Prevalence and associated harm of engagement in self-Asphyxial behaviours ('choking game') in young people:A systematic review

OBJECTIVE: To assess the prevalence of engagement in self-asphyxial (risk-taking) behaviour (SAB) (‘choking game’) and associated morbidity and mortality in children and young people up to age 20. DESIGN: Systematic literature review. SEARCH STRATEGY: Electronic database search of MEDLINE, Embase, PsycINFO, CINAHL, PubMed, Web of Science Core Collection, BIOSIS citation index and the Cochrane register with no language or date limits applied. References of key papers were reviewed, and experts were contacted to identify additional relevant papers. ELIGIBILITY CRITERIA: Systematic reviews, cross-sectional, cohort and case–control studies, and case reports examining SAB with regard to individuals aged 0–20 years, without explicitly stated autoerotic, suicidal or self-harm intentions were included. RESULTS: Thirty-six relevant studies were identified, and SAB was reported in 10 countries. In North America, France and Colombia, awareness of SAB ranged from 36% to 91% across studies/settings, and the median lifetime prevalence of engagement in SAB was 7.4%. Six studies identified the potential for SAB to be associated with engagement in other risk behaviours. Ninety-nine fatal cases were reported. Of the 24 cases described in detail, most occurred when individuals engaged in SAB alone and used a ligature. CONCLUSIONS: The current evidence on SAB among young people is limited, and stems predominantly from North America and France. Awareness of SAB among young people is high, and engagement varies by setting. Further research is needed to understand the level of risk and harm associated with SAB, and to determine the appropriate public health response

Infrared spectroscopy of cataclysmic variables: III. Dwarf novae below the period gap and novalike variables

We present K-band spectra of the short-period dwarf novae YZ Cnc, LY Hya, BK Lyn, T Leo, SW UMa and WZ Sge, the novalike variables DW UMa, V1315 Aql, RW Tri, VY Scl, UU Aqr and GP Com, and a series of field dwarf stars with spectral types ranging from K2-M6. The spectra of the dwarf novae are dominated by emission lines of HI and HeI. The large velocity and equivalent widths of these lines, in conjunction with the fact that the lines are double-peaked in the highest inclination systems, indicate an accretion disc origin. In the case of YZ Cnc and T Leo, for which we obtained time-resolved data covering a complete orbital cycle, the emission lines show modulations in their equivalent widths which are most probably associated with the bright spot (the region where the gas stream collides with the accretion disc). There are no clear detections of the secondary star in any of the dwarf novae below the period gap, yielding upper limits of 10-30% for the contribution of the secondary star to the observed K-band flux. In conjunction with the K-band magnitudes of the dwarf novae, we use the derived secondary star contributions to calculate lower limits to the distances to these systems. The spectra of the novalike variables are dominated by broad, single-peaked emission lines of HI and HeI - even the eclipsing systems we observed do not show the double-peaked profiles predicted by standard accretion disc theory. With the exception of RW Tri, which exhibits NaI, CaI and 12CO absorption features consistent with a M0V secondary contributing 65% of the observed K-band flux, we find no evidence for the secondary star in any of the novalike variables. The implications of this result are discussed.Comment: 13 pages, 5 figures, to appear in MNRA

Early Surgery for Traumatic Spinal Cord Injury: Where Are We Now?

Study Design: Narrative review. Objective: There is a strong biological rationale to perform early decompression after traumatic spinal cord injury (SCI). With an enlarging clinical evidence base, most spine surgeons internationally now favor early decompression for the majority of SCI patients; however, a number of pertinent questions remain surrounding this therapy. Methods: A narrative review evaluating the status of early surgery for SCI. In particular, we addressed the following questions: (1) Which patients stand to benefit most from early surgery? 2) What is the most appropriate time threshold defining early surgery? Results: Although heterogeneity exists, the evidence generally seems to support early surgery. While the best evidence exists for cervical SCI, there is insufficient data to support a differential effect for early surgery depending on neurological level or injury severity. When comparing thresholds to define early versus late surgery-including a later threshold (48-72 hours), an earlier threshold (24 hours), and an ultra-early threshold (8-12 hours)-the 2 earlier time points seem to be associated with the greatest potential for improved outcomes. However, existing prehospital and hospital logistics pose barriers to early surgery in a significant proportion of patients. An overview of recommendations from the recent AOSpine guidelines is provided. Conclusion: In spite of increasing acceptance of early surgery post SCI, further research is needed to (1) identify subgroups of patients who stand to derive particular benefit-in particular to develop more evidence-based approaches for central cord syndrome and (2) investigate the efficacy and feasibility of ultra-early surgery targeting more aggressive timelines

Mapping the contribution of Allied Health Professions to the wider public health workforce : a rapid review of evidence-based interventions

Objectives: The objective was to identify a selection of the best examples of the public health contributions by Allied Health Professionals (AHPs) in order to encourage a wider awareness and participation from that workforce to public health practice. Study design: A mapping exercise was used to identify evidence-based interventions that could lead to health improvements across a population. Methods: A rapid review was undertaken to identify evidence, followed by a survey of Allied Health Profession (AHP) practitioners and an expert panel consensus method to select the examples of AHP public health interventions. Results: Nine evidence-based interventions are identified and selected as examples of current AHP good practice. These examples represent a contribution to public health and include screening interventions, secondary prevention and risk management. Conclusions: This study contributes to a strategy for AHPs in public health by appraising the effectiveness and impact of some exemplar AHP practices that contribute to health improvement. There is a need for AHPs to measure the impact of their interventions and to demonstrate evidence of outcomes at population level. Keywords: allied health professions; Applied Health Professionals; evidence-based practice; health improvement; public health; rapid revie

The Quiescent Spectrum of the AM CVn star CP Eri

We used the 6.5m MMT to obtain a spectrum of the AM CVn star CP Eri in quiescence. The spectrum is dominated by He I emission lines, which are clearly double peaked with a peak-to-peak separation of ~1900 km/s. The spectrum is similar to that of the longer period AM CVn systems GP Com and CE 315, linking the short and the long period AM CVn systems. In contrast with GP Com and CE 315, the spectrum of CP Eri does not show a central 'spike' in the line profiles, but it does show lines of SiII in emission. The presence of these lines indicates that the material being transferred is of higher metallicity than in GP Com and CE 315, which, combined with the low proper motion of the system, probably excludes a halo origin of the progenitor of CP Eri. We constrain the primary mass to M_1>0.27 M_sun and the orbital inclination to 33 degr < i < 80 degr. The presence of the He I lines in emission opens up the possibility for phase resolved spectroscopic studies which allows a determination of the system parameters and a detailed study of helium accretion disks under highly varying circumstances.Comment: 12 pages, 2 figures, accepted for publication in ApJ Letter

Case Report: Hemorrhage into an Occult Spinal Ependymoma after Epidural Anesthesia

Epidural anesthesia is a procedure which is well tolerated and has a low incidence of adverse events. In performing caesarean sections, regional anesthesia (spinal or epidural) is the preferred modality for anesthetic delivery. Although rare with continuous epidural anesthesia, epidural hematomas have been reported to occur with an incidence between 1:150,000 and 1:190,00010. An underlying bleeding diathesis has been implicated as a causative factor. We present the sixth reported case of hemorrhage into an occult intradural neoplasm after spinal or epidural anesthesia. Similar lesions have not been reported in the recent spine literature

Variability of patient spine education by Internet search engine.

BACKGROUND: Patients are increasingly reliant upon the Internet as a primary source of medical information. The educational experience varies by search engine, search term, and changes daily. There are no tools for critical evaluation of spinal surgery websites. PURPOSE: To highlight the variability between common search engines for the same search terms. To detect bias, by prevalence of specific kinds of websites for certain spinal disorders. Demonstrate a simple scoring system of spinal disorder website for patient use, to maximize the quality of information exposed to the patient. STUDY DESIGN: Ten common search terms were used to query three of the most common search engines. The top fifty results of each query were tabulated. A negative binomial regression was performed to highlight the variation across each search engine. RESULTS: Google was more likely than Bing and Yahoo search engines to return hospital ads (P=0.002) and more likely to return scholarly sites of peer-reviewed lite (P=0.003). Educational web sites, surgical group sites, and online web communities had a significantly higher likelihood of returning on any search, regardless of search engine, or search string (P=0.007). Likewise, professional websites, including hospital run, industry sponsored, legal, and peer-reviewed web pages were less likely to be found on a search overall, regardless of engine and search string (P=0.078). CONCLUSION: The Internet is a rapidly growing body of medical information which can serve as a useful tool for patient education. High quality information is readily available, provided that the patient uses a consistent, focused metric for evaluating online spine surgery information, as there is a clear variability in the way search engines present information to the patient

Correlation of C2 fractures and vertebral artery injury.

STUDY DESIGN: Retrospective review of prospectively collected data. SUMMARY OF BACKGROUND DATA: Vertebral artery injuries (VAI) occur commonly after cervical spine trauma. No study has yet examined the association between VAI and specific variants of C2 fractures. OBJECTIVE: To evaluate the incidence of VAI (as defined by magnetic resonance imaging/angiography [MRI/A]) in subtypes of C2 fractures. To define the association between the incidence, morphology, and severity of C2 fractures, based on fracture angulation and comminution, and the occurrence of VAI. METHODS: Patients admitted to the hospital with C2 fractures between October 2006 and December 2008 to a tertiary care referral center were identified through a prospectively maintained database. Computed tomography (CT) and MRI/A studies were individually reviewed to evaluate the specific C2 fracture type and the occurrence of VAI. Fracture displacement and angulation were measured. Incidence of VAI was compared between different types and subtypes of C2 fractures. The effects of displacement and angulation of the fracture, morphology of foramen transversarium fracture, patient age, and patient gender on VAI were also analyzed. RESULTS: One hundred one patients were identified with C2 fractures that met inclusion criteria, and 18 (17.8%) had VAI by MRI/A. There was no correlation between fracture types and VAI. However, in subtype analysis, there was a correlation of VAI with traumatic spondylolisthesis of axis (TSA) and greater degree of angulation (P = 0.0023), communition fracture (P = 0.0341), and presence of bone fragment(s) within the foramen transversarium (P = 0.0075). Multivariate logistic regression indicated that age, gender and the presence of fragments within foramen transversarium were associated with greater risk of VAI. CONCLUSION: Vertebral artery injuries are more likely to occur in C2 fractures with comminuted fractures involving the foramen transversarium, with fractures manifesting bony fragment(s) within the foramen transversarium, or with fractures having greater angulation. These risk factors should be considered when a patient presents with isolated axis fracture