This book includes detailed information on many of the factors surrounding injuries--the man-made systems and products involved, the groups at greatest risk, and effective ways to protect people from injuries. The circumstances under which injuries occur, the etiologic agents, and the characteristics of the people involved are examined. Chapter 2 summarizes the importance of injuries in relation to other prominent health problems. Subsequent chapters describe injury mortality and, in cases where good population-based studies are available, nonfatal injuries. The analyses in Chapters 3-15 are primarily of injury deaths during 1977-1979, the most recent years for which detailed mortality data were available in mid-1983 for deaths other than those related to motor vehicles. Most of these data were collected by the U.S. Department of Health and Human Services, National Center for Health Statistics (NCHS). Chapters 16-20 summarize data on deaths from motor vehicle-related injuries. Most of these detailed data were obtained from the U.S. Department of Transportation, National Highway Traffic Safety Administration (NHTSA). Data from the 1980 census provided denominators for the rates throughout the book, except for trendline calculations which were based on interpolations between census years. The purpose of this book is to improve understanding of the nature and magnitude of the injury problem in the United States. Although it includes some discussion of ameliorative approaches, there is no comprehensive coverage of injury research, theory, or prevention, since these have been comprehensively discussed elsewhere. This book is a thorough documentation of the injury problem. Most of the information presented is new, the product of analyses not previously published in any form.

https://link.springer.com/content/pdf/10.2307%2F3342319.pdf

The injury fact book

The coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the most formidable challenge to humanity in a century. It is widely believed that prepandemic normalcy will never return until a safe and effective vaccine strategy becomes available and a global vaccination programme is implemented successfully. Here, we discuss the immunological principles that need to be taken into consideration in the development of COVID-19 vaccine strategies. On the basis of these principles, we examine the current COVID-19 vaccine candidates, their strengths and potential shortfalls, and make inferences about their chances of success. Finally, we discuss the scientific and practical challenges that will be faced in the process of developing a successful vaccine and the ways in which COVID-19 vaccine strategies may evolve over the next few years.

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Immunological considerations for COVID-19 vaccine strategies.

Objective: To evaluate interrater reliability using 5 newly trained observers in the assessment of pressure pain threshold (PPT) using a fixed-angle algometer. Methods: The study design comprised 2 phases. Phase 1: 5 undergraduate physical therapists were trained in algometry at a predefined angle, at a rate of 5 Newtons (N)/s, to the first dorsal interosseous muscle. Each observer then underwent a competency test of the application speed. The aim was to achieve repeated applications at 5 N/s without visual feedback from the algometer. Phase 2: the 5 observers measured PPT of 13 healthy volunteers, at the first dorsal interosseous muscle. The sequence of observer measurements for each participant was randomized. Mean PPT values for each observer were analyzed using repeated measures analysis of variance, intraclass correlation coefficient (ICC2,1), and standard error of measurement, with 95% confidence intervals (CIs). Results: No significant differences between observers’ mean values were found (P = 0.094), suggesting no bias. The ICC was 0.91 (95% CI 0.82, 0.97). The standard error of measurement value was 6.27 N/cm 2 (95% CI 5.35, 7.59). Differences in PPT measurements of more than 17.39 N/cm 2 (1.77 kg/cm 2 ) are likely to exceed the magnitude of measurement error, and could be used to indicate true change. This margin of error is, however, somewhat larger than a previously proposed minimum clinically important difference in PPT of 14.71 N/cm 2 (1.5 kg/cm 2 ). Discussion: This study provides new evidence that trained observers can apply an algometer at a consistent rate and provide highly reliable measures of PPT in healthy humans, when PPT is calculated as the mean of 3 trials.

Interrater reliability of algometry in measuring pressure pain thresholds in healthy humans, using multiple raters

From the Medical-Surgical Group, Office of Patient Care Services (R.G.D.), and the Office of Public Health and Environmental Hazards (M.J.H.), Veterans Health Administration, Washington, D.C.; and the Uniformed Services University of the Health Sciences, Bethesda, Md. (D.G.B., H.R.C.). Address reprint requests to Dr. DePalma at the Office of Patient Care Services, Veterans Health Administration, 810 Vermont Ave. NW, 111B, Washington, DC 20420, or at rgdepalma@mail.va.gov.

CURRENT CONCEPTS blast injuries

Since the terrorist suicide truck bombing of the U.S. Marine barracks in Beirut in 1983, the “imagination” of Americans has continued to be taxed with devastating consistency. Explosions and bombings remain the most common deliberate cause of disasters involving large numbers of casualties, especially as instruments of terrorism, yet we still have not learned how to anticipate and manage the tragic carnage they cause with any degree of effectiveness. These attacks virtually always are directed against the untrained and unsuspecting civilian population. Unlike the military, civilians are poorly equipped or prepared to handle the severe emotional, logistical, and medical burdens of a sudden large casualty load, and thus are completely vulnerable to terrorist aims.

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Medical management of disasters and mass casualties from terrorist bombings: how can we cope?

ObjectivesTo compare injury patterns resulting from explosions in the open air versus within confined spaces.MethodsMedical charts of 297 victims of four bombing events were analyzed. Two explosions occurred in the open air and two inside buses. Similar explosive devices were applied in all four inc

Blast injuries : Bus versus open-air bombings-a comparative study of injuries in survivors of open-air versus confined-space explosions

Eardrum Perforation in Explosion Survivors: Is It a Marker of Pulmonary Blast Injury?

Background. Improving the appropriateness of testing behavior and reducing the number of laboratory tests have been recognized as essential parts of quality improvement.

Objective. To assess the effectiveness of an administrative and a short-term educational intervention aimed at reducing clinical biochemistry laboratory utilization.

Design. An analysis comparing utilization of laboratory tests performed on in-patients before and after the intervention.

Setting. Computerized database of all laboratory tests performed in Hadassah Ein Kerem Medical Center, Jerusalem, Israel during 1999–2003.

Intervention. The administrative intervention included restricting available emergency laboratory tests and frequency of repeated orders. The educational measures included: discussion of the misuse of laboratory tests and its consequences with the hospital medical staff, and presentation of the new restrictive policy. A feedback of the intervention’s results was sent to the wards and reviewed with senior medical staff.

Main outcome measures. Change in utilization (measured as rates per 100 hospital days) of clinical biochemistry tests by hospital division and by selected laboratory tests.

Results. An overall reduction of 19% in laboratory tests (95% CI: 18.8–19.2%) was observed in the year after the intervention. Utilization decreased significantly in all the hospital’s medical divisions, within a range of 14.9–43.8%. During the intervention period, utilization of hematology tests was reduced by 7.6% ( P = 0.009). Statistically significant reductions were noted in the ordering of all 12 selected clinical biochemistry tests. Although the orders of total cholesterol decreased by 72.2%, the utilization of ‘high-volume’ tests, such as glucose and electrolytes, showed only a modest decrease (7.9% and 6.9%, respectively).

Conclusions. The present study included all hospital medical staff and covered all the available clinical biochemistry tests. This rather simple and low-cost intervention resulted in significant reductions in clinical biochemistry test orders as well as in the ordering of hematological blood tests.

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An administrative intervention to improve the utilization of laboratory tests within a university hospital.

On September 11, 2001, the world changed. The vicious giant of terrorism that was dormant until that date had arisen. After the horrific mass-casualty terror attack on the United States, any and all forms of assault seem possible. Owing to the complexity of injuries encountered in terror attack victims, fast and accurate imaging plays an essential role in triage and identification of abnormalities associated with injuries. The radiologist becomes a crucial part of the first-line team of doctors treating these patients. Knowledge that the best available treatment is given to terror attack victims can enhance the strength and endurance of society against terror. On the basis of the authors' experience with terror events in Israel, the steps involved in imaging of terror attack patients include conventional radiography, focused abdominal sonography in trauma, computed tomography, and angiography, with the judicious use of supplemental imaging.

Shmuel C. Shapira

Papers

Blast injuries : Bus versus open-air bombings-a comparative study of injuries in survivors of open-air versus confined-space explosions

Eardrum Perforation in Explosion Survivors: Is It a Marker of Pulmonary Blast Injury?

An administrative intervention to improve the utilization of laboratory tests within a university hospital.

Facing the new threats of terrorism: radiologists' perspectives based on experience in Israel

Electronic pressure algometry of deep pain in healthy volunteers