomatic treatments being developed and applied in the clinic, targeting lung regeneration is also essential to restore lung homeostasis in COVID-19 patients.

Brain Networks With Modified Connectivity in Patients With Neuropathic Pain and Spinal Cord Injury.

Background. Neuropathic pain (NP) following spinal cord injury (SCI) affects the quality of life of almost 40% of the injured population. The modified brain connectivity was reported under different NP conditions. Therefore, brain connectivity was studied in the SCI population with and without NP with the aim to identify networks that are altered due to injury, pain, or both. Methods. The study cohort is classified into 3 groups, SCI patients with NP, SCI patients without NP, and able-bodied. EEG of each participant was recorded during motor imagery (MI) of paralyzed and painful, and nonparalyzed and nonpainful limbs. Phased locked value was calculated using Hilbert transform to study altered functional connectivity between different regions. Results. The posterior region connectivity with frontal, fronto-central, and temporal regions is strongly decreased mainly during MI of dominant upper limb (nonparalyzed and nonpainful limbs) in SCI no pain group. This modified connectivity is prominent in the alpha and high-frequency bands (beta and gamma). Moreover, oscillatory modified global connectivity is observed in the pain group during MI of painful and paralyzed limb which is more evident between fronto-posterior, frontocentral-posterior, and within posterior and within frontal regions in the theta and SMR frequency bands. Cluster coefficient and local efficiency values are reduced in patients with no reported pain group while increased in the PWP group. Conclusion. The altered theta band connectivity found in the fronto-parietal network along with a global increase in local efficiency is a consequence of pain only, while altered connectivity in the beta and gamma bands along with a decrease in cluster coefficient values observed in the sensory-motor network is dominantly a consequence of injury only. The outcomes of this study may be used as a potential diagnostic biomarker for the NP. Further, the expected insight holds great clinical relevance in the design of neurofeedback-based neurorehabilitation and connectivity-based brain-computer interfaces for SCI patients.

Psychological assistance at disaster in Bulgaria - contemporary policies for health risk management

Abstract Issue Health risk management (HRM) in Bulgaria is provided to citizens in emergencies, disasters, accidents and catastrophes (E&DAC). According to the legislation in the country, this is a part of the mandatory package of medical provision for the injured population (MPIP) and concerns any acute life-threatening condition (LTC). In the dynamically changing environment of E&DAC, a special form of health consequences among survivors are related to mental health (MeH). Description of the problem In practice, any serious E&DAC has a direct or indirect psychological impact. It can manifest itself acutely or remotely over time, puts the victims in temporary or permanent disability and is followed by serious social effects. A strategy has been proposed for inclusion in the obligatory package of MPIP in case of significant E&DAC and primary psychological assistance (PPA) for every citizen who has survived. Results In the country, PPАs to citizens for decades is an on-demand service provided mainly by the private sector. Within the BRC, a group has been formed to provide PPA with a modest resource capacity. The emotional citizens culture in the country is far from active demand for PPA in general and severely limited in resources and the MeH is not a priority. This system of public health care, based on withdrawal from the MeH, also exposes to increased risk of psycho-somatic and distress-provoked physical illnesses (PSDPPhI). Lessons Carrying out timely PPA for those in need changes the range of adverse mental effects, reducing them. Provides a better adaptive response to reduced risk of PTSD and PSDPPhI. A volume of preventive measures organized in stages over time gives a greater chance to a larger number of victims. Key messages The health of the nation is a complex program for controlling both the acute health problems at E&DAC and the protection of MeH. To provide modern sustainable policies for the implication of PPA in everyone who has seriously experienced E&DAC is resulted in good health practices.

The Effects of Soft Tissue Flossing on Hamstring Range of Motion and Lower Extremity Power.

BackgroundFlossing includes wrapping a specialized latex band around a muscle group providing compression, partially occluding blood flow, followed by performing exercises. This is hypothesized to improve flexibility by dissipating myofascial adhesions; however, research is lacking.ObjectiveTo determine the effect of the application of a floss band to the thigh on hamstring flexibility and lower extremity power.DesignCrossover StudySettingExercise Physiology Laboratory.ParticipantsTwenty-one recreationally active individuals (8 male, 13 female; age = 22.62±2.99 years; height = 171.52±9.08 cm; mass = 73.57±11.37 kg).MethodsThree counterbalanced interventions were studied during body weight squats, lunges, and hamstring curls (without resistance): floss, sham, and control. The floss treatment included wrapping the Rogue Wide Voodoo Floss Band™ from the proximal knee to the gluteal fold at a pressure of 140 to 200 mmHg. The sham treatment included wrapping the same band in the same location with less pressure (10 to 40 mmHg) while the control treatment did not include floss band application. Hip flexion range of motion, via the straight leg raise, and power (single-leg vertical jump) were compared from pre-test to post-test using a 3x2 repeated measures ANOVA.ResultsThere was a significant interaction between time and session for hamstring flexibility (F(2,40)=17.54, p<0.001, η2=0.47). Post hoc tests showed significant differences between pre- (86.14±8.06 degrees) and post-test (90.81±7.69 degrees) for the floss session (p<0.001, Mean Difference=4.67, CI95=3.35-5.98) and between pre- (87.67±7.51 degrees) and post-test (89.86±7.88 degrees) for the sham session (p=0.001, Mean Difference=2.19, CI95=0.98-3.40). There were no significant interactions for jump power (F(2,40)=1.82, P=0.18, η2=0.08, 1-β=0.36).ConclusionsFlossing treatment increased hamstring flexibility more than the sham session without affecting lower body power. Flossing could be beneficial when treatment or performance preparation goals are increased flexibility without decreased power. Future studies should continue to examine the clinical effectiveness of flossing on an injured population.

787 OSA Risk is Associated with Number of White Matter Hyperintensities, But History of Mild TBI is Not: A LIMBIC-CENC Study

Abstract Introduction Individuals with a history of mild traumatic brain injury (mTBI) have higher risk levels for obstructive sleep apnea (OSA). However, no studies have examined the association between OSA and white matter hyperintensities (WMHs) in this group. The purpose of this study is to explore the relationship between OSA risk, mTBI, and WMHs in a military cohort with a history of combat deployment. Methods Secondary analyses were conducted from a large clinical database of a multi-center, longitudinal study of current and former military personnel. Participants were included who had complete STOPBANG (sleep apnea risk) data and MRI. Univariable and multivariable regressions were conducted, including age, race, gender, education, hypertension, diabetes, history of mTBI, and STOPBANG score in the models. Results The final sample (N=1017) included participants with (n=823) and without (n=194) a history of mTBI. The sample was predominantly male (87%) with a median age of 38 (IQR; 32–48). WMHs were reported in 37% of the sample. Univariate analyses revealed that increasing age, female sex, hypertension, diabetes, and higher sleep apnea risk score were each positively associated with higher number of WMHs, while a history of lifetime mTBI exposure was not associated. Multivariable analyses revealed that of these factors, only age remained associated with WMH presence. When restricting the sample to the 37% with WMHs, OSA risk and female sex were each associated with higher number of WMHs (p&amp;lt;.05), but history of mTBI was not. Conclusion Consistent with the literature in non-brain injured populations, age was the strongest predictor of WMH presence and number. In those with identified WMHs, OSA risk was a significant predictor of WMH number, while history of mTBI was not. Thus, in persons with mTBI, presence of WMHs may be linked to sleep comorbidities, providing potential treatment targets. Limitations include assessment of OSA rather than established diagnosis. Support (if any) Defense and Veterans Brain Injury Center (HT0014-19-C-004), DOD(W81XWH-13-2-0095), VA(I01 CX001135). The views expressed in this abstract are those of the authors and do not necessarily represent the official policy or position of the Defense Health Agency, Department of Defense, or any other U.S. government agency. For more information, please contact dha.TBICoEinfo@mail.mil. UNCLASSIFIED

Обоснование системы электроснабжения жизнеобеспечения спасательных формирований и пострадавшего населения при полевом размещении

Introduction. Increasing of number, scale and duration of the consequences of emergency situations associated with the violation of the conditions of normal living of people requires the creation of temporary field accommodation points for the affected population and rescue units. At the same time, electric power supply in field temporary accommodation facilities plays a crucial role in the complex of tasks and measures aimed at providing life to the injured population and rescue units. At the same time, there are no mobile autonomous sources of electric energy for providing life support to people in the field in the organizational and staff structure of rescue units, and the existing sources of electric energy in the complexes of equipment used in areas of emergency situations cannot be used for these purposes. Therefore, it is necessary to develop a scientific and methodological approach to determine necessary and sufficient number of sources of electric energy for the power supply of the life support of the injured population and rescue units when they are placed in field temporary accommodation points. The purpose of the study. Electric power supply of field temporary accommodation points for the injured population and rescue units, ensuring the required reliability of electric power supply, maximizing its efficiency in the conditions of possible resource constraints and minimizing the influence of the uncertainty factor in the planning of electricity consumption. Research methods. The main provisions of the calculation of electrical loads, system theory, set theory, probability theory and the apparatus of mathematical statistics. The results of the study. A methodology has been developed that allows to justify the power of electric energy sources for the power supply of field temporary accommodation points for the injured population and rescue units, rational options for the power supply system, the nomenclature and number of electric energy sources for the life support of people in the field; to calculate the electric network; to evaluate the operation of the power supply system, based on the probability of failure-free operation of the source of electric energy; to justify the composition of engineering means to ensure the creation of the power supply system. Conclusion. The scientific and methodological approach for determining the composition of electric energy sources for the power supply of life support for the injured population and rescue units when they are placed in field temporary accommodation points is justified, which also allows to resolve the contradiction between the need to organize the power supply of life support for people in temporary accommodation points and the lack of a reasonable structure of electric energy sources for these purposes. Keywords: temporary accommodation point, injured population, rescue formation, consumers, electric power supply, organization

Damage Control Thoracotomy: A Systematic Review of Techniques and Outcomes.

Damage control surgery is the practice of delaying definitive management of traumatic injuries by controlling hemorrhage in the operating room and restoring normal physiology in the intensive care unit prior to definitive therapy. Presently, damage control or "abbreviated" laparotomy is used extensively for abdominal trauma in an unstable patient. The application of a damage control approach in thoracic trauma is less established and there is a paucity of literature supporting or refuting this practice. We aimed to systematically review the current data on damage control thoracotomy (DCT), to identify gaps in the literature and techniques in temporary closure. An electronic literature search of Pubmed, MEDLINE, and the Cochrane Database of Collected Reviews from 1972-2018 was performed using the keywords "thoracic," "damage control," and "thoracotomy." Studies were included if they reported the use of DCT following thoracic trauma and included survival as an outcome. Of 723 studies, seven met inclusion criteria for a total of a 130 DCT operations. Gauze packing with temporary closure of the skin with suture was the most frequently reported form of closure. The overall survival rate for the seven studies was 67%. Survival rates ranged from 42-77%. Average injury severity score was 30, and 64% of injuries were penetrating in nature. The most common complications included infections (57%; pneumonia, empyema, wound infection, bacteremia), respiratory failure (21%), ARDS (8%), and renal failure (18%). DCT may be associated with improved survival in the critically injured patient population. Delaying definitive operation by temporarily closing the thorax in order to allow time to restore normal physiology may be considered as a strategy in the unstable thoracic trauma patient population. The impact an open chest has on respiratory physiology remains inconclusive as well as best mechanisms of temporary closure. Multi-center studies are required to elucidate these important questions.

Injury trends in alpine skiing and a snowboarding over the decade 2008–09 to 2017–18

ObjectivesThis research explores snowsport injury trends in western Canadian resorts over the decade 2008−2018. DesignEcological study. MethodsInjury and participation data on alpine skiing and snowboarding was provided by the Canada West Ski Areas Association for 2008−2018. Inclusion criteria were met by 29 of 52 resorts, resulting in the analysis of 107,540 injury reports via SPSS 24, using descriptive statistics and chi-squared analysis. ResultsOver the decade: there was a gradual decline in the injury rate, averaging 2.24 injuries per 1000 skier days. Male snowboarders accounted for 1/3 of all injured participants, females were 42% of all. Day-ticket holders were the most injured of all customer-types, with most injuries occurring as the result of falls on marked, green/easiest terrain. For skiers, injuries to lower limbs, and especially knees, were most common. For snowboarders, upper limb injuries, especially wrists, were most common. 12.8% of the injured population required emergency transport. Advanced slopes/terrain had the highest proportion requiring emergency transport. Fewer skiers experienced head injuries than snowboarders. Snowboarders experienced a higher proportion of serious injuries. ConclusionsSnowsport injuries are relatively rare when compared to other sports. Skiers were most prone to knee injuries and snowboarders to wrist injuries. Emergency transport was proportionally needed more from advanced slopes/terrain. Further research is needed into why and how participants make decisions around risk. Future injury prevention strategies should be evaluated in light of potential risk factors such as, social determinants of injury, fall mechanisms, changing participation patterns, age, snowsport discipline, and legal cannabis use.

Using 3D Volume Measurements on Weightbearing Computed Tomography Scan to Diagnose Syndesmotic Instability

Category:AnkleIntroduction/Purpose:Diagnosing syndesmotic instability, especially when subtle, remains challenging. Weight bearing computed tomography (WBCT) offers a unique opportunity to evaluate the distal syndesmosis under physiologic load while simultaneously comparing the injured and uninjured side. We hypothesized that WBCT volumetric measurements of the distal syndesmosis were increased on the injured side as compared to the contralateral uninjured side among patients with syndesmotic instability. Our secondary hypothesis was that these 3-dimensional calculations were an even more sensitive determinant of instability as compared to 2-dimensional methodology.Methods:Twelve patients with unilateral syndesmotic instability requiring operative fixation who underwent preoperative bilateral foot and ankle WBCT were included in the study group. The control group comprised of 24 patients without ankle injury who underwent similar imaging. For each WBCT scan, 2-dimensional measurements of the interspace between the distal fibula and tibia were measured 1cm above the joint line in the axial plane, namely the syndesmosis area and the direct anterior, middle and posterior difference. Furthermore, three volumetric measurements of the interspace between the distal fibula and tibia were evaluated: 1) from the tibial plafond extending until 3cm proximally, 2) 5cm proximally, and 3) 10cm proximally from the joint line.Results:In patients with unilateral syndesmotic instability, all weightbearing volumetric measurements were significantly larger on the injured side as compared to the contralateral, uninjured side (p<0.001). In the control group, there was no difference between syndesmotic volumes at any level. Of the three anatomic reference points, the volumetric measurement spanning from the tibial plafond to a level 5cm proximally had the highest relative volumetric ratio between the injured and uninjured side, suggesting it is more sensitive in distinguishing stable and unstable syndesmotic injuries (median ratios (IQR) 1.3(1.2-1.4), 1.8(1.6-2.1), 1.4(1.3-1.5), respectively; p<0.001). Additionally, this relative volumetric ratio was also more sensitive than 2-dimensional measurements (p=0.001).Conclusion:Volumetric measurement of the distal tibiofibular interspace using WBCT appears to be the most effective way to diagnose syndesmotic instability. The measurement from the tibial plafond extending until 5cm proximally is more sensitive to detect syndesmotic instability than using either more traditional 2D WBCT syndesmosis measurements or using more distal (3cm) or proximal (10cm) 3D volumetric measurements. This does not seem surprising given the overall spectrum and 3D nature of the syndesmotic injury across the injured population.TablesTable 1.Table 2.

Robust Method for Mid-Activity Tracking and Evaluation of Ankle Health Post-Injury.

To present a robust methodology for evaluating ankle health during ambulation using a wearable device.Methods:We developed a novel data capture system that leverages changes within the ankle during ambulation for real-time tracking of bioimpedance. The novel analysis compares the range of reactance at 5kHz to the range of reactance at 100kHz; which removes the technique's previous reliance on a known baseline. To aid in interpretation of the measurements, we developed a quantitative simulation model based on a literature review of the effects on joint bioimpedance of variations in edematous fluid volume, muscle fiber tears, and blood flow changes.Results:The results of the simulation predicted a significant difference in the ratio of the range of the reactance from 5kHz to 100kHz between the healthy and injured ankles. These results were validated in 15 subjects - with 11 healthy ankles and 7 injured ankles measured. The injured subjects had lateral ankle sprains 2-4 weeks prior to the measurement. The analysis technique differentiated between the healthy and the injured population (p<<0.01), and a correlation (R = 0.8) with a static protocol previously validated for its sensitivity to edema.Conclusion:The technology presented can detect variations in ankle edema and structural integrity of ankles, and thus could provide valuable feedback to clinicians and patients during the rehabilitation of an ankle injury.Significance:This technology could lead to better-informed decision making regarding a patient's readiness to return to activity and / or tailoring rehabilitation activities to an individual's changing needs.

Study of relationship of posterior tibial slope in anterior cruciate ligament injury

ObjectiveTo determine the relationship between Posterior Tibial slope in terms of medial and lateral in Anterior cruciate ligament deficient patients. MethodsMagnetic resonance images (MRI) of the knee of 100 ACL injured patients and 100 ACL intact patients were studied. Their medial and lateral posterior tibial slopes were measured using MRI. Of 200 subjects, 100 (Male- 63, Female- 37) were controls, other 100 (Male – 68, Female-32) were ACL injured cases. Using DIACOM viewer software,the slopes of both medial and lateral slopes were measured. Range of Variation, mean value and standard deviation of medial tibial plateau slope (MTS), lateral tibia plateau slope (LTS) of controls and ACL injured patients were measured. The data collected were entered into Microsoft excel worksheet and analysed using statistical package for social sciences, Version 15.0 (SPSS Inc. Chicago, IL, USA). Distribution of data was confirmed using Shapiro's Wilk Test and appropriate parametric statistics were applied. For all analysis p value < 0.05 was set to be significant. ResultsIn control (ACL uninjured) population mean MTS was 5.95° with SD 3.09°, mean LTS was 6.08° with SD 3.48°. In ACL injured population mean MTS 6.41° with SD 2.66°, mean LTS was 8.12° with SD 3.65°. So ACL injured population had MTS steeper than control population with no statistical significance (p value < 0.27) and LTS was steeper than control population with statistical significance (p value < 0.001),where as there were comparable results between male and females. ConclusionOur current results indicate that lateral PTS is a risk factor for patients with primary ACL tears as compared with ligament-intact controls. Therefore,PTS should be considered as independent modifiable risk factors in ACL injury.

The prevalence of head and facial injuries among children in Saudi Arabia following road traffic crashes.

ABSTRACTBACKGROUND: Motor vehicle crashes (MVCs) are the leading cause of death among children in Saudi Arabia. Childhood injuries can be prevented or minimized if safety measures, such as car seats, are implemented. The literature on the epidemiology of head and facial injury among children is limited, which affects the ability to understand the extent of the burden and hinders investment in public health prevention.OBJECTIVE: Describe the epidemiology of head and facial injuries among children admitted to the hospital following MVCs.DESIGN: Retrospective chart review.SETTING: Five hospitals in several regions.PATIENTS AND METHODS: We collected data on all patients ≤16 years old, who were admitted to the hospital following MVCs between 2016-2019. Differences in various characteristics like head injury status and age groups were compared.MAIN OUTCOME MEASURES: Head and facial injuries.SAMPLE SIZE: 253 patients.RESULTS: Of the injured population, 97 (38.3%) sustained a head injury, and 88 (34.8%) had a facial injury. Thirteen (9.1%) children were driving the car at the time of the crash. About half of the children were seated in the back (53.8%) without a seatbelt or safety seat.CONCLUSION: The prevalence of head and facial injuries is striking. In addition, the study revealed that driving among children is not uncommon, which warrants monitoring and implementing interventions. Improved documentation of restraint use and police enforcement of safety laws can play a significant role in reducing associated injuries. The study findings highlight the importance of combination or rear seating as well as age-appropriate restraint in order to reduce the likelihood of head or facial injuries among children.LIMITATIONS: Retrospective study using the electronic search system to identify patients, but may have missed cases that were not coded correctly. Large amount of missing data for some variables. Additionally, the analysis was limited to those admitted to the hospital.CONFLICT OF INTEREST: None.

Catching CAUTIs Midstream: Impact of a Nurse-driven Infection Prevention Initiative in a Neurotrauma Intensive Care Unit

<h3>Background</h3> A preventable hospital-associated condition, Catheter-Associated Urinary Tract Infection (CAUTI) increases morbidity, mortality, and hospital length of stay and cost. Neurologic and injured patients are at high-risk for adverse outcomes associated with bladder dysfunction. Thus, higher utilization, reinsertion and infection rates related to indwelling urinary catheter use is reported in these complex populations. What is the impact of an innovative nurse-driven initiative to reduce CAUTI incidence in a neurotrauma intensive care unit (NTICU) to a Standardized Infection Ratio (SIR) < 1.0? <h3>Methods</h3> A nurse-led interprofessional team utilized a Define-Measure-Analyze-Improve-Control model to implement an evidence-based CAUTI prevention initiative. A 12-bed unit providing care to neurologic and injured patients in a level one trauma, academic medical center was the study setting. Cornerstone interventions included conduct of a staff culture of safety survey; revision of ICU Fever and Bladder Management Guidelines; interprofessional education; and use of a trial without catheter (TWOC) checklist to assess for catheter removal readiness. To sustain improvements, a nursing clinical team leader (CTL) driven initiative included daily patient rounds and audits of catheter care bundle and guideline compliance over a two-year period. Infection rates, device utilization rates and SIR were compared pre and post intervention. <h3>Results</h3> CAUTI rates reduce post intervention by nearly 40% (CAUTI rate 2017, 5.48; 2018, 2.91) and sustained through 2019 (2.97). The SIR for CAUTI reduce nearly 50% from 2.0 in 2017 to 1.06 in 2018 and sustained at 0.92 in 2019. No significant change in the utilization rate was noted (2017, 0.49; 2018, 0.55; 2019, 0.50). <h3>Conclusions</h3> At the unit level, a CTL driven initiative sustains quality improvements in catheter care bundle and guideline compliance, significantly reducing CAUTI incidence in a NTICU. Innovative use of an additional assessment checklist for catheter removal readiness may further support CAUTI reduction in high-risk neurologic and injured ICU populations.

Modeling the combined effect of high hydrostatic pressure and mild heat on the sub‐lethal injury of Listeria monocytogenes by Box–Behnken design

AbstractIn this study, a predictive model based on the Box–Behnken design of response surface methodology was applied to investigate the effects of high hydrostatic pressure (300, 400 and 500 MPa), temperature (20, 30 and 40°C) and treatment time (5, 10 and 15 min) on the sub‐lethal injury of Listeria monocytogenes (L. monocytogenes). The percentage of sub‐lethal injury was calculated by the difference in L. monocytogenes counts observed on nonselective and selective media. The established predictive model presented a goodness of fit to the experimental data (p &lt; .001) with high correlation coefficient value (R2 = .9999) and adjusted correlation coefficient value (Adj‐R2 = .9995), along with an insignificant lack‐of‐fit term (p = .4299). The synergistic effects of pressure, temperature and treatment time on the sub‐lethal injury of L. monocytogenes were found within the tested experimental ranges. Results indicated that the established model has the potential for predicting the effects of high hydrostatic pressure processing on the sub‐lethal injury of L. monocytogenes.Practical ApplicationsHigh hydrostatic pressure (HHP) processing has been an attractive way to replace conventional heat treatments to inactivate microorganisms for the preservation of foods. However, HHP processing can cause microorganisms to enter sub‐lethal injury state which pose a threat to food safety. There is a great need of quantification of injured population of L. monocytogenes in a wide range of pressure and temperature conditions. In this study, the changes of sub‐lethal injury of L. monocytogenes are described, which can be used to assess the HHP treatment efficacy and the synergistic action in food sterilization processes. The modeling for the sub‐lethal injury of L. monocytogenes cells induced by HHP processing combined mild heat was established. The effects of HHP processing on the sub‐lethal injury of L. monocytogenes could be understood further by this modeling which was helpful to facilitate industrial adoption of this technology. Based on these data, there was a reference for us to select appropriate processing parameters to avoid appearance of sub‐lethal injury of L. monocytogenes cells as far as possible during HHP in food industry.

Exposure to a motor vehicle collision and the risk of future back pain: A systematic review and meta-analysis

ObjectiveThe purpose of this study is to summarize the evidence for the association between exposure to a motor vehicle collision (MVC) and future low back pain (LBP). Literature surveyPersistent low back pain (LBP) is a relatively common complaint after acute injury in a MVC, with a reported 1 year post-crash prevalence of at least 31 % of exposed individuals. Interpretation of this finding is challenging given the high incidence of LBP in the general population that is not exposed to a MVC. Risk studies with comparison control groups need to be examined in a systematic review. MethodologyA systematic search of five electronic databases from 1998 to 2019 was performed. Eligible studies describing exposure to a MVC and risk of future non-specific LBP were critically appraised using the Quality in Prognosis Studies (QUIPS) instrument. The results were summarized using best-evidence synthesis principles, a random effects meta-analysis and testing for publication bias. SynthesisThe search strategy yielded 1136 articles, three of which were found to be at low to medium risk of bias after critical appraisal. All three studies reported a positive association between an acute injury in a MVC and future LBP. Pooled analysis of the results resulted in an unadjusted relative risk of future LBP in the MVC-exposed and injured population versus the non-exposed population of 2.7 (95 % CI [1.9, 3.8]), which equates to a 63 % attributable risk under the exposed. ConclusionsThere was a consistent positive association in the critically reviewed literature that investigated the risk of future LBP following an acute MVC-related injury. For the patient with chronic low back pain who was initially injured in a MVC, more often than not (63 % of the time) the condition was caused by the MVC. These findings are likely to be of interest to clinicians, insurers, patients, governments and the courts. Future studies from both general and clinical populations would help strengthen these results.

Injuries Caused by Freshwater Stingrays in the Western Amazon: Folk Medicine and Beliefs

The envenomation caused by freshwater stingrays is one of the most frequent injuries related to aquatic animals in South America. Such injury is severe with skin necrosis as a probable result of the sting and subsequent intense pain. Here, we characterized the accidents caused by freshwater stingrays in Juruá Valley, Acre, Brazil, with reports of people who had suffered injuries. Data collection was performed in nearby communities in the Juruá River and its tributaries through a semi-structured questionnaire. Bathers and fishermen were the main group affected, and injuries were mainly in the lower limbs. The results were similar to those previously reported for other regions of Brazil, except for the treatment applied. Severe pain, edema, erythema, necrosis, and ulceration of the wound are some of the symptoms reported by the injured population. Most of the treatment is based on folk remedies, such as human urine, hot boiled egg, medicinal plants, and nonprescription drugs. In most cases, injuries usually occur in remote areas which favor the use of folk remedies, but the accidents are still neglected by the population itself because of the low lethality. Therefore, educational activities and prophylactic measures should be carried out with a standardization of first aid and late measures. In addition, the correct use of medicinal plants and folk remedies could be a strong ally to ensure a safe and affordable care for the population.

Relationship between mechanical properties (shear modulus and viscosity), age, and sex in uninjured Achilles tendons.

Tendon mechanical properties have been proposed as a biomarker of tendon health to track response to injury and treatment. Prior to utilizing these properties in an injured population, it is critical to understand how these are influenced by age and sex in an uninjured population. A retrospective analysis was conducted of 118 uninjured Achilles tendons to evaluate the relationship between tendon mechanical properties, age and sex. Mechanical properties (shear modulus and viscosity) were assessed using continuous shear wave elastography. A moderator regression analysis was completed to examine the relationship between tendon mechanical properties, age and sex, after adjusting for body mass index and physical activity level. There was an interaction between age and sex for shear modulus (p=0.049, R2 change=0.034). Females had a negative relationship between age and shear modulus (p=0.030, β=-0.350) but no relationship was observed for males (p=0.78, β=0.031). A positive relationship was found between age and viscosity (p=0.034, β=0.214). Increased viscosity was related to increased age with no difference between sexes. The effect of aging on shear modulus differed between men and women and may help explain sex specific injury risks and their differing response to mechanical load.

505 Burn Sepsis: Does the Initial Vitamin C Level Matter?

Abstract Introduction After the first 24 hours, the principle cause of death in burn patients is multiple organ dysfunction/failure syndrome. It is preceded by infection in 83% of burn patients, with reported septic mortality up to 65%. In a recent journal article involving septic medical ICU patients, Marik et al. reports that all initial Vitamin C levels were below the normal range (0.4–2.0 mg/dL) prior to any intervention. Independent of each other, both early recognition and treatment of infection and vitamin C have been shown to be beneficial in sepsis. We monitored Vitamin C levels as part of our “Burn Code Sepsis” algorithm to obtain a baseline understanding of Vitamin C levels in infected adult burn patients. Methods Adult (≥18 yo) admissions between 7/1/2018 – 6/30/2019 were identified from our Burn Registry and all sepsis screens were evaluated in the EMR. Patients were screened clinically at least BID and were considered a “positive” screen if MAP &amp;lt; 65 mmHg (SBP&amp;lt; 90 mmHg) or if 2 of the 3 occurred: Temp &amp;gt;102.2F; HR &amp;gt;120; RR &amp;gt;28 (or RR &amp;gt;10% of ventilator set rate if set rate is &amp;gt;24 bpm). A positive screen prompted lab work to include CBC, BMP, procalcitonin (PCT), lactic acid (LA) and Vitamin C (VC), per protocol. If PCT &amp;gt;3.0 ng/ml or LA &amp;gt;2.0 mmol/L, or both thrombocytopenia and hyperglycemia were present, a “Burn Code Sepsis” was initiated and included cultures, a CXR, and empiric antibiotics. If the cultures were positive or the CXR demonstrated an infectious process, a patient was considered “septic”. All burn injured patients with greater than or equal to 20% TBSA burns receive Vitamin C supplementation as part of our standard of care. Results There were 286 admissions during the 12-month period, with 38 positive initial sepsis screens (mean TBSA = 35%) that have an associated VC level. Of these positive screens, 26 (65%) were infected and 12 (35%) were not infected. ROC Curve analysis of VC levels and its ability to diagnose septic patients yields an AUC = 0.60 (p = 0.37). The mean VC level of infected patients at the time of initial screening was 1.9 +/- 1.4 mg/dL, and the mean VC level of non-infected patients at initial screening was 1.5 +/- 1.0 mg/dL. Conclusions Our results contrast with the previously published article on Vitamin C levels in a septic, non-burn injured population. Only 1 of 26 infected patients possessed a Vitamin C level below the normal range (0.4–2.0 mg/dL). Infected patients possessed higher Vitamin C levels than the non-infected patients, though not statistically significant (p = 0.35). AUC analysis indicates Vitamin C level is a poor prognostic test for sepsis. Applicability of Research to Practice Further research on Vitamin C levels and Its role in sepsis in the burn injured population is warranted.

Selenite Cystine Agar for Enumeration of Inoculated Salmonella Serovars Recovered from Stressful Conditions During Antimicrobial Validation Studies.

Process validation studies often require the inoculation of select foodborne pathogens into targeted foods to determine the lethality of the process or antimicrobial ingredients, and quantitative recovery of surviving inoculum bacteria helps to make those assessments. Such processes introduce various stressors on the inoculated challenge microorganisms whereby traditional selective media are too harsh to enumerate the remaining viable and injured population quantitatively. Innate antibiotic resistance of challenge organisms has often been used to establish simple selective media (i.e., Tryptic Soy Agar/TSA + antibiotics) for recovering inoculated strains, but sometimes antibiotic resistant background microorganisms are higher than desired. Salmonella Thompson 120, Salmonella Heidelberg F5038BG1, Salmonella Hadar MF60404, Salmonella Enteritidis H3527, and Salmonella Typhimurium H3380 were characterized for antibiotic resistance and acid adaptation in Tryptic Soy Broth containing 0%, 0.25%, or 1.0% glucose. Sodium pyruvate was evaluated for recovery after stress but no enhancing effect was observed, possibly because the strains were acid-adapted. Selenite Cystine Broth, traditionally used as a selective enrichment broth, was used as the basis for Selenite Cystine Agar (SCA) in combination with three antibiotics to which our Salmonella are resistant. Serovars of Salmonella, both individually and in mixtures, were enumerated on TSA, SCA, Xylose Lysine Desoxycholate (XLD), and Hektoen Enteric (HE) selective agars (all containing the same antibiotics) after conditions of nutrient starvation, desiccation, acid stress, and thermal stress. The data show that quantitative enumeration of our Salmonella serovars on SCA was not significantly different (p > 0.05) than those achieved on TSA for all tested stress categories. Levels of Salmonella enumerated on XLD and/or HE were significantly different (p < 0.05) than on TSA and SCA and often more than 1–2-log lower, consistent with the inhibition of injured cells. These data confirm that SCA (+ antibiotics) is a suitable selective medium for enumeration of these acid-adapted Salmonella serovars as challenge organisms recovered from various conditions of stress.