Fall, Crush, Kick: Mechanisms and Outcomes in a Cohort of Equine-Related Injuries.

INTRODUCTION: The potential for significant traumatic injury to individuals who interact with horses remains high due to animal size, forces applied, and unpredictability. Despite an estimated 30 million riders in the United States annually, few recent publications have addressed this patient population. OBJECTIVES: This study describes characteristics of patients injured in interactions with horses, focusing on mechanism of injury and use of protective equipment. METHODS: We queried our institution's trauma registry for all patients admitted for equine-related injuries (ERI) between January 1, 2013 and December 31, 2017. We categorized by specific mechanism of injury (fall, crush, kick, fall + crush, and fall + kick) and presence or absence of protective devices. RESULTS: We discovered 143 patients admitted for injuries in equine-related accidents. Patients averaged 49.2 years old, and 62.2% were female. Crush injuries resulted in a high rate of rib fractures. Riders who were kicked had an increased chance of solid organ and facial injuries and falls most commonly led to rib fractures and extremity trauma. Despite lack of documentation on most subjects, protective devices were associated with less severe injuries in those with data (n = 36). CONCLUSIONS: In this relatively large series of patients with ERI, we found mechanism differences within injury groups. Providers should more carefully document specific circumstances of ERIs. All individuals working with or around horses should exercise prudence and consider using protective equipment.

Local climate change cultures: climate-relevant discursive practices in three emerging economies.

In recent decades, greater acknowledgement has been given to climate change as a cultural phenomenon. This paper takes a cultural lens to the topic of climate change, in which climate-relevant understandings are grounded in wider cultural, political and material contexts. We approach climate-relevant accounts at the level of the everyday, understood as a theoretically problematic and politically contested space This is in contrast to simply being the backdrop to mundane, repetitive actions contributing to environmental degradation and the site of mitigative actions. Taking discourse as a form of practice in which fragments of cultural knowledge are drawn on to construct our environmental problems, we investigate citizens' accounts of climate-relevant issues in three culturally diverse emerging economies: Brazil, South Africa and China. These settings are important because greenhouse gas (GHG) emissions are predicted to significantly increase in these countries in the future. We conducted semi-structured interviews with a range of citizens in each country using a narrative approach to contextualise climate-relevant issues as part of people's lifestyle narratives. Participants overwhelmingly framed their accounts in the context of locally-salient issues, and few accounts explicitly referred to the phenomenon of climate change. Instead, elements of climate changes were conflated with other environmental issues and related to a wide range of cultural assumptions that influenced understandings and implied particular ways of responding to environmental problems. We conclude that climate change scholars should address locally relevant understandings and develop dialogues that can wider meanings that construct climate-relevant issues in vernacular ways at the local level.

Compensatory and Catalyzing Beliefs: Their Relationship to Pro-environmental Behavior and Behavioral Spillover in Seven Countries.

There is growing research interest in behavioral spillover and its potential for enabling more widespread lifestyle change than has typically been achieved through discrete behavioral interventions. There are some routes by which spillover could take place without conscious attention or explicit recognition of the connections between separate behaviors. However, in many cases there is an expectation that an individual will perceive behaviors to be conceptually related, specifically in terms of their compensatory (suppressing further action) or catalyzing (promoting further action) properties, as a prerequisite for both negative and positive spillover. Despite this, relatively little research has been carried out to assess the beliefs that may underpin spillover processes as held by individuals themselves, or to measure these directly. We develop and evaluate a survey-based instrument for this purpose, doing so in a sample of seven countries worldwide: Brazil, China, Denmark, India, Poland, South Africa, and the United Kingdom (approx. 1,000 respondents per country). This approach allows us to assess these measures and to compare findings between countries. As part of this, we consider the connections between beliefs about behavioral relationships, and other key variables such as pro-environmental identity and personal preferences. We observe higher levels of endorsement of compensatory beliefs than previous research, and even higher levels of endorsement of novel items assessing catalyzing beliefs. For the first time, we present evidence of the validity of such measures with respect to comparable constructs, and in relation to people's consistency across different types of behaviors. We reflect on the implications of considering the relationships between behaviors in the context of people's subjective beliefs and offer recommendations for developing this line of research in the broader context of spillover research and within a cross-cultural framework.

Reflecting on Behavioral Spillover in Context: How Do Behavioral Motivations and Awareness Catalyze Other Environmentally Responsible Actions in Brazil, China, and Denmark?

Responding to serious environmental problems, requires urgent and fundamental shifts in our day-to-day lifestyles. This paper employs a qualitative, cross-cultural approach to explore people's subjective self-reflections on their experiences of pro-environmental behavioral spillover in three countries; Brazil, China, and Denmark. Behavioral spillover is an appealing yet elusive phenomenon, but offers a potential way of encouraging wider, voluntary lifestyle shifts beyond the scope of single behavior change interventions. Behavioral spillover theory proposes that engaging in one pro-environmental action can catalyze the performance of others. To date, evidence for the phenomenon has been mixed, and the causal processes governing relationships between behaviors appear complex, inconsistent and only partly understood. This paper addresses a gap in the literature by investigating accounts of behavioral spillover in three diverse cultural settings using qualitative semi-structured interviews. The analysis shows that while around half of participants overall who were questioned recalled spillover effects, the other half had not consciously experienced spillover. There were few significant differences across cultures, though some forms of spillover effects were reported more in some cultures than others. More environmentally engaged participants across all three countries were significantly more likely to experience spillover than those who were less engaged. Accounts of within-domain spillovers were most commonly reported, mainly comprising waste, resource conservation and consumption-related actions. Accounts of between-domain spillover were very rare. Recollection of contextual and interpersonal spillover effects also emerged from the interviews. Our findings suggest that more conscious behavioral spillover pathways may be limited to those with pre-existing environmental values. Behavioral spillover may comprise multiple pathways incorporating conscious and unconscious processes. We conclude that targeting behavioral catalysts that generate more socially diffuse spillover effects could offer more potential than conventional spillover involving a single individual.

Is Obesity Protective in Thoracoabdominal Penetrating Trauma?

The incidence of obesity has been increasing in the United States, and the medical care of obese patients after injury is complex. Obesity has been linked to increased morbidity after blunt trauma. Whether increased girth protects abdominal organs from penetrating injury or complicates management from obesity-associated medical comorbidities after penetrating injury has not been well defined. All patients admitted with penetrating injury between January 1, 2010, and December 31, 2013, at a university-affiliated Level I center trauma center were reviewed. Primary endpoints for analysis were the presence of significant injuries requiring operative intervention and outcomes, including inpatient complications. Logistic regression, chi-squared tests, and the Kruskal-Wallis test were used to compare groups. Five hundred patients were included in the study; 225 with stabs and 275 with gunshot wounds (GSWs). In each group, there was no major difference between obese and nonobese patients in regard to injury location, operative approach, or postoperative outcomes. Unadjusted odds ratios comparing both overweight and obese individuals to normal BMI patients did not suggest a decreased rate of therapeutic operations for either population after stabs or GSWs. In obese or overweight patients, there is no difference in the rate of operative intervention for significant injuries after penetrating axial trauma compared with a normal BMI population. On the other hand, obesity was not associated with prolonged length of stay, increased complications, or death after penetrating injuries.

Perceptions of Local Environmental Issues and the Relevance of Climate Change in Nepal's Terai: Perspectives From Two Communities.

The direct and indirect impacts of global climate change entail serious consequences for global biophysical and social systems, including the health, well-being and sustainability of communities. These impacts are especially serious for vulnerable groups in economically developing societies. While climate change is a global phenomenon, it is at the local level that impacts are most felt, and from where responses to climate change are enacted. It is increasingly urgent that communities possess the capacity to respond to climate change, now and in the future. Community representations of climate-relevant issues are critical to underpinning responses. Environmental representations do not directly reflect actual physical conditions but are interpreted through social and cultural layers of understanding that shape environmental issues. This paper investigates environmental and climate-relevant perceptions within two communities in the Terai region of Nepal; the city of Bharatpur and the village of Kumroj in Chitwan Province. Following mixed findings on levels of climate change awareness in Nepal, we set out to explore perspectives on the environment and climate change awareness by conducting 30 qualitative interviews with local people. The study found that issues linked to sanitation and cleanliness were most important in both communities, while reports of temperature and weather changes were less common and typically linked to local causes rather than climate change. Imagined futures were also closely related to current environmental issues affecting communities and did not discuss climate change, though temperature and weather changes were anticipated. However, when talk of climate change was deliberately elicited, participants displayed their awareness, though this was rarely linked to local conditions. We conclude that, in light of other pressing local issues, climate change is yet to penetrate the environmental representations of some communities and there is a need to address the disconnect between local issues and global climate change. Making climate change relevant at the local level by connecting to salient local issues and co-benefits comprises an important step in bridging the gap between more global awareness and its relevance more locally, particularly for communities at risk.

Necrotizing Soft Tissue Infections: A Review.

BACKGROUND: Soft tissue infections are a common reason for general surgical consultation. Necrotizing soft tissue infections (NSTI) are a rapidly progressive form of this infection that account for significant morbidity and many deaths. METHODS: Review of relevant English-language publications. RESULTS: There are approximately 500-1,500 cases of NSTI annually in the United States, although accurate estimates of their frequency are difficult to obtain. These infections may be polymicrobial or monomicrobial, and substantial regional heterogeneity exists regarding anatomic location and the involved organisms. Source control with early surgical debridement and targeted anti-microbial therapy are the mainstays of treatment. CONCLUSION: Necrotizing soft tissue infections remain a common indication for general surgical consultation. Early diagnosis and prompt surgical treatment are essential for effective control.

Not All Abdomens Are the Same: A Comparison of Damage Control Surgery for Intra-abdominal Sepsis versus Trauma.

Damage control surgery (DCS) was developed to manage exsanguinating trauma patients, but is increasingly applied to the management of peritoneal sepsis and abdominal catastrophes. Few manuscripts compare the outcomes of these surgeries on disparate patient populations. A multi-institutional three group propensity score matched case cohort study comparing penetrating trauma (PT-DCS), blunt trauma (BT-DCS), and intraperitoneal sepsis (IPS-DCS) was performed comparing patients treated with DSC between 2008 and 2013. Propensity scoring was performed using demographic and presenting physiologic data. Four hundred and twelve patients were treated with DCS across two institutions. Propensity matching for age, gender, and initial Acute Physiology and Chronic Health Evaluation II score 80 identified 80 patients per group for comparison. Rate of primary fascial closure was lowest in the IPS-DCS group, and highest in the penetrating trauma DCS group. Intra-abdominal complication rates were highest in the IPS-DCS group. IPS-DCS had increased time to definitive closure compared with the other two groups (RR 1.8; 1.3-2.2; P < 0.03). Mortality at 90 days was highest in the IPS-DCS group and patients whose definitive closure was delayed >eight days were more than twice the risk of death at 90 days across all groups. (RR 2.15; 1.2-3.5; P < 0.002). Expected outcomes after the use of DCS for trauma and emergency general surgery are quite different. Despite this difference, prompt abdominal closure at the earliest possible opportunity afforded the best outcome in patients managed via DCS.

Seat Belt Use and its Effect on Abdominal Trauma: A National Trauma Databank Study.

We sought to use the National Trauma Databank to determine the demographics, injury distribution, associated abdominal injuries, and outcomes of those patients who are restrained versus unrestrained. All victims of motor vehicle collisions (MVCs) were identified from the National Trauma Databank and stratified into subpopulations depending on the use of seat belts. A total of 150,161 MVC victims were included in this study, 72,394 (48%) were belted. Young, male passengers were the least likely to be wearing a seat belt. Restrained victims were less likely to have severe injury as measured by Injury Severity Score and Abbreviated Injury Score. Restrained victims were also less likely to suffer solid organ injuries (9.7% vs 12%, P < 0.001), but more likely to have hollow viscous injuries (1.9% vs 1.3%, P < 0.001). The hospital and intensive care unit length of stay were significantly shorter in belted victims with adjusted mean difference: -1.36 (-1.45, -1.27) and -0.96 (-1.02, -0.90), respectively. Seat belt use was associated with a significantly lower crude mortality than unrestrained victims (1.9% vs 3.3%, P < 0.001), and after adjusting for differences in age, gender, position in vehicle, and deployment of air bags, the protective effect remained (adjusted odds ratio for mortality 0.50, 95% confidence interval 0.47, 0.54). In conclusion, MVC victims wearing seat belts have a significant reduction in the severity of injuries in all body areas, lower mortality, a shorter hospital stay, and decreased length of stay in the intensive care unit. The nature of abdominal injuries, however, was significantly different, with a higher incidence of hollow viscous injury in those wearing seat belts.