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Handlos P, Švecová T, Vrtková A, Handlosová K, Dokoupil M, Klabal O, Timkovič J, Uvíra M. Review of patterns in homicides by sharp force: one institution's experience. Forensic Sci Med Pathol 2023; 19:525-533. [PMID: 36763090 PMCID: PMC10752844 DOI: 10.1007/s12024-023-00576-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2023] [Indexed: 02/11/2023]
Abstract
This paper presents a retrospective review of patterns found in cases of homicides by sharp force over a 13-year period at the Department of Forensic Pathology of the Ostrava University Hospital, Czech Republic. The review summarizes all frequently discussed aspects of such cases including the number and localization of injuries, the presence of defensive wounds, the type of the offending weapon, the cause of death, the place of death, victims' and perpetrators' profiles, their relationship, or toxicological findings. Furthermore, special attention was paid to the evaluation of any accompanying blunt force trauma that may be indicative of an escalation of the assault. The set of data was statistically analyzed. Even though most of the results of this review are consistent with available published studies, noteworthy differences have emerged in some aspects such as the sex and age of the victims, the relationship between the number of injuries suffered and the victims' sex, or the severity of alcohol intoxication in victims.
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Affiliation(s)
- Petr Handlos
- Institute of Forensic Medicine, University Hospital Ostrava, Ostrava, Czech Republic
| | - Tereza Švecová
- Institute of Forensic Medicine, University Hospital Ostrava, Ostrava, Czech Republic
| | - Adéla Vrtková
- Faculty of Electrical Engineering and Computer Science, Department of Applied Mathematics, VSB - Technical University of Ostrava, Ostrava, Czech Republic
- Department of the Deputy Director for Science, Research, and Education, University Hospital Ostrava, Ostrava, Czech Republic
| | - Klára Handlosová
- Institute of Forensic Medicine, University Hospital Ostrava, Ostrava, Czech Republic
| | - Marek Dokoupil
- Institute of Forensic Medicine, University Hospital Ostrava, Ostrava, Czech Republic
| | - Ondřej Klabal
- Faculty of Arts, Department of English and American Studies, Palacký University Olomouc, Olomouc, Czech Republic
| | - Juraj Timkovič
- Clinic of Ophthalmology, University Hospital Ostrava, Ostrava, Czech Republic
| | - Matěj Uvíra
- Institute of Forensic Medicine, University Hospital Ostrava, Ostrava, Czech Republic.
- Faculty of Medicine in Hradec Kralove, The Fingerland Department of Pathology, Charles University, Hradec Kralove, Czech Republic.
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Corbitt M, Schmidt E, Swift K, O'Neill J, Brunott N. Overview of stab injuries in Far North Queensland: A new insight into the demographics, injury patterns and management. Injury 2022; 54:1386-1391. [PMID: 36604289 DOI: 10.1016/j.injury.2022.12.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 12/20/2022] [Accepted: 12/30/2022] [Indexed: 01/02/2023]
Abstract
BACKGROUND Cairns Hospital is the northernmost tertiary referral hospital in Far North Queensland (FNQ) and manages trauma from a large catchment area. A large burden of stab injuries occurs in at-risk patient groups, such as Indigenous and mental health patients, in this region. This research aims to present an overview of the demographics, injury patterns, management and outcomes for stabbings injuries in FNQ. METHODS A five-year retrospective single-centre study of all patients treated for neck, torso or junctional stab wounds in Far North Queensland was performed searching for all patients with a coded diagnosis of stabbing or knife injury from 1 March 2016 to 31 March 2021. RESULTS 214 knife injuries were identified and 50.5% of those injured identified as Aboriginal and/or Torres Strait Islander. Stabbing injury locations were most commonly the abdomen/flank/pelvis (n = 81) and the chest/thorax (n = 77). Two-thirds of injuries that breached abdominal fascia had concurrent intra-abdominal injury. Hollow viscus injury commonly involved the small bowel (n = 8), colon (n = 5) and stomach (n = 2), whilst the liver was the most frequently injured solid organ (n = 6). There were 19 vascular injuries, excluding the extremities. 89.2% received diagnostic imaging in the emergency department. FAST scan had 76% sensitivity and 100% specificity for intra-abdominal injury at operation. Overall, 35% of patients required an operation. There were only two in-hospital deaths. CONCLUSION Stab injuries annually in FNQ are comparable to other centres in Australia. Overall injury severity was low, with excellent survival rates and outcomes for patients who reached hospital. Operative intervention rates for abdominal stab wounds were low in FNQ compared to available data and imaging again appears protective against negative laparotomy rate.
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Affiliation(s)
- Matthew Corbitt
- Department of Surgery, Cairns & Hinterland Hospital and Health Service, 165 Esplanade, Cairns, QLD, Australia; School of Medicine & Dentistry, Griffith University, Parklands Drive, Gold Coast, QLD, Australia.
| | - Emily Schmidt
- Department of Surgery, Cairns & Hinterland Hospital and Health Service, 165 Esplanade, Cairns, QLD, Australia
| | - Kate Swift
- Department of Surgery, Cairns & Hinterland Hospital and Health Service, 165 Esplanade, Cairns, QLD, Australia; Faculty of Medicine, University of Queensland, 288 Herston Road, St Lucia, QLD, Australia
| | - John O'Neill
- Department of Emergency Medicine, Cairns & Hinterland Hospital and Health Service, 165 Esplanade, Cairns, QLD, Australia
| | - Nathan Brunott
- Department of Surgery, Cairns & Hinterland Hospital and Health Service, 165 Esplanade, Cairns, QLD, Australia
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Homicidal sharp force cases: An 11-year autopsy-based study. J Forensic Leg Med 2022; 88:102347. [DOI: 10.1016/j.jflm.2022.102347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 03/23/2022] [Accepted: 03/26/2022] [Indexed: 11/24/2022]
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Blanco P, Menéndez MF. Stab wound of the superficial femoral artery early diagnosed by point-of-care Doppler ultrasound. Ultrasound J 2020; 12:32. [PMID: 32542421 PMCID: PMC7295924 DOI: 10.1186/s13089-020-00179-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 06/01/2020] [Indexed: 11/28/2022] Open
Abstract
Background Traumatic vascular injury of the limbs has the potential to cause substantial patient morbidity and mortality, and therefore, early recognition and treatment are crucial to improve outcomes. While patients with hard signs of arterial injury mandate for an immediate surgical intervention, patients presenting with soft signs of arterial injury need further diagnostic evaluation. Case presentation A 24-year-old male was admitted to the emergency department after suffering a stab wound in the anterolateral aspect of his left upper thigh. Entry wound measures approximately 3 cm × 0.7 cm; no exit wound was observed. On examination of the injured limb, the thigh was swollen and painful. Skin color was mildly pale and skin temperature was slightly diminished in his leg; leg numbness was also pointed out by the patient. Common femoral artery pulse was normal, while distal pulses were diminished. Point-of-care Doppler ultrasound (DUS) showed a subfascial hematoma in the thigh, which filled on color Doppler, corresponding to a pseudoaneurysm. On spectral Doppler, signs of distal low blood supply were noted. The patient was immediately transferred to the operating room where a 1-cm laceration was found in the anterior aspect of the superficial femoral artery. The involved artery was successfully repaired and distal flow was reestablished, as assessed by clinical examination, pulse palpation and DUS. Conclusions Based on its several advantages, DUS should be considered as the first-line diagnostic tool in the diagnostic workup of patients with soft signs of arterial injury.
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Affiliation(s)
- Pablo Blanco
- Intensive Care Unit, Clínica Cruz Azul, 2651, 60 St, Necochea, 7630, Argentina. .,Department of Teaching and Research, Hospital "Dr. Emilio Ferreyra", 4801, 59 St, Necochea, 7630, Argentina.
| | - María Fernanda Menéndez
- Intensive Care Unit, Hospital "Dr. Emilio Ferreyra", 4801, 59 Ave, Necochea, 7630, Argentina
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Koea J, Ronald M. What do indigenous communities want from their surgeons and surgical services: A systematic review. Surgery 2019; 167:661-667. [PMID: 31653491 DOI: 10.1016/j.surg.2019.08.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 08/07/2019] [Accepted: 08/17/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND This investigation was undertaken to define the factors determining the optimal and most productive relationship among indigenous communities, surgeons, and providers of surgical services. METHODS A systematic literature review was conducted to identify studies reporting on the experience of indigenous communities with surgeons, medical practitioners, and the providers of surgical and other health services. The databases searched were MEDLINE, EMBASE, PubMed, Web of Science, and Google Scholar, including all literature available until the search date of April 3, 2019. The reference lists of all included articles and related review articles were searched manually to identify further relevant studies. An inductive approach was used to identify common themes. RESULTS Thirty-three publications discussed the experiences of New Zealand Māori (n = 2), Aboriginal and Torres Strait Islanders (n = 20), North American First Nation (n = 10), and Indigenous Latin Americans (n = 1). Across all indigenous peoples, 6 themes emerged: accessible health services, community participation and community governance, continuous quality improvement, a culturally appropriate and clinically skilled workforce, a flexible approach to care, and holistic healthcare. CONCLUSION To provide medical and surgical services in indigenous communities successfully requires a diverse range of skills and core technical and academic competencies. Many skills lie within the definition of professionalism and advocacy as well as the ability to undertake and operationalize community consultation and empowerment. If surgical services serving Indigenous communities are to be successful in addressing health disparity, specific training in these skills will need to be developed and made available.
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Affiliation(s)
- Jonathan Koea
- Department of Surgery, North Shore Hospital, Auckland, New Zealand.
| | - Maxine Ronald
- Department of Surgery, North Shore Hospital, Auckland, New Zealand
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Shortz AE, Mehta RK, Peres SC, Benden ME, Zheng Q. Development of the Fatigue Risk Assessment and Management in High-Risk Environments (FRAME) Survey: A Participatory Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E522. [PMID: 30781731 PMCID: PMC6406396 DOI: 10.3390/ijerph16040522] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 02/02/2019] [Accepted: 02/10/2019] [Indexed: 12/26/2022]
Abstract
Existing risk assessment tools are not effective or sustainable in identifying Oil and Gas Extraction (OGE) workers at high risk of fatigue-related injuries or incidents. We developed a comprehensive Fatigue Risk Assessment and Management in high-risk Environments (FRAME) survey through an industry-academic participatory approach. The FRAME survey was developed through: (1) systematic gathering of existing fatigue scales; (2) refining the inventory using the Delphi Consensus technique; and (3) further refinement through employee/worker focus groups. The participatory approach resulted in a final FRAME survey across four fatigue dimensions-sleep, shiftwork, physical, and mental fatigue, and was composed of 26 items. The FRAME survey was founded on occupational fatigue science and refined and tailored to the OGE industry, through rigorous industry stakeholder input, for safer, effective, practical, and sustainable fatigue assessment and management efforts.
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Affiliation(s)
- Ashley E Shortz
- Department of Environmental and Occupational Health, Texas A&M University, College Station, TX 77843, USA.
| | - Ranjana K Mehta
- Department of Industrial and Systems Engineering, Texas A&M University, College Station, TX 77843, USA.
| | - S Camille Peres
- Department of Environmental and Occupational Health, Texas A&M University, College Station, TX 77843, USA.
| | - Mark E Benden
- Department of Environmental and Occupational Health, Texas A&M University, College Station, TX 77843, USA.
| | - Qi Zheng
- Department of Epidemiology and Biostatistics, Texas A&M University, College Station, TX 77843, USA.
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Johannesdottir U, Jonsdottir GM, Johannesdottir BK, Heimisdottir AA, Eythorsson E, Gudbjartsson T, Mogensen B. Penetrating stab injuries in Iceland: a whole-nation study on incidence and outcome in patients hospitalized for penetrating stab injuries. Scand J Trauma Resusc Emerg Med 2019; 27:7. [PMID: 30674331 PMCID: PMC6343331 DOI: 10.1186/s13049-018-0582-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 12/27/2018] [Indexed: 11/10/2022] Open
Abstract
Background Studies on penetrating injuries in Europe are scarce and often represent data from single institutions. The aim of this study was to describe the incidence and demographic features of patients hospitalized for stab injury in a whole nation. Materials and methods This was a retrospective nationwide population-based study on all consecutive adult patients who were hospitalized in Iceland following knife and machete-related injuries, 2000–2015. Age-standardized incidence was calculated and Injury Severity Score (ISS) was used to assess severity of injury. Results Altogether, 73 patients (mean age 32.6 years, 90.4% males) were admitted during the 16-year study period, giving an age-standardized incidence of 1.54/100,000 inhabitants. The incidence did not vary significantly during the study period (P = 0.826). Most cases were assaults (95.9%) occurring at home or in public streets, and involved the chest (n = 32), abdomen (n = 26), upper limbs (n = 26), head/neck/face (n = 21), lower limbs (n = 10), and the back (n = 6). Median ISS was 9, with 14 patients (19.2%) having severe injuries (defined as ISS > 15). The median length of hospital stay was 2 days (range 0–53). Forty-seven patients (64.4%) underwent surgery and 26 of them (35.6%) required admission to an intensive care unit (ICU), all with ISS scores above 15. Three patients did not survive for 30 days (4.1%); all of them had severe injuries (ISS 17, 25, and 75). Conclusion Stab injuries that require hospital admission are rare in Iceland, and their incidence has remained relatively stable. One in every five patients sustained severe injuries, two-thirds of whom were treated with surgical interventions, and roughly one-third required ICU care. Although some patients were severely injured with high injury scores, their 30-day mortality was still low in comparison to other studies.
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Affiliation(s)
- Una Johannesdottir
- Department of Cardiothoracic Surgery, Landspitali University Hospital, Reykjavik, Iceland
| | | | | | | | - Elias Eythorsson
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland.,Department of Internal Medicine, Landspitali University Hospital, Reykjavik, Iceland
| | - Tomas Gudbjartsson
- Department of Cardiothoracic Surgery, Landspitali University Hospital, Reykjavik, Iceland.,Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Brynjolfur Mogensen
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland. .,Department of Emergency Medicine, Landspitali University Hospital, Reykjavik, Iceland.
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Pascual-Marrero A, Ramos-Meléndez EO, García-Rodríguez O, Morales-Quiñones JE, Rodríguez-Ortiz P. Trauma epidemiology in Puerto Rico: in-hospital morbidity and mortality from 2002 to 2011. Int J Inj Contr Saf Promot 2017; 25:14-22. [PMID: 28417686 DOI: 10.1080/17457300.2017.1310738] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This study aimed to describe the distribution of injury mechanisms and to assess the impact of those mechanisms on the morbidity and mortality of trauma. All patients admitted to Puerto Rico Trauma Hospital (2002-2011) for road-traffic collisions (RTCs, 5,371), gunshot wounds (GSWs, 2,946), falls (2,319), pedestrian accidents (1,652), and stab wounds (SWs, 1,073) were selected. Gunshot victims were 1.19 (95%CI: 1.07-1.33) times as likely as road-traffic victims to have an ISS ≥25. Pedestrians were 1.76 (95%CI: 1.49-2.09) times more likely to have a GCS ≤8 than road-traffic victims were. The risk of dying was 2.64 (95%CI: 2.20-3.16) times higher for gunshot victims and 1.51 (95%CI: 1.23-1.86) times higher for pedestrians compared to patients who had had RTCs. Gunshot victims and pedestrians had the worst clinical outcomes. Accordingly, these patients should receive the most aggressive clinical management. Furthermore, it is imperative to develop public health campaigns on trauma prevention.
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Affiliation(s)
- Annette Pascual-Marrero
- a Department of Surgery , Medical Sciences Campus , University of Puerto Rico , San Juan , Puerto Rico
| | | | | | - José E Morales-Quiñones
- c Department of Biology , Rio Piedras Campus , University of Puerto Rico , San Juan , Puerto Rico
| | - Pablo Rodríguez-Ortiz
- a Department of Surgery , Medical Sciences Campus , University of Puerto Rico , San Juan , Puerto Rico.,b Puerto Rico Trauma Hospital , San Juan , Puerto Rico
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Omond KJ, Charlwood C, Byard RW. Customary law, traditional punishment, and death in the Anangu Pitjantjatjara Yankunytjatjara (APY) lands of Central Australia. Forensic Sci Med Pathol 2016; 12:527-529. [PMID: 27503507 DOI: 10.1007/s12024-016-9804-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Kimberley J Omond
- School of Medicine, The University of Adelaide, Frome Road, Level 3 Medical School North Building, Adelaide, 5005, Australia
| | | | - Roger W Byard
- School of Medicine, The University of Adelaide, Frome Road, Level 3 Medical School North Building, Adelaide, 5005, Australia.
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Nair MS, Uzzaman MM, Al-Zuhir N, Jadeja A, Navaratnam R. Changing trends in the pattern and outcome of stab injuries at a North London hospital. J Emerg Trauma Shock 2012; 4:455-60. [PMID: 22090737 PMCID: PMC3214500 DOI: 10.4103/0974-2700.86628] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2010] [Accepted: 05/21/2011] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To study the incidence, pattern and outcome of stab injuries attending a North London Teaching Hospital over a 3-year (2006-2008) period. MATERIALS AND METHODS A retrospective review of collected data from the Hospital database was conducted. The database contains comprehensive medical records for all patients attended by the trauma team for deliberate stab injuries. It is updated by the surgical team after each admission. All patients with deliberate penetrating injury who were attended by the service between 1 January 2006 and 31 December 2008 were identified. Patients who died in the prehospital phase, those managed exclusively by the emergency department and limb injuries without vascular compromise were excluded from the study. RESULTS Six hundred and nineteen patients with stab injuries (following knife crime) from North London attended the Hospital in the above period. One hundred and thirty-seven paients required surgical admission. Two were cases of self-inflicted knife injuries. Over the 3-year period the percentage of victims below 20 years of age is increasing. Ninety-three percent of knife crime occured between 6 pm and 6 am; recently moving toward week days from weekend period. CONCLUSIONS The overall rate of penetrating injuries (stab injuries) is slowly declining. Timely cardiothoracic support facility is vital in saving lives with major cardiac stab injuries. Although alcohol drinking restriction has been lifted, most cases of stabbings are still occurring out-of-hours when surgical personnel are limited.
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Affiliation(s)
- Manojkumar S Nair
- Department of General Surgery, North Middlesex University Hospital, London, United Kingdom
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Abstract
In Alice Springs, assault and attempted homicide, self-harm and attempted suicide and transportation accidents contribute substantially to the burden of disease, especially among the aboriginal population who are poor and disadvantaged. While road traffic accidents and self-inflicted injuries are the leading causes of injury-related deaths worldwide, violence is a major factor in Alice Springs trauma. Violence accounted for more than half the annual trauma case load. Aboriginal Central Australians bear a disproportionate risk of injury and illness compared to their non-aboriginal counterparts. Rampant alcoholism and social and family breakdown are thought to be significant contributors to the high incidence of violence in Alice Springs. There were 2,800 trauma admissions to Alice Springs hospital in 2006 compared to 1,800 admissions in 2003. Geographical location often limits timeliness, access and level of health care available to rural and isolated regions of central Australia. Solutions to the trauma epidemic in our Remote indigenous population must look past the Emergency and Surgical Departments that care for the injured to the individual, community, environmental, social and economic factors that underpin the traumas. Traumatic injury and death maybe the most preventable of all health issues. While tremendous resources are spent caring for injured patients in hospital, less attention is paid towards gaining a better understanding of injury prevention.
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Abstract
Trauma systems have been shown to provide the best trauma care for injured patients. A trauma system developed for Indigenous people should take into account many factors including geographical remoteness and cultural diversity. Indigenous people suffer from a significant intentional and non-intentional burden of injury, often greater than non-Indigenous populations, and a public health approach in dealing with trauma can be adopted. This includes transport issues, prevention and control of intentional violence, cultural sensitization of health providers, community emergency responses, community rehabilitation and improving resilience. The ultimate aim is to decrease the trauma burden through a trauma system with which indigenous people can fully identify.
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Affiliation(s)
- Frank Plani
- Trauma Surgery, Royal Darwin Hospital, Darwin, NT, Australia.
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