The Incidence of Snow Blower-Related Injuries to the Hand in the United States.

BACKGROUND: Snow blowers represent a highly preventable and increasingly common mechanism of hand injury. This study examines current safety features and their impact on decreasing the incidence of snow blower-related injuries. METHODS: The National Electronic Injury Surveillance System was queried to look for injuries related to the use of snow throwers or blowers between 2001 and 2016. From all of the injuries related to snow blowers, we collected information on identifying characteristics, location of injury, and type of injury (i.e., avulsion). Chi-squared tests were used for categorical variable comparisons, and Student t tests were used for continuous variable comparisons. Data analysis was performed using SAS statistical software, version 9.3 (SAS Institute, Inc., Cary, NC). The Consumer Product Safety Commission's provided SAS algorithm was used to calculate all national injury estimates and variances. Statistical significance was determined based on P < 0.05. RESULTS: Within the study period, there were 3,550 reported injuries. The extrapolated national incidence was 92,799, with an average annual incidence of 5,800 or 1.9 injuries per 100,000 US population per year. The most commonly injured body part was the finger followed by the hand. Most common types of injuries were fractures, lacerations, and amputations. CONCLUSIONS: The incidence of snow blower injuries increased from 2001 to 2016. Unlike with other power tools, Consumer Product Safety Commission-mandated guidelines for safer operation and improvements in equipment have not been successful in producing a decrease in the incidence of snow blower injuries to the upper extremity. Based on this, further equipment modifications are necessary and should be aimed at preventing operators from placing their hand into the exit chute while the machine is still running. Physicians should take an active role in their practice as well as in their professional societies to educate and counsel patients to prevent further injury.

Reversible Conformational Change in the Plasmodium falciparum Circumsporozoite Protein Masks Its Adhesion Domains.

The extended rod-like Plasmodium falciparum circumsporozoite protein (CSP) is comprised of three primary domains: a charged N terminus that binds heparan sulfate proteoglycans, a central NANP repeat domain, and a C terminus containing a thrombospondin-like type I repeat (TSR) domain. Only the last two domains are incorporated in RTS,S, the leading malaria vaccine in phase 3 trials that, to date, protects about 50% of vaccinated children against clinical disease. A seroepidemiological study indicated that the N-terminal domain might improve the efficacy of a new CSP vaccine. Using a panel of CSP-specific monoclonal antibodies, well-characterized recombinant CSPs, label-free quantitative proteomics, and in vitro inhibition of sporozoite invasion, we show that native CSP is N-terminally processed in the mosquito host and undergoes a reversible conformational change to mask some epitopes in the N- and C-terminal domains until the sporozoite interacts with the liver hepatocyte. Our findings show the importance of understanding processing and the biophysical change in conformation, possibly due to a mechanical or molecular signal, and may aid in the development of a new CSP vaccine.

Linking mosquito infestation to resident socioeconomic status, knowledge, and source reduction practices in suburban Washington, DC.

Eliminating water-holding containers where mosquitoes oviposit and develop (source reduction) can help manage urban disease-vector mosquitoes. Source reduction requires residents to be knowledgeable of effective practices and motivated to implement them. We tested relationships between demographics, resident knowledge, attitudes, and practices (KAP), and mosquito infestation by administering larval mosquito surveys and KAP questionnaires in Washington, DC. Respondents who reported practicing source reduction had lower numbers of pupae-positive containers and Culex pipiens-positive containers, but not Aedes albopictus-positive containers or water-holding containers, in their yards. When controlling for numbers of water-holding containers in statistical models, residents who reported source reduction had lower numbers of A. albopictus-positive containers in addition to numbers of pupae-positive containers and C. pipiens-positive containers. These results suggest that while active container reduction may be effective at reducing C. pipiens and overall pupal production, it may be offset by other resident activities that add containers to yards, and that source reduction that involves mosquito habitat management without outright container removal can also be effective at reducing A. albopictus. Source reduction was related to respondent knowledge of mosquitoes and, in particular, specific knowledge of mosquito development, which both varied with demographics alongside respondent motivation to control mosquitoes. Respondents from high socioeconomic status households reported greater knowledge but lower motivation than respondents from middle and low socioeconomic-status households. We conclude that mosquito-related education will help promote community-based container management as part of integrated mosquito management programs, particularly in middle and low socioeconomic status neighborhoods with lower knowledge and high motivation.

Rapid adaptive evolution of photoperiodic response during invasion and range expansion across a climatic gradient.

Abstract Understanding the mechanisms of adaptation to spatiotemporal environmental variation is a fundamental goal of evolutionary biology. This issue also has important implications for anticipating biological responses to contemporary climate warming and determining the processes by which invasive species are able to spread rapidly across broad geographic ranges. Here, we compare data from a historical study of latitudinal variation in photoperiodic response among Japanese and U.S. populations of the invasive Asian tiger mosquito Aedes albopictus with contemporary data obtained using comparable methods. Our results demonstrated rapid adaptive evolution of the photoperiodic response during invasion and range expansion across ∼15° of latitude in the United States. In contrast to the photoperiodic response, size-based morphological traits implicated in climatic adaptation in a wide range of other insects did not show evidence of adaptive variation in Ae. albopictus across either the U.S. (invasive) or Japanese (native) range. These results show that photoperiodism has been an important adaptation to climatic variation across the U.S. range of Ae. albopictus and, in conjunction with previous studies, strongly implicate the photoperiodic control of seasonal development as a critical evolutionary response to ongoing contemporary climate change. These results also emphasize that photoperiodism warrants increased attention in studies of the evolution of invasive species.

Lisfranc and Chopart amputations.

The issue of choosing an amputation level can be difficult for physicians. Every attempt should be made to maintain as much pedal length as possible to increase biomechanical function and ambulatory power. When there is excessive soft tissue loss because of trauma, infection, or vascular compromise, a Lisfranc amputation should be considered as a limb-salvage procedure. A more proximal midfoot amputation than Lisfranc is one at Chopart's articulation. This article addresses Lisfranc and Chopart amputations.