Injury Patterns Research Articles

Clinical characteristics and HLA associations of azithromycin-induced liver injury.

Azithromycin (AZ) is a widely used antibiotic. The aim of this study was to characterise the clinical features, outcomes, and HLA association in patients with drug-induced liver injury (DILI) due to AZ. The clinical characteristics of individuals with definite, highly likely, or probable AZ-DILI enrolled in the US Drug-Induced Liver Injury Network (DILIN) were reviewed. HLA typing was performed using an Illumina MiSeq platform. The allele frequency (AF) of AZ-DILI cases was compared to population controls, other DILI cases, and other antibiotic-associated DILI cases. Thirty cases (4 definite, 14 highly likely, 12 probable) of AZ-DILI were enrolled between 2004 and 2022 with a median age of 46 years, 83% white, and 60% female. Median duration of AZ treatment was 5 days. Latency was 18.5 days. 73% were jaundiced at presentation. The injury pattern was hepatocellular in 60%, cholestatic in 27%, and mixed in 3%. Ten cases (33%) were severe or fatal; 90% of these were hepatocellular. Two patients required liver transplantation. One patient with chronic liver disease died of hepatic failure. Chronic liver injury developed in 17%, of which 80% had hepatocellular injury at onset. HLA-DQA1*03:01 was significantly more common in AZ-DILI versus population controls and amoxicillin-clavulanate DILI cases (AF: 0.29 vs. 0.11, p = 0.001 and 0.002, respectively). Azithromycin therapy can lead to rapid onset of severe hepatic morbidity and mortality in adult and paediatric populations. Hepatocellular injury and younger age were associated with worse outcomes. HLA-DQA1*03:01 was significantly more common in AZ cases compared to controls.

Characterizing Physical Intimate Partner Violence-Associated Injuries Among Adults in Low- and Middle-Income Countries: A Systematic Review

Forty-two percent of women who experienced intimate partner violence (IPV) reported that their experience of IPV resulted in an injury. This review aims to review the existing literature from low- and middle-income countries (LMICs) on IPV-related injuries as well as identify IPV-related injury patterns and locations. A systematic electronic database search was conducted between August and September 2021 (Prospero ID: CRD42021281519). Five databases yielded 408 articles; 328 remained for title and abstract screening after duplicates were removed. Of the 59 eligible for full-text review, 19 articles were eligible for extraction. After quality assessment, 18 articles were included in the study. Most (56%) studies were observational studies. Studies represented 15 different countries. The majority of the studies (89%) had authors whose institutional affiliation was located in the country where the study took place. Soft tissue injuries were the most commonly reported injury type followed by fractures and burns. The most common injury locations were the head, neck, and face followed by both upper and lower limbs. The most commonly cited injury mechanism was bodily force. The findings of this study echo what has been written in the literature regarding IPV-related injury patterns from high-income countries (HICs). One limitation of this study is that the search only included literature published in English. The injury patterns identified in this article confirm the need for awareness and action on the part of both medical and surgical providers in order to best address IPV in LMICs.

The incidence of fractures in children under two years of age: a systematic review

BackgroundEpidemiological research on fractures in children under the age of two is of great importance to help understand differences between accidental and abusive trauma.ObjectiveThis systematic review aimed to evaluate studies reporting on the incidence of fractures in children under two years of age, excluding birth injuries. Secondary outcome measures included fracture location, mechanisms of injury and fracture characteristics.MethodsA systematic literature review (1946 to February 7th 2024), including prospective and retrospective cohort studies and cross-sectional cohort studies, was performed. Studies including children from other age groups were included if the actual measures for those aged 0–2 years could be extracted. We also included studies restricted to infants. Annual incidence rates of fractures were extracted and reported as the main result. Critical appraisal of was performed using the Appraisal tool for Cross-Sectional Studies.ResultsTwelve moderate to good quality studies met eligibility criteria, of which seven were based on data from medical records and five were registry studies. Studies investigated different aspects of fractures, making comprehensive synthesis challenging. There was an overall annual fracture incidence rate of 5.3 to 9.5 per 1,000 children from 0–2 years of age; with commonest sites being the radius/ulna (25.2–40.0%), followed by tibia/fibula (17.3–27.6%) and the clavicle (14.6–14.8%) (location based on 3 studies with a total of 407 patients). In infants, the reported incidence ranged between 0.7 to 4.6 per 1,000 (based on 3 studies), with involvement of the clavicle in 22.2% and the distal humerus in 22.2% of cases (based on 1 study). Only a single metaphyseal lesion was reported (proximal humerus of an 11-month-old infant). Fracture mechanisms were detailed in four studies, with fall from chair, bed, table, own height or fall following indoor activities causing 50–60% of fractures.ConclusionsThere is a paucity of good quality data on fracture incidence in children under the age of two. Larger, prospective and unbiased studies would be helpful in determining normal pattern of injuries, so that differences from abusive trauma may be better understood.

Open Fractures of the Hand: is there No Alternative to Definitive Osteosynthetic Treatment in an Emergency Situation?

There is an emergency indication for the treatment of open fractures. Fracture stabilisation and soft tissue care are equal prerequisites for an uncomplicated course of treatment and a good functional result. However, challenges arise in cases of extensive wound contamination and compromised perfusion, limiting options for stable osteosynthesis in emergency situations. Furthermore, resource constraints may pose a challenge to adhering strictly to the six-hour time window. This prompts deliberations on whether, under certain circumstances, a deviation from the conventional approach is feasible by exploring the possibility of prioritising immediate surgical wound care during emergencies, with definitive fracture care deferred to a later point in time. Between 2019 and 2021, 301 patients with open fractures of the hand skeleton were treated (median age 44 years, 85% male, 15% female). Definitive treatment was carried out as a primary emergency procedure in 215 patients (group A), whereas it was performed at an interval after an average of 3 days in 86 patients (group B), who had received surgical wound care, splint placement, and antibiotic coverage on the day of the injury. In a retrospective study, the following criteria were analysed: comorbidities, injury patterns, injury location, timing of treatment, number of follow-up procedures, infection rate, and duration of hospitalisation. The course was complicated by infection in six patients (1.9%). Five of these patients were in group A (infection rate 2.3%), and only one patient was in group B (infection rate 1.1%). All six infections occurred after crush injuries, all at the fingertip or end joint. These numbers underscore the relevance of soft tissue trauma and primary stump formation. Comorbidities were not statistically significant in our study with a view to the occurrence of infection. In conclusion, it can be stated that, with antibiotic protection, definitive treatment of an open fracture in an interval is possible if it is preceded by initial emergency surgical wound care with subsequent immobilisation.

A Case Series of Monoclonal Immunoglobulin-Depositing Proliferative Glomerulonephritis

Proliferative glomerulonephritis with monoclonal immunoglobulin deposition disease (PGNMIDD) is a rare entity. We evaluated the clinicopathological features of PGNMIDD and the effectiveness of different treatment regimens in 13 cases diagnosed using kidney biopsy. Most had chronic kidney disease followed by acute nephritic syndrome, rapidly progressive glomerulonephritis, and nephrotic syndrome. Membranoproliferative glomerulonephritis was the most common pattern of renal injury. Three patients had abnormal bone marrow studies. Different treatment regimens were deployed; >60% had partial remission at the end of six months and 30.7% progressed to end stage renal disease.

Evaluating synthetic aperture radar surface winds for convective squalls in the Gulf of Mexico

AbstractThe detection and quantification of strong sea surface winds, reaching up to 25 m·s−1, whether associated with deep convection aloft or not, have been extensively discussed in previous studies. This method involves the combined observation of the same event from both low‐orbit altitude and geostationary (GEO) satellites. Strong surface winds observed by the Sentinel‐1 C‐band synthetic aperture radar (SAR) are robustly associated with deep convective clouds detected by GEO infrared sensors. The current paper aims to generalize the previous assessment of several convective wind events by collecting a larger dataset and comparing these data to in‐situ wind observations. To achieve this, we evaluated wind speeds retrieved from Sentinel‐1 SAR images against corresponding in‐situ wind measurements from all active buoys/stations in the Gulf of Mexico. Significant agreement between satellite‐based winds and in‐situ data was achieved, particularly for wind speeds exceeding 3 m·s−1, with even better agreement for wind speeds over 10 m·s−1. From this dataset, three specific convective cases were extracted to illustrate various stages of convective squall events: before, during, and after the occurrence of a squall peak. In each case, comparison with in‐situ measurements showed that SAR‐estimated wind speeds closely matched observed speeds, including the peak convective winds, which were estimated at 18.90 m·s−1 and measured at 20.69 m·s−1. Furthermore, combining these findings with GOES‐16 sequential images illustrates the temporal and spatial similarity between deep convection areas, estimated strong sea surface wind patterns, and measured wind speeds.

Management of sustainable investments: A comprehensive financial evaluation of wind energy facilities in Kastamonu

The rich renewable sources of nature, such as water, wind, solar, geothermal, and biomass, are converted into energy, revitalized into the economy without causing pollution, and ensure sustainability in energy management. Wind power plants have been among the most preferred renewable energy sources in recent years since they are harmless to the environment and easy to install in places with consistent and sufficient wind speed. This study focuses on conducting a feasibility analysis of a Wind Power Plant (WPP) in Kastamonu, a region known for its persistent wind patterns. The analysis aims to contribute to the existing literature by examining the potential of a WPP investment project within the region. Utilizing wind speed data collected from 23 observation stations for six years, starting from 2017 to 2022, a total of 1,200,600 h, a statistical evaluation method known as the Weibull probability density function is employed to indicate the wind energy potential. The parameters are determined by applying the maximum likelihood method. The findings indicate that it is feasible to establish Wind Energy Power Plants in specific locations, namely İnebolu, İnebolu Kar, Küre, and Tosya stations. The cost estimation for establishing a 10 MW power plant with three different turbine powers across these four locations ranges from 10 million USD to 20,8 million USD. Furthermore, the analysis indicates that the net profit for producing 1 kW of electrical energy falls from 9.39 to 50.65 USD. The projected payback period for the investment ranges from 2 to 25 years, depending on factors such as the exact site of the facility and the size of the turbines. Some investments are more feasible than others, with economic viability and potential return on investment varying significantly within the specified locations.

Burden and Patterns of Electric Scooter-Related Injuries: Insights From 2 Polish Emergency Departments.

BACKGROUND The widespread adoption of electric scooters (e-scooters) as a mode of urban transportation has led to a notable upsurge in e-scooter-related injuries globally. Variations in e-scooter regulations across countries contribute to differences in injury patterns. This study sought to investigate the healthcare burden posed by e-scooter-related injuries on emergency departments (EDs) in Poland, and to delineate the epidemiological and clinical features of these injuries. MATERIAL AND METHODS Medical records of patients who presented to 2 distinct EDs - in Poznań and Bydgoszcz, Poland - with injuries directly linked to e-scooter use were collected and retrospectively analyzed. RESULTS A total of 633 patients were admitted to the EDs due to e-scooter injuries during the study period, and 413 of these patients were further analyzed. The majority were males (64.65%), with a median age of 27 years. Most admissions occurred in the afternoon and nighttime (71.94%), with a higher incidence in the summer (46.73%). Falls were the most frequent mechanism of injury (74.09%), with the head and upper and lower extremities being the most frequently affected locations (36.08%, 29.78%, and 21.07%, respectively). Twelve patients (2.91%) confirmed recent alcohol consumption. Hospitalization costs were higher in cases involving alcohol use and among males. CONCLUSIONS The findings of this study underscore the significant strain exerted by e-scooter-related injuries on EDs in Poland. Injuries, notably to the head and limbs, carry significant long-term implications and strain healthcare resources. Collaboration with policymakers is crucial to ensure the safety of e-scooter users and appropriate healthcare resource allocation.

Rate of abnormalities in quantitative MR neuroimaging of persons with chronic traumatic brain injury

BackgroundMild traumatic brain injury (mTBI) can result in lasting brain damage that is often too subtle to detect by qualitative visual inspection on conventional MR imaging. Although a number of FDA-cleared MR neuroimaging tools have demonstrated changes associated with mTBI, they are still under-utilized in clinical practice.MethodsWe investigated a group of 65 individuals with predominantly mTBI (60 mTBI, 48 due to motor-vehicle collision, mean age 47 ± 13 years, 27 men and 38 women) with MR neuroimaging performed in a median of 37 months post-injury. We evaluated abnormalities in brain volumetry including analysis of left-right asymmetry by quantitative volumetric analysis, cerebral perfusion by pseudo-continuous arterial spin labeling (PCASL), white matter microstructure by diffusion tensor imaging (DTI), and neurometabolites via magnetic resonance spectroscopy (MRS).ResultsAll participants demonstrated atrophy in at least one lobar structure or increased lateral ventricular volume. The globus pallidi and cerebellar grey matter were most likely to demonstrate atrophy and asymmetry. Perfusion imaging revealed significant reductions of cerebral blood flow in both occipital and right frontoparietal regions. Diffusion abnormalities were relatively less common though a subset analysis of participants with higher resolution DTI demonstrated additional abnormalities. All participants showed abnormal levels on at least one brain metabolite, most commonly in choline and N-acetylaspartate.ConclusionWe demonstrate the presence of coup-contrecoup perfusion injury patterns, widespread atrophy, regional brain volume asymmetry, and metabolic aberrations as sensitive markers of chronic mTBI sequelae. Our findings expand the historic focus on quantitative imaging of mTBI with DTI by highlighting the complementary importance of volumetry, arterial spin labeling perfusion and magnetic resonance spectroscopy neurometabolite analyses in the evaluation of chronic mTBI.

Stability before and after percutaneous anterior medullary fixation of lateral compression 1 and 2 pelvic ring disruptions: Should surgeons prioritize the anterior ring?

Surgical intervention for lateral compression (LC) 1 and 2 pelvic ring fractures is controversial. Posterior ring stabilization remains the most common mode of initial fixation. However, greater mechanical instability is observed in the anterior component of LC pelvic fractures. This study tested whether reduction and percutaneous superior ramus fixation will decrease the instability of LC pelvic fractures on intraoperative fluoroscopic imaging. All adult patients (≥ 18 years) presenting with either a Young-Burgess LC1 or LC2 pelvic ring disruption treated operatively with percutaneous anterior followed by posterior fixation by a single surgeon from July 2021 to June 2023 were retrospectively reviewed. Displacement of the anterior ring to intraoperative manual internal rotation stress examination under fluoroscopy was compared before and after anterior pelvic ring reduction and fixation and prior to posterior pelvic ring fixation. Pre- and post-operative visual analog scores (VAS) for pain were also compared. Twenty-one patients with a mean age of 48.7 years were included. Fifteen patients (71.4%) presented with an LC1, and six (28.6%) with an LC2 injury patterns. Anterior pelvic fixation alone provided 7.5mm reduction in mean displacement of the anterior pelvic ring (pre-operative = 9.2 mm vs. post-operative = 1.6 mm, p < 0.001). VAS significantly decreased from 7.2 one-day pre-operatively to 2.2 twenty-four h post-operatively (p < 0.001). Reduction and fixation of the anterior pelvic ring prior to posterior fixation for LC1 and LC2 pelvic ring disruptions substantially improves mechanical stability on intraoperative stress examination. Combination of percutaneous anterior and posterior fixation significantly decreased VAS above the MCID 24 h after stabilization.

242 The Burden of Penetrating Junctional Injuries in a UK Major Trauma Centre: A Retrospective Cohort Study

Abstract Aim Junctional injuries occur at the join of anatomically distinct zones. Recent battlefield casualties have shown junctional wounds account for 21% of potentially survivable deaths from haemorrhage. Although well studied in military literature, this is not the case in civilian setting. This paper aims to describe the civilian injury pattern to improve management and resource allocation. Method Retrospective study of all patients with penetrating injuries to a junctional zone presenting to an urban MTC in 2018. Patient records searched and data extracted on site of injury, management, and discharge code. Discharge codes were referenced with the National Schedule of NHS costs to produce a cost. Results 132 patients, 92.4% (n=122) male; median age 27.5; in hospital mortality 0.8% (n=1). 37.9% (n=50) of injuries were buttock; 22% (n=29) neck; 18.9% (n=25) multiply injured; 8.3% (n=11) axilla; 6.8% (n=9) diaphragm; and 6.1% (n=8) groin. Median Injury Severity Score (ISS) 8; median ISS multiply injured 29; diaphragm 16; groin 9; neck 5; axilla 4; buttock 4. 46.2% (n=61) underwent surgery; 50.8% (n=67) were admitted, 7.6% (n=10) to ITU. Median length of ward-stay 3 days. 15.9% (n=21) received blood products. The overall cost was £914,076; £6925/patient. Per patient for multiply injured £19,676; diaphragm £11,435; groin £7,483; axilla £3,553; neck £3,026; buttock £2,651. Conclusions Junctional injuries are a significant resource burden. Buttock wounds were the most common but had the lowest median ISS and cost. Diaphragmatic injuries appear distinct in terms of ISS and cost and should be considered as separate to other junctional wounds.

Brain 3T magnetic resonance imaging in neonates: features and incidental findings from a research cohort enriched for preterm birth

Background and objectivesThe survival rate and patterns of brain injury after very preterm birth are evolving with changes in clinical practices. Additionally, incidental findings can present legal, ethical and practical...

Monkey Bar-Associated Pediatric Fractures: A National Epidemiologic Study of Emergency Department Visits.

Emergency department (ED) visits because of pediatric fractures are not only burdensome for patients and their families but also result in an increased healthcare expenditure. Almost half of all children experience at least one fracture by the age of 15. Many fractures occur in playgrounds, with monkey bars and other climbing apparatuses noted as frequent mechanisms of injury. Our purpose was to identify the pattern of injury and the population sustaining monkey bar-associated fractures. We queried the National Electronic Injury Surveillance System database for all monkey bar-associated injuries in patients aged 0 to 18 years from January 1, 2009, to December 31, 2019. We described demographic data, patient disposition from the ED, fracture pattern, and injury setting using unweighted and weighted estimates. Weighted results that more closely reflect national estimates were calculated. During the study period, 30,920 (862,595 weighted) monkey bar-associated injuries presented to EDs; 16,410 (53.1%) (weighted injuries: 408,722 [47.4%]) were fracture injuries. The average age of kids sustaining fractures was 6.5 years, with most injuries (66.4%) occurring in kids between 6 and 12 years. A higher percentage of male patients presented to the ED with fractures compared with female patients (53% versus 47%). Upper extremity fractures were most common, 382,672 (94%) with forearm fractures constituting the majority (156,691 [38%]). Most children were treated and released (354,323 [87%]), with only 35,227 children (9%) being admitted for treatment. Places of recreation/sports were the most common setting of fractures (148,039 [36%]), followed by schools (159,784 [39%]). A notable association was observed between year and ethnicity and between month period and injury setting. Monkey bar-associated injuries are a major cause of upper extremity fractures in children, with most injuries occurring in recreational areas or schools. Young elementary school children are at the highest risk of injury. ED visits because of monkey bar-associated fractures have increased over the study period, and these injuries continue to be a major cause of fractures in children. Additional measures should be installed to decrease these preventable fractures among children, with schools as a potential starting point.

Investigating the spatial propagation patterns of meteorological drought events and underlying mechanisms using complex network theory: A case study of the Yangtze River Basin, China

AbstractThe spatial propagation patterns of meteorological drought events (MDEs) and underlying mechanisms contribute to elucidating and forecasting drought evolution. In this study, gridded MDEs in the Yangtze River Basin (YRB) throughout the entire year, wet season and dry season were extracted from 3-month Standardized Precipitation Evapotranspiration Index (SPEI-3) series. Event synchronization (ES) and complex networks (CN) were employed to construct the MDE synchronization networks and MDE spatial propagation networks for various periods. The former were utilized to identify MDE synchronized subregions where MDEs co-occur and co-evolve in the YRB, while the latter were used to quantify the MDE spatial propagation patterns over both the basin and its subregions. The driving mechanisms behind MDE spatial propagation were further investigated by diagnosing the concomitant drought-inducing climate systems. The findings reveal the presence of four MDE synchronized subregions during the wet season and five subregions during the entire year and dry season. These subregions exhibited distinct spatial propagation patterns of MDEs, aligning with overall findings across the YRB. Notable differences were observed between wet and dry seasons, with various subregions exhibiting distinctive spatial propagation patterns during each season. These patterns are driven by variations in the controlling atmospheric circulation systems, leading to anomalies of wind patterns and moisture distribution, ultimately resulting in deficient moisture supply. The variations of tropical sea surface thermal conditions, influences of the Tibetan Plateau and MDE self-propagation triggered by land–atmosphere feedback are considered as three primary influencing factors for MDE spatial propagation in the YRB.

Climate change in the Canary/Iberia upwelling region: the role of ocean stratification and wind

The Canary/Iberia region (CIR), part of the Canary Current Upwelling System, is well-known for its coastal productivity and crucial role in enriching the oligotrophic open ocean through the offshore transport of the upwelled coastal waters. Given its significant ecological and socio-economic importance, it is essential to assess the impact of climate change on this area. Therefore, the goal of this study is to analyze the climate change signal over the CIR using a high-resolution regional climate system model driven by the Earth system model MPI-ESM-LR under RCP8.5 scenario. This modelling system presents a regional atmosphere model coupled to a global ocean model with enough horizontal resolution at CIR to examine the role of the upwelling favourable winds and the ocean stratification as key factors in the future changes. CIR exhibits significant latitudinal and seasonal variability in response to climate change under RCP8.5 scenario, where ocean stratification and wind patterns will play both complementary and competitive roles. Ocean stratification will increase from the Strait of Gibraltar to Cape Juby by the end of the century, weakening the coastal upwelling all year long. This increase in stratification is associated with a freshening of the surface layers of the North Atlantic. However, modifications in the wind pattern will play a primary role in upwelling source water depth changes in the southernmost region of the CIR in winter and in the north of the Iberian Peninsula in summer. Wind pattern changes are related to the intensification of the Azores High in winter and to a deepening of the Iberian thermal low in summer months.

Pattern and management of bile duct injuries presented to Hepatobiliary Unit of Shaikh Zayed Hospital Lahore.

Objective: To find out the pattern and management of Bile Duct Injuries (BDIs) presented to Hepatobilliary unit. Study Design: Descriptive Cross Sectional. Setting: Hepatobiliary Unit, Shaikh Zayed Hospital Lahore. Period: November 1, 2022, to April 30, 2023. Methods: Total of 79 patients with Bile duct injuries were included. Demographic data and relevant investigations were performed. BDIs severity was classified using the Strausberg Classification. Patients underwent appropriate surgical interventions, with follow-up for period of 6 months postoperative complications. Results: The mean age was 39.89±10.01 yrs, primarily females (81%). BDI resulted from laparoscopic cholecystectomy in 44.3%, open cholecystectomy in 51.9%, and conversion to open surgery in 3.8% cases. Jaundice (58.2%), bile leak (38.0%), and itching (3.8%) were common presentations. Surgical procedures included hepaticojejunostomy (77.2%), right hepatectomy with hepaticojejunostomy (8.9%), and liver resection + hepaticojejunostomy (13.9%). BDI classification revealed E2 (57.0%), E3 (36.7%), and E4 (6.3%) cases. Surgical site infection was observed in 11.4% of cases. Postoperatively 5.1% patients experienced anastomotic leaks and only the site of BDI was a significant factor for leak with the p value of &lt;0.001. Conclusion: In conclusion the majority of BDIs were E2 (57.0%), E3 (36.7%), and E4 (6.3%).Procedure performed were hepaticojejunostomy (77.2%), right hepatectomy with hepaticojejunostomy (8.9%), and liver resection + hepaticojejunostomy (13.9%). Anastomotic leaks were significantly linked to the site of BDI.

A strike to the head: Parallels between the pediatric and adult human and the rodent in traumatic brain injury.

Traumatic brain injury (TBI) is a condition that occurs commonly in children from infancy through adolescence and is a global health concern. Pediatric TBI presents with a bimodal age distribution, with very young children (0-4 years) and adolescents (15-19 years) more commonly injured. Because children's brains are still developing, there is increased vulnerability to the effects of head trauma, which results in entirely different patterns of injury than in adults. Pediatric TBI has a profound and lasting impact on a child's development and quality of life, resulting in long-lasting consequences to physical, cognitive, and emotional development. Chronic issues like learning disabilities, behavioral problems, and emotional disturbances can develop. Early intervention and ongoing support are critical for minimizing these long-term deficits. Many animal models of TBI exist, and each varies significantly, displaying different characteristics of clinical TBI. The neurodevelopment differs in the rodent from the human in timing and effect, so TBI outcomes in the juvenile rodent can thus vary from the human child. The current review compares findings from preclinical TBI work in juvenile and adult rodents to clinical TBI research in pediatric and adult humans. We focus on the four brain regions most affected by TBI: the prefrontal cortex, corpus callosum, hippocampus, and hypothalamus. Each has its unique developmental projections and thus is impacted by TBI differently. This review aims to compare the healthy neurodevelopment of these four brain regions in humans to the developmental processes in rodents.

Deliberate Practice as an Effective Method for Reducing Diagnostic Error in Identifying Burn and Bruise Injuries Suspicious for an Abusive Injury

To examine the effectiveness of an education intervention for reducing physician diagnostic error in identifying pediatric burn and bruise injuries suspicious for abuse, and to determine case-specific variables associated with an increased risk of diagnostic error. This was a multicenter, prospective, cross-sectional study. A convenience sample of pediatricians and other front-line physicians who treat acutely injured children in the United States and Canada were eligible for participation. Using a web-based education and assessment platform, physicians deliberately practiced with a spectrum of 300 pediatric burn and bruise injury image-based cases. Participants were asked if there was a suspicion for abuse present or absent, were given corrective feedback after every case, and received summative diagnostic performance overall (accuracy), suspicion for abuse present (sensitivity), and absent (specificity). Of the 93/137 (67.9%) physicians who completed all 300 cases, there was a significant reduction in diagnostic error (initial 16.7%, final 1.6%; delta -15.1%; 95% CI 13.5, 16.7), sensitivity error (initial 11.9%, final 0.7%; delta -11.2%; 95% CI 9.8, 12.5), and specificity error (initial 23.3%, final 6.6%; delta -16.7%; 95% CI 14.8, 18.6). Based on 35,627 case interpretations, variables associated with diagnostic error included patient age, sex, skin color, mechanism of injury, and size and pattern of injury. The education intervention substantially reduced diagnostic error in differentiating the presence versus absence of a suspicion for abuse in children with burn and bruise injuries. Several case-based variables were associated with diagnostic error, and these data can be used to close specific skill gaps in this clinical domain.

Dynamics of Noctiluca scintillans blooms: A 20-year study in Jangmok Bay, Korea

This 20-year study (2001–2020) conducted in Jangmok Bay, Korea, assessed the intricate relationships between environmental factors and Noctiluca scintillans blooms. Granger causality tests and PCA analysis were used to assess the impact of sea surface temperature (SST), salinity, dissolved oxygen (DO) concentration, wind patterns, rainfall, and chlorophyll-a (Chl-a) concentration on bloom dynamics. The results revealed significant, albeit delayed, influences of these variables on bloom occurrence, with SST exhibiting a notable 2-month lag and salinity a 1-month lag in their impact. Additionally, the analysis highlighted the significant roles of phosphate, ammonium, and silicate, which influenced N. scintillans blooms with lags of 2 to 3 months. The PCA demonstrates how SST and wind speed during spring and summer, along with wind direction and salinity in winter, significantly impact N. scintillans blooms. We noted not only an increase in large-scale N. scintillans blooms but also a cyclical pattern of occurrence every 3 years. These findings underscore the synergistic effects of environmental factors, highlighting the complex interplay between SST, salinity, DO concentration, and weather conditions to influence bloom patterns. This research enhances our understanding of harmful algal blooms (HABs), emphasizing the importance of a comprehensive approach that considers multiple interconnected environmental variables for predicting and managing N. scintillans blooms.

An analysis of referral patterns of traumatic brain injury at Groote Schuur Hospital Trauma Centre

Background. Traumatic brain injury (TBI) can result in significant morbidity and mortality if not diagnosed in a timely manner. Brain computed tomography (CT) is the diagnostic gold standard but is of limited availability in most South African public hospitals, resulting in transfer of TBI patients to tertiary hospitals. Objective. To describe the referral patterns and outcomes of patients with TBI referred to Groote Schuur Hospital Trauma Centre. Methods. This was a retrospective audit of all patients admitted to the Trauma Centre who had a brain CT scan for suspected TBI between 1 February 2022 and 31 March 2022. Demographic data (age, sex), mechanism of injury and Glasgow Coma Score were recorded. Referral pathways were determined, and final disposition of patients was recorded. Results. A total of 522 patients had a brain CT for TBI. Of these, 314 (60.1%) were referred from other hospitals. CT scan was abnormal in 178 (34.1%) patients. Three hundred and two (58.6%) were discharged home within 24 hours. The mean time between referral and CT scan was 13 hours. Conclusion. More than half of patients referred for a CT scan were discharged from the Trauma Centre within 24 hours of admission, which indicates additional costs and inefficiencies in the health system. These data are useful to guide resource planning and allocation for district hospitals, since less expensive point-of-care modalities now exist to diagnose TBI, and which are useful in indicating the prognosis of patients.