Risk of concomitant traumatic brain injuries in children with traumatic dental injuries in a pediatric emergency department: A case-control study.

BACKGROUND: Children with traumatic dental injuries (TDIs) may simultaneously sustain a traumatic brain injury (TBI). The aim of this study was to investigate the risk of concomitant TBI in children with TDIs. METHODS: Children (≤ 18 years) who sought treatment at the emergency department of a major children's hospital for TDIs from 2010 through 2019 were identified. Children with a concomitant TBI were assigned as case patients (TDI and TBI). Two control patients (TDI only) were randomly age- and sex-matched with each case patient. Associations between variables of TDI and concomitant TBI were tested using 6 logistic regression models. RESULTS: Of 2,126 children with TDIs, 119 had concomitant TBIs (case patients). The control group consisted of 238 children with TDIs only who were age- and sex-matched with case patients. Mean (SD) age of children was 8.9 (4.8) years. Twenty-seven percent of case patients were female vs 32% of control patients. There was a statistically significant direct association between total number of injured teeth and concomitant TBIs (P = .01; odds ratio, 2.42; 95% CI, 1.22 to 4.79). For every tooth injured, the odds of concomitant TBI increased by 45% (P < .001; odds ratio, 1.45; 95% CI, 1.18 to 1.79). Number of displaced teeth, presence of avulsion or intrusion, number of fractured teeth, presence of complicated tooth fracture, and presence of alveolar fracture were not significantly associated with the odds of concomitant TBI. CONCLUSIONS: The total number of injured teeth was positively associated with higher odds of concomitant TBI in this setting. PRACTICAL IMPLICATIONS: In an emergency department setting, children with various types of TDIs sustained concomitant TBIs. For every tooth injured, the odds of concomitant TBI increased by 45%. Clinicians must systematically evaluate children with any TDI to rule out the possibility of concomitant TBI.

An ambivalent atmosphere: Employment training programs and mental health recovery.

This article critically examines the role of employment training programs in the personal recovery of adults living with mental illness in community settings. Using Cameron Duff's (2014) notion of 'assemblages of recovery,' we explore how, and to what extent, employment training programs provide the supportive resources linked to personal recovery. Using an ethnographic case study, we describe the ambivalent atmospheres associated with one program. This ambivalence expresses the fundamental tension between the genuine aspirations of personal recovery and the realities of the capitalist labor process.

Sol-gel chemistry in molten Brønsted acids towards "activated" carbons and beyond.

"Chemical activation" using Brønsted acids as chemical agents is widely used to generate activated carbons for various sorption applications. Commercially relevant is especially a process using phosphoric acid as activating agent applied to abundant and inexpensive biomass such as wood or coconut shells. In this manuscript, we revisit the porogenesis mechanism based on experiments involving molecular model compounds and oxygen-free polymer precursors, as well as different molten acids as activating agents. Describing acid activation with principles of sol-gel chemistry results in a more general understanding and uncovers a versatile synthetic tool for materials nanochemistry.

Dosimetric evaluation of intensity-modulated radiotherapy, volumetric modulated arc therapy, and helical tomotherapy for hippocampal-avoidance whole brain radiotherapy.

BACKGROUND: Whole brain radiotherapy (WBRT) is a vital tool in radiation oncology and beyond, but it can result in adverse health effects such as neurocognitive decline. Hippocampal Avoidance WBRT (HA-WBRT) is a strategy that aims to mitigate the neuro-cognitive side effects of whole brain radiotherapy treatment by sparing the hippocampi while delivering the prescribed dose to the rest of the brain. Several competing modalities capable of delivering HA-WBRT, include: Philips Pinnacle step-and-shoot intensity modulated radiotherapy (IMRT), Varian RapidArc volumetric modulated arc therapy (RapidArc), and helical TomoTherapy (TomoTherapy). METHODS: In this study we compared these methods using 10 patient datasets. Anonymized planning CT (computerized tomography) scans and contour data based on fused MRI images were collected. Three independent planners generated treatment plans for the patients using three modalities, respectively. All treatment plans met the RTOG 0933 criteria for HA-WBRT treatment. RESULTS: In dosimetric comparisons between the three modalities, TomoTherapy has a significantly superior homogeneity index of 0.15 ± 0.03 compared to the other two modalities (0.28 ± .04, p < .005 for IMRT and 0.22 ± 0.03, p < .005 for RapidArc). RapidArc has the fastest average delivery time of 2.5 min compared to the other modalities (15 min for IMRT and 18 min for TomoTherapy). CONCLUSION: TomoTherapy is considered to be the preferred modality for HA-WBRT due to its superior dose distribution. When TomoTherapy is not available or treatment time is a concern, RapidArc can provide sufficient dose distribution meeting RTOG criteria and efficient treatment delivery.