bluuebunny/crossref_metadata_2025 huggingface dataset:
Combination of Drugs and Drug-Resistant Reverse Transcriptase Results in a Multiplicative Increase of Human Immunodeficiency Virus Type 1 Mutant Frequencies
Authors: Mansky Louis M. , Pearl Dennis K. , Gajary Lisa C.
Published: October 2002

Replication of drug-resistant human immunodeficiency virus type 1 (HIV-1) in the presence of drug can lead to the failure of antiretroviral drug treatment. Drug failure is associated with the accumulation of drug resistance mutations. Previous studies have shown that 3′-azido-3′-deoxythymidine (AZT), (−)2′,3′-dideoxy-3′-thiacytidine (3TC), and AZT-resistant HIV-1 reverse transcriptase (RT) can increase the virus in vivo mutation rate. In this study, the combined effects of drug-resistant RT and antiretroviral drugs on the HIV-1 mutant frequency were determined. In most cases, a multiplicative effect was observed with AZT-resistant or AZT/3TC dually resistant RT and several drugs (i.e., AZT, 3TC, hydroxyurea, and thymidine) and led to increases in the odds of recovering virus mutants to over 20 times that of the HIV-1 mutant frequency in the absence of drug or drug-resistance mutations. This observation indicates that HIV-1 can mutate at a significantly higher rate when drug-resistant virus replicates in the presence of drug. These increased mutant frequencies could have important implications for HIV-1 population dynamics and drug therapy regimens.
Hepatitis C Virus Core Protein Leads to Immune Suppression and Liver Damage in a Transgenic Murine Model
Authors: Soguero Carolina , Joo Myungsoo , Chianese-Bullock Kimberly A. , Nguyen Duong Tony , Tung Kenneth , Hahn Young S.
Published: October 2002

Hepatitis C virus (HCV) is remarkably efficient in establishing persistent infection, possibly mediated by an impaired immune response to HCV infection. There is compelling evidence that HCV can infect immune cells, such as macrophages, B cells, and T cells. It has been previously reported that HCV core, the first protein expressed during the early phase of viral infection, contains the immunomodulatory function of suppressing host immune responses. This altered function of immune cells caused by HCV infection may explain the ineffective immune response to HCV. To further characterize the immunomodulatory role of HCV core in vivo, we generated transgenic (TG) mice by directing the expression of core protein to T lymphocytes by using the CD2 promoter. T-lymphocyte responses, including the production of gamma interferon and interleukin-2, were significantly diminished in these mice compared to their non-TG littermates. The inhibition of T-lymphocyte responsiveness may be due to the increased susceptibility of peripheral T lymphocytes to Fas-mediated apoptosis. Surprisingly, significant lymphocyte infiltration was observed in the portal tracts of livers isolated from core TG mice, associated with increasing serum alanine aminotransferase levels. Moreover, no intrahepatic lymphocytes or liver damage was found in non-TG littermates and core TG mice bred to Fas-deficientlprmice. These results suggest that HCV core drives liver injury by increasing Fas-mediated apoptosis and liver infiltration of peripheral T cells.
The Epstein-Barr Virus SM Protein Is Functionally Similar to ICP27 from Herpes Simplex Virus in Viral Infections
Authors: Boyer Julie L. , Swaminathan Sankar , Silverstein Saul J.
Published: October 2002

The herpes simplex virus type 1 (HSV-1) ICP27 protein is an essential RNA-binding protein that shuttles between the nucleus and cytoplasm to increase the cytoplasmic accumulation of viral late mRNAs. ICP27 homologs have been identified in each of the herpesvirus subfamilies, and accumulating evidence indicates that homologs from the gammaherpesvirus subfamily function similarly to ICP27. In particular, the Epstein-Barr virus (EBV) SM protein posttranscriptionally regulates gene expression, binds RNA in vitro and in vivo, and shuttles between the nucleus and cytoplasm. To determine if these two proteins function through a common mechanism, the ability of EBV SM to complement the growth defect of an HSV-1 ICP27-null virus was examined in a transient-expression assay. ICP27 stimulated the growth of the null mutant more efficiently than did SM, but the ability of SM to compensate for the ICP27 defects suggests conservation of common functions. To assay for complementation in the context of a viral infection, the growth properties of an HSV recombinant expressing SM in an ICP27-null background were analyzed. SM stimulated growth of the recombinant, although this growth was reduced by comparison to that of an ICP27-expressing virus. By contrast, an HSV recombinant expressing an SM mutant allele defective for transactivation activity and nucleocytoplasmic shuttling did not grow at all. These results suggest that SM and ICP27 may regulate gene expression through a common pathway that is evolutionarily conserved in herpesviruses.
Baculovirus Transregulator IE1 Requires a Dimeric Nuclear Localization Element for Nuclear Import and Promoter Activation
Authors: Olson Victoria A. , Wetter Justin A. , Friesen Paul D.
Published: October 2002

Immediate-early protein IE1 is a principal regulator of viral transcription and a contributor to origin-specific DNA replication of the baculovirus
Autographa californica
multicapsid nucleopolyhedrovirus (Ac
M
NPV). Since these viral functions involve interaction of dimeric IE1 with palindromic homologous region (
hr
) enhancer-origin elements of the Ac
M
NPV genome within the nucleus, it is presumed that proper nuclear transport of IE1 is essential for productive infection. To investigate the mechanisms of IE1 nuclear import, we analyzed the effect of site-directed mutations on IE1 subcellular distribution. As demonstrated by fluorescence microscopy and biochemical fractionation of plasmid-transfected cells, wild-type IE1 localized predominantly to the nucleus. Substitution or deletion of amino acid residues within a positively charged domain (residues 534 to 538) adjacent to IE1's oligomerization motif impaired nuclear import and caused loss of transactivation. Moreover, upon coexpression, these import-defective mutations prevented nuclear entry of wild-type IE1. In contrast, double-mutated IE1 defective for both nuclear import and dimerization failed to block nuclear entry or transactivation by wild-type IE1. Thus, import-defective IE1 dominantly interfered with wild-type IE1 by direct interaction and cytosolic trapping. Collectively, our data indicate that the small basic domain encompassing residues R
537
and R
538
constitutes a novel nuclear localization element that functions only upon IE1 dimerization. These findings support a model wherein IE1 oligomerizes within the cytosol as a prerequisite for nuclear entry and subsequent high-affinity interaction with the symmetrical binding sites comprising Ac
M
NPV
hr
enhancer-origin elements.
Growth of Rotaviruses in Primary Pancreatic Cells
Authors: Coulson Barbara S. , Witterick Paul D. , Tan Yan , Hewish Marilyn J. , Mountford Joanne N. , Harrison Leonard C. , Honeyman Margo C.
Published: October 2002

Rotavirus infection in children at risk of developing type 1 diabetes has been temporally associated with development of pancreatic islet autoantibodies. In this study, nonobese diabetic mice were shown to be susceptible to rhesus rotavirus infection and pancreatic islets from nonobese diabetic mice, nonobese diabetes-resistant mice, fetal pigs, and macaque monkeys supported various degrees of rotavirus growth. Human rotaviruses replicated in monkey islets only. This islet susceptibility shows that rotavirus infection of the pancreas in vivo might be possible.
New Multigram-Scale Preparation of 1,10-Dicarba-closo-decaborane
Authors: Holub Josef , Jelínek Tomáš , Janoušek Zbyněk
Published: October 2002

Ten vertex p-carborane, 1,10-C2B8H10 (1), has been prepared in high yield from nido-carborane 5,6-C2B8H12 (2) in one pot reaction by thermal dehydrogenation followed by skeletal rearrangement.
13-Vertex Carbacobaltaboranes: Synthesis and Molecular Structures of the 4,1,6-, 4,1,8- and 4,1,12-Isomers of Cp*CoC2B10H12
Authors: Burke Anthony , McIntosh Ruaraidh , Ellis David , Rosair Georgina M. , Welch Alan J.
Published: October 2002

Attempted crystallographic studies of the known compounds 4-Cp-4,1,8-closo-CoC2B10H12 and 4-Cp-4,1,12-closo-CoC2B10H12 were frustrated because of disorder which was impossible satisfactorily to model. Thus the family of Cp* compounds 4-Cp*-4,1,6-closo-CoC2B10H12, 4-Cp*-4,1,8-closo-CoC2B10H12 and 4-Cp*-4,1,12-closo-CoC2B10H12 were prepared. The 11B NMR spectroscopic properties of these compounds are closely similar to those of their Cp analogues. All three compounds were studied crystallographically. The 4,1,8- and 4,1,12-species are isomorphous and partially disordered, however the disorder was successfully modelled and structural analyses of 4,1,8- and 4,1,12-MC2B10 compounds are reported for the first time. A new technique for distinguishing between cage C and B atoms in crystallographic study of (hetero)carboranes is reported. The 12-vertex compound 3-Cp*-3,1,2-closo-CoC2B9H11 is formed as a minor co-product along with 4-Cp*-4,1,6-closo-CoC2B10H12 and is believed to result from partial degradation of the latter. The 12-vertex species has also been subjected to crystallographic analysis.
Monocarbaborane Anion Chemistry. Syntheses and Structures Within the closo Nine-Vertex System
Authors: Jelínek Tomáš , Thornton-Pett Mark , Kennedy John D.
Published: October 2002

Reaction of HCHO with B10H14 under aqueous alkaline conditions yields the arachno 10-vertex [6-CB9H14]- anion 2 (60%) which upon solid-state thermolysis as its Cs+ salt yields the closo 9-vertex [4-CB8H9]- anion 1 (45%). MeCHO reacts similarly to give the C-methylated arachno [6-Me-6-CB9H13]- anion 4 (37%) which upon thermolysis gives the closo [4-Me-4-CB8H8]- anion 3 (72%). PhCHO with B10H14 under alkaline conditions gives the nido 10-vertex [6-Ph-6-CB9H11]- anion 6 (85%) which upon thermolysis of its [NEt4]+ salt gives the closo [4-Ph-4-CB8H8]- anion 5 (73%). In a preliminary iodination investigation, unsubstituted closo anion 1 with elemental I2 in CH2Cl2 gives approximately equimolar closo [4-CB8H8-3-I]- 12 and closo [4-CB8H8-5-I]- 13 (ca 60%) and smaller amounts of closo [4-CB8H7-5,6-I2]- 14 (12%). The [NEt4]+ salts of 1, 3 and 5 are characterised crystallographically, as is the [PMePh3]+ salt of 12.
An audit of first aid qualifications and knowledge among team officials in two English youth football leagues: a preliminary study
Authors: Cunningham A
Published: October 2002

Objectives: To determine if youth football officials responsible for dealing with injuries have appropriate first aid qualifications and knowledge?

Methods: Information was collected from two youth football leagues by questionnaire. First aiders were asked to provide details of their qualifications and their response from a list of alternatives to an injury scenario.

Results: Fifty two of 86 respondents did not have a current first aid qualification. Only 12% and 38% respectively gave the correct response to the injury scenarios “player choking” and “player unconscious”. Health and injury records for the players were kept by 40% and 19% of teams. Written parental consent to emergency treatment was obtained by 30%.

Conclusion: This preliminary study shows an obligation on teams who do not possess a qualified first aider to evaluate their legal and moral responsibilities to their players. The Football Association and Health and Safety Executive should produce a list of recommended equipment, facilities, and first aid qualified personnel to which teams should have access at games and training sessions. Providers of first aid training should reassess their teaching of the management of the choking and unconscious casualty.
Children are not goldfish—mark/recapture techniques and their application to injury data
Authors: Jarvis Stephen N , Lowe Philip J , Avery Alison , Levene Sara , Cormack Richard M
Published: October 2002

Objectives—Mark/recapture (or capture-recapture) is a simple technique commonly applied to estimate the hypothetical total (including undercount) in a register composed of cases from two or more independent and separately incomplete case lists. This paper seeks to illustrate serious drawbacks in the use of the mark/recapture technique when applied to injuries.

Setting and subjects—Northumbrian children under 15 years of age who were seriously injured in motor vehicle accidents (MVAs) over a five year period ascertained from two data sources: police reports and hospital inpatient records.

Methods—Individuals (n) appearing in both police (S) and hospital (H) case lists are identified using various matching criteria. The separate and combined influence of age, sex, and casualty class (cyclist, passengers, pedestrians) on the probability of such matching is estimated using multivariate techniques. The hypothetical total incidence of child MVA victims (N) is calculated from N = (S × H)/n.

Main outcomes—Estimates of the incidences of “serious” injuries in MVAs under various conditions of stratification and matching. The overall procedure is tested for conformity with accepted criteria for valid use of mark/recapture.

Results—About one third of the 1009 police and 836 hospital records could be exactly matched. There were significant variations in matching proportions by class of accident (pedestrianvpassengervcyclist). This selective recapture or “heterogeneity” was not affected by sex, but was independently influenced by the age of the child. Further uncertainty was introduced when matching criteria were slightly relaxed. Estimates of the total population of children with serious injuries vary accordingly from 1729 to 2743. A number of plausible reasons why these two data sources might not be unbiased or mutually independent samples of the total target population are proposed as explanations for this heterogeneity.

Conclusion—This typical example of two sample mark/recapture estimation in an epidemiological setting can be shown to violate virtually all the requirements for valid use of the technique. Very little can be deduced accurately about the scale or characteristics of an unobserved group by the use of mark/recapture applied to two overlapping health event registers.
Testing the impact attenuation of loose-fill playground surfaces
Authors: Mack Mick G , Sacks Jeffrey J , Thompson Donna
Published: October 2002

Objectives—Our objective was to measure the impact attenuation performance of five types of loose-fill playground surfaces at a variety of drop heights, material depths, and conditions.

Methods—In a laboratory setting, an instrumented head form was dropped on varying depths of loose-fill materials at one foot height increments until critical deceleration values were exceeded. The effects of test box size, material temperature, and compression were also studied.

Results—Data suggest that a larger test box size influences test results. Uncompressed materials performed quite unexpectedly, that is, resilience did not necessarily increase with increasing depth of material and temperature did not have uniform effects. Compression before testing improved consistency of results.

Conclusion—The current standard test procedure (ASTM F1292) appears problematic for loose-fill materials. Our results indicate that (1) shredded rubber was the best performer; (2) there was little difference between sand, wood fibers, and wood chips; and (3) pea gravel had the worst performance, making it a poor choice for playground surfacing.
Sequelae after unintentional injuries to children: an exploratory study
Authors: Tursz Anne , Crost Monique
Published: October 2002

Goal—To determine the frequency and categories of sequelae related to accidental injuries (of all types) in childhood, a prospective follow up study was conducted on a geographically defined population near Paris, France.

Methods—The study concerned all child residents of one health care district, aged under 15 years, and hospitalised in the two public hospitals of the district, and/or transported by mobile emergency units, after an accident, during a one year period (in 1981–82; n = 785). Initial severity was scored using the injury severity score (ISS). Sequelae were defined as established impairments (leading or not to disabilities), identified by physicians, reporting their clinical diagnosis or complaints by the child and/or the family.

Results—After a follow up period of 3.6–29.2 months after the accident, six children died and 78 (10%) were lost to follow up. Among the 701 others, 73 (10.4%) presented 80 sequelae, major (limiting daily activities) in 44 children (6.3%), with no gender difference. These increased significantly with age. The main causes of major sequelae were eye injuries and sports related injuries to the limbs. ISS did not correlate well with sequelae, but the maximum abbreviated injury scale appeared to be a better predictor of long term functional prognosis.

Conclusion—Prospective follow up and population based studies are still needed, especially on children's injuries initially perceived as benign, such as most of the sports related injuries in our study.
Comparison of work related fatal injuries in the United States, Australia, and New Zealand: method and overall findings
Authors: Feyer A-M , Williamson A M , Stout N , Driscoll T , Usher H , Langley J D
Published: October 2002

Objectives—To compare the extent, distribution, and nature of fatal occupational injury in New Zealand, Australia, and the United States.

Setting—Workplaces in New Zealand, Australia, and the United States.

Methods—Data collections based on vital records were used to compare overall rates and distribution of fatal injuries covering the period 1989–92 in Australia and the United States, and 1985–94 in New Zealand. Household labour force data (Australia and the United States) and census data (New Zealand) provided denominator data for calculation of rates. Case definition, case inclusion criteria, and classification of occupation and industry were harmonised across the three datasets.

Results—New Zealand had the highest average annual rate (4.9/100 000), Australia an intermediate rate (3.8/100 000), and the United States the lowest rate (3.2/100 000) of fatal occupational injury. Much of the difference between countries was accounted for by differences in industry distribution. In each country, male workers, older workers, and those working in agriculture, forestry and fishing, in mining and in construction, were consistently at higher risk. Intentional fatal injury was more common in the United States, being rare in both Australia and New Zealand. This difference is likely to be reflected in the more common incidence of work related fatal injuries for sales workers in the United States compared with Australia and New Zealand.

Conclusions—The present results contrasted with those obtained by a recent study that used published omnibus statistics, both in terms of absolute rates and relative ranking of the three countries. Such differences underscore the importance of using like datasets for international comparisons. The consistency of high risk areas across comparable data from comparable nations provides clear targets for further attention. At this stage, however, it is unclear whether the same specific occupations and/or hazards are contributing to the aggregated industry and occupation group rates reported here.
Injuries among children and youth in farm households: Regional Rural Injury Study-I
Authors: Gerberich S G , Gibson R W , French L R , Renier C M , Lee T-Y , Carr W P , Shutske J
Published: October 2002

Objectives—The purpose of this effort was to identify the incidence and consequences of both farming and non-farming related injuries and the potential risk factors for farming related injuries among children and youth, aged 0–19 years, who lived in farm households in a large region of the United States.

Methods—Data were collected from randomly selected farm households during 1990. Rates and rate ratios with 95% confidence intervals were calculated for sociodemographic and exposure variables. Multivariate analyses were conducted, using a priori and backward stepwise logistic regression models.

Results—Within the population of 3939 farm households and 13 144 persons, children and youth accounted for 33%. Injury rates for farming and non-farming sources, respectively, were 1683 and 6980 per 100 000 persons. Animals (40%) were the primary sources of the farming operation related injuries; sports/recreation sources (61%) were associated primarily with non-farming related injuries. Of the farming and non-farming operation related injury cases, 83% and 90%, respectively, required some type of health care; moreover, 17% and 24%, respectively, were restricted from regular activities for one month or more. Through multivariate analyses, important increased rate ratios were observed for operating a tractor, working with dairy cattle, and being male. Increased rate ratios for working with beef cattle, operating a harvester, and living on a farm where there were all terrain vehicles in use, and a decreased rate ratio for living on a farm where there were sheep, appeared suggestive.

Conclusions—Based on the relevant rates, injury consequences, and potential risk factors identified, injuries to children and youth on farms represent a significant problem. Future analytic studies are essential to identify more specific risk factors that can serve as a basis for development of appropriate intervention efforts. Given the population at risk, and the opportunity for intervention in this unique occupational setting, many of these injuries may be readily amenable to prevention efforts.
Potential benefits of restrictions on the transport of teenage passengers by 16 and 17 year old drivers
Authors: Chen L-H , Braver E R , Baker S P , Li G
Published: October 2002

Objectives—The presence of passengers is associated with fatal motor vehicle crashes of teenage drivers. A restriction against newly licensed teenage drivers carrying passengers has been included in some, but not all, graduated licensing systems. The purpose of this study was to predict the net effects on all types of road users, including vehicle occupants and non-occupants, of possible prohibitions against 16–17 year old drivers carrying passengers.

Methods—Two national datasets, a census of fatal crashes and a sample of trips in the United States, were used to compute 1995 road user death rates. Potential effects of restrictions on drivers ages 16–17 carrying passengers younger than 20 were estimated, based on road user death rates and potential choices made by passengers who would have traveled with 16–17 year old drivers if there were no restrictions.

Results—There were 1181 road user deaths in 1995 involving drivers ages 16–17 whose passengers were all younger than age 20. The predicted number of lives in the United States that would be saved annually ranges from 83 to 493 (corresponding to reductions of 7–42% in road user deaths) for drivers ages 16 and 17 combined. Similar percentages of reductions (8–44%) were predicted solely for 16 year old drivers. Assuming passenger restrictions would apply to all 16 year old drivers and at least one third of 17 year old drivers, an estimated 60–344 fewer deaths per year may occur if restrictions are mandated.

Conclusions—Restrictions on carrying passengers younger than 20 should be considered for inclusion in graduated licensing systems. Even if fewer than half the drivers obey the restrictions, a substantial reduction in road user deaths would be expected. Further evaluation based on real world experience is needed to confirm their efficacy.
Pupil injury risks as a function of physical and psychosocial environmental problems experienced at school
Authors: Laflamme L , Menckel E
Published: October 2002

Objectives—To investigate relations between physical and psychosocial environmental problems in schools, as perceived by school principals, and injuries among pupils.

Method—Proportionate injury ratios (PIRs) were computed for 77 public sector Swedish schools (33 248 pupils), and divided into four classes based on types of environmental problems reported. Sports related injuries, injuries during recesses, and violence related injuries were considered.

Results—The schools reporting psychosocial problems (9.1% of schools and 7.3% of pupils) had more injuries than expected by chance than all types of injuries aggregated (PIR = 1.92; 95% confidence interval (CI) 1.64 to 2.27), and in the case of sports related injuries (PIR = 1.79; 95% CI 1.37 to 2.34) and injuries due to physical violence (PIR = 2.20; 95% CI 1.33 to 3.65). There were no significant excess risks of injuries for schools facing physical problems or a combination of physical and psychosocial problems.

Conclusions—Psychosocial problems may exacerbate the risk of intentional and unintentional injuries among pupils. The results offer a reminder that school environment must be planned as part of any assessment of youth safety.
Booster seats for child passengers: lessons for increasing their use
Authors: Rivara F P , Bennett E , Crispin B , Kruger K , Ebel B , Sarewitz A
Published: October 2002

Objective—To explore parental knowledge, attitudes, beliefs, and barriers to use of booster seats in cars for 4–8 year old children.

Methods—Three focus groups conducted by a professional marketing firm.

Results—Many parents were confused about the appropriate weight and age of children who should be in booster seats; most parents incorrectly identified the age at which it was safe to use a lap-shoulder belt. Legislation was viewed as a positive factor in encouraging use. Cost of seats was frequently cited as a barrier to ownership, as were child resistance, peer pressure from older children, the need to accommodate other children in the vehicle, and the belief that a lap belt was adequate. Messages from health care providers, emergency medical services, or law enforcement personnel were believed to be most effective.

Conclusion—Campaigns to promote booster seat use should address issues of knowledge about appropriate age and size of the child, cost, inadequacy of lap belts, and resistance to use by the child.
Bicycle helmet use among schoolchildren—the influence of parental involvement and children's attitudes
Authors: Berg P , Westerling R
Published: October 2002

Objective—To study attitudes towards and use of bicycle helmets among schoolchildren; to determine whether these attitudes are associated with the involvement of parents and school in bike safety.

Settings—Nine intermediate level schools and five upper level schools in two Swedish municipalities.

Method—A survey with 1485 participants aimed at pupils aged 12–15 years conducted during late spring 1997. Associations between parent and school involvement and children's attitudes and helmet use were studied using LisRel analyses.

Result—At some point during their school years, a majority of the children stopped wearing bicycle helmets. Of 12–13 year olds, 80% said that they had used helmets when they were younger but at the time of the study, only 3% aged 14–15 years used helmets. Use decreased significantly during school years (p<0.001). The majority stated they quit using helmets because they were ugly, silly, uncomfortable, or inconvenient. There was a strong association between parental involvement, children's attitudes, and helmet use. However, parent involvement decreased as the children grew older.

Conclusion—To increase the voluntary use of bicycle helmets among schoolchildren their attitudes must be influenced. An intervention aimed at both parents and children may be required.
Barriers to safe hot tap water: results from a national study of New Zealand plumbers
Authors: Jaye C , Simpson J C , Langley J D
Published: October 2002

Introduction—Many countries still have unacceptably high hospitalizations and deaths from scalds from hot tap water. Prevention strategies implemented in some countries may not work in others. Legislation aimed at changing environments that are conducive to hot tap water scalds may not be effective in many situations for a number of reasons, including lack of acceptability and practicality.

Method—A qualitative study of a purposefully selected group of craftsman plumbers across New Zealand was conducted using a structured format with open ended questions. The questionnaire was administered by telephone. Information was sought on the opinions, knowledge, and practice of these plumbers regarding hot tap water safety in homes.

Results—Several barriers to hot tap water safety in homes were identified by the plumbers. These included common characteristics of homes with unsafe hot tap water, such as hot water systems heated by solid fuel, and public ignorance of hot tap water safety. Other factors that emerged from the analysis included a lack of knowledge by plumbers of the hazards of hot tap water, as well as a lack of importance given to hot tap water safety in their plumbing practice. Shower performance and the threat to health posed by legionella were prioritized over the prevention of hot tap water scalds.

Conclusion—The findings of this study allow an understanding of the practical barriers to safe hot tap water and the context in which interventions have been applied, often unsuccessfully. This study suggests that plumbers can represent a barrier if they lack knowledge, skills, or commitment to hot tap water safety. Conversely, they represent a potential source of advocacy and practical expertise if well informed, skilled, and committed to hot tap water safety.
Hospitalized fall injuries and race in California
Authors: Ellis A A , Trent R B
Published: October 2002

Objective—To compare risks for falls and their consequences among four major race/ethnic groups in California.

Methods—Cases are 104 902 hospital discharges of California residents with a same level fall injury as the principal external cause of injury. Included are all discharges for a first hospitalization for a given injury in any California non-federal hospital from 1995–97. Analysis includes crude and age standardized rates to describe risks, diagnoses, and consequences.

Results—Rates per 100 000 for same level hospitalized fall injuries for whites (161) are distinctively higher than for blacks (64), Hispanics (43), and Asian/Pacific Islanders (35). Whites are more likely to have a fracture diagnosis and to be discharged to long term care rather than home, suggesting a poorer outcome or greater severity. Same level falls absorb a large proportion of hospital resources directed to the treatment of injuries.

Conclusions—In a four way comparison among race/ethnic groups, whites are distinguished by their high incidence, rates of fracture, and unfavorable discharge status. Prevention, particularly aimed at whites, has potential to improve health and save treatment resources.
Dog bite and injury prevention—analysis, critical review, and research agenda
Authors: Ozanne-Smith J , Ashby K , Stathakis V Z
Published: October 2002

Objectives—To analyze Australian dog bite injury data and make international comparisons; to review risk and protective factors relating to the dog, injured person, and environment; and to recommend action for prevention and research.

Methods—Australian dog bite injury data, complemented by detailed Victorian and regional data from routine health records and vital statistics, were analyzed to determine incidence, severity, nature, circumstances, and trends. International comparison data were extracted from published reports. Risk and protective factor studies were selected for review from electronic and bibliographic searches where data were recent, sample sizes substantial, and bias limited.

Results—The Australian dog bite death rate (0.004/100 000) is lower than both the United States (0.05–0.07/100 000) and Canadian rates (0.007/100 000). Victorian hospitalized trend rates were stable between 1987 and 1998, but there was a decline for children <5 years (p=0.019) corresponding with a reduction in dog ownership. Children 0–4 years have the highest rate of serious injury, particularly facial. Adults have longer hospitalizations, most frequently for upper extremity injury. Risk factors include: child, males, households with dogs, certain breeds, male dogs, home location, and leashed dog.

Conclusions—Dog bite rates are high and it may therefore be assumed that current preventative interventions are inadequate. Responsible dog ownership, including separating young children from dogs, avoiding high risk dogs, neutering, regulatory enforcement, and standardized monitoring of bite rates are required. Controlled investigations of further risk and protective factors, and validated methods of breed identification, are needed.
Vehicles reversing or rolling backwards: an underestimated hazard
Authors: Mayr J M , Eder C , Wernig J , Zebedin D , Berghold A , Corkum S H
Published: October 2002

Objectives—A retrospective analysis of injuries caused by vehicles that were reversing or rolling backwards to establish guidelines for prevention was performed.

Patients and methods—Medical records and questionnaires completed by parents for 32 children admitted to the Department of Pediatric Surgery, Graz, within the past eight years, were analysed.

Results—The median age was 2.1 years (1.0–14.0 years). Fourteen of 32 of the cars were driven by family members (43.8%); three were rolling backwards without a driver (9.4%). The median injury severity score was 3 (1–27) and the most common injuries were contusions (40.6%), fractures (31.3%), and lacerations/burns (21.9%). Most incidents occurred in driveways (37.5%) or farmyards (21.9%). Altogether 70.3% of children sustained “run-over” injuries, 29.6% were hit by the rear bumper or injured by a breaking window.

Conclusions—Toddlers playing in driveways or farmyards are at risk of a injury caused by reversing vehicles/vehicles rolling backwards.
Use of Washington State newspapers for submersion injury surveillance
Authors: Baullinger J , Quan L , Bennett E , Cummings P , Williams K
Published: October 2002

Objectives—To evaluate the usefulness of newspapers as a surveillance tool for submersion injury, the proportion of submersion events and important details reported in Washington State newspapers was determined. It was also determined whether a letter sent to newspaper editors to encourage reporting changed the proportion and content of reported submersion events.

Methods—Newspaper articles regarding submersion were collected from 225 Washington newspapers from June 1993 through September 1998. Newspaper articles were linked to computerized state death and hospital records. Reporting during periods before and after a letter was sent encouraging more newspaper articles on submersion injury and preventative factors was compared.

Results—A total of 1874 submersion victims were identified in the three data sources. Of the 983 victims who had a death certificate, 52% were reported in at least one news article. Of the 471 persons in hospital discharge data, 25% were reported in a newspaper. Reporting of pediatric victims who died increased from 63% to 79% (p=0.008); reporting of hospitalized persons increased from 23% to 27% (p=0.3). There were increases in reporting of swimming ability (7% to 15%, p<0.001), supervision (82% to 91%, p<0.001), and alcohol use (7% to 24%, p<0.001). Reporting of life vest use decreased (35% to 23%, p<0.001).

Conclusions—Newspapers failed to report about one half of fatal submersions and three quarters of submersions that resulted in a hospitalization. An effort to improve reporting was associated with an increase in the proportion of pediatric drownings that were reported, but a consistent improvement in content was found. The usefulness of newspaper articles as a surveillance tool may be limited.
Case-crossover studies of occupational trauma: methodological caveats
Authors: Sorock G S , Lombardi D A , Gabel C L , Smith G S , Mittleman M A
Published: October 2002

Objectives—The case-crossover study design was developed to examine triggers for the onset of myocardial infarction. This paper seeks to examine selected methodological issues when applying the case-crossover method to the study of traumatic injuries in the work environment.

Methods—Researchers known to be working on occupational case-crossover studies were invited to present at a workshop held at the National Occupational Injury Research Symposium in October 2000. Data from ongoing studies were used to illustrate various methodological issues involved in case-crossover studies of occupational injury.

Key findings and issues identified—To utilize the case-crossover design, investigators must clearly define the time during which a worker is at risk of injury, the period of time during which a particular transient exposure could cause an injury and carefully select control time periods that estimate the expected frequency of exposure. Other issues of concern are changing work tasks over time, correlated exposures over time and information bias.

Conclusions and future research needs—More case-crossover studies of occupational injury are needed to compare results from multiple studies. The validation of the timing of transient exposures relative to injury onset, whether done in a laboratory or field setting, should be conducted. Nested case-crossover designs in other epidemiological studies (case-control or cohort) can examine both transient and fixed risk factors for occupational injury, and should be attempted.
Agricultural Disability Awareness and Risk Education (AgDARE) for high school students
Authors: Reed D B , Kidd P S , Westneat S , Rayens M K
Published: October 2002

Objective—Develop and test a farm health and injury prevention educational intervention for high school agriculture students.

Setting—Twenty one high schools in Kentucky, Iowa, and Mississippi.

Methods—A quasiexperimental crossover design was used to test the effectiveness of two sets of instructional materials designed through participatory action research with agriculture teachers and students. Narrative simulations based on farm work stories and simulations of farm work while students pretended to have a disability were completed in 14 schools (n = 373) over the academic year. Students in seven control schools (n = 417) received no intervention but completed, in the same time frame as students in the treatment schools, demographic surveys and pre-measures and post-measures of farm safety attitudes and intent to change safety behaviors. One year after the intervention, 29 students from the treatment group received farm visits to measure their farm safety behaviors.

Results—Students engaged in hazardous work on farms. Thirty two were involved in tractor overturns and 11 had received injuries from rotating power take-off mechanisms. One fourth reported hearing problems, and 21% had respiratory symptoms after working in dusty farm surroundings. Students who completed at least two physical and two narrative simulations of the Agricultural Disability Awareness and Risk Education (AgDARE) curriculum showed statistically significant positive changes in farm safety attitude and intent to change behaviors.

Conclusions—Adolescents engage in farm work that places them at risk for injury and illness. The AgDARE curriculum may be an effective and efficient method of teaching farm safety in high school agriculture classes.
The New Zealand Blood Donors' Health Study: baseline findings of a large prospective cohort study of injury
Authors: Ameratunga S N , Norton R N , Whitlock G , MacMahon S , Coggan C , Jackson R T , Langley J D , Parag V , Smith D , Woodfield D G
Published: October 2002

Introduction: Cohort studies have contributed important scientific knowledge regarding the determinants of chronic diseases. Despite the need for etiologic investigations, this design has been infrequently used in injury prevention research.

Objectives: To describe the baseline findings of the New Zealand Blood Donors' Health Study, a large prospective study designed to investigate relationships between lifestyle, psychosocial factors, and serious injury due to road crashes, falls, self harm, assault, work, sport, and recreation.

Methods: Participants were recruited from fixed and mobile collection sites of a voluntary non-profit blood donor program. Baseline exposure data (for example risk taking behaviors, alcohol and marijuana use, sleep habits, and depression) were collected using a self administered questionnaire. Outcome data regarding serious injury will be collected prospectively through computerized record linkage of participants' unique identifiers to national morbidity and mortality databases.

Results: In total, 22 389 participants enrolled in the study (81% response rate). The diverse study population included 36% aged 16–24 years, 20% rural residents, and large variability in exposures of interest. For example, in the 12 months before recruitment, 21% had driven a motor vehicle when they considered themselves over the legal limit for alcohol, and 11% had been convicted of traffic violations (excluding parking infringements). Twelve per cent had seriously considered attempting suicide sometime in their life.

Conclusions: This is the first, large scale cohort study investigating determinants of serious injury in New Zealand and among the largest worldwide. Preliminary findings from prospective analyses that can inform injury prevention policy are expected within five years.
Setting priorities in injury prevention: the application of an incidence based cost model
Authors: Mulder S , Meerding W J , van Beeck E F
Published: October 2002

Objectives: To make detailed calculations on the direct medical costs of injuries in the Netherlands to support priority setting in prevention.

Methods: A computerised, incidence based model for cost calculations was developed and incidence figures derived from the Dutch Injury Surveillance System (LIS) which provides national estimates of the annual number of patients treated at an emergency department. A comprehensive set of cost elements (that is, health care segments) was obtained from health care registrations and a LIS patient survey. Patients were assigned to specific groups based on LIS characteristics (for example, age, injury type). Average costs per patient group were calculated for each cost element and total costs estimated by adding costs for all patient groups.

Results: The direct costs of injury average 2000 guilders per injury patient attending an emergency department. Home and leisure injuries account for over half of the costs, although cost per patient is highest for motor vehicle injuries. Injuries to the lower extremities account for almost half of the total costs and are incurred mainly in the home or recreation. Motor vehicle crashes are the major cause of head injuries.

Conclusions: The model permits continuous and detailed monitoring of injury costs. Estimates can be compiled for any LIS patient group or injury subcategory. The results can be used to rank injuries for prioritisation of prevention by injury categories (for example, traffic, home, or leisure), or by specific scenarios (for example, fall at home).
Research on injury prevention: topics for systematic review
Authors: Rivara F P , Johansen J M , Thompson D C
Published: October 2002

Background:Duplication should be avoided in research and only effective intervention programs should be implemented.

Objective:To arrive at a consensus among injury control investigators and practitioners on the most important research questions for systematic review in the area of injury prevention.

Design:Delphi survey.

Methods:A total of 34 injury prevention experts were asked to submit questions for systematic review. These were then collated; experts then ranked these on importance and availability of research.

Results:Twenty one experts generated 79 questions. The prevention areas with the most number of questions generated were fires and burns, motor vehicle, and violence (other than intimate partner), and the least were other interventions (which included Safe Communities), and risk compensation. These were ranked by mean score. There was good agreement between the mean score and the proportion of experts rating questions as important or very important. Nine of the top 24 questions were rated as having some to a substantial amount of research available, and 15 as having little research available.

Conclusions:The Delphi technique provided a useful means to develop consensus on injury prevention research needs and questions for systematic review.
Child bicyclist injuries: are we obtaining enough information in the emergency department chart?
Authors: Moll E K , Donoghue A J , Alpern E R , Kleppel J , Durbin D R , Winston F K
Published: October 2002

Objective:The purpose of this study was to assess the range of information relevant to bicyclist injury research that is available on routinely completed emergency department medical records.

Methods:A retrospective chart review of emergency department medical records was conducted on children who were injured as bicyclists and treated at an urban level I pediatric trauma center. A range of variables relevant to bicyclist injury research and prevention was developed and organized according to the Haddon matrix. Routinely completed free text emergency department medical records were assessed for the presence of each of the targeted elements. In addition, medical records of seriously injured patients (for whom a more structured medical record is routinely used) were compared to free form records of less seriously injured patients to identify differences in documentation that may be related to the structure of the medical record.

Results:Information related to previous medical history (96% of records), diagnosis (89%), documentation of pre-hospital care (82%), and child traumatic contact points (81%) were documented in the majority of medical records. Information relevant to prevention efforts was less commonly documented: identification of motor vehicle/object involved in crash (58%), the precipitating event (24%), the location of the crash (23%), and documentation of helmet use (23%). Records of seriously injured patients demonstrated significantly higher documentation rates for pre-hospital care and child traumatic contact points, and significantly lower documentation rates for previous medical history, child kinematics, main body parts impacted, and location of injury event.

Conclusions:Routinely completed free text emergency department medical records contain limited information that could be used by injury researchers in effective surveillance. In particular information relating to the circumstances of the crash event that might be used to design or target prevention efforts is typically lacking. Routine use of more structured medical records has the potential to improve documentation of key information.
The role of the church in developing the law: an Islamic response
Authors: Badawi Z
Published: October 2002

The concept of Hisba in Muslim law has been used by members of certain Islamic groups to impose, through the courts, limitations on freedom of expression. In so doing they sought to circumvent the right of parliament to legislate on matters of personal freedom. This device is now restricted by the Egyptian authorities.
The case of Ms B: suicide’s slippery slope?
Authors: Keown J
Published: October 2002

In the case of Ms B, the High Court ruled that as Ms B was a competent adult patient, her doctors acted unlawfully in overriding her refusal of life-preserving ventilation. This commentary considers whether this case supports the proposition that in English law the right to refuse treatment extends even to refusals which are clearly suicidal.