► Jatropha curcas plants can be considered as a drought-resistant shrub species. ► J. curcas under drought condition show a water conservation strategy. ► J. Curcas avoids water loss by decreasing ...leaf growth and stomatal conductance. ► This crop in arid and/or semiarid ambient should be focused on avoiding soil degradation.
Jatropha curcas L. has recently drawn the attention of the international research community due to its potential as a biodiesel crop. In addition, it is very well adapted to arid and semiarid climate conditions. In this research, the effects of drought on growth, leaf water relation and organic solutes, leaf and root mineral concentration, chlorophyll fluorescence parameters, leaf gas exchange and carbohydrate concentration were studied in seedlings of J. curcas to elucidate the physiological and morphological mechanisms related to their drought tolerance. Four-week-old seedlings were grown in growth chambers with five different water regimes corresponding to 100, 75, 50, 25, and 0% field capacity (FC) for four weeks. Seedlings, maintained a good water status regardless of the drought stress treatment because all water regimes affected the leaf relative water content, whereas the leaf water potential was only reduced in the water-stressed plants from the 0% and 25% FC treatments. Drought treatments reduced leaf, stem and root growth. However, the decrease in growth was higher in the aerial part of the plant than in the root, so that the root-to-shoot ratio in drought-stressed plants increased compared to that in the well-watered plants. Net assimilation of CO2(ACO2) and stomatal conductance (gs) decreased in all treatments, although ACO2 gradually declined as the water supply was decreased, while the reduction in stomatal conductance was similar in all drought stress treatments. Hence, we conclude that the strong control of transpirational water loss by reducing both stomatal conductance and biomass from aerial parts could be involved in the ability of this plant to resist drought conditions.
Abstract Background Trauma is a leading cause of death among children worldwide. Detailed knowledge of the epidemiology of childhood fatal injuries is necessary for preventing injuries. Objective To ...determine clinical differences between children who were treated in an emergency department for accidental or abusive injuries. Methods A retrospective review of all deceased patients who were treated in two urban pediatric emergency departments between 1998 and 2010 was performed. Patients were categorized into two groups, accidental and abusive, for comparison. Results A total of 1498 patients died during the study period, with 124 deaths being attributable to injury for a rate of 9.5 injury-related deaths per year. Most fatal injuries were accidental. Children with abusive fatal injuries were younger and more likely to have been seen for an injury in a clinic or emergency department within 2 months of their death. Eighty-two percent of abusive fatal injuries had documented subdural hematomas, whereas only 7.2% of accidental fatal injuries had a subdural hematoma documented. Nearly 50% of abusive fatal injuries had retinal hemorrhages reported, although no child with an accidental fatal injury had this type of injury documented. Conclusion Younger children, especially those previously seen in an emergency department or clinic for injury, are more likely to sustain an abusive fatal injury. Sentinel physical findings associated with abusive fatal injuries include subdural hematomas and retinal hemorrhages, and the presence of these findings should prompt an investigation into the circumstances of injury.
Slime’s increasing popularity has caused children to be more frequently exposed to glue. There is no comprehensive literature describing pediatric glue-related injuries. This study’s purpose is to ...characterize pediatric glue-related injuries presented to U.S. emergency departments (EDs). We queried the National Electronic Injury Surveillance System for pediatric glue-related injuries from 2009 to 2018. Data were abstracted from discrete and case narrative data. Odds ratios were calculated to determine age-related differences in injuries. An estimated 18,126 pediatric patients were treated in U.S. EDs for glue-related injuries. Injury incidence increased over time. The most frequently injured body part was the eye, and the most common diagnosis was foreign body without documented sequelae. The most common injury mechanism was unintentional splash/squirt/explosion. Younger children were more likely to accidentally ingest glue; older children were more likely to sustain burns. Preventive efforts should focus on personal protective equipment, proper storage/labeling, and supervision of use.
Abstract Background Pelvic injuries in young children are rare, and it has been difficult to establish clinical guidelines to assist providers in managing blunt pelvic trauma, especially in non−Level ...1 trauma centers. Objective Our aim was to describe the relationship among clinical findings, mechanism of injury, and the radiographic resources utilized in children with pelvic fractures presenting to a non−Level 1 trauma center. Methods A retrospective review of patients with a pelvic fracture treated in two urban pediatric Level 3 emergency departments was performed. Results Between 2001 and 2010, a total of 208 patients were identified. Avulsion/iliac wing fractures were the most common fractures (58.7%), and sports-related injuries were the most common mechanism of injury (50.0%). Children with sports-related injuries were more likely to sustain an avulsion fracture ( p < 0.001), less likely to have a computed tomography scan obtained in the emergency department ( p < 0.001), and less likely to have an associated injury ( p < 0.001) than other children. Children struck by a motor vehicle ( p < 0.001) or involved in a motor vehicle accident ( p < 0.001) were more likely to receive a computed tomography scan ( p < 0.001) and have associated head and extremity injuries ( p < 0.001). Mechanism of injury was associated with abnormal computed tomography scans. Nearly all patients were treated nonoperatively (98.1%) and no deaths were reported in this study. Conclusions Patterns of injury, based on mechanism of injury, have been reported to assist the assessment and management of children with minor pelvic injuries.
Abstract Background Inadequate treatment of painful conditions in children is a significant and complex problem. The wide range of cognitive abilities associated with a child's age is a particular ...challenge for providers treating children with painful conditions. Study Objective To examine the effect of patient age on the provision of analgesic medicines at discharge in children treated emergently for a long bone fracture. Methods A retrospective review was performed of all patients during a 1-year period with a long bone fracture treated in two urban pediatric Emergency Departments (EDs). Results Eight hundred seventy-eight patients were identified who met our inclusion criteria. Nearly 60% of patients received a prescription for an opioid-containing medicine and 19% received a prescription for an over-the-counter analgesic medicine at ED discharge. Patients younger than 4 years old had lower pain scores, less severe fractures, and overall were significantly less likely to receive an opioid-containing prescription compared to children 4 years old or greater. In children with more severe fractures requiring reduction in the ED, no significant age-related differences were noted in opioid prescription rates. No age-related significant differences were noted for over-the-counter prescription analgesic medicines provided at discharge. Conclusion Young patient age is associated with different analgesic prescription patterns in children treated in the ED for a long bone fracture.
Dog bite injuries often present to Emergency Departments (ED), and between 2001 and 2003, approximately 4.5 million adults and children were injured. Injuries may range from puncture wounds to deep ...tissue lacerations or avulsions. Deaths have been described. Our objective was to describe dog bite injuries, the overall location of injuries, and need for vaccination among children who presented to a Pediatric ED designated as a level III trauma center with a robust facial surgical infrastructure. This was a 6-year retrospective study. Charts were identified by International Classification of Diseases, Tenth Revision (ICD-10) codes for lacerations or injuries secondary to animal bites and accessing the hospital’s trauma database. Variables abstracted were age, sex, type of injury, location, need for antibiotics, immunization states and requirement of tetanus or rabies vaccine, disposition from ED to the operating room, home, or any in-patient unit. We excluded children older than 17 years of age and children who had a post-bite injury infection or injury not initially managed in our facility or medical system. The final cohort consisted of 152 children. The median age was 52 months and age ranged from 2 to 215 months. Children with a single bite injury were older when compared with those with numerous injuries, 81 and 62 months of age, respectively. Among young children, 75% of injuries occurred above the neck and 15.1% were managed in the operating room. Twenty-four percent of children required either a tetanus or rabies vaccination. Most dog bite injuries occurred to facial structures. Comprehensive care of dog victims included awareness of both dog and injured child vaccination status.
To describe emergency department (ED) visits for self-inflicted injury (SII) among adolescents, examine trends in SII mechanisms, and identify factors associated with increased risk.
Analyses ...included patients aged 10 to 18 years from the National Trauma Data Bank, years 2009 to 2012. We used Cochran-Armitage trend tests to examine change over time and generalized linear models to identify risk factors for SII.
We examined 286,678 adolescent trauma patients, 3664 (1.3%) of whom sustained an SII. ED visits for SII increased from 2009 to 2012 (1.1% to 1.6%, P for trend ≤ .001), whereas self-inflicted firearm visits decreased (27.3% to 21.9%, P for trend = .02). The most common mechanism in males was firearm (34.4%), and in females, cut/pierce (48.0%). Odds of SII were higher in females (odds ratio OR 1.41, 95% confidence interval CI 1.13-1.77), older adolescents (OR 2.73, 95% CI 2.38-3.14), adolescents with comorbid conditions (OR 1.64; 95% CI 1.49-1.80), and Asian adolescents (OR 1.67, 95% CI 1.35-2.08) and lower in African American adolescents (OR 0.78, 95% CI 0.70-0.87). Adolescents in the public or self-pay insurance category had higher odds of SII (OR 1.44, 95% CI 1.27-1.64) than those in the private insurance category (OR 1.15, 95% CI 1.01-1.31). Adolescents with an SII had higher odds of death than those with other injuries (OR 12.9, 95% CI 6.78-24.6).
We found a significant increase in the number of SIIs by adolescents that resulted in ED visits from 2009 to 2012. Although SIIs increased, we found a significant decrease in the percentage of adolescents who self-injured with a firearm. SIIs reflect a small percentage of ED visits, but these patients have dramatically higher odds of death.
A comparative effectiveness trial tested 2 parent-based interventions in improving the psychosocial recovery of hospitalized injured children: (1) Link for Injured Kids (Link), a program of ...psychological first aid in which parents are taught motivational interviewing and stress-screening skills, and (2) Trauma Education, based on an informational booklet about trauma and its impacts and resources.
A randomized controlled trial was conducted in 4 children's hospitals in the Midwestern United States. Children aged 10 to 17 years admitted for an unintentional injury and a parent were recruited and randomly assigned to Link or Trauma Education. Parents and children completed questionnaires at baseline, 6 weeks, 3 months, and 6 months posthospitalization. Using an intent-to-treat analysis, changes in child-reported posttraumatic stress symptoms, depression, quality of life, and child behaviors were compared between intervention groups.
Of 795 injured children, 314 children and their parents were enrolled into the study (40%). Link and Trauma Education was associated with improved symptoms of posttraumatic stress, depression, and pediatric quality of life at similar rates over time. However, unlike those in Trauma Education, children in the Link group had notable improvement of child emotional behaviors and mild improvement of conduct and peer behaviors. Compared with Trauma Education, Link was also associated with improved peer behaviors in rural children.
Although children in both programs had reduced posttrauma symptoms over time, Link children, whose parents were trained in communication and referral skills, exhibited a greater reduction in problem behaviors.
Abstract Background Various characteristics of floors and floor coverings are well established as injury hazards. Loose carpeting, such as rugs, is often cited as a hazard leading to injury. Purpose ...To describe the epidemiology and patterns of rug, mat, and runner-related injuries in patients seeking emergency treatment. Methods Data from the National Electronic Injury Surveillance System from 1990 through 2009 were investigated. Sample weights were used to calculate national estimates. US Census Bureau data were used to calculate injury rates per 100 000 individuals. Linear regression and computation of relative risks (RRs) with 95% confidence intervals (CIs) were performed. Results An estimated 245 605 patients were treated in US emergency departments for rug-related injuries during the study period, with an average of 12 280 cases per year. Females (72.3%) and individuals older than 64 years (47.1%) sustained the largest number of injuries. Patients younger than 6 years were more likely to injure the head or neck region (RR, 3.52 95% CI, 3.26-3.81) compared with all other groups. Patients older than 18 years were more likely to experience a fracture or dislocation (RR, 2.52 95% CI, 2.13-2.88) and sustain an injury as a result of tripping or slipping on a rug (RR, 1.36 95% CI, 1.26-1.41 compared with other age groups. Increasing age was associated with increased risk of hospitalization in this study. Patients who sustained an injury from a rubber or plastic mat/rug were significantly less likely to be admitted (RR, 0.67 95% CI, 0.55-0.83). Injuries occurring in kitchens or bathrooms resulted in significantly higher admission rates (RR, 1.45 95% CI, 1.34-1.54). Conclusions Rug-related injuries are an important source of injury for individuals of all ages.
Abstract Background Osteochondral fractures are reported to complicate patellar dislocations in 5–95% of patients. For this reason, post-reduction radiographs are recommended for the routine ...evaluation of patellar dislocations in all patients. To date, no data have been reported regarding the impact plain radiography has on the Emergency Department (ED) management of pediatric patients with lateral patellar dislocations. Study Objectives To estimate the incidence of fractures detected by post-reduction plain radiographs in pediatric patients presenting with unreduced lateral patellar dislocations and to examine differences in ED management between patients with and without radiographically apparent fractures. Methods Retrospective review of records for pediatric patients who presented to an ED, received a diagnosis of lateral patellar dislocation, and underwent a reduction procedure. Results Of 80 patients who met criteria for inclusion in the study, 8 patients (10%; 95% CI 3–17) had a fracture identified. All patients, regardless of their radiographic findings, had their dislocation reduced uneventfully and were discharged with knee immobilization and a plan for outpatient follow-up. There were no statistically significant differences between those patients who had a detected fracture as compared to those without in terms of intravenous line placement ( p = 1.000), parenteral analgesic administration ( p = 0.965), procedural sedation administration ( p = 0.922), ED length of stay ( p = 0.706), or provision of a prescription for an oral analgesic upon discharge ( p = 0.103). Conclusion Osteochondral fractures were detected by plain radiography in 10% of patients presenting with lateral patellar dislocation and did not alter ED management. Pediatric patients with lateral patellar dislocations may be candidates for discharge from the ED after reduction without plain radiography. The modality by which to best determine the presence of a complicating osteochondral fracture (i.e., plain radiography, computed tomography, magnetic resonance imaging, or arthroscopy) may be left to the discretion of the orthopedic surgeon accepting the child in follow-up. Further study is needed to determine if forgoing plain radiographs in the ED decreases length of stay and reduces patient costs.
