Burden of fatal drowning in California, 2005-2019

OBJECTIVE

To characterise risk factors for fatal drowning in California, USA to inform priorities for prevention, policy and research.

METHODS

This retrospective population-based epidemiological review of death certificate data evaluated fatal drowning events in California from 2005 to 2019. Unintentional, intentional, and undetermined drowning deaths and rates were described by person (age, sex, race) and context-based variables (region and body of water).

RESULTS

California's fatal drowning rate was 1.48 per 100 000 population (n=9237). Highest total fatal drowning rates occurred in the lower population density northern regions, among older adults (75-84 years: 2.54 per 100 000 population; 85+: 3.47 per 100 000 population) and non-Hispanic American Indian or Alaska Native persons (2.84 per 100 000 population). Male drowning deaths occurred at 2.7 times the rate of females; drowning deaths occurred mainly in swimming pools (27%), rivers/canals (22.4%) and coastal waters (20.2%). The intentional fatal drowning rate increased 89% during the study period.

CONCLUSIONS

California's overall fatal drowning rate was similar to the rest of the USA but differed among subpopulations. These divergences from national data, along with regional differences in drowning population and context-related characteristics, underscore the need for state and regional level analyses to inform drowning prevention policy, programmes and research.

The impact of sitagliptin in palmitic acid-induced insulin resistance in human HepG2 cells through the suppressor of cytokine signaling 3/phosphoinositide 3-kinase/protein kinase B pathway

Patients with type 2 diabetes respond differently to sitagliptin, an oral anti-hyperglycemic medication. Patients whose blood sugar levels were effectively managed while using sitagliptin had significantly lower levels of a protein called suppressor of cytokine signaling 3 (SOCS3), according to our earlier research. In this study, we established an in vitro insulin resistance cell model for human HepG2 cells to investigate the possible mechanism of the effect of sitagliptin on glucose metabolism via the SOCS3/phosphoinositide 3-kinase (PI3K)/protein kinase B (Akt) pathway. Since insulin resistance first develops in the liver, palmitic acid was used to generate an insulin resistance cell model in human HepG2 cells, after which small interfering ribonucleic acid (siRNA)-SOCS3 and sitagliptin were used to intervene. We then examined the changes in cell viability and biochemical indices in the insulin resistance cell model. SOCS3, Akt, and glycogen synthase kinase 3beta (GSK-3β) gene expression levels were quantified using reverse transcription-polymerase chain reaction, and the protein expression levels of SOCS3, Akt, phosphorylated Akt (p-Akt), GSK-3β, and phosphorylated GSK-3β (p-GSK-3β) were quantified using Western blot. In results: the expression of the SOCS3 gene was considerably raised in both the insulin resistance model group and the insulin resistance model + siRNA-negative control group, but decreased following treatment with sitagliptin. After sitagliptin intervention, the protein expression of Akt, p-Akt, and p-GSK-3β were dramatically decreased in the model group, while SOCS3 was significantly decreased. We conclude that sitagliptin can reduce insulin resistance by downregulating SOCS3 and regulating glucose metabolism in a hypoglycemic manner.

Gender Discrimination and Sexual Harassment in a Department of Pediatrics

The last substantial description of gender discrimination and harassment described in the journal Pediatrics was in 2019. It is unclear whether the field has made progress toward its goal of equity. We aimed to describe: (1) the recent gender-equity climate according to women and men faculty in the department of pediatrics at a single, large academic center, and (2) institutional efforts to address persistent gender discrimination and harassment. In late 2020, we distributed an anonymous survey to all department faculty that included demographic data, a modified version of the Overt Gender Discrimination at Work Scale, questions about experiences/witnessed discriminatory treatment and sexual harassment, and if those experiences negatively affected career advancement. Of 524 pediatrics faculty, 290 (55%) responded. Compared with men, women more commonly reported gender discrimination (50% vs. 4%, P < .01) and that their gender negatively affected their career advancement (50% vs 9%, P < .01). More than 50% of women reported discriminatory treatment at least annually and 38% recognized specific sexist statements; only 4% and 17% of men reported the same (P < .01 for both). We concluded that a disproportionately low number of male faculty recognized the harassment female faculty experienced. In the 18 months since, our department and university have made efforts to improve salary equity and parity in leadership representation, created an anonymous bias-reporting portal, mandated bias training, and implemented new benchmarks of "professionalism" that focus on diversity. Although we acknowledge that culture change will take time, we hope our lessons learned help promote gender equity in pediatrics more broadly.

Can Use of Default Dispensing Quantities in Electronic Medical Record Lower Opioid Prescribing?

OBJECTIVES

Leftover opioids can contribute to misuse and abuse. Recommended dosing quantities in the electronic medical record can guide prescribing patterns. We hypothesized that decreasing the default from 30 doses to 12 doses would decrease the overall number of opioids prescribed without increasing second opioid prescriptions or additional health utilization.

METHODS

We performed a single-center retrospective study of children with forearm and elbow fractures who presented to the emergency department for evaluation and subsequent orthopedic follow-up between January 15, and September 19, 2017. The default dispensing quantity was decreased on June 1, 2016 from 30 doses to 12 doses. Patients were categorized to preintervention and postintervention groups. We compared the number of opioids prescribed, second opioid prescriptions, emergency department visits, and pain-related telephone calls and orthopedic visits with χ2 and logistic regression analyses.

RESULTS

There were 1107 patients included. Rates of opioid prescribing were similar preintervention and postintervention (61% vs 56%, P = 0.13). After the change to the default quantity, the median number of doses decreased from 18 to 12 doses, with opioid prescriptions of 30 or more doses dropping from 35% to 11%. No significant association was found between preintervention versus postintervention, opioid prescription at discharge, and having 1 or more pain-related or unexpected follow-up visits.

CONCLUSIONS

Lowering the default dispensing quantity of opioids in the electronic medical record decreases the number of opioids prescribed without increasing second prescriptions or additional health care utilization. These findings suggest that a further reduction in the number of opioids prescribed for upper-extremity fractures may be possible.

Factors Associated With Opioid Prescribing for Distal Upper Extremity Fractures at a Pediatric Emergency Department

OBJECTIVE

The aims of this study were to describe the prescribing patterns of oxycodone for patients with distal upper extremity fractures and to evaluate factors that influence the quantity of oxycodone prescribed at discharge.

METHODS

We retrospectively studied oxycodone prescriptions for patients with upper extremity fractures presenting to a single center tertiary pediatric emergency department (ED) from June 1, 2014, to May 31, 2016. We used logistic regression models to evaluate the association of opioid administration in the ED, fracture reduction under ketamine sedation, initial pain scores (low, medium, and high), patient demographics, and type of prescriber (residents, attendings, fellows, and advanced registered nurse practitioners) with oxycodone prescription at discharge and the number of doses prescribed (≤12 or >12 doses).

RESULTS

A total of 1185 patients met the inclusion criteria. Of these, 669 (56%) were prescribed oxycodone at discharge. Children with fractures requiring reduction had 13 times higher odds [95% confidence interval (CI), 9.45-20.12] of receiving an oxycodone prescription compared with children with fractures not requiring reduction. Opioid administration in the ED was associated with 7.5 times higher odds (95% CI, 5.41-10.51) of receiving an outpatient prescription. Children were more likely to have a higher quantity of oxycodone prescribed if they had a fracture reduction in the ED [odds ratio (OR), 1.73; 95% CI, 1.20-2.50], received an opioid in the ED (OR, 2.13; 95% CI, 1.43-3.20), or received their prescription from an emergency medicine resident (OR, 2.8; 95% CI, 1.44-5.74).

CONCLUSIONS

Opioid prescribing differs based on patient- and provider-related factors. Given the variability in prescribing patterns, changing suggested opioid prescriptions in the electronic medical record may lead to more consistent practice and therefore decrease unnecessary prescribing while still ensuring adequate outpatient analgesia.

Prevention of Drowning

Drowning is a leading cause of injury-related death in children. In 2018, almost 900 US children younger than 20 years died of drowning. A number of strategies are available to prevent these tragedies. As educators and advocates, pediatricians can play an important role in prevention of drowning.

Forensic Analysis of 43 Medical Disputes Caused by Death after Cardiac Surgery

Abstract

Objective To explore the causes and characteristics of medical disputes caused by death after cardiac surgery and to analyze the pathological changes after cardiac surgery and the key points of forensic anatomy, thus to provide pathological evidence for clinical diagnosis and treatment of cardiac surgery and judicial appraisal as well as reference for the prevention of medical disputes in such cases. Methods Forensic pathological cases of medical disputes caused by death after cardiac surgery which were accepted by the Center for Medicolegal Expertise of Sun Yat-Sen University from 2013 to 2018 were analyzed retrospectively from aspects such as causes of death, pathological diagnosis, surgery condition, medical misconduct, and so on. Results The causes of death after cardiac surgery of 43 patients were abnormal operation, low cardiac output syndrome, postoperative infection, postoperative thrombosis, and other diseases. Among the 43 cases, there were 18 cases without medical fault while 25 cases had medical fault. Conclusion The medical disputes caused by death after cardiac surgery are closely related to the operative technique and postoperative complications. The causes of medical faults include defects in diagnosis and treatment technique, as well as unfulfillment of duty of care.

Adolescent Water Safety Behaviors, Skills, Training and Their Association with Risk-Taking Behaviors and Risk and Protective Factors

Background: Drowning remains the third leading cause of unintentional injury death for adolescents in the United States. Aims: This study described adolescent swimming lessons, behaviors (life jacket wear while boating) and comfort (swimming in deep water) and their association with protective and risk factors and risk-taking behaviors reported by Washington State students in Grades 8, 10, 12, primarily comprised of youth ages 13 to 18 years. Methods: This study used the 2014 Washington State Healthy Youth Survey (HYS), a publicly available dataset. Results: Most students reported having had swimming lessons, using life jackets, and comfort in deep water. Differences reflected racial, ethnic and socioeconomic disparities: being White or Caucasian, speaking English at home and higher maternal education. Lowest rates of comfort in deep water were among Hispanics or Latino/Latinas followed by Blacks or African Americans. Greater life jacket wear while boating was reported by females, those in lower grades and negatively associated with alcohol consumption, sexual activity and texting while driving. Having had swimming lessons was associated with fewer risk-taking behaviors. Conclusions: The HYS was useful to benchmark and identify factors associated with drowning risk among adolescents. It suggests a need to reframe approaches to promote water safety to adolescents and their families. Multivariate analysis of this data could identify the key determinants amongst the racial, ethnic, and socioeconomic disparities noted and provide stronger estimation of risk-taking and protective behaviors.

Promoting Equity, Social Justice, and Saving Lives with Life Jacket and Clothing Policies

Worldwide, diverse racial/ethnic groups have disproportionately higher drowning rates. Learning to swim and wearing life jackets decrease drowning risk. We evaluated aquatic facilities’ policies regarding use of life jackets, clothing, and diapers through a lens of social justice, equity, and inclusion to ensure they met the needs of the diverse high-risk groups they serve and changing aquatic activities and programs. Public recreational pools, beach and waterpark facilities in the US and international organizations were surveyed regarding their policies on life jacket use, clothing, and diapers between 2015 and 2016. A total of 562 facilities responded, mostly pools. Almost all facilities allowed wearing life jackets in the shallow end but less so in the deep end, and wearing of T-shirts, shorts, and clothes for modesty reasons. Policies varied most on wearing non-swim clothes. Almost universal requirement of diapers applied to infants only. Respondents’ reported themes included cost, access, safety, hygiene and equipment maintenance. Reviewed policies generally reflected facilities’ responsiveness to diverse populations’ specific needs. However, policy variations around wearing clothing and swim diapers could be costly, confusing, and impede participation in aquatic activities by vulnerable populations, specifically young children and racial and ethnic minorities. Standardization of these policies could assist aquatic facilities and their users. A best-practices-based policy is outlined.

Association of designated open water swim area regulations and open water drowning rates

BACKGROUND

Although most persons over 5 years of age drown in open water, few laws have sought to regulate open water swim sites. We examined the association between regulations for designated open water swim sites and open water drowning death rates by state.

METHODS

Using International Classification of Disease (ICD)-10 codes in the CDC Web-based Injury Statistics Query and Reporting System (WISQARS), we identified and calculated open water drowning deaths involving all ages from 2012 to 2017 for 50 states and calculated open water drowning death rates. We then identified and categorised types of state regulations (lifeguards, water quality, rescue equipment, tracking/planning/reporting and signage) for open water swim sites in place in 2017 for a sample of 30 states (20 high-drowning, 10 low-drowning). Analyses evaluated associations between open water drowning rates in three groups (overall, youth and non-white) and the total number and types of state regulations.

RESULTS

Swim site regulations and open water drowning death rates for 10 839 victims were associated in all regression models. States with more types of regulations had lower open water drowning death rates in a dose-response relationship. States lacking regulations compared with states with all five types of regulations had open water drowning death rates 3.02 times higher among youth (95% CI 1.82 to 4.99) and 4.16 times higher among non-white residents (95% CI 2.46 to 7.05). Lifeguard and tracking/planning/reporting regulations were associated with a 33% and 45% reduction in open water drowning rates overall and among those aged 0-17 years.

CONCLUSION

States' open water swim area regulations, especially addressing tracking/planning/reporting and lifeguards, were associated with lower open water drowning death rates.

Characteristics and outcomes of AED use in pediatric cardiac arrest in public settings: The influence of neighborhood characteristics

BACKGROUND

Automated external defibrillators (AEDs) are critical in the chain of survival following out-of-hospital cardiac arrest (OHCA), yet few studies have reported on AED use and outcomes among pediatric OHCA. This study describes the association between bystander AED use, neighborhood characteristics and survival outcomes following public pediatric OHCA.

METHODS

Non-traumatic OHCAs among children less than18 years of age in a public setting between from January 1, 2013 through December 31, 2017 were identified in the CARES database. A neighborhood characteristic index was created from the addition of dichotomous values of 4 American Community Survey neighborhood characteristics at the Census tract level: median household income, percent high school graduates, percent unemployment, and percent African American. Multivariable logistic regression models assessed the association of OHCA characteristics, the neighborhood characteristic index and outcomes.

RESULTS

Of 971 pediatric OHCA, AEDs were used by bystanders in 10.3% of OHCAs. AEDs were used on 2.3% of children ≤1 year (infants), 8.3% of 2-5 year-olds, 12.4% of 6-11 year-olds, and 18.2% of 12-18 year-olds (p < 0.001). AED use was more common in neighborhoods with a median household income of >$50,000 per year (12.3%; p = 0.016), <10% unemployment (12.1%; p = 0.002), and >80% high school education (11.8%; p = 0.002). Greater survival to hospital discharge and neurologically favorable survival were among arrests with bystander AED use, varying by neighborhood characteristics.

CONCLUSIONS

Bystander AED use is uncommon in pediatric OHCA, particularly in high-risk neighborhoods, but improves survival. Further study is needed to understand disparities in AED use and outcomes.

Long-Term Survival After Drowning-Related Cardiac Arrest

BACKGROUND

Long-term outcomes after drowning-related cardiac arrest are not well characterized.

OBJECTIVE

Our aims were to estimate long-term survival and identify prognostic factors in a large, population-based cohort of drowning victims with cardiac arrest.

METHODS

We conducted a population-based prospective cohort study (1974-1996) of Western Washington Drowning Registry (WWDR) subjects with out-of-hospital cardiac arrest and attempted professional resuscitation. The primary outcome was long-term survival through 2012. We tabulated Utstein-style exposure variables, estimated Kaplan-Meier curves, and identified prognostic factors with Cox proportional hazard modeling.

RESULTS

Of 2824 WWDR cases, 407 subjects (median age 17 years [interquartile range 3-33 years], 81% were male) were included. Only 54 (13%) were still alive after 1663 person-years of follow-up. Most deaths occurred after termination of initial resuscitation or during initial hospitalization. Risk of subsequent death after hospital discharge was 9.6 (95% confidence interval [CI] 5.7-15.9) per 1000 person-years. Long-term survival differed by Utstein variables (older age, illicit substance use, pre-drowning activity, submersion duration, cardiopulmonary resuscitation duration, intubation, defibrillation, and medications) and inpatient markers of illness severity (vital signs, Glasgow Coma Scale, laboratory values, shock). In adjusted analyses, older age (hazard ratio [HR] 1.01; 95% CI 1.01-1.02), epinephrine administration (HR 1.92; 95% CI 1.31-2.80), antiepileptic administration (HR 0.53; 95% CI 0.35-0.81), initial arterial pH (HR 0.49; 95% CI 0.26-0.92), and shock (HR 2.19; 95% CI 1.16-4.15) were associated with higher risk of death.

CONCLUSIONS

Most cases of drowning-related cardiac arrest were fatal, but survivors to hospital discharge had a low risk of subsequent death that was independently associated with older age and clinical evidence of shock.

Three novel microRNAs based on microRNA signatures for gastric mucosa-associated lymphoid tissue lymphoma

This study aimed to identify novel microRNAs (miRNAs) that play crucial regulatory roles in the pathogenesis of mucosa-associated lymphoid tissue (MALT) lymphoma by retrieving and analyzing the miRNA expression profile GSE23877. Differentially expressed miRNAs between gastric MALT lymphoma samples and human tonsil tissue samples as well as their target genes were identified. The transcriptional regulatory relationships between miRNAs and target genes were analyzed, and the regulatory network between them was constructed. Target genes annotated as transcription factors (TFs) were screened, and an miRNA-target gene regulatory network was established. Moreover, the expression levels of miRNAs and target genes as well as the correlation between them were verified. In total, 53 upregulated and 25 downregulated miRNAs were obtained, for which 35 and 25 experimentally validated miRNA-target interactions, respectively, were screened. Some miRNAs were significantly enriched in certain pathways; for example, miR-320a was enriched in systemic lupus erythematosus and ribosome, miR-622 in the p53 signaling pathway and chronic myeloid leukemia, and miR-429 in cancer-related pathways. In addition, upregulated miRNAs, including miR-320a, miR-940, and miR-622, and downregulated miRNAs, including miR-331-3p and miR-429, were hub nodes in the miRNA-target gene regulatory network, and the TF MYC was a co-target of miR-320a, miR-622, and miR-429. The expression trends of miR-320a and miR-429 as well as of some of their target genes were consistent with those in the results of microarray analysis. In conclusion, miR-320a, miR-622, and miR-429 are possibly novel miRNAs participating in the pathomechanism of gastric MALT lymphoma.

Strategy of the Causes of Death of Dependents

Abstract

Objective To discuss the methods and strategies to identify the causes of dependents' deaths, as well as provide the experiences that can be used for reference and scientific basis for the forensic identification of the potentially growing deaths of the same kind in the future. Methods The 13 cases concerning death of dependents accepted by Sun Yat-sen University Forensic Center were collected, and the basic information of the dependents were statistically described. The nutritional status, environmental condition and medical care condition were evaluated according to dietary energy, living space, environment and medical treatment condition. Results Among the 13 dependents, there were 11 males and 2 females, with the oldest 74 and the youngest 9 and dwelling time was from 0.4 to 5.6 years. Forensic pathological examination showed that 13 dependents had infectious diseases and 11 were severely dystrophic. There were no fatal mechanical injuries or poisoning in dependents. Molecular pathological screening of 4 cases revealed no pathogenic variants of sudden death susceptible genes. The poor status of the diet, nutrition, living environment and medical care of these dependents were discovered. The direct cause of death of all 13 dependents was identified to be disease. The lack of nutrition, poor living environment and lack of medical care were thought to play a dominant role in causing the deaths of 12 dependants. Conclusion The death identification should follow the judicial procedure. In identification of the causes of death and analysis of the proportion of the affecting factors resulting in death, all factors, including nutrition,environment, medical care, injury and diseases, need to be considered.

Prevention of Drowning

Drowning is a leading cause of injury-related death in children. In 2017, drowning claimed the lives of almost 1000 US children younger than 20 years. A number of strategies are available to prevent these tragedies. As educators and advocates, pediatricians can play an important role in the prevention of drowning.

Magnetic graphene enabled tunable microwave absorber via thermal control

By synthesizing nitrogen-doped graphene (NG) via a facile thermal annealing method, a fine control of the amount and location of doped nitrogen as well as the oxygen-containing functional groups is achieved with varying annealing temperature. The favorable magnetic properties have been achieved for N-doped rGO samples obtained at two temperatures of all NG samples, i.e., 500 °C and 900 °C with saturation magnetization of 0.63 emu g^-1 and 0.67 emu g^-1 at 2 K, respectively. This is attributed to the optimized competition of the N-doping and reduction process at 500 °C and the dominated reduction process at 900 °C. NG obtained at 300 °C affords the best overall absorbing performance: when the absorber thickness is 3.0 mm, the maximum absorption was -24.6 dB at 8.51 GHz, and the absorption bandwidth was 4.89 GHz (7.55-12.44 GHz) below -10 dB. It owes its large absorbing intensity to the good impedance match and significant dielectric loss. The broad absorption bandwidth benefits from local fluctuations of dielectric responses contributed by competing mechanisms. Despite the significant contribution from materials loss to the absorption, the one quarter-wavelength model is found to be responsible for the reflection loss peak positions. Of particular significance is that an appropriate set of electromagnetic parameters associated with reasonable reduction is readily accessible by convenient control of annealing temperature to modulate the microwave absorbing features of graphene. Thus, NG prepared by thermal annealing promises to be a highly efficient microwave absorbent.

2015 Revised Utstein-Style Recommended Guidelines for Uniform Reporting of Data From Drowning-Related Resuscitation: An ILCOR Advisory Statement

BACKGROUND

Utstein-style guidelines use an established consensus process, endorsed by the international resuscitation community, to facilitate and structure resuscitation research and publication. The first "Guidelines for Uniform Reporting of Data From Drowning" were published over a decade ago. During the intervening years, resuscitation science has advanced considerably, thus making revision of the guidelines timely. In particular, measurement of cardiopulmonary resuscitation elements and neurological outcomes reporting have advanced substantially. The purpose of this report is to provide updated guidelines for reporting data from studies of resuscitation from drowning.

METHODS

An international group with scientific expertise in the fields of drowning research, resuscitation research, emergency medical services, public health, and development of guidelines met in Potsdam, Germany, to determine the data that should be reported in scientific articles on the subject of resuscitation from drowning. At the Utstein-style meeting, participants discussed data elements in detail, defined the data, determined data priority, and decided how data should be reported, including scoring methods and category details.

RESULTS

The template for reporting data from drowning research was revised extensively, with new emphasis on measurement of quality of resuscitation, neurological outcomes, and deletion of data that have proved to be less relevant or difficult to capture.

CONCLUSIONS

The report describes the consensus process, rationale for selecting data elements to be reported, definitions and priority of data, and scoring methods. These guidelines are intended to improve the clarity of scientific communication and the comparability of scientific investigations.

[Correlation between Genetic Variants and Polymorphism of Caveolin and Sudden Unexplained Death]

OBJECTIVES

To explore the genetic variation sites of caveolin （CAV） and their correlation with sudden unexplained death （SUD）.

METHODS

The blood samples were collected from SUD group （71 cases）, coronary artery disease （CAD） group （62 cases） and control group （60 cases）, respectively. The genome DNA were extracted and sequencing was performed directly by amplifying gene coding region and exon-intron splicing region of CAV1 and CAV3 using PCR. The type of heritable variation of CVA was confirmed and statistical analysis was performed.

RESULTS

A total of 4 variation sites that maybe significative were identified in SUD group, and two were newfound which were CAV1： c.45C>T （T15T） and CAV1：c.512G>A （R171H）, and two were SNP loci which were CAV1：c.246C>T （rs35242077） and CAV3：c.99C>T （rs1008642） and had significant difference （P<0.05） in allele and genotype frequencies between SUD and control groups. Forementioned variation sites were not found in CAD group.

CONCLUSIONS

The variants of CAV1 and CAV3 may be correlated with a part of SUD group.

Do wave heights and water levels increase ocean lifeguard rescues?

OBJECTIVE

To investigate the association of wave height and tidal water level changes with the frequency of ocean lifeguard rescues.

METHODS

All ocean lifeguard rescues recorded by Newport Beach Lifeguards in 2015 and 2016 were linked by time and location to weather and ocean variables contained in other historical databases. We performed separate multivariable analyses using mixed effects negative binomial regression to evaluate the total effects of wave height, mean water level (primarily set by tidal elevation), and rising vs. falling water level, on the frequency of ocean rescue in the study location, controlling for confounding variables.

RESULTS

Newport Beach Lifeguards made 8046 rescues during the study period. In all areas of the beach, rescue frequency increased as waves got larger (IRR: 3.25; 95%CI: 2.91-3.79) but then decreased in large surf (IRR: 0.52; 95%CI: 0.37-0.73). In two sections of beach, lifeguards made more rescues during lower water levels, but in the third section of beach, made more rescues during higher water levels. Rescue frequency increased in two sections of beach with rising water levels, but did not in the other section.

CONCLUSIONS

Wave height, water level, and water level direction were associated with rescue frequency, but the environmental factors included in the analysis did not fully account for most variation in rescue frequency. Other factors need to be evaluated to identify major determinants of rescue frequency.

The ocean lifeguard drowning prevention paradigm: how and where do lifeguards intervene in the drowning process?

Drowning is a global health problem that can be addressed with multiple strategies including utilisation of lifeguards in recreational swim areas. However, few studies have described lifeguard prevention activities. We conducted a retrospective analysis using lifeguard activity data collected in real time with a Computer-Aided-Dispatch (CAD) system to characterise the nature of lifeguard primary and secondary drowning prevention at a popular ocean beach in California. Preventative actions constituted the majority (232 065/423 071; 54.8%) of lifeguard activities, while rescues represented 1.9%. Most preventative actions and rescues occurred during summer months, weekends and afternoons. Statistically significant geographical clusters of preventative actions were identified all over the beach, while rescue clusters were primarily restricted to two sites. Using the most reliable and valid collection system to date, these data show spatial and temporal patterns for ocean lifeguard provision of primary prevention as well as secondary drowning prevention (rescue).

[Research Progress of the Correlation between Caveolin and Unexpected Sudden Cardiac Death]

Due to the negative autopsy and without cardiac structural abnormalities, unexpected sudden cardiac death （USCD） is always a tough issue for forensic pathological expertise. USCD may be associated with parts of fatal arrhythmic diseases. These arrhythmic diseases may be caused by disorders of cardiac ion channels or channel-related proteins. Caveolin can combine with multiple myocardial ion channel proteins through its scaffolding regions and plays an important role in maintaining the depolarization and repolarization of cardiac action potential. When the structure and function of caveolin are affected by gene mutations or abnormal protein expression, the functions of the regulated ion channels are correspondingly impaired, which leads to the occurrence of multiple channelopathies, arrhythmia or even sudden cardiac death. It is important to study the effects of caveolin on the functions of ion channels for exploring the mechanisms of malignant arrhythmia and sudden cardiac death.

Use of life jackets and other types of flotation for in-water recreation in designated swim areas in Washington State

Most fatal drownings worldwide occur in open water. Flotation devices may protect swimmers. Their use by those recreating in water has not been described.

METHODS

Observational survey of swimmers and waders at designated swim sites at lakes and rivers evaluated them by age group, sex, type of flotation used (life jacket vs substandard flotation, eg, water wings, noodles, inflatables) and, for children <6 years, being within arm's reach of an adult.

RESULTS

Of 1967 swimmers/waders observed, 37% used some type of flotation device. Use rates, especially of life jackets, decreased with increasing age. Children <6 years had the highest use of some type of flotation (140/212, 66%) and the highest use of life jackets (50.5%). Children <13 years were more likely to use flotation devices and life jackets than teens (RR 6.78, 3.62 to 12.71); boys were more likely than girls to wear life jackets (RR 1.47, 1.18 to 1.83). While teenagers and adults used flotation (29.5% and 23.5%), they rarely used life jackets (2-3%). Boys <6 years who were further than arm's length of an adult were more likely to wear life jackets than girls. Substandard flotation use did not differ among age groups (15.5-26.5%) but their use was greater among females in most age groups.

CONCLUSIONS

Flotation devices were frequently used for recreational wading and swimming in open water by all age groups. Life jacket use was limited to children. Promoting use of flotation devices with safety standards that provide protection as well as fun could potentially decrease open water drowning rates.

Bystander CPR is associated with improved neurologically favourable survival in cardiac arrest following drowning

BACKGROUND

Cardiac arrest associated with drowning is a major public health concern with limited research available on outcome. This investigation aims to define the population at risk, and identify factors associated with neurologically favourable survival.

METHODS

The Cardiac Arrest Registry for Enhanced Survival (CARES) database was queried for patients who had suffered cardiac arrest following drowning between January 1, 2013 and December 31, 2015. The primary outcomes of interest were for favourable or unfavourable neurological outcome at hospital discharge, as defined by Cerebral Performance Category (CPC).

RESULTS

A total of 919 drowning patients were identified. Neurological outcome data was available in 908 patients. Neurologically favourable survival was significantly associated with bystander CPR (Odds Ratio (OR)=2.94; 95% Confidence Interval (CI) 1.86-4.64; p<0.001), witnessed drowning (OR=2.6; 95% CI 1.69-4.01; p<0.001) and younger age (OR=0.97, 95% CI 0.96-0.98; p<0.001). Public location of drowning (OR=1.17; 95% CI 0.77-1.79; p=0.47), male gender (OR=0.9, 95% CI 0.57-1.43; p=0.66), and shockable rhythm (OR=1.54; 95% CI 0.76-3.12; p=0.23), were not associated with favourable neurological survival. AED application prior to EMS was associated with a decreased likelihood of favourable neurological outcome (OR=0.38; 95% CI 0.28-0.66; p<0.001). In multivariate analysis, bystander CPR (adjusted OR 3.02, 95% CI 1.85-4.92, p<0.001), witnessed drowning (adjusted OR 3.27, 95% CI 2.0-5.36, p<0.001) and younger age (adjusted OR 0.97, 95% CI 0.96-0.98, p<0.001) remained associated with neurologically favourable survival.

CONCLUSIONS

Neurologically favourable survival after drowning remains low but is improved by bystander CPR. Shockable rhythms were uncommon and not associated with improved outcomes.

Observed long-term mortality after 18,000 person-years among survivors in a large regional drowning registry

AIM

Long-term outcomes beyond one year after non-fatal drowning are uncharacterized. We estimated long-term mortality and identified prognostic factors in a large, population-based cohort.

METHODS

Population-based prospective cohort study (1974-1996) of Western Washington Drowning Registry (WWDR) subjects surviving the index drowning through hospital discharge. Primary outcome was all-cause mortality through 2012. We tabulated Utstein-style exposure variables, estimated Kaplan-Meier curves, and identified prognostic factors with Cox proportional hazard modeling. We also compared 5-, 10-, and 15-year mortality estimates of the primary cohort to age-specific mortality estimates from United States Life Tables.

RESULTS

Of 2824 WWDR cases, 776 subjects (5[IQR 2-17] years, 68% male) were included. Only 63 (8%) non-fatal drowning subjects died during 18,331 person-years of follow-up. Long-term mortality differed by Utstein variables (age, precipitating alcohol use, submersion interval, GCS, CPR, intubation, defibrillation, initial vital signs, neurologic status at hospital discharge) and inpatient markers of illness severity (mechanical ventilation, vasopressor use, seizure, pneumothorax). Survival differed by age (HR 1.04;95%CI 1.03-1.05), drowning-related cardiac arrest (HR 3.47;95%CI 1.97-6.13), and neurologic impairment at hospital discharge (HR 5.10;95% CI 2.70-9.62). In adjusted analysis, age (HR 1.05;95%CI 1.03-1.06) and severe neurologic impairment at discharge (HR 2.31;95%CI 1.01-5.28) were associated with long-term mortality. Subjects aged 5-15 years had higher mortality risks than those calculated from Life Tables.

CONCLUSION

Most drownings were fatal, but survivors of non-fatal drowning had low risk of subsequent long-term mortality similar to the general population that was independently associated with age and neurologic status at hospital discharge.

Relative 3D Reconstruction Using Multiple Uncalibrated Images

In this article we show how relative 3D reconstruction from point correspondences of multiple uncalibrated images can be achieved through reference points. The original contributions with respect to related works in the field are mainly a direct global method for relative 3D reconstruction and a geometric method to select a correct set of reference points among all im age points. Experimental results from both simulated and real image sequences are presented, and robustness of the method and reconstruction precision of the results are discussed.

Predicting outcome of drowning at the scene: A systematic review and meta-analyses

OBJECTIVE

To identify factors available to rescuers at the scene of a drowning that predict favourable outcomes.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

PubMed, Embase and Cochrane Library were searched (1979-2015) without restrictions on age, language or location and references lists of included articles.

STUDY SELECTION

Cohort and case-control studies reporting submersion duration, age, water temperature, salinity, emergency services response time and survival and/or neurological outcomes were eligible. Two reviewers independently screened articles for inclusion, extracted data, and assessed quality using GRADE. Variables for all factors, including time and temperature intervals, were categorized using those used in the articles. Random effects meta-analyses, study heterogeneity and publication bias were evaluated.

RESULTS

Twenty-four cohort studies met the inclusion criteria. The strongest predictor was submersion duration. Meta-analysis showed that favourable outcome was associated with shorter compared to longer submersion durations in all time cutoffs evaluated: ≤5-6min: risk ratio [RR]=2.90; (95% confidence interval [CI]: 1.73, 4.86); ≤10-11min: RR=5.11 (95% CI: 2.03, 12.82); ≤15-25min: RR=26.92 (95% CI: 5.06, 143.3). Favourable outcomes were seen with shorter EMS response times (RR=2.84 (95% CI: 1.08, 7.47)) and salt water versus fresh water 1.16 (95% CI: 1.08, 1.24). No difference in outcome was seen with victim's age, water temperatures, or witnessed versus unwitnessed drownings.

CONCLUSIONS

Increasing submersion duration was associated with worse outcomes. Submersion durations <5min were associated with favourable outcomes, while those >25min were invariably fatal. This information may be useful to rescuers and EMS systems deciding when to perform a rescue versus a body recovery.

Can you really swim? Validation of self and parental reports of swim skill with an inwater swim test among children attending community pools in Washington State

BACKGROUND

Drowning is the second leading cause of unintentional injury death among US children. Multiple studies describe decreased drowning risk among children possessing some swim skills. Current surveillance for this protective factor is self/proxy-reported swim skill rather than observed inwater performance; however, children's self-report or parents' proxy report of swim skill has not been validated. This is the first US study to evaluate whether children or parents can validly report a child's swim skill. It also explores which swim skill survey measure(s) correlate with children's inwater swim performance.

METHODS

For this cross-sectional convenience-based sample, pilot study, child/parent dyads (N=482) were recruited at three outdoor public pools in Washington State. Agreement between measures of self-reports and parental-reports of children's swim skill was assessed via paired analyses, and validated by inwater swim test results.

RESULTS

Participants were representative of pool's patrons (ie, non-Hispanic White, highly educated, high income). There was agreement in child/parent dyads' reports of the following child swim skill measures: 'ever taken swim lessons', perceived 'good swim skills' and 'comfort in water over head'. Correlation analyses suggest that reported 'good swim skills' was the best survey measure to assess a child's swim skill-best if the parent was the informant (r=0.25-0.47). History of swim lessons was not significantly correlated with passing the swim test.

CONCLUSIONS

Reported 'good swim skills' was most correlated with observed swim skill. Reporting 'yes' to 'ever taken swim lessons' did not correlate with swim skill. While non-generalisable, findings can help inform future studies.

Identification of potential therapeutic targets for melanoma using gene expression analysis

Metastatic melanoma represents a significant cause of death in patients with melanoma and the frequency is increasing. The aim of this study was to identify potential therapeutic targets for metastatic melanoma. Gene expression profile GSE44660 was downloaded from Gene Expression Omnibus database. A total of 22 samples were analyzed in our study, including 3 specimens of normal melanocytes, 12 specimens of melanoma LNM (lymph node metastasis) and 7 specimens of MBM (melanoma brain metastasis). DEGs (differentially expressed genes) in LNM and MBM were identified respectively using Limma package. GO (Gene Ontology) and KEGG (Kyoto Encyclopedia of Genes and Genomes) pathways analyses of common DEGs between two comparison groups were performed using DAVID, followed by cancer-related genes and transcription factor analysis. PPI (protein-protein interaction) network was constructed by STRING, and significant key genes were selected. Totally, 401 common DEGs were identified. Disease analysis showed that ICAM1 (intercellular adhesion molecule 1) and NBN (nibrin) were related to melanoma. In the PPI network, BIRC5 (baculoviral IAP repeat containing 5), BUB1 (BUB1 mitotic checkpoint serine/threonine kinase), GMNN (geminin, DNA replication inhibitor), AURKA (aurora kinase A), TOP2A (topoisomerase (DNA) II alpha) and BUB1B (BUB1 mitotic checkpoint serine/threonine kinase B) were with higher degree more than 50. ICAM1, NBN, BIRC5, BUB1, BUB1B, GMNN, AURKA and TOP2A may play key roles in the progression and development of melanoma. They may be used as specific therapeutic targets in the treatment of metastatic melanoma. However, further experiments are still needed to confirm our results.

Barriers to life jacket use among adult recreational boaters

OBJECTIVE

To identify barriers to life jacket use.

DESIGN

Cross-sectional survey.

SETTING

Nine public boat ramps in western Washington State, USA, August-November, 2008.

PARTICIPANTS

675 adult boaters (>18 years) on motor boats <26 feet long.

MAIN OUTCOME

Low or no life jacket use (0-50% of time) versus high life jacket use (51-100% of time).

RESULTS

Low/no life jacket use (0-50% of time) was associated with longer boat length (per foot, risk ratio [RR] 1.03, 95% CI 1.02 to 1.05), alcohol use (RR 1.11, 95% CI 1.01 to 1.20), perception of life jackets as 'uncomfortable' (RR 1.29, 95% CI 1.09 to 1.52), perceived greater level of swimming ability (RR 1.25, 95% CI 1.03 to 1.53 for 'expert swimmer') and possibly with lack of confidence that a life jacket may save one from drowning (RR 1.13, 95% CI 0.96 to 1.32). Low life jacket use was less likely when an inflatable life jacket was the primary life jacket used by a subject (RR 0.77, 95% CI 0.63 to 0.94), a child was onboard (RR 0.88, 95% CI 0.79 to 0.99) or if the respondent had taken a boating safety class (RR 0.94, 95% CI 0.87 to 1.01).

CONCLUSIONS

Life jacket use may increase with more comfortable devices, such as inflatable life jackets, and with increased awareness of their efficacy in preventing drowning. Boater education classes may be associated with increased life jacket use among adults.

Association of water temperature and submersion duration and drowning outcome

AIM

Evaluate the roles of water temperature and submersion duration in the outcome of drowning victims.

METHODS

Subjects were those who drowned in open water (lakes, rivers, and ocean) in three counties in Washington State between 1975 and 1996. We performed a case control study to assess the association between age, reported submersion duration, and estimated water temperature and drowning outcomes. Cases were victims with good outcomes (survival with normal or mild/moderate neurologic sequelae). Controls were victims with bad outcomes (death or severe neurologic sequelae or persistent vegetative state). We used Poisson regression to estimate odds ratios (OR) and 95% confidence intervals (CI).

RESULTS

Of the total 1094 open water drowning victims, most were male (85%),white (84%), and with a mean age of 27 years. Most drownings occurred in lakes (51%) and in cold (≥6-16 °C (44%)) or very cold waters (<6 °C (34%)). Most (78%) had bad outcomes (74% died; 4% survived with severe neurologic sequelae. Of those with good outcomes, 88.2% were submerged <6 min, 7.4% 6-10 min and 4.3% for 11-60 min. Victims with good outcomes were 61% (95% CI 0.23-0.65) less likely to be submerged for 6 to 10 min and 98% (95% CI 0.01-0.04) less likely to be submerged for 11 or more minutes. Water temperature was not associated with outcome.

CONCLUSIONS

A protective effect of cold water for drowning victims was not found; estimated submersion duration was the most powerful predictor of outcome. Recommendations for initiation of rescue and resuscitation efforts should be revised to reflect the very low likelihood of good outcome following submersion greater than 10 min.

Low life jacket use among adult recreational boaters: a qualitative study of risk perception and behavior factors

BACKGROUND

Life jackets may prevent one in two drowning deaths, however, 85% of recreational boating-related drowning victims in the United States in 2012 did not wear a life jacket. This study explored behavioral factors and strategies to encourage consistent life jacket use among adult recreational boaters.

METHODS

We conducted a qualitative study among boat owners who boat regularly, and explored factors associated with life jacket use by adults and child or adolescent passengers. Sixteen boaters participated in four focus groups.

RESULTS

Most boaters reported inconsistent use of life jackets, using them only when conditions were poor. Each described episodes of unpredictable boating risk which occurred despite favorable conditions. Most required younger child passengers to wear a life jacket, but reported resistance among older children. Barriers to consistent life jacket use included discomfort and the belief that life jacket use indicated inexperience or poor swimming ability. Participants stated that laws requiring life jacket use would change behavior especially for children. The only demonstrated behavior change among group members was associated with use of inflatable life jacket devices.

CONCLUSIONS

Boating risk is inherently unpredictable; therefore interventions should focus on strategies for increasing consistent use of life jackets. Passage and enforcement of life jacket legislation for older children and adults is likely a promising approach for behavior change. Designing more comfortable, better-fitting, more appealing life jackets will be paramount to encouraging consistent use.

Long-term outcomes following pediatric out-of-hospital cardiac arrest*

OBJECTIVES

Pediatric out-of-hospital cardiac arrest is an uncommon event with measurable short-term survival to hospital discharge. For those who survive to hospital discharge, little is known regarding duration of survival. We sought to evaluate the arrest circumstances and long-term survival of pediatric patients who experienced an out-of-hospital cardiac arrest and survived to hospital discharge.

DESIGN

Retrospective cohort study

SETTING

King County, WA Emergency Medical Service Catchment and Quaternary Care Children's Hospital

PATIENTS

Persons less than 19 years old who had an out-of-hospital cardiac arrest and were discharged alive from the hospital between 1976 and 2007.

INTERVENTION

None.

MEASUREMENTS AND MAIN RESULTS

During the study period, 1,683 persons less than 19 years old were treated for pediatric out-of-hospital cardiac arrest in the study community, with 91 patients surviving to hospital discharge. Of these 91 survivors, 20 (22%) subsequently died during 1449 person-years of follow-up. Survival following hospital discharge was 92% at 1 year, 86% at 5 years, and 77% at 20 years. Compared to those who subsequently died, long-term survivors were more likely at the time of discharge to be older (mean age, 8 vs 1 yr), had a witnessed arrest (83% vs 56%), presented with a shockable rhythm (40% vs 10%), and had a favorable Pediatric Cerebral Performance Category of 1 or 2 (67% vs 0%).

CONCLUSIONS

In this population-based cohort study evaluating the long-term outcome of pediatric survivors of out-of-hospital cardiac arrest, we observed that long-term survival was generally favorable. Age, arrest characteristics, and functional status at hospital discharge were associated with prognosis. These findings support efforts to improve pediatric resuscitation, stabilization, and convalescent care.

Medical complexity and pediatric emergency department and inpatient utilization

OBJECTIVES

To characterize the use of and disposition from a tertiary pediatric emergency department (PED) by children with chronic conditions with varying degrees of medical complexity.

METHODS

We conducted a retrospective cohort study using a dataset of all registered PED patient visits at Seattle Children's Hospital from January 1, 2008, through December 31, 2009. Children's medical complexity was classified by using a validated algorithm (Clinical Risk Group software) into nonchronic and chronic conditions: episodic chronic, lifelong chronic, progressive chronic, and malignancy. Outcomes included PED length of stay (LOS) and disposition. Logistic regression generated age-adjusted odds ratios (AOR) of admission with 95% confidence intervals (CIs).

RESULTS

PED visits totaled 77 748; 20% (15 433) of which were for children with chronic conditions. Compared with visits for children without chronic conditions, those for children with chronic conditions had increased PED LOS (on average, 79 minutes longer; 95% CI 77-81; P < .0001) and hospital (51% vs 10%) and PICU (3.2% vs 0.1%) admission rates (AOR 10.3, 95% CI 9.9-10.7 to hospital and AOR 25.0, 95% CI 17.0-36.0 to PICU). Admission rates and PED LOS increased with increasing medical complexity.

CONCLUSIONS

Children with chronic conditions comprise a significant portion of annual PED visits in a tertiary pediatric center; medical complexity is associated with increased PED LOS and hospital or PICU admission. Clinical Risk Group may have utility in identifying high utilizers of PED resources and help support the development of interventions to facilitate optimal PED management, such as pre-arrival identification and individual emergency care plans.

Association between wearing a personal floatation device and death by drowning among recreational boaters: a matched cohort analysis of United States Coast Guard data

OBJECTIVE

To estimate the association between wearing a personal floatation device (PFD) and death by drowning among recreational boaters.

DESIGN

Matched cohort study analysis of Coast Guard data.

SETTING

United States.

SUBJECTS

Recreational boaters during 2000-2006.

MAIN OUTCOME MEASURES

Risk ratio (RR) for drowning death comparing boaters wearing a PFD with boaters not wearing a PFD.

RESULTS

Approximately 4915 boater records from 1809 vessels may have been eligible for our study, but because of missing records and other problems, the analysis was restricted to 1597 boaters in 625 vessels with 878 drowning deaths. The adjusted RR was 0.51 (95% CI 0.35 to 0.74).

CONCLUSIONS

If the estimated association is causal, wearing a PFD may potentially prevent one in two drowning deaths among recreational boaters. However, this estimate may be biased because many vessels had to be excluded from the analysis.