Pediatric emergency department visits for pedestrian injuries in relation to the enactment of Complete Streets policy

IntroductionThis study aimed to evaluate the rate of pediatric emergency department (ED) visits for pedestrian injuries in relation to the enactment of the Complete Streets policy.MethodsThe National Complete Streets policies were codified by county and associated with each hospital's catchment area and date of enactment. Pedestrian injury-related ED visits were identified across 40 children's hospitals within the Pediatric Health Information System (PHIS) from 2004 to 2014. We calculated the proportion of the PHIS hospitals' catchment areas covered by any county policy. We used a generalized linear model to assess the impact of the proportion of the policy coverage on the rate of pedestrian injury-related ED visits.ResultsThe proportion of the population covered by Complete Streets policies increased by 23.9%, and pedestrian injury rates at PHIS hospitals decreased by 29.8% during the study period. After controlling for years, pediatric ED visits for pedestrian injuries did not change with increases in the PHIS catchment population with enacted Complete Streets policies.ConclusionAfter accounting for time trends, Complete Streets policy enactment was not related to observed changes in ED visits for pedestrian injuries at PHIS hospitals

Revised timing of cenozoic atlantic incursions and changing hinterland sediment sources during southern patagonian orogenesis

New detrital zircon U-Pb geochronology data from the Cenozoic Magallanes-Austral Basin in Argentina and Chile ~51° S establish a revised chronostratigraphy of Paleocene-Miocene foreland synorogenic strata and document the rise and subsequent isolation of hinterland sources in the Patagonian Andes from the continental margin. The upsection loss of zircons derived from the hinterland Paleozoic and Late Jurassic sources between ca. 60 and 44Ma documents a major shift in sediment routing due to Paleogene orogenesis in the greater Patagonian-Fuegian Andes. Changes in the proportion of grains from hinterland thrust sheets, comprised of Jurassic volcanics and Paleozoic metasedimentary rocks, provide a trackable signal of long-term shifts in orogenic drainage divide and topographic isolation due to widening of the retroarc fold-thrust belt. The youngest detrital zircon U-Pb ages confirm timing of Maastrichtian-Eocene strata but require substantial age revisions for part of the overlying Cenozoic basinfill during the late Eocene and Oligocene. The upper Río Turbio Formation, previously mapped as middle to late Eocene in the published literature, records a newly recognized latest Eocene-Oligocene (37-27Ma) marine incursion along the basin margin. We suggest that these deposits could be genetically linked to the distally placed units along the Atlantic coast, including the El Huemul Formation and the younger San Julián Formation, via an eastward deepening within the foreland basin system that culminated in a basin-wide Oligocene marine incursion in the Southern Andes. The overlying Río Guillermo Formation records onset of tectonically generated coarse-grained detritus ca. 24.3Ma and a transition to the first fully nonmarine conditions on the proximal Patagonian platform since Late Cretaceous time, perhaps signaling a Cordilleran-scale upper plate response to increased plate convergence and tectonic plate reorganization.Fil: Fosdick, Julie C.. University of Connecticut; Estados UnidosFil: VanderLeest, R. A.. University of Connecticut; Estados UnidosFil: Bostelmann, J. E.. Universidad de Chile; ChileFil: Leonard, J. S.. Arizona State University; Estados UnidosFil: Ugalde, R.. Universidad Mayor; ChileFil: Oyarzún, J. L.. Parque Geo-paleontológico la Cumbre-baguales; ChileFil: Griffin, Miguel. Universidad Nacional de La Plata. Facultad de Ciencias Naturales y Museo. División Paleozoología Invertebrados; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata; Argentin

Stat5 Synergizes with T Cell Receptor/Antigen Stimulation in the Development of Lymphoblastic Lymphoma

Signal transducer and activator of transcription (STAT) proteins are latent transcription factors that mediate a wide range of actions induced by cytokines, interferons, and growth factors. We now report the development of thymic T cell lymphoblastic lymphomas in transgenic mice in which Stat5a or Stat5b is overexpressed within the lymphoid compartment. The rate of lymphoma induction was markedly enhanced by immunization or by the introduction of TCR transgenes. Remarkably, the Stat5 transgene potently induced development of CD8+ T cells, even in mice expressing a class II–restricted TCR transgene, with resulting CD8+ T cell lymphomas. These data demonstrate the oncogenic potential of dysregulated expression of a STAT protein that is not constitutively activated, and that TCR stimulation can contribute to this process

Management of children with mild traumatic brain injury and intracranial hemorrhage

BACKGROUND: Traumatic brain injury (TBI) is a significant public health problem affecting tens of thousands of children each year, and an important subset of these patients sustains intracranial hemorrhage (ICH). The purpose of this study was to test the hypothesis that we could identify a subset of children with traumatic ICH who could be monitored on a general neurosurgery ward with a low risk of clinical deterioration. METHODS: We performed a retrospective review of pediatric patients 18 years or younger with mild TBI (Glasgow Coma Scale [GCS] score 14Y15) and traumatic ICH admitted to Saint Louis Children's Hospital between 2006 and 2011. We excluded patients with injuries unrelated to the TBI that would require intensive care unit (ICU) admission and those with penetrating intracranial injuries. RESULTS: We identified 118 patients meeting inclusion criteria. Repeat neuroimaging was obtained in 69 (58%) of 118 patients. Radiologic progression was noted in 6 (8.7%) of 69 patients, with a trend toward more frequent progression in patients with epidural hematoma (EDH) versus other ICH (3 [20%] of 15 vs. 3 [5.6%] of 54; p = 0.11). Of 118 patients, 8 (6.8%) experienced clinically important neurologic decline (CIND) and 6 (5.1%) required neurosurgical intervention. Both CIND and the need for neurosurgical intervention were significantly higher in patients with EDH (21% each) compared with those with other types of ICH (4% and 2%, respectively) (p = 0.02, p G 0.01). Based on these results, we developed a preliminary management framework to assist in determining which patients can be safely observed on a neurosurgery ward without an ICU admission. Specifically, those patients without EDH, intraventricular hemorrhage, coagulopathy, or concern for a high-risk neurosurgical lesion (e.g., arteriovenous malformation) may be safely observed on the ward. CONCLUSIONS: These results demonstrate that few children with mild TBI and ICH experience CIND and the preliminary framework we developed assists in identifying which patients can safely avoid ICU admission. This framework should be validated prospectively and externally. (J Trauma Acute Care Surg. 2014;76: 1089Y1095

Pest population dynamics are related to a continental overwintering gradient

Overwintering success is an important determinant of arthropod populations that must be considered as climate change continues to influence the spatiotemporal population dynamics of agricultural pests. Using a long-term monitoring database and biologically relevant overwintering zones, we modeled the annual and seasonal population dynamics of a common pest, Helicoverpa zea (Boddie), based on three overwintering suitability zones throughout North America using four decades of soil temperatures: the southern range (able to persist through winter), transitional zone (uncertain overwintering survivorship), and northern limits (unable to survive winter). Our model indicates H. zea population dynamics are hierarchically structured with continental-level effects that are partitioned into three geographic zones. Seasonal populations were initially detected in the southern range, where they experienced multiple large population peaks. All three zones experienced a final peak between late July (southern range) and mid-August to mid-September (transitional zone and northern limits). The southern range expanded by 3% since 1981 and is projected to increase by twofold by 2099 but the areas of other zones are expected to decrease in the future. These changes suggest larger populations may persist at higher latitudes in the future due to reduced low-temperature lethal events during winter. Because H. zea is a highly migratory pest, predicting when populations accumulate in one region can inform synchronous or lagged population development in other regions. We show the value of combining long-term datasets, remotely sensed data, and laboratory findings to inform forecasting of insect pests

Whole genome sequencing to investigate the emergence of clonal complex 23 Neisseria meningitidis serogroup Y disease in the United States

In the United States, serogroup Y, ST-23 clonal complex Neisseria meningitidis was responsible for an increase in meningococcal disease incidence during the 1990s. This increase was accompanied by antigenic shift of three outer membrane proteins, with a decrease in the population that predominated in the early 1990s as a different population emerged later in that decade. To understand factors that may have been responsible for the emergence of serogroup Y disease, we used whole genome pyrosequencing to investigate genetic differences between isolates from early and late N. meningitidis populations, obtained from meningococcal disease cases in Maryland in the 1990s. The genomes of isolates from the early and late populations were highly similar, with 1231 of 1776 shared genes exhibiting 100% amino acid identity and an average πN = 0.0033 and average πS = 0.0216. However, differences were found in predicted proteins that affect pilin structure and antigen profile and in predicted proteins involved in iron acquisition and uptake. The observed changes are consistent with acquisition of new alleles through horizontal gene transfer. Changes in antigen profile due to the genetic differences found in this study likely allowed the late population to emerge due to escape from population immunity. These findings may predict which antigenic factors are important in the cyclic epidemiology of meningococcal disease