Kimberley Transitions, Collaborating to Care for Our Common Home: Beginnings...

This scoping paper is a preliminary introduction to the aspirations, interrelated literature and research involved in development of the Kimberley Transitions Project. Our focus is on Western Australia’s Kimberley region, a landscape of immense natural and cultural significance. Along with the rest of Australia, and indeed the world in which we all live, the Kimberley is on the verge of major climate, political, social and economic change. The direction of changes being proposed by governments and industry are regularly criticised, both globally and locally, by individuals and organisations concerned about damage to its rich biodiversity and cultural integrity. With the aim of collaboratively generating Kimberley-based responses grounded in local knowledges, a mix of disciplines and emerging international theories, scholars and relevant groups have come together to form a Kimberley-wide practical and shared research agenda. One of the key influences behind the project is an international transitions movement which aims to generate collaborative change incorporating a process of transition. Locally identified issues using local knowledges and capacity are central to its evolution. A conceptual and theoretical framing known as ‘transitions discourse’ is also emerging internationally and nationally, one that foregrounds diverse epistemologies and challenges mainstream economics and associated ideologies, such as neoliberalism. Via the Kimberley Transitions project, Kimberley-based researchers and collaborators aim to support and further document social, cultural and economic change inspired by the transitions movement and informed by transition discourses. It has the Kimberley landscape and people at its heart; a transformative approach featuring cultural healing, intellectual rigour and an ethos aimed at enduring, practical and interconnected sustainable outcomes.https://researchonline.nd.edu.au/nulungu_research/1001/thumbnail.jp

Pediatric Thoracic Trauma Mortality in Iraq and Afghanistan Compared to the United States National Trauma Data Bank

INTRODUCTION: The authors compared pediatric thoracic patients in the Joint Theatre Trauma Registry (JTTR) to those in the National Trauma Data Bank (NTDB) to assess differences in patient mortality rates and mortality risk accounting for age, injury patterns, and injury severity. MATERIALS AND METHODS: Patients less than 19 years of age with thoracic trauma were identified in both the JTTR and NTDB. Multiple logistic regression, χ2, Student\u27s t-test, or Mann-Whitney U test were used as indicated to compare the two groups. RESULTS: Pediatric thoracic trauma patients seen in Iraq and Afghanistan (n = 955) had a significantly higher mortality rate (15.1 vs. 6.0%, P \u3c.01) than those in the NTDB (n = 9085). After controlling for covariates between the JTTR and the NTDB, there was no difference in mortality (odds ratio for mortality for U.S. patients was 0.74, 95% CI 0.52-1.06, P = .10). The patients seen in Iraq or Afghanistan were significantly younger (8 years old, interquartile ratio (IQR) 2-13 vs. 15, IQR 10-17, P \u3c.01) had greater severity of injuries (injury severity score 17, IQR 12-26 vs. 12, IQR 8-22, P \u3c.01), had significantly more head injuries (29 vs. 14%, P \u3c.01), and over half were exposed to a blast. DISCUSSION: Pediatric patients with thoracic trauma in Iraq and Afghanistan in the JTTR had similar mortality rates compared to the civilian population in the NTDB after accounting for confounding covariates. These findings indicate that deployed military medical professionals are providing comparable quality of care in extremely challenging circumstances. This information has important implications for military preparedness, medical training, and casualty care

Pediatric thoracic trauma in Iraq and Afghanistan

Introduction: The objective of this study is to review available data on pediatric thoracic trauma seen at U.S. military treatment facilities in Iraq and Afghanistan and describe the scope of injuries, patterns seen, and associated mortality. The results were compared with adults injured in Iraq and Afghanistan and other reports of pediatric thoracic trauma in the literature. Materials and Methods: The investigators received approval from the Uniformed Services University of the Health Sciences\u27 institutional review board before the study. The Joint Theatre Trauma Registry was queried for all patients with an ICD-9 code for thoracic trauma. Two-tailed Student\u27s t-test, Mann-Whitney rank sum, χ2, ANOVA, or multiple logistic regression was used as indicated. Results: There were 955 patients under the age of 18 yr, just over 12% of all thoracic trauma. Penetrating injuries were common (73.6%), including gunshot wounds. The most common pediatric diagnoses were contusions (45%), pneumothorax (40%), and rib and/or sternal fractures (18%). The overall mortality for children was 15.2% compared with 13.8% and 9% for civilian adults and Coalition members with thoracic trauma, respectively. Mortality was inversely related to age among pediatric patients. Children under 2 yr of age had the highest mortality (25.1%). Patients under 12 yr of age were more likely to die than those between 12 and 18 (OR 2.02, 95% CI 1.27-3.22) yr. Thoracic vascular injuries and cardiac injuries resulted in the highest mortality among pediatric patients. The presence of a hemothorax was independently associated with an increased risk for mortality (OR 1.78, 95% CI 1.06-2.99) as was a concomitant head injury (OR 2.17, 95% CI 1.33-3.54). There was a 2.7% incidence of burns among pediatric patients with a high associated mortality (46.2%). Nearly one-half of all the children identified required a transfusion (47%). Conclusion: Penetrating injuries predominated and these children commonly required a transfusion. Mortality was inversely related to age. Children with a hemothorax or a concomitant head injury had significant increases in mortality. Children with thoracic injury as the result of a burn suffered the highest mortality