An Analysis of Factors Associated with Burn Injury Outcomes in Low- and Middle-Income Countries.

BACKGROUND: Burn injuries are a major cause of morbidity and mortality within low- and middle-income countries (LMICs). The World Health Organization developed the Global Burn Registry to centralize data collection for the guidance of burn prevention programs. This study analyzed the epidemiologic and hospital-specific factors associated with burn injury outcomes in LMICs and high-income countries (HICs). METHODS: A retrospective review was performed using the Global Burn Registry over 3 y. Patients were stratified by income region. Bivariate analyses and stepwise regressions were performed to evaluate patient and hospital demographics and variables associated with injury patterns and outcomes. Outcomes of interest included mortality and length of stay. RESULTS: Over the study period, data were collected on 1995 patients from 10 LMICs (20 hospitals) and four HICs (four hospitals). Significantly higher mortality was seen in LMICs compared with HICs (17% versus 9%; P < 0.001). There was no significant difference between income regions for injury patterns (P = 0.062) or total body surface area of the burn injury (P = 0.077). Of the LMIC hospitals in this data set, 11% did not have reliable access to an operating theater. CONCLUSIONS: HICs had a lower overall mortality even with higher rates of concurrent injuries, as well as longer length of stay. LMIC hospitals had fewer resources available, which could explain increased mortality, given similar total body surface area. This study highlights how investing in health care infrastructure could lead to improved outcomes for patients in low-resource settings.

The Spinal Dural Arteriovenous Fistula in a Patient With Metastatic Renal Cell Carcinoma.

Spinal dural arteriovenous fistula (SDAVF) is an elusive and underdiagnosed disease. Congestive myelopathy occurs from increased venous pressure transmitted by the fistula between a radiculomeningeal artery and the spinal venous plexus. While its cause remains unknown, associations between SDAVF and hyper-vascular states have been reported. We present the first documented case report of a de novo SDAVF diagnosis in a patient with active renal cell carcinoma (RCC) metastasis to the spinal epidural space and review the literature.

A Conservation-Based Approach to Compensation for Livestock Depredation: The Florida Panther Case Study.

Calf (Bos taurus) depredation by the federally endangered Florida panther (Puma concolor coryi) on ranches in southwest Florida is an important issue because ranches represent mixed landscapes that provide habitat critical to panther recovery. The objectives of this study were to (1) quantify calf depredation by panthers on two ranches in southwest Florida, and (2) develop a habitat suitability model to evaluate the quality of panther hunting habitat on ranchlands, assess whether the model could predict predation risk to calves, and discuss its potential to be incorporated into an incentive-based compensation program. We ear-tagged 409 calves with VHF transmitters on two ranches during 2011-2013 to document calf mortality. We developed a model to evaluate the quality of panther hunting habitat on private lands in southwest Florida using environmental variables obtained from the Florida Natural Areas Inventory (FNAI) Cooperative Landcover Database and nocturnal GPS locations of panthers provided by the Florida Fish and Wildlife Conservation Commission (FWC). We then tested whether the model could predict the location of calf depredation sites. Tagged calf loss to panthers varied between the two ranches (0.5%/yr to 5.3%/yr) and may have been influenced by the amount of panther hunting habitat on each ranch as the ranch that experienced higher depredation rates contained a significantly higher probability of panther presence. Depredation sites of tagged calves had a significantly greater probability of panther presence than depredation sites of untagged calves that were found by ranchers in open pastures. This suggests that there may be more calves killed in high risk environments than are being found and reported by ranchers and that panthers can hunt effectively in open environments. It also suggests that the model may provide a means for evaluating the quality of panther hunting habitat and the corresponding risk of depredation to livestock across the landscape. We suggest that our approach could be applied to prioritize and categorize private lands for participation in a Payment for Ecosystem Services program that compensates landowners for livestock loss and incentivizes conserving high quality habitat for large carnivores where livestock depredation is a concern.