Globe and adnexal trauma at Australian trauma centres.

INTRODUCTION: In multisystem trauma, the assessment and management of globe and adnexal trauma is often complex. Ophthalmology input may assist managing such patients. To understand the role of ophthalmology in tertiary trauma centres we report on the management of globe and adnexal trauma at two tertiary trauma centres in Sydney, Australia. METHOD: A retrospective case series was completed at Royal North Shore Hospital (RNSH) and Royal Prince Alfred Hospital (RPAH) on patients admitted between January 2015 and December 2019. International Classification of Disease, Tenth Revision codes, diagnostic and procedural coding data were used to identify patients admitted with globe and/or adnexal trauma. Data extracted from medical records included demographics, mechanism of injury, ocular examination and specialist ophthalmic referral. RESULTS: Over 5-years, 773 patients, average age of 53.2years and 62% male, were admitted to RNSH and RPAH with globe and/or adnexal trauma. Most patients (83%) first presented to RNSH or RPAH. The most common mechanism of injury was falls (45%) followed by burns (13%). Two-hundred and thirty-five patients had multisystem trauma, of these patients, 121 (51%) suffered globe trauma with 49 (21%) classified as severe. Three patients were not diagnosed initially due to delayed ophthalmology referral. CONCLUSION: Falls followed by burns were common causes of globe and adnexal trauma in Sydney, Australia. The presence of orbital/mid-facial injury may indicate a patient has globe trauma. In multisystem trauma, globe trauma may be diagnosed late or not identified. Ophthalmology review has an important role in diagnosing and managing globe trauma in multisystem trauma.

Complete Genome Sequences of Nine Mycobacteriophages from New Zealand, Beatrix, Carthage, Daegal, Dulcie, Fancypants, Fenn, Inca, Naira, and Robyn.

Beatrix, Carthage, Daegal, Dulcie, Fancypants, Fenn, Inca, Naira, and Robyn are newly isolated bacteriophages capable of infecting Mycolicibacterium smegmatis mc2 155. We discovered, sequenced, and annotated these New Zealand bacteriophages. These phages illustrate that New Zealand harbors a selection of the highly diverse and distributed mycobacteriophage clusters found globally.

Trends in unintentional-injury deaths during the 20th century.

Since 1900 the number of deaths per 100,000 population due to unintentional injuries (accidents) was reduced by 53 percent, dropping from 72 to 34. Had this rate not decreased almost 4.2 million more people would have died from unintentional injuries over the century. Of the seven kinds of injury events that accounted for 90 percent of all unintentional injury deaths in 1998, only two experienced increases in rates. Death rates from falls, fires and burns, drowning, poisoning by gases and vapors and firearms were reduced between 61 and 90 percent. The mortality rate due to poisoning by solids and liquids, however, increased 19 percent while that from motor-vehicle crashes sky-rocketed by 7,500 percent. In 1910 there were 468,500 vehicles registered in the United States and the death rate from these crashes was 0.2 per 100,000. In 1998, however, there were 215.4 million vehicles and a death rate of 15.2. Deaths due to solid and liquid poisonings ranged between 1,500 and 2,500 until the late 1960s and now number more than 8,000 annually. The increase is greatest among persons between the ages of 25 and 44 and is largely attributed to illegal drugs. Death rates in this category were lowest in the 1950s and now are as high as in the mid-1910s. Deaths due to falls fluctuated from about 7,400 in 1910 to nearly 25,000 annually in the 1940s, to about 11,400 in 1986, and to 16,600 in 1998. Death rates for age groups under 65 years are at their lowest while those for the 65 and older age group have been increasing. Drowning and firearms deaths have decreased fairly steadily since the early 1970s. Death rates for all age groups have shown steady reductions over the century and are now at or near their lowest points. The firearms death rate for 15-24 year olds, however, was and is substantially greater than all other age groups. The number of deaths due to fires and burns and gas and vapor poisonings have been declining since the mid-1960s and late 1970s respectively. Fire and burn death rates among young children and the elderly have shown the greatest improvement.

A clinical evaluation of 3M no sting barrier film.

The maintenance of healthy skin depends on factors such as moisture, the nutritional status of the patient, and mechanical forces. A barrier film can be a valuable adjunct in the prevention and treatment of injury to skin. One hospital evaluated barrier film, a new alcohol-free film-forming liquid skin protectant, in its geriatric and spinal cord rehabilitation units. A total of 33 patients were enrolled in the study. The purpose of the evaluation was to determine if barrier film reduced redness, assisted in the adhesion of dressing and condom catheters, prevented or reduced maceration, prevented or reduced skin stripping, and/or had any adverse effects on patients. Redness was reduced in 96% of patients who were at risk. Maceration was prevented in 94% of subjects, and skin stripping was prevented in 100% of patients. Dressing adhesion improved significantly in 90% of subjects. For all subjects, regardless of method of application, barrier film was easy to apply. No patient experienced any adverse effects during the study. On the basis of this clinical trial, we found barrier film to be an effective liquid skin sealant and protectant.

Hazards for nearby residents and cleanup workers of waste sites.

This study weighs the risks to workers of cleaning up Superfund sites against the risks to residents if the sites were not cleaned up. Risks are measured by the number of deaths and disabilities due to injuries and diseases, as well as by the costs of these deaths and disabilities. We posit three methods to clean up the sites: one that is labor-intensive and two that are not. We posit 24 hypothetical sites, with varying numbers of residents and levels of cancer death and cancer disability rates. Depending on the cleanup method, the number of residents, and the rates, we find that the risks to workers frequently outweigh the risks to residents. We conclude that risks to workers should be accounted for in Environmental Protection Agency judgments regarding which and how Superfund sites should be cleaned up.

Structural determinants of the abortion rate: a cross-societal analysis.

Data for a sample of 89 countries are used to examine societal-level predictors of the legal status of abortion and its incidence as indicated by abortion rates. Measures of socioeconomic development, women's labor force participation, and dominant religion are considered as predictors of abortion. Logistic regression analysis reveals that socioeconomic development has a positive effect on the probability of abortion being legal. Both a greater dominance of Catholicism and Islam in a society reduce the probability that abortion is legal. Results of tobit analyses show that development has curvilinear effects on abortion rates, with lower rates of abortion at both the lower and higher ends of development. Findings also indicate a positive effect of female labor force participation on the abortion rate that initially grows stronger with increases in socioeconomic development, but weakens with further increases. Finally, a greater proportion of Catholics in a population lowers the abortion rate.

PIP: This cross-societal analysis examines the net effects of socioeconomic development, women's labor force participation, and dominant religion on both the legality and incidence of abortion. Available abortion data for a sample of 89 countries was utilized in this study. The logistic regression analysis showed that socioeconomic development has a positive effect on the probability of abortion being legal. The predominance of Catholicism and Islam in a society significantly lowers the likelihood of legalizing abortion. In the tobit analysis, development has curvilinear effects on abortion rates, with lower rates of abortion at both the lower and higher ends of development. Results also indicate a positive effect of female labor force participation on the abortion rate, which initially grows stronger with increases in socioeconomic development but weakens with further increases. Lastly, a greater proportion of Catholics in a population lowers the abortion rate.

Assessment of fogging resistance of anti-fog personal eye protection.

The propensity for occupational eye protectors to fog in warm and moist conditions is often offered as a reason by workers not to wear occupational eye protection even where mandatory eye protection areas have been specified. A study of eye protection practices in the New South Wales coal mining industry identified the number one issue in underground coal mine conditions as being fogging of eye safety wear. Conventional anti-fog treatments and cleaners were considered by the miners as completely inadequate in these conditions. At the time of the study claims were being made for a new generation of lens treatments. These merited evaluation. Spectacles and goggles claimed to be fog resistant were obtained from manufacturers and suppliers and subjected to the test set out in BS EN 168 and the compliance criterion of BS EN 166. Some lenses claimed to be fog resistant failed the requirement, some new technology lenses showed arguably superior performance but failed the criterion of the standard. Modifications to the test procedure of BS EN 168 and acceptance criteria of BS EN 166 are proposed.

Fatal falls: trends and characteristics.

Falls accounted for more than 14,000 deaths and 22 million visits to hospitals and physicians' offices in 1996. They are the second leading cause of unintentional-injury death for people of all ages and the leading cause for people 79 years old and older. Fall death rates increase steadily with age and the death rate for men is always greater than the rate for women. Homes and resident institutions are the two most commonly named places where fatal falls occur. Fall death rates by state show no particular geographical patterns. There has been a significant decline in both numbers of deaths and death rates due to falls over the past 50 years. The improvement in the death rate has been achieved in all age groups. From 1948 to 1996, the death rate in each age group decreased between 61 percent and 80 percent. The change is most evident in the 65 and older age group, whose rate dropped from 136.8 per 100,000 persons to 33.1. Possible reasons for the decline in death rates include specific programs, such as "Children Can't Fly," and workplace fall protection programs; general factors such as improved acute care, rehabilitation and nutrition, as well as long-term changes in environmental factors such as design of and materials for stairs, steps and handrails; improved materials for shoe soles; and improved floor finishes and floor coverings.

Nursing management of pressure ulcers using a hydrogel dressing protocol: four case studies.

People with spinal cord injury (SCI) are at risk for developing pressure ulcers throughout their lives. Pressure ulcers can lead to significant morbidity, prolonged hospitalization, and diminished quality of life. Rehabilitation nurses play a vital role in preventing and treating pressure ulcers in these clients. In this article, the authors describe four case studies of clients with SCI who have pressure ulcers and discuss the implementation and outcome of a nursing management protocol based on the use of hydrogel dressings. These dressings have been found to promote wound healing, protect against contamination and infection, and reduce pain. They also are usually acceptable to the client and are cost-effective. Hydrogel dressings should be considered as one component of an individualized plan of care for the development of pressure ulcers.

Estimated risk of occupational fatalities associated with hazardous waste site remediation.

This study presents a method to assess short term traumatic fatality risks for workers involved in hazardous waste site remediation to provide a quantitative, rather than qualitative, basis for evaluating occupational exposures in remediation feasibility studies. Occupational employment and fatality data for the years 1979-1981 and 1983 were compiled from Bureau of Labor Statistics data for 11 states. These data were analyzed for 17 occupations associated with three common remediation alternatives: excavation and landfill, capping, and capping plus slurry wall. The two occupations with the highest death rates, truck driver and laborer, contributed most to total exposure hours in each alternative. Weighted average death rates were produced for each alternative and multiplied by respective total person-years of exposure. The resultant expected number of fatalities was converted, using the Poisson distribution, to the risk of experiencing at least one fatality, as follows: 0.149 for excavation and landfill, 0.012 for capping, and 0.014 for capping plus slurry wall. These risks were discussed in light of the need to obtain more reliable and comprehensive data than are currently available on the occupational safety and health risks associated with hazardous waste site remediation and the need for a more scientific, quantitative approach to remediation decisions involving risks to workers.

A proposed classification code for farm and agricultural injuries.

A fundamental problem with classifying agriculturally related injury is that there is neither a rational nor a comprehensive scheme for grouping incidents into categories describing actual exposures encountered on farms and in agricultural work. Current surveillance systems are unable to differentiate between work that is related to farm production and work that is not, and to include all exposed persons in the surveillance. The proposed Farm and Agricultural Injury Classification Code is a step toward overcoming these problems. When it was applied to previously analyzed fatality data, 40% of cases previously identified as farm production work were reclassified into other categories.

Sorsby's pseudoinflammatory macular dystrophy.

Forty-three additional members of a family described originally by Sorsby and Mason have been examined in order to typify pseudoinflammatory macular dystrophy more accurately. Six new affected members were identified by history alone and a further 7 were examined. Vision is lost from disciform macular degeneration generally during the 5th decade of life. Thereafter peripheral degeneration occurs in some affected members. Before loss of vision the fundus changes include fine drusen-like deposits at the level of Bruch's membrane, angioid streaks, and plaque-like deposits of yellow subretinal material in the macular region. These changes are different from those seen in dominant drusen.

Tears of detached retinal pigment epithelium.

Ripping of detached pigment epithelium appears to be a common sight-threatening complication of pigment epithelial detachments and occurs at the junction of the detachment and flat pigment epithelium. The characteristics of the detachment prior to the rip suggest that the tear occurs in pigment epithelium which is detached without its basement membrane. The tear is followed by retraction of the pigment epithelium, revealing bare Bruch's membrane. The defect may remain apparently unaltered, or may be recovered by normal looking pigment epithelium, but most commonly is replaced by a fibrous plaque. Most patients had a profound reduction in visual acuity.