Imaging and reporting considerations for suspected physical abuse (non-accidental injury) in infants and young children. Part 2: axial skeleton and differential diagnoses

Recognising the skeletal manifestations of inflicted injury (II) in infants and young children is of crucial importance. There are specific fracture patterns which are highly suspicious of II in addition to common differential diagnoses with which radiologists should be familiar. Our objective is to provide a non-exhaustive review of the important factors relevant to the imaging and reporting of II as a platform for further learning. Part 2 encompasses fracture patterns of the axial skeleton and important differential diagnoses

Migration, Environment and Public Health: Theory and Interdisciplinary Research from a Regional Science Perspective

As regional climate evolves into new climatic states in different parts of the world, humanity will be facing increasing issues associated with migration environment and health concerns. Challenges of major hazards and impacts on human societies, involving water resources, agriculture, economy and energy issues are central issues. This paper examines the generalization of Tiebout’s model in our understanding of the forced environmental migration of the Great Planes farmers to California during the Dust Bowl period in 1931-1939. The paper considers the issues of public health that arose from this migration after the arrival and settlement of the Okies in California. Settlement of the migrants in California was more bitter than the migration itself, prompting John Steinbeck to write his award winning novel of the journey in the “Grapes of Wrath.” Among many health risks in their new environment a relatively unappreciated and unpublicized airborne fungus causing Valley fever when inhaled emerged. Valley fever was, and is today, highly endemic in California’s San Joaquin Valley where many of the Okies remained, staying for employment in agriculture and working the fertile soil that harbored the fungus. The vast majority of migrants into the San Joaquin Valley had been infected, but we know today that most who were, did not report it. A very high percentage of migrants did become infected when a few statistics emerged, such as 25% of the population of one migrant camp were diagnosed with the disease. Many migrants fought the disease only to die later in the 1940s and 1950s. The destiny of the migrants was not exposed in books or mass media until the early 1960s. Many migrants escaped infection when they left the fields for employment in the factories and manufacturing supporting the World War II effort. Other reasons for this historical silence were the Great Depression, those who went to war, the Cold War era, and the Californian farmers themselves who kept the infection secret. The second generation migrants or the “survivors” from Valley fever infection exposed the destiny of their parents in the Californian farms in the mass media in the early 1960s and later on Internet webpages and blogs in the 1980s. We examine the general implications and lessons learned from these historical cases

Market disruption, cascading effects, and economic recovery:a life-cycle hypothesis model.

This paper builds upon previous work [Sprigg and Ehlen, 2004] by introducing a bond market into a model of production and employment. The previous paper described an economy in which households choose whether to enter the labor and product markets based on wages and prices. Firms experiment with prices and employment levels to maximize their profits. We developed agent-based simulations using Aspen, a powerful economic modeling tool developed at Sandia, to demonstrate that multiple-firm economies converge toward the competitive equilibria typified by lower prices and higher output and employment, but also suffer from market noise stemming from consumer churn. In this paper we introduce a bond market as a mechanism for household savings. We simulate an economy of continuous overlapping generations in which each household grows older in the course of the simulation and continually revises its target level of savings according to a life-cycle hypothesis. Households can seek employment, earn income, purchase goods, and contribute to savings until they reach the mandatory retirement age; upon retirement households must draw from savings in order to purchase goods. This paper demonstrates the simultaneous convergence of product, labor, and savings markets to their calculated equilibria, and simulates how a disruption to a productive sector will create cascading effects in all markets. Subsequent work will use similar models to simulate how disruptions, such as terrorist attacks, would interplay with consumer confidence to affect financial markets and the broader economy

Interdisciplinary Science to Confront Coccidioidomycosis

The long journey of research to lower risks of Coccidioidomycosis (CM) began in the late 19th century in Argentina and continued north to Mexico, the US and other countries. During this trip, medical science led the way. Although interdisciplinary research is not alien to medical science, e.g. geographic epidemiology, interaction with other disciplines has been low priority. This paper argues that the efficacy of CM mitigation and treatment can be improved through multi- and inter-disciplinary information exchange, particularly with earth and environmental sciences. Greater interaction and open publication practice are essential. Section 1 describes CM-epidemiology, the clinical features, the diagnosis and finally, the treatment.Section 2 discusses epidemiological evidence for atmospheric influence on cases of CM.Section 3 highlights the most important contributions and controversies in the history of CM-research through scientometric or bibliometric evaluations of research that are based on Garfield’s work on the propagation of scientific thinking.

Full employment and competition in the Aspen economic model: implications for modeling acts of terrorism.

Acts of terrorism could have a range of broad impacts on an economy, including changes in consumer (or demand) confidence and the ability of productive sectors to respond to changes. As a first step toward a model of terrorism-based impacts, we develop here a model of production and employment that characterizes dynamics in ways useful toward understanding how terrorism-based shocks could propagate through the economy; subsequent models will introduce the role of savings and investment into the economy. We use Aspen, a powerful economic modeling tool developed at Sandia, to demonstrate for validation purposes that a single-firm economy converges to the known monopoly equilibrium price, output, and employment levels, while multiple-firm economies converge toward the competitive equilibria typified by lower prices and higher output and employment. However, we find that competition also leads to churn by consumers seeking lower prices, making it difficult for firms to optimize with respect to wages, prices, and employment levels. Thus, competitive firms generate market ''noise'' in the steady state as they search for prices and employment levels that will maximize profits. In the context of this model, not only could terrorism depress overall consumer confidence and economic activity but terrorist acts could also cause normal short-run dynamics to be misinterpreted by consumers as a faltering economy

The incidence of first stroke in pregnant and non-pregnant women of childbearing age: a population-based cohort study from England

Background: Pregnant women may have an increased risk of stroke compared to non-pregnant women of similar age, but the magnitude and the timing of such risk are unclear. We examined the risk of first stroke event in women of childbearing age and compared the risk during pregnancy and in the early postpartum period to background risk outside these periods. Methods and Results: We conducted an open cohort study of 2,046,048 women aged 15-49 years between 1st April 1997 and 31th March 2014 using linked primary (Clinical Practice Research Datalink) and secondary (Hospital Episode Statistics) care records in England. Risk of first stroke was assessed by calculating the incidence rate of stroke in antepartum, peripartum (2 days before until 1 day after delivery), early (first six weeks) and late (second six weeks) postpartum periods, compared with non-pregnant time using a Poisson regression model with adjustment for maternal age, socioeconomic group and calendar time. A total of 2,511 women had a first stroke. The incidence rate of stroke was 25.0 per 100,000 person-years (95% confidence interval 24.0-26.0) in non-pregnant time. The rate was lower antepartum (10.7/100,000 person-years, 7.6-15.1), but 9-fold higher peripartum (161.1/100,000 person-years, 80.6-322.1) and 3-fold higher early postpartum (47.1/100,000 person-years, 31.3-70.9). Rates of ischaemic and haemorrhagic stroke both increased peripartum and early postpartum. Conclusions: Although the absolute risk of first stroke is low in women of childbearing age, health care professionals should be aware of a considerable increase in relative risk during the peripartum and early postpartum periods

Re: A comprehensive toolkit for imaging children who may have been abused: new guidance from the Royal College of Radiologists and the Society and College of Radiographers

Correspondenc

Approach and development strategy for an agent-based model of economic confidence.

We are extending the existing features of Aspen, a powerful economic modeling tool, and introducing new features to simulate the role of confidence in economic activity. The new model is built from a collection of autonomous agents that represent households, firms, and other relevant entities like financial exchanges and governmental authorities. We simultaneously model several interrelated markets, including those for labor, products, stocks, and bonds. We also model economic tradeoffs, such as decisions of households and firms regarding spending, savings, and investment. In this paper, we review some of the basic principles and model components and describe our approach and development strategy for emulating consumer, investor, and business confidence. The model of confidence is explored within the context of economic disruptions, such as those resulting from disasters or terrorist events