Injuries Worldwide Research Articles

Synthesis and characterization of polymeric responsive CMC/Pectin hydrogel films loaded with Tamarix aphylla extract as potential wound dressings

The fourth most predominant overwhelming type of trauma is burn injuries worldwide. Ideal wound healing dressings help in the wound healing process in a lower time with less pain. Commonly used dry wound dressing, like absorbent gauze or absorbent cotton, possess limited therapeutic effects and require repeated use, which further exaggerates patients’ suffering. In contrast, hydrogels films present a promising alternative to improve healing by guaranteeing a moisture balance at the wound site. The aim of the current study was to synthesize Tamarix aphylla (T. aphylla) extract-loaded hydrogel film with Na-CMC and pectin and to study their wound healing properties. The Na-CMC/Pectin hydrogels films were synthesized and characterized for HPLC analysis, FTIR, surface morphology, rheology, tensile strength, swelling behavior, drug release kinetics, and in vivo wound healing in an animal model. FTIR confirmed the existence of strong interaction between both polymers but no interaction with the extract. SEM photographs showed successful embedding of extract in small pores of hydrogel film and showed smooth and homogenous morphology. Rheological and texture profiles indicated that hydrogels behaved as strong gels. Swelling and erosion were dependent on the amount of the CMC. HPLC showed drug content of three selected formulation (A3, E3 and S3) as 85 ± 0.1%, 82.5 ± 0.4% and 80 ± 0.3%, respectively. The release of the drug from the hydrogel was controlled by a Fickian diffusion mechanism. In vivo wound healing activity of hydrogel film confirmed that T. aphylla extract successfully promoted healing rate by significantly reducing (P < 0.05) the size of wound closure compared to the control group, evidenced by intensive collagen formation in histopathological and biochemical analysis. The capability of these hydrogels for burn wounds could be valuable for medical uses as a new window of safe and effective medication.

Prevalence of alcohol use among road traffic crash victims presenting to a Malawian Central Hospital: A cross-sectional study

Background Alcohol consumption is a well-known risk factor for sustaining road traffic injuries worldwide. Malawi is a low-income country with a large and increasing burden of road traffic injuries. It has generally been viewed as a country with relatively little alcohol consumption. This study investigates the role of alcohol in road traffic injuries in and around the capital Lilongwe. Methods All patients presenting to the emergency department of Kamuzu Central Hospital after being injured in road traffic crashes were asked to participate in the study. Alcohol testing was done with a breathalyzer or a saliva test. Participants were asked about alcohol use before the injury as well as hazardous drinking using the AUDIT-C questionnaire. Results Of 1347 patients age 18 years or older who were asked to participate, 1259 gave informed consent, and data on alcohol use (alcohol test results and/or self-reported intake) were available for 1251 participants. Of those, 251 (20.1%) tested positive for alcohol, whereas 221 (17.7%) reported alcohol use before the crash; in total 311 (24.9%, 95% CI 22.5–27.3) either tested positive, reported use, or both. Females had a low prevalence of alcohol use (2.5%), while 30.6% of males had consumed alcohol before the injuries. Pedestrians had the highest prevalence at 41.8% (95% CI 35.5–48.4), while car drivers had 23.8% (95% CI 18.2–30.5). Among male pedestrians, 49.5% had used alcohol before the injury. Alcohol-associated injuries had a peak in the evening and at night, especially in the weekends. Of the patients, 63.1% reported that they had not consumed alcohol during the last year, while 21.4% had an AUDIT-C score suggesting hazardous drinking, and 66.2% of those had used alcohol before the injury. Conclusions A large percentage of road traffic injured patients had been drinking alcohol before their injury, especially male pedestrians. A large proportion of the patients were abstaining from alcohol, but those not abstaining had a high prevalence both of alcohol use when injured and hazardous drinking identified by AUDIT-C. This has important implications for prevention.

Temporal trends in the incidence of and associations between the risk factors for obstetrical anal sphincter injuries

Obstetrical anal sphincter injuries are an important complication of vaginal deliveries that may result in short- and long-term pelvic floor morbidity and a diminished quality of life in young, healthy women. The prevalence of obstetrical anal sphincter injuries ranges from 0.1% to 8.7%. Over recent years, there seems to be a trend of increasing occurrence of obstetrical anal sphincter injuries worldwide. It is unclear why the rates are rising. Previous studies have examined the effect of different risk factors on the prevalence of obstetrical anal sphincter injuries. The change in the incidence of some risk factors for obstetrical anal sphincter injuries can partially explain the overall increase in obstetrical anal sphincter injuries. There is no previous study that explored the impact of the changes of individual risk factors over time on the risk for obstetrical anal sphincter injuries. The main aim of this study was to examine the temporal trends in the prevalence and odds ratio of the major risk factors known to be associated with obstetrical anal sphincter injuries in the period from 1988 to2016. This was a retrospective cohort study that included all women who underwent vaginal deliveries between 1988 and 2016 at a tertiary university medical center. The time intervals were divided into 4 periods (1988-1997, 1998-2007, 2008-2016, and the total time from 1988 to 2016) and the incidence of each risk factor was calculated for each time period. Correlation models and regression analysis were performed to examine the association between obstetrical anal sphincter injuries and the different risk factors over time. Furthermore, the trends in the odds ratios of the important risk factors over the time periods were evaluated using a multivariate regression analysis in which the primiparous women were separated from the multiparous women. During the study period, there were 295,668 vaginal deliveries. Of these, 591 women were diagnosed with obstetrical anal sphincter injuries (0.2%). The significant risk factors for obstetrical anal sphincter injuries (P<.05) in the multivariable analysis were the following: primiparity, vaginal birth after cesarean delivery, vacuum extraction, and a birthweight of >4 kg. There was a significant (P<.05) increase in the incidence over the study period for the following risk factors: primiparity, vaginal birth after cesarean delivery, and vacuum extraction. No change was found in the incidence of the risk factor of a birthweight of >4 kg. In addition, we found a strengthening of the association between vaginal birth after cesarean delivery and macrosomia with obstetrical anal sphincter injuries, as opposed to a decline in the relative contribution of vacuum extraction to the overall risk for obstetrical anal sphincter injuries. Moreover, we found that obstetrical anal sphincter injuries among primiparous women increased 7-fold over the study period but was unchanged among multiparous women. We have shown significant (P<.05) temporal trends in the incidence and odds ratio of some of the known risk factors for obstetrical anal sphincter injuries. A better understanding of the changes in the incidence and specific contribution of important risk factors for obstetrical anal sphincter injuries may explain, in part, the worldwide increase in the prevalence of this important and detrimental complication of vaginal birth.

Thoracolumbar Fractures in Adolescent Patients: Epidemiological, Clinical, Radiological Characteristics and Recent Methods of Management

Background: Spine fractures account for a large portion of musculoskeletal injuries worldwide; approximately 54.9% of the patients had fractures in the thoracolumbar spine; with most of these occurring at the thoracolumbar junction (T10-L2). Objective: To assess the epidemiologic characteristics of spinal injuries in adolescents, their unique anatomic, and radiographic characteristics. Patients and Methods: 18 selected patients presented with traumatic thoracolumbar fractures admitted to the Neurotrauma Unit of Neurosurgery Department, Zagazig University Hospitals, and Al-Ahrar Teaching Hospital, Sharkia, Egypt with our study prospective study and post-resuscitation they were of both sexes and their age range starts from 12:17 years adolescent group. Results: the number of patients (18 patients) was 20.2% from 189 cases of all spine fractures in adolescent patients. Sex were 11 males (61.1%) falling from height is the most common cause of thoracolumbar fractures (50%), followed by road traffic accidents (33.3%). the most common type of fracture in both groups was a wedge and burst where it constituted more than 80%. Orthopedics fractures were the most common associated injuries which were found in 6 patients (33%). According to motor power, 14 patients had full motor power (77.7%). the most common level of injury was L1 vertebrae 11patients (61.1%). The mean height of the vertebral body in the conservative treated group was 26.11±4.85, but in the surgically treated group is 25.55 ±4.63. Conclusion: The most common cause of trauma was fall from a height (50%). The most affected vertebra was L1 (61.1%). Over 80% of patients were neurologically intact. The angle of kyphosis in the surgically treated group improved and decreased from 23 degrees to18.22 degrees.

Clinical and Radiological Assessment of Interbody Fusion and Short-Segment Fixation in Dorso-Lumbar Fractures

Background: Spine fractures account for a large portion of musculoskeletal injuries worldwide. Approximately 75% to 90% of spinal fractures occur in the thoracic and lumbar spine, with most of these occurring at the thoracolumbar junction (T10-L2). Surgical treatment has demonstrated better clinical and radiological results than conservative treatment. Objective: To evaluate the outcome of short-segment fixation with interbody fusion in dorsolumbar fractures clinically and radiologically. Patients and Methods: This study took place at the Neurotrauma Unit of Neurosurgery Department, Zagazig University Hospitals. It included sixteen patients with thoracolumbar fractures treated by short-segment open transpedicular posterior fixation with interbody fusion. Results: Male was the predominant sex (68.7%), mean age was 37.88 years (range: 19-55 years) and the residence in rural areas was 50 % and in urban areas was 50 %. Housewives were the predominant occupation and constitute 31.3%. 81.3% of patients were married. The most prevalent AO spine type of fracture was A3 fracture where it constituted 62.5% of patients, the level of fracture was L2 in 50 % of patients & about 38% had severe pain as reported on VAS score. In our Study there was significant change in ASIA score 12 weeks postoperatively. While 62.5% had E score preoperatively, 87.5% had it 12 weeks postoperatively and 12.5% turned had score C 12 weeks preoperatively versus no one postoperatively had C ASIA score. Conclusion: Surgical treatment of thoracic and lumbar fractures allows for immediate stabilization of the spine, restoration of sagittal alignment, and the possibility of spinal canal decompression.

Magnetic responsive materials modulate the inflammatory profile of IL-1β conditioned tendon cells

Tendinopathies represent half of all musculoskeletal injuries worldwide. Inflammatory events contribute to both tendon healing and to tendinopathy conditions but the cellular triggers leading to one or the other are unknown. In previous studies, we showed that magnetic field actuation modulates human tendon cells (hTDCs) behavior in pro-inflammatory environments, and that magnetic responsive membranes could positively influence inflammation responses in a rat ectopic model.Herein, we propose to investigate the potential synergistic action of the magnetic responsive membranes, made of a polymer blend of starch with polycaprolactone incorporating magnetic nanoparticles (magSPCL), and the actuation of pulsed electromagnetic field (PEMF): 5 Hz, 4mT of intensity and 50% of duty cycle, in IL-1β-treated-hTDCs, and in the immunomodulatory response of macrophages.It was found that the expression of pro-inflammatory (TNFα, IL-6, IL-8, COX-2) and ECM remodeling (MMP-1,-2,-3) markers tend to decrease in cells cultured onto magSPCL membranes under PEMF, while the expression of TIMP-1 and anti-inflammatory genes (IL-4, IL-10) increases. Also, CD16++ and CD206+ macrophages were only found on magSPCL membranes with PEMF application.Magnetic responsive membranes show a modulatory effect on the inflammatory profile of hTDCs favoring anti-inflammatory cues which is also supported by the anti-inflammatory/repair markers expressed in macrophages. These results suggest that magnetic responsive magSPCL membranes can contribute for inflammation resolution acting on both resident cell populations and inflammatory cells, and thus significantly contribute to tendon regenerative strategies.Statement of significanceMagnetically-assisted strategies have received great attention in recent years to remotely trigger and guide cell responses. Inflammation plays a key role in tendon healing but persistent pro-inflammatory molecules can contribute to tendon disorders, and therefore provide a therapeutic target for advanced treatments.We have previously reported that magnetic fields modulate the response of human tendon cells (hTDCs) conditioned to pro-inflammatory environments (IL-1β-treated-hTDCs), and that magnetic responsive membranes positively influence immune responses. In the present work, we combined pulsed electromagnetic field (PEMF) and magnetic responsive membranes to guide the inflammatory profile of IL-1β-treated-hTDCs and of macrophages. The results showed that the synergistic action of PEMF and magnetic membranes supports the applicability of magnetically actuated systems to regulate inflammatory events and stimulate tendon regeneration.

"It's All Sort of Cool and Interesting…but What Do I Do With It?" A Qualitative Study of Stroke Survivors' Perceptions of Surface Electromyography.

Background: Stroke is one of the most common neurologic injuries worldwide. Over decades, evidence-based neurorehabilitation research and advancements in wireless, wearable sensor design have supported the deployment of technologies to facilitate recovery after stroke. Surface electromyography (sEMG) is one such technology, however, clinical application remains limited. To understand this translational practice gap and improve clinical uptake, it is essential to include stakeholder voices in an analysis of neurorehabilitation practice, the acceptability of current sEMG technologies, and facilitators and barriers to sEMG use in the clinic and the community. The purpose of this study was to foreground the perspectives of stroke survivors to gain a better understanding of their experiences in neurorehabilitation, the technologies they have used during their recovery, and their opinions of lab-designed and commercially-available sEMG systems.Methods: A qualitative, phenomenological study was completed. In-depth, semi-structured interviews were conducted with eight stroke survivors (age range 49–78 years, 6 months to 12 years post-stroke) and two caregivers from a large metropolitan region. A demonstration of four sEMG systems was provided to gather perceptions of sensor design, features and function, and user interface. Interviews were audio-recorded, transcribed verbatim, and coded for analysis using constant comparison until data saturation was reached.Results: Three themes emerged from the data: (1) “Surface EMG has potential….but…” highlights the recognition of sEMG as a valuable tool but reveals a lack of understanding and need for clear meaning from the data; (2) “Tracking incremental progress over days or years is important” highlights the persistence of hope and potential benefit of sEMG in detecting small changes that may inform neurorehabilitation practice and policy; and (3) “Neurorehabilitation technology is cumbersome” highlights the tension between optimizing therapy time and trying new technologies, managing cost, logistics and set-up, and desired technology features.Conclusion: Further translation of sEMG technology for neurorehabilitation holds promise for stroke survivors, but sEMG system design and user interface needs refinement. The process of using sEMG technology and products must be simple and provide meaningful insight to recovery. Including stroke survivors directly in translational efforts is essential to improve uptake in clinical environments.

Metabolic Profiling of a Porcine Combat Trauma-Injury Model Using NMR and Multi-Mode LC-MS Metabolomics-A Preliminary Study.

Profiles of combat injuries worldwide have shown that penetrating trauma is one of the most common injuries sustained during battle. This is usually accompanied by severe bleeding or hemorrhage. If the soldier does not bleed to death, he may eventually succumb to complications arising from trauma hemorrhagic shock (THS). THS occurs when there is a deficiency of oxygen reaching the organs due to excessive blood loss. It can trigger massive metabolic derangements and an overwhelming inflammatory response, which can subsequently lead to the failure of organs and possibly death. A better understanding of the acute metabolic changes occurring after THS can help in the development of interventional strategies, as well as lead to the identification of potential biomarkers for rapid diagnosis of hemorrhagic shock and organ failure. In this preliminary study, a metabolomic approach using the complementary platforms of nuclear magnetic resonance (NMR) spectroscopy and liquid chromatography coupled with mass spectrometry (LC-MS) was used to determine the metabolic changes occurring in a porcine model of combat trauma injury comprising of penetrating trauma to a limb with hemorrhagic shock. Several metabolites associated with the acute-phase reaction, inflammation, energy depletion, oxidative stress, and possible renal dysfunction were identified to be significantly changed after a thirty-minute shock period.

The alginate–chitosan composite sponges with biogenic Ag nanoparticles produced by combining of cryostructuration, ionotropic gelation and ion replacement methods

Uncontrolled bleeding causes more than 30% of deaths due to injuries worldwide. Modern hemostatic materials based on synthetic and biological macromolecules focus mainly on the time prior to hemostasis, but the prevention of a bacterial infection is also crucial for increasing survival. Silver is known to exhibit potent antimicrobial activity and strong biocidal effects against various types of bacteria. A new method for producing of composite sponges with a pronounced antimicrobial effect based on such biological polymers as alginate and chitosan with the addition of silver nanoparticles has been proposed. The method is based on the combination of cryostructuring, ionotropic gelation and ion substitution methods during the formation of the macroporous structure of the sponge at the gelation stage with subsequent freeze drying. Silver nanoparticles isolated by three fungal cultures were introduced into the sponges in low concentrations. The alginate–chitosan–composite sponges with Ag nanoparticles showed high sorption capacity, microporous structure and increased antimicrobial activity compared to a composite sponge without the inclusion of silver nanoparticles.

A Rare Case of Podophyllin Poisoning: Early Intervention is Lifesaving.

ABSTRACTAccidental poisoning in children is very common, making up 10.9% of all unintentional injuries worldwide. Africa has the highest incidence of fatal poisonings worldwide, at 4 per 100,000. Poisoning with podophyllin is rare, with most cases documented around the 1970s to 1980s. Podophyllin is a resin mixture obtained from the dried Rhizome and roots of Podophyllin peltatum (North America) and Podopyllin emodi (India). Podophyllotoxin is the most toxic chemical present in the podophyllin, which is lipid soluble; so crosses the cell membrane easily and inhibits mitotic spindle formation. Both topical application and oral consumption can cause podophyllin poisoning. Neurotoxicity is the most serious effect along with bone marrow depression, gastrointestinal irritation, and hepatic and renal dysfunction. Management of podophyllin toxicity is mainly symptomatic, and no specific antidote exists. We report a case of a 2-year-old-year girl with accidental podophyllin poisoning, who presented with neurotoxicity followed by multiorgan dysfunction and then succumbed. Education of parents and healthcare workers on home safety still remains the mainstay of prevention.How to cite this article: Jain MK, Patnaik S, Rup AR, Gaurav A. A Rare Case of Podophyllin Poisoning: Early Intervention is Lifesaving. Indian J Crit Care Med 2020;24(6):477–479.

First Report of Traumatic Brain Injury in Luanda, Angola

Traumatic brain injury (TBI) is a global problem and is the greatest contributor to death and disability among all trauma-related injuries worldwide. Road traffic accidents are an important cause of TBI. The purpose of this paper is to present the first data on TBI in Angola. This was a retrospective study of the clinical and radiologic profile of patients admitted to the intensive care unit of a tertiary hospital in Luanda, Angola, from January 2018 to December 2018. The medical records of patients with moderate and severe TBI admitted to the intensive care unit were reviewed. The inclusion criteria were adult patients who suffered from TBI. The exclusion criteria were incomplete medical records, pediatric age, and mild TBI. We included 29 patients (6 female) with a mean age of 31 years. Of them, 31% visited the hospital without an ambulance (using private or commercial vehicles), 58.6% suffered from severe TBI, and the mortality rate in our sample was 34.5%. Road accident was the most frequent cause of trauma. This first report of TBI in Angola reveals major problems with TBI management, road accident prevention, prehospital management, and loss of lives of young patients.

Still careless: findings from a cross-sectional study of young pedestrians\u2019 risky road crossing behaviors

BackgroundPedestrian-vehicle collision is one of the most common traffic injuries worldwide. This study aimed to investigate the determinants of pedestrians’ road crossing beliefs and behaviors in potentially risky situations using the Theory of Planned Behavior among Iranian young adults.MethodsThis was a population-based study on a sample of 562 young adults aged 18 to 25 years living in Tehran, Iran. Data were collected by using a self-administered validated questionnaire including constructs of the theory of planned behavior and items of perceived risk and severity. The data were analyzed using independent t-test, analysis of covariance and multivariate analysis of variance.ResultsFrom all the respondents, 17.8% reported that they had previous experience of vehicle-collision. Among the participants, those who had previous experience of vehicle-collision reported less safety behaviors in crossing the road than those who had not experience an accident. It was found significant differences between participants with and without a history of vehicle-collision for perceived risk (mean difference, adjusted multivariate P-value: − 5.77, 0.027) and perceived severity (− 6.08, 0.003), attitude toward traffic regulations (− 6.34, 0.006), attitude toward behavior (− 7.56, 0.005), perceived behavioral control (− 5.20, 0.018), behavioral intention (− 5.35, 0.046) and road crossing behavior in potentially risky situations (− 5.37, 0.004).ConclusionsPrevious unpleasant experience of vehicle-collision is not the only determinant of self-protective behaviors in road- crossing which indicate the role of cognitive and motivational factors such as, subjective norms, attitudes towards risk, feelings of invulnerability in case of facing with vehicle collision.

Open fracture management

Open fractures are commonly encountered injuries worldwide and are often complicated by infection. Many present significant treatment challenges, where surgeons’ early decision-making can affect long-term outcomes. While evidence-based recommendations exist to guide some of these decisions, several treatment areas continue to be controversial. This supplement seeks to outline critical treatment elements for open fractures, including antibiotic administration, surgical timing, bone defect management, and soft-tissue coverage as well as management of fracture-related infections. The expectation is that a better understanding of these issues will help improve the future care of these potentially disabling injuries.

Metabolomics analysis of the hippocampus in a rat model of traumatic brain injury during the acute phase.

BackgroundTraumatic brain injury (TBI) has increased in rank among traumatic injuries worldwide. Traumatic brain injury is a serious obstacle given that its complex pathology represents a long‐term process. Recently, systems biology strategies such as metabolomics to investigate the multifactorial nature of TBI have facilitated attempts to find biomarkers and probe molecular pathways for its diagnosis and therapy.MethodsThis study included a group of 20 rats with controlled cortical impact and a group of 20 sham rats. We utilized mNSS tests to investigate neurological metabolic impairments on day 1 and day 3. Furthermore, we applied metabolomics and bioinformatics to determine the metabolic perturbation caused by TBI during the acute period in the hippocampus tissue of controlled cortical impact (CCI) rats. Notably, TBI–protein–metabolite subnetworks identified from a database were assessed for associations between metabolites and TBI by the dysregulation of related enzymes and transporters.ResultsOur results identified 7 and 8 biomarkers on day 1 and day 3, respectively. Additionally, related pathway disorders showed effects on arginine and proline metabolism as well as taurine and hypotaurine metabolism on day 3 in acute TBI. Furthermore, according to metabolite–protein database searches, 25 metabolite–protein pairs were established as causally associated with TBI. Further, bioinformation indicated that these TBI‐associated proteins mainly take part in 5′‐nucleotidase activity and carboxylic acid transmembrane transport. In addition, interweaved networks were constructed to show that the development of TBI might be affected by metabolite‐related proteins and their protein pathways.ConclusionThe overall results show that acute TBI is susceptible to metabolic disorders, and the joint metabolite–protein network analysis provides a favorable prediction of TBI pathogenesis mechanisms in the brain. The signatures in the hippocampus might be promising for the development of biomarkers and pathways relevant to acute TBI and could further guide testable predictions of the underlying mechanism of TBI.

Long-term study of functional outcomes of floating knee injuries

Background: Floating knee injuries are commonly occurring fractures in the high-velocity trauma. The mode of injury is usually due to road traffic accidents. Over the years, there have been many studies which have shown results of various conservative, external fixation, and finally, internal fixation treatment all over the world. However, still, there is very less work on long-term outcome-based analysis of functional outcomes of floating knee injuries. The aim of the study was to assess the long-term functional outcome of operated patients of floating knee injuries. Materials and Methods: A total of 30 patients with floating knee injuries who were undergone surgical fixation by any means were included in ths study. The study was done at a tertiary teaching institute and hospital from April 2013 to May 2019. The patients were followed up at 6 weeks, 6 months, 1 year, and 5 years (final) after the surgery. The assessment of pain, functional activity, walking ability, and range of motion was assessed by Karlstrom and Olerud criteria at 6 months, 1 year, and 5 years. Results: We included 30 patients diagnosed with floating knee injuries in our study with a mean age of 40.83 years (18–75 years range) and a female-to-male ratio of 5:1 with 25 males (83.3%) and 5 females (16.7%). All the patients underwent fixation under spinal/epidural anesthesia/general anesthesia. Fifteen patients were Fraser type 1, 4 patients were Fraser type 2A, 5 patients were Fraser type 2B, and 6 patients were Fraser type 2C. Average operating time was 120 ± 55 min. Right-sided involvement was more common (17 patients) than the left side (13 patients). The good/excellent outcome was found in 63.4% of the cases. Patients with age 40 years of age (df = 12, P = 0.014). Final outcomes had no difference in males as compared to females at 5 years postoperatively (df = 4, P = 0.265). Complications such as knee stiffness, infection, malunion, delayed union, and nonunion were also encountered. Conclusion: Surgical fixation is an effective treatment for floating knee injuries worldwide. On long-term follow-up of patients treated surgically, the functional and radiological outcomes were good with few complications rates.

Why "accidents" are not accidental: Using psychological science to understand and prevent unintentional child injuries.

Injuries are the leading cause of death for American children, killing over 11,000 children in 2017. They are also a rapidly increasing public health challenge globally: The World Health Organization ranks injury as the leading cause of death globally for children Ages 5 to 18 years, and the Global Burden of Diseases project estimates over 2 million children Ages 0 to 19 years died from injuries worldwide in 2017. Unintentional injuries, sometimes referred to as "accidents" by the lay public, are generally preventable, and psychological science has much to offer in societal efforts to develop, evaluate, implement, and disseminate effective prevention strategies. I first discuss the multifaceted causes of child injuries, which can be conceptualized using classic psychological theory, such as Bronfenbrenner's ecological theory, or classic injury prevention theory, such as the Haddon Matrix. In either case, behavioral risks stem from the child's developmentally influenced decisions and behaviors; the child's family, social, and physical contexts; and the child's broader cultural environments. Risks can also be conceptualized temporally, through behavioral analysis such as antecedents, behaviors, and consequences of the injury. I then present examples of behaviorally focused interventions that target the child, the adult supervisor, and the environment. In each case, I consider psychological risk factors present and the theory-based strategies that might interrupt or alter risk pathways to prevent injury events. I close with comments on the scope of injury as a global public health challenge and the central role psychologists can and should play to reduce the burden of child injury on the world's population. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Environmental controls on surf zone injuries on high-energy beaches

Abstract. The two primary causes of surf zone injuries (SZIs) worldwide, including fatal drowning and severe spinal injuries, are rip currents (rips) and shore-break waves. SZIs also result from surfing and bodyboarding activity. In this paper we address the primary environmental controls on SZIs along the high-energy meso–macro-tidal surf beach coast of southwestern France. A total of 2523 SZIs recorded by lifeguards over 186 sample days during the summers of 2007, 2009 and 2015 were combined with measured and/or hindcast weather, wave, tide, and beach morphology data. All SZIs occurred disproportionately on warm sunny days with low wind, likely because of increased beachgoer numbers and hazard exposure. Relationships were strongest for shore-break- and rip-related SZIs and weakest for surfing-related SZIs, the latter being also unaffected by tidal stage or range. Therefore, the analysis focused on bathers. More shore-break-related SZIs occur during shore-normal incident waves with average to below-average wave height (significant wave height, Hs = 0.75–1.5 m) and around higher water levels and large tide ranges when waves break on the steepest section of the beach. In contrast, more rip-related drownings occur near neap low tide, coinciding with maximised channel rip flow activity, under shore-normal incident waves with Hs &gt;1.25 m and mean wave periods longer than 5 s. Additional drowning incidents occurred at spring high tide, presumably due to small-scale swash rips. The composite wave and tide parameters proposed by Scott et al. (2014) are key controlling factors determining SZI occurrence, although the risk ranges are not necessarily transferable to all sites. Summer beach and surf zone morphology is interannually highly variable, which is critical to SZI patterns. The upper beach slope can vary from 0.06 to 0.18 between summers, resulting in low and high shore-break-related SZIs, respectively. Summers with coast-wide highly (weakly) developed rip channels also result in widespread (scarce) rip-related drowning incidents. With life risk defined in terms of the number of people exposed to life threatening hazards at a beach, the ability of morphodynamic models to simulate primary beach morphology characteristics a few weeks or months in advance is therefore of paramount importance for predicting the primary surf zone life risks along this coast.

Biopelículas bacterianas en heridas crónicas

En las últimas tres décadas, el estudio de las biopelículas bacterianas ha tomado gran relevancia gracias a su identificación como uno de los factores más importantes en el desarrollo de infecciones crónicas. Una de las patologías de mayor interés en el área de la salud, y de la cual se ha logrado profundizar en mayor medida, corresponde a las heridas crónicas, en donde se estima que las biopelículas bacterianas están presentes en el 60%, comparadas con las heridas agudas en donde se presentan solo en el 20%.&#x0D; Las heridas crónicas representan el 1-2% de todas las heridas a nivel mundial, pero la carga socioeconómica y emocional que generan, repercute notablemente debido a los costos en curaciones, tratamientos convencionales y en complicaciones tan graves como las amputaciones de extremidades. El objetivo de este artículo de revisión es proporcionar información relevante sobre el concepto de las biopelículas bacterianas, su implicación en el desarrollo de heridas crónicas, el diagnóstico y los posibles tratamientos.

Neurologic injuries following road traffic accidents in the Dominican Republic: Examining causes and potential solutions

Objective: Road traffic accidents (RTAs) are the number one cause of traumatic brain injuries (TBIs) worldwide. This study examines RTA-related TBIs in the Dominican Republic, a country in the Caribbean with the highest RTA fatality rate in the Western Hemisphere.Methods: We interviewed 117 adult patients or medical guardians of patients admitted to Hospital Traumatológico Dr. Ney Arias Lora in Santo Domingo following an RTA. Information regarding the type of accident, patient demographics, and injuries sustained was collected for each patient.Results: Most study participants were males (79.5%), and the most common method of transportation was motorized 2-wheeled vehicle (MTW; 74.4%). Of the 69 patients who suffered a TBI, 66.7% were classified as moderate–severe TBIs and 30.3% were classified as mild TBIs. The most common types of intracranial hemorrhage were subdural hemorrhage (12%) and subarachnoid hemorrhage (9.4%). Helmet use among admitted MTW riders was reported at 22.4%, and none of the 9 MTW riders who died in the hospital were wearing a helmet. Only 58.1% of patients lived in an area that offered 911 emergency response services at the time of the study. At 66.2%, the majority of people living within the 911 service area utilized emergency response services following an RTA.Multiple logistic regression determined that the utilization of 911 emergency response services was associated with a decrease in the likelihood of presenting with a moderate/severe TBI by a factor of 0.78 (adjusted odds ratio [OR]; P < .008; 95% confidence interval [CI], 0.65, 0.93). Nonuse of a helmet was associated with a 1.22 times increased risk of presenting with a moderate/severe TBI (adjusted OR; P < .04; 95% CI, 1.01, 1.61). Age and gender were not statistically significant in this model.Conclusions: The results of this study support 2 important avenues for reducing the burden of RTA-associated neurologic disease in the Dominican Republic. As with many other middle-income countries, MTWs represent an economical and efficient mode of transportation. Therefore, increasing helmet use may be the most effective way to reduce RTA-associated TBIs. In addition, continuing the expansion of postcrash emergency response services may mitigate the severity of RTA-associated neurologic disease.

A 3D Printable and Bioactive Hydrogel Scaffold to Treat Traumatic Brain Injury

AbstractTraumatic brain injury accompanied by intracranial hypertension remains one of the most fatal injuries worldwide. Usually, patients must undergo two surgeries, craniectomy and cranioplasty, to reduce the intracranial pressure and then repair the skull. Traditional biomaterials, such as autologous bones and titanium meshes, which have poor stretchability and very high Young's modulus values up to hundreds of GPa, tend to constrain intracranial tissue and cannot be implanted directly after craniectomy. Thus far, finding elastic and degradable biomaterials to be immediately implanted after a craniectomy has remained a great challenge, which should not only repair cranial defects but also avoid secondary surgery and reduce the risk of complications, has remained a great challenge. Herein, a 3D printable bioactive hydrogel scaffold with high elasticity that can protect brain tissue, adapt to intracranial pressure changes, allow for the transport of nutrients and the proliferation and osteogenic differentiation of bone mesenchymal stem cells is presented. As indicated by in vivo experiments, the hydrogel scaffold helps to treat traumatic brain injury within 8 weeks and degrades safely. With these advantages, this material shows the potential to open up new horizons for cranioplasty and to help patients survive traumatic brain injury.