Pediatric wilderness recreational deaths in western Washington State.

STUDY OBJECTIVE: To determine the causes and characteristics of pediatric recreational wilderness deaths. METHODS: All deaths of children between 12 months and 20 years of age involving a wilderness recreational activity in 5 western Washington counties between 1987 and 1996 were identified by medical examiners' logs. Univariate analysis was used to examine variables such as age, gender, activity, mechanism of injury, adult presence, blood alcohol level, safety equipment, and mode of evacuation. RESULTS: Of 40 cases meeting inclusion criteria, 90% involved male subjects and 83% of victims were 13 to 19 years old. Hiking (33%), swimming (20%), and river rafting (10%) were the most common activities. Death was most often by drowning (55%) or closed head injury (26%). No victim was alone. All children younger than 10 years of age were accompanied by an adult, in contrast to only 26% of individuals 10 years or older. Only 4 victims had drugs or alcohol in their system. No victim wore a personal flotation device or helmet, and only 5% had foul weather gear. Although nearly one third of victims were transported by airlift, more than half of the victims were dead at the scene. CONCLUSION: Males and teenagers were the 2 major risk groups for recreational wilderness deaths. Traditional activities such as hiking and swimming were the most common causes of death. Children younger than 10 years died despite the presence of an adult, whereas teenagers were usually with groups of peers. The majority of victims were not prepared for adverse events with basic safety equipment.

A wilderness medicine course for pediatric residents.

OBJECTIVE: To design a structured curriculum to teach pediatric residents about wilderness medicine. BACKGROUND: An increasing number of children are involved in more rigorous and potentially risky outdoor activities. Despite the breadth of exposure characteristic of most pediatric residences, we are aware of no formalized syllabus that prepares residents to both treat injuries sustained in outdoor pursuits, and help parents and children to prepare safely for such activities. METHODS: The first half of the course was designed to teach a broad range of topics in wilderness medicine through a series of readings, lectures, and field trips. The second half of the course involved a six-day course in wilderness skills. RESULTS: Over a three-week period, the major topics of wilderness medicine were thoroughly covered. The three residents involved in the planning and execution of the course felt that the course succeeded in filling an important gap in their pediatric residency training. CONCLUSIONS: The addition of a structured wilderness medicine elective to pediatric residencies, with or without a field component, may provide a valuable opportunity for pediatric residents to broaden their skills and knowledge base to include these increasingly important topics.

A nucleic acid-based test for detection of Fasciola hepatica.

The use of nucleic acid techniques in the diagnosis of parasitic infection has become increasingly widespread. An oligonucleotide probe derived from a rRNA sequence was developed for the detection of Fasciola hepatica in its intermediate snail host Pseudosuccinea columella. Total RNA obtained from whole adult liver flukes was used in a polymerase chain reaction to isolate and amplify a region of approximately 650 base pairs in the small subunit rRNA. This portion of the ribosomal cDNA, which contains highly conserved regions as well as variable regions, was subcloned and sequenced. In comparison to known small subunit rRNA sequences, a sequence unique to F. hepatica was identified and an oligonucleotide probe (CS4) for detection of F. hepatica was developed. A northern blot analysis using CS4 successfully identified small subunit rRNA from F. hepatica. Slot-blot analysis determined that RNA derived from 5 miracidia can be detected with CS4. Moreover, a slot blot utilizing CS4 distinguished RNA derived from snails infected with F. hepatica from RNA of uninfected snails.

Targeted transformation in Coprinus cinereus.

We examined the influence of DNA form and size on the arrangement and genomic location of transforming DNA sequences in the basidiomycete Coprinus cinereus. Protoplasts with either single or double mutations in the tryptophan synthetase (TRP1) gene were transformed with cloned copies of this gene which contained only a single DNA strand, contained a specific single nick within the C. cinereus sequences (4.8 kb), contained a specific double-strand break, or contained an additional 35 kb of flanking genomic sequences. Gene replacement events were recovered when each DNA type was used. However, none of these substrates offers a substantial improvement in transformation or targeting frequency when compared to supercoiled circular DNA, which has allowed recovery of both gene replacements as well as homologous insertions in 5% of the transformants analyzed. The frequency of transformants carrying tandem insertions with multiple copies of the transforming DNA was reduced when single-stranded DNA was used, and increased when DNA containing double-strand breaks was used. These results have important implications for the efficient design of targeted transformation and co-transformation experiments.