26 cm fall caught on video causing subdural hemorrhages and extensive retinal hemorrhages in an 8-month-old infant.

Severe, too many to count retinal hemorrhages (RH) in infants have been associated with abusive head trauma, but can occur in short falls. An 8-month-old male fell backward from a height of 26 cm, landing on his buttocks then hitting the back of his head on a vinyl floor. The fall was videotaped. Acute subdural hemorrhages were found along with extensive, too many to count intra-RH in both eyes. Falls from small heights on to the occiput can lead to extensive RH of the type often associated with abusive head trauma.

Why admitted cases of AHT make a low quality reference standard: A survey of people accused of AHT in France.

Several influential articles that attempt to establish diagnostic methods for Abusive Head Trauma (AHT) use admitted cases as a reference standard. This study analyses a survey of people accused of AHT in France, to understand the environment and situations in which such admissions are made. Multiple reasons to question the reliability of admissions to AHT are demonstrated in the responses, including reduced sentences, the return of children to the family home, a desire to stop accusations being leveled at a partner and for legal proceedings to end. These factors must be considered in the context of proceedings that are long, expensive and stressful, leading to depression and financial hardship, and that seem to be inevitably heading towards conviction. The ineluctable conclusion is that admitted cases do not make a suitably reliable reference standard for undertaking scientific investigation, or for validating the diagnostic methods used for AHT.

Evidence for significant misdiagnosis of abusive head trauma in pediBIRN data.

Independently witnessed events are used as a reference standard to robustly categorize accidental or non-abusive head trauma (non-AHT) cases in the pediBIRN data set of acutely symptomatic infants with closed head injuries. Findings in such independently witnessed non-AHT cases are compared to findings in cases that were diagnosed as AHT but were not independently witnessed. The data shows that 14% of independently witnessed non-AHT cases are misdiagnosed as AHT, and that risk factors for misdiagnosis include acute encephalopathy, bilateral or interhemispheric SDH, and/or severe retinal hemorrhages, findings that are commonly associated with AHT. The data also shows that "dense retinal hemorrhages extending to the periphery" are not highly suggestive of AHT, as they also occur in independently witnessed non-AHT cases.

Retraction of a peer reviewed article suggests ongoing problems with Australian forensic science.

We describe events arising from the case of Joby Rowe, convicted of the homicide of his three month old daughter, and explore what they illustrate about systemic problems in the forensic science community in Australia. A peer reviewed journal article that scrutinized the forensic evidence presented in the Rowe case was retracted by a forensic science journal for reasons unrelated to quality or accuracy, under pressure from forensic medical experts criticized in the article. Details of the retraction obtained through freedom of information mechanisms reveal improper pressure and subversion of publishing processes in order to avoid scrutiny. The retraction was supported by the editorial board and two Australian forensic science societies, which is indicative of serious deficiencies in the leadership of forensic science in Australia. We propose paths forward including blind peer review, publication of expert reports, and a criminal cases review authority, that would help stimulate a culture that encourages scrutiny, and relies on evidence-based rather than eminence-based knowledge.

The different baryonic Tully-Fisher relations at low masses.

We compare the Baryonic Tully-Fisher relation (BTFR) of simulations and observations of galaxies ranging from dwarfs to spirals, using various measures of rotational velocity Vrot. We explore the BTFR when measuring Vrot at the flat part of the rotation curve, Vflat, at the extent of H i gas, Vlast, and using 20 per cent (W20) and 50 per cent (W50) of the width of H i line profiles. We also compare with the maximum circular velocity of the parent halo, [Formula: see text], within dark matter only simulations. The different BTFRs increasingly diverge as galaxy mass decreases. Using Vlast one obtains a power law over four orders of magnitude in baryonic mass, with slope similar to the observed BTFR. Measuring Vflat gives similar results as Vlast when galaxies with rising rotation curves are excluded. However, higher rotation velocities would be found for low-mass galaxies if the cold gas extended far enough for Vrot to reach a maximum. W20 gives a similar slope as Vlast but with slightly lower values of Vrot for low-mass galaxies, although this may depend on the extent of the gas in your galaxy sample. W50 bends away from these other relations towards low velocities at low masses. By contrast, [Formula: see text] bends towards high velocities for low-mass galaxies, as cold gas does not extend out to the radius at which haloes reach [Formula: see text]. Our study highlights the need for careful comparisons between observations and models: one needs to be consistent about the particular method of measuring Vrot, and precise about the radius at which velocities are measured.

Comprehensive Emergency Airway Response Team (EART) Training and Education: Impact on Team Effectiveness, Personnel Confidence, and Protocol Knowledge.

OBJECTIVE: To evaluate the efficacy and utility of simulation of the Emergency Airway Response Team (EART) at a tertiary care hospital to improve team dynamics and confidence and knowledge in managing an emergency airway. METHODS: This was a descriptive, quantitative performance improvement study. From September 1, 2013, to December 1, 2013, 177 members of the EART from anesthesia, otolaryngology, trauma surgery, emergency medicine, ICU nursing, and respiratory therapy participated in emergency airway simulations. Team dynamics and confidence levels and knowledge of EART were assessed using pre-and post-simulation questionnaires. RESULTS: All participants regardless of their role, experience in the medical field, or any prior exposure to a difficult airway showed significant improvement in self-rated team participation and confidence and objective knowledge regarding EART after undergoing simulation. CONCLUSION: Our study highlights the efficacy and utility of simulation in assessing personnel team dynamics and confidence levels and knowledge of emergency airway scenarios. Practitioners in all fields and level of experience benefit in EART training and simulation. We hope that with this information, we will be able to conduct future studies on reduction of patient morbidity and mortality.

Impact of pandemic (H1N1) 2009 influenza on critical care capacity in Victoria.

OBJECTIVE: To describe the demand for critical care hospital admissions in Victoria resulting from the rapid rise in the number of pandemic (H1N1) 2009 influenza cases, and to describe the role of modelling tools to assist with the response to the pandemic. DESIGN AND SETTING: Prospective modelling with the tools FluSurge 2.0 and FluAid 2.0 (developed by the United States Centers for Disease Control and Prevention) over 12 weeks from when the pandemic "Contain" Phase was declared on 22 May 2009, compared with data obtained from daily hospital reports of pandemic (H1N1) 2009 influenza-related admissions and transfers to intensive care units (ICUs). MAIN OUTCOME MEASURES: The effect on hospitals as projected by the FluAid 2.0 model compared with observed hospital admissions and ICU admissions. RESULTS: Prospective use of the FluAid 2.0 model provided valuable health intelligence for assessment and projection of hospitalisation and critical care demand through the first 10 weeks of the pandemic in Victoria. The observed rate of hospital admissions for pandemic (H1N1) 2009 was broadly consistent with a 5% gross clinical attack rate, with 0.3% of infected patients being hospitalised. Transfers to ICUs occurred at a rate of 20% of hospital admissions, and were associated with vulnerable patient groups, and severe respiratory failure in 82% of patients admitted to ICUs. Most patients treated in ICUs (85%) survived after an average ICU length of stay of 9 days (SD, 6.5 days). Mechanical ventilation was required by 72% of patients admitted to ICUs, and extracorporeal membrane oxygenation (ECMO) was used for 7%. Pre-existing haematological malignancy accounted for half of all the deaths in patients admitted to ICUs with pandemic (H1N1) 2009 influenza. CONCLUSIONS: Prospective use of modelling tools informed critical decisions in the planning and management of the pandemic. Early estimation of the clinical attack rate, hospitalisation rates, and demand for ICU beds guided implementation of surge capacity. ECMO emerged as an important treatment modality for pandemic (H1N1) 2009 influenza, and will be an important consideration for future pandemic planning.

Removal of RNA impurities by tangential flow filtration in an RNase-free plasmid DNA purification process.

Addition of animal-derived ribonuclease A to degrade RNA impurities is not recommended in the manufacture of pharmaceutical-grade plasmid DNA. Tangential flow filtration (TFF) takes advantage of the significant size difference between RNA and plasmid DNA to remove RNA in the permeate while plasmid remains in the retentate, in an RNase-free plasmid purification process. Operating conditions including transmembrane pressure, membrane pore size, conductivity of the diafiltration buffer, and plasmid load on the membrane were investigated to maximize RNA clearance. Although direct TFF of clarified lysate removed substantial amounts of RNA, the RNA levels left in the retentate were still significant. Calcium chloride is a potent precipitant of high-molecular-weight RNA. The addition of calcium chloride to the clarified lysate combined with the clearance of low-molecular-weight RNA by TFF resulted in complete RNA removal and high plasmid recovery.