A taxonomy of childhood pedal cyclist injuries from latent class analysis: associations with factors pertinent to prevention

Background: Studies of pedal cyclist injuries have largely focused on individual injury categories, but every region of the cyclist\u27s body is exposed to potential trauma. Real-world injury patterns can be complex, and isolated injuries to one body part are uncommon among casualties requiring hospitalization. Latent class analysis (LCA) may identify important patterns in heterogeneous samples of qualitative data. Methods: Data were taken from the Trauma Quality Improvement Program of the American College of Surgeons for 2017. Inclusion criteria were age 18 years or less and an external cause of injury code for pedal cyclist. Injuries were characterized by Abbreviated Injury Scale codes. Injury categories and the total number of injuries served as covariates for LCA. A model was selected on the basis of the Akaike and Bayesian information criteria and the interpretability of the classes. Associations were analyzed between class membership and demographic factors, circumstantial factors, metrics of injury severity, and helmet wear. Within-class associations of helmet wear with injury severity were analyzed as well. Results: There were 6151 injured pediatric pedal cyclists in the study sample. The mortality rate was 0.5%. The rate of helmet wear was 18%. LCA yielded a model with 6 classes: \u27polytrauma\u27 (5.5%), \u27brain\u27 (9.0%), \u27abdomen\u27 (11.0%), \u27upper limb\u27 (20.9%), \u27lower limb\u27 (12.4%), and \u27head\u27 (41.2%). Class membership had highly significant univariate associations with all covariates except insurance payer. Helmet wear was most common in the \u27abdomen\u27 class and least common in the \u27polytrauma\u27 and \u27brain\u27 classes. Within classes, there was no association of helmet wear with severity of injury. Conclusions: LCA identified 6 clear and distinct patterns of injury with varying demographic and circumstantial associations that may be relevant for prevention. The rate of helmet wear was low, but it varied among classes in accordance with mechanistic expectations. LCA may be an underutilized tool in trauma epidemiology

Tangential Cranial Gunshot Wound in an Infant in Historical Context: Illustrative Case

BACKGROUND Military neurosurgeons have long known that tangential cranial gunshot wounds can be associated with intracranial complications out of proportion to the external appearance of the injury. This phenomenon seems not to have been described in infancy. OBSERVATIONS An infant suffered a massive, acute subdural hemorrhage from a contralateral tangential gunshot wound that did not facture the skull. LESSONS Similar to adults, infants are subject to catastrophic intracranial injury from gunshots that do not penetrate the skull. The nature of the injury in this case reflected distinctive aspects of the tissue characteristics and proportions of the infant head

Clinical Factors Associated With Need for Neurosurgical Care in Young Children With Imaging for Macrocephaly: A Case Control Study

BACKGROUND: Macrocephaly is present in 2.3% of children with important neurosurgical conditions in the differential diagnosis. The objective of this study was to identify clinical associations with actionable imaging findings among children with head imaging for macrocephaly. METHODS: We conducted a case-control study of head imaging studies ordered for macrocephaly among children 24 months and younger in a multistate children\u27s health system. Four neurosurgeons reviewed the images, determining cases to be a \u27concern\u27 if neurosurgical follow-up or intervention was indicated. Electronic health records were reviewed to collect patient-level data and to determine if surgery was performed. Controls were matched 3:1 to cases of \u27concern\u27 in a multivariate model using conditional logistic regression. RESULTS: In the study sample (n = 1293), 46 (4%) were concern cases, with 15 (1%) requiring surgery. Significant clinical factors associated with neurosurgical concern were bulging fontanel [aOR 7.47, (95% CI: 2.28-24.44), P \u3c 0.001], prematurity [aOR 21.26, (95% CI: 3.76-120.21), P \u3c 0.001], any delay [aOR 2.67, (95% CI: 1.13-6.27), P = 0.03], and head-weight Z-score difference (W_diff, defined as the difference between the Z-scores of head circumference and weight) [aOR 1.70, (95% CI: 1.22-2.37), P = 0.002]. CONCLUSIONS: Head imaging for macrocephaly identified few patients with findings of concern and fewer requiring surgery. A greater head-weight Z-score difference appears to represent a novel risk factor for neurosurgical follow-up or intervention

Sorption and Biodegradation of Organic Solutes Undergoing Transport in Laboratory-scale and Field-scale Heterogeneous Porous Media.

The first study focused on the magnitude and rate of sorption of hydrophobic organic compounds by two, well-characterized soils. The composition of organic matter had a small effect on the magnitude of the organic carbon normalized equilibrium distribution coefficients. The sorbates sorbed more strongly to the humic-coated soil, most likely due to the organic matter's less polar nature as compared to the fulvic material. The molecular solute descriptor, ¹Xᵛ, performed slightly better than the empirical solute descriptor, K(ov), in evaluating equilibrium sorption coefficients. Thus, sorbate structure may have a secondary influence on the overall magnitude of equilibrium sorption. Sorbate structure exhibited a greater influence on sorption kinetics than on sorption equilibrium. Distinct differences in the magnitudes of mass transfer coefficients for the humic and fulvic soils were observed when relating them to the molecular solute descriptor, ¹Xᵛ. The differences in mass transfer coefficients were attributed to both sorbate structure and the quantity and morphology of soil organic matter. The intrasorbent diffusion coefficients were believed to be the same for both the humic and fulvic material. The second study focused on using a biodegradable solute to measure processes that affect in-situ biodegradation during well-controlled field and laboratory experiments. Specifically, this study investigated how residence time and scale influence the extent and rate of in-situ biodegradation of an organic solute undergoing transport. The transport of the biodegradable solute was compared to that of bromide and/or pentafluorobenzoic acid, which are conservative, non-degradable tracers. Laboratory experiments were conducted to simulate both the flow velocity and residence time conditions existent in the field. Mass recovery the biodegradable solute decreased as the residence time increased, ranging from 14 to 95 percent for the field sites. Mass recoveries in the laboratory experiments were approximately 30% to 40 % less than in the field experiments. The first-order biodegradation rate constants did not vary with residence time for either field site. In addition, the average rate constant value for both field sites was very similar (0.21 d⁻¹).hydrology collectio

Lesiones del plexo braquial durante el nacimiento

Las lesiones del plexo braquial durante el nacimiento son muy comunes, pero la mayor\ueda de los reci\ue9n nacidos afectados se recupera con rapidez sin ninguna intervenci\uf3n espec\uedfica. Una minor\ueda sufre lesiones m\ue1s graves que originan grados diversos de incapacidad toda la vida. T\ue9cnicas microquir\ufargicas modernas permiten reconstruir ciertas lesiones del plexo y, en pacientes seleccionados cuidadosamente, pueden restablecer la actividad voluntaria de los grupos musculares que se tratan. El grado al cual la reanimaci\uf3n de m\ufasculos paralizados mejora la funci\uf3n y la calidad de vida de estos ni\uf1os es un tema m\ue1s importante que a\ufan no se aborda utilizando los est\ue1ndares modernos de pruebas. La reconstrucci\uf3n del plexo braquial s\uf3lo es un printer paso en cl proceso multidisciplinario necesario para lograr resultados funcionales \uf3ptimos a largo plazo en lactantes afectados gravement

Hallazgos inesperados en im\ue1genes del cerebro v la columna

En la pr\ue1ctica de la pediatr\ueda en el consultorio, disminuy\uf3 en los \ufaltimos a\uf1os el umbral cl\uednico para solicitar estudios de im\ue1genes del cerebro y la columna vertebral y se multiplicaron las solicitudes para consultas a fin de valorar el resultado de hallazgos inesperados en im\ue1genes. La tamiliaridad con las entidades m\ue1s comunes que dan lugar a estas solicitudes permite que el pediatra alivie la ansiedad de los padres mediante una asesor\ueda preliminar informada y establezca las prioridades apropiadas para referencias e investigaciones subsecuentes

Reconocimiento de padecimientos neuroquir\ufargicos en el consultorio del pediatra

En la pr\ue1ctica pedi\ue1trica general surgen con frecuencia problemas cl\uednicos con posibles implicaciones neuroquir\ufargicos, como cefalea y anormalidades del tama\uf1o y la forma de la cabeza. Otras afeccionen neuoquir\ufargicos pueden manifestarse por s\ued mismas con menos frecuencia y de manera mas insidiosa. En cualquiera de los casos, el pediatra que est\ue1 alerta a la gama de presentaciones de los padecimientos neuroquir\ufargicos dirigir\ue1 sus investigaciones y referencias con eficiencia e inspirar\ue1 confianza al paciente y la familia