Needless abdominal CT scans can be avoided in children, study says

Feb. 1, 2013 ? A study of more than 12,000 children from emergency departments throughout the country in the Pediatric Emergency Care Applied Research Network (PECARN) has identified seven factors that can help physicians determine the need for a computed tomography (CT) scan following blunt trauma to the abdomen. Because CT scans pose radiation hazards for youngsters, the findings may enable doctors to determine which children do not need to be exposed to such tests after a traumatic injury.

The study is online first in advance of an upcoming issue of the Annals of Emergency Medicine.

"CT scans involve significant radiation risk, especially for children, who are more vulnerable than adults to radiation's effects," said principal investigator and lead author of the study James Holmes, a professor of emergency medicine at the UC Davis School of Medicine. "We have now identified a population of pediatric patients that does not typically benefit from a CT scan, which is an important step in reducing radiation exposure."

The prospective study involved children who arrived at emergency departments in the PECARN network after blunt trauma to their torsos, such as sustained from a car or bicycle crash, a fall or an assault. A variety of factors related to the children's histories and clinical presentations were evaluated. Among these, seven were identified by statistical analysis to correlate with risk for involving a clinically important injury. The factors included evidence of trauma on the abdomen or chest (such as seat-belt marks), neurological changes, abdominal pain or tenderness, abnormal breath sounds and vomiting.

Children who had none of the factors when evaluated in the emergency department had only a 0.1 percent chance of having an abdominal injury that required acute intervention. For the great majority of these cases, therefore, a CT scan would not likely provide additional useful information. According to the authors, the risk of developing a future cancer from radiation exposure from a CT scan in this situation (i.e., when lacking all seven factors) outweighs the risk of having a significant medical problem from the abdominal injury.

The authors stated that the prediction rule is intended only to help "rule out" the need for CT for children when none of the seven factors is present. However, the rule does not mandate a CT solely based on any one of the factors being present. If the prediction rule were used in that way, CT usage would actually increase over current levels. The authors emphasized that clinical judgment must play an important role in determining whether a CT is needed in each case. Extending the period of observation in the emergency department, and using findings from laboratory tests and ultrasonography, can also contribute to decision-making in cases of abdominal trauma.

According to Holmes, the prediction rule must be tested in another clinical trial designed specifically to evaluate its validity before being generally adopted. He expects that this will be carried out in the near future.

Another related ongoing study at UC Davis Medical Center is investigating the role of ultrasonography in the evaluation of abdominal trauma in children, and whether increasing its usage can lead to further reduction of the need for CT scans.

This study also was conducted through PECARN, a network of pediatric emergency departments throughout the United States that enables researchers to gather enough data to perform significant studies on critical issues in pediatric emergency medicine. PECARN studies have previously led to new standards of care for infants or children presenting with head trauma, diabetic crisis and infections.

"Because of PECARN, we are uniquely positioned to perform large studies that can provide important information," said Nathan Kuppermann, senior investigator of the study, who is professor of pediatrics and emergency medicine and chair of the Department of Emergency Medicine at the UC Davis School of Medicine. "The results of such studies are making emergency medicine decision-making more of a science and leading to better and safer outcomes for children."

Kuppermann is founding chair of PECARN and leads one of the network's research nodes, which is centered at UC Davis Medical Center and includes the children's hospitals of the University of Utah and University of Pennsylvania.

Other UC Davis Medical Center investigators involved in the study are Peter Sokolove, professor of emergency medicine, David Wisner, professor of surgery, and Sandra Wootton-Gorges, professor and medical director of radiology at the ShrinersHospital for Children Northern California. Other authors were from emergency departments in Maryland, Massachusetts, Michigan, Missouri, New York, Ohio, Utah, Wisconsin and Washington, D.C. A complete listing of the authors and their affiliations can be found in the article.

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Story Source:

The above story is reprinted from materials provided by University of California - Davis Health System.

Note: Materials may be edited for content and length. For further information, please contact the source cited above.

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Journal Reference:

1. James F. Holmes, Kathleen Lillis, David Monroe, Dominic Borgialli, Benjamin T. Kerrey, Prashant Mahajan, Kathleen Adelgais, Angela M. Ellison, Kenneth Yen, Shireen Atabaki, Jay Menaker, Bema Bonsu, Kimberly S. Quayle, Madelyn Garcia, Alexander Rogers, Stephen Blumberg, Lois Lee, Michael Tunik, Joshua Kooistra, Maria Kwok, Lawrence J. Cook, J. Michael Dean, Peter E. Sokolove, David H. Wisner, Peter Ehrlich, Arthur Cooper, Peter S. Dayan, Sandra Wootton-Gorges, Nathan Kuppermann. Identifying Children at Very Low Risk of Clinically Important Blunt Abdominal Injuries. Annals of Emergency Medicine, 2013; DOI: 10.1016/j.annemergmed.2012.11.009

Note: If no author is given, the source is cited instead.

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of ScienceDaily or its staff.

Source: http://feeds.sciencedaily.com/~r/sciencedaily/top_news/top_health/~3/EzDIoClzZvQ/130201132330.htm

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Less bang for Beijing New Year due to smog

BEIJING (Reuters) - China's notoriously smog-bound capital Beijing asked residents on Friday to set off fewer fireworks over this month's Chinese New Year period as it battles a persistent air quality crisis.

Air quality in Beijing has mostly stayed above "very unhealthy" and "hazardous" levels for about two weeks, though strong winds cleared the haze away on Friday.

Chinese New Year, which begins February 10, is marked by riotous fireworks displays traditionally thought to bring good luck for the year ahead, which turn cities into near war zones and blacken the skies with thick smoke for hours on end.

"To improve the air quality and create a favorable environment for you and your family members, please set off fewer fireworks or no fireworks, in order to reduce emissions of pollutants," the official Xinhua news agency cited an unnamed official with the Beijing Office of Fireworks and Firecrackers as saying.

The city's three main fireworks retailers have reduced to 750,000 the number of cartons of fireworks in stock for this year's festivities, down from 810,000 last year.

The number of shops approved to sell fireworks in has also been cut to 1,337 from 1,429, Xinhua added.

Pollution in Beijing regularly exceeds 500 on an index that measures particulate matter in the air with a diameter of 2.5 micrometers. Above 300 is considered hazardous, while the World Health Organisation recommends a daily level of no more than 20.

Last month pollution hit a record, 30-45 times above recommended safety levels, blanketing the city in a thick, noxious cloud that grounded flights and forced people indoors, and prompting emergency measures such as factory closures.

(Reporting by Ben Blanchard)

Source: http://news.yahoo.com/less-bang-beijing-due-smog-082237516.html

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PFT: Osi hopes to stay a Giant; Jets an option

Getty Images

The NFLPA has demonstrated its general mistrust of team doctors.

Now they have a specific target.

According to Michael Gehlken of U-T San Diego, the union wants the Chargers to replace Dr. David Chao.

The union has asked the league find a ?suitable replacement? for Chao, according to NFLPA? assistant executive director of external affairs George Attalah.

?(Chao) has a clear track record of misconduct,? NFLPA President Domonique Foxworth said. ?It?s unfortunate for the guys who play there. It?s something that we can?t control, but we can definitely put pressure to improve. We?re trying now.

?I don?t know that it?s appropriate to talk about all the steps we?re taking, but the first step is that we?re making people aware.?

During the NFLPA press conference, Chao was the one doctor singled out by executive director DeMaurice Smith during a discussion of the union?s problems with medical care for players.

?There is a team doctor named Dr. Chao who is currently the San Diego team doctor,? Smith said, ?who has been found liable of medical malpractice twice ? twice. The same doctor was the subject of a DEA investigation. He?s still the San Diego Chargers team doctor.

?Now, I?m not a doctor. I don?t even play one on TV. But it seems to me that the players of the National Football League deserve to have a doctor who?s not been found liable of malpractice, and that?s within the last year.?

The Chargers did not respond, saying they were still gathering information.

Source: http://profootballtalk.nbcsports.com/2013/01/31/osi-umenyiora-hopes-to-stay-with-giants-open-to-playing-for-jets/related/

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Moveable Magnetic Shelving Is an Amazing Storage Solution

This magnetic storage concept by Benoit Bayol is half art, half practical furniture: neatly arranged on the wall it's reminiscent of a Mondrian painting, but it also offers an incredibly versatile storage solution. More »

Source: http://feeds.gawker.com/~r/gizmodo/full/~3/e733ATDgfiQ/moveable-magnetic-shelving-is-an-amazing-storage-solution

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Will the Mormons knife the Boy Scouts if gay ban is lifted? (Americablog)

Share With Friends: | | Politics - Top Stories News, RSS Feeds and Widgets via Feedzilla.

Source: http://news.feedzilla.com/en_us/stories/politics/top-stories/281827459?client_source=feed&format=rss

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Egypt politicians renounce violence at crisis talks

CAIRO (Reuters) - Egypt's feuding politicians finally met on Thursday, summoned by the country's most influential Islamic scholar who made them call an end to violence after a week of the deadliest protests since President Mohamed Mursi took office.

The meeting, called by the head of the thousand-year-old al-Azhar university and mosque, was attended both by top officials of Mursi's Muslim Brotherhood and secularist foes who had previously rebuffed the Islamist president's calls for talks.

Sheikh Ahmed al-Tayyeb told the politicians that a national dialogue, "in which all elements of Egyptian society participate, without any exclusion, is the only tool to resolve any problems or differences".

"Political work has nothing to do with violence or sabotage and the welfare of everyone and the fate of our nation depends on respect for the rule of law," the sheikh said.

Leaders of all the main political parties signed a document at the meeting renouncing violence, attendee Ahmed Maher said in a Twitter message.

Al-Azhar, one of the main seats of learning in Sunni Islam worldwide, has tended to keep itself above Egypt's political fray. The extraordinary intervention follows a warning by the army chief on Tuesday that street battles could bring about the collapse of the state.

Nearly 60 people have been killed in violent protests, which broke out last week to mark the second anniversary of the uprising that toppled President Hosni Mubarak.

SPIRIT OF THE REVOLUTION

The opposition accuses Mursi of betraying the spirit of the revolution by concentrating too much power in his own hands and those of the Brotherhood, a decades-old underground Islamist movement that was banned under Mubarak. The Brotherhood accuses its foes of trying to topple Egypt's first elected leader.

Participants at Thursday's meeting included Mahmoud Ezzat, deputy leader of the Muslim Brotherhood, and Saad el-Katatni, the head of its political party. Television footage showed them sitting opposite liberal politicians Mohamed ElBaradei and Amr Moussa and leftist Hamdeen Sabahi - all prominent figures in an alliance of parties opposed to Mursi.

ElBaradei is a former head of the U.N. nuclear watchdog and Moussa was foreign minister under Mubarak era and then head of the Arab League.

Tayyeb presented the politicians with a document he said had been drawn up by youth activists, which called for them to renounce violence and commit to dialogue.

Leaving the meeting early, liberal politician Ayman Nour described it as "a promising start" towards ending the crisis.

Attending the meeting was a partial reversal for the secularist opposition alliance, which had previously spurned Mursi's call for negotiations, demanding the president first agree to include opponents in a national unity government.

The call for a unity government has also been backed by the hardline Islamist Nour party, in an unlikely alliance of Mursi's critics from opposite ends of the political spectrum.

The Brotherhood rejects a unity government as an attempt by Mursi's foes to take power they could not win at the ballot box.

The crisis forced Mursi to cut short a visit to Europe on Wednesday that had been intended to lure investment to Egypt.

While in Berlin, the president sidestepped calls for a unity government, saying the next cabinet would be formed after parliamentary elections due in April.

The streets have grown quieter in the past few days, and on Wednesday authorities scaled back a curfew imposed by Mursi on three restive cities along the Suez canal where most of the week's blood was spilt.

However, the opposition alliance had called fresh protests for Friday, the Islamic sabbath, which could unleash more violence. It was not immediately clear whether the calls for protest would be affected by the al-Azhar meeting.

The past week's violence followed weeks of demonstrations last year against a new constitution, as Mursi failed to unite Egyptians despite the Brotherhood winning repeated elections.

The rise of an elected Islamist president in the Arab world's most populous state after generations of secularist military rule is probably the most important outcome of the wave of Arab revolts over the past two years.

But his rule has been tarnished by the civil unrest, which has thwarted efforts to end an economic crisis that has forced Cairo to sell off most of its reserves to keep the pound currency from crashing.

Ejijah Zarwan, who analyses Egyptian politics for the European Council on Foreign Relations, said Thursday's intervention by al-Azhar was important, but it was far from clear whether it would be enough to calm the streets.

"It's a good first step. Certainly it will help the formal opposition to be very clearly on record as opposing violence," he said. But a deal among political leaders would not be enough to satisfy Egyptians angry at the failure of the revolution to improve their daily lives.

"The people fighting the police and burning buildings are not partisans of any political party. They might not even vote," Zarwan said. "There's a political crisis and there's a social and economic crisis. A negotiated solution to the political crisis will certainly help but it's just a necessary first step towards resolving the social and economic crisis."

(Additional reporting by Omar Fahmy; Editing by Paul Taylor)

Source: http://news.yahoo.com/egypt-politicians-renounce-violence-crisis-talks-113853078.html

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APNewsBreak: EPA moves to ban some rodent poisons

WASHINGTON (AP) ? The Environmental Protection Agency is moving to ban the sale of a dozen rat and mouse poisons sold under the popular D-Con brand in an effort to protect children and pets.

The agency said Wednesday it hopes to reduce the thousands of accidental exposures that occur every year from rodent-control products. Children and pets are at risk for exposure because the products typically are placed on floors.

The agency had targeted a handful of companies two years ago, saying they needed to develop new products that are safer for children, pets and wildlife. All but Reckitt Benckiser Inc., manufacturer of D-Con, did so.

The company will have at least 30 days to request a hearing before an administrative law judge. If no hearing is requested, the ban will take effect.

Associated Press

Source: http://hosted2.ap.org/APDEFAULT/bbd825583c8542898e6fa7d440b9febc/Article_2013-01-30-Rodent%20Poisons/id-daa051d16e334f389823571a9742a6d2

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