Fatal non-accidental pediatric cranial fracture risk and three-layered cranial architecture development.

This study examines the influence of three-layered cranial architecture development upon blunt force trauma (BFT) cranial outcomes associated with pediatric non-accidental injury (NAI). Macroscopic and microscopic metric and morphological comparisons of subadult crania ranging from perinatal to 17 years of age chronicle the ontogenetic development and spatial and temporal variability in the emergence of a mature cranial architecture. Cranial vault thickness increases with subadult age, accelerating in the first 2 years of life due to rapid brain growth during this period. Three-layer differentiation of the cranial tables and diploë initiates by 3-6 months but is not consistently observed until 18 months to 2 years; diploë formation is not well developed until after age 4 and does not manifest a mature appearance until after age 8. These results allow topographic documentation of cortical and diploic development and temporal and spatial variability across the growing cranium. The lateral cranial vault is identified as expressing delayed development and reduced expression of the three-layer architecture, a pattern that continues into adulthood. Comparison of fracture locations from known BFT pediatric cases with identified cranial fracture high-risk impact regions shows a concordance and suggests the presence of a higher fracture risk associated with non-accidental BFT in the lateral vault region in subadults below the age of 2. The absence or lesser development of a three-layered architecture in subadults leaves their cranial bones, particularly in the lateral vault, thin and vulnerable to the effects of BFT.

Paediatric musculoskeletal learning needs for general practice trainees: achieving an expert consensus.

BACKGROUND: Paediatric musculoskeletal (pMSK) disorders are common in clinical practice, but training in their recognition and management is suboptimal at both undergraduate and postgraduate level. Exposure to pMSK conditions is variable in GP training, and there is no standardised curriculum for what GPs should know about pMSK medicine. AIM: To attain expert agreement on the gold standard of pMSK skills and knowledge required at completion of GP training. DESIGN AND SETTING: Modified Delphi process followed by consensus group meeting and focus groups. METHODS: Two iterative rounds of Delphi process conducted by email, followed by a face-to-face meeting of stakeholders. Items with >80% agreement included in final curriculum statement. Member checking by GPs conducted through focus group meetings. RESULTS: A curriculum covered by 12 overarching statements was developed, with positive feedback from GP educators on the feasibility of delivering the curriculum and usefulness of the items. CONCLUSION: The introduction of expert-derived learning needs to the GP curriculum on pMSK medicine should help with improving the recognition and management of children with MSK disorders.

Explore nursing abroad! Interview by Sandy Dancer.

International nursing allows nurses to experience a different culture of practice, to appreciate the variations in healthcare among countries, and to learn from each other. In this question-and-answer account, American nurse Donna Boyd shares her experience working as a nurse in the United Kingdom.

Theory and the scientific basis for forensic anthropology.

Forensic anthropology has long been criticized for its lack of a strong theoretical and scientific foundation. This paper addresses this problem by examining the role of theory in forensic anthropology at different hierarchical levels (high-level, middle-range, and low-level) and the relevance of various theoretical concepts (taphonomic, agency, behavioral archaeology, nonlinear systems, and methodological theories) to the interpretation of forensic contexts. Application of these theories to a case study involving the search for the WWII Goettge Patrol illustrates the explanatory power these theories offer to the interpretation of forensic events as the end product of an often complex set of environmental constraints and behavioral interactions and choices. It also emphasizes the importance of case studies in theory building and hypothesis testing. A theoretical foundation does indeed currently exist in forensic anthropology; however, a recognition and broader implementation of anthropological (archaeological) theory is warranted and will further define forensic anthropology as a scientific endeavor.

Three-year prospective validation of a pre-endoscopic risk stratification in patients with acute upper-gastrointestinal haemorrhage.

OBJECTIVE: To assess the accuracy of a risk stratification that is used at initial assessment to identify groups with increased risk of mortality and requirement for urgent treatment intervention. DESIGN: Prospective assessment of risk stratification in consecutive patients with acute upper-gastrointestinal haemorrhage. METHODS: Over a 3-year period, 1349 consecutive patients with acute upper-gastrointestinal haemorrhage presenting to a single teaching hospital were prospectively risk stratified before endoscopy and followed up for outcome. MAIN OUTCOME MEASURES: Two-week, all-cause mortality, re-bleeding, and need for urgent treatment intervention. RESULTS: Stratification within the high-risk group predicted a significant increased risk of 2-week, all-cause mortality (P < 0.001) when compared with intermediate- and low-risk patients (11.8%, 3% and 0%, respectively), re-bleeding (P < 0.001) (44.1%, 2.3% and 0%, respectively), and need for urgent treatment intervention (P < 0.001) (71%, 40.6% and 2.6%, respectively). CONCLUSIONS: Over a 3-year period, medical staff at this institution have routinely used this risk stratification, which identifies groups of patients at high and low risk of mortality, re-bleeding and need for urgent treatment intervention following acute upper-gastrointestinal haemorrhage. Use of this risk stratification should allow targeting of more intensive treatment where it might be of most benefit. Those patients at lowest risk from outpatient management are also identified.